A delay in the diagnosis of paediatric acute and subacute haematogenous osteomyelitis can lead to potentially devastating morbidity. There are no definitive guidelines for diagnosis, and recommendations in the literature are generally based on expert opinions, case series and cohort studies. All articles in the English literature on paediatric osteomyelitis were searched using MEDLINE, CINAHL, EMBASE, Google Scholar, the Cochrane Library and reference lists. A total of 1854 papers were identified, 132 of which were examined in detail. All aspects of osteomyelitis were investigated in order to formulate recommendations. On admission 40% of children are afebrile. The tibia and femur are the most commonly affected long bones. Clinical examination, blood and radiological tests are only reliable for diagnosis in combination. Staphylococcus aureus is the most common organism detected, but isolation of Kingella kingae is increasing. Antibiotic treatment is usually sufficient to eradicate the infection, with a short course intravenously and early conversion to oral treatment. Surgery is indicated only in specific situations. Most studies were retrospective and there is a need for large, multicentre, randomised, controlled trials to define protocols for diagnosis and treatment. Meanwhile, evidence-based algorithms are suggested for accurate and early diagnosis and effective treatment.

Patellar tracking is defined as the motion of the patella relative to the femur or femoral groove on knee flexion and extension. Abnormalities of tracking (maltracking) are thought to relate to many disorders of the patellofemoral joint and may be defined easily or may be extremely difficult to observe. Accurate measurement of patellar tracking, and definition of normal tracking, have not been achieved yet in experimental conditions or in clinical conditions. Such information would be valuable in the diagnosis and treatment of patellofemoral disorders. In the current report, the literature is reviewed critically with an emphasis on methodology and results. The reporting of patellar tracking is affected significantly by basic definitions of coordinate systems and reference points. The method of muscle loading, range, and direction of knee motion, use of static or dynamic measurement techniques, and tibial rotation also will affect the results obtained. The accuracy of the equipment used is important as differences in tracking may be small. Comparison between existing studies is difficult because of differences in methodology. There is general agreement that the patella translates medially in early knee flexion and then translates laterally. Regarding patellar tilt, results are less consistent, especially in vivo and the results for patellar rotation are highly variable.

Our objectives were to establish the envelope of passive movement and to demonstrate the kinematic behaviour of the knee during standard clinical tests before and after reconstruction of the anterior cruciate ligament (ACL). An electromagnetic device was used to measure movement of the joint during surgery. Reconstruction of the ACL significantly reduced the overall envelope of tibial rotation (10 degrees to 90 degrees flexion), moved this envelope into external rotation from 0 degrees to 20 degrees flexion, and reduced the anterior position of the tibial plateau (5 degrees to 30 degrees flexion) (p < 0.05 for all). During the pivot-shift test in early flexion there was progressive anterior tibial subluxation with internal rotation. These subluxations reversed suddenly around a mean position of 36 +/- 9 degrees of flexion of the knee and consisted of an external tibial rotation of 13 +/- 8 degrees combined with a posterior tibial translation of 12 +/- 8 mm. This abnormal movement was abolished after reconstruction of the ACL.

Patellofemoral motion is significant clinically, yet in the literature many different methods and terminologies are used, thus making comparison between papers difficult. The aim of this study was to review and explain the different methods used for the description of patellofemoral joint motion, compare these methods by experimentation, and propose a standardised method. We found three main methods for describing patellar motion: motion of the patella about femoral body fixed axes, about patellar body fixed axes, or a combination of these. Description about femoral body fixed axes does not make sense clinically. Description about patellar body fixed axes is straightforward, yet the definition of these axes is prone to error due to the lack of anatomical landmarks. The combination method makes most sense clinically and uses more easily found anatomical landmarks. Patellar flexion varied by up to 26% when describing the motion about different axes. Tilt and shift were highly sensitive to the choices of coordinate systems and the axes of motion. The pattern of rotation was consistent between all methods, however, differences between the methods increased with patellar flexion. We propose the description of patello-femoral motion in terms of shift (along a femoral medial-lateral axis), tilt (about the patellar long axis), rotation (about a floating patellar anterior-posterior axis) and flexion (about the femoral medial-lateral axis).