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Caffey's disease or infantile cortical hyperostosis is a rare cause of irritability, bone pain, soft tissue swelling and fever in the infant.To review the presentation and diagnosis of an 8-week old infant with focal tenderness of the tibia.The symptoms, signs, laboratory work-up and radiology are reviewed.The child presented with focal bony tenderness and pyrexia. Laboratory work-up was inconclusive. The diagnosis of Caffey's disease was made following a skeletal survey to outrule non-accidental injury, which showed similar changes of cortical thickening in the mandible as well as the affected tibia.With our increasing immigrant population, an increasing number of differential diagnoses must be considered when evaluating patients presenting to our emergency rooms. Caffey's disease is an unusual cause of bone pain in the infant. Symptoms and signs are subtle and the diagnosis is generally made with plain X-rays.

Urinary retention is an important complication of hip and knee arthroplasty. The insertion of a urinary catheter has been associated with an increased incidence of implant infection in previous studies (David and Vrahas in J Am Acad Orthop Surg 8(1):66–74, 2000; Haase and Harding in Compan Surg 1(4):1–6, 1984). The purpose of this study was to assess the rates of urinary retention post-arthroplasty in our unit and to investigate if the patient’s pre-operative International Prostate Symptom Score (IPSS) could be used to predict the development of post-operative urinary retention. Patients numbering 118 were enrolled prospectively for this study. Twenty-eight were attending for knee arthroplasty with 90 attending for hip arthroplasty. The patients were asked to fill out an IPSS questionnaire form on admission. The patient’s age, mode of anaesthetic, intraoperative blood loss and operative time were recorded. Forty-five patients (38.14%) developed urinary retention post-operatively. Thirty-one patients (34.4%) following total hip replacement, and 14 patients (50%) following total knee replacement developed urinary retention. The mean pre-operative IPSS score was 8.73 for those who went into retention, compared to 4.315 for the other patients (P < 0.01). The mean IPSS score was significantly higher in patients requiring catheterization. These results show that this scoring system could be used to predict the development of post-operative urinary retention in patients presenting for hip or knee arthroplasty.

Our aims were to map the tibial footprint of the posterior cruciate ligament (PCL) using MRI in patients undergoing PCL-preserving total knee replacement, and to document the disruption of this footprint as a result of the tibial cut. In 26 consecutive patients plain radiography and MRI of the knee were performed pre-operatively, and plain radiography post-operatively. The lower margin of the PCL footprint was located a mean of 1 mm (−10 to 8) above the upper aspect of the fibular head. The mean surface area was 83 mm2 (49 to 142). One-third of patients (8 of 22) had tibial cuts made below the lowest aspect of the PCL footprint (complete removal) and one-third (9 of 22) had cuts extending into the footprint (partial removal). The remaining patients (5 of 22) had footprints unaffected by the cuts, keeping them intact. Our study highlights the wide variation in the location of the tibial PCL footprint when referenced against the fibula. Proximal tibial cuts using conventional jigs resulted in the removal of a significant portion, if not all of the PCL footprint in most of the patients in our study. Our findings suggest that when performing PCL-retaining total knee replacement the tibial attachment of the PCL is often removed.

Our review has shown that there has been a changing trend in THA component usage over the last 10 years. Our assumption is that this is secondary to a better understanding of optimal component fixation and soft tissue balancing. These observations are made with the knowledge that not all THAs are performed using Charnley components. The institution of a national arthroplasty register would be useful for identifying future trends.