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Unlabelled: The most common treatment for displaced pediatric supracondylar humerus fractures is closed reduction and percutaneous pinning. However, the time for return of elbow motion after treatment of these injuries is not well documented. To describe the return of elbow motion after closed reduction and percutaneous pinning of these fractures we retrospectively reviewed 63 patients (age range, 1.6-13.8 years) with displaced supracondylar fractures of the humerus stabilized with either two or three lateral entry pins. Pins were removed by 3 to 4 weeks. No patient participated in formal physical therapy. At each followup, elbow range of motion (ROM) was recorded for the injured and uninjured extremities. Elbow ROM returned to 72% of contralateral elbow motion by 6 weeks after pinning and progressively increased to 86% by 12 weeks, 94% by 26 weeks, and 98% by 52 weeks. After closed reduction and percutaneous pinning of a displaced, uncomplicated, supracondylar humerus fracture, 94% of the child's normal elbow ROM should be expected by 6 months after pinning. Further improvement may occur up to 1 year postoperatively. This information may be helpful in advising parents what to expect after their child's injury., Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Unlabelled: Ankle infection is a serious problem with limited published information on microbiology and associated morbidities. We describe the laboratory findings, microbiology, and occurrence of adjacent osteomyelitis in patients with hematogenous septic ankle arthritis. We retrospectively reviewed 30 patients with hematogenous septic arthritis of the ankle admitted over a 10-year period. Twenty-two patients were male and eight female. The mean age was 46 years (range, 23-67 years). C-reactive protein and erythrocyte sedimentation rate were elevated in all patients, but the peripheral white blood cell count was elevated in only 47% of patients. Staphylococcus aureus (S. aureus) was the most common pathogen, isolated in 13 (54%) of the 24 patients with positive cultures; four of these isolates (four of 24; 17% of positive cultures) were oxacillin-resistant. Four (17%) of the 24 patients with positive cultures had a mycobacterial infection. We identified adjacent osteomyelitis in 30% of patients, which was considerably associated with the presence of patient comorbidities. S. aureus is the most common pathogen in septic ankle arthritis and empiric antibiotic therapy is recommended. Adjacent osteomyelitis may be present and a high index of suspicion is necessary in patients with comorbidities., Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Unlabelled: Thigh abscesses due to pyomyositis are uncommon. To guide empiric antibiotic therapy in diabetics we determined the rate of such infections due to oxacillin-resistant Staphylococcus aureus and Gram-negative organism infections, and whether the occurrence of oxacillin-resistant pathogens increased during the study period. We retrospectively reviewed 39 adult patients with diabetes mellitus treated for a deep thigh abscess. There were 29 men and 10 women; their mean age was 45 years. Comorbidities were present in 15 patients. S. aureus was the most common pathogen, present in 82% (32/39) of our patients. Gram-negative organisms were cultured in 14% (6/39) of patients and anaerobes in 10% (4/39). The infection was polymicrobial in 12 of 39 patients (31%). Oxacillin-resistant S. aureus comprised 25% (8/32) of infections due to S. aureus. Oxacillin-resistance increased during the last 3 years of this study from one of 18 S. aureus isolates from 1994 to 2004 to seven of 14 isolates from 2004 to 2006. In diabetic patients with thigh pyomyositis, empiric antibiotic therapy should provide broad spectrum coverage for oxacillin-resistant S. aureus, Gram-negative, as well as anaerobic organisms., Level of Evidence: Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Ankle syndesmotic injury does not necessarily lead to ankle instability; however, the coexistence of deltoid ligament injury critically destabilizes the ankle joint. Syndesmotic injury may occur in isolation or may be associated with ankle fracture. In the absence of fracture, physical examination findings suggestive of injury include ankle tenderness over the anterior aspect of the syndesmosis and a positive squeeze or external rotation test. Radiographic findings usually include increased tibiofibular clear space decreased tibiofibular overlap, and increased medial clear space. However, syndesmotic injury may not be apparent radiographically; thus, routine stress testing is necessary for detecting syndesmotic instability. The goals of management are to restore and maintain the normal tibiofibular relationship to allow for healing of the ligamentous structures of the syndesmosis. Fixation of the syndesmosis is indicated when evidence of a diastasis is present. This may be detected preoperatively, in the absence of fracture, or intraoperatively, after rigid fixation of the medial malleolus and fibula fractures. Failure to diagnose and stabilize syndesmotic disruption adversely affects outcome.