Nine cases of anaerobic osteomyelitis of long bones are reviewed, and data are tabulated for an additional 52 cases from the literature. Three major clinical presentations of this disease entity include an acute hematogenous form usually involving previously normal bones in younger patients; a chronic infection in which the anaerobic bacteria superinfect a fracture site already compromised by osteomyelitis due to aerobic organisms, usually Staphylococcus aureus; and an indolent infection at the site of indwelling prosthetic devices. This last form appears to be initiated at the time of surgery by the introduction of normal cutaneous anaerobic flora into the wound, but disease does not become apparent until months to years later. The responsible organisms, pathophysiology, and clinical presentations of these three forms are discussed; and the therapeutic necessity to remove all devitalized tissues, reestablish vascularity, graft bony defects, and combine this with long-term antibiotic therapy, preferably bactericidal against the causative organisms, is emphasized.

Adolescent↗

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Legg-Calve-Perthes Syndrome (L.C.P.S.). A critical analysis of roentgenographic measurements.

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Acetabulum↗

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Intravenous regional anesthesia for closed treatment of fractures and dislocations of the upper extremities.

Intravenous regional anesthesia for the treatment of fractures and dislocations of the upper extremity is a very effective, consistent and safe form of analgesia which requires low doses of lidocaine and can be performed in an emergency room using a regular blood pressure cuff. Dosage should be related to body weight and the blood pressure cuff should be maintained at higher than systolic pressure for a minimum of 15 minutes after the lidocaine is injected. Release of the tourniquet should be staged as described. Ninety-one per cent of 77 patients had excellent analgesia following the IVRA. Eight per cent had fair results, but this was still adequate to perform the reduction with only minimal but definite discomfort to the patient. Only one patient failed to respond to the IVRA technique. Other advantages such as muscle relaxation during the anesthetic and rapid full return of sensation after cuff release, permit ease of reducion and early anticipation of cast discomfort or pressure pain from sharp edges of plaster. Unpleasant long term side effects of axillary block anesthesia, such as persistent paresthesia have not been seen.

Adolescent↗