We reviewed 190 children with brucellosis admitted over a 7.8-year period. Seventy of these had articular involvement (36%) and the most common site was the hip (18%). All but one patient had unilateral infection. The hip was the only joint infected in 20 patients (57%). The next most common articular site was the knee. All patients had painful limitation of movement and this was the only articularsign in 28 (80%). Extraarticular signs included fever and hepatosplenomegaly. Brucella infection should be considered in every child from an endemic area who presents with fever andjoint symptoms. The insidious onset and a normal or low leucocyte count help the differentiation from acute septic arthritis. Children with hip involvement had a slower response to treatment, longer hospital stays and a higher incidence of complications and relapse than those without. Complications included dislocation (n = 4) and avascular necrosis of the femoral head (n = 1). Treatment by combination chemotherapy for 6 to 12 weeks usually achieves cure and prevents relapse. A multidisciplinary team approach to management is recommended.

The role of muscle function in the aetiology of recurrent dislocation of the patella has been examined. Eleven of the 12 patients we studied had joint hypermobility. Muscle biopsies from eight of nine patients treated by surgery had a predominance of abnormal Type 2C fibres, and three of six patients whose quadriceps muscles were studied by electromyography also had abnormal results. Our preliminary findings suggest that there may be a primary muscular defect in many cases of recurrent dislocation of the patella.

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The objective of our study was to examine cases of musculoskeletal trauma sustained by survivors of a major road traffic accident (RTA), and evaluate their immediate management. Eighty-four RTA survivors were admitted on a single day at the Asir Central Hospital, Abha, Saudi Arabia. The Division of Orthopedics and Traumatology made an assessment of the various musculoskeletal injuries sustained by the survivors, using the Injury Severity Score (ISS) in the evaluation of their condition. Although RTAs are common in Saudi Arabia, there has been no report about one involving the mass transportation service. Of the 84 patients admitted, 41 (48.8%) had an ISS of over 16, indicating major trauma. Twenty-two of these stayed in the hospital for more than three weeks with a mean ISS of 26.36. Musculoskeletal trauma topped the list, and with neurological injuries were found to be a major contributing factor for long hospital stay. Our paper describes the primary management of the musculoskeletal injuries and suggests measures to prevent morbidity relating to these injuries.