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Hip aspirate model to teach physicians

Project Overview

Septic arthritis of the hip is a pediatric orthopedic emergency. Failure to accurately diagnose the condition in a timely manner can lead to life long sequelae. Fortunately septic arthritis is a relatively uncommon childhood disorder occurring in about (3-12.5/100,000). Most commonly this infection involves children under the age of 2 years old. It is generally felt that the intra-articular infection occurs when bacteria are transmitted hematogenously from other common sites of childhood infection (ears, nose, throat, cuts, scrapes etc.) to the proximal femur. Because the proximal femoral growth plate resides within the hip joint capsule, the bacterial can spread from the bone into the joint space itself. Once in the joint, the bacteria and the ensuing immune response, with its cytotxic chemicals, can cause destruction of the hip joint cartilage. As the infection continues, increased pressure builds within the hip joint that can eventually decrease the vascular perfusion of the femoral head and lead to avascular necrosis. Avascular necrosis in these young children can result in lifelong disability and pain.

The optimal care for these children involves timely diagnosis and treatment, including appropriate antibiotic coverage and surgical debridement. While vital signs, clinical exam, and blood tests can aid in making an accurate diagnosis, joint fluid obtained from X-ray or ultrasound (US) guidance, is critical in confirming the diagnosis. At many centers, hip aspiration relies on the availability of fellowship trained MSK or pediatric radiologists to aspirate fluid from the hip joint. When they are unavailable, the child often has ideal treatment delayed, until the diagnostic procedure can be performed. This often occurs despite “hip joint aspiration and debridement” being one of the required ACGME surgical skills necessary to document orthopedic resident proficiency. Due to the relatively low frequency of this disorder, and yet the high clinical importance of accurate diagnosis, orthopedic and radiology residents get very little hands-on experience practicing and performing these procedures, despite the ACGME requirement. Currently there are no commercially available simulation models that would allow residents to practice X-ray and US guided hip aspiration in the infant.

The long-term goal of this proposal is to develop an infant hip model and OSATS that will allow residents to practice and document proficiency at X-Ray and US guided hip aspiration as well as the anterior surgical approach to the hip joint. Once completed, this would ideally be available for use at multiple training centers. We will accomplish this by the development of a base infant model. An aspiration insert and an anatomic insert will be developed. These inserts will be easily replaceable for use and reuse of the model. While the model will be able to address both aspiration and debridement, the focus of this grant will be joint aspiration.

Team Picture

My An-adirekkun, Jessica Brand, Stephen Schwartz
My An-adirekkun, Jessica Brand, Stephen Schwartz

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Contact Information

Team Members

  • Ms. Jessica Brand - Team Leader
  • Stephen Schwartz - Communicator & BPAG
  • My An-Adirekkun - BSAC & BWIG

Advisor and Client

  • Dr. Ed Bersu - Advisor
  • Dr. Matthew Halanski - Client

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