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Sequelae of hematogenous septic arthritis in newborn and infant


, : Sequelae of hematogenous septic arthritis in newborn and infant. Chirurgie Pediatrique 26(3): 143-151

For 25 years, 102 hematogenous septic arthritis have been observed in 82 newborns and infants. The hip joint was the most common site of involvement (63 cases), than the knee (23 cases), the shoulder (7 cases), the elbow (5 cases), the ankle (3 cases) and one wrist. 14 times, two or more joints were involved. When the diagnosis was made early, an aspiration of pus and an irrigation of the joint was done. But in severe and delayed arthritis, an arthrotomy was prefered. In all cases, joints were immobilized in a post-operative cast or with a traction management, and parental antibiotics were prescribed. 52 sequellae were noted, two thirds of these were seen in second hand. Sequellae are detailed joint by joint, and the authors describe different stages from minor dysplasia and abnormal growth of the epiphysis to severe destruction of the bones and persistent dislocation. Treatment of sequellae is proposed: 1. THE HIP JOINT-Dysplasiae and deformities of the head and/or the neck were corrected with femoral osteotomy. In 2 cases, pelvic innominate osteotomy was performed. Progressive coxa vara with short neck and greater trochanteric overgrowth were treated with femoral neck lengthening (personal technic). Dislocations needed open reduction of the hip and extensive excision of the acetabular fibro-fatty tissue. In a few cases, a Colonna's procedure was made. In total destructions of the upper femoral extremity, the treatment consisted in trochanteroplasty. 2. THE KNEE JOINT- In partial epiphyseodesis of a femoral condyle, disepiphyseodesis was obtained with resection of the physeal bone bridge (2 cases) or with free physeal transplantation with microvascular anastomosis (2 cases). When the deviation of the knee persisted, the best solution was a femoral osteotomy and the correction of the leg length discrepancy. In total epiphyseodesis, the inequality of limb lengths would exceed 10 cm when growth is over. A program of equalization needed lengthening of the femur. In destruction of the femoral epiphysis, femoral osteotomies and lengthening diminished the severity of the complication. 1. UPPER LIMB-One problem was the total growth arrest of the proximal humerus (4 cases) with 7 to 9 cm of shortening (predictive and real). Two lengthenings with the Wagner's method led a good result. The authors emphasize the gravity of hematogenous septic arthritis if diagnosis is delayed and if correct treatment is not performed in emergency.

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