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We present a rewiev of orthopaedic literature, our clinical experience, and examples on pediatric ankle fractures. The rules of anatomic physeal and articular surface reduction in intraarticular injuries are emphasised. We present complications, specially ankle axial deformities caused by bony bars and its reasons, specially periosteal interposition or jatrogenic physeal damage by an inapropriate stabilisation.

We present results of treatment in 36 cases of distal tibial epiphyseolysis in 34 patients treated between 1999 and 2005 with a minimal follow up of 12 months (average 28,5, range 13-84 months). The mean age at injury was 12 years (range from 7 to 16). There were 22 cases of type II injury according to the Salter-Harris classification, 5 cases of type VII, 3 of type IV, 2 of type I and two cases of triplane fracture, one case of retrospectively recognised type V and one of type III. 12 children required open reduction and K-wire fixation, the rest of 22 children underwent closed reduction followed by percutaneus fixation in 12 cases. Concomitant fibular fracture occured in 30 cases and required open reduction and fixation in 4. There were 18 good, 14 fair and 3 bad results according to Gleizes. The mean AOFAS scale result was 92.7. One child underwent 2 weeks of intravenous antybiotic therapy to recover from superficial skin infection around percutaneus K-wires. Four cases of physeal bar formation were noted. In two of them distal tibial osteotomy to correct ankle varus was necessary and one underwent bony bridge removal followed by fatty tissue interposition. The remaining physeal bar resulted in 10 degree of ankle valgus without functional dispairement.

We present Ignatio Ponseti's approach to idiopathic clubfoot management and its biological basis. The key principles of the Ponseti method of treatment are 1. All deformity components are corrected simultaneously except equinus, which is corrected last, usually by percutaneous Achilles tenotomy. 2. The correction is maintained by external foot rotation around the head of the talus. 3. The excavatus is corrected by supination of the first ray of the foot. 4. The corrections are performed weekly and after 4-5 weeks of treatment a percutaneous Achilles tenotomy is performed in local or general anaesthesia. 5. After another 3 weeks of plaster cast immobilisation, a Dennis Brown brace is used to keep the correction until 4-5 years of life.

We present a rare case of an aggressive form of chondroblastoma arising from proximal radius. Because of an initial histopathologic diagnosis of paraosteal osteosarcoma, the patient was treated with preoperative chemotherapy and afterwards a local tumor resection with one half of proximal radius was performed. A final histopathologic examination revealed typical benign chondroblastoma. We discuss the rare localisation of chondroblastoma and its differential diagnosis with surface osteosarcoma.

We present 6 children with Ehlers-Danlos syndrome (EDS) with concomitant joint contractures. In 3 of them bilateral clubfeet together with hip, and (or) knee, or wrist flexion contractures were observed. In all of them, after initial soft tissue surgery for clubfeet, reccurences were noted requiring another surgery. Clubfeet were the only manifestation of joint contractures in another 2 children. In one of them soft tissue surgery was succesful, in the second a hypercorrection was noted. One child with EDS had a recurvatum knee deformity which was succesfully treated conservatively. We speculate on two different forms of EDS with joint contractures: a mild one, in which clubfeet are the only joint contractures, and in which a soft tissue surgery may lead to overcorrection, and a severe one, with multiple joint contractures like in arthrogryposis multpiplex congenita, in which soft tissue surgery for clubfeet and joint contractures may lead to reccurences.

We present 33 children with 34 elbow dislocations. In 22 cases concomittant fractures around the elbowe were noted: 13 displaced medial epicondyle fractures, 5 radial neck fractures, 2 radial head fractures, 2 coronoid process fractures, 1 olecranon fracture, 1 lateral condyle fracture, 1 medial condyle fracture. In 5 children more than one concomittant fracture were noted. The mean age during dislocation was 11 years (from 4 to 15), the mean follow up period was 3.5 years (from 2 to 5). On follow up a clinical examination of the elbow was performed including axis assesment and elbow ROM. X-ray were taken in all children in AP and lateral view. All children had a satisfying function of the extremity and no pain was noted. No difference in ROM was noted in children with isolated elbow dislocation or with concomittant medial epicondyle fractures however in 3 of those children a persistent flexion contracture was observed. Among children with other fractures poorer results occured in 3 patients, specially after displaced radial neck fractures. In one of them there was slight supination and pronation restriction, in second a complete ankylosis of proximal radioulnar joint occured in neutral forearm position. In one child after elbow dislocation and medial condyle fracture a late radial dislocation occured. We think that concomitant medial epicondyle fracture does not impare good results of elbow dislocation treatment if well recognised and treated. Other fractures, specially radial neck fractures, increase the risk of complications.

This article describes our clinical experience with the so-called biological methods of reconstruction after limb salvage bone tumor resections. Depending on the localization and resection type (transarticular, extraarticular) we have used various types of auto- and allogenic bone grafts, arthrodesis, arthrodesis with elongation, and Van Nes rotationplasty. The advantages and disadvantages of these methods are discussed.

Between 1993-2003 the authors treated 5 girls with idiopathic chondrolysis of the hip joint. Their mean age at first symptoms were 9 years (range 6-11 years). In all initial symptoms were pain and a hip flexion contracture of a mean 33 degrees (range 30-40 degrees). All were treated with multiple stationary rehabilitation including traction, range of motion exercises, analgetic physical therapy and longlasting walking with crutches. At the follow up examination only one hip was I 10 degree. Remaining 4 children were painfree. In 2 of them an acetabular protrusion, hip joint space narrowing and degenerative changes were observed on anteroposterior radiographs and clinically the hips were stiff in functional position. In the remaining 2 children, the hip range of motion was limited, with 30 and 90 degree of flexion, but joint space became wider on radiographs. Results were bad, because we do not know neither effective causative non symptomatic methods of treatment. Maybe the new technics of treatment, like arthrodiastasis, will bring better results.

The authors present early results of conservative treatment in congenital clubfeet connected with the percutaneous tendon Achilles tenotomy in 10 children (16 feet). 9 feet were of type III and 7 of type IV according to the Dimeglio scale. Minimum follow up was 6 months, with an average follow up period of 10 months. All cut Achilles tendons regenerated completely. On follow up 9 feet were completely corrected, 5 presented with mild forefoot adduction and 2 feet required surgery because of recurrent equinovarus deformity. The authors claim that the percutaneous tendon Achilles tenotomy is a safe and valuable procedure which allows to avoid early surgery in 88% of clubfeet.

We resected eight calcaneus-navicular bars in six children. The average age at the surgery was fifteen years, and the average follow up period was four years. In all cases the extensor digitorum brevis was interposed into the gap created by an excision of the bar. On the follow up three feet were painfree and four were occasionally painful. In one case a coalition recurred, and the pain did not improve. The ankle range of motion was normal in all cases, whereas the subtalar motion was limited in three feet, and normal in the remaining five.

The authors treated 6 children with sarcoma telangiectaticum (SOT). Their average ages was 7.8 years (ranging from 4 to 15 years of age). In 3 children the tumor was located in the proximal epiphysis of the femur and in the remaining 3 cases in the distal epiphysis of the femur. Clinical symptoms were present on average 8.6 weeks (ranging from 2 to 20 weeks) before the final diagnosis was made. In 3 children the final diagnosis was made after performing 1 biopsy, while in the remaining 3 cases a second biopsy was required to confirm the diagnosis. All cases were given pre-op chemotherapy (Cisplatin, Adriablastine). In all cases quick growth of the tumor was noted and in all cases a pathological fracture occurred. In 2 children mutilating surgical procedures were performed, 1 child had an endoprosthesis implanted outside our facility and 1 child was treated for lung metastases. Two children are alive, but no information about their medical condition is available.

The authors present the results of treatment of 2 cases of fibroma chondromyxoides in children. In Polish orthopaedic literature only 2 other cases have been presented. The first case--a 13-year-old boy--was referred to our centre because of a recurrent tumour in the 1st metatarsal bone and surrounding soft tissues. The boy had received treatment 3 years earlier outside our centre, where curettage of the tumour was performed. The bone cavity was then filled with bone grafts. The tumour was removed again and autogenous bone grafts were applied. On follow-up 7 years after surgery no recurrence was noted, along with full remodelling of the bone grafts. The second case was a 9-year-old child. The tumour was localised in the proximal phalanx of the thumb. During curettage and application of autogenous bone grafts for the tibia, transplantation of the tumour site occurred to the donor site. Two years after surgery tumour recurrence was observed. A re-operation was performed, with complete resection of the basal phalanx, with a fibular graft implantation. The tumour in the tibia was also removed. Two and a half years after surgery both tumour sites remain free of signs of recurrence.

The authors present the results of surgical treatment of 16 cases of aneurysmal bone cyst between 1998 and 2000. Age of patients at the onset of symptoms ranged from 5 to 15 years (average 11.3 years). In 12 cases the cysts were aggressive, and in 5 cases they were active (according to the capanne classification). In 12 cases the characteristic lining of the cyst was removed, curettage was performed and bone grafts were inserted into the bone cavity. In 3 cases autografts were used, in 2 cases both allografts and autografts were used, and in 7 cases only allografts were applied. Two cysts of the fibula were removed en-bloc, a cyst located in the scapule was treated with radiotherapy. In 15 cases the cyst was successfully managed surgically. While in 1 case a revision procedure was performed.

The authors present a review of literature of the past 40 years, relevant to the pathological anatomy of congenital clubfoot and their own views--based on intra-operative observations. Performing Goldner's procedure the authors noted the talar bone was rotated internally, as a whole and externally in relation to the forefoot. The head and neck of the talar bone were deviated medially in relation to the trochlear axis. These deformities lead to pronation and supination movements instead of the normal flexion and extension of the foot. The authors believe a wide capsulotomy with resection of the ligaments is necessary to achieve proper clubfoot correction.

Between 1996 and 2000 the authors followed-up 6 children with congenital hypertrophy of 7 feet. Surgical treatment was performed in 4 children (4 feet). The average age at the time of surgery was 9 years, and the average follow-up period was 3 years. 2 cases of macrodactyly of the I and II rays of the foot and 1 case of macrodactyly of the II ray of the foot were observed. Amputations of phalanges or toes in all 3 cases were performed with amputations of distal parts of adjacenet metatarsals in 2 cases. Soft tissue debulking was routinely done. Operative treatment of 1 case of the foot gigantism connected a resection of the IV and V metatarsals, a removal of the III metatarsal, an epiphysiodesis of II metatarsal and an amputation of all toes at the MIP joint level. A good cosmetic result was achieved in all children with macrodactyly and all of them were normal shoes. The treatment in the case of foot gigantism yielded good functional result and satisfactory cosmetic result. The patient required orthopaedic foot-wear. In the authors' opinion the resection of the lateral rays of the foot is superior the central ray resection.

The authors present the results of surgical treatment of resistant idiopathic and recurrent clubfoot (type IV according to Dimeglio classification). In the group who underwent a primary procedure, results were noted according to the Magone classification: 35.7% very good results, 11.9% good results, 9.52% satisfactory and 42.5% bad results (recurrent clubfeet accounts for 37.5%). The authors noted that the Goldner technique yields results comparable to the peri-talar release technique.