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

[Nonoperative treatment of clubfoot] 814 cases

814 feet which have congenital talipes equinovarus of 537 children were followed at the surgical and Pediatric orthopedic clinic of the Casablanca children's hosp ital during the period February 1976 to September1990. 64,2% of the feet were examined during the first three months after birth and 70,4% of the children were masculin. The bilateraly was noted in 51,6% of the cases and 42,3 of the feet were irreducible [classified type III]. 15 cases of congenital dislocation of the hip were associated to clubfoot as well as to other malformations. The functional [orthopedic] treatment was applied at the service since 1980, in the form of manipulations with the utilization of posture splints. 131 feet of 81 children benefited from a series of plasters before hand. The aim of manipulations is to correct the various and the supination at first; the peroneus muscles stimulated by a toothbruch during the second phase. At the end, the equins is corrected in pulling the heel downwards. The Denis Brown splints are borne continuously, and are removed only during their-education sessions or in case of complications. Bearing this equipment needs surveyance on the part of the physiotherapist and the mother. Cutaneous ulceration may appear following the placement of the splints; they decreased markedly during our study thanks to artifices applied by the physiotherapist of the favorable shoes evolution, wearing reversed ankle shoes is permitted during the daytime. For the evolution of results, criteria of a morphological and radiological as well as of a functional nature were assessed. Only 495 feet of 318 children were able to be judged with sufficient retreat: the average period being 5 years. In this way, appraisals were done at birth, and on the third, sixth and tenth month of the functional treatment. The x-rays of the tenth month were particularly decisive; they permitted follow-up on the treatment or else they indicated the necessity for conducting surgery. The global results of the treatment were good in 31,1% of cases. Reviewing the literature allowed a comparative study with our works; thus our results were close to those obtained by Turco [35%] and Seringe [38,7%]; Knowing that all the feet were examined by most of the authors before the 30 th day afterbirth. results obtained were even better [36,5%] when the treatment started during the first three months after birth instead of afterwards [13,7%]; this was the case when the foot was initially reducible [classified type I] [39,7%]. 83,8% the feet classified type II [partially reducible] and treated as type I, responded badly to the treatment. Stiff feet, made flexible by using series of plasters, obtained poor results in 57,3% of the cases. All the feet of group III [with bad results] were proposed for surgery, only 197 were operated of which.56,8% had 8 to 12 months of age. 83,7% of these feet underwent minor surgery of the posteromedial release type

[Hip osteo-arthritis sequelas in infant: classification and therapeutics indications]

From a test of classification with regard to osteo-articular lesions and their functional effect, the authors precise the therapeutic indication through 56 cases of hip osteo-arthritis sequelas in the infant. It's about a retrospective study based on 62 hips trated from 1976 to 1990. The group of increasing gravity has been individualized: a first group of stable and mobile hips required remodeling: a second group of stiff hips treated orthopeadically and a third group of dislocated hips who imposed abstention or artroplasty. The result has been appreciated on joint stability and the evolution of joint articular lesions. All hips of group I have preserved a good stability. In group II, the orthopedic treatment led towards the recovery of a modest mobility towards stiffness without articular fusion or towards surgical arthrodesis. In group III, only 2 good results have been preserved by anthroplasty seven years after. The analysis of observation in retrospect of seven years allowed to note that if the dislocation of the hip should occur it would be done in the first months that follow the stage of the arthritis. This notice led the authors to propose a classification based on the stability of the hip at the sequel stage. This classification allowed, in addition, to guide therapeutic indications

Pott's disease in children: medical or surgical treatment? About 100 cases

Between 1976 and 1984, 100 children aged 13 months to 15 years were treated for tuberculosis of the spine. 29 patients seen at an early stage and presenting limited lesions healed completely with mild or moderate residual kyphosis after orthopaedic treatment associating antibiotherapy and strict immobilization in plaster shells. 71 patients having extensive vertebral destruction or after failure of the orthopaedic treatment underwent surgery for excision and anterior spine fusion. A supplementary posterior spine fusion was performed in 48 patients. This procedure, in conjunction with preoperative traction, obtained stabilization of the spine and healing of vertebral lesions in most cases with excellent correction of recent kyphosis. In view of these results, it seems possible to determine which treatment is best adapted according to: - the extent, severity and level of the lesions, - the degree and age of kyphosis, - the existence or not of paraplegia. The possibility to reduce fixed severe kyphosis [6 cases] and the opportunity of a supplementary posterior fusion arc evaluated

[Hair strangulation of the penis. Report of 38 cases]

When confronted to a section of the glans in a child, whether or not accompanied by urethral fistula, it is possible to eliminate an accident during circumcision in favour of a strangulation by means of a hair as the cause of the injury: first of all the finding of a hair wound around the penis secundly the time elapsed between circumcision and the discovery of the strangulation symptoms. Reviewing 38 cases treated over 4 years, the authors have aimed at classifying the various resulting wounds into 4 main types which imply different appropriate treatments. The social aspects of this pathology are also investigated: while in some cases the procedure may be traced back to more or less rational motives [haemostasis following circumcision child play or attempt to treat enuresis] many are the cases which can only be the result of ritual or criminal practice