Journal of Children's Orthopaedics最新文献

{"title":"Lumbo-sacral motion conserved after isthmic reconstruction: long-term results.","authors":"C de Bodman,&nbsp;F Bergerault,&nbsp;B de Courtivron,&nbsp;C Bonnard","doi":"10.1007/s11832-014-0560-9","DOIUrl":"https://doi.org/10.1007/s11832-014-0560-9","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to analyze the clinical and radiological results of repair of the interarticularis pars defect by a modified Buck's repair technique in patients with symptomatic spondylolysis with grade 1 spondylolisthesis. These patients with painful spondylolisthesis are the most eligible for direct repair of the defect rather than lumbo-sacral fusion in an attempt to save motion segments.</p><p><strong>Methods: </strong>Forty-six patients with symptomatic spondylolysis with grade 1 spondylolisthesis and normal L4-L5 and L5-S1 disks, following the failure of conservative treatment, underwent surgery between 1988 and 2010. All interventions involved direct pars repair by a modified Buck's repair technique with internal fixation of the defect using screws and cancellous bone grafting. The Oswestry Disability Index (ODI) was used to evaluate the functional outcome. Healing of the pars defect was assessed by plain radiographs and computed tomography (CT) scanning. Motion of the L4-L5 and L5-S1 segments was measured with dynamic radiographs in flexion and extension.</p><p><strong>Results: </strong>Thirty-five patients were evaluated. The mean follow-up period was 10 years. Functional outcome was excellent in 22 patients (ODI ≤ 10) and good for 8 patients (10 < ODI ≤ 20); five patients continued to have pain (ODI >20). Isthmus bone union occurred in 32 of 35 patients (91.4 %). L4-L5 motion was conserved with a mean angle of 11.8° (0-22); the mean lumbo-sacral angle was 9.9° (0-21).</p><p><strong>Conclusion: </strong>Direct repair of spondylolisthesis was described to avoid fusion in young patients with slight slipping and painful symptoms. A modified Buck's repair technique allows the conservation of L4-L5 motion with a rate of consolidation comparable to other series. The anatomy and stability of the spine were normalized by restoring the continuity of the loose posterior elements using this modified Buck's technique.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"97-103"},"PeriodicalIF":1.4,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-014-0560-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32084623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The epidemiology of transient synovitis in Liverpool, UK.","authors":"William D Harrison,&nbsp;A K Vooght,&nbsp;R Singhal,&nbsp;C E Bruce,&nbsp;D C Perry","doi":"10.1007/s11832-014-0556-5","DOIUrl":"https://doi.org/10.1007/s11832-014-0556-5","url":null,"abstract":"<p><strong>Background: </strong>The epidemiology of transient synovitis is poorly understood, and the aetiology is unknown, although a suggestion of a viral association predominates.</p><p><strong>Purpose: </strong>This population-based study investigated the epidemiology in order to formulate aetiological theories of pathogenesis.</p><p><strong>Patient and methods: </strong>Cases in Merseyside were identified between 2004 and 2009. Incidence rates were determined and analysed by age, sex, season and region of residence. Socioeconomic deprivation scores were generated using the Index of Multiple Deprivation, allocated by postcode. Poisson confidence intervals were calculated and Poisson regression was used to check for trends.</p><p><strong>Results: </strong>Two hundred and fifty-nine cases were identified over 5.5 years. The annual incidence was 25.1 (95 % CI 22.1-28.5) per 100,000 0-14 year-olds. Male to female ratio was 3.2:1 (p < 0.001). Mean age at presentation was 5.4 years (95 % CI 5.0-5.8), which demonstrated a near-normal distribution. No relationship was identified between seasonality and incidence (p = 0.64). A correlation was identified with socioeconomic deprivation in Merseyside: incidence rate ratio 1.16 (95 % CI 1.06-1.26, p < 0.001), although further analysis within the subregion of Liverpool did not confirm this finding (p = 0.35).</p><p><strong>Conclusions: </strong>The normal distribution for age at disease presentation suggests a specific disease entity. The absence of seasonality casts some doubt on the popular theory of a viral aetiology. The absence of a consistent socioeconomic gradient in both Merseyside and Liverpool challenges a previous suggestion of an association with Perthes' disease. This paper provides ecological evidence that may challenge existing aetiological theories, though transient synovitis remains an enigma.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"23-8"},"PeriodicalIF":1.4,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-014-0556-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32084622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term results of a nationwide general ultrasound screening system for developmental disorders of the hip: the Austrian hip screening program.","authors":"Christoph Thallinger,&nbsp;Renata Pospischill,&nbsp;Rudolf Ganger,&nbsp;Christof Radler,&nbsp;Christoph Krall,&nbsp;Franz Grill","doi":"10.1007/s11832-014-0555-6","DOIUrl":"https://doi.org/10.1007/s11832-014-0555-6","url":null,"abstract":"<p><strong>Background: </strong>Diagnosis and early treatment of developmental dysplasia of the hip (DDH) continue to be issues of discussion. In 1992, a nationwide general ultrasound screening program using Graf technique was introduced to detect DDH in Austria. We investigated the effects of this program on the rates of operative and conservative interventions and the influence of the program on the number of hospital admissions for the treatment of DDH.</p><p><strong>Methods: </strong>All cases of DDH documented in Austrian hospitals from 1992 to 2008 were included in this retrospective study. The database of the Austrian Ministry of Health was used to extract documented diagnoses and treatments.</p><p><strong>Results: </strong>Since the introduction of the screening program, the number of patients who require pelvic surgery to treat DDH has decreased by 46 % and the number of open reductions is as low as 0.16 per 1,000 live births. Hospital admissions for the treatment of DDH decreased from 9.5 to 3.6 per 1,000 live births. All noted results gained statistical significance.</p><p><strong>Conclusion: </strong>Compared with routine clinically based screening programs, our results confirm low numbers of open reductions and pelvic surgeries. We, therefore, advocate a standardized nationwide general ultrasound screening program to reduce the rates of operative interventions and hospital admissions associated with the treatment of DDH.</p><p><strong>Level of evidence: </strong>Level III, diagnostic.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"3-10"},"PeriodicalIF":1.4,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-014-0555-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32084621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stair falls: caregiver's \"missed step\" as a source of childhood fractures.","authors":"Andrew T Pennock,&nbsp;George D Gantsoudes,&nbsp;Jennifer L Forbes,&nbsp;Amanda M Asaro,&nbsp;Scott J Mubarak","doi":"10.1007/s11832-014-0551-x","DOIUrl":"https://doi.org/10.1007/s11832-014-0551-x","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to describe fractures sustained by children and to analyze the associated costs when a caretaker falls down stairs while holding a child.</p><p><strong>Materials and methods: </strong>Between 2004 and 2012, 16 children who sustained a fracture after a fall down stairs while being carried by a caregiver were identified. Parents/caregivers were interviewed to see how the fall occurred, and a cost analysis was performed.</p><p><strong>Results: </strong>The average age of the patients was 14.5 months (7-51 months). The lower extremity was involved in 15 of 16 fractures, with 8 involving the femur. The majority were buckle fractures, but all diaphyseal femur fractures were spiral. Three patients required a reduction in the operating room. All fractures healed with cast immobilization. Five patients underwent skeletal surveys, as the treating physicians were concerned about potential child abuse. The average cost of treatment was $6785 (range $948-45,876). Detailed histories from the caregivers showed that they \"missed a step\" due to the child being carried in front of the caregiver, obscuring their vision.</p><p><strong>Conclusions: </strong>A fall in a caregiver's arms while going down stairs can result in multiple orthopedic injuries. The costs of treating these injuries are not insignificant, and the suspicion of child abuse can be both costly and unnecessary in the case of a true accident. While descending the stairs with a child in their arms, the caregiver should hold the child to the side so as not to obscure their vision of the step with one arm, ideally holding the handrail with the other.</p><p><strong>Level of evidence: </strong>IV case series.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"77-81"},"PeriodicalIF":1.4,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-014-0551-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32084618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calcaneocuboid arthrodesis for recurrent clubfeet: what is the outcome at 17-year follow-up?","authors":"Alice Chu,&nbsp;Sonia Chaudhry,&nbsp;Debra A Sala,&nbsp;Dan Atar,&nbsp;Wallace B Lehman","doi":"10.1007/s11832-014-0557-4","DOIUrl":"https://doi.org/10.1007/s11832-014-0557-4","url":null,"abstract":"<p><strong>Purpose: </strong>Calcaneocuboid arthrodesis was used during revision clubfoot surgery in order to maintain midfoot correction. The purposes of this study were to determine: (1) functional level at 17-year follow-up compared to 5-year follow-up; (2) patients' current functional level, satisfaction, and pain; and (3) current arthropometric measurements.</p><p><strong>Methods: </strong>Twenty patients (27 clubfeet) with clubfoot relapse underwent revision soft tissue release and calcaneocuboid fusion between 1991 and 1994. They were previously evaluated at a mean follow-up of 5.5 years. Ten out of 20 patients (13 clubfeet), mean age of 24 years, were reevaluated at mean follow-up of 17.5 years. The Hospital for Joint Diseases Functional Rating System (HJD FRS) for clubfoot surgery, Outcome Evaluation in Clubfoot developed by the International Clubfoot Study Group, the Clubfoot Disease-Specific Instrument, American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Outcomes Questionnaire, Laaveg and Ponseti's functional rating system for clubfoot and pain scale were completed by patient and/or surgeon to assess function, patient satisfaction and pain. Foot and ankle radiographs and anthropometric measurements were reviewed. For HJD FRS, scores from original follow-up were compared to current ones.</p><p><strong>Results: </strong>The HJD FRS score of all feet was 65.9, demonstrating a significant decline from the original mean score of 77.8 (p = 0.03). Excellent/good HJD FRS scores went from 85 to 38 %. Mean AAOS Foot Ankle Outcomes Questionnaire standardized core and shoe comfort scores were 84.6 and 84.5, respectively. Average foot pain was 1.8 on a scale of 1-10. Patients were very/somewhat satisfied with status of foot in 76 % of feet and appearance of foot in 46 % of feet, based on Clubfoot Disease-Specific Instrument questions.</p><p><strong>Conclusions: </strong>Revision clubfoot surgery with calcaneocuboid fusion in patients 5-8 years of age showed an expected decline in functional outcome measures over a 17-year follow-up period. It still produced comparable results to other studies for a similar population of difficult, revision cases, and should have a place in current surgical treatment techniques.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"43-8"},"PeriodicalIF":1.4,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-014-0557-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32098348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An operative approach to address severe genu valgum deformity in the Ellis-van Creveld syndrome.","authors":"Dennis S Weiner,&nbsp;Jason C Tank,&nbsp;David Jonah,&nbsp;Melanie A Morscher,&nbsp;Amy Krahe,&nbsp;Steven Kopits,&nbsp;William C Schrader","doi":"10.1007/s11832-014-0552-9","DOIUrl":"https://doi.org/10.1007/s11832-014-0552-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The genu valgum deformity seen in the Ellis-van Creveld syndrome is one of the most severe angular deformities seen in any orthopaedic condition. It is likely a combination of a primary genetic-based dysplasia of the lateral portion of the tibial plateau combined with severe soft-tissue contractures that tether the tibia into valgus deformations. Progressive weight-bearing induces changes, accumulating with growth, acting on the initially distorted and valgus-angulated proximal tibia, worsening the deformity with skeletal maturation. The purpose of this study is to present a relatively large case series of a very rare condition that describes a surgical technique to correct the severe valgus deformity in the Ellis-van Creveld syndrome by combining extensive soft-tissue release with bony realignment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review examined 23 limbs in 13 patients with Ellis-van Creveld syndrome that were surgically corrected by two different surgeons from 1982 to 2011. Seven additional patients were identified, but excluded due to insufficient chart or radiographic data. A successful correction was defined as 10° or less of genu valgum at the time of surgical correction. Although not an outcomes study, maintenance of 20° or less of genu valgum was considered desirable. Average age at surgery was 14.7 years (range 7-25 years). Clinical follow-up is still ongoing, but averages 5.0 years (range 2 months to 18 years). Charts and radiographs were reviewed for complications, radiographic alignment, and surgical technique. The surgical procedure was customized to each patient's deformity, consisting of the following steps: 1. Complete proximal to distal surgical decompression of the peroneal nerve 2. Radical release and mobilization of the severe quadriceps contracture and iliotibial band contracture 3. Distal lateral hamstring lengthening/tenotomy and lateral collateral ligament release 4. Proximal and distal realignment of the subluxed/dislocated patella, medial and lateral retinacular release, vastus medialis advancement, patellar chondroplasty, medial patellofemoral ligament plication, and distal patellar realignment by Roux-Goldthwait technique or patellar tendon transfer with tibial tubercle relocation 5. Proximal tibial varus osteotomy with partial fibulectomy and anterior compartment release 6. Occasionally, distal femoral osteotomy&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In all cases, the combination of radical soft-tissue release, patellar realignment and bony osteotomy resulted in 10° or less of genu valgum at the time of surgical correction. Complications of surgery included three patients (five limbs) with knee stiffness that was successfully manipulated, one peroneal nerve palsy, one wound slough and hematoma requiring a skin graft, and one pseudoarthrosis requiring removal of hardware and repeat fixation. At last follow-up, radiographic correction of no more than 20° of genu valgum was mainta","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"61-9"},"PeriodicalIF":1.4,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-014-0552-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32084619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heritability of clubfoot: a twin study.","authors":"Vilhelm Engell,&nbsp;Jan Nielsen,&nbsp;Frank Damborg,&nbsp;Kirsten Ohm Kyvik,&nbsp;Karsten Thomsen,&nbsp;Niels Wisbech Pedersen,&nbsp;Mikkel Andersen,&nbsp;Søren Overgaard","doi":"10.1007/s11832-014-0562-7","DOIUrl":"https://doi.org/10.1007/s11832-014-0562-7","url":null,"abstract":"<p><strong>Introduction: </strong>The aetiology of congenital clubfoot is unclear. Although studies on populations, families, and twins suggest a genetic component to the aetiology, other studies have identified environmental factors. The purpose of this study was to calculate heritability in order to determine to what extent genetic and/or environmental factors contribute to the aetiology of congenital clubfoot and to asses whether there was a change in the prevalence over time.</p><p><strong>Materials and methods: </strong>The Odense based Danish Twin Registry is unique as it contains data on all the approximately 85,000 twin pairs born in Denmark over the last 140 years. All 46,418 twin individuals born from 1931 through 1982, who had earlier consented to contact, received a 17-page Omnibus questionnaire in the spring of 2002. Data were analysed with structural equation models to identify the best fitting aetiological model based on a balance of goodness-of-fit and parsimony and to estimate heritability.</p><p><strong>Results: </strong>We found an overall self-reported prevalence of congenital clubfoot of 0.0027 (95 % confidence interval 0.0022-0.0034). Fifty-five complete (both twins answered the question) twin pairs were identified representing 12 monozygotic, 22 same-sex dizygotic, 18 opposite-sex dizygotic, and 3 with unclassified zygosity. The model with only environmental factors (CE) was best fitting based on AIC, and the model with an additive genetic factor (ACE) came in second. Due to the small statistical power, we hypothesise that the model with both genetic and environmental effects (ACE) was the better model. Choosing the ACE-model we found a heritability of clubfoot of 30 %. Regression coefficient for age was -0.002 (-0.011 to 0.005), indicating that there has been no change in prevalence of clubfoot over the 50-year age span we examined.</p><p><strong>Discussion: </strong>We conclude that non-genetic factors must play a role, and a genetic factor might contribute, in the aetiology of congenital clubfoot.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"37-41"},"PeriodicalIF":1.4,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-014-0562-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32098349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of radiographs in assessment of displacement in lateral humeral condyle fractures.","authors":"Ashleen Knutsen,&nbsp;Tigran Avoian,&nbsp;Sean L Borkowski,&nbsp;Edward Ebramzadeh,&nbsp;Lewis E Zionts,&nbsp;Sophia N Sangiorgio","doi":"10.1007/s11832-014-0553-8","DOIUrl":"https://doi.org/10.1007/s11832-014-0553-8","url":null,"abstract":"<p><strong>Purpose: </strong>Determining the magnitude of displacement in pediatric lateral humeral condyle fractures can be difficult. The purpose of this study was to (1) assess the effect of forearm rotation on true fracture displacement using a cadaver model and to (2) determine the accuracy of radiographic measurements of the fracture gap.</p><p><strong>Methods: </strong>A non-displaced fracture was created in three human cadaveric arms. The specimens were mounted on a custom apparatus allowing forearm rotation with the humerus fixed. First, the effect of pure rotation on fracture displacement was simulated by rotating the forearm from supination to pronation about the central axis of the forearm, to isolate the effects of muscle pull. Then, the clinical condition of obtaining a lateral oblique radiograph was simulated by rotating the forearm about the medial aspect of the forearm. Fracture displacements were measured using a motion-capture system (true-displacement) and clinical radiographs (apparent-displacement).</p><p><strong>Results: </strong>During pure rotation of the forearm, there were no significant differences in fracture displacement between supination and pronation, with changes in displacement of <1.0 mm. During rotation about the medial aspect of the forearm, there was a significant difference in true displacements between supination and pronation at the posterior edge (p < 0.05).</p><p><strong>Conclusion: </strong>Overall, true fracture displacement measurements were larger than apparent radiographic displacement measurements, with differences from 1.6 to 6.0 mm, suggesting that the current clinical methods may not be sensitive enough to detect a displacement of 2.0 mm, especially when positioning the upper extremity for an internal oblique lateral radiograph.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"83-9"},"PeriodicalIF":1.4,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-014-0553-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32083748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kingella kingae septic arthritis in children: recognising an elusive pathogen.","authors":"Nicole Williams,&nbsp;Celia Cooper,&nbsp;Peter Cundy","doi":"10.1007/s11832-014-0549-4","DOIUrl":"https://doi.org/10.1007/s11832-014-0549-4","url":null,"abstract":"<p><strong>Purpose: </strong>Kingella kingae is an increasingly identified cause of musculoskeletal infections in young children. We report our experience with a recently developed polymerase chain reaction (PCR) method and review the clinical course of children diagnosed with K. kingae septic arthritis in a tertiary referral paediatric hospital.</p><p><strong>Methods: </strong>All positive cases of K. kingae identified by PCR analysis of synovial fluid from August 2010 until July 2013 were included. A chart review was undertaken to determine history, presentation and management.</p><p><strong>Results: </strong>27 Children (14 male, 13 female) had PCR positive synovial fluid samples for K. kingae with median age of 19 months (range 4 months to 5 years 3 months). The sites of infection were knee (17 cases), hip (2 cases), ankle (5 cases), shoulder (2 cases) and elbow. The median temperature on presentation was 37.1 °C, median peripheral white blood cell count 12.4 (9.9-13.8) × 10(9)/L, erythrocyte sedimentation rate 55 (48-60) mm/h and C-reactive protein 24 (8-47) mg/L. The median synovial fluid white cell count was 21.8 (16.7-45.0) × 10(9)/L. Routine cultures identified K. kingae in only two synovial fluid samples. Two samples were additionally positive for Staphylococcus aureus.</p><p><strong>Conclusions: </strong>Kingella kingae is a significant cause of septic arthritis in young children. The authors recommend maintaining a high index of suspicion in young children presenting with joint inflammation, especially if indices of infection are mild. It appears likely that children historically treated with antibiotics for \"culture negative\" septic arthritis were infected with K. kingae. PCR techniques for detection of K. kingae should be encouraged.</p>","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"91-5"},"PeriodicalIF":1.4,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-014-0549-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32083679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial.","authors":"Fritz Hefti,&nbsp;Shlomo Wientroub","doi":"10.1007/s11832-013-0548-x","DOIUrl":"https://doi.org/10.1007/s11832-013-0548-x","url":null,"abstract":"","PeriodicalId":138259,"journal":{"name":"Journal of Children's Orthopaedics","volume":" ","pages":"1"},"PeriodicalIF":1.4,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11832-013-0548-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32083677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}