Voluntary femoro-tibial subluxations: a benign differential diagnosis in the snapping knee of a child.

Purpose: Voluntary femoro-tibial subluxation is a rare entity predominantly found in pretoddlers. It presents as a dynamic phenomenon with uni- or bilateral audible snapping of the knee, often in a context of fatigue or irritation at the end of the day. The aim of the study was to observe the evolution and recovery in these patients.

Flexed-knee gait in children with cerebral palsy: a long-term follow-up study.

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.

[Osteoid osteoma on distal phalanx tip of second toe, without scintigraphy fixation].

Osteoid osteoma is a very small painful, benign tumor, located preferentially on long bones. Cases on the phalanxes of the toes are very rare. Pain takes up nearly all the clinical presentation.

ACL reconstruction in children: a transphyseal technique.

The annual incidence of ACL tears is increasing steadily in pediatric patients. Chronic anterior instability causes meniscal lesions at a frequency that increases significantly with the injury-to-surgery interval. Conservative therapy, simple suturing, and isolated extra-articular tendon reconstruction are associated with high failure rates.

Flexed-knee gait in children with cerebral palsy: a 10-year follow-up study.

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.

Idiopathic scoliosis: etiological concepts and hypotheses.

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).

The anatomical basis for anterior interosseous nerve palsy secondary to supracondylar humerus fractures in children.

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.

High failure rate of the Pavlik harness in dislocated hips: is it bilaterality?

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.

Flexible intramedullary nailing for distal femoral fractures in patients with myopathies.

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.

Flexible intramedullary nailing in children: nail to medullary canal diameters optimal ratio.

Background: Postoperative axial deviations and delayed unions are possible complications after flexible intramedullary nailing (FIN). The goals of this study were to determine if a correlation exists between occurrence of the above complications and the ratio of the diameter between nail and medullary canal [nail diameter (ND)/MCD ratio], to study the interobserver variability in the measurement of MCD, and to define a threshold to be respected to optimize the results.

Methods: Eighty-one consecutive diaphyseal fractures treated by means of FIN were evaluated.

Analysis of segmental residual growth after progressive bone lengthening in congenital lower limb deformity.

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.

Classification of complications after progressive long bone lengthening: proposal for a new classification.

Introduction: Long bone lengthening surgery using progressive surgical methods has been the source of frequent complications. Some authors have classified these complications either descriptively, according to the date of onset after the operation, or based on their severity. The Caton classification (1985) has had the virtue of contributing the notion of the treatment contract stipulating the objective to reach in treatment.

Visuo-oculomotor deficiency at early-stage idiopathic scoliosis in adolescent girls.

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.

Early complications with flexible intramedullary nailing in childhood fracture: 100 cases managed with precurved tip and shaft nails.

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.

Rectus femoris transfer improves stiff knee gait in children with spastic cerebral palsy.

Background: 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.

Questions/purposes: 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.

[Sports injuries and their prevention in childhood and adolescence].

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.

Wilmington robotic exoskeleton: a novel device to maintain arm improvement in muscular disease.

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.

Hip septic arthritis in children: assessment of treatment using needle aspiration/irrigation.

Introduction: This retrospective series evaluated the surgical treatment of hip arthritis in children by needle aspiration-irrigation alone.

Patients And Methods: Forty-three cases of septic hip arthritis were treated by needle aspiration-irrigation under general anesthesia associated with intravenous then oral administration of antibiotics. Clinical and biological criteria at admission, during hospitalization and at final follow-up were studied to identify any criteria carrying a predictive value for unsuccessful needle aspiration-irrigation.

Postural instability in early-stage idiopathic scoliosis in adolescent girls.

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.

Child calcaneonavicular coalitions: MRI diagnostic value in a 19-case series.

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.

Flexible intramedullary nail use in limb lengthening.

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.

Ollier's disease limb lenghtening: should intramedullary nailing be combined with circular external fixation?

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.

Is combining massive bone allograft with free vascularized fibular flap the children's reconstruction answer to lower limb defects following bone tumour resection?

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.

Anatomically based comparison of the different transthoracic routes for colon ascension after total esogastrectomy.

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.