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MUSCULOSKELETAL INFECTION CAUSED BY MYCOBACTERIA Tuberculous arthritis/osteomyelitis remains prevalent in low- and middle-income countries. There is now a resur gence across the world as a consequence of migration and immunocompromise (including human immunod...

Management Successful treatment requires accurate diagnosis and a multi - disciplinary approach to deliver a package of care, summarised as follows: /uni25CF Preoperative: /uni25CF patient assessment and clinical staging of disease; /uni25CF full discussion ...

Microbiology Virulent Gram-positive organisms, particularly Staphylococcus - aureus , are the most common cause of bone or joint infection in native tissue. However, once prosthetic material is implanted, a wide range of organisms can be involved. This includ...

NATIVE JOINT SEPTIC ARTHRITIS Epidemiology Bacterial infection of native joints occurs with an estimated incidence of 4–10 per 100 /uni00A0 000 population per year in western Europe, with higher rates associated with socioeconomic deprivation and in developi...

PROSTHETIC JOINT INFECTION Epidemiology The incidence of PJI is around 1% per joint per year, with upper limb joints at a higher risk. Infection can be minimised with improved operative practice, prophylactic systemic anti biotics, local antibiotics in cement...

ABNORMALITIES OF THE KNEE AND LOWER LEG Many knee problems in children or adolescents are self-limiting. Others require surgical consideration to reduce the risk of later degenerative change. ABNORMALITIES OF THE KNEE AND LOWER LEG Many knee problems in child...

ABNORMALITIES OF THE UPPER LIMB Minor finger abnormalities are common ( Table 44.11 not all require surgical intervention. Comfort and function are more important than appearance. Robert Kienböck , 1871–1953, Professor of Radiology , Vienna, Austria, described...

ANKLE Parents are often concerned that minor abnormalities will limit function but this is rarely the case. ANKLE Parents are often concerned that minor abnormalities will limit function but this is rarely the case. ANKLE Parents are often concerned that minor...

Anterior knee pain In adolescents the extensor mechanism of the knee is a common site of knee pain. Osgood–Schlatter disease is a traction apophysitis of the patellar tendon insertion. Pain, tenderness and swelling at the tibial tubercle, exacerbated by exer...

Back pain Children report back pain less frequently than adults, although >50% will have had one episode by late adolescence. Back pain in a child is a ‘red flag’ for serious spinal pathology; however, if it is mild, intermittent or occurring only on strenuous ...

Blount’s disease The aetiology of the disordered growth in the posteromedial proximal tibial physis is unknown. The infantile form is more Walter Putnam Blount , 1900–1992, Professor of Orthopaedic Surgery , Marquette University , Milwaukee, WI, USA, describe...

Brachial plexopathy Neonatal brachial plexus injury is still common, with a devas - tating e ff ect on upper limb function, particularly if antigravity motor activity has not recovered by 6 months. Physiotherapy is the mainstay of early treatment to maintain m...

CLINICAL DILEMMAS The limping child Children may limp because of pain, weakness, deformity or to gain attention; the causes vary from sepsis to a spinal tumour and from a leg length discrepancy to a simple blister. Serious causes must be excluded and the ‘sur...

CONGENITAL AND DEVELOPMENTAL ABNORMALITIES 1 CONGENITAL AND DEVELOPMENTAL ABNORMALITIES 1 CONGENITAL AND DEVELOPMENTAL ABNORMALITIES 1

Cerebral palsy Cerebral palsy (CP) is caused by a non-progressive insult to the developing brain in the perinatal period; in most cases only risk factors, such as prematurity , rather than specific causes, such as hypoxia (hypoxic ischaemic encephalopathy [HIE]...

Complications of bone and joint sepsis Treated appropriately , most cases of sepsis resolve with no sequelae. However, significant complications can occur, particularly in terms of chronic infection and where there has been damage to the joint and/or the phys...

Congenital pseudarthrosis of the tibia This rare condition presents with an anterolateral bow of the tibia with or without a fracture. Classic radiographic changes are noted and 50% are associated with neurofibromatosis. Once fractured the tibia is reluctant t...

Congenital radial head dislocation The dislocation is usually posterolateral, compared with the classic traumatic anterior dislocation ( Figure 44.33 ). Some restriction of elbow joint movement and forearm rotation is noted along with discomfort on activity ....