[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

[Childhood soft tissue chondroma. two cases report]

Soft tissue chondroma is a rare benign tumour, which is generally seen in adult. It consists of islands of heterotopic cartilaginous tissue and most localised on the hands and the feet. The hypothesis that microtrauma is involved in the aetiology of this condition has yet to find any factual support. To report two paediatric cases of soft tissue chondroma. The first is a soft tissue chondroma of the posterior aspect of the left axilla in a 3-year-old boy. CT scans showed a spherical fatty density soft tissue mass without evident calcifications, attaching the infraspinous muscle. The second patient is a 9-year-old girl presented with a right auricular finger soft tissue chondroma. Radiographs showed several punctuated calcifications with adjacent bone scalloping. MRI revealed a lobulated soft tissue mass attaching the flexor tendons. The tumours were entirely removed. Histological examination showed cartilaginous tissue in both cases. At follow-up, the patients had good functions without evidence of recurrence. Simple excision should suffice to treat soft tissue chondroma but care should be taken to make the excision complete if recurrence are to be avoided

Imaging of benign lipomatous tumours of the limbs in children

Lipomatous tumours of the limbs in children are rare, and lipoblastoma is the most common soft tissue tumour. Most of them have typical imaging features, but their clinical presentation and their management may vary, depending on the exact histological subtype.The aim of our study is to illustrate the main clinical, radiological and histological features of the different benign lipomatous tumours in children. review of the literature. it is about a descriptive study of paediatric cases of benign lipomatous tumours of limb in children. The imaging findings are helpful and can provide essential components for the diagnosis

[ 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

Les abces primitifs du psoas chez l'enfant

About 8 cases of primary psoas abscess that have been treated surgically in our department since 1990, and after reviewing literature, we emphasizing the rarity of this entity, the difficult and late diagnosis because of simulation with other aflections [arthritis of the hip, appendicitis.].The etiology of primary psoas absess remains speculative. A post traumatic hematoma within the psoas muscle secondarily infected by hematological transmission from a pre-existing focus on the skin, secms to be the most likely etiology. Percutaneous guided catheter drainage has changed the therapeutic approach to psoas abcesses. It represents the best alternative to surgery of this disease