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Material and Method: Acetabular anteversion angle (AAA) and orientation angle of the iliac bone (AOOI) determined by use of a CT scan were studied in CDH. 55 children with CDH were selected on hip arthrography for this study. Subluxated hips were excluded (i.e. opposite hip of a unilateral CDH is normal). 10 boys and 45 girls with a mean of age of 2 years 1 month (extremes from 1 to 4 years 3 months) were studied. CT scan was performed before any orthopaedic treatment in 3 cases of bilateral luxation and 14 cases of unilateral. In the other cases, time between the end of orthopaedic treatment and CT scan varied between 4 and 18 months. A group of 23 normal children, 10 boys and 13 girls, (mean age of 2 years 10 months) served as reference group. On the selected CT slide we measured AAA, AOOI, IAA and IAP (anterior acetabular index and posterior acetabular index as proposed by Guggenheim)., Results: We noted that the orientation of the iliac bone was variable in the two groups. This orientation angle could have higher or lower values. AAA: in bilateral luxation, this angle was higher (16 degrees +/- 5 degrees) than in reference group (13 degrees +/- 4 degrees), p < 0.005. In unilateral luxation there was no statistical difference (14 degrees +/- 4 degrees) with reference group, between normal and pathological side and when CT scan was performed before or after orthopaedic reduction. AOOI: there was no significant difference between bilateral, unilateral or reference group. Correlation analysis showed that AAA and AOOI moved in the same direction. IAA: in bilateral luxation this index was higher (p < 0.001); in unilateral luxation only right luxation showed an higher index (p = 0.002). IAP: no significant difference between the different groups., Discussion: This study shows that there is any typical CT scan aspects of morphologic abnormality in CDH. The lesions of the anterior or posterior acetabular wedge are variable. The orientation of the iliac bone is also variable; we concluded that acetabular anteversion must be analysed depending on the morphologic aspects of the anterior and posterior extremities of the acetabulum and iliac bone orientation.

The authors report a series of 19 children (ten boys and nine girls) presenting fibrous dysplasia with an average follow-up of 7 years 10 months. Twenty five bones were involved. The average age at diagnosis was 9 years (range 3 years to 14 years). Fatigue fractures and pains were the main reasons for consultation. The most frequent anatomic sites were the femur, the tibia and the humerus. In six cases it was decided to simply watch the children without any treatment. The clinical results were good for 18 children. In two cases the initial radiological lytic aspect remained at the longest follow-up. Nine complications (among which two iterative fractures and three recurrences) occurred. None of the cases developed malignant transformation. The authors discuss the different possibilities of treatment with a review of the literature.

The authors have analysed a series of aneurysmal bone cysts (A.B.C.) in children and adolescents which were reviewed at an average follow-up of 4 years 2 months (6 months-15 years). The average age at diagnosis was 8 years (3-19 years). Pathological fractures were the main reason for consultation, probably due to the predominance of central lesions. If conventional radiology remains indispensable to diagnosis, magnetic resonance imaging is nevertheless the most important examination in determining the extent of the affection. The diagnosis remains anatomopathological, even if this may be difficult due to associated lesions (A.B.C. illness and A.B.C. symptoms). In long bones lesions, we observed recurrence after curettage in 3 out of 7 cases. For this reason the recommend simple resection or reconstructive resection rather than curettage whenever possible. 5 lesions in contact with growth plate were observed. In such cases we recommend its conservation by careful curettage, especially in young children. We feel that subsequent recurrence is easier to treat than an epiphysiodesis bridge. The surgical techniques employed to conserve the plate are described along with methods of bone reconstruction after surgery.

Forty-six hips treated by a shelf operation in childhood and adolescence have been reviewed. The mean follow-up was 8 years 1 month (4Y-26Y) after operation. The indications were residual dysplasia of the acetabulum, neurologic hips and sequelae of osteochondritis. All patients were operated after the age of 8.5 years except 2. In poliomyelitis and sequelae of osteochondritis the results were good. In dysplasia we had two bad results in 18 cases (1 painful hip after operation and 1 ankylosing hip) and in cerebral palsy 4 bad results in 13 cases, due to difficulty of maintaining a correct reduction for a long period. After a review of the literature to compare the results of this intervention with pelvic osteotomies we conclude that the shelf procedure is beneficial in childhood and adolescence, due to the quality of acetabular cover, to its improvement in time and to ease of intervention.

The authors reviewed a series of 72 hips in 60 children with sequelae of septic arthritis of the hip to evaluate the long term evolution. The average follow up was 7 years 8 months (Range 1Y-17Y). 40 hips were operated and 32 were not. The results were analysed according to clinical and radiological criterions in an attempt to propose a guide for treatment. Sequelae might also occur after both initial treatment with open drainage or aspiration. The study of sequelae according to the factors of severity (organism, age when infected) showed that the evolution of these cases of arthritis cannot be forecast. The authors noticed that very severe roentgenographic lesions could be well tolerated clinically, at least on a medium term basis. They advise great care before operating on dislocated hips when they are clinically well tolerated. Finally the authors insist on 2 little known lesions: caput valgum and caput antetorsum.

Sixty-two patients with histiocytosis X were followed for an average of 5 years. The patients were classified into three groups: general visceral types (14 cases), multiple eosinophilic granulomas (nine cases), and solitary eosinophilic granulomas (39 cases). One hundred bony lesions were noted in 60 of the 62 patients. The bone lesions showed progressive improvement in single and multiple eosinophilic granulomas independent of treatment type. After biopsy, patients received no treatment unless there was a dangerous extension into the soft tissues because of its site, i.e., in the skull. In the general visceral types, chemotherapy was effective in visceral sites and in extensions of the tumor outside the bone but did not alter the natural history of the bony lesion.

Fifteen pediatric cases of vertebral involvement in histiocytosis X are reported. The study of these cases and a review of the literature shows that every patient with histiocytosis X should have a local and systemic staging work-up to differentiate isolated eosinophilic granulomas of the bone, multiple eosinophilic granulomas of the bone, and visceral disseminated disease. Management varies according to the extension of the disease. Systemic chemotherapy may be indicated in patients with extraosseous lesions. Local investigations should be performed to look for instability of the spine, which may require surgery, and above all for spread to the soft parts indicating chemotherapy with or without surgery. Forms which are strictly confined to the bone and cause no instability, such as vertebra plana, require no treatment.

The authors have made a review of the literature about two cases of osteomyelitis of the iliac ala. They insist on rarity of the disease and how often the right diagnosis may be delayed because of misleading clinical symptoms. Any tumefaction of the buttock associated with pelvic pain and with an infectious syndrome necessarily evoke an iliac osteomyelitis. The bone scan may be negative which need not exclude the possibility. The evolution may be the formation of intra or extra or sometimes simultaneous sub-periosteal abscesses which must be drained. This is the reason why the authors advise to verify systematically the other side of the ilium by its surgical trepanning in case of a sub-periosteal abscess.

A centrally located bone bar of the lower tibia was removed after epiphyseolysis with an Ilizarov device. The bone bridge attached to the metaphysis was easy to remove, and methylmethacrylate was used as an interpositional material. Varus deformity was corrected at the level of the epiphyseolysis. At the 2-year follow-up, there was evidence of further growth and correction of the varus was maintained.

The authors report two rare cases of pygomelus monster. The appearance and operative procedures undertaken are described. Pygomelus and caudal duplication are often mixed in literature. This monstruosity is classified in the twin monsters, but minor forms any be discussed with sacro-coccygeal teratomas and reduplication of lower limbs.

On the basis of 12 cases, the authors suggest use of the axillary approach in everyday surgery on the shoulder and the upper end of the humerus, because of the quality of healing it offers. They describe its safety and limitations. Problems are restricted to slight transverse adhesions across the axilla which are easily cured and even more easily avoidable.

Three cases of sleeve fractures of the patella are reported. These lesions are epiphyseal fractures. Attention is drawn to the fact that the diagnosis may be missed. Surgical treatment is necessary to attaining and maintaining reduction. The authors focus on that avascular necrosis is important in sleeve fractures and the open reduction increases this risk.

Between 1980 and 1988, 70 varus inducing and varus derotation osteotomies of the upper end of femur were carried out in children. The osteotomies were maintained by a plate and screws developed by the author. This plate combines a bend to medialize the inferior fragment and screw perforations for easy positioning; it facilitates the procedure since the degree of varus correction depends completely on the shape of the plate. This firmly maintains the desired correction and reduces the amount of radiation received at subsequent controls.

Fifteen old dislocations of the radial head in children were treated by open reduction combined with a high osteotomy of the ulna and a reconstruction of the annular ligament. This method, described by the authors in 1978, was used in nine post-traumatic, three congenital, two paralytic and one dislocation associated with multiple exostoses. Twelve children were reviewed with a follow-up of two to 11 years. Nine radial heads remained stable and well reduced. The three congenital dislocations recurred. Eight elbows showed normal alignment and the other four were only improved. Ten elbows had normal movement or better movement than before the operation. Eleven children used their elbow normally or better than before. In all, 14 children were improved, and only one elbow had unaltered function. The results obtained in congenital dislocations should be able to be improved by a number of technical precautions.

One hundred hips in children were examined by computer assisted tomography. They were either dysplastic, subluxated or dislocated. The study resulted in more precision as to the degree of femoral anteversion and acetabular anteversion. The indications for femoral or pelvic osteotomy can thus be more accurate. Mechanical effects of some pelvic osteotomies have been analysed.

Concerning 14 cases with a follow-up of over 5 years, the authors describe their acetabuloplasty technique which is applied to dysplastic sockets with normal cotyloid cavity anteversion, innominate osteotomy is reserved for cases in which this anteversion is excessive; results have been excellent for 11 cases with adequate lowering of the roof-edge of the cavity and improvement of the C and CE angles as well as satisfactory subsequent bone growth; the result was insufficient in 3 cases in which either the head of the femur was off-centre or deformed by osteochondritis. The age of the patients was between 16 and 37 months. No growth disorder caused by the operation has been observed. Three failures may be related to pre-existing abnormalities in the growing areas of the acetabulum or to ischaemic troubles in the femoral head.