BackgroundLyme arthritis can be readily treated with use of oral antibiotics without any need for surgery. In Lyme-endemic areas, differentiating between Lyme arthritis and septic arthritis can be difficult. Laboratory testing for Lyme disease often results in a delay in diagnosis because many labs batch-test Lyme specimens only two times per week due to lack of equipment or increased expense. Delayed diagnosis can lead to unneeded surgery in cases in which the surgeon indicates the patient for a joint irrigation and debridement (I & D) for possible septic arthritis while waiting for Lyme serology results. The purpose of this study was to develop an algorithm for the treatment of patients with possible Lyme arthritis, with particular attention to poly-articular involvement.MethodsThirty-nine patients with poly-articular Lyme arthritis, including ankle involvement, were reviewed retrospectively. Patients were included if the ankle was involved, if they were less than 18 years of age, and had available laboratory information and a serologic diagnosis of Lyme disease.ResultsOnly two patients had isolated ankle involvement; of those with poly-articular involvement, 34 patients had ankle/knee involvement. Nine patients presented with pain in the ankle with passive range of motion (PROM) (22 %); two (4.8 %) had refusal to bear weight, and 10 (24 %) had an antalgic gait. All patients had a positive Western blot. Ten patients had a peripheral white blood cell (WBC) count >12,500/mm3 , and 16 patients had an erythrocyte sedimentation rate (ESR) >40 mm/h.ConclusionWithout immediate availability of Lyme serology, the decision to perform surgical drainage of a swollen joint in the setting of possible Lyme arthritis versus septic bacterial arthritis remains a clinical dilemma. Our data suggests that patients presenting with one or fewer Kocher criteria symptoms, poly-articular disease, and minimal pain with PROM have Lyme, rather than septic, arthritis. These patients can be treated with joint aspiration for cultures, appropriate antibiotics for Lyme disease, and careful serial exams while waiting for results of Lyme serology rather than immediate surgical I & D.

Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been described as a risk factor for postsurgical infection. The purpose of this study is to determine the prevalence of MRSA in pediatric orthopaedic patients and whether being a MRSA carrier is a predictor of postoperative infection. Six hundred and ninety-nine consecutive pediatric patients who underwent MRSA nasal screening prior to surgery were studied. Postoperative cultures, total surgical site infections (SSIs), and epidemiological and surgical prophylaxis data were reviewed. Forty-four of 699 patients (6.29%) screened positive for MRSA. Nine of the 44 patients (20.5%) that screened positive for MRSA had a subsequent SSI compared to 10 of the 655 patients (1.52%) that screened negative (p < 0.05). All 9 patients with a SSI had myelomeningocele. The prevalence of MRSA was 6.30% and was predictive of postoperative infection. Children with myelomeningocele were at the highest risk for having a positive MRSA screening and developing SSI.

Objective.-Thousands of people set out daily to climb the world's highest mountains in hopes of summiting. Although many 3000-m summits are accessible in favorable weather, conditions may turn calamitous quickly, requiring practiced navigation or rescue. Owing to the portability and low cost of many technological devices, many climbers have eschewed map and compass navigation. We sought to evaluate climbers' reliance on technologic devices, as well as their effectiveness and reliability for rescue. Methods.-This survey study evaluated a convenience sample of climbers and hikers who arrived at Camp Muir, Mount Rainier (10,188 feet). Investigators ascended on 6 separate dates to the study site to collect data. The primary outcome evaluated was the percentage of climbers relying on a technologic device for rescue. Results.-Two hundred forty-four of 308 climbers (79%) brought some technologic means for rescue. However, only 133 (43%) had a nontechnological backup plan in event of device failure. Therefore, 57% relied solely on the functioning of their devices in a rescue situation. Of the 102 climbers who relied solely on a cell phone as their means of rescue, 49 (48%) had service at the time of the survey. Thirty-three of 308 (11%) reported that they had required a technologic means of rescue in the past, most commonly an avalanche beacon (n ¼ 13). For the 24 rescue devices that failed, the most common reasons were dead batteries in global positioning satellite equipment and lack of cell phone service. Conclusions.-Reliance on technological devices is becoming commonplace among climbers on Mount Rainier and largely replacing map and compass orienteering. The lack of reliable service for these devices as well as their failures among climbers who have had to use a rescue device in the past is, however, alarming.

Objective.-Thousands of people set out daily to climb the world's highest mountains in hopes of summiting. Although many 3000-m summits are accessible in favorable weather, conditions may turn calamitous quickly, requiring practiced navigation or rescue. Owing to the portability and low cost of many technological devices, many climbers have eschewed map and compass navigation. We sought to evaluate climbers' reliance on technologic devices, as well as their effectiveness and reliability for rescue. Methods.-This survey study evaluated a convenience sample of climbers and hikers who arrived at Camp Muir, Mount Rainier (10,188 feet). Investigators ascended on 6 separate dates to the study site to collect data. The primary outcome evaluated was the percentage of climbers relying on a technologic device for rescue. Results.-Two hundred forty-four of 308 climbers (79%) brought some technologic means for rescue. However, only 133 (43%) had a nontechnological backup plan in event of device failure. Therefore, 57% relied solely on the functioning of their devices in a rescue situation. Of the 102 climbers who relied solely on a cell phone as their means of rescue, 49 (48%) had service at the time of the survey. Thirty-three of 308 (11%) reported that they had required a technologic means of rescue in the past, most commonly an avalanche beacon (n ¼ 13). For the 24 rescue devices that failed, the most common reasons were dead batteries in global positioning satellite equipment and lack of cell phone service. Conclusions.-Reliance on technological devices is becoming commonplace among climbers on Mount Rainier and largely replacing map and compass orienteering. The lack of reliable service for these devices as well as their failures among climbers who have had to use a rescue device in the past is, however, alarming.

Lyme arthritis results from acute inflammation caused by the spirochete Borrelia burgdorferi. The number of cases per year has been rising since 2006, with a majority of patients being affected in the northeastern United States. Development of Lyme arthritis is of particular importance to the orthopedic surgeon because Lyme arthritis often presents as an acute episode of joint swelling and tenderness and may be confused with bacterial septic arthritis. Considering the vast difference in treatment management between these 2 pathologies, differentiating between them is of critical importance. Septic arthritis often needs to be addressed surgically, whereas Lyme arthritis can be treated with oral antibiotics alone. Laboratory testing for Lyme disease often results in a delay in diagnosis because many laboratories batch-test Lyme specimens only a few times per week because of increased expense. The authors present a case of Lyme arthritis in the pediatric ankle in an endemic region. No clear algorithm exists to delineate between septic arthritis and Lyme arthritis of the joint. Improved clinical guidelines for the identification and diagnosis of Lyme arthritis of the ankle are important so that appropriate antibiotics can be used and surgery can be avoided.