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Purpose This study was designed to review the diagnostic yield of single photon emission computed tomography-computed tomography (SPECT/CT) in children with complex foot/ankle pain. Methods We reviewed the records of 33 patients with complex foot and ankle pain referred for SPECT/CT (36 scans) performed between 1st September 2009 to 30th September 2019. All patients had foot and ankle radiographs and 18 out of 33 patients had undergone magnetic resonance imaging (MRI) prior to SPECT/CT. The diagnostic contribution of SPECT/CT was established at the time of the scan during a multi-disciplinary team meeting. Results The patients’ mean age was 13.4 years (range six to 16.5 years) and 58% were female. In total, 18 patients had undergone previous surgical treatment. SPECT/CT was found to have decisive clinical value compared with radiographs and CT/MRI in 28 out of 36 cases. In ten patients it prompted surgical management (coalition excision, arthrodesis), in seven patients it redirected conservative management, in six patients it excluded other pathology and in five patients it showed additional/unexpected focal areas of mechanical stress, thus avoiding surgery. When compared with MRI, SPECT/CT added further clinical information in 13 out of 18 cases. SPECT/CT added decisive clinical value in five out of five patients with accessory ossicles, eight out of nine patients with tarsal coalition, five out of seven patients with surgically treated Congenital Talipes Equinovarus (CTEV) and four out of five patients with neuromuscular feet. In eight out of 36 cases SPECT/CT confirmed the diagnosis without adding significant information. Conclusions SPECT/CT can identify foci of active mechanical stress at cortical bone level in children with unexplained complex foot and ankle pain, particularly in the multiply operated foot, accessory ossicles and tarsal coalitions. Level of Evidence IV

Purpose Double and triple femoral neck lengthening osteotomies have been described to correct coxa brevis deformity. Only small studies reported the results. Our aim was to provide an overview of the outcomes of double and triple femoral neck lengthening. Methods After an extensive search of different online databases, we included studies reporting the results of double and triple femoral neck osteotomies. Clinical and radiological outcomes, and reported complications were extracted. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results After evaluating 456 articles, we included 11 articles reporting 149 osteotomies in 143 patients (31% male, 64% female, 5% unspecified). Mean age of the patients was 20 years (range 7 years to 52 years). Indications were developmental hip dysplasia (51%), Perthes disease (27%), infection (6%), post-trauma (4%), congenital disorders (2%), slipped capital femoral epiphysis (1%), idiopathic (3%) and unknown (6%). The mean limb length discrepancy reduced by 12 mm (0 mm to 40 mm). In total, 65% of 101 positive Trendelenburg sign hips experienced improvement of abductor muscle strength. An 18% (9% to 36%) increase could be found in functional hip scores. Mean increase in articulo-trochanteric distance was 24 mm (10 mm to 34 mm). Five patients older than 30 years at the time of osteotomy and two younger patients with prior hip incongruency had disappointing results and required arthroplasty. In all, 12 complications occurred in 128 osteotomies, in which complications were reported. Conclusions Double and triple femoral neck lengthening osteotomies in coxa brevis show good results with few complications in the literature, especially in young patients with non-arthritic hips. Level of evidence III

Background Patients with severe bone fractures and complex bone deformities are treated by orthopedic surgeons with external fixation for several months. During this long treatment period, there is a high risk of inflammation and infection at the superficial skin area (pin site). This can develop into a devastating, sometimes fatal, and always costly condition of deep bone infection. Objective For pin site infection surveillance, thermography technology could be the solution to build an objective and continuous home-based remote monitoring tool to avoid frequent nursing care and hospital visits. However, future studies of infection monitoring require a preliminary step to automate the process of locating and detecting the pin sites in thermal images reliably for temperature measurement, and this step is the aim of this study. Methods This study presents an automatic approach for identifying and annotating pin sites on visible images using bounding boxes and transferring them to the corresponding thermal images for temperature measurement. The pin site is detected by applying deep learning-based object detection architecture YOLOv5 with a novel loss evaluation and regression method, control distance intersection over union. Furthermore, we address detecting pin sites in a practical environment (home setting) accurately through transfer learning. Results and conclusion The proposed model offers the pin site detection in 1.8 ms with a high precision of 0.98 and enables temperature information extraction. Our work for automatic pin site annotation on thermography paves the way for future research on infection assessment on thermography.

Introduction: Ludloff’s procedure for open reduction of congenital dislocation of the hip (CDH) is recommended for its minimal tissue damage, but is criticised for the risk of late avascular necrosis (AVN) of the femoral head. The aim of present study was primarily to assess the risk of late AVN of the femoral head and secondly the range of motion (ROM) of the hip and the quality of life in children following Ludloff’s procedure. Methods and materials: 13 hips in 11 children after Ludloff’s procedure due to CDH were included retrospectively from 1997 to 2005 at Aarhus University Hospital. Radiographs were evaluated for the presence of AVN of the femoral head and classified according to the Bucholz and Ogden classification, with type 2-4 having clinical relevance. A clinical examination included range of motion (ROM) and leg length discrepancy (LLD) measurements. The HAGOS hip questionnaire evaluated activity, participation and quality of life. Results: No severe type 3-4 AVN was observed. 2 type 2 and 5 type 1 were observed. AVN was observed in 7 of the 13 operated hips (54%). An 8.6° difference in flexion for unilaterally treated hips was observed (pConclusions: Only minor AVN of clinical importance was seen after Ludloff’s procedure.