Radiologic classification of chronic hematogenous osteomyelitis in children.

BACKGROUND: Childhood hematogenous chronic osteomyelitis remains a serious cause of morbidity throughout the developing world. The aim of our study was to develop a reliable and clinically useful classification system for this condition in children. METHODS: The case notes and radiographs of 87 children with chronic hematogenous osteomyelitis of one or more long bone were reviewed to devise a classification system. We undertook reliability studies of the proposed classification system. Five observers classified the selected radiographs of 32 patients on two separate occasions. RESULTS: The classification divides the condition into 3 main types: type A--Brodie's abscess, type B--sequestrum involucrum, and type C--sclerotic. Type B has four subtypes. Intraobserver agreement was 95% for the main types and 77% (kappa coefficient 0.7) with the subtypes. Interobserver agreement was 95% to 97% for the main types and 78% (multirater kappa=0.54) for the subtypes. CONCLUSIONS: The results suggest that our classification system for chronic hematogenous osteomyelitis in children is reliable.

The behaviour of the periosteum during callotasis.

Periosteal behaviour during callotasis has been studied in animals but not in humans. Markers were inserted into the periosteum of seven patients who underwent callotasis. All of them had tibial callotasis, five patients had bone transport procedure and two had leg lengthening due to congenital disorder. They were followed up radiologically at regular intervals and during the distraction the movement of the periosteal markers was recorded. This enabled observation of the way the periosteum elongates during the procedure and also the calculation of periosteal strain at different stages at the points where the periosteum is fixed to bone. The study indicated that in most cases the periosteum acts as an elastic sleeve surrounding the newly formed tissue during lengthening. The site of attachment between sleeve and cortex became established early during lengthening, and hardly changed position at later stages. There was a wide spread of attachment sites and periosteal strains. Attachment sites were not related to pin or wire entry points, and strains were not predictive of callus shape or healing time.

Ossification of the femoral head at closed reduction for developmental dysplasia of the hip and its influence on the long-term outcome.

The management of developmental dysplasia of the hip, particularly the timing of closed reduction with regard to the presence of the femoral head ossific nucleus, is controversial. The clinical and radiological outcome was assessed in a strictly defined group of 48 hips in 42 patients with an average of 11.1 years follow-up. One hundred percent of patients had an excellent or good result at final follow-up; 8.3% showed evidence of avascular necrosis and six hips underwent further surgery after closed reduction. There was no relationship between the presence or absence of an ossific nucleus at the time of closed reduction and the final outcome. In this well-defined group, closed reduction is safe and provides excellent results in the long term.