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Ce questionnement n’est pas anodin, dans sa formulation tout d’abord. Parler de préservation fonctionnelle situe d’emblée ce propos autour d’un objectif stabilisation de la fonction, de lutte contre sa lente et inexorable détérioration. L’objectif ne serait donc pas forcément d’obtenir un « gain » fonctionnel ce qui est le quotidien du chirurgien orthopédiste. La chirurgie orthopédique ne serait donc pas ici comme ce qui la décrit littéralement dans sa traduction sino-française « la main qui rend le printemps » mais plutôt comme la main qui évite au patient porteur d’une pathologie neuro-musculaire de se faire rattraper par un hiver trop précoce.

Forearm sarcoma is rare in children. Here, we report three cases. One child presented undifferentiated soft-tissue sarcoma involving the ulna, another had Ewing's sarcoma of the ulna, and the third had Ewing's sarcoma of the proximal radius. In the first case, there were episodes of iterative aseptic nonunion, treated surgically. At last follow-up (respectively 11, 9 and 8 years postoperatively), the mean Musculoskeletal Tumor Society (MSTS) score was 80%, 90% and 77% respectively, and all cases were in remission. The induced membrane technique to reconstruct bone defect after sarcoma resection in children is a possible limb-salvage strategy.

Riassunto Gli obiettivi del trattamento chirurgico delle scoliosi idiopatiche sono cambiati poco negli ultimi decenni, ma la capacita dei chirurghi di raggiungere l’obiettivo desiderato e migliorata. L’obiettivo finale e realizzare un’artrodesi di buona qualita. Questa artrodesi di una maggiore o minore estensione del rachide deforme deve portare a una schiena armoniosa e correttamente bilanciata sopra il bacino. Anche la derotazione delle vertebre scoliotiche e un obiettivo da raggiungere, in quanto partecipa alla qualita estetica del risultato finale. Dallo sviluppo della strumentazione di Cotrel e Dubousset nei primi anni ′80, molte altre strumentazioni e tecniche si sono sviluppate parallelamente. Le strumentazioni anteriori, l’utilizzo di viti peduncolari, le fasce sublaminari e le tecniche di traslazione e flessione in situ hanno consentito di migliorare la qualita della correzione tridimensionale della deformita scoliotica. Le complicanze associate all’uso di queste diverse tecniche sono sempre possibili, ma possono essere ridotte al minimo attraverso il rigoroso rispetto delle indicazioni, la pianificazione preoperatoria e la perfetta padronanza della tecnica operatoria e del neuromonitoraggio intraoperatorio.

Resumen Los objetivos del tratamiento quirurgico de las escoliosis idiopaticas han variado poco en las ultimas decadas, aunque la capacidad de los cirujanos para obtener el objetivo deseado ha mejorado. El objetivo final es realizar una artrodesis de buena calidad. Esta artrodesis, de mayor o menor extension de la columna deformada, debe dar como resultado una espalda armoniosa y correctamente equilibrada por encima de la pelvis. La desrotacion de las vertebras escolioticas tambien es un objetivo que hay que conseguir, ya que contribuye en la calidad estetica del resultado final. Desde el desarrollo de la instrumentacion de Cotrel y Dubousset a inicios de la decada de 1980, se han desarrollado paralelamente muchas otras tecnicas e instrumentaciones. Las instrumentaciones anteriores, el empleo de tornillos pediculares, las bandas sublaminares y las tecnicas de traslacion y de curvado in situ han permitido progresar en la calidad de la correccion tridimensional de la deformacion escoliotica. Las complicaciones relacionadas con el empleo de estas diferentes tecnicas siempre son posibles, pero se pueden minimizar mediante un respeto estricto de las indicaciones, del dominio perfecto de la tecnica quirurgica y de la neuromonitorizacion perioperatoria.

Riassunto In pediatria, le patologie dell’anca sono multiple, spesso legate ad anomalie della crescita e all’anatomia specifica dell’articolazione coxofemorale. Qualunque sia la patologia che colpisce questa articolazione, l’evoluzione naturale causera, nella maggior parte dei casi, alterazioni architettoniche irreversibili, per questo e necessario agire tempestivamente per proteggere l’articolazione fragilizzata ed evitare il suo deterioramento. E, inoltre, necessario favorire la congruenza delle superfici articolari, in modo che i fenomeni di ricostruzione si svolgano in condizioni ottimali. Il trattamento ortopedico consiste nello scarico e/o nell’immobilizzazione dell’articolazione per proteggerla ed evitare lesioni secondarie. La chirurgia interviene solo in caso di trauma o di importanti sequele architettoniche. Il fisioterapista ha un ruolo di monitoraggio dei vari mezzi di contenzione, di informazione e di educazione della famiglia. Partecipa anche alla conservazione della mobilita delle coxofemorali e anche delle altre articolazioni durante i periodi di trazione. E, inoltre, chiamato in causa per la ripresa dell’appoggio e della deambulazione dopo l’intervento chirurgico.

Background data Little is known about daily walking distance levels, which accounts for approximately 80% of overall physical activity per day, in adolescents with idiopathic scoliosis (AIS). Objective The aim of this study was to assess the level of walking distance in AIS treated by bracing or not, comparing this activity with that of a control group. We used an original method based on smartphone pedometers for studying walking distance in everyday life. Methods Nineteen AIS patients, aged 14.1 (13–17) years, and 25 asymptomatic patients, aged 12.9 (12–14) years were included prospectively. The 19 AIS cases comprised 9 untreated individuals and 10 with ongoing night brace treatment. The mean walking distance per day as estimated by the pedometer application on smartphones for 2 months was assessed. Weekly sports activities (hours per week) were also reported. Results During the first month, the mean walking distance was 2.58 ± 0.65 km/day for control patients, 2.31 ± 1.38 km/day for untreated AIS, and 3.65 ± 0.72 km/day for AIS patients treated with a night brace. During the second month, the mean walking distance was 2.60 ± 0.73 km/day for control patients, 2.40 ± 1.41 km/day for untreated AIS, and 3.70 ± 0.72 km/day for AIS patients treated with a night brace. Statistical analysis between groups showed a statistically significant difference with a higher level of daily walking distance in adolescents treated with a night brace compared with other groups. Conclusion The pedometer on smartphones is a cost-effective and friendly tool to assess adolescents’ level of walking distance. Our results indicate no restriction in terms of daily walking distance between adolescents without scoliosis and those with idiopathic scoliosis. Level of evidence Level II.

Resumen En pediatria, las afecciones de la cadera son numerosas, a menudo relacionadas con anomalias de crecimiento y la anatomia particular de la articulacion coxofemoral. Cualquiera que sea la patologia que afecte a esta articulacion, la evolucion natural conducira a trastornos estructurales irreversibles en la mayoria de los casos, por lo que es necesario actuar con prontitud para proteger la articulacion fragilizada y evitar su deterioro. Tambien se debe facilitar la congruencia de las superficies articulares para que los fenomenos de reconstruccion se produzcan en condiciones optimas. El tratamiento ortopedico consiste en el reposo y/o la inmovilizacion de la articulacion para protegerla y evitar lesiones secundarias. La cirugia solo interviene en casos de traumatismos o secuelas estructurales significativas. El papel del kinesiterapeuta es vigilar los diversos metodos de contencion e informar y educar a la familia. Tambien participa en el mantenimiento de la movilidad de la articulacion coxofemoral y las otras articulaciones durante los periodos de traccion. Ademas, contribuye a la reanudacion del apoyo y la marcha despues de la cirugia.

BACKGROUND: The first case of SARS-CoV-2 was detected in France in January 2020 and the government decided on national confinement from March 17 to May 11, 2020. Our aim was to analyze the incidence of pediatric emergency department (ED) visits and hospitalizations for traumatic injuries during this period. METHODS: Any visit with an ICD-10 discharge diagnosis code of burn, fracture, traumatic wound, or sprain/bruise contusion was recorded within the 2 weeks before (weeks 10 and 11) and during the confinement (weeks 12 and 19). The visits with the same ICD-10 discharge diagnosis code during similar weeks of the previous 2 years were also included. For each of those visits, the number of hospitalizations was counted. RESULTS: The number of recorded visits between week 10 and 19 in 2018, 2019, and 2020 was, respectively, 2657, 2625, and 1106 children. The average number of visits per day during the confinement (13±5) was significantly different from the average number of visits per day during the same weeks in 2018 and 2019 (38±8 vs. 39±9, P

Introduction Epidemiological studies of fractures of the spine in children are all old, mostly single-centre, with series spanning periods of 5 to 20 years. Hypothesis As lifestyle is constantly changing, notably with an increase in sports activities and improvements in the prevention of road and household accidents, epidemiology has likely changed. Objective To update the description of spinal trauma in children and adolescents compared to the existing literature. Material and method A multicentre cross-sectional study of spinal fracture, dislocation and spinal cord injury without radiological abnormality (SCIWORA) in children was carried out in 15 French university hospital centres, for a period of one year (2016). Results One hundred and sixty-five children were identified: 85 girls, 80 boys; mean age 11 years (range, 10 months–17 years); median, 12 years 6 months. One hundred and fifty-two children (92%) had fracture, 8 (5%) dislocation (including 7 C1-C2 rotary dislocations), and 5 (3%) SCIWORA. Fractures were multiple in 80 cases (49%), contiguous in 73 cases (91%) and non-contiguous in 7 (9%). Locations were cervical in 25 cases (15%), thoracic in 85 (52%), lumbar in 75 and sacral in 4 (2%). Fracture types comprised 234 vertebral compactions (78%), 25 burst fractures (8%), 5 chance fractures (2%), 2 odontoid fractures, and 33 other lesions. Causes comprised fall in 77 cases (47%), sports accidents in 56 (34%), road accidents in 29 (18%), and others in 3. In 52 cases (32%), there was ≥ 1 associated lesion: appendicular in 35 cases (67%), thoracic or abdominal in 31 (60%), and head in 16 (31%). Twenty-one cases had multiple lesions (40%). Eighteen cases showed neurological involvement (11%) including 5 SCIWORAs. Neurological complications were more frequent before 9 years of age. Conclusion The epidemiology of spine fractures in children has slightly changed. There are now fewer cervical lesions. Causes are less often road accidents and more often sports accidents. Multi-level lesions remain frequent and the rate of neurological complications is around 10%. Compaction fracture is the most common type.

Surgical correction of thoracic scoliosis leads to a height improvement. Our objectives were to assess how the linear and developed spinal column lengths relate to the frontal and sagittal parameters after a surgical correction of thoracic idiopathic scoliosis, and whether the measurement of these lengths is reliable using quasi-automatic 3D reconstruction methods with biplanar X-rays.Consecutive children with thoracic idiopathic scoliosis who underwent spinal fusion surgery and biplanar pre and postoperative X-rays in free-standing position were included prospectively. Quasi-automatic computed 3D reconstructions of the spine were done using a previously validated technique and allowed the automatic computation of geometrical spinopelvic parameters including OD-pelvis, linear, and developed T1-T12 and T1-L5 lengths.Thirty patients with scoliosis were included, and 240 reconstructions were performed (2 operators x2 repetitions x30 patients pre and postoperative). The main thoracic Cobb angle, T1-T12, T1-L5 linear and developed distance, OD-pelvis were significantly improved (p 0.001). The gain of the main thoracic Cobb angle (31.6°;SD = 9°) was correlated to the gain of the linear distance T1-T12 (15.3 mm;SD=7.3 mm)(rho = 0.76;p 0.0001) and T1-L5 (24.7 mm;SD = 8 mm)(rho = 0.64;p 0.0001). The postoperative change of developed length between T1-L5 represented 41% of the gain in linear distance between the same vertebrae. Similarly, the gain of T1-T12 developed length was 50% of linear T1-T12 height gain. Both differences were significant (p = 0.01). Absolute bias using BlandAltman plots was lower than 1 mm for linear distance (0.1%) and lower than 2 mm (0.3%) for developed distance.The gain in spinal length is correlated to the thoracic Cobb angle correction in the surgical treatment of idiopathic thoracic scoliosis. The new significant finding is that the developed spinal height gain represented approximately a little less than 50% of the linear spinal height gain and these parameters were reliable from a 3D quasi-automatic reconstruction of biplanar X-ray.

Resume Introduction Le pronostic des infections osteoarticulaires (IOA) s’est ameliore depuis 20 ans mais peut encore etre severe. Le traitement s’est simplifie et raccourci. En 2008, le Groupe de pathologie infectieuse pediatrique (GPIP) a etabli de nouvelles propositions pour le standardiser en France. L’objectif de cette etude etait d’analyser les pratiques dans un hopital pediatrique et l’efficacite de ce traitement a court et moyen termes. Materiels et methodes Il s’est agi d’une etude retrospective sur l’annee 2012 concernant les patients de plus de 3 mois sans comorbidite, hospitalises a l’hopital Trousseau (Paris) pour une IOA aigue, dont le suivi avait ete d’au moins 4 semaines. Resultats Soixante-quatre enfants sur 156 ont ete retenus pour l’analyse. Le diagnostic d’IOA aigue avait ete confirme bacteriologiquement (29/64) ou presume sans preuve bacteriologique (35/64). L’âge median etait de 22 mois et 78 % des patients etaient febriles. Trente-cinq (54,7 %) enfants avaient eu une arthrite, 21 (32,8 %) une osteomyelite aigue (OMA), 7 (10,9 %) une osteoarthrite, 1 une spondylodiscite. Les localisations preferentielles avaient ete le genou et la hanche. Soixante et un pour cent des arthrites avaient ete diagnostiquees grâce a l’echographie, 54 % des osteomyelites par la scintigraphie. Les deux germes principaux identifies avaient ete Kingella kingae (62,1 %) et Staphylococcus aureus (24,1 %). Dans 98 % des cas, les enfants avaient recu un traitement par cefamandole associe ou non a de la gentamicine pour une duree mediane de 3 jours (1–10) par voie intraveineuse. Il y avait eu le plus souvent un relais oral par amoxicilline-acide clavulanique pendant 6 semaines, en association avec de la rifampicine sans justification dans 40 % des cas. La duree mediane du suivi avait ete de 13 semaines, et le taux de succes du traitement avait ete de 86 %. Conclusion L’etude de nos pratiques a montre que les propositions du GPIP n’etaient pas appliquees strictement, le traitement oral etant trop long et non conforme aux recommandations. La tendance actuelle va vers des traitements raccourcis de 10 a 20 jours, avec une phase parenterale plus courte.

Nosocomial infections contracted in surgical unites are and important burden to health care systems and we believe that prevention programs involving medical file folders can help to reduce the personal, social and economic consequences of these health-care related diseases. Therefore we decided to investigate the contamination of folders in operating rooms. We present quantitative and qualitative results regarding pathogenic and nonpathogenic contamination of medical file folders in surgical units. This study is the first to identify such microorganisms using MALDI-TOF spectrometry which allowed us to identify precisely a wide spectrum of microbes. We aimed to contribute to developing awareness among healthcare givers and we hope that our study can be used to establish and reinforce international recommendations regarding unanimated material present in operating rooms in order reduce nosocomial infections.

Supplemental Material, GSJ_Supplemental_Material for Cell Therapy for Treatment of Intervertebral Disc Degeneration: A Systematic Review by Dino Samartzis, Niccole M. Germscheid, Michael G. Fehlings, Charles G. Fisher, Marinus de Kleuver, F. Cumhur Öner, S. Tim Yoon, Luiz R. Vialle, Hans-Joerg Meisel, Neha Agarwal, Patrick C. Hsieh, Andrea Skelly, Jong-Beom Park, Darrel Brodke, Jeffrey C. Wang, S. Tim Yoon and Zorica Buser in Global Spine Journal

Resume Introduction Le but de notre etude etait d’analyser les resultats a moyen et long termes de l’osteotomie de l’extremite proximale de l’ulna avec et sans ligamentoplastie dans les lesions de Monteggia vieillies chez l’enfant. Materiel et methodes Dans cette etude retrospective, multicentrique de 28 patients, les criteres cliniques concernaient la mobilite, la douleur, et le score MEPI ; les criteres radiographiques, la ligne de Storen, le head-neck ratio, l’angulation du col radial, et la recherche de remaniements osteo-arthrosiques. Resultats Vingt-huit patients ont ete revus, avec un recul moyen de 6 ans (2–34 ans). Seize patients ont eu une osteotomie proximale de l’ulna sans ligamentoplastie, 12 patients ont eu une ligamentoplastie. Les deux groupes ont eu une amelioration significative clinique et radiologique. Il n’a pas ete retrouve de difference significative en comparant leurs resultats. Les patients operes dans un delai inferieur a 1 an presentaient de meilleurs resultats cliniques et radiologiques. Il n’existait pas de correlation entre l’âge a l’intervention et la qualite des resultats. Les 5 patients ayant eu une broche trans-condylo-radiale ont eu une recidive precoce de la luxation et des remaniements osteo-arthrosiques. Les trois cas Bado 3 ont eu une recidive precoce de la luxation. Discussion L’intervention de Bouyala donne de bons resultats a long terme, dans les lesions Bado 1, quel que soit l’âge, en cas de prise en charge avant 1 an, en l’absence de remaniement osteo-arthrosique. L’interet de la ligamentoplastie depend de la complication a traiter. Niveau de preuve IV (etude retrospective).

Every doctor can be confronted, during his career, with patients presenting symptoms they created themselves. Because it is easily accessible, the hand is a favored target organ for these self-inflicted injuries. The diagnosis of factitious disorder of the hand is very difficult, rarely suggested and widely under-estimated. The real issue is detecting it early on to develop a cohesive diagnostic and therapeutic approach. The three clinical cases reported in this article illustrate the difficulty of caring for this pathology at all stages, from diagnosis to treatment. These disorders must be distinguished from malingering. A psychiatrist must be part of the treatment team. The prognosis of factitious disorders is poor. It is vital to maintain contact with the patient once the diagnosis is established. The risk is that the patient consults with other professionals, restarting a new cycle. The featured clinical cases were chosen to remind surgeons that factitious disorders of the hand are a recognized psychiatric disease. It must be evoked in the context of an unusual injury with a vague history. Everything possible must be done to confirm the diagnosis and avoid surgery.

Background: Spinal muscular atrophy is an autosomal recessive neuromuscular disorder that is caused by an insufficient level of survival motor neuron (SMN) protein. Nusinersen is an antisense oligonucleotide drug that modifies pre–messenger RNA splicing of the SMN2 gene and thus promotes increased production of full-length SMN protein. Methods: We conducted a randomized, double-blind, sham-controlled, phase 3 efficacy and safety trial of nusinersen in infants with spinal muscular atrophy. The primary end points were a motor-milestone response (defined according to results on the Hammersmith Infant Neurological Examination) and event-free survival (time to death or the use of permanent assisted ventilation). Secondary end points included overall survival and subgroup analyses of event-free survival according to disease duration at screening. Only the first primary end point was tested in a prespecified interim analysis. To control the overall type I error rate at 0.05, a hierarchical testing strategy was used for the second primary end point and the secondary end points in the final analysis. Results: In the interim analysis, a significantly higher percentage of infants in the nusinersen group than in the control group had a motor-milestone response (21 of 51 infants [41%] vs. 0 of 27 [0%], P Conclusions: Among infants with spinal muscular atrophy, those who received nusinersen were more likely to be alive and have improvements in motor function than those in the control group. Early treatment may be necessary to maximize the benefit of the drug.

Introduction/Background In the treatment of severe scoliosis, pre-surgical halo-gravity traction (HGT) achieves an increase in curve flexibility and in preoperative pulmonary function as well as a neurologic risk reduction following final surgery. Our aim was to describe the benefits and complications of HGT in adolescents with idiopathic scoliosis or secondary scoliosis while awaiting vertebral fusion. Material and method A descriptive and retrospective study. Sixteen patients admitted to hospital and carrying a HGT between January 2014 and December 2017 were included. The main judgment criteria were the height gain, the final weight of traction, the decrease in the Cobb angle, the gain in the forced vital capacity (FVC) and the description of complications. Results There were eight teenagers with an idiopathic scoliosis aged-mean (SD) 12.1(1.9) years old, a height gain of 7.6(2.3)cm, a final weight of traction of 13.7(3.9)kg corresponding to 37.2(7.5)% of body weight. Cobb angle mean(SD) of 97.5(8)° was reduced of 26.9(11.1)° at the end of traction. And a FVC gain mean (SD) of 12.4(8.8)%. Likewise, eight adolescents with a secondary scoliosis aged-mean(SD) 12.8(1.2) years old, a height gain of 9.2(2.8)cm, a final weight of traction of 12.7(1.3)kg corresponding to 38.9(11.6)% of body weight. Cobb angle mean(SD) of 100(13.8)° was reduced of 26.5(8.4)° at the end of traction. And a FVC gain mean(SD) of 7.1(9.7)%. The most frequent complications in the group of idiopathic scoliosis (n = 8) were neck pain (75%), headache (37.5%), pin pain (25%), visual disorders, thorax pain and pin infection (12.5%). In the group of secondary scoliosis (n = 8), neck pain (100%), headache (62.5%), back pain (50%), pin pain and anxiety (25%), neurological disorders and pin infection (12.5%). Conclusion HGT was in general well tolerated and should be considered before vertebral fusion to improve spinal flexibility and respiratory function in idiopathic or secondary scoliosis.

Resume Objectifs Dans le myelome multiple, les radiographies du squelette sont toujours considerees comme l’examen d’imagerie de reference car elles permettent d’etablir le stade de la maladie selon la classification de Salmon et Durie. L’IRM corps entier utilisant les sequences T1 et STIR augmente la detection des lesions myelomateuses. La diffusion mesuree par IRM a demontre sa grande sensibilite en termes de detection en oncologie. L’objectif principal de cette etude etait donc de comparer le bilan radiographique standard et une methode IRM de diffusion corps entier (DWIBS) dans la detection des lesions osseuses de pathologies plasmocytaires monoclonales (myelomes multiples, leucemie a plasmocytes, plasmocytome, gammapathie monoclonale de signification indeterminee [MGUS]). Patients et methodes Vingt-sept patients dont 24 myelomes multiples, une leucemie a plasmocytes, une MGUS et un plasmocytome ont beneficie d’une IRM corps entier sequence DWIBS. L’IRM de diffusion et les radiographies standards, ainsi que le stade de Salmon et Durie etabli par les deux methodes ont ete comparees. En cas de lesions douteuses, le suivi evolutif sur 12 mois a ete utilise comme methode de reference au diagnostic definitif. Resultats Le taux de concordance global entre les deux techniques etait de 63 %. La sequence DWIBS detectait un nombre superieur de lesions conduisant a un stade de Salmon et Durie superieur chez 37 % des patients : un de stade I a II, sept de stade I a III et deux de stade II a III. Chez 18,5 % des patients, l’IRM etait positive alors que les radiographies etaient normales et ces discordances etaient le plus souvent situees dans les sites mal explores par les radiographies : rachis, bassin et gril costal. Chez un patient (4 %) la sequence DWIBS donnait un stade inferieur a celui des radios (stade II vs III). Dans ce cas, les radios etaient positives au niveau des humerus et des femurs, contrairement a la sequence DWIBS. Notre analyse site par site confirmait la nette superiorite de la sequence DWIBS par rapport aux radiographies dans l’exploration du rachis cervical (56 vs 0 % d’examens positifs, p Conclusion L’IRM-DWIBS entraine une majoration du stade de Salmon et Durie. Sa place dans le bilan pre therapeutique du myelome multiple reste encore a evaluer mais cette etude semble montrer qu’il s’agit d’une methode potentiellement interessante.

Optimal treatment of injuries to the thoracolumbar spine is based on a detailed analysis of instability, as indicated by injury morphology and neurological status, together with significant modifying factors. A classification system helps to structure this analysis and should also provide guidance for treatment. Existing classification systems, such as the Magerl classification, are complex and do not include the neurological status, while the TLICS system has been accused of over-simplifying the influence of fracture morphology and instability. The AOSpine classification group has developed a new classification system, based mainly upon the Magerl and TLICS classifications, and with the aim of overcoming these drawbacks. This differentiates three main types of injury: Type A lesions are compression lesions to the anterior column; Type B lesions are distraction lesions of either the anterior or the posterior column; Type C lesions are translationally unstable lesions. Type A and B lesions are split into subgroups. The neurological damage is graded in 5 steps, ranging from a transient neurological deficit to complete spinal cord injury. Additional modifiers describe disorders which affect treatment strategy, such as osteoporosis or ankylosing diseases. Evaluations of intra- and inter-observer reliability have been very promising and encourage the introduction of this AOSpine classification of thoracolumbar injuries to the German speaking community.

La exploracion del pie es una etapa primordial en la valoracion de un recien nacido. La mayoria de las anomalias pueden detectarse en la exploracion fisica sin necesidad de pruebas complementarias. En la mayoria de los casos, se trata de «malposiciones» y, por lo tanto, de deformidades posturales, debidas a la posicion fetal intrauterina, en su gran mayoria espontaneamente reversibles sin necesidad de tratamiento. Es necesario saber establecer el diagnostico diferencial con verdaderas anomalias congenitas del pie que requieren un tratamiento especializado. Se debe realizar una exploracion ortopedica general ante cualquier recien nacido que presente una anomalia de los pies. La exploracion minuciosa de las caderas es indispensable para buscar una luxacion congenita o una displasia que estuviera asociada. Se pueden observar algunas anomalias de los pies, presentes desde el nacimiento, en el caso de sindromes malformativos mas amplios o de enfermedades neurologicas o musculares. En cualquier caso, es necesaria una intervencion precoz, tanto diagnostica como terapeutica.

The prognosis of osteoarticular infections has improved over the past 20 years but it still remains potentially severe. The treatment of these infections has been simplified and shortened. In 2008, the Pediatric Infectious Disease Group (GPIP) established new therapeutic guidelines in order to standardize treatment in France. The aim of this study is to analyze practices in a Parisian hospital and assess the efficacy of this treatment in short and medium terms.This retrospective study focused on patients older than 3 months, without comorbidities, who were hospitalized for an acute osteoarticular infection in 2012 at Trousseau Hospital (Paris), with a follow-up of at least 4 weeks. The patients were selected from the hospital register.The study included 64 patients of 156, who were admitted for examination with a diagnosis of acute osteoarticular infection, bacteriologically confirmed (29/64) or presumed on the basis of bacteriological evidence (35/64). The median age of the patients was 22 months. Of the patients, 78 % were febrile; 35 patients had arthritis (54.7 %), 21 osteomyelitis (32.8 %), seven osteoarthritis (10.9 %), and one spondylitis. Preferential localizations were the knees and hips; 61 % of arthritis cases were diagnosed with ultrasound, 54 % of osteomyelitis cases with scintigraphy. The two main microorganisms found were Kingella kingae (62.1 %) and Staphylococcus aureus (24.1 %). In 98 % of cases, patients were treated by cefamandole, with or without gentamicine, for a median duration of 3 days (1-10) intravenously, with oral relay by amoxicillin-clavulanic acid, for a total duration of 6 weeks, but in association with rifampicin in 40 % of cases without explanation. The median follow-up was 13 weeks, with a treatment success rate of 86 %.The study of local practices showed us that the GPIP guidelines are not followed, with the duration of oral treatment being too long. The trend in therapy is toward short treatments of 10-20 days, with a shorter intravenous phase.

Chronic pericarditis: CT and MR imaging features A diagnosis of constrictive pericarditis is suggested by the presence of pericardial thickening (≥ 4 mm in thickness) and abnormal motion of the interventricular septum. Additional findings have been reported: tubular appearance of the right or left ventricles, dilatation of the vena cava, atrial dilatation or abnormal diastolic expansion of one or both ventricles. In patients with suspected chronic pericarditis, CT can more easily demonstrate the presence of pericardial calcifications compared to US and MRI, as well as detect the presence of mediastinal adenopathy and lung lesions, suggesting tuberculosis. Septal motion analysis should be performed during protodiastole and systole using a cine technique with both CT and MR.

Polymers and self aggregating molecules have been widely tested as vaccine adjuvants. For this type of adjuvant, electrostatic potential can be managed through the selection of chemical synthesis routes and monomer types in order to control adsorption phenomena of amphiphilic charged macromolecules according to isoelectric points at different pH. Thanks to an original polymerisation process, compatible with injectable polymers development, calibrated spheric micronic gel particles of sodium polyacrylate have been synthesised. These aggregates measuring about one micrometer in diameter are made of a reticulated high molecular weight synthetic polymer. Adsorption properties (possibly leading to sustained release) persistence at the injection site and irritation phenomena are the main mechanism of action identified as responsible for immune response improvement. Synthetic cross linked macromolecules, highly chemically stable and used at low rate can persist at injection site. Microgel particles have been characterised with one model antigen to establish binding constants in various conditions. During development steps, safety profile of this innovative formula was assessed through Guinea pig histological studies after intramuscular injection and compared to aluminium salts based adjuvant.

Tanto en el nino como en el adulto puede aparecer un desequilibrio sagital del tronco responsable de una hipercifosis, la cual puede ser armoniosa y regular, como en los casos frecuentes de epifisitis vertebral del crecimiento (enfermedad de Scheuermann) o, por el contrario, puede ser una deformidad corta y angulada. La deformidad asienta a menudo en la region toracica o toracolumbar. En casos de cifosis armoniosas, mas concretamente en la enfermedad de Scheuermann, el tratamiento ortopedico con corse se indica para las deformidades importantes (mas de 60°) y evolutivas, debido a la capacidad de crecimiento residual y, en consecuencia, de empeoramiento potencial. El objetivo del tratamiento ortopedico es ante todo detener el empeoramiento de la deformidad. En todo caso, en el nino o en el adolescente, la correccion de la deformidad puede ser duradera, ya que una vez que se hiperextiende el raquis se facilita el crecimiento de la parte anterior de los cuerpos vertebrales. En los casos de cifosis rigidas y angulares, el tratamiento ortopedico debe ser mantenido y prolongado. La correccion de la deformidad puede requerir el uso de corses de distraccion cuyo manejo es delicado. A menudo, el tratamiento ortopedico no frena la progresion de la deformidad y hay que esperar a la suficiente madurez osea para valorar un tratamiento quirurgico definitivo. El tratamiento ortopedico de las cifosis sigue siendo una empresa exigente, con complicaciones cutaneas y tambien neurologicas y digestivas. La mayoria de estos tratamientos deben seguirse de cerca en un medio especializado en rehabilitacion y protesis.

Depuis 2000, un comite international propose une methode d’evaluation des reponses tumorales utilisant la radiographie, le scanner et l’imagerie par resonance magnetique : les criteres RECIST (Response Evaluation Criteria in Solid Tumors). Cette methode, derivee des criteres OMS, repose sur la mesure du plus grand diametre des lesions cibles et non sur une mesure bidimensionnelle. Ces criteres viennent d’etre revises en janvier 2009 (version 1.1), apportant des informations complementaires et simplifiant encore le nombre de lesions a suivre. Une exception dans la mesure des lesions est faite pour les ganglions. Ceux-ci doivent etre mesures selon leur plus petit diametre, qui doit etre infracentimetrique pour etre normal. L’utilisation des criteres RECIST est fortement recommandee, mais non obligatoire dans les essais cliniques, permettant ainsi de standardiser le suivi des tumeurs solides et ainsi de faciliter les etudes experimentales. Quatre reponses sont possibles : RC (remission complete) = disparition de toutes les lesions et/ou plus petit axe des atteintes ganglionnaires Ce travail detaille l’utilisation de ces criteres et les illustre par quelques exemples.

Resume Les tumeurs endocrines (TE) peuvent produire et secreter des hormones. Ces tumeurs realisent un veritable challenge diagnostique : elles sont classees comme symptomatiques ou non symptomatiques, sur la base du retentissement clinique, differentiees ou non selon l’examen anatomopathologique et pancreatiques ou extrapancreatiques selon leur localisation. Le scanner multidetecteur joue un role important dans le diagnostic et la classification de ces lesions. En regle, les lesions symptomatiques sont de petite taille, de moins de 3 cm et se rehaussent de facon intense apres injection de produit de contraste. Les lesions non symptomatiques sont souvent plus grosses et heterogenes. L’imagerie par resonance magnetique (IRM) semble presenter un interet dans la recherche des localisations pancreatiques et le bilan des lesions secondaires hepatiques. L’echoendoscopie et la scintigraphie des recepteurs a la somatostatine restent les piliers du bilan des ces lesions. Ce travail presente le role de l’imagerie dans la prise en charge de ces patients.

Paradoxical embolism is a diagnosis of exclusion. Clinical triad associates deep venous thrombosis with or without pulmonary embolism, arterial embolism, and intracardiac communication with right-to-left shunt. The intracardiac communication is generally related to a patent foramen ovale (PFO). We report a 75-year-old patient, who presented with bilateral deep venous thrombosis of the legs, complicated by massive pulmonary embolism and paradoxical embolisms through a PFO. This resulted in cerebral, mesenteric, splenic and bilateral kidney infarctions. A promptly initiated anticoagulant treatment allowed a favourable outcome.

Resume Les tumeurs de la vesicule biliaire les plus frequentes sont benignes. L’exploration echographique est suffisante pour diagnostiquer les formes typiques d’adenome, de polype cholesterolique ou d’adenomyomatose. Seules les lesions symptomatiques relevent d’une indication de cholecystectomie. La principale difficulte reside dans le depistage d’une lesion precancereuse ou maligne. La cholecystectomie preventive est licite pour tous polypes de plus de 1 cm. En cas de doute diagnostique devant un epaississement parietal ou une lesion polypoide, l’echoendoscopie est utile pour evaluer l’infiltration tumorale au sein de la paroi de la vesicule biliaire. En l’absence d’un traitement rapide, le diagnostic est encore trop souvent realise tardivement a un stade ou le traitement chirurgical n’est plus possible. Le recours a la tomodensitometrie et a l’imagerie par resonance magnetique est utile a ce stade pour realiser le bilan d’extension locale et a distance.

Background: Radiofrequency heating of the intervertebral disc has been proposed for the treatment of chronic low back pain using two methods: a flexible needle inserted into the annulus fibrosus achieving a full 360° penetration, or a rigid needle inserted into the nucleus pulposus. The first technique is effective on pain, but the clinical benefit of the second is uncertain. Purpose: To evaluate a technique for radiofrequency heating of the lumbar intervertebral disc by a needle placed into the nucleus pulposus. Material and Methods: The method was tested in 17 patients according to the criteria used in previous intradiscal radiofrequency studies. Before and after treatment, disability was assessed by the Oswestry disability score. A pain reduction of at least 50% was considered a success. Results: Fifteen patients were responders at 1 month (88%), nine at 3 months (53%), and 12 at 6 months (70.6%). No complications were observed. Conclusion: A new method of providing discal radiofrequency treatment for lower back pain had a substantial clinical benefit in 71% of the observed patients. A prospective study comparing this new method with placebo should be conducted to confirm these initial results.

Resume La scoliose idiopathique survient sans cause decelable, chez des enfants en parfaite sante. Il s’agit d’une deformation progressive du rachis dans les trois plans de l’espace, ayant pour consequences une rotation vertebrale responsable d’une gibbosite et une modification de l’equilibre sagittal du tronc. Le diagnostic de scoliose est facile, par le simple examen du tronc penche en avant qui met en evidence la gibbosite et permet d’eliminer bon nombre d’« attitudes scoliotiques ». La scoliose presente un risque d’aggravation, particulierement net durant la periode de croissance. Durant la puberte, la scoliose peut parfois evoluer rapidement vers une deformation importante, ce qui est frequemment le cas des scolioses apparues tot dans l’enfance. Toute scoliose doit donc beneficier d’une surveillance particulierement attentive, au minimum deux fois par an, durant toute la periode de croissance.

Kyphosis could be defined as an anterior spinal curvature. In physiological conditions, spinal sagittal plane is a succession of harmonious sagittal curves of opposite direction: lumbar lordosis, thoracic kyphosis, cervical lordosis. These curves are constituted during the growth and their amplitudes vary from one individual to another. For each individual, the spinal sagittal balance is a compensated combination resulting in an "economic" physiological standing posture. Many different physiological standing postures are present in the population to lead to this sagittal balance and multiple factors interfere for each person. It is necessary to take into account this great variability in spinal sagittal balance before qualifying a spinal curvature as "pathological". Pathological kyphoses are divided into two great groups. Regular kyphoses are localized in a harmonious way on a wide part of the spine. Their "pathological" character rests on the importance of the curve, its stiffness, its evolutivity, or its localization on a usually lordotic spinal segment. Angular kyphoses are localized only on a small number of vertebrae. They are often significant and stiff deformations whose "pathological" character is undeniable. Multiple causes, congenital or acquired, are responsible for the development of a pathological spinal kyphosis. Analysis of the deformation and knowledge of the natural course constitute an essential prerequisite for any therapeutic project. The principal diagnostic and therapeutic stages for each of the most frequent causes of pathological spinal kyphosis are summarized and analyzed in a didactic way.

Las deformaciones de la columna vertebral de los pacientes que presentan una miopatia representan una entidad especifica dentro de las deformaciones raquideas. Responden a multiples causas (neurologicas centrales, neurologicas perifericas y musculares) y pueden provocar deformaciones progresivas del esqueleto axial, debido a una debilidad global del tronco, o bien a una asimetria de las fuerzas ejercidas sobre la columna. Por tanto, las deformaciones que aparecen pueden ser posturales, relacionadas con la malposicion del tronco en el espacio, o estructurales, asociadas a deformaciones de la propia columna vertebral. Ademas de describir las deformaciones encontradas y sus posibilidades terapeuticas y tecnicas cada vez mas novedosas, este articulo hace hincapie en el tratamiento global y en ocasiones muy complejo que requieren estos pacientes. En algunas personas con una discapacidad grave, los tratamientos cardiacos, digestivos o respiratorios son parametros indisociables del enfoque terapeutico, sobre todo si este debe ser quirurgico. Por tanto, el tratamiento «ideal» de estos pacientes debe ser multidisciplinario. Se puede establecer una estrategia comun a lo largo de varios meses, en incluso anos, con un mismo objetivo, que sera el de estabilizar la deformacion raquidea de forma duradera y con un equilibrio satisfactorio del tronco.