Hip pain as initial presentation for varicella-zoster infection in an adolescent male.

Hip pain and varicella infections are common diagnoses affecting children and adolescents. Hip pain in childhood can be a challenging presenting complaint for the pediatrician or orthopedic physician. The differential diagnosis is broad, and ranges from benign conditions, such as transient synovitis and muscle strains, to more serious infections or malignancies. Acute hip pain is usually referred to an orthopedic surgeon, and the principal concern is to distinguish infection of the hip joint or pelvis from an irritable hip or musculoskeletal pain. The Varicella-zoster virus, a member of the herpes virus family, often presents as a generalized, pruritic, vesicular rash. The primary infection is commonly known as chickenpox. The prevalence of varicella infections has decreased significantly over the past decade with use of the varicella vaccine. Reactivation of varicella infection, or herpes zoster, in patients younger than 20 years is seen in only 68 per 100,000 people. Hip pain as the presenting symptom for onset of a herpes zoster infection is rare. This article presents a case of herpes zoster infection with initial presentation of hip pain in a 13-year-old boy. This case highlights the difficulty in diagnosing atraumatic joint pain in the pediatric population. The clinical importance of a thoughtful differential diagnosis, and the necessity of close follow-up by a pediatrician and/or orthopedic surgeon until there is a confirmed diagnosis cannot be overstated.

The effect of interference screw diameter on fixation of soft-tissue grafts in anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to evaluate the effect that interference screw diameter has on fixation strength of a soft-tissue anterior cruciate ligament (ACL) graft. METHODS: We prepared 32 fresh-frozen bovine tibiae with 9-mm ACL tibial tunnels. Accompanying 9-mm soft-tissue bovine Achilles grafts were also prepared. Bioabsorbable interference screws of increasing diameters were used for tibial fixation. There were 4 groups, consisting of 8-, 9-, 10-, and 11-mm screws for fixation of the 9-mm graft in the 9-mm tunnel. Tensile testing and cyclic loading from 50 to 250 N at 2 Hz for a total of 1,500 cycles were performed with a hydraulic biaxial materials testing machine. Graft slippage was measured with a video analysis technique with photo-reflective markers. At the end of cyclic testing, the grafts were loaded to failure, and the ultimate strength was recorded. RESULTS: All grafts failed at the tendon-bone-screw interface. The ultimate strength (+/- SD) was greatest for the 11-mm screw (624 +/- 133 N), with slightly decreased strength for the 10-mm (601 +/- 54 N), 9-mm (576 +/- 85 N), and 8-mm (532 +/- 185 N) screws. Graft slippage (+/- SD) was least for the 9-mm screw (2.65 +/- 2.38 mm). There were no statistically significant differences in ultimate strength and graft slippage between screws (P = .45 and P = .34, respectively). CONCLUSIONS: All interference screws tested provided adequate fixation strength. The results of this study show no statistical significance for ultimate strength or graft slippage with variable screw diameter. CLINICAL RELEVANCE: Aperture fixation with the interference screw technique provides adequate stability for soft-tissue grafts in ACL reconstruction. Although no statistical significance was found, there was a trend toward less graft-site motion when we used a screw diameter equal to tunnel size.

Pediatric supracondylar humerus fractures.

Pediatric supracondylar humerus fracture can occur in children and young teenagers; however, it is an injury seen most commonly between ages 5 and 8 years. Injuries tot he left arm are more common than to the right. Girls are affected as frequently as boys. Concurrent fractures in the same limb are possible, particularly fractures of the forearm and distal radius.