Arthroscopic anterior cruciate ligament reconstruction in a patient with multiple hereditary exostoses.

Background Multiple hereditary exostoses (MHE) also known as Multiple Osteochondromas is a rare benign bone tumour disease, characterized by multiple osteocartilaginous masses. The knee is one of the most affected sites. Anterior cruciate ligament (ACL) surgery is the most common and generally most successful surgical knee procedure; however, the association between MHE and ACL reconstruction is very rare and may represent a challenging procedure because of the anatomical anomaly related to presence of multiple masses around the knee.

Trochanteroplasty to treat sequelae of septic arthritis of the hip in infancy. Case series and review of the literature.

The authors report a series of 11 patients treated surgically by trochanteroplasty for septic arthritis of the hip at our institution from 1974 to 2010. Trochanteroplasty was indicated due to the absence of a valid alternative, and because it does not rule out the option of total hip arthroplasty at a later stage.

A modified technique for reconstruction of the femoral neck in paediatric patients.

Hip deformities during early childhood following Perthes' disease, congenital dislocation or septic arthritis are not rare, causing limitation of motion and limping. A number of proximal femoral osteotomies to address residual deformities have been described, but the outcome has been variable. We describe a proximal femoral osteotomy aimed at restoring a more anatomic insertion of the gluteus medius.

Fractures of the proximal humerus in children.

Ninety-one children who had been treated for fractures of the proximal humerus (59 metaphyseal fractures; 32 epiphyseal fractures) from 1980 to 1992 at an average age of 10.7 years (range 3 to 14 years) were reviewed. In 82 cases a nonsurgical treatment (Desault bandage in 11 cases, hanging cast in nine cases, closed reduction and shoulder spica cast in 62 cases) was performed.

Trochanteric arthroplasty in the treatment of sequelae after septic arthritis of the hip in infancy.

The authors describe 17 patients submitted to trochanteric arthroplasty between 1979 and 1999 at the Division of Pediatric Orthopaedics and Traumatology of the Rizzoli Orthopaedic Institute. There were 9 females and 8 males aged from 1 to 8 years (mean of 4) affected with the sequelae of septic arthritis of the hip with complete destruction of the epiphysis and of the femoral neck (types IVB and V according to the Hunka classification system). Mean follow-up was 9 years (minimum 1, maximum 23).

Involvement of the skull base and vault in chronic idiopathic hyperphosphatasia.

Chronic idiopathic hyperphosphatasia (CIH) is a rare generalised skeletal dysplasia in childhood. The clinical, radiographic and cerebral MR findings in a 5-year-old girl with the severe infantile form of CIH are reported. In spite of cranial enlargement, the intracranial space and the skull base were markedly reduced, the whole brain was compressed and a Chiari I malformation was present.

The Steindler method in the treatment of paralytic elbow flexion.

Based on an average follow-up of 8.6 years, the authors analyse the functional results obtained in 16 patients submitted to Steindler flexoroplasty of the elbow between 1975 and 1986. The absence of active flexion of the elbow produces a severe deficit in the upper limb even when there is good function of the shoulder and hand.

The correction of valgus knee by temporary epiphyseal stapling.

Unilateral temporary epiphysiodesis with Blount staples is a surgical method used to gradually correct axial deviations of the knee, slowing down the growth of one side of the conjugate cartilage. The authors analyse the results obtained with this method in the treatment of infantile valgus knee, in an attempt to determine an average monthly value of angular correction, based on which it is possible to plan the best time to perform this type of surgery. They affirm the effectiveness of the procedure, the success of which nonetheless appears to be related to the correct choice of the site of application and the number of staples used.

Traumatic dislocation of the hip in children and adolescents.

The authors carried out a long-term review of 22 children and adolescents treated for traumatic dislocation and fracture dislocation of the hip with a view to ascertaining the factors responsible for unsatisfactory results. They considered the age of the patient, the severity of the trauma, the presence of associated fractures of the acetabular rim, the method of reduction, the time between injury and reduction, and the time between reduction and full weight-bearing. They stress the importance of early recognition of bone or soft tissue fragments included in the joint after closed reduction and immediate operation to remove them.

Trochanteroplasty in the treatment of infantile septic arthritis of the hip.

The aim of the present contribution is to explore the possible surgical solution of the problem of dislocation of the hip secondary to infantile septic arthritis, particularly in the form in which the femoral head is totally destroyed. The operation of trochanteroplasty is based on transposing the intact epiphysis of the great trochanter to act as a new femoral head and subsequently restoring the correct anatomical alignment by a trochanteric adduction osteotomy. Sixteen cases so treated over the 11 year period from 1969 to 1980 are reported.