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Background: The treatment of radial club hands is difficult and requires staged procedures in specialised centres. Objective: To report the Ivorian experience with this condition. Settings: Yopougon Teaching Hospital, Abidjan and "Don Orione” Centre for the Crippled, Bonoua. Subjects and Methods: The management of 22 club hands in a cohort of 14 patients (nine boys and five girls) aged 14 days - 12 years (mean age, 3.3 years + 4.3) over a 14-year period, was reviewed. Three of the children were neonates, six were aged one month-one year while the rest were older than one year. The lesions were classified according to the method described by Bayne & Klug. Theywere all treated surgically with preoperative physical care in the neonates and infants. Functional and aesthetic results were assessed by using the criteria of Cattaneo etal at a mean follow up period of 2.4 years. Results: Twelve of the children had Bayne type IV deformity, nine type I and one type II. Eleven children with type IV deformity were treated by centralization with ulnar osteotomy and one child with type IV, by centralization alone. Complications included one case of wound infection, two with haematomas and two pin migrations without recurrence of wrist deviation. According to Cattaneo et al's staging score, the hand function was good in 18 cases and average in four; aesthetic result was good in 12 hands, average in six and poor in four. Conclusion: The treatment provided satisfactory results for the children and their families with the result that there has since been an increase in the number of club hands referred to the hospital.

Context: Elastic stable intramedullary nailing has revolutionised the treatment of fractures in children. Aim: To report our experience with this current technique of management of fractures in children. Methods and Materials: A retrospective study of all children with fractures treated by this method from November 2003 to June 2006 at the Paediatric Surgery Department of Yopougon Teaching Hospital, Abidjan, Côte d'Ivoire. Data were recorded from their medical charts regarding demographics, fracture patterns, associated injuries, morbidity, and outcome. Results: A total of 38 children (14 boys; mean age, 11.7 years; range, 9-15 years) with 41 fractures, sited at femur (n=15), humerus (n=8), tibia and fi bula (n=6), forearm (n=7), and radial neck (n=5), associated with other injuries in 7 cases, were enrolled in the study. The mean interval for surgery was 6.8 days. Open reduction was required 5 times (12.1%). The hospital stay was in the range 5-12 days. Minor adverse events were 1 (2.4%) early tibial loss of reduction, 3 (7.3%) skin irritations and 2 (4.8%) transient knee limitations. Complications (17.3%) included 2 axial (4.8%) and 1 rotational (2.4%) femoral malunions below 15°; 3 elbow (7.3%) and 1 knee stiffness (2.4%) in openly reduced cases. Solid consolidation was achieved in all cases, with no disturbance in standard union times. At a mean follow-up period of 16 months (range, 9-28 months), all but 3 patients with opened joints recovered full range of motion, and none showed either limp and gait anomalies or re-fracture after removal of wires. Conclusion: Elastic stable intramedullary nailing in children fractures is easy to perform and has little complications if a proper technique is used. [ABSTRACT FROM AUTHOR]

Background: In most children proximal humeral fractures are treated non-operatively with generally good results. This review discusses the indications of operative treatment and assesses the treatment results. Materials and Methods: The charts of 20 patients (14 girls; mean age: 12.3± 2.8 years; range: 7-16 years) with proximal humeral fractures who were operated on at our institution were reviewed from 1992 to 2002. Results: There were five metaphyseal fractures and 15 physeal injuries which were angulated according to Neer-Horowitz score as grade III in four cases and grade IV in 16 cases with a mean angulation of 47.8±39.1 degrees (range: 6-148 degrees). Associated lesions comprised open fracture and head trauma in two cases each. Patients with associated injuries were operated on primarily and the 16 others by secondary intention. All but one were reduced via an anterior approach with internal fixation. They were assessed for clinical and radiological healing at a mean follow up of 3.6 years ranging from 1.2 to 7.8 years. Conclusion: Based on our study, surgical option is indicated for severely displaced and unstable fractures in older children and adolescents. [ABSTRACT FROM AUTHOR]