Joint effusion in children with an irritable hip: US diagnosis and aspiration.

Ninety-six children with an irritable hip possibly representing septic arthritis underwent clinical and laboratory evaluation, radiography, and ultrasonography (US). Forty had normal US scans; none were later shown to have septic arthritis, although three had osteomyelitis. Fifty-six children had effusion at US. Thirty-one of these underwent US-guided aspiration, two unsuccessfully. On the basis of results of aspirate analysis, 15 of these 31 patients underwent surgical drainage, and septic arthritis was diagnosed in all 15. The mean peripheral white blood cell (WBC) count was not significantly higher in patients with septic arthritis (n = 21) than in patients with toxic synovitis (n = 24) (P = .44). However, the erythrocyte sedimentation rate and synovial fluid WBC count were significantly greater in those with septic arthritis than in those with toxic synovitis (P = .002 and P < .0001, respectively). Clinical evaluation, radiographs, and sonograms together determined the need for US-guided aspiration. US-guided aspiration allowed selection of only those with septic arthritis for operative drainage and shortened that procedure. Negative sonograms allow exclusion of septic arthritis but not osteomyelitis.

Osteomyelitis in children: gadolinium-enhanced MR imaging.

Fifteen pediatric patients with biopsy- or culture-proved nonspinal osteomyelitis were studied with magnetic resonance (MR) imaging. Osteomyelitis was acute in seven patients, subacute in three, and chronic in five. Four patients had subperiosteal abscesses, one had a large associated soft-tissue abscess, and one had an intraosseous (Brodie) abscess. Areas of active inflammation had decreased marrow signal intensity on T1-weighted images, increased signal intensity on T2-weighted images, and enhancement on T1-weighted images obtained after gadopentetate dimeglumine administration (n = 10). Abscesses were rim enhancing (n = 3) or not (n = 2) with gadolinium-enhanced MR imaging. Nonenhancing areas presumably represented necrotic material. Gadolinium-enhanced MR imaging assisted in definition of the presence and extent of nonvascularized fluid collections within the bone and/or adjacent soft tissues and the extent of bone involvement in patients with chronic osteomyelitis. It also helped guide surgical debridement of intraosseous disease (n = 7) and open or percutaneous drainage of subperiosteal or soft-tissue fluid collections (n = 5).

Management of vascular injuries in displaced supracondylar humerus fractures without arteriography.

One hundred forty-three displaced (type III) supracondylar fractures of the humerus in children were treated over a 5.5-year period with 17 (11.9%) having signs of vascular impairment at the time of presentation. Rapid reduction and Kirschner wire stabilization without arteriogram was performed in each case. In three cases in which satisfactory blood supply to the hand was not present after reduction, circulation was restored after exploration of the brachial artery revealed two intimal tears and one arterial entrapment. The remaining 14 patients were normal at follow-up with no late vascular compromise. Based on these findings, we feel prereduction arteriography is not indicated in this injury.