The follow-up results 1 to 11 years (mean 5 years) after resection arthroplasty of the forefoot or arthrodesis of the first metatarsophalangeal (MTP) joint performed on 100 patients (179 feet) with classical or definite rheumatoid arthritis are presented and analysed. The main indication for surgery was pain in the damaged and more or less luxated MTP joint. Resection arthroplasty of MTP joints II-V was performed from the plantar approach in 167 feet. The Keller or Mayo operation was performed on the first MTP joint in 129 feet. Arthrodesis of the first MTP joint was done in 17 feet. The proximal joint of the hallux was not treated in 33 feet. According to the subjective assessment, results after surgery were considered good by 49 patients (91 feet, 51%), fair by 44 (76 feet, 42%), and poor by 7 (12 feet, 7%). These 7 patients complained of persistent pain or a disabling deformity of the toes, or both. Although these results were generally satisfactory, the objective results were not good. At follow-up more than 50% of the patients had recidivistic callosities, a hallux valgus deformity, a dorsal dislocation and lateral deviation of the lesser toes, or radiologically observable bony proliferations of the distal ends of the metatarsals--or a combination of these. All patients in whom a proximal or interphalangeal joint of the hallux was surgically or spontaneously fused were satisfied: the stiff joint was painless on walking. When destruction of the first MTP joint is severe and painful, arthrodesis is recommended.
We analysed the records of 44 paediatric cases of acute haematogenous osteomyelitis (age 0-14 years) and 25 cases of purulent arthritis (age 0-13 years). The annual incidences were 4.5 and less than two per 100,000 children, respectively. Bacteriologic diagnosis was achieved in 82% of the acute haematogenous osteomyelitis cases and in 40% of the acute purulent arthritis cases. Staphylococcus aureus was responsible for 70% of the proven acute haematogenous osteomyelitis and acute purulent arthritis cases combined, followed by streptococci (20%) and Haemophilus influenzae (7%), which caused only acute purulent arthritis. Acute haematogenous osteomyelitis was localized in the femur in 41% of the cases and acute purulent arthritis in the knee joint in 76%. Surgery (in most cases drilling, fenestration or arthrotomy) was performed on 82% of the acute haematogenous osteomyelitis and on 32% of the acute purulent arthritis patients. Although six of the acute haematogenous osteomyelitis patients (but none of the acute purulent arthritis patients) underwent surgery for a second time, permanent damage, which was functionally non-significant, developed in only 14%. No sequelae were found in the acute purulent arthritis group. The average duration of antimicrobial therapy was 44 days in the acute haematogenous osteomyelitis group and 29 days in the acute purulent arthritis group. The prognosis for the children was similar, irrespective of whether the drugs used were staphylococcal penicillins, ampicillin, lincomycin or clindamycin.
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