Search

Resume Introduction Le rachitisme par carence alimentaire en calcium, maladie rare, peu connue et epidemique dans le sud-est du Bangladesh, occasionne des deformations importantes des membres inferieurs. Le but de ce travail etait d’evaluer le benefice d’un traitement chirurgical par osteotomie a la lumiere de 16 ans d’engagement humanitaire dans ce pays. Materiel et methode Ont ete retenus pour cette etude les 156 enfants ayant eu une osteotomie isolee des membres inferieurs. Le choix de techniques simples, reproductibles, avec risque infectieux faible a ete privilegie. Resultats La deformation moyenne est passe de 28° en preoperatoire a 5° en postoperatoire. Le resultat etait bon dans 60 % des cas, ameliore dans 26 %, mediocre dans 12 % et montrait une aggravation dans 2 % des cas. Le taux de complications etait de 14 % et le taux d’infection de 4 %. Discussion Que ce soient les problemes de suivi, de technique chirurgicale, de recidive des deformations, de complications neurologiques ou infectieuses, l’experience acquise progressivement a permis de faire regresser les difficultes. Cela a permis a 86 % des enfants operes de voir leur vie transformee. Moyennant une grande rigueur, le rapport benefice–risque semble en faveur de la prise en charge chirurgicale par osteotomie. Niveau de preuve IV etude retrospective.

Aims The purpose of this study was to evaluate the long-term outcome of adolescents with cerebral palsy who have undergone single-event multilevel surgery for a flexed-knee gait, followed into young adulthood using 3D motion analysis. Patients and Methods A total of 59 young adults with spastic cerebral palsy, with a mean age of 26 years (sd 3), were enrolled into the study in which their gait was compared with an evaluation that had taken place a mean of 12 years (sd 2) previously. At their visits during adolescence, the children walked with excessive flexion of the knee at initial contact and surgical or therapeutic interventions were not controlled between visits. Results Based on the change in flexed-knee gait over approximately ten years, improvements were seen in increased Gait Deviation Index (p Conclusion While some small significant changes were noted, little clinically significant change was seen in function and gait, with gross motor function maintained between adolescence and young adulthood. Cite this article: Bone Joint J 2018;100-B:549–56.

The Spectral Separation Assembly (SSA) is a key component of the Flexible Combined Imager (FCI), an instrument that will be onboard Meteosat Third Generation (MTG). It splits the input beam coming from the telescope into five spectral groups, for a total of 16 channels, from 0.4 to 13.3 μm. It comprises a set of four dichroics separators followed by four collimating optics for the infrared spectral groups, which feed the cold imaging optics. To assess the optical performances, a specific multi-wavelength infrared test bench has been designed. The wavefront error can be measured for each channel of each spectral group. Other parameters can also be measured, namely pupil centering, line of sight, pupil diameter and pupil aberrations. This paper will present this test bench and the solutions developed to enable these measurements on a very large spectral range.

Resume Introduction Selon les series, 6,6 a 31 % des fractures supracondyliennes de l’humerus de l’enfant presentent des complications nerveuses. Parmi celles-ci, un tiers sont des paralysies du nerf interosseux anterieur (NIOA) se traduisant essentiellement par un deficit de flexion active du pouce et de l’index. Le but de ce travail anatomique est de decrire le trajet du nerf pour comprendre le mecanisme lesionnel. Materiel et methode Sur 35 pieces anatomiques, le nerf median et ses branches nerveuses collaterales a destinee musculaire etaient dissequees au coude et a l’avant-bras. Les niveaux d’emergence des differentes branches etaient mesures par rapport a une ligne bi-epicondylienne. Une dissection intrafasciculaire du NIOA dans le nerf median permettait sa description topographique intranerveuse. Resultats Le NIOA emergeait a 45 mm en moyenne de la ligne bi-epicondylienne. La dissection des fascicules du NIOA dans le nerf median avant son emergence les retrouvait systematiquement dans sa partie posterieure. A partir de son emergence, deux zones de NIOA etaient identifiees : zone 1 : la portion transitionnelle depuis son emergence situee jusqu’a son entree dans l’espace interosseux ou il changeait de direction ; et la zone 2 : la portion interosseuse entre le radius et l’ulna au contact de la membrane interosseuse antebrachiale a laquelle il etait fixe sur tout son parcours jusqu’a sa terminaison dans le muscle pronator quadratus (PQ). Les branches musculaires destinees aux muscles flexor pollicis longus (FPL) et flexor digitorum profondus (FDP) naissaient le plus souvent dans la zone 1 qui etait la portion transitionnelle entre le nerf median et la zone 2 fixee. Les branches destinees aux muscles pronator teres (PT) et flexor carpi radialis (FCR) etaient plus proximales et superficielles. Discussion Les mecanismes lesionnels a l’origine de la paralysie preferentielle du NIOA dans les fractures supracondyliennes du coude de l’enfant sont probablement le fait de deux facteurs : une contusion directe de la face posterieure du nerf median, et donc des fascicules du NIOA, par le fragment proximal (hypothese defendue par Sunderland (1945) [26] ) ; un etirement de la zone 1 du NIOA, dont la reserve d’etirement a ce niveau, du fait de la fixite de la zone 2, est plus faible que celle du nerf median et de ses autres branches. Conclusion Les particularites de l’emergence et du trajet du NIOA permettent d’expliquer le pourcentage eleve de sa paralysie dans les fractures supracondyliennes du coude. Niveau de preuve Niveau IV etude anatomique.

International audience; Scoliosis is diagnosed as idiopathic in 70 % of structural deformities affecting the spine in children and adolescents, probably reflecting our current misunderstanding of this disease. By definition, a structural scoliosis should be the result of some primary disorder. The goal of this article is to give a comprehensive overview of the currently proposed etiological concepts in idiopathic scoliosis regarding genetics, molecular biology, biomechanics, and neurology, with particular emphasis on adolescent idiopathic scoliosis (AIS). Despite the fact that numerous potential etiologies for idiopathic scoliosis have been formulated, the primary etiology of AIS remains unknown. Beyond etiology, identification of prognostic factors of AIS progression would probably be more relevant in our daily practice, with the hope of reducing repetitive exposure to radiation, unnecessary brace treatments, psychological implications, and costs-of-care related to follow-up in low-risk patients.

Study design Cross-sectional study. Objective To determine whether adolescent idiopathic scoliosis (AIS) at onset is associated with oculomotor dysfunction and whether these oculomotor anomalies are correlated to the amplitude of the spine deformation. Summary of background data AIS is related to abnormalities of postural control. To date, few studies have focused on visuo-oculomotor and vestibulo-ocular functions at early-stage AIS. Methods Fifty-three adolescent girls were diagnosed with AIS (mean age: 11.6 ± 2.1 yr) on clinical and radiological criteria (mean Cobb angle: 14.8° ± 5.0°). Visuo-oculomotor and vestibulo-ocular functions were studied with video-oculography, including saccades, smooth pursuit, caloric test, and pendular rotation, with visual vestibular ocular reflex and vestibulo-ocular reflex sequences. Two patient groups were defined according to the mean Cobb angle: group 1 included 29 patients with a Cobb angle from 5° to 14° and group 2 included 24 patients with a Cobb angle from 15° to 25°. Results The group 2 showed different saccade characteristics than group 1: higher latencies for saccade sequences characterized by temporal uncertainty and predictive direction; lower velocity regardless of the type of the saccades. No difference was observed for saccadic accuracy and smooth-pursuit gain. For the visual vestibular ocular reflex, group 2 showed lower total maximal slow-phase velocity than group 1, whereas the vestibulo-ocular reflex (tested in dark) did not differ between groups. No difference was observed concerning the caloric vestibular test. Conclusion Patients with a Cobb angle of 15° or more presented normal vestibulo-ocular responses but altered visuo-oculomotor functions, especially for the saccadic latency and velocity. This could be the result of a dysfunction of oculomotor pathways at cerebellar and/or brainstem level. These central disorders may be incriminated in the development of AIS.

Resume Introduction L’etablissement du pronostic d’inegalite de longueur chez les enfants atteints d’anomalie congenitale reste toujours un sujet de preoccupation. La strategie therapeutique doit tenir compte du pronostic en longueur, afin d’adapter a la fois les techniques d’egalisation et la chronologie des traitements. Cependant, il apparait que le pronostic initialement calcule peut etre fausse, des lors qu’une ou plusieurs interventions chirurgicales ont ete effectuees sur le membre pathologique. Objectif Le but de cette etude est de definir les differents types de reponse de croissance que peut presenter un segment osseux apres un allongement progressif, dans le cadre des inegalites de longueur d’origine congenitale. Patients et methodes Nous avons analyse de maniere retrospective une serie de 114 allongements progressifs par fixateur externe, realises chez 36 filles et 50 garcons, ayant tous une inegalite de longueur des membres inferieurs d’origine congenitale. Nous avons mesure les vitesses de croissance des segments osseux avant l’allongement, puis durant la premiere annee suivant l’ablation du fixateur et enfin a long terme, en calculant les longueurs radiologiques osseuses rapportees au nombre de mois entre deux mesures de longueur. Le recul moyen est de 4,54 ± 0,2 ans. Resultats Les modifications des vitesses de croissance a court et long terme ont permis de mettre en evidence cinq types differents de comportement osseux apres un allongement progressif, allant de l’acceleration de la croissance jusqu’a l’arret definitif de celle-ci. Discussion Ces cinq types de croissance osseuse residuelle sont sous la dependance de certains facteurs qui conditionnent l’acceleration ou au contraire le ralentissement de la croissance. Il s’agit de l’âge au moment de l’allongement, du pourcentage d’allongement et du delai minimal entre deux allongements. La connaissance de ces criteres permet d’optimiser les conditions de reprise de croissance apres un allongement segmentaire progressif, tout en evitant celles qui risquent d’entrainer un ralentissement ou un arret de la croissance du segment allonge. Il s’agit d’une aide a la planification d’un programme d’allongement, lorsque celui-ci est iteratif. Niveau de preuve Niveau IV etude retrospective.

Resume Introduction La chirurgie d’allongement des os longs par methodes chirurgicales progressives est a l’origine de frequentes complications. Des auteurs ont classe ces complications soit de facon descriptive, soit selon leur date de survenue par rapport a l’operation, soit selon leur gravite. La classification de Caton (1985) a eu le merite d’apporter la notion de contrat et d’objectif a atteindre dans le traitement. Dans le cadre de l’information preoperatoire delivree aux patients et a leur famille, ce contrat peut etre ameliore en y ajoutant une notion de duree maximale du traitement. Le but de ce travail est donc de proposer une classification qui integre le respect d’un triple contrat associant le gain d’allongement planifie, la duree du traitement et la survenue de sequelles. Materiel et methode Notre classification des complications comprend quatre grades : grade I = triple contrat respecte incluant quelques traitements sans anesthesie generale ; grade II = triple contrat respecte au prix d’interventions sous anesthesie generale non planifiees ; grade III = la notion de temps n’est pas respectee parce que le delai pour obtenir la consolidation osseuse a ete trop long ou parce que le programme a ete interrompu ; grade IV = des sequelles sont presentes. Cette classification est evaluee a partir d’une serie consecutive de 34 procedures chirurgicales chez 32 patients (deux patients ayant subi deux allongements durant cette periode) au niveau de 43 segments osseux associant des allongements progressifs par fixateur externe ou par clou d’allongement. Le grade de chaque complication a ete determine par chacun des auteurs selon la classification proposee ici et d’autres classifications de la litterature (Caton, Paley, Popkov, et Donnan). Resultats Environ un tiers (dix) des 34 allongements n’a presente aucune complication. Deux tiers (24) ont presente 30 complications. Un consensus a ete obtenu entre tous les auteurs sur les grades proposes pour notre classification et celle de Caton, ce qui ne fut pas le cas avec les autres classifications dont une partie de l’interpretation est subjective (Paley, Popkov, et Donnan). Discussion La classification proposee s’attache au respect d’objectifs fixes lors d’une chirurgie d’allongement des membres selon un triple contrat : « gain–duree–fonction ». Elle est fiable et reproductible par des operateurs differents car les criteres de choix sont de nature objective. Elle est egalement applicable a des techniques chirurgicales diverses, qu’il s’agisse de fixateurs externes et/ou d’osteosyntheses internes. Niveau de preuve avec le type de l’etude IV : retrospectif ou serie historique.

Summary Background and purpose Diaphyseal and metaphyseal fractures in children are frequently treated with the flexible intramedullary nailing (FIN) method. The aim of this study was to record postoperative complications and outcome in consecutive fracture patients treated with the new precurved tip and shaft nails and dedicated ergonomic instrumentation. Methods We report the analysis of 100 consecutive fractures followed up for a minimum of 6 months. Ninety-seven children were included, comprising 77 shaft and 23 metaphyseal fractures. Demographic data, duration of surgery, nail and medullary canal diameter, date of nail removal, clinical assessment, follow-up radiographs and all complications were recorded. Results Mean age was 9.7 years, and mean body weight 35.1 kg. Twenty-one fractures had associated lesions. Mean duration of surgery was 42.4 minutes. Nail removal was at a mean 6.1 months. Twelve percent of patients had complications, with six insufficient reductions, one delayed union, one non-union, one iterative fracture, and three skin impingements. Unexpected surgical revision was required in seven cases. At follow-up, only one patient showed functional impairment, with 20° pronation loss, and three showed more than 10° axial deviation on X-ray. Conclusion The low rate of skin impingement compared with the literature may be due to the new dedicated instruments. We believe that other complications can be avoided if one follows the FIN principles, avoiding weak assembly due to an insufficient nail/medullary canal diameter ratio, which is a limiting factor for indications in adolescents. The surgeons reported that precurved shaft nails facilitated the FIN procedure, although this subjective judgment may be due simply to the novelty of the nails. Level of evidence Level IV. Retrospective study.

Resume Introduction Les fractures diaphysaires et metaphysaires chez l’enfant sont frequemment osteosynthesees par un embrochage centromedullaire elastique stable (ECMES). Le but de ce travail est d’evaluer les complications postoperatoires et les resultats d’une serie de fractures traitees avec de nouveaux clous prebequilles et precintres et l’utilisation d’une instrumentation ergonomique dediee. Patients/methode Nous rapportons 100 fractures consecutives suivies pendant un minimum de six mois. Quatre-vingt-dix-sept patients ont ete inclus comprenant 77 fractures diaphysaires et 23 metaphysaires. Les donnees demographiques, la duree operatoire, le diametre des clous (DC) et du canal medullaire (DCM), la date d’ablation des clous, l’evaluation clinique et les controles radiographiques ainsi que les complications ont ete enregistres. Resultats L’âge moyen etait de 9,7 ans, le poids moyen de 35,1 kg. Vingt et une fractures presentaient des lesions associees. La duree operatoire moyenne etait de 42,4 minutes. Les clous ont ete enleves en moyenne a 6,1 mois. Douze pour cent des patients ont presente une complication incluant six reductions jugees insuffisantes, un retard de consolidation, une pseudarthrose, une refracture et trois lesions cutanees sur clous. Une reintervention chirurgicale non attendue a ete necessaire sept fois. Au recul, un seul patient avait une diminution de fonction avec une perte de 20° de pronation pour une fracture de l’avant-bras, et trois patients presentaient un cal vicieux radiographique superieur a 10° (deux humerus et un tibia). Discussion Compare avec la litterature, le faible taux de lesions cutanees est a rapprocher de l’instrumentation dediee. Les autres complications devraient etre evitables en respectant les principes de la technique ECMES, en eliminant les erreurs de construction de montage et en observant un rapport DC/DCM suffisant qui est un facteur limitant l’indication de l’ECMES chez l’adolescent. Pour les chirurgiens utilisateurs, le precintrage des clous a facilite le geste chirurgical, mais ce critere subjectif peut-etre du a la nouveaute de la forme des implants. Niveau de preuve Niveau de preuve avec le type de l’etude = IV : retrospectif ou serie historique.

Stiff knee gait is common among children with ambulatory cerebral palsy (CP). When surgery is indicated, rectus femoris transfer as a primary treatment enhances knee range of motion, reduces time to peak knee flexion, increases peak knee flexion, and reduces toe drag.We determined whether (1) distal rectus femoris transfer improved knee range of motion, time to peak knee flexion, peak knee flexion, and toe drag in children with CP diagnosed with stiff knee gait; and (2) patients in some subgroups (eg, those with relatively high knee range of motion compared with those with low knee range of motion before rectus femoris transfer) had greater improvement in these parameters.We retrospectively reviewed gait data from 56 patients (99 limbs) preoperatively, short-term, and long-term. Subgroup analyses were performed to determine whether patients with high knee range of motion relative to those with low or moderate knee range of motion improved differentially after rectus femoris transfer. The minimum followup was 7 years (mean ± SD, 10 ± 2 years; range, 7-13 years).The mean peak knee flexion increased from baseline to short-term and to long-term followup. Patients with low peak knee flexion had the greatest improvement of peak knee flexion after rectus femoris transfer relative to the moderate and high peak knee flexion subgroups. Similarly, the greatest improvement after rectus femoris transfer for knee range of motion occurred in the low knee range of motion subgroup relative to moderate and high subgroups. Rectus femoris transfer improved mean time to peak knee flexion at short-term and long-term followup compared with baseline. Likewise, there was a decrease in toe drag at short- and long-term after rectus femoris transfer.Distal rectus femoris transfer selectively improved peak knee flexion, toe drag, and reduced time to peak knee flexion in ambulatory children with CP with stiff knee gait.Level IV, therapeutic study. See guidelines for authors for a complete description of levels of evidence.

Background The aim of this study was to evaluate the influence of the external fixation associated with intramedullary nailing on the healing index in limb lengthening.

Background Upper-extremity movement is limited in individuals with muscular weakness. This paper describes a novel, articulated upper-extremity orthosis, the Wilmington Robotic Exoskeleton (WREX), which helps people overcome this movement deficit. Methods This prospective, case-controlled study involved an ambulatory patient with arthrogryposis multiplex congenita and 2 nonambulatory patients with spinal muscular atrophy type II. The WREX uses elastic bands to negate the effects of gravity; it allows a person with neuromuscular weakness to move their arm in 3 dimensions. The WREX can be fixed on a brace for ambulatory patients and on the wheelchair for nonambulatory patients. Assessment was performed through motion analysis (with and without the WREX), clinical examination, and qualitative questionnaire. Results Motion analysis showed a marked improvement in upper-extremity function with the WREX. The questionnaire illustrated enhanced functionality with the WREX including self-feeding, fine motor control, and use of a television remote control. Enhanced functionality resulted in improved quality of life by increasing participation in school, raising self-esteem, and increasing social interaction. Two unexpected outcomes were increased security with trunk inclination and amelioration of the effects of contractures. Conclusions The WREX provided an increase in functionality and improved the quality of life of the patients. The device has become an integral part of the lives of the 3 patients. Level of evidence Level III in Therapeutic Studies-Investigating the Results of Treatment.

Resume Introduction Afin d’evaluer le traitement chirurgical par ponction-lavage seul des arthrites septiques de hanche de l’enfant, nous avons analyse les resultats d’une serie retrospective. Patients et methodes Quarante-trois arthrites septiques de hanche ont ete traitees par une ponction-lavage articulaire sous anesthesie generale, associee a un traitement antibiotique intraveineux puis per os. Nous avons etudie les criteres cliniques et biologiques a l’entree, ainsi qu’au cours de l’hospitalisation et au plus long recul, afin d’extraire des criteres predictifs eventuels de l’inefficacite du lavage articulaire. Resultats Dans cette serie, 38 hanches ont evolue favorablement, alors que cinq hanches ont necessite une reprise chirurgicale par arthrotomie, pour un lavage iteratif. Les criteres retrouves en commun dans le groupe des hanches reprises chirurgicalement etaient un delai de prise en charge tardif superieur ou egal a six jours, et des elements biologiques initiaux, avant tout traitement tres perturbes. Un seuil predictif a pu etre extrait, telle que la C Reactive Proteine superieure a 100, une polynucleose superieure a 15 000 et une vitesse de sedimentation au-dela de 25 a la premiere heure et 50 a la deuxieme heure. Discussion Les modalites du traitement des arthrites de hanche chez l’enfant restent controversees et les differentes techniques montrent toutes leur efficacite dans la litterature. La moins agressive d’entre elle, la ponction-lavage a fait la preuve de ses bons resultats, meme pour les hanches, malgre l’emboitement serre de cette articulation, reputee difficile a laver. Les criteres pronostiques sont particulierement difficiles a mettre en evidence, et tous les auteurs s’accordent sur le delai tardif de prise en charge, rendant l’evacuation des debris intra-articulaires difficile. Conclusion On peut admettre l’efficacite de la ponction-lavage dans les arthrites septiques de hanche, a condition d’en respecter les principes. Le retard therapeutique et certains criteres biologiques doivent etre pris en compte dans le choix de la technique lorsqu’ils sont presents, puisque cinq hanches presentant tous les criteres pejoratifs definis dans l’etude ont necessite une arthrotomie secondaire. Niveau de preuve IV.

Summary Introduction In case of hindfoot pain, diagnosis of calcaneonavicular tarsal coalition may be missed on X-ray due to the absence of any visible synostosis. All other possible etiologies (too-long anterior process (TLAP) of the calcaneum, synchondrosis, syndesmosis) must be investigated. The literature tends to recommend imaging associating standard X-ray and CT, and possibly bone scintigraphy. MRI is, however, also worth assessing, due to the many non-osseous forms calcaneonavicular pain may take. Material and methods Thirty-two cases of surgically treated calcaneonavicular tarsal coalition were studied. Nineteen cases, in 14 children, over a 10-year period, showed no visible synostosis on initial standard X-ray. In seven cases, bone scintigraphy was performed, CT in seven and MRI in 12. On the basis of the literature, our attitude was in favor of X-ray associated to CT in our early experience. Repeated diagnostic difficulties, however, led us to replace CT by MRI in case of foot pain combined to symptomatology suggestive of coalition. Results The series comprised four cartilaginous forms, four fibrous forms and eight TLAPs. In 10 of the 19 feet, radiology was strictly normal, the others showing indirect osseous signs. Only three of the seven scintigraphies showed hyperfixation. CT-scan enabled diagnosis in seven cases (two synchondroses and five rudimentary forms), and missed diagnosis in four (two cartilaginous and two fibrous forms). Second intention MRI showed two synchondroses and two syndesmoses. In the light of these 11 cases, a subsequent series of eight feet was assessed by MRI in first intention, obtaining systematic diagnosis. In all the feet of the series, the symptomatic coalition was treated by surgery, allowing peroperative findings to be compared with the imaging data. Discussion Given a rigid and painful foot syndrome suggestive of tarsal coalition, two diagnostic situations arise: (a) the clinical aspect is suggestive and standard X-ray enables diagnosis; (b) the clinical aspect is suggestive, but radiography proves non-contributive, in which case we recommend MRI with sagittal, frontal and axial slices in gadolinium-enhanced T1-weighted and fat-sat T2-weighted sequences, revealing direct (cartilaginous or fibrous coalition) or indirect signs (peripheral inflammation, osteomedullary edema, chondral lesion) unobtainable on CT scans. MRI is particularly effective in as much as most of the children concerned will not have reached bone maturity. Conclusion We consider MRI to be the most effective means of precise diagnosis (causes and consequences) of tarsal coalition, especially for calcaneonavicular locations. It entails minimal invasion and irradiation, at a lower cost than CT associated to scintigraphy. Level of evidence IV. Diagnostic study.

Resume Introduction En presence d’une symptomatologie calcaneo-naviculaire douloureuse, la radiographie peut etre prise en defaut par l’absence de synostose visible. Or toutes les autres causes de douleurs (bec calcaneen long, synchondrose, syndesmose) doivent etre identifiees. La litterature est en faveur d’un bilan d’imagerie associant radiographie standard-TDM ± scintigraphie osseuse. L’interet de l’IRM merite d’etre etudie en raison des nombreuses formes non osseuses de cette pathologie. Materiel et methodes Nous avons etudie 32 cas de coalition tarsienne calcaneo-naviculaire operee. Parmi elles, nous en avons retenu 19 sans synostose visible sur la radiographie standard initiale chez 14 enfants, sur une periode de dix annees. Nous avons eu recours sept fois a la scintigraphie osseuse, 11 fois a la tomodensitometrie et 12 fois a l’IRM. La sequence radiographie et tomodensitometrie a ete preferee au debut de notre experience, en accord avec les donnees de la litterature. C’est au fil des cas et des difficultes diagnostiques rencontrees que notre attitude a change vis-a-vis d’un pied douloureux a la symptomatologie evocatrice d’une coalition. Nous avons alors abandonne la tomodensitometrie au profit de l’IRM. Resultats La serie se compose de sept formes cartilagineuses, quatre formes fibreuses et huit becs calcaneens longs. Parmi les 19 radiographies realisees, dix etaient strictement normales, les autres ont montre des signes indirects de souffrance osseuse. Sur les sept scintigraphies realisees, seules trois ont montre une hyperfixation. La tomodensitometrie a permis le diagnostic positif dans sept cas correspondant a deux synchondroses et cinq formes rudimentaires. Elle a ete prise en defaut quatre fois (deux formes cartilagineuses et deux formes fibreuses). L’IRM effectuee en seconde intention chez ces patients a permis la mise en evidence de deux synchondroses et deux syndesmoses. C’est a la suite de ces 11 cas que nous avons realise une serie complementaire de huit pieds ou l’IRM a ete realisee d’emblee et a toujours apporte le diagnostic. Tous les pieds de la serie ont fait l’objet d’une cure chirurgicale de la coalition symptomatique, permettant la confrontation des donnees peroperatoires aux donnees de l’imagerie. Discussion Face a un syndrome douloureux evoquant une coalition tarsienne, nous avons retenu deux cas de figure : (a) la situation clinique est evocatrice et la radiographie standard fait le diagnostic ; (b) la situation clinique est evocatrice mais la radiographie est non contributive, nous preconisons la realisation d’une IRM, avec des coupes sagittales, frontales et axiales en sequences T1 avec injection de gadolinium et T2 en saturation des graisses, revelant alors des signes directs (bandes cartilagineuses, bandes fibreuses…) et indirects (inflammation peripherique, œdeme osteo-medullaire, lesions cartilagineuses…) non visibles au scanner. L’IRM est d’autant plus efficace que la majorite des enfants concernes n’ont pas atteint la maturite osseuse. Conclusion L’IRM est donc a notre sens l’examen le plus performant au diagnostic precis (causes et consequences) des coalitions tarsiennes, et en particulier pour les localisations calcaneo-naviculaires. Elle est peu invasive, non irradiante, et de cout inferieur au couple TDM/scintigraphie. Niveau de preuve III.

Sports injuries are common in children and adolescents. Typical musculoskeletal disorders include overuse injuries such as stress fractures and apophyseal avulsions. Gymnastics has one of the highest injury rates of all girls' sports. Intensive gymnastics can cause chronic spine and wrist trauma. Prevention of sport injuries should be a priority for parents, coaches and children themselves. Protection (helmet, padding) is mandatory for some activities. Proper education and preparation are necessary for all sports activities.

Resume Introduction Lors de l’allongement progressif des membres inferieurs dans la maladie d’Ollier, l’index de consolidation ( healing index [HI]) generalement decrit dans la litterature se situe aux alentours de 35 jours/cm. Un des objectifs therapeutiques est de diminuer la duree du port du fixateur externe. Hypothese L’utilisation d’un embrochage centromedullaire elastique stable (ECMES) associe au fixateur externe circulaire diminue de facon significative l’HI. Patients et methodes Deux groupes de patients ont ete compares. Dans le groupe I, sept patients ont ete operes d’un allongement progressif par fixateur externe circulaire associe a un ECMES : quatre allongements monosegmentaires du femur, un allongement monosegmentaire du tibia et deux allongements polysegmentaires femorotibiaux. L’embrochage consistait en l’utilisation de deux clous intramedullaires deja utilises en traumatologie. La date d’ablation du fixateur externe coincidait avec la date de la consolidation radiologique. Les clous etaient laisses en place. Le groupe II comprenait 37 patients qui ont eu un allongement osseux par le seul fixateur externe. Pour les deux groupes, l’HI a ete calcule et les complications ont ete etudiees. Resultats Les valeurs moyennes de l’HI etaient : dans le groupe I : 23,3 jours/cm pour le femur, 22,4 jours/cm pour le tibia et 11,6 jours/cm pour les cas polysegmentaires. Dans le groupe II : 31,6 jours/cm pour le femur, 35,7 jours/cm pour le tibia et 19,9 jours/cm pour les cas polysegmentaires. La diminution de HI dans les cas du groupe I etait statistiquement significative pour les allongements femoraux monosegmentaires. Conclusion Les avantages de l’association du fixateur externe circulaire avec un ECMES dans la maladie d’Ollier sont la diminution reelle de la duree du fixateur externe, la diminution des complications postoperatoires et la prevention de fractures pathologiques ulterieures. Niveau de preuve Niveau III, etude retrospective comparative.

Summary Purpose of the study Bone tumours are frequent conditions in children, and their surgical resection may lead to extensive defects which reconstruction is often challenging. Indeed, local conditions do not promote bone healing, and the achieved surgical result requires to be life-lasting. Capanna suggested a reconstruction technique combining massive allograft and free vascularized fibular flap. The first one is intended to withstand mechanical stress, and the second one offers biological and vascular support to improve bone healing and prevent infections. Materiel and methods We report our experience with this technique when applied to the lower limb in a prospective study including seven children, with a mean follow-up of 44 months. Results Bone healing was achieved by one single procedure in 85.7% of the cases, usually 7 months after surgery. Six out of seven patients achieved a final and long-lasting outcome, five of them following a simple surgical history. Partial weight-bearing was post-operatively allowed at about 2 months, full weight-bearing was initiated at about 5.5 months. Discussion A low complication rate was reported despite the extent of the disease and the type of the surgical procedure. Capanna's combined reconstructive technique appears very efficient in the management of massive bone defects following tumour resection in children's lower limb. Level of evidence Level IV. Retrospective therapeutic study.

Resume Introduction L’exerese des tumeurs osseuses de l’enfant peut entrainer des pertes de substance osseuse etendues, dont la reconstruction est difficile. En effet, les conditions locales sont peu favorables a la consolidation et le resultat obtenu doit si possible etre perenne. Capanna a propose une technique combinant une allogreffe massive, qui assume les contraintes mecaniques, associee a un transfert de fibula vascularisee libre, qui apporte une meilleure resistance a l’infection et ameliore la consolidation osseuse. Patients et methodes Nous rapportons notre experience de cette technique appliquee au membre inferieur sur une serie prospective homogene de sept patients pediatriques a un recul moyen de 44 mois. Resultats La consolidation a ete obtenue per primam dans 85,7 % des cas et cela en sept mois habituellement. Six patients sur sept ont atteint un resultat final qui peut etre considere comme durable et cinq d’entre eux avec un parcours chirurgical relativement simple. L’appui partiel a ete autorise aux alentours du second mois. Discussion Le taux de complications osseuses est relativement faible en regard du terrain et de la lourdeur de ce type de chirurgie. Cette technique combinee de reconstruction constitue un apport non negligeable pour le traitement des pertes de substance osseuses etendues des membres inferieurs chez l’enfant.

Detachment of the proximal epiphyseal plate of the femur is a rare observation in infants. The context usually involves obstetrical injury or child abuse. There is however a high risk in certain children with epilepsy. Fractures and dislocations can occur during hypertonic seizures in a context of iatrogenic bone weakening due to drug treatments. Emergency reduction is required and requires a double fixation with osteosynthesis and plaster cast in order to reduce the risk of secondary displacement in this particular context. The risk of major impact on growth requires prolonged radiographic and clinical follow-up.

Idiopathic scoliosis (IS) is correlated with a muscular disequilibrium of the spine and an alteration of balance control, efficient performance of the latter being necessary for physical and sporting activities (PSA). However, the type of the IS curve has different effects on muscle and on balance control according to the primary curve location. This study aimed to determine the relationships between IS type and PSA practice. One hundred and sixty-nine girl adolescents with IS [double major curve (DMC) scoliosis: n=74; single major curve (SMC) scoliosis: n=95] and 100 age-matched control girl adolescents completed an epidemiological questionnaire informing on curricular and extracurricular PSA. Adolescents with DMC scoliosis practised more PSA than those with SMC scoliosis. Moreover, among all PSA referenced, gymnastic activities are the most practiced PSA both in IS teenagers, whatever the curve type, and in controls. Besides, teenagers practising gymnastics were more numerous in those with DMC scoliosis than those with SMC scoliosis and controls. The highest proportion of adolescents with DMC scoliosis practising PSA, especially gymnastics, could be linked to the fact that they are less subject to scoliosis-related biomechanical repercussions leading to a better balance control, which is essential in these PSA.

Summary Introduction Various studies have found that 6.6 to 31% of supracondylar elbow fractures in children have nerve-related complications. One-third of these are cases of anterior interosseous nerve (AIN) palsy that usually result in a deficit of active thumb and index flexion. The goal of this cadaver study was to describe the course of the AIN to achieve a better understanding of how it may get injured. Materials and methods On 35 cadaver specimens, the median nerve and its collateral branches destined to muscles were dissected at the elbow and forearm levels. The distance at which the various branches arose was measured relative to the humeral intercondylar line. Interfascicular dissection of the AIN was used to map its distribution within the median nerve. Results The AIN arises at an average of 45 mm from the humeral intercondylar line. Before emerging from the median nerve, the AIN fascicles were always found in the dorsal part of the median nerve. After emerging, the AIN was divided into two zones. Zone 1 was the transitional portion from its exit point until its entrance into the interosseous space, where it changes direction. Zone 2 was the interosseous portion between the radius and ulna that comes into contact with the anterior interosseous membrane to which it is attached over its entire length until it ends in the pronator quadratus (PQ) muscle. The muscle branches of the AIN destined for the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) muscles mostly originated in Zone 1, which is the transitional portion between the median nerve and the fixed Zone 2. The branches destined to the pronator teres (PT) and flexor carpi radialis (FCR) originating from the median nerve are more proximal and superficial. Discussion The injury mechanisms leading to selective AIN palsy secondary to supracondylar elbow fracture in children are probably the result of two factors: direct contusion of the posterior aspect of the median nerve, and thereby the AIN fascicles, by the proximal fragment; stretching of AIN in Zone 1, which has less ability to withstand stretching than the median nerve and its other branches because the AIN is fixed in Zone 2. Conclusion Details about the origin and course of the AIN can explain the high percentage of AIN palsy in supracondylar elbow fractures in children. Level of evidence Level IV. Anatomic study.

Background The purpose of this study was to evaluate the efficacy of Pavlik harness treatment in patients with bilaterally dislocated Graf type IV hips and compare them to cases with unilaterally dislocated hips. Methods Twenty-one patients (42 hips) who presented with bilaterally dislocated hips with no prior treatment were studied. The comparison group consisted of 33 patients (33 hips) with unilateral hip dislocation treated with the same protocol. Successful treatment was defined as relocation of the hips within 3 weeks of Pavlik harness application. Results Twelve of 21 patients (57%) in the bilateral group (6 failed bilaterally, 6 unilaterally) and 18/33 patients (54.5%) in the unilateral group failed harness treatment. Conclusions The use of the Pavlik harness in dislocated hips is associated with a high failure rate. Patients presenting with bilaterally dislocated hips however, are at no greater risk for failure than patients presenting with unilateral hip dislocation. Level of evidence Level III.

Background While several studies have evaluated the short-term effectiveness of conservative and surgical treatment of flexed-knee gait in children with cerebral palsy (CP), few have explored the long-term outcomes using gait analysis. The purpose of this study was to examine, through gait analysis, the 10-year outcomes of flexed-knee gait in children with CP. Methods Ninety-seven children with spastic CP who walked with a flexed-knee gait underwent two gait evaluations [age 6.1 ± 2.1 and 16.2 ± 2.3 years, Gross Motor Function Classification System (GMFCS) I (12), II (45), III (37), IV (3)]. Limbs with knee flexion at initial contact >15° were considered walking with a flexed-knee gait and were included in the study ( n = 185). Kinematic data were collected using an eight-camera motion analysis system (Motion Analysis, Santa Rosa, CA). Surgical and therapeutic interventions were not controlled. Results A comparison between the two gait studies showed an overall improvement in gait at 10 years follow-up. Significant improvements were seen in knee flexion at initial contact, Gait Deviation Index (GDI), Gross Motor Function Measure (GMFM), and gait speed ( P < 0.01 for all). Outcome was also evaluated based on the severity of flexed-knee gait at the initial visit, with functional skills and overall gait (GDI) improving in all groups ( P < 0.01 for all). The group with a severe flexed-knee gait exhibited the most improvement, while subjects with a mild flexed-knee improved the least. Conclusions Children at a specialty hospital whose orthopedic care included gait analysis and multi-level surgery showed improvement of flexed-knee gait and gross motor function over a 10-year course, regardless of the initial severity.

Purpose Distal femoral fractures are quite common in nonambulating patients with myopathies, as they present marked osteoporosis. The deterioration of preexisting knee flexion contracture is a known problem, as these fractures are usually angulated posteriorly. The goals of treatment are to reduce immobilization and bed rest to a minimum, prevent function loss, and prevent refracture. The aim of our work was to investigate if these goals can be achieved by an operative treatment with closed reduction and flexible intramedullary nailing (FIN). Methods Six distal femoral fractures in four nonambulating patients with myopathies (three Duchenne muscular dystrophy and one nemaline myopathy) were treated with FIN between 2005 and 2011. Patient charts and radiographs were reviewed to determine if intra- or postoperative complications occurred and to detect the interval to wheelchair mobilization and hospital discharge. Pre- and postoperative knee flexion contracture was noted from the patient charts of our reeducation unit, where patients were already known preoperatively. Results Wheelchair mobilization without further immobilization after an interval of 2–3 days was possible. No aggravation of knee flexion contracture was detected in our patient series. No complications associated to the operative treatment itself and no refractures in the follow up occurred. Conclusion Our experience showed that FIN is a low invasive and sufficiently stable osteosynthesis in such fractures. Left in place, nails will reinforce mechanical stability.

Sports injuries are common in children and adolescents. Typical musculoskeletal disorders include overuse injuries such as stress fractures and apophyseal avulsions. Gymnastics has one of the highest injury rates of all girls' sports. Intensive gymnastics can cause chronic spine and wrist trauma. Prevention of sport injuries should be a priority for parents, coaches and children themselves. Protection (helmet, padding) is mandatory for some activities. Proper education and preparation are necessary for all sports activities.

Summary Introduction The issue of prognosis in limb length discrepancy in children affected by congenital abnormality remains a subject of concern. Therapeutic strategy must take length prediction into account, to adapt equalization techniques and the timing of treatment. Initial prognosis, however, may need revising after completion of one or several surgical interventions on the pathologic limb. The aim of this study was to determine the different types of growth response that a bone segment can present after progressive lengthening in case of congenital limb length discrepancy. Materials and methods A series of 114 bone lengthenings with external fixator, performed in 36 girls and 50 boys with congenital lower limb length discrepancy, was retrospectively analyzed. Bone segment growth rates were measured before lengthening, during the first year after frame removal and finally over long-term follow-up, calculating the ratios of radiological bone length to the number of months between two measurements. Mean follow-up was 4.54 ± 0.2 years. Results Changes in short- and long-term growth rate distinguished five patterns of bone behavior after lengthening, ranging from growth acceleration to total inhibition. Discussion These five residual growth patterns depended on certain factors causing acceleration or, on the contrary, slowing down of growth: age at the lengthening operation, percentage lengthening, and minimal period between two lengthenings. These criteria help optimize conditions for resumed growth after progressive segmental lengthening, avoiding conditions liable to induce slowing down or inhibition, and providing a planning aid in multi-step lengthening programs. Level of evidence Level IV. Retrospective study.

Study design Cross-sectional study. Objective To evaluate whether the amplitude of spine deformation in adolescent idiopathic scoliosis (AIS) is an important factor for postural control at disease onset. Summary of background data AIS is related to disorders of postural control with potential involvement of vestibular, proprioceptive, and visual input. So far no assessment of postural control has been done in an AIS population at the onset of spine deformation. Methods Sixty-five female patients with AIS (mean age: 11.4 ± 2.3 years) were clinically and radiologically assessed at the time of diagnosis and evaluated in posturography, including static tests-with and without sensory conflict-and dynamic tests. Two groups were formed according to the mean Cobb angle of the primary curve. Results The mean Cobb angle was 14.8° ± 5.1°; 35 patients were included in group I with a Cobb angle of 5° to 14°, and 30 patients into group II with a Cobb angle of 15° to 25°. The latter group displayed higher body sways in static tests, characterized by a larger area covered by center of foot pressure in both eyes open and eyes closed conditions, and by higher lateral oscillations in only the eyes closed condition. Group II patients displayed poorer balance control, mainly in visual and somatosensory conflict conditions. Group II patients used fewer anticipatory strategies to stabilize body oscillations than Group I patients, especially in the more challenging sensory conflict and dynamic situations. Conclusion Poorer postural performance, especially in sensory conflict situations, observed in patients with a Cobb angle greater or equal to 15°, reflect less effective central information processing.

Background: The aim of this study is to evaluate the influence of the external fixation associated with flexible intramedullary nailing (FIN) on the healing index (HI) in limb lengthening. Methods: We compared the healing index between 2 groups of children undergone the lengthening of upper and lower limbs carried out with the Ilizarov external fixator alone (group I, 194 cases of lengthening) or with the combination of the Ilizarov external fixator and intramedullary nailing (group II, 92 cases). Two nails of the diameter from 1.5 to 2.0 mm with the ray of curvature about 40 degrees to 50 degrees were used for the intramedullary nailing. Results: The HI was less in every subgroup of Group II compared with Group I. A significant difference was noted in congenital pathologies: monofocal monosegmental lengthening at the level of femur and forearm, bifocal lengthening of the tibia, polysegmental lengthening; and in acquired discrepancy: monofocal tibial lengthening, bifocal femoral lengthening, and the forearm lengthening. The reduction of HI was between 60% and 85% in congenital pathologies: monosegmental femur and forearm, bifocal femur and tibia lengthening; and in acquired discrepancy: femur, tibia, humerus and forearm monosegmental lengthening, humerus and tibia bifocal lengthening, and polysegmental in upper and lower limbs. This difference varies from 1.9 days/cm to 19.1 days/cm. That means that the duration of the external fixator was decreased of 20% to 33% of the number of days between the Group I and the Group II. Maximum diminution of HI was noted for monofocal acquired forearm cases (51.3%) and bifocal acquired femoral lengthening cases which (59.9%). Conclusions: The flexible intramedullary nailing allows adding multiple advantages to the method of limb lengthening with the external fixator. Correctly applied the FIN indeed respects the bone biology that is essential during the limb lengthening. The major effect of application of the combination of Ilizarov frame fixation with FIN is a significant decrease of duration of the external osteosynthesis. Level of Evidence: II.

International audience; Colon interposition is the method of choice to restore the digestive tract after esogastrectomy. The aim of this study was to compare the length of the four available routes for colon transposition (posterior mediastinum route, transpleural route, substernal route and subcutaneous route) and to achieve a specific evaluation of the transpleural route. Our study was conducted with anatomical (dissection) and radiological (2D CT scan reconstructions) protocols. For both, the posterior mediastinum route was always the shortest way and the subcutaneous route was always the longest. For the anatomical results, the transpleural route and the substernal route were similar in terms of length and for the radiological study, the transpleural route was shorter than the substernal route (P < 0.001) and shorter than the subcutaneous route (P < 0.001). We demonstrated that the transpleural route was acceptable for colon transposition in term of length, and could be an alternative when the substernal route is unavailable.

Summary Introduction During progressive lower limb lengthening in the management of Ollier's disease, the mean bone-healing index usually reported in the literature stands around 35 days/cm. One of the therapeutic objectives is to reduce the duration of the external fixation. Hypothesis The use of an elastic stable intramedullary nailing system (ESIN) combined with a circular external fixator significantly reduces the healing index. Material and methods Two groups of patients were compared. In group I, seven patients were operated on for progressive limb lengthening using a circular external fixator associated with an ESIN system: four monosegmental femoral lengthenings, one monosegmental tibial lengthening and two polysegmental femorotibial lengthenings. Nailing was performed via two intramedullary nails already used in traumatology. The date of external fixator removal coincided with that of radiographic healing. The nails were left in place. Group II included 37 patients who underwent limb lengthening by means of an external fixator only. The healing index was calculated and complications were analysed in both groups. Results The mean healing index (HI) values were: in group I: 23.3 days/cm for the femur, 22.4 days/cm for the tibia and 11.6 days/cm for polysegmental lengthenings ; in group II: 31.6 days/cm for the femur, 35.7 days/cm for the tibia and 19.9 days/cm for polysegmental lengthenings. Group I demonstrated a statistically significant decrease in the HI for monosegmental femoral lengthenings. Conclusion A substantially reduced duration of external fixation, limited postoperative complications and prevention of later pathologic fractures are the reported advantages of the associated use of a circular external fixator with an ESIN system in the management of Ollier's disease. Level of evidence Level III, comparative retrospective study.

UNLABELLED: Elastic stable intramedullary nailing (ESIN) has became a well-accepted method of osteosynthesis of diaphyseal fractures in children and adolescents for many reasons including the following: no need for postoperative cast, primary bone union with avoidance of growth plate injury, and minimum invasive surgery. OPERATIVE TECHNIQUE: The principle is to introduce 2 elastic nails, titanium or stainless steel, into the medullary canal through a metaphyseal approach. The bended nails must have their maximum of curve at the level of the fracture, and their orientation, most often face to face, is in charge of the reduction and, so far, the stabilization, of the fracture. The usual size of the nails is equal to 0.4 times the diameter of the medullary canal. As far as possible, a bigger diameter is better than a thinner one. Most fractures of the femur are treated with a bipolar retrograde ESIN when some distal fractures need an antegrade subtrochanteric approach. Forearm fractures need a combined retrograde radial and antegrade ulnar through the posterolateral part of the olecranon. Humerus and tibial diaphyseal fractures may also be treated with ESIN. Complications are mainly caused by technical errors including too-thin nails, asymmetry of the frame, and malorientation of the implants. Nonunion was never observed in fractures of the femur and the forearm; osteomyelitis rate is 2%, and mean overgrowth of the femur is less than 10 mm before the age of 10 years. Indications of ESIN are fractures of the diaphysis: all the fractures of the femur between the age of 6 years and the end of growth except for the severe open grade III fractures, all the unstable fractures of the forearm, and some unstable fractures of the humerus and the tibia during adolescence or before the end of growth. In addition, ESIN is indicated in polytraumatism and multiple injuries. CONCLUSIONS: The good results of this reliable technique are obtained when surgeons have a good knowledge of it, especially in the understanding of the principle of the correction of the fracture and its stability.

Introduction Nous presentons une serie de 10 cas d’osteomes osteoides, dont le diagnostic positif preoperatoire repose une sequence d’angio-IRM dynamique 3D. Materiel et methode Une serie prospective de 10 enfants presentant une suspicion d’osteome osteoide des os long a ete etudiee en IRM, selon une sequence particuliere angiographique dynamique. Dans tous les cas, les enfants avaient une symptomatologie et un aspect radiographique evocateurs, permettant de centrer l’examen. Celui-ci repose sur l’analyse de la vascularisation arterielle de la tumeur, vascularisation qui a une cinetique particuliere. De maniere a valider la methode, tous les enfants ont eu de facon concomitante, un reperage scannographique, et une scintigraphie osseuse au technetium 99. Resultats Dans tous les cas, le diagnostic preoperatoire d’osteome osteoide a ete evoque sur l’aspect caracteristique en IRM. Il a ete confirme par l’analyse histologique de la piece de resection dans tous les cas. L’aspect caracteristique est la visualisation du nidus au temps arteriel tres precoce (quelques millisecondes), avant que n’apparaisse le rehaussement inflammatoire peripherique. On peut ainsi determiner une courbe de vascularisation d’aspect typique d’un osteome osteoide. Discussion et Conclusion La courbe arterielle du nidus est caracteristique, et superposable dans tous les cas etudies, ce qui en fait un examen reproductible de maniere fiable. D’autre part, l’IRM permet un reperage tridimensionnel aise et une analyse precise des rapports anatomiques et de la reaction osseuse ou synoviale de voisinage. Cela dispense de la realisation d’un scanner complementaire. Enfin, cette methode non-irradiante est particulierement interessante dans les formes atypiques ou la symptomatologie inflammatoire predomine et/ou l’image du nidus est difficile a retrouver sur les radiographies comme dans le cas des osteomes osteoides para-articulaires. Ainsi, l’angio-IRM dynamique 3D est une methode simple, non irradiante, performante permettant de remplacer le scanner et la scintigraphie dans le depistage des osteomes osteoides.

Introduction Nous presentons une serie retrospective de 6 cas d’osteomyelite sclerosante de Garre observes dans notre service pendant la periode 1989-2006, afin d’analyser les aspects en imagerie (radiographie, scanner, IRM et scintigraphie), et de determiner des criteres diagnostiques specifiques de cette pathologie. Materiel et Methodes La serie comprend 3 localisations metaphyso-diaphysaires (2 humerus, 1 tibia), 1 localisation diaphysaire femorale et 2 atteintes des os plats (omoplate, clavicule). La symptomatologie a toujours ete douloureuse, de type inflammatoire. Tous les cas ont une exploration radiologique identique, comprenant des radiographies standards, une scintigraphie osseuse au technetium 99, une tomodensitometrie, et une IRM. Chaque localisation a ete etudiee avec tous ces examens, et le diagnostic a ete confirme a chaque fois par une biopsie chirurgicale. Resultats Tous les cas ont un aspect stereotype en imagerie standard et tomodensotometrique avec un remaniement cortical de type epaississement plurilamellaire et fibrillaire pseudonodulaire, comblant progressivement le canal medullaire, respectant le canal nourricier sans extension dans les parties molles. La scintigraphie est constamment hyperfixante, tres moderement au temps precoce, et plus intensement au temps tardif. Les parties molles presentent un aspect inflammatoire variable en IRM. Discussion et Conclusion Cette pathologie rare, d’etiologie indeterminee est actuellement classee dans les pathologies inflammatoires chroniques et pose principalement le probleme du diagnostic differentiel avec la tumeur d’Ewing et l’osteome osteoide. Les criteres radiographiques sont tres fortement evocateurs, meme s’ils ne sont pas suffisants, et ne permettent pas de se dispenser de biopsie. L’analyse anatomopathologique met en evidence une atteinte inflammatoire de type chronique de degre variable et seule une bonne connaissance des aspects radiologiques typiques de l’osteomyelite sclerosante de Garre permet de faire le diagnostic formel de cette pathologie, lorsque l’on confronte les criteres radiographiques et histologiques. Le traitement fait appel aux anti-inflammatoires non steroidiens.