Suggestion for new 4.4 mm pubo-femoral distance cut-off value for hip instability in lateral position during DDH screening.

Background and purpose - Current selective screening algorithms for developmental dysplasia of the hip (DDH) are insufficient. Universal screening programs have been proposed but so far have been deemed too expensive and time consuming. The pubo-femoral distance may solve this problem as a quick, low-cost, highly sensitive, and specific sonographic measurement for DDH, but this has only been validated in the supine position. Therefore we validated pubo-femoral distance (PFD) in the lateral position as an indicator for instability of the hip. Methods - All participants had undergone ultrasonographic diagnostics using the modified Graf technique. In addition, PFD measurements in lateral position were performed. Results were compared between 25 infants who had been treated for DDH because of dysplastic appearance on ultrasound combined with clinical instability and a control group consisting of 100 untreated infants screened for DDH. Sensitivity, specificity, and cut-off points were determined using Receiver operating characteristics (ROC) analysis. Results - We found a mean PFD of 6.8 mm (6.2-7.4) in the treated group with a control group PFD of 3.4 mm (3.3-3.6) (p < 0.005). A PFD value above a threshold of 4.4 mm yielded a sensitivity of 100% and a specificity of 93% for detecting unstable DDH. Interpretation - PFD measured in lateral position was statistically significantly increased in hips of children treated for DDH with Denis Browne hip brace compared with healthy children with unaffected stable hips. Furthermore, the PFD measurement had a high level of sensitivity and specificity at a cut-off value of 4.4 mm. A cut-off value of 6.00 mm has previously been reported as the gold standard in supine position. We suggest that 4.4 mm is used in lateral position.

Correlation of radiological and clinical measurement of genu valgum in children.

INTRODUCTION: Genu valgus is a condition characterised by a lateral shift of the knee's mechanical axis. The deformity can be characterised using clinical examinations and long hip-knee-ankle (HKA) angles, but it is unclear how these investigations correlate with each other. Our aim was to examine the correlation between clinical and radiographic measurements of the lower extremities in children. METHODS: A total of 49 children between 5.9 and 16.7 years of age who had been referred with genu valgum deformity were included. They all had their intermalleolar (IM) distance measured and a standardised anterior-posterior radiograph of the lower extremities taken. IM distance was adjusted for the mean tibial and femoral length to adjust for differences in leg length. We calculated the Spearman's rank correlation coefficient to study the reliability between radiographs and clinical examinations. RESULTS: We found no correlation between clinical IM distance and the HKA angles. Spearman's rho for comparison between adjusted clinical IM distance measurements and HKA angles on radiographs was found to be 0.36. CONCLUSIONS: We found a poor correlation between clinical examinations and HKA angles as data were corrected for leg length. More studies are needed to provide clear recommendations for following children with malalignment. FUNDING: none. TRIAL REGISTRATION: The study was registered with the Danish Data Protection Agency.

[Treatment of simple subcutaneous abscesses].

Simple subcutaneous abscesses are common, and we have examined the literature concerning the ideal treatment of subcutaneous abscesses. We recommend radical debridement with removal of all pus, the abscess wall and any necrosis. If primary suture is chosen, preoperative antibiotics should be administered, and the cavity should be closed without dead space. Antibiotics should not routinely be given, but always be considered in immunocompromised patients or patients with septicaemia. Routine examination of the microbiology has no influence on the treatment and is not recommended.

Life-threatening MRSA sepsis with bilateral pneumonia, osteomyelitis, and septic arthritis of the knee in a previously healthy 13-year-old boy: a case report.

The incidence and severity of methicillin resistant Staphylococcus aureus (MRSA) infections are increasing and cause high mortality and morbidity. We describe the first pediatric case in Scandinavia with Panton-Valentine leucocidin (PVL) positive MRSA septicemia who developed bilateral pneumonia, arthritis of the knee, and osteomyelitis of the tibia. Radiological investigation and interpretation directed the treatment, especially the surgical debridement, and combined with clinical and biochemical findings lead to close interdisciplinary treatment with frequent surgical interventions and antimicrobial combination therapy. The outcome was a healthy patient without sequelae, a favorable course unlike those previously described in the literature. This case underlines the necessity of a close interdisciplinary cooperation in children with severe MRSA infection encompassing pneumonia, septic arthritis, and osteomyelitis, using different imaging modalities to guide the surgical and antibiotic treatment.