osteoid osteoma at the child [about 9 cases]

The osteoid osteoma is a benign lesion characterized by multiple clinic and topographic aspects-exposing to diagnostic and therapeutic problems. Through a retrospective study managed form 1981 to 2002, about 9 cases, the diagnostic means and the results of therapeutic follow-up have been rated. The mean age was 10 years old and the sex-ratio was about 1.22. in 66% of the cases, the lesion is localized in the long borne of the lower limb and in 22% of the cases at the level of the rachis. The lesion was diaphysial in 71% of the cases and epihysometaphysial in 29% of the cases. The motive of consultation was a typical pain in 55% of the cases, yielding to the aspirin in 4 times out of 5 and associate to a claudication in 44% of the cases. The scoliotic attitude has been found in 2 cases. We didn't notice any neurologic sign. The preoperative diagnosis has been based on the standard radiography in 44% of the cases, on the scintigraphy and the computerized tomography at the same time in 33% of the cases and the IMR in 11% of the cases. In 2 cases, the diagnosis has been based only on the anatomopathologic study. The surgical exercise was total in 78% of the cases, partial in 22% of the cases and the osseous graft was necessary in 1 case. After a mean recession of 10 months, the evolution was favorable in 67% of the cases, the pain persisted in one case associate to incomplete exercises and two patients have been lost to follow-up. The progress of modern imaging permits now a great diagnostic reliability and therapeutic approach less invasive. Indeed, the location reached the target, because the practice of the scano-assisted Percutaneous resection that has the tendency to substitute for classical surgical treatment

[Congenital insensitivity to pain]

Congenital insensitivity to pain is rare hereditary sensory neuropathy which was first described by Deaborn in 1930. It usually manifestated in childhood by a history of unrecognized trauma, in difference to clinical features are stereotyped but its exact nosological status remains in doubt. We report two cases diagnosed with congenital insensivity to pain. These children present self-mutilations of fingers and tips, with cutaneous windys and chronic ulcerations. The diagnosis is usually delayed because of the disease's rarity and difficulties in communicating with the child because of his or her mental retardation. Management includes early recognition of the condition, prevention of injury, immobilization of extremities, and surgical correction of established deformities

[Femoral nerve block for fractured or the femur in children [15 cas]]

The orthopedic treatment of the fractured femoral shaft child is based either on the reduction with plaster immobilization, usually practiced under general anesthesia, or on pulling during 10 days followed of plaster immobilization without any analgesia. The block of the femoral nerve is a simple technic that permits a good quality analgesia after fracture of the femur and can be practiced out operative room. We tried to value the possibility of realization of orthopedic treatment of femoral fractures under block of femoral nerve alone. These are the preliminary it is an open prospective study about 15 children aged from 2 to 9 years, they suffer from fractured femoral shaft. The fracture was insulate, there was no alteration of consciousness and any antalgesis medication has been is realized by an anesthesist doctor or sergeon with admiscture of Xylocaine 1% and marcain 1,5%. The pain, the muscular relaxation and the hemodynamic variation are noticed before during 5,10 and 15 minutes after the achievenement of the block. Finally, we noticed also the quality of recution. The spontaneous pain or this caused by papation of the fractured member disappeared 10 minutes after the achievenement of the femoral block, on average, and the muscular relaxation of the thigh has been obtained 11 minutes later. The pulling of the member with manipulation of the fracture focus permitted to get in all the cases an acceptable, or else anatomic reduction of the fracture. The block of the insulate femoral nerve has been for us an effective method and easy to realize even ambulatory