Background Clinicians cannot reliably predict complications of acute hematogenous osteomyelitis (AHO). Methods Consecutive cases of AHO from 2 pediatric centers in the United States were analyzed retrospectively to develop clinical tools from data obtained within 96 hours of hospitalization to predict acute and chronic complications of AHO. Two novel composite prediction scores derived from multivariable logistic regression modeling were compared with a previously published severity of illness (SOI) score, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) using area under the receiver operating characteristic curve analyses. Results The causative organisms were identified in 73% of 261 cases. Bacteremia (45%), abscesses (38%), and associated suppurative arthritis (23%) were relatively common. Acute or chronic complications occurred in 24% and 11% of patients, respectively. Multivariable logistic regression identified bone abscess (odds ratio [OR], 2.3 [95% confidence interval {CI}, 1.0–5.2]), fever > 48 hours (OR, 2.7 [95% CI, 1.2–6.0]), suppurative arthritis (OR, 3.2 [95% CI, 1.3–7.5]), disseminated disease (OR, 4.6 [95% CI, 1.5–14.3]), and delayed source control (OR, 5.1 [95% CI, 1.4–19.0]) as strong predictors of acute complications. In a separate model, CRP ≥ 100 mg/L at 2–4 days after antibiotics (OR, 2.7 [95% CI, 1.0–7.3]), disseminated disease (OR, 3.3 [95% CI, 1.1–10.0]), and requirement for bone debridement (OR, 6.7 [95% CI, 2.1–21.0]) strongly predicted chronic morbidity. These variables were combined to create weighted composite prediction scores for acute (A-SCORE) and chronic (C-SCORE) osteomyelitis, which were superior to SOI, CRP, and ESR and had negative predictive values > 90%. Conclusions Two novel composite clinical scores were superior to existing tools to predict complications of pediatric AHO.

Background: Patellofemoral Pain Syndrome (PFPS) is one of the most common diagnoses made for patients referred to physical/rehabilitation and orthopedic clinics. The most common symptom of PFPS is a diffuse pain in front of either one or both knees exacerbated by intense activity, kneeling, squatting, climbing, and weakness of quadriceps muscle. Lumbosacral manipulation and knee exercises are the most commonly used methods in physical medicine with no major side effects. Objectives: The current study aimed to compare the efficacy of the lumbosacral manipulation technique with knee exercises versus sole knee exercises in patients with PFPS. Study Design was Randomized Controlled Clinical Trial. Methods: In this randomized controlled clinical trial, 30 patients (18 females and 12 males) diagnosed with PFPS were divided into two groups of study and control, each with 15 subjects. Those in the intervention group received a single bilateral lumbosacral manipulation after ruling out any contraindication for lumbosacral manipulation by lumbosacral radiography. Quality of life, gait, quadriceps muscle strength, keen pain improvement, and range of motion were evaluated at the beginning and four weeks following the knee strengthening exercises for all participants. Results: The mean age of participants was 34 ± 5 years. The difference between the groups concerning the swing phase of walking and quadriceps muscle strength was in both groups was investigated following providing interventions. Conclusions: The manipulation technique had a greater effect on improving the function of patients with PFPS compared to therapeutic knee exercises.