Background Slipped capital femoral epiphysis (epiphysiolysis of the femoral head, SCFE) is the most common pediatric hip disease in 10-14 years old children. The most used procedure to correct a stable form of SCFE is in situ pinning. Instead, the proper treatment for unstable forms is controversial. The first purpose of this study was to estimate annual admissions for SCFE in Italian patients from 2001 to 2015, basing on the hospitalization reports. The second aim was to assess the difference between regions regarding SCFE procedures. Lastly, a statistical prediction of the volume of SCFE procedures performed in Italy based on data from 2001 to 2015 was performed. Methods Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health regarding the years of this paper. The yearly number of hospital admission for SCFE, the percentage of males and females, the average age, days of hospitalization, primary diagnoses and primary procedures in the whole Italian population were calculated using descriptive statistical analyses. Results From 2001 to 2015, 4893 hospitalizations for SCFE were recorded in Italy, with a mean incidence of 2.9 (cases/100.000 inhabitants). The majority of patients treated by SCFE were males (70.6%). Conclusion National health statistics for SCFE are attractive for an international audience, as different approaches to screening are reported between countries. These differences allow comparing outcomes internationally. Moreover, sharing national statistics and correlating those to other countries protocols, could be helpful to compare outcomes for different procedures internationally. However, further studies are required to understand the specific reasons for regional variation for SCFE procedures in Italy. Level of evidence III.

/pdf/slipped-capital-femoral-epiphysis-an-epidemiological-4fuqptmiwc.pdf

Slipped capital femoral epiphysis: an epidemiological Nationwide study in Italy from 2001 to 2015

Pediatric Osteomyelitis: A Case Report.

Une boiterie non-traumatique est une manifestation clinique peu spécifique et très fréquente au sein de la population pédiatrique. Elle ouvre un large éventail d’hypothèses diagnostiques, notamment les atteintes de la hanche ainsi que les pathologies neurologiques, inflammatoires, infectieuses ou néoplasiques. Les hernies discales doivent être également évoquées car elles peuvent se présenter comme une radiculalgie isolée et entraîner une altération de la marche. Une anamnèse ainsi qu’un examen clinique minutieux sont, dès lors, indispensables pour orienter d’éventuelles explorations complémentaires. Non-traumatic limping is a common and non-specific symptom that involves a wide range of differential diagnosis including hip pathologies but also malignancy, infectious, neurological or inflammatory diseases. Disc herniation is one of them as they can present by isolated leg pain and secondary gait impairment. A systematic approach with exhaustive physical examination and personal history is necessary to target the most appropriate investigations. 

Cause atypique de boiterie chez l’enfant

Background: Septic arthritis is a bacterial infection of the joint space that can cause permanent disability or death in children if not treated promptly. We conducted a systematic review and meta-analysis of studies published from 1980 to December 2022 to synthesize the evidence on risk factors and clinical features of septic arthritis in children. Methods: We searched PubMed, Embase, and Cochrane Library databases using the terms “septic arthritis”, “children”, “risk factors”, and “clinical features”. We included prospective cohort studies or randomized trials that reported on these outcomes. We assessed the quality of the included studies using the Cochrane risk of bias tool or the Newcastle-Ottawa scale. We pooled the results using random-effects models and calculated odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). Results: We included 42 studies with a total of 6,120 children. Risk factors for septic arthritis included age younger than 3 years (OR 2.54, 95% CI 1.87-3.46), male sex (OR 1.32, 95% CI 1.14-1.53), previous joint problems or surgery (OR 2.19, 95% CI 1.50-3.20), immunodeficiency (OR 2.76, 95% CI 1.86-4.10), and recent infection or injury (OR 2.45, 95% CI 1.72- 3.49). Clinical features varied but commonly included fever (OR 5.67, 95% CI 3.66-8.79), joint pain (OR 9.23, 95% CI 5.97-14.28), swelling (OR 8.41, 95% CI 5.44-13.01), and reduced movement (OR 10.12, 95% CI 6.55-15.65). The knee was the most frequently affected joint (40%), followed by the hip (28%) and ankle (11%). Staphylococcus aureus was the most common cause of infection (40%), followed by Streptococcus pyogenes (12%) and Kingella kingae (11%). Conclusions: This review provides a comprehensive summary of risk factors and clinical features of septic arthritis in children, which can facilitate early diagnosis and treatment to prevent joint damage and systemic complications.

Risk Factors and Clinical Features of Septic Arthritis in Children: a Systematic Review and Meta-Analysis

Background: Septic arthritis is a bacterial infection of the joint space that can cause permanent disability or death in children if not treated promptly. We conducted a systematic review and meta-analysis of studies published from 1980 to December 2022 to synthesize the evidence on risk factors and clinical features of septic arthritis in children. Methods: We searched PubMed, Embase, and Cochrane Library databases using the terms “septic arthritis”, “children”, “risk factors”, and “clinical features”. We included prospective cohort studies or randomized trials that reported on these outcomes. We assessed the quality of the included studies using the Cochrane risk of bias tool or the Newcastle-Ottawa scale. We pooled the results using random-effects models and calculated odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). Results: We included 42 studies with a total of 6,120 children. Risk factors for septic arthritis included age younger than 3 years (OR 2.54, 95% CI 1.87-3.46), male sex (OR 1.32, 95% CI 1.14-1.53), previous joint problems or surgery (OR 2.19, 95% CI 1.50-3.20), immunodeficiency (OR 2.76, 95% CI 1.86-4.10), and recent infection or injury (OR 2.45, 95% CI 1.72- 3.49). Clinical features varied but commonly included fever (OR 5.67, 95% CI 3.66-8.79), joint pain (OR 9.23, 95% CI 5.97-14.28), swelling (OR 8.41, 95% CI 5.44-13.01), and reduced movement (OR 10.12, 95% CI 6.55-15.65). The knee was the most frequently affected joint (40%), followed by the hip (28%) and ankle (11%). Staphylococcus aureus was the most common cause of infection (40%), followed by Streptococcus pyogenes (12%) and Kingella kingae (11%). Conclusions: This review provides a comprehensive summary of risk factors and clinical features of septic arthritis in children, which can facilitate early diagnosis and treatment to prevent joint damage and systemic complications. 

The limping child: a systematic approach to assessment and management

144 The Burden of Harm of a Long Wait Time for Laparoscopic Cholecystectomy; the Experience of a National Referral Centre


 
 
 With waiting times for surgery in Scotland increasing year on year, all trusts across the country can now refer patients to have laparoscopic cholecystectomy performed sooner at a national referral centre. Our aim was to evaluate the overall patient experience from decision for surgery to 30 days post-operatively.
 
 
 
 Retrospective analysis was performed of 191 patients who had laparoscopic cholecystectomies over a 7-month period. Their notes were examined for original referral dates and operation notes, biliary related admissions while awaiting surgery and post-operative complications within 30 days.
 
 
 
 Of the 191 patients, 5 (3%) had missing operation notes, 2 (1%) were abandoned, 1 (0.5%) was cancelled on the day, and 8 (4%) declined on the day. The average age of the patients was 51 (range 20-81), 81% of patients were female.
 The median number of days spent on the waiting list was 301 days (range 35 – 1961). Once referred to our centre, patients waited a median of 91 days.
 5.2% (10 patients) had biliary related admission while awaiting their surgery.
 Examination of operative notes provided variable information, with 11% mentioning duodenal adhesions and two were entirely abandoned due to complexity. 2 post-operative complications were identified. These were graded at I and II on the clavien-dindo scale respectively.
 
 
 
 Patients overall waiting time does not reach guideline targets. Patients waiting a long time increases cost on the NHS by increasing unnecessary pre-operative hospital admissions. Our data demonstrates an excellent safety profile of patients undergoing laparoscopic cholecystectomy out-with their original healthboard.


160 The Patient Experience of Laparoscopic Cholecystectomy as a Day Case at a National Referral Centre; a 7 Month Evaluation of Outcomes

Introduction: Magseed localised targeted axillary dissection (mTAD) is associated with decreased false negative rates in patients with node positive disease undergoing neoadjuvant chemotherapy (NAC). We examine the outcomes for mTAD across 2 units in Glasgow. 

Magseed localised TAD for node positive patients following neoadjuvant chemotherapy in Glasgow

Introduction: Radiological response following neoadjuvant chemotherapy (NAC) in node positive patients provides guidance to select those patients who may be suitable for targeted axillary dissection (TAD). We examined the clinicopathological outcomes for patients undergoing TAD/SNB versus those undergoing axillary clearance (ANC). 

Outcomes for TAD/SLNB compared to ANC in node positive patients following neoadjuvant chemotherapy

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