A protocol for the management of irritable hip was assessed; this protocol avoids hospital admission while detecting all other serious causes of hip pain, in particular septic arthritis, at the earliest possible opportunity.Fifty children with painful hips were studied prospectively with immediate ultrasound guided aspiration and Gram stain of all hip effusions. Bone scintigraphy performed at an early stage was reserved for patients with unremitting symptoms.Thirty six hips were aspirated. Only two patients were admitted. The final diagnoses were transient synovitis (45 cases), Perthes' disease (three cases), fracture (one case), and septic arthritis (one case). The single case of hip sepsis was diagnosed on presentation.The traditional approach to management is questioned and the advantages of the protocol highlighted, including earliest diagnosis of sepsis and other serious pathology, avoidance of hospital admission, and the relief of pain by joint decompression. (Arch Dis Child 1995; 72: 110-114)
Study DesignRetrospective case series.PurposeTo report a novel approach to open posterior sacroiliac (SI) joint arthrodesis using a threaded titanium cage containing rhBMP-2.Materials & MethodsTwenty consecutive patients with a mean age of 57.7 years (range: 33-84) underwent posterior SI joint fusion. Two closely related novel posterior oblique approaches were employed. Enrolled subjects included 17 females and three males. The mean follow-up time for CT to assess fusion was 27 months (range: 17-45 months). Insurance included a mixture of public and private payers. One of the patients (patient 19) was on worker’s compensation. During follow-up, patients were assessed radiologically for radiographic bony union and asked to rate their satisfaction with the procedure. The Oswestry Disability Index (ODI) was applied on a one-time basis upon follow-up. All patients were diagnosed with sacroiliac joint pain based primarily on a positive response to fluoroscopically guided injections into the sacroiliac joint.ResultsOut of 20 patients, 33 SI joints were considered symptomatic and operated, and 32/33 joints successfully fused radiographically (a 96.9% fusion success rate). The average procedure satisfaction rating (PSR) was 7.25 out of a maximum 10 (range 1-10). Seventeen patients responded to post-surgery follow-up questions, and 13 patients (76%), indicated they would elect to have the surgery again as well as recommend it to others. Average estimated blood loss was less than 50 mL, and average length of stay was one day.ConclusionsPreliminary experiences with these novel posterior approaches to the SI joint described here seem to be safe and effective. The novel posterior approaches to the SI joint described here appear, preliminarily, to have many advantages over previously described procedures including markedly reduced surgical morbidity.
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