Acute arthritis of the hip--case series describing emergency physician performed ultrasound guided hip arthrocentesis.

We report two cases of acute hip arthritis where arthrocentesis was able to be performed rapidly, at the bedside by the emergency physician using ultrasound guidance, expediting diagnosis and patient care. In the first case, the patient, who was 23 weeks pregnant, was diagnosed with septic hip arthritis, taken for operative washout of the joint and did very well postoperatively with no pregnancy or other complications. In the second case, the patient was determined to have a noninfectious etiology and also did well. Skilled ultrasound guidance allows hip arthrocentesis to be performed by the treating clinician, decreasing the time to diagnosis and definitive care.

Injury prevention and recreational all-terrain vehicle use: the impact of helmet use in West Virginia.

UNLABELLED: All-terrain vehicles (ATVs) are a popular source of outdoor activity in the United States, particularly in West Virginia. During the period of time from 1999 to 2007, deaths associated with ATVs in West Virginia increased by 28%. Helmet use among bicycle and motorcycle riders has been shown to decrease morbidity and mortality following trauma. METHODS: We performed a retrospective observational study to compare injury patterns, hospital course, and resource utilization of non-helmeted and helmeted riders involved in ATV accidents using data from the West Virginia Trauma Center System. Descriptive statistics were calculated for all study variables and comparisons were made between helmeted and non-helmeted riders. RESULTS: In 2010, there were 1,059 patients aged 18 and over with traumas resulting from ATV accidents within the System. Riders involved in ATV trauma occurring on farms and streets were significantly more likely to be non-helmeted, while those using ATVs for recreational purposes were more likely to be helmeted. Non-helmeted riders were significantly more likely to arrive to the hospital via helicopter than helmeted riders, and were less likely to be discharged home from the ED compared to helmeted riders. Non-helmeted riders sustained significantly more head, neck, soft tissue injuries, concussions, intracranial hemorrhages, facial fractures, skull fractures, and thoracic spine fractures than helmeted riders. DISCUSSION: The findings of the current study support previous studies documenting that helmet use is protective against intracranial injury and other injuries of the head and neck. ATV use continues to be a significant contribution to trauma morbidity and mortality in West Virginia. CONCLUSION: Efforts that focus on increased helmet use have the potential to significantly reduce morbidity and mortality following ATV trauma. Enforcement of the current West Virginia ATV Law should be encouraged. Legislation expanding the mandatory use of safety equipment and rider training should be enacted in West Virginia.

A new look at the incidence of slipped capital femoral epiphysis in new Mexico.

PURPOSE: Past epidemiological studies demonstrated a nearly fivefold lower incidence of slipped capital femoral epiphysis (SCFE) in New Mexico compared with Connecticut. A recent study demonstrated some regional variability but did not address this earlier finding. We sought to reexamine the incidence of SCFE in New Mexico to improve the understanding of the epidemiology and ultimately the disorder itself. METHODS: The discharge databases for the 11 major medical centers in the state were reviewed for the ICD-9 code for SCFE (732.2) for 1995 to 2006. The data were analyzed by comparison with the 2000 New Mexico census data. The incidence data are reported as cases per 100,000 boys aged 10 to 17 years and girls aged 8 to 15 years, as per Kelsey's original article. RESULTS: The incidence of SCFE in New Mexico for the study period was 5.99. This is a doubling of the reported incidence in the 1960s (2.13) and represents a statistically significant change (P < 0.001). More detailed analysis of our data demonstrated a statistically significant increase during 3-year intervals: 1995-1997, 2.27; 1998-2000, 2.75; 2001-2003, 4.73; and 2004-2006, 7.38. The mean age of onset was 12.2 years. There was a male to female ratio of incidence of 1.94:1. Relative frequencies by race were as follows: 4.63x for African Americans, 2.20x for Hispanics, and 2.20x for Native Americans. A preponderance of cases was treated at the state's only tertiary pediatric orthopaedic center: 168 to 15 in the remaining 10 centers. CONCLUSIONS: The incidence of SCFE has increased dramatically in New Mexico since Kelsey's epidemiological study in 1970. Obesity is a patient factor that has changed over this same period. According to the National Health and Nutrition Examination Survey Data for 2003/2004, the rates of obesity have tripled since 1971. In New Mexico, 25% of high-school children are estimated to be overweight. However, according to a recent study examining a national database (compiled from 27 states), the national incidence of SCFE remained fairly constant at 10.8 per 100,000.Interestingly, as more patients are seen at a tertiary center for children's orthopaedics, the rate of diagnosis in New Mexico has risen to resemble national trends. In the 1960, that center was located in a remote site and did not provide acute care for children's musculoskeletal issues. Increased obesity in children and improved access to pediatric orthopaedic evaluation may have contributed to a significant increase in reported incidence of SCFE in New Mexico.