LOCAL ANTIBIOTIC ADMINISTRATION THROUGH A N ELECTRONICALLY PROGRAMMABLE PORTABLE EXTERNAL MICRO-PUMP IN THE TREATMENT OF OSTEOMYELITIS

Introduction The aim of our study was to verify the correlation betwee n clinical and sonographic screening for CDH. Materials and methods Cl inical and sonographic screening was carried out in 1000 newborns (200 0 hips) during the first week of life, Anamnestic risk factors were ev aluated and clinical examination was performed using the BARLOW, Le DA MANY and ORTOLANI maneuvers. We also took into account a possible limi tation of abduction due to adductor hypertonia and the presence of a h ip crepitation. All hips were evaluated by ultrasound examination usin g Graf's morphologic method. We considered as clinically pathological the positive BARLOW, Le DAMANY and ORTOLANI hips and << doubtful >> th e stable hips having << crepitation >> or << hypertonia of the adducto rs >>. The hips considered pathological with the ultrasound were the h ips 2c, 3a and 3b according to GRAF. Results 1) Hips clinically pathol ogical (BARLOW, Le DAMANY and ORTOLANI): 150 (7,5 per cent). 2) The cl inically stable hips but << doubtful >>: - crepitation: 105 (5,25 per cent); adductor hypertonia: 86 (4,3 per cent), totaL 191 (9,55 per cen t). 3) Hips clinically normal but with at least an anamnestic risk fac tor: 198 (9,9 per cent); 4) Hips clinically normal but without anamnes tic risk factor: 1461 (73,05 per cent). 5) Hips echographically pathol ogical, that is 2c, 3a and 3b according to Graf: 124 (6,2 %) and parti cularly 2c: 61 (3,05 per cent), 3a: 61 (3,05 per cent) and 3b: 2 (0,1 per cent). Discussion 1) In the clinically pathological hips (BARLOW p ositive) 36 were echographically pathological with a clinical-sonograp hic correlation of 28,3 per cent (36 out of 127); all the ORTOLANI pos itive hips, were echographically pathological (100 per cent (23 out of 23)). In doubtful hips, sonograms were pathological in 17 of 105 hips with << crepitation >> (0,85 per cent) and in 13 of 86 hips with << a dductor hypertonia >> (0,65 per cent). 2) The clinically and echograph ically pathological hips at birth, that is 2c, 3 a and 3 b, must be fo llowed for months. At follow up, they showed in almost all the cases a n evolution towards normality. It is, therefore, indicated to repeat t he clinical and sonographic examination in the first month, before und ertaking any kind of treatment. 3) Finally, 12 hips, 0,6 per cent, pre senting pathological sonographic type 2c and 3a, were found clinically normal. Nevertheless, almost all of these hips evolved normally. From this study only 0,05 per cent of clinically normal hips presented, la ter, a dysplasia of the acetabulum. Analysis of the results clearly sh owed that ultrasound examination may be an excellent help to clinical examination which, if well performed, has top priority for early diagn osis of C.D.H. Conclusion The clinical examination, carefully performe d in the first days of life, has priority because it allows discoverin g a pathological hip or a hip at risk. The sonographic examination is a useful image complementing the clinical examination because it allow s confirmation of the diagnosis and follow up of the morphologic evolu tion of the hip with an inoffensive method and it can give indications for possible treatment. From our study we may conclude that at birth a clinical screening is preferable and that the ultrasound study is to be reserved for pathological, doubtful or at risk hips.