Literature review and a case report of spontaneous subscapular abscess in a child.

Subscapular space is an uncommon site for abscess formation. There are only seven reports of subscapular abscesses in the literature. Only three of these cases are reported in children. We recently treated a child with subscapular abscess. We performed the literature search using a combination of the keywords: subscapular, scapular, abscess and infection. One case was diagnosed on post-mortem autopsy, and only three of these cases are reported in children. The organism was Staphylococcus aureus in five cases (two were methicillin-resistant S. aureus), Haemophilus influenzae in one case, and no organism was grown in the last case. (Patient received a course of empirical antibiotics and samples did not grow any organism.) We describe a case of spontaneous subscapular abscess in a 7-year-old boy. The abscess was visualised on magnetic resonance imaging (MRI), and the organism was identified as S. aureus bacteria. The abscess was treated surgically with debridement and antibiotics, and the patient had full recovery with no subsequent effects. Subscapular abscess needs high index of suspicion and early imaging investigation. MRI is the modality of choice for accurate diagnosis. Early intervention leads to favourable outcome, while delays in diagnosis can be fatal.

Clinical and radiological outcome following total hip arthroplasty with an uncemented trabecular metal monoblock acetabular cup.

Uncemented acetabular components are associated with a significant incidence of polyethylene wear and secondary osteolysis. The new tantalum/polyethylene composite (Hedrocel) acetabular component is designed to reduce the polyethylene wear and to increase the longevity of the acetabular cups. We report our short- term clinical outcome and patient satisfaction following use of an uncemented tantalum acetabular component in a single centre. During 1999 to 2002, 113 uncemented tantalum acetabular cups were implanted in 105 patients in our institution. The average age at operation was 56.8 years. All patients were assessed pre- and post-operatively with the Oxford 12 item hip questionnaire and standard radiographs of the pelvis. At a mean follow-up of 32 months (range: 18 to 48), 112 Hedrocel cups were assessed in 104 patients. Subjective patient's satisfaction was also assessed. At the time of evaluation, one patient had died due to an unrelated cause. Eight patients had bilateral acetabular cups implanted. The mean Oxford hip score improved from 45 preoperatively to 14 post-operatively. Subjectively 99% were very satisfied or satisfied. Only one patient expressed dissatisfaction about the outcome of this surgery. Radiologically, there were no signs of cup loosening or wear. This study shows that at short-term the new uncemented tantalum/polyethylene composite (Hedrocel) acetabular component can yield a satisfactory clinical and radiological outcome and has a high patient satisfaction. Although the short-term result from our centre is very encouraging, similar results from other centres and longer follow-up are required.

Concomitant talar neck fracture and Achilles tendon rupture.

A 56-year-old man fell down 1 m from a ladder and sustained a forced dorsiflexion injury to his right ankle when his foot contacted a lower rung, which resulted in the rare combination of a Hawkins II fracture of the neck of the talus and a concomitant rupture of the Achilles tendon. Clinical examination and diagnostic imaging confirmed the injuries, and surgical fixation of the fracture and repair of the Achilles tendon were achieved by means of a posterior approach. Healing proceeded unremarkably, and, at 18 months postoperatively, the patient had regained full function despite a 5 degrees limitation of subtalar joint range of motion.

Hand injuries in children: a prospective study.

The purpose of this prospective clinical study was to identify the true incidence, pattern, and location of the injury and nature of fracture after hand injuries in different pediatric age groups attending a hand unit. Three hundred sixty children (237 boys, 123 girls) under 16 years of age who presented with hand injuries between April 1, 2000, and Sept. 30, 2000, were included in the study. Bony injuries accounted for 65.5% (236 injuries); 33.3% (120 injuries) were soft tissue injuries. The projected annual incidence rate for skeletal injuries was 418/100,000 children. The incidence was low in toddlers (34/100,000), more than doubled in preschool children (73/100,000), and steeply increased to around 20-fold after the 10th year (663/100,000). Girls had a higher incidence of hand injuries among toddlers and preschool children. Crushing was the most common cause of hand injury (64%), and most injuries were sustained at home (45%). Toddlers sustained soft tissue injuries predominantly (86%) and older children sustained more bony injuries (77%). Sport was the cause of injures commonly in the older children. There was a higher incidence of fracture in the little finger (52%) followed by the thumb (23%). The proximal phalanx was the most frequently fractured bone (67%) among the phalanges. Diaphyseal fractures (46%) were more common in the metacarpals, and basal fractures (51%) were common in the phalanges. At discharge more than 80% of the patients felt that they were cured or significantly better. This paper highlights the changing pattern and the different varieties of hand injuries in different pediatric age groups.