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Feng W, Wang Q, Yao Z, Zhu D, Song B, Zhang X. Analysis of poor prognostic factors for septic arthritis of the hip in children: a case series of 76 patients. J Pediatr Orthop B 2024; 33:379-386. [PMID: 38047567 DOI: 10.1097/bpb.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
The clinical characteristics, treatment and outcomes of children with septic arthritis of the hip in our hospital were analyzed to identify the risk factors for a poor prognosis. The clinical data of 76 children with septic arthritis of the hip who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. According to the most recent follow-up data, the patients were classified as good prognosis or poor prognosis. The differences between the two groups were analyzed. From January 2010 to December 2020, a total of 76 children with septic arthritis of the hip were admitted to our hospital, comprising 52 (68.4%) with a good prognosis and 24 (31.6%) with a poor prognosis. The risk of a poor prognosis was significantly higher in the group with time from onset to surgery >22 days than in the group with time from onset to surgery <11 days. The risk of poor prognosis in the group with C-reactive protein (CRP) > 100 mg/L was significantly higher than that in the group with CRP < 20 mg/L. Time from onset to surgery >14 days and CRP > 93 mg/L were the cutoff values for a poor prognosis. Significant elevation of CRP and prolonged time from onset to surgery in children with septic arthritis of the hip are risk factors for a poor prognosis. Early diagnosis and effective treatment are very important because delays in these factors can lead to a poor prognosis. Level of Evidence: Level II, retrospective study.
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Affiliation(s)
- Wei Feng
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Adelstein JM, Sinkler MA, Li LT, Mistovich RJ. ChatGPT Responses to Common Questions About Slipped Capital Femoral Epiphysis: A Reliable Resource for Parents? J Pediatr Orthop 2024; 44:353-357. [PMID: 38597253 DOI: 10.1097/bpo.0000000000002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND We sought to evaluate the ability of ChatGPT, an AI-powered online chatbot, to answer frequently asked questions (FAQs) regarding slipped capital femoral epiphysis (SCFE). METHODS Seven FAQs regarding SCFE were presented to ChatGPT. Initial responses were recorded and compared with evidence-based literature and reputable online resources. Responses were subjectively rated as "excellent response requiring no further clarification," "satisfactory response requiring minimal clarification," "satisfactory response requiring moderate clarification," or "unsatisfactory response requiring substantial clarification." RESULTS ChatGPT was frequently able to provide satisfactory responses that required only minimal clarification. One response received an excellent rating and required no further clarification, while only 1 response from ChatGPT was rated unsatisfactory and required substantial clarification. CONCLUSIONS ChatGPT is able to frequently provide satisfactory responses to FAQs regarding SCFE while appropriately reiterating the importance of always consulting a medical professional.
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Affiliation(s)
- Jeremy M Adelstein
- Department of Orthopaedic Surgery, Case Western Reserve University/University Hospitals, Cleveland, OH
| | - Margaret A Sinkler
- Department of Orthopaedic Surgery, Case Western Reserve University/University Hospitals, Cleveland, OH
| | - Lambert T Li
- Department of Orthopaedic Surgery, Case Western Reserve University/University Hospitals, Cleveland, OH
| | - R Justin Mistovich
- Department of Orthopaedic Surgery, Case Western Reserve University/University Hospitals, Cleveland, OH
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine
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Feng W, Yao Z, Liu H, Zhu D, Song B, Wang Q. Clinical characteristics of and risk factors for poor outcomes in children with bacterial culture-negative septic arthritis of the hip. J Orthop Sci 2023:S0949-2658(23)00218-X. [PMID: 37597975 DOI: 10.1016/j.jos.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Septic arthritis of the hip is a serious infection in children. However, blood and joint fluid cultures are often negative, which makes the diagnosis and treatment challenging. We analyzed the clinical features of children with septic arthritis of the hip with negative bacterial cultures and identified the risk factors for poor outcomes. METHODS The clinical data of children with septic arthritis of the hip with negative bacterial cultures who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. The clinical characteristics and outcomes of the culture-negative cohort were compared with those of children with positive bacterial cultures treated during the same period. Culture-negative patients were divided into a group with good outcomes and a group with poor outcomes. The differences between the two groups were compared. RESULTS Thirty-nine children with culture-negative septic arthritis of the hip were compared with 37 children with culture-positive sepsis. Compared with the culture-positive group, the culture-negative group had a significantly younger mean age and a significantly lower mean serum C-reactive protein concentration. Logistic regression analysis of culture-negative patients with good versus poor outcomes revealed that the independent risk factors for poor outcomes were an increased serum C-reactive protein concentration and prolonged time from onset to surgery. The cut-off values for predicting a poor outcome in the culture-negative group were a time from onset to surgery of greater than 21 days and a C-reactive protein concentration of greater than 23 mg/L. CONCLUSIONS Culture-negative septic arthritis of the hip has similar clinical features to culture-positive septic arthritis of the hip and can result in sequelae of varying severity. Therefore, active anti-infective and hip drainage therapy should be performed when children present with clinical symptoms, inflammatory marker concentrations, and imaging findings that are clinically diagnostic for septic arthritis of the hip. LEVEL OF EVIDENCE Level II, retrospective study.
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Affiliation(s)
- Wei Feng
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Ziming Yao
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Haonan Liu
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Danjiang Zhu
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Baojian Song
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Qiang Wang
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China.
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Zhao Y, Zhang G, Song Q, Fan L, Shi Z. Intramedullary core decompression combined with endoscopic intracapsular decompression and debridement for pre-collapse non-traumatic osteonecrosis of the femoral head. J Orthop Surg Res 2023; 18:6. [PMID: 36593524 PMCID: PMC9809108 DOI: 10.1186/s13018-022-03477-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The effect of core decompression on the treatment of pre-collapse non-traumatic osteonecrosis of the femoral head (ONFH) is still limited. This study aimed to explore the efficacy of core decompression combined with intra-articular decompression (debridement of the hip joint and incision of the hip capsule) under hip arthroscopic guidance in patients with pre-collapse ONFH. METHODS The clinical data of 101 patients with pre-collapse ONFH were analysed retrospectively. Sixty patients (80 hips) received small-diameter multi-channel core decompression alone in first half review period (group B). Forty-one patients (59 hips) were treated with small-diameter multi-channel core decompression combined with intra-articular decompression under hip arthroscopy guidance in second half review period (group A). The surgical duration; intraoperative bleeding; intra-articular pressure(IAP) before and after surgery; length of hospital stay; hospitalisation expenses; visual analogue scale (VAS) score before, 1 week, 4 weeks, 3 months and 1 year after surgery; and Harris score of the hip joint before, 3 months and 1 year after surgery were recorded and compared between group A and group B. X-ray examination was performed every month to observe the collapse of the femoral head within 2 years after surgery, which was compared using the Kaplan-Meier survival curve analysis. RESULTS When the two groups were compared, the surgical duration was longer and hospitalisation expenses were higher in group A than in group B (P < 0.05). However, the VAS score and the Harris score of the hip joint after surgery improved significantly compared with those before surgery (P < 0.05), which were more apparent in group A than in group B (P < 0.05). X-ray examination revealed that 6 hips in group A and 22 in group B received femoral head collapse at the 2-year follow-up. The survival rate of the femoral head in group A was significantly higher than that in group B (P < 0.05). CONCLUSION Small-diameter multi-channel core decompression combined with intra-articular decompression (debridement of the hip joint and incision of the hip capsule) under hip arthroscopic guidance for treating early ONFH can more effectively alleviate joint pain, improve joint function and delay ONFH progression.
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Affiliation(s)
- Yan Zhao
- grid.452672.00000 0004 1757 5804Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, 157 Xiwu Road, Xi’an, 710004 Shaanxi Province People’s Republic of China
| | - Guangyang Zhang
- grid.452672.00000 0004 1757 5804Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, 157 Xiwu Road, Xi’an, 710004 Shaanxi Province People’s Republic of China
| | - Qichun Song
- grid.452672.00000 0004 1757 5804Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, 157 Xiwu Road, Xi’an, 710004 Shaanxi Province People’s Republic of China
| | - Lihong Fan
- grid.452672.00000 0004 1757 5804Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, 157 Xiwu Road, Xi’an, 710004 Shaanxi Province People’s Republic of China
| | - Zhibin Shi
- grid.452672.00000 0004 1757 5804Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, 157 Xiwu Road, Xi’an, 710004 Shaanxi Province People’s Republic of China
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Zhang X, Deng W, Ju J, Zhang S, Wang H, Geng K, Wang D, Zhang G, Le Y, Hou R. A Method to Visualize and Quantify the Intraosseous Arteries of the Femoral Head by Vascular Corrosion Casting. Orthop Surg 2022; 14:1864-1872. [PMID: 35818638 PMCID: PMC9363727 DOI: 10.1111/os.13319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe a method to display the three-dimensional distribution of intraosseous arteries in the femoral head by vascular corrosion casting. METHODS An experimental study was done to expose the intraosseous arteries of the femoral head by a microperfusion corrosion method between January 2021 and May 2021. Specimens were 23 swine femoral heads (12 female specimens and 11 male specimens, where age of swine ranged from 8 to 12 months, and the weight was approximately 150 kg). The femoral heads were microperfused with the vascular casting resin through retinacular arteries, and the bone of the femoral head was dissolved with 50% sodium hydroxide and 10% hydrochloric acid and rinsed under the microscope until the vessel casts were completely exposed. The distribution and anastomosis of the arteries in the femoral head were observed under direct vision and microscopy. The diameter of the artery in the femoral head was measured at 0.5 cm after its entry into the bone of the femoral head with a microscale under the microscope. The number of internal arteries with diameter ≥0.05 mm was counted. The number and diameter of the main trunk of the epiphyseal arteries in the femoral head between male and female swine were compared. RESULTS The vascular casting specimen of the swine femoral head was successfully produced by using epoxy resin as a casting agent, and the three-dimensional intraosseous vascular structures were clearly visible. The number of epiphyseal arteries in male and female swine was 8.55 ± 2.15 and 8.83 ± 2.15 (t = -0.31, p = 0.38), respectively. The diameters of the superior epiphyseal arteries in male and female swine were 0.35 ± 0.09 and 0.31 ± 0.08 mm (t = 1.03, p = 0.16), the diameters of the inferior epiphyseal arteries were 0.47 ± 0.05 and 0.49 ± 0.09 mm (t = -0.57, p = 0.29), and the diameters of the anterior epiphyseal arteries were 0.34 ± 0.08 and 0.33 ± 0.13 mm (t = 0.32, p = 0.37). There was no significant difference in the number and diameter of the main trunk of intraosseous arteries between male and female swine (p > 0.05). The main trunk of intraosseous arteries formed an anastomosis in the center of the femoral head. Among 23 swine femoral head samples, three types of intraosseous anastomosis were observed, including 13 (57%) posterior superior-posterior inferior, seven (30%) posterior inferior-anterior, and three (13%) uniform intraosseous anastomosis. CONCLUSION The microperfusion corrosion method can produce the vascular casting specimen of swine femoral head revealing the three-dimensional structure of the intraosseous artery, which clearly shows the origin, course and branches, and diameter, as well as the anastomosis, of nutrient arteries in the femoral head. This method provides a simple and rapid technique for quantifying and visualizing intraosseous arteries.
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Affiliation(s)
- XiangNan Zhang
- Department of Orthopaedics, Suzhou Ruihua Orthopedic Hospital, Suzhou, China.,Suzhou Medical College of Soochow University, Suzhou, China
| | - Wei Deng
- Department of Orthopaedics, Suzhou Ruihua Orthopedic Hospital, Suzhou, China.,Suzhou Medical College of Soochow University, Suzhou, China
| | - JiHui Ju
- Department of Orthopaedics, Suzhou Ruihua Orthopedic Hospital, Suzhou, China.,Teaching Hospital of Medical College of Yangzhou University, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - Songqiang Zhang
- Department of Orthopaedics, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - HongYu Wang
- Department of Orthopaedics, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - KaiLong Geng
- Department of Orthopaedics, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - DingSong Wang
- Department of Orthopaedics, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - GuangLiang Zhang
- Department of Orthopaedics, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
| | - YingYing Le
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - RuiXing Hou
- Department of Orthopaedics, Suzhou Ruihua Orthopedic Hospital, Suzhou, China.,Teaching Hospital of Medical College of Yangzhou University, Suzhou Ruihua Orthopedic Hospital, Suzhou, China
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Andras LM, Abousamra O. What's New in Pediatric Orthopaedics. J Bone Joint Surg Am 2021; 103:287-294. [PMID: 33369978 DOI: 10.2106/jbjs.20.01953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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