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One of the worst complications of surgery for spinal deformity is postoperative neurological deficit. Multimodal intraoperative neuromonitoring (IONM) can be used to detect impending neurological injuries. This study aimed to analyze IONM in non-idiopathic scoliosis using a minimally invasive fusionless surgical technique.This retrospective, single-center study was performed from 2014 to 2018. Patients with non-idiopathic scoliosis who underwent a minimally invasive fusionless procedure and had at least 2 years of follow-up were included. IONM was performed using a neurophysiological monitoring work station with somatosensory evoked potentials (SSEP) and neurogenic mixed evoked potentials (NMEP).A total of 290 patients were enrolled. The mean age at surgery was 12.9±3 years. The main etiology was central nervous system (CNS) disorders (n=139, 48%). Overall, 35 alerts (11%) in the SSEP and 10 (7%) in the NMEP occurred. There were two neurological deficits with total recovery after 6 months. There were no false negatives in either SSEP or NMEP, although there was one false positive in SSEP and two false positives for NMEP in the group without signal recovery. There was no significant relationship between the incidence of SSEP or NMEP loss and age, body mass index (BMI), number of rods used, upper instrumented vertebrae (p=0.36), lower instrumented vertebrae, or type of surgery. A preoperative greater Cobb angle was associated with a significantly higher risk of NMEP loss (p=0.02). In CNS patients, a higher BMI was associated with a statistically significant risk of NMEP loss (p=0.004). The use of a traction table was associated with a higher risk of signal loss (p=0.0005).A preoperative higher Cobb angle and degree of correction were associated with a significant risk of NMEP loss. In CNS scoliosis, a higher BMI was associated with a significant risk of NMEP loss. The use of a traction table was associated with a higher risk of signal loss.

This study aimed to characterize pharmacokinetics of intravenous and oral ciprofloxacin in children to optimize dosing scheme.Children treated with ciprofloxacin were included. Pharmacokinetics were described using non-linear mixed-effect modelling and validated with an external dataset. Monte Carlo simulations investigated dosing regimens to achieve a target AUCA total of 189 children (492 concentrations) were included. A two-compartment model with first-order absorption and elimination best described the data. An allometric model was used to describe bodyweight (BW) influence, and effects of estimated glomerular filtration rate (eGFR) and age were significant on ciprofloxacin clearance.The recommended IV dose of 10 mg/kg q8h, not exceeding 400 mg q8h, would achieve AUC

Forearm deformities are often observed in patients with hereditary multiple osteochondroma, resulting in functional disability and cosmetic impairment. The aim of this study was to assess clinical and radiological outcomes after corrective osteotomy of the radius (COR). We performed a retrospective analysis of clinical and radiologic data from patients with forearm deformities who underwent COR combined with osteochondroma resection between 1978 and 2015. Seventeen patients (17 forearms) were included. The mean (range) age at surgery was 11.8 years (3.2-14.4), and the mean interval between surgery and last follow-up was 8.2 years (2-34.2). Range of motion was moderately increased and postoperative radiological assessments found significant improvements in ulnar variance, radial articular angle, bowing of the radius, and carpal slip. At last follow-up, a loss of ulnar variance correction was noted in 11 cases (mean loss: 4mm). The mean score on the Quick Disabilities of the Arm, Shoulder and Hand self-administered questionnaire was 13.9. Our results show that a forearm deformity in a patient with hereditary multiple osteochondroma is an appropriate indication for COR combined with osteochondroma resection and should be performed at the end of growth. This simple, safe technique corrects bowing of the radius and radius-ulna length discrepancy and could limit the risk of radial head dislocation. LEVEL OF EVIDENCE: IV.

Background Triple pelvic osteotomy (TPO) is a treatment option in children and adolescents with residual acetabular dysplasia after developmental dislocation of the hip (DDH). However, TPO to redirect the acetabulum is often blamed for anterior and lateral overcoverage of the femoral head. The main objectives of this study were to assess the potential clinical impact, frequency, and radiological features of acetabular overcorrection. Evidence of post-operative remodelling and associations linking younger age at surgery and/or dysplasia severity to the existence and magnitude of overcorrection were sought. Hypothesis Acetabular overcorrection has little or no clinical impact. Patients and methods TPO was performed on 41 hips in 31 patients at a mean age of 6.3 years (range, 3.0–15.2 years). Mean follow-up was 13.8 years (range, 5.4–28.7 years) and mean age at last re-evaluation was 22.1 years (range, 13–39 years). Clinical outcomes were assessed based on the Harris Hip Score (HHS) and Postel-Merle d’Aubigne (PMA) score. Radiographs were used to look for a cross-over sign (CO+) and to measure the vertical-centre edge (VCE) and vertical-centre anterior (VCA) angles and the acetabular index (AI). Overcorrection was defined as AI ≤ 0° and/or VCE ≥ 35° and/or VCA ≥ 40° and/or CO+. Results The HHS and PMA score values were good or excellent for 39 (94%) hips. One or more parameters indicated overcorrection of 33 (80.5%) hips. No significant differences were found between the overcorrected hips and the hips with normal parameters. Discussion TPO effectively corrects residual acetabular dysplasia. Overcorrection is common in all three planes but has little clinical impact in young adults. The high frequency of overcorrection mandates a careful pre- and intra-operative evaluation of acetabular version. Level of evidence IV, retrospective study.

Purpose The aim of the study was a review of the literature in order to evaluate the results and complications of closed reduction in late-detected developmental dysplasia of the hip (DDH). Methods This study consisted of an analysis of the literature relative to late-detected DDH treatment options considering hip congruency, rates of re-dislocation and of avascular necrosis. Results Gradual closed reduction (Petit-Morel method) appears to be an effective method concerning joint congruency restitution. Dislocation relapse and avascular necrosis are more efficiently prevented with closed versus open reduction. The tendency for spontaneous correction of acetabular dysplasia decreases if closed reduction is performed after 18 months of age. Patient age at the beginning of traction should be considered for the prognosis, with a lower rate of satisfactory results showing after the age of 3 years. Conclusion In our opinion, the Petit-Morel method is a suitable treatment option for children aged between six months and three years with idiopathic DDH.

Most of tumours of the foot are tumour-like (synovial cyst, foreign body reactions and epidermal inclusion cyst) or benign conditions (tenosynovial giant cells tumours, planta fibromatosis). Malignant tumours of the soft-tissue and skeleton are very rare in the foot and their diagnosis is often delayed with referral to specialised teams after initial inappropriate procedures or unplanned excisions. The adverse effect of these misdiagnosed tumours is the increasing rate of amputation or local recurrences in the involved patients. In every lump, imaging should be discussed before any local treatment. Every lesion which is not an obvious synovial cyst or plantar fibromatosis should have a biopsy performed. After the age of 40 years, chondrosarcoma is the most usual malignant tumour of the foot. In young patients bone tumours such as osteosarcoma or Ewing’s sarcoma, are very unusually located in the foot. Synovial sarcoma is the most frequent histological diagnosis in soft tissues. Epithelioid sarcoma or clear cell sarcoma, involve more frequently the foot and ankle than other sites. The classic local treatment of malignant conditions of the foot and ankle was below-knee amputation at different levels. Nowadays, with the development of adjuvant therapies, some patients may benefit from conservative surgery or partial amputation after multidisciplinary team discussions. The prognosis of foot malignancy is not different from that at other locations, except perhaps in chondrosarcoma, which seems to be less aggressive in the foot. The anatomy of the foot is very complex with many bony and soft tissue structures in a relatively small space making large resections and conservative treatments difficult to achieve. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160078. Originally published online at www.efortopenreviews.org

La epifisiolisis femoral proximal (EFP) consiste en un deslizamiento de la epifisis femoral proximal respecto al cuello femoral. La zona de crecimiento es la localizacion de este deslizamiento, cuyo desplazamiento se produce en la mayoria de los casos en sentido posteromedial, por el efecto del peso del cuerpo. Esta afeccion de produce la mayoria de las veces durante la pubertad. Se han identificado varios factores de riesgo epidemiologicos y metabolicos, a la cabeza de los cuales se situa el sobrepeso. Hay que insistir en el retraso frecuente del diagnostico en las formas cronicas. La evolucion espontanea esta dominada por el aumento del deslizamiento y el riesgo de aparicion de un deslizamiento «agudo», que provocan complicaciones precoces (condrolisis, osteonecrosis, etc.) y a largo plazo (conflicto femoroacetabular, artrosis secundaria. El tratamiento tiene como finalidad detener la progresion del deslizamiento para evitar las complicaciones, cuya frecuencia aumenta con la importancia del desplazamiento. En la actualidad, la clasificacion clinica y radiologica que tiene en cuenta la estabilidad de la epifisis es la mas utilizada para guiar las indicaciones terapeuticas y parece la que mejor correlaciona con el pronostico. En las formas poco desplazadas y estables, la fijacion in situ mediante un tornillo canulado es el metodo de eleccion y proporciona buenos resultados en la mayoria de los pacientes. En las formas inestables o con gran desplazamiento, que plantean mas problemas, las diversas opciones quirurgicas y el momento en el que realizar la intervencion son motivo de controversia. Un diagnostico precoz es el mejor factor pronostico en esta afeccion.

Resume Introduction Les resultats a long terme des arthrodeses rachidiennes anterieures dans le traitement des scolioses idiopathiques de l’adolescent (SIA) sont peu documentes dans la litterature. Cette etude retrospective a pour objectif d’evaluer les resultats cliniques et radiologiques d’une serie monocentrique utilisant une technique d’arthrodese en un temps a l’aide de plaques vissees en titane preformees. Materiel et methodes Cent onze patients ont beneficie de cette intervention entre 1975 et 1993. Tous les patients inclus devaient disposer d’une evaluation clinique et radiologique complete au recul minimum de 15 ans. Le questionnaire SRS-30 et le score d’Oswestry ont ete utilises pour l’evaluation des resultats fonctionnels. Les grands cliches de face et de profil preoperatoires, postoperatoires et au dernier recul ont ete utilises pour l’evaluation radiographique. Resultats Trente-cinq patients ont ete revus a un recul moyen de 21 ans (15–31). L’angle de Cobb moyen preoperatoire etait de 44°. Les patients ont ete operes a un âge moyen de 14,7 ans. Le score SRS-30 moyen etait de 3,65/5 et le score d’Oswestry de 14,9 %. Au dernier recul, l’angle de Cobb moyen etait de 14,7°. Vingt-cinq patients presentaient un desequilibre frontal, en moyenne de 12 mm. Dans le plan sagittal, la « C7 plumbline » moyenne au dernier recul etait de −28 mm avec une translation anterieure de 8 mm par rapport a la valeur postoperatoire. On a retrouve une correlation statistiquement significative entre les resultats fonctionnels (SRS-30) et deux parametres : version pelvienne et translation anterieure de la « C7 plumbline ». Conclusion L’arthrodese anterieure donne de bons resultats fonctionnels a long terme dans le traitement des SIA. Cette technique permet l’obtention d’une correction satisfaisante et perenne. La reequilibration du rachis en avant semble etre correlee a de meilleurs resultats fonctionnels. Niveau de preuve IV. Etude retrospective.

Resume Nous rapportons un cas d’osteoarthrite C1-C2 du rachis cervical a Bartonella Henselae , agent de la maladie des griffes du chat, avec osteolyse du massif articulaire de C2 chez un adolescent de 14 ans. Le traitement antibiotique oral a ete insuffisant et une mise a plat par voie posterieure a ete necessaire pour traiter l’infection articulaire. Ce cas permet de discuter des osteo-arthrites bacteriennes du rachis cervical et des atteintes osseuses dans les bartonelloses disseminees.

El quiste oseo aneurismatico es una lesion benigna que se origina a menudo en posicion excentrica en la metafisis de los huesos largos y que, al crecer, puede provocar el abombamiento del hueso. Este seudotumor tambien puede afectar a la pelvis y la columna vertebral. La lesion puede ocasionar dolor de intensidad variable y provocar una tumefaccion que se hace visible si el tumor produce abombamiento. En los huesos largos, la fractura patologica es infrecuente, salvo en los quistes de localizacion central; sin embargo, a nivel vertebral, los aplastamientos no son infrecuentes. Aunque la radiografia estandar a veces puede bastar para establecer el diagnostico, la resonancia magnetica (RM) es mas eficaz para el diagnostico diferencial. Se impone una biopsia, ya que el quiste aneurismatico a veces es secundario a una lesion maligna como el osteosarcoma telangiectasico. La teoria etiopatogenica mas difundida es la de un proceso reactivo a una malformacion venosa, aunque actualmente se piensa en la teoria neoplasica a partir del descubrimiento de la translocacion t(16;17)(q22;p13), recurrente en los quistes aneurismaticos primarios. Se han comunicado casos de curacion espontanea o de curacion tras biopsia, pero son infrecuentes; a menudo es necesario el tratamiento. Dado que el quiste aneurismatico es un tumor benigno, el tratamiento nunca debe ser demasiado invasivo. Hoy dia, se encuentran disponibles y han mostrado su eficacia numerosas tecnicas minimamente invasivas.

Background In haemophiliacs, synovectomy is indicated for recurrent joint bleedings, despite medical treatment. Method We report a series of 23 surgical synovectomies of the knee with a median follow-up of 8.8 years. The median age of patients at surgery was 13.5 years. Clinical and radiological evaluations were made according to the Petrini and the Pettersson scores, at 1 and 5 years after surgery, and at the last follow-up. Wilcoxon and Spearman's tests were used for the statistical analysis. Result The Petrini score improved at 1 and 5 years ( P < 0.001). Nine patients have 20 years of follow-up and a stable result. In more than half of the knees, no episode of recurrent bleeding occurred. The effect of surgery on the range of motion (ROM) was moderate and mobilisation under anaesthesia did not improve it significantly. There was a progressive worsening of the radiological score, but no correlation between clinical and radiological score was noticed ( ρ = 0.08, P = 0.77). Conclusion Complete synovectomy gives good long-term results in term of bleeding recurrence and overall function.

Background Few published data are available on long-term outcomes of anterior spinal fusion for adolescent idiopathic scoliosis (AIS). The objective of this single-centre retrospective study was to assess clinical and radiological outcomes of one-stage anterior spinal fusion achieved using precontoured titanium anterior screw-plates. Hypothesis Our hypothesis was that anterior instrumentation produced both good functional outcomes and good correction in the coronal and sagittal planes. Material and methods This procedure was performed in 111 patients between 1975 and 1993. Among them, those who underwent a comprehensive evaluation at least 15 years later were included. The SRS-30 questionnaire and Oswestry Disability Index (ODI) were used to assess functional outcomes. Radiographic outcomes were evaluated on antero-posterior and lateral full-spine radiographs obtained pre-operatively, post-operatively, and at last follow-up. Results The study included 35 patients, who were re-evaluated after a mean of 21 years (15-31 years). Mean pre-operative Cobb's angle was 44°, mean age at surgery was 14.7 years, mean SRS-30 score was 3.65/5, and mean ODI was 14.9%. At last follow-up, mean Cobb's angle was 14.7° and 25 patients exhibited coronal misalignment with a mean deviation of 12 mm. In the sagittal plane, the mean sagittal vertical axis (SVA) measured using the C7 plumb line was -28 mm, with 8 mm of anterior translation compared to the post-operative value (36 mm). The functional outcome assessed using the SRS-30 score correlated significantly with pelvic tilt and anterior SVA translation. Conclusion Anterior spinal fusion produces good long-term functional outcomes in AIS. Correction is both satisfactory and sustained. Anterior SVA translation over time may be associated with better functional outcomes. Level of evidence IV (retrospective study).

La epifisiolisis femoral superior (EFS) corresponde a la separacion de la epifisis femoral superior respecto al cuello del femur. El desprendimiento se produce en la zona de crecimiento y, en la mayoria de los casos, se efectua hacia atras y hacia dentro por efecto del peso del cuerpo. El trastorno se observa casi siempre en la pubertad y se han encontrado factores de riesgos epidemiologicos y metabolicos, entre los que destaca el sobrepeso. Hay que insistir en el frecuente retraso diagnostico de las formas cronicas. En la evolucion espontanea predominan el incremento de la separacion y el peligro de desprendimiento «agudo» y sus complicaciones precoces (coxitis, osteonecrosis, etc.) o a largo plazo (artrosis secundaria). Con el tratamiento se intenta detener el avance de la separacion para evitar las complicaciones, cuya frecuencia aumenta con la magnitud del desplazamiento. La clasificacion clinica y radiologica basada en la estabilidad de la epifisis es la que mas se aplica hoy en dia para guiar las indicaciones terapeuticas y parece ser la mas correlativa con el pronostico. En las formas poco desplazadas o estables, la fijacion in situ con tornillo canulado es el metodo de eleccion y proporciona buenos resultados en la mayoria de los pacientes. En las formas inestables o con separacion acentuada, que causan mas problemas, la reduccion con tecnicas ortopedicas o quirurgicas y el tiempo de espera para la intervencion quirurgica son motivo de controversia. El mejor factor pronostico de la enfermedad sigue siendo el diagnostico precoz.

In patients with Apert syndrome, the hands demonstrate many disturbances of soft tissue and bony structures. These include a short thumb with radial clinodactyly, complex syndactyly with a bony fusion involving the index, long and ring fingers, symphalangism and simple syndactyly of the fourth web space. The soft tissue anomalies involve the intrinsic muscles, the extrinsic tendon insertions and the neurovascular bundles. We have reviewed 52 patients who underwent surgical reconstruction of their hands. The aim of this study is to propose a better surgical management in the light of recent publications and to improve our understanding of the syndrome, attempting to reduce the number of procedures and to select the best possible procedures for each patient.

Solid aneurysmal bone cyst (S-ABC) is a variant of aneurysmal bone cyst (ABC), an uncommon benign bone tumor. There are few cases described in the cervical spine in kids up today. We treated a recurrent case with neurological involvement that needed multiple surgical procedures and radiotherapy. We report a case of C4 located S-ABC concerning a 2-year-old boy treated surgically by anterior and posterior approach. Three months after the initial procedure appearance of a tetraparesis led to diagnose a local recurrence treated by sclerotherapy and a second surgery. The patient had a full neurological recovery. Three months later, a follow-up CT scan showed a second recurrence requiring a new surgical revision by anterior approach and radiotherapy. At 6-year follow-up after four surgical procedures, sclerotherapy and radiotherapy, the aneurysmal bone cyst has been healed. Patient had neurological impairment after a local recurrence but had full recovered after final revision surgery.

We report our experience and results in the use of reed pronating osteotomy in supination deformities secondary to obstetrical brachial plexus injury. This retrospective study involved 11 patients with paralytic supination of the forearm due to a brachial plexus injury. Other causes of paralytic supination were excluded. The surgical technique consisted of a proximal osteotomy of the ulna fixed by an intramedullary nail and a stable elastic reed osteotomy of the radius. The minimum postoperative follow-up was 2 years. Four boys and seven girls mean aged 8 years (5-12) were operated on between 2000 and 2010. The mean preoperative supination was measured at 63°. The final position average pronation was 37°. Loss of pronation was measured at 15°. No complication was observed. With a mean follow-up of 4 years (2-12), the reed osteotomy of radius associated with a proximal transverse osteotomy of ulna has proven itself effective for correction of paralytic supination of the forearm without complication or reoperation.

We performed ninety-five consecutive Latarjet procedures for the treatment of recurrent anterior instability of the shoulder between 1969 and 1983. In 1993, we retrospectively reviewed the clinical and radiographic results that were available for fifty-six patients (fifty-eight shoulders) who had been followed for an average of 14.3 years (range, ten to twenty-three years). The purpose of the study was to determine the prevalence of glenohumeral osteoarthrosis and the factors related to its development after the Latarjet procedure. The procedure was performed for the treatment of recurrent anterior dislocation in fifty shoulders and painful recurrent anterior subluxation in eight. All patients had a radiographic evaluation (three anteroposterior radiographs, with the humerus in external, neutral, and internal rotation, and one lateral radiograph) before the operation and at the latest follow-up examination. At the time of the latest follow-up, none of the patients had recurrent dislocation, six patients had apprehension with regard to possible dislocation, and one had occasional subluxation. According to the system of Rowe et al., fifty-one (88 per cent) of the fifty-eight shoulders had an excellent or good result; five (9 per cent), a fair result; and two (3 per cent), a poor result. Twenty-two shoulders had no glenohumeral osteoarthrosis. Thirty-four shoulders had centered glenohumeral osteoarthrosis (the humeral head remained in front of the center of the glenoid cavity), which was grade 1 in twenty-five shoulders, grade 2 in four, grade 3 in three, and grade 4 in two, and two shoulders had grade-4 eccentric glenohumeral osteoarthrosis (the humeral head was more proximal than normal in relation to the center of the glenoid cavity). Postoperative grade-1 glenohumeral osteoarthrosis, unlike the higher grades, had no effect on the function of the shoulder.

The purpose of this investigation was to determine whether induced micromovement could improve the consolidation of diaphyseal elongation by callus distraction. Two series of paired rabbit hindlimbs were studied. The surgical procedure, waiting period, and elongation period were identical. One hindlimb was then left under neutralization conditions, but the other limb was stimulated by axial micromovements. Reproducible tibial osteotomy and lengthening of the two tibiae were confirmed radiographically. The mineralized callus was quantified by dual-beam x-ray absorptiometry. The anteroposterior and lateral diameters of the callus were measured. A semiquantitative histologic study allowed the ratio between fibrous or cartilaginous callus or both and mineralized callus to be determined. Bones were axially compressed to failure. Callus volume, callus mineral content, callus mineral density, and mechanical forces required to failure were significantly superior on the stimulated side compared with the neutralized side, so micromovements applied after the end of elongation were beneficial for bone healing. Mechanical forces required to failure were significantly correlated to callus volume and callus mineral density.

Traumatisms of distal extremities are frequent in children. They can associate fingertip skin, bone and nail complex injuries. Their severity level is very variable, from simple subungual bruise to distal amputation. Initial care needs careful repair of injured structures. Secondary treatment of sequelae is much more difficult.

In order to evaluate the role of gadolinium-DOTA enhanced MRI in the management of painful osseous crises in children with sickle cell anemia (SCA), nine children with SCA underwent MRI, bone scans and ultrasonographic studies during 11 osseous crises. Imaging findings were compared with the final diagnosis: three acute osteomyelitis (AO) and 16 acute infarcts (AI). MRI could not differentiate AO from AI. The appearance of severe AI was very misleading and was similar to the usual appearance of AO, including soft tissue changes, periosteal reaction and patterns of enhancement. Gadolinium-DOTA enhanced MRI was useful for determining the anatomic site and extent of AO or AI and for distinguishing between necrotic material, fluid collection and vascularized inflammatory tissue. It can also help to guide the aspiration of intraosseous, subperiosteal and soft tissue fluid collections.

La synostose de l'avant-bras est une affection rare caracterisee par une fusion radio-ulnaire proximale, responsable de la disparition des mouvements de prono-supination, avec un avantbras bloque le plus souvent en position neutre ou en hyperpronation. L'etiologie de la synostose de l'avant-bras reste inconnue, une cause genetique est suggeree devant l'existence d'histoires familiales ou son association plus frequente a des maladies genetiques comme le syndrome d'Apert, de William ou de Klinefelter [ 1 ]. Un defaut de segmentation longitudinale survenant precocement vers la 7 e semaine de developpement fœtal serait a l'origine de la malformation, responsable de la persistance d'un pont fibreux ou osseux entre le radius et l'ulna, secondaire a une anomalie du trajet de l'artere interosseuse posterieure. La synostose fixant definitivement le squelette de la partie superieure de l'avant-bras en position neutre par rapport a la palette humerale, la difference de croissance entre l'arbre arteriel et le radius dans le developpement ulterieur du squelette est responsable de la pronation habituelle de l'avant-bras connue dans cette anomalie [ 2 ]. Il s'y associe des anomalies de la tete radiale qui peut etre hypoplasique, luxee ou pour certains auteurs absente et qui est a l'origine de diverses classifications. Cela ne modifie pas toutefois la prise en charge de la malposition.

Lors de la formation de la clavicule, il existe un noyau d'ossification primaire pour chaque extremite, sternale et acromiale de la clavicule. Se developpent ainsi deux ebauches distinctes qui finissent par fusionner .

Toe walking is a frequent situation for a clinic in pediatric orthopedic. It is, in most cases, an idiopathic trouble. Neurologic examination is very important to recognize spastic diplegia or neuromuscular disease. A contracture of the triceps can occur and will require a specific treatment from physiotherapy to surgery. A psychological approach is sometimes necessary.

Pigmented villonodular synovitis is an exceptional condition in children. The clinical, biological and imaging presentation is not specific and a histology sample is required for certain diagnosis. Because of this lack of specificity, together with the rare occurrence of the disease, late diagnosis is not uncommon, making correct management an even greater challenge in the growing child.Between 1995 and 2001, six children were treated for pigmentary villonodular synovitis, four girls and two boys, mean age 11.5 years. The knee was involved in five cases (three diffuse forms and two localized forms). One diffuse form involved the ankle. The diagnosis was suggested by the MRI findings in all patients and confirmed at the histological examination of a biopsy sample. Surgery was used in five cases and medical treatment in one patient with a diffuse form affecting the knee. A synoviorthesis (Hexatrione) was used systematically in three diffuse forms affecting the knee joint.Mean follow-up was 58 months. Recurrence was noted in two diffuse forms, one involving the knee at 10 months from arthroscopic synovectomy and one involving the ankle 24 months after surgical synovectomy. Systematic use of the synoviorthesis did not prevent recurrence in one case. The synoviorthesis was also used in the two cases of recurrence as a complement to surgical treatment but with no effect. Growth was not affected in any of the children.The etiopathogenic mechanism underpinning pigmented villonodular synovitis remains unclear. Genetic factors are suspected in childhood cases. MRI is the complementary examination of choice for diagnosis and follow-up. In children, treatment of pigmented villonodular synovitis depends on marginal excision of the lesion for localized forms and total synovectomy for the diffuse forms. The efficacy of the triamcinolone hexacetonide synoviorthesis remains open to debate and would require a larger series with longer follow-up for evaluation.

Fibrous dysplasia is a rare benign bone tumor which occurs preferentially in the proximal femur. In children, there is a risk of repeated fractures and coxa vara deformity, particularly in the polyostotic form. The most common orthopedic problem is fibrous dysplasia of the proximal femur which generally requires surgical treatment. The purpose of this study was to analyze clinical and radiological outcome after surgical treatment.All children who underwent surgical treatment for fibrous dysplasia of the proximal femur between 1979 and 2001 were reviewed retrospectively. The study cohort included 22 children (11 boys and 11 girls). Eight patients had a monostotic form and 14 a polyostotic form of the disease. For the monostotic forms, the type of treatment depended on the size of the tumor and its localization but curettage was used in all cases. For the polyostotic forms, treatment consisted in valgus osteotomy with "humeralization" in the event of associated coxa vara in combination with internal fixation, generally with a centromedullary nail.In the monostotic forms, the clinical outcome was considered good in all cases. Nearly total involution of the tumor was noted in 75% of patients. In the polyostotic forms, osteotomy with "humeralization" and centromedullary nailing provided stable correction of the deformation. Outcome was less satisfactory because of fractures and deformities.In light of our results and those reported in the literature, the prognosis of the monostotic form can be considered good after surgical treatment. For the polyostotic form, preventive fixation is necessary. Osteotomy with "humeralization" appears to correct the deformity and prevent coxa vara in certain cases. For the more severe forms, medical treatment with biphosphonates may be a useful complement to the surgical treatment.

Tillaux fractures in adolescents correspond to Salter and Harris type III fractures involving the anterolateral portion of the tibial epiphysis. These are intra-articular fractures. The objective was to determine the circumstances of these fractures, the radiological signs, and the therapeutic modalities as well as the long-term clinical and radiological outcome.We reviewed 19 Tillaux fractures. Ten patients underwent surgical treatment and nine orthopedic treatment following importance of displacement.At mean follow-up of 33.8 months, results were rated good in 17 on 19 cases.This fracture is often observed in teenagers victims of trauma with external rotation of the foot. Closure of distal growth cartilage of the tibia occurs medially to laterally, the anterolateral portion remaining open longer. Forced external rotation of the anterior tibiofibular ligament pulls off an anterolateral fragment of the distal tibial epiphysis. Surgical treatment is indicated for fractures with a displacement of more than 2 mm or a vertical displacement to achieve open reduction and screw fixation. Orthopedic treatment is used for non-displaced fractures.The prognosis of Tillaux fractures is good as was observed in our series and in series reported in the literature.

Fracture of the anterior tibial tubercle is exceptional in adolescents. The purpose of this work was to better understand the circumstances of such fractures, identify potential complications, and assess outcome of different therapeutic options.This was a retrospective analysis of a consecutive series of 22 children with avulsion fracture of the anterior tibial tubercle. The circumstances of the fracture were noted. The Ogden classification was used to establish the radiological type. Associated lesions were also noted as were any complications. Two types of treatment were given: orthopedic or surgical (several types). The functional outcome was assessed at last follow-up.Mean age at fracture of the anterior tibial tubercle was 13 years (range 12-16) in 14 boys and 7 girls. It occurred after a jump or reception after a jump in 22 of the children. Five patients presented symptomatic homo- or contralateral anterior tibial apophysitis before the accident. The fracture was not displaced (type IA) in ten patients and was treated orthopedically. In twelve patients, the fracture was displaced (type IB, II, or III) and required osteosynthesis. Immobilization was maintained for four weeks on average (range 3-7). Associated lesions were observed in half of the twelve displaced fractures, with five cases of patellar ligament avulsion and three cases of meniscal injury. There were no complications with type IA fractures. For the twelve displaced fractures, complications were observed in seven children: hematoma (n = 2), infrapatellar hypoesthesia (n = 2), complete rupture of the patellar ligament 38 months after surgery (n = 1), recurvatum with leg length discrepancy (n = 1), and stiff knee (n = 1). Mean follow-up was two years (range 9 months-8 years). The functional outcome was excellent in all patients with a non-displaced fracture and in seven of the twelve patients who underwent surgical treatment.Non-displaced fracture of the anterior tibial tubercle I children (type IA) should be considered as a separate entity responding very well to orthopedic treatment. The other cases of displaced fracture generally require surgery which enables an assessment of often associated lesions. The prognosis of displaced fractures of the anterior tibial tubercle is more sever due to the associated lesions and potential complications. We describe the second case of recurvatum and leg length discrepancy following fracture of the anterior tibial tubercle.Displaced fracture of the anterior tibial tubercle in adolescents is often associated with soft tissue injury (patellar ligament, menisci). Surgery is indispensable and provides good functional results.

To describe bacteriologic epidemiology of bone and joint infections, a total of 52 osteomyelitis, 52 arthritis and 20 osteoarthritis of children aged one month to 15 years during a one-year period (2001) were included in a retrospective unicentric review. The mean age was 3,9 +/-3,6 years. Fever and pain were the most common clinical symptoms. The site of infection was single in 95%, involving lower extremities in 80%. Bone scintigraphy was abnormal in 71% of osteomyelitis. Positive cultures was obtained in 29% of all cases (blood cultures: 20%, aspiration cultures: 29%), but in 42% of cases which have both blood and aspiration cultures. Thirty-six bacteria were identified: 19 Staphylococcus (14 aureus), ten Streptococcus (four pneumoniae), three Salmonella, three Kingella kingae, one Moraxella. All the isolates were susceptible to the empiric antibiotic therapy. Outcome was good in 100% of osteomyelitis and in 96% of arthritis.