[Epidemiology of acute hematogenous osteomyelitis in children: a prospective study over a 32 months period]

To determine the demographic, clinical, biological and bacteriological profile of acute community acquired hematogenous osteomyelitis [AHO] in children. Prospective study including children admitted for AHO. We noted the demographic parameters of patients and the clinical, biological and radiological characteristics of the infection. Blood cultures and local specimen in operated children were systematically performed. 70 patients were included. The mean age was 7.7 years. The mean time between onset of symptoms and admission was 3.2 days. Distal tibia was the most frequent localization [18.66%]. Fever higher than 38[degree sign] on admission was found in 92.8% of patients. Creactive protein [CRP] was superior to 20 mg / L in 95.8% and ESR superior to 20 mm in the first hour in 92% of cases. A deep venous thrombosis was found in 7 patients and a pleuropulmonary Staphylococcus infection in 4 patients. Amicroorganism was isolated in 64.7% of cases. Staphylococcus aureus methicillin susceptible [SAMS] was the predominant germ. Staphylococcus aureus methicillin resistant [SAMR] accounted for 15.7% of staphylococcus aureus infections. The importance of CRP on admission and time to resolution of fever after the start of treatment were significantly higher in SAMR infections. The existence of deep venous thrombosis and a pleuropulmonary Staphylococcus infection and the need for surgical drainage were significantly more frequent in SAMR infections. The existence of a severe form of AHO should lead to a high suspicion of SAMR infection and prompt the prescription of an appropriate antibiotiotherapy

[ proximal humeral osteotomy associated with the transfert of latissimus dorsi and teres major in treatment of sequelae of the obstetrical brachial plexus Palsy]

Shoulder sequelae of obstetrical brachial plexus palsy put a different problem of coverage according to the age of the patients and the presence or not of osteo-articular deformations. At an advanced age and in the presence of osteo-articular deformations, the muscles liberation and transfers tendons only are insufficient for the restoring of a satisfactory function to the paralytic shoulder. The purpose of this study is to report an original technique by the association of libertation of retracted muscles and a humeral osteotomy to improve the abduction and to acquire an active external rotation in internal rotation retraction of the shoulder sequelae of obstetrical brachial plexus palsy. This retrospective study concerned twelve patients admitted in the service of Childish Orthopaedics of Children's hospital of Tunis between 1997 and 2003. The average age of the patients are 11 years. All the patients have a proximal humeral osteotomy above the deltoi'delloid V with a re-insertion of the Subscapularis and to the transfer of the Latissimus Dorsi and Teres Major, realized by a single posterior approch. After a mean follow up of 48 month a frank aesthetic and functional improvement was noted in every case. The importance of retraction for an advanced age, made that a humeral osteotomy of external derotation is necessary. Have a practice above the deltoi'dien V it allows to improve at the same time the external rotation and the abduction due to the lateral translation of the deltoid. This last one strengthen by the re-insertion of a retracted Subscapularis and levying of the co-contractions of the Latissimus Dorsi and Teres major with the deltoid almost constant

[Preliminary results of surgical treatment of developmental dislocation of the hip in older children]

Reduction of developmental dislocation of the hip is difficult to achieve in children after walking age and particularly in older children. In fact, at this age the important retraction of the muscles around the hip associated with a marked acetabular dysplasia and elongation of the joint capsule explain the difficulty and instability of reduction and the frequency of complications. In this study we reviewed retrospectively the clinical and radiological results of 26 developmental dislocations of the hip treated by open reduction, pelvic osteotomy and femoral shortening in 21 children aged more than 5 years. Age at surgery ranged from 5 to 11 years [mean 7.5 years] with a follow-up of 1 to 8 years [mean 2 years 7 months]. According to the clinical classification of MC Kay, 17 hips had a good result while 9 hips had a fair or poor result. According to the Severin classification system 18 hips had an excellent and good radiological result. Ten hips developed an avascular necrosis of the femoral head following the reduction