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Intramedullary lengthening nails for lower limb reconstruction in children are a rapidly growing field and represent an alternative to external fixators. Today, two types of intramedullary lengthening nails are used: motorized (FITBONE) and magnetically driven (PRECISE) bone lengthening nails. Indications for limb lengthening nails are: 1) Significant lower limb length discrepancy; 2) Short stature and deformities due to musculoskeletal or dysplastic syndromes; 3) Constitutional short stature. Intramedullary lengthening surgery is challenging and represents a safe and reliable mode of treatment in patients under 18 years of age with an excellent reported outcome., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Displaced proximal humeral fractures in older children with low remodeling potential need to be reduced and fixed. There are many options for stabilization, including external fixation, rigid internal fixation with screws and plates, percutaneous pinning, and flexible intramedullary nailing. The use of 2 flexible retrograde nails, originated at the University of Nancy, France, became the most popular technique in Europe. The aim of this study was to describe and assess a modified, single retrograde nail technique to treat fractures of the proximal part of the humerus., Methods: We performed a retrospective monocentric study. From June 2016 to May 2019, a modified retrograde nail technique with 1 prebent nail was used for the management of 21 consecutive children with a closed displaced proximal humeral fracture. Demographic and surgical data were collected. The surgical technique is similar to the classic elastic stable intramedullary nailing, but only 1 nail is used. The average surgical time and perioperative complications were used as criteria for the feasibility of this technique. Radiographs were obtained preoperatively; at 1, 4, and 6 weeks postoperatively; and after implant removal at an average of 4.2 months postoperatively. The clinical outcomes were assessed on the basis of the shoulder range of motion documented in the medical records and by using the French edition of the QuickDASH (shortened version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) evaluation scale at the time of implant removal., Results: Nineteen patients with a mean age of 12.6 years and a mean follow-up of 6 months were included in the study. The mean surgical time was 49 minutes. The single intramedullary nail technique provided a satisfactory reduction of all fractures. No perioperative complication occurred. In 1 case, partial loss of reduction was observed on the first-week control radiograph. All patients had a healed fracture, no deficits, excellent results according to the QuickDASH score, a normal range of motion, and excellent strength of the shoulder joint at the time of implant removal (at a mean of 4.2 months)., Conclusions: The current study confirms the feasibility and efficacy of the single retrograde intramedullary nail technique to treat displaced proximal humeral fractures in children., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A237)., (Copyright © 2021 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)

Background: The aim of this study was to improve knowledge of pediatric pyogenic sacroiliitis (PSI) in the pediatric population based on a consecutive case series., Method: We conducted a single-center cross-sectional study on 16 patients admitted to the emergency department of our Hospital between January 1990 and December 2015 with a confirmed diagnosis of PSI. The patients were divided into 2 groups by age: infants (6 months to 4 years) and children-adolescents (4-16 years). The features of PSI, clinical signs and symptoms, laboratory tests, bacteriologic investigations, radiologic examinations and outcome were compared among the 2 groups., Results: Patients in the children-adolescent group usually presented with a history of limping and buttock or lower back pain, and methicillin-susceptible Staphylococcus aureus was the most frequent pathogen. We observed a second peak of incidence of PSI in infants with consistent difference in clinical and microbiologic presentation. Infants were more likely to have an ambiguous onset with the refusal to bear weight as the only consistent clinical manifestations, and biologic investigations demonstrated higher erythrocyte sedimentation rate and platelet counts. However, all blood and joint fluid cultures were sterile in the infant group., Conclusion: PSI in infants and adolescents may represent 2 different conditions. Although PSI is mainly caused by S. aureus in the children-adolescent group, clinical manifestations and biologic characteristics of PSI in infants suggest Kingella kingae as the etiology osteoarticular infection. Thus, oropharyngeal swab polymerase chain reaction assay for K. kingae and magnetic resonance imaging should be considered for early diagnosis and treatment of this condition in the younger age group.

Lower limb length discrepancy and malalignment in paediatric orthopaedics constitute a set of acquired or malformative structural pathologies. These anomalies, which may alter statics of lower limbs, are susceptible to engender an asymmetry of mechanical constraints' distribution across joints, and thus to promote the onset of arthritic phenomenons. The purpose of this review's article is to define the limits of tolerance of the various malformations and describe the innovative techniques available in order to correct them., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.