Search

Congenital pseudarthrosis of the clavicle (CPC) is a rare congenital malformation. We describe the outcomes of surgical treatment of CPC in a series of 10 patients. The hypothesis was that surgical treatment is an acceptable solution that will lead to satisfactory healing in asymptomatic patients. The aims were to determine if 1) surgical treatment of CPC will produce a satisfactory union rate, 2) surgical treatment causes complications and impacts the postoperative outcomes and 3) risk factors can be identified that affect the success of the surgical care.Ten patients with CPC who were treated by resection and bone grafting were included in this case series. The CPC was always in the right clavicle. All patients except one were asymptomatic preoperatively. The mean age at the time of the procedure was 5.1 years (range, 1.7-13.4). The initial fixation consisted of a K-wire in 9 patients and a plate in 1 patient. Iliac crest autograft was harvested in all patients. The mean length of postoperative immobilization was 10 weeks (range, 6-18 weeks).At a mean follow-up of 29 months (range, 3-129 months), all patients were pain-free and had full range of motion. Bone union was achieved in 70% (7/10) after revision at a mean of 3.8 months (range, 1.1-13.3). Three clavicles did not heal, two of which had been revised surgically. Four patients suffered a complication: three cases of K-wire migration and one case of infection. Among them, two patients had the fixation changed to a plate while preserving the graft, while the fixation device was removed in two patients, one of whom was undergoing revision for infection. The patients who had complications were all under 5 years of age at the time of surgery (mean 3.7 years, range 1.7-5 years).Surgical treatment of CPC generates a moderate union rate with a complication risk that is not insignificant. Age at the time of surgery appears to affect the outcomes. Thus, we propose waiting until the patient is at least 5 years of age before implementing surgical treatment.IV, Retrospective study.

In this observation, we report an unusual presentation of a pilomatricoma in an 8-year-old girl who was initially referred to the department of vascular medicine for diagnosis and care of a suspected mixed lymphatic venous malformation. The lesion on her left shoulder presented as a giant bluish-purple red solitary mass, painful and rapidly growing, measuring 7 cm in anteroposterior diameter. This mass did not present the typical characteristics of a lymphatic venous malformation but exhibited warning signs of malignancy on clinical examination and imaging. The diagnosis of pilomatricoma was reached by fine-needle aspiration biopsy of the mass, showing mummified "ghost" squamous cells and a granulomatous inflammatory reaction stroma with scattered multinucleated giant cells and no sign of malignancy. Complete surgical excision associated with plastic surgery was curative. Diagnostic and management approach to skin lesion in childhood is subject of great concern for health care professionals, including dermatologists and vascular medicine specialists who may be confronted with this atypical presentation of one of the most common causes of superficial neck masses in children.

The paper outlines the main features of Memory of the World, a UNESCO Programme to safeguard endangered documentary heritage, democratize access to it, increase awareness of its significance and distribute, on a large scale, products derived from it. Criteria to list documentary heritage on the Memory of the World Register and to select projects are set out, together with a brief account of the Programme's technical, legal and financial framework.

‘Memory of the World’ is a new UNESCO Programme to safeguard endangered documentary heritage, democratize access to it, increase awareness of its significance and distribute, on a large scale, information products derived from it. It represents an innovative approach designed to complement the Organization’s traditional activities in the field of preservation and conservation of archive and library holdings. The author is on the staff of UNESCO’s General Information Programme and is responsible for co-ordinating the ‘Memory of the World’ Programme.

The purpose of this study was to evaluate a minimally invasive subscapularis-preserving arthroscopic release of capsule in the treatment of internal rotation contracture of the shoulder due to Erb's palsy. We performed our procedure (subscapularis-preserving arthroscopic release of capsule) in 10 paediatric shoulders with an average age of 20.2 months and followed them for an average period of 41.5 months. All the patients were assessed clinically and radiologically preoperatively and postoperatively at regular intervals. The Mallet scoring system was used for analysing the results. The average gain in passive external rotation was 50°. The active internal rotation was preserved in all the cases. With the mid-term follow-up, there was no loss of the gained external rotation or the recurrence of internal rotation contracture of the shoulder. Our hypothesis has achieved its goal in preserving subscapularis, active internal rotation and treatment of internal rotation contracture of the shoulder. The success of this procedure lies in the early identification of starting of internal rotation contracture and early surgical intervention to prevent progressive permanent glenohumeral osseocartilaginous deformity.

Internal rotation contracture of the shoulder in brachial plexus birth palsy frequently leads to shoulder dysplasia. Six children underwent anterior arthroscopic release sparing the subscapularis. Clinical examination and MRI were performed preoperatively and repeated at the 5-year follow-up. MRI was carried out for assessment of glenohumeral dysplasia. Passive external rotation was improved by 63.3° without any limitation of active internal rotation. Active antepulsion/abduction was improved by 90°. Remodeling of the glenoid and improved coverage of the humeral head were observed in all cases. Shoulder arthroscopic release sparing the subscapularis seems to be an efficient procedure to restore external rotation without affecting active internal rotation.

La camptodactylie est une pathologie a la physiopathologie imparfaitement connue. Sa prise en charge ne fait pas l’objet d’un consensus strict. Nous avons analyse a moyen terme le resultat de leur traitement. Il s’agit d’une etude retrospective monocentrique incluant les enfants ayant consulte entre janvier 2011 et septembre 2014, avec un suivi minimum de 9 mois, soit 27 enfants (37 doigts). L’âge moyen au diagnostic etait 6,1 ans (0,1–16,8). Le traitement etait soit orthopedique (orthese d’extension statique nocturne, kinesitherapie), soit chirurgical d’emblee en cas de flessum superieur a 60° ou apres echec du traitement orthopedique. La chirurgie consistait en une liberation palmaire sequentielle selon les constatations peroperatoires (plastie cutanee, liberation du tissu sous-cutane, tenotomie du flechisseur superficiel, liberation de la plaque palmaire, arthrorise de l’interphalangienne proximale [IPP]). Le suivi moyen etait de 31 mois (9–129). Le traitement a ete conservateur pour 32 doigts et chirurgical pour 5 doigts (dont une reprise chirurgicale pour recidive). Pour les doigts traites orthopediquement, le flessum initial etait en moyenne de 41° (15–90), reduit significativement a un flessum residuel de 16° (0–45) ( p n = 4 et p = 0,12). Aucun deficit d’enroulement n’a ete deplore. Une evaluation clinique minutieuse (importance du flessum, reductibilite, manœuvres specifiques, recherche d’autres malformations associees) permet de poser au mieux les indications therapeutiques. Le traitement orthopedique doit toujours etre tente surtout s’il s’agit de formes peu severes (flessum inferieur a 60°), reductibles et diagnostiquees precocement. La chirurgie de liberation sequentielle est indiquee dans les deformations plus severes, non reductibles ou apres echec du traitement conservateur. Elle est guidee par l’examen clinique preoperatoire et les donnees peroperatoires. Lorsqu’elle est realisee, l’arthrorise de l’IPP doit etre breve, pour maintenir la reduction du flessum, permettre la cicatrisation cutanee mais sans entrainer de raideur en extension. Une prise en charge optimale, permet ainsi de recuperer une extension satisfaisante de l’IPP, sans compromettre l’enroulement global des doigts.

UNESCO set up a Clearing House in 1992 to promote and disseminate the information it gathers and to create new information sources corresponding to the needs of Member States. A survey of needs showed a strong demand for CD-ROMs, and the success of a prototype, UNESCO Databases, encouraged it to prepare a new edition and plan two more CD-ROMs, Index Translationum and World Heritage. Another programme involves the CD-ROMs of full text as a means of helping less developed countries to obtain affordable economic access to literature. An agreement has been reached with ADONIS whereby free subscriptions to the ADONIS discs for 1991 and 1992 are given to ten selected institutions in Africa, the Arab states, Asia, and Latin America and the Caribbean. A further initiative is the joint ICSU/UNESCO International Network for the Availability of Scientific Publications, a cooperative network of donors and recipients. Training workshops are also being held in different parts of the world, and an inventory of CD-ROM in developing countries is being prepared.

Ce programme considere la necessite d'ameliorer l'acces aux publications scientifiques comme l'un des aspects du programme general de transfert et d'acces a l'information scientifique dans les pays en voie de developpement. Les aspects techniques destines a assurer l'acces aux publications scientifiques aus utilisateurs potentiels sont exposes. L'article insiste sur le cout et les difficultes rencontrees pour repondre a un niveau international aux besoins et des arguments sont donnes pour renforcer l'action de l'UNESCO

Fourteen wrists in 11 girls, mean age 13.3 years (range 9–16) at surgery, were treated for Madelung’s deformity. The presenting complaint was incapacitating pain. All were treated by radial closing wedge osteotomy and ulnar shortening osteotomy. The dorsal retinaculum was also surgically repaired in six cases. At a mean follow-up of 5.1 years (range 4–8.75), we observed improved range of motion in both flexion/extension and pronation/supination and absence of pain during daily activity. Radiographically, positioning of the distal radial articular surface and lunate subsidence were improved. Union was obtained after all osteotomies without secondary procedures. Posterior displacement of the ulnar head persisted in two wrists. Combined radioulnar osteotomy restored the anatomy to as near normal as possible. This technique provides satisfactory and encouraging results and does not compromise the surgical future of the wrist. However, longer follow-up is required to assess recurrence or possible long-term degenerative consequences.

Introduction La crainte des complications ischemiques rend le traitement orthopedique par methode de Blount controverse dans les fractures supracondyliennes de l’humerus de l’enfant (FSH) de stades III et IV de Lagrange et Rigault. L’objectif de cette etude etait d’evaluer les resultats cliniques et radiographiques de la methode de Blount dans ces indications. Patients et methode Il s’agit d’une etude retrospective, monocentrique, de 2003 a 2013. L’evaluation clinique etait faite selon les criteres de Flynn. L’analyse radiographique comprenait la mesure de l’angle de Baumann, de l’angle d’anteversion epiphysaire, la ligne humerale anterieure et l’angle humero-ulnaire. Resultats Parmi les 447 enfants pris en charge pour une FSH types III ou IV, 339 enfants ont ete traites par la methode de Blount. Deux cent cinquante-quatre ont ete inclus dans l’analyse clinique et radiographique avec un suivi moyen de 36,8 mois. Quatre-vingt-cinq qui n’ont pas ete revus apres la consolidation ont ete inclus uniquement dans l’analyse radiographique. Il s’agissait de 173 garcons et 166 filles. L’âge moyen etait de 6 ans (1–14). Soixante et onze pour cent des FSH etaient de type IV. Le delai moyen de prise en charge etait de 5,7 heures. Les resultats cliniques selon les criteres de Flynn etaient satisfaisants dans 97 % des cas. Aucun syndrome des loges n’etait deplore. 16 deplacements secondaires avaient necessite une reprise chirurgicale a un delai moyen de 9 jours (1–15). Cinq patients avaient developpe une deformation en cubitus varus et n’avaient aucune consequence fonctionnelle ou esthetique. Il existait une tendance a la correction du cubitus varus avec le recul (p = 0,00025). Aucune modification de l’angle d’anteversion epiphysaire n’etait retrouve avec le recul. Au dernier recul, la ligne humerale anterieure croisait le tiers moyen ou la jonction tiers moyen-tiers posterieur du capitellum dans 96,7 % des cas et l’angle humero-ulnaire moyen etait de 8,7° IC95 % [7,84 + 9,62]. Conclusion Les indications du traitement par la methode de Blount peuvent etre etendues aux stades III et IV, a condition d’obtenir une reduction anatomique et stable. Les echecs sont le plus souvent dus a des erreurs d’indication. La surveillance clinique et radiologique doit etre rigoureuse afin d’eliminer le syndrome des loges et les deplacements secondaires.

Various surgical techniques have been used to treat displaced radial neck fractures in children, in order to reduce the displacement and to avoid complications. We report the results of a retrospective study performed on 20 patients with severely displaced radial neck fractures, who were treated with intramedullary pinning (Métaizeau technique). Mean age at injury was 9 years. Clinical and radiographic evaluation was performed. At final follow-up, there were 17 (85%) excellent or good results, 1 (5%) fair and 2 (10%) poor. Complications noted were anterior epiphysiodesis in one case and avascular necrosis of the radial head in another. Heterotopic ossification, neurovascular deficit or deep infection were noted in no instance.

Introduction La maladie de Madelung est une deformation du poignet due a une atrophie de la partie mediale du cartilage de croissance distal du radius. Il en resulte une subluxation antero-mediale du carpe. Plusieurs techniques ont ete utilisees visant a restaurer une anatomie normale du poignet. Nous rapportons notre experience de la double osteotomie radio ulnaire dans le traitement de cette maladie. Materiel De 1995 a 2004, 14 poignets (11 filles) presentant une maladie de Madelung ont ete operes. L’âge moyen lors de l’intervention etait de 13,3 ans. Methode L’indication chirurgicale a toujours ete posee devant des douleurs et/ou une gene fonctionnelle. Dans tous les cas, il a ete realise une osteotomie radiale de fermeture postero laterale associee a une osteotomie de raccourcissement de l’ulna. L’osteosynthese a ete assuree par embrochage au niveau du radius et par plaque en compression au niveau de l’ulna. Une plastie du retinaculum dorsal a ete utile dans 6 cas. Le protocole de revision comportait un examen comparatif clinique et radiographique. Le recul moyen etait de 37 mois. Resultats Cliniquement, 11 poignets sur 14 n’etaient plus douloureux. L’aspect esthetique a ete juge satisfaisant dans 12 cas. Une amelioration significative des amplitudes articulaires (extension et supination) a ete notee dans tous les cas. Dans deux cas, il persistait une subluxation posterieure de la tete de l’ulna. Radiographiquement, l’inclinaison de la glene radiale et la variance ulnaire etaient significativement ameliorees (p Discussion Dans la maladie de Madelung les options therapeutiques sont nombreuses. L’objectif est d’ameliorer l’orientation de la glene radiale, de supprimer le conflit ulno-carpien et de stabiliser la radio ulnaire distale. La double osteotomie radio ulnaire a permis de remplir ce cahier des charges. Les resultats fonctionnels et esthetiques sont bons dans la plupart des cas. Conclusion La double osteotomie radio ulnaire dans le traitement de la maladie de Madelung est une technique fiable. Elle permet d’ameliorer les rapports anatomiques du poignet, sans compromettre son avenir chirurgical.

Une large part des vastes quantités d’informations produites dans le monde est d’origine numérique et se présente sous une grande diversité de formats : texte, base de données, son, film, image. Pour les institutions culturelles, qui ont traditionnellement la charge de recueillir et de préserver le patrimoine culturel, il est devenu extrêmement urgent de savoir quels sont les matériaux qu’il convient de conserver pour les générations futures et comment il faut procéder à leur sélection et à leur préservation. Ce gigantesque trésor d’informations numériques, produit aujourd’hui dans presque tous les domaines de l’activité humaine et conçu pour être accessible sur ordinateur, risque d’être perdu si l’on ne développe pas des techniques et des politiques spécifiques en vue de le conserver. L’intérêt que porte l’UNESCO à cette situation n’a rien de surprenant. Cette organisation internationale existe en partie pour encourager et permettre la conservation et la jouissance du patrimoine culturel, scientifique et informatif des peuples du monde entier. Elle ne pouvait négliger l’augmentation du patrimoine numérique et sa vulnérabilité., A significant part of the vast quantity of information produced worldwide is numeric and comes in several formats: text, data bases, sound, film, and image. For cultural institutions, traditionally responsible for the acquisition and preservation of the cultural heritage, it has become very important to know which materials should be conserved for future generations and how these materials should be selected and conserved. This gigantic treasure trove of numeric data, produced in all domains of human activity and designed to be accessed by computers, could be lost if specific techniques and policies are not developed with its conservation in mind. UNESCO's interest in this issue comes a no surprise. This international organisation exists partly to promote the conservation and the enjoyment of the cultural, scientific and information heritage of humanity. Therefore, it could not neglect the growing numeric heritage and its vulnerability., Una parte considerable de la extensa cantidad de información que se produce en el mundo es digital y se presenta en una gran variedad de formatos: texto, base de datos, sonido, película, imagen. Para las instituciones culturales que tienen tradicionalmente la responsabilidad de preservar el patrimonio cultural, es extremadamente urgente saber cuáles son los materiales que vale la pena conservar para las generaciones futuras y cómo se deben seleccionar y preservar. Ese gigantesco tesoro de información digital que hoy día producen casi todos los sectores de la actividad humana y que ha sido concebido para ser accesible por computadora, corre el riesgo de perderse si no desarrollamos técnicas y políticas específicas destinadas a conservario. No es nada sorprendente que la UNESCO se interese en esta cuestión. Parte de la función de esta organización internacional es fomentar y facilitar la preservación y el goce del patrimonio cultural, científico e informático de los pueblos de todo el mundo. La UNESCO no podía desentenderse del aumento del patrimonio digital y de su vulnerabilidad.