Penetrating Chest Trauma in a Child Caused by a Fall on a Metallic Bar: A Case Report.

Penetrating chest trauma in children is an uncommon condition. Patients may be asymptomatic or in a critical state. Visceral and vascular damage are frequently present when penetrating objects enter the thoracic cavity. Although many studies have discussed penetrating thoracic trauma in adults, very few deal with the pediatric population. Here, we present the case of a 13-year-old child with an intrathoracic metallic bar after penetrating chest trauma. The clinical examination showed a stable patient with a palpable bar and subcutaneous emphysema in the left axillary area. The radiological scan did not reveal any vital damage. The bar was removed through the entry wound without thoracotomy or thoracoscopy. The patient evolved without any incident and was discharged after three days. Good improvement was noted over three months of follow-up. Intrathoracic foreign bodies secondary to penetrating trauma are rare in children. An exhaustive imaging examination is required to identify the precise location of the foreign material and find any severe organ or vascular injuries. If the condition permits, direct removal should be attempted in an operating room, in case surgical intervention is needed after the extraction.

Retrospective Comparative Study between Duplay and Koff Methods in Repair of Distal Hypospadias.

BACKGROUND: Hypospadias repair is a complicated surgery even in the best of hands. To date, there is a lack of consensus on which surgical technique offers more favourable post-operative outcomes. AIMS AND OBJECTIVES: The present work was undertaken to evaluate and compare the outcomes and complications rates of two single-stage techniques widely used to repair primary anterior hypospadias, namely Thiersch-Duplay Tubularized Plate Urethroplasty and Koff Urethral Mobilisation and Advancement. SUBJECTS AND METHODS: Data from the medical records of 120 patients operated on for primary anterior hypospadias were retrospectively analysed and compared. The patients were divided into two groups: 60 patients underwent Thiersch-Duplay procedure (Group A) and 60 patients underwent Koff procedure (Group B). They were compared using the Chi-squared or Fisher's exact test to assess the relationship between the adopted surgical technique and the complications' development with a P < 0.05. RESULTS: Neither intraoperative complications nor acute post-operative complications occurred, whereas 28.3% (n = 34/120) cases have exhibited at least one late post-operative surgical complication, including 38.3% (n = 23/60) in Group A and 18.3% (n = 11/60) in Group B, revealing a better outcome of the Koff procedure despite the statistical insignificance (P = 0.102). We did not objectify any other complication besides meatal stenosis (MS), urethro-cutaneous fistula (UCF) and wound dehiscence. CONCLUSION: Overall, our study could not demonstrate the superiority of one technique above another. At the same time, it established the versatility, satisfactory cosmetic and functional results, low MS and UCF rates of Koff urethral mobilization and advancement technique in primary anterior hypospadias repair.

[Embryonal rhabdomyosarcoma of the scalp: about a case]. / Rhabdomyosarcome embryonnaire du cuir chevelu: à propos d'un cas.

We report the case of a newborn male admitted on the first day of his life with temporo-occipital swelling detected at birth. Clinical examination showed conscious, hemodynamically and respiratory stable, afebrile, vigorous and responsive newborn; craniofacial examination objectified soft, mobile, temporo-occipital mass covered by the scalp measuring 10 cm along its longer left paramedian axis (A). Craniocerebral CT scan showed large heterogeneous left subgaleal parietal-temporal-occipital mass measuring 40/80 mm, suggesting a tumor of soft tissue components of the scalp (B). The newborn underwent surgery which revealed bilobed tumor of the left temporo occipital soft tissue components, without extension to the cranial or the endocranial vault (C). Complete resection of the two masses was performed (D). Anatomo-pathologic study showed histological and immunohistochemical features of embryonal rhabdomyosarcoma. Staging evaluation was unremarkable. No chemotherapy or radiotherapy was proposed to the patient. At 1-year follow-up the child was asymptomatic and ultrasound examination of the surgical site was unremarkable.

[Galeazzi fracture in children: about 5 cases and literature review]. / Fracture de Galeazzi chez l'enfant: à propos de 5 cas et revue de la littérature.

Galeazzi fracture describes a fracture of the radial diaphysis in association with distal radioulnar dislocation (most often dorsal). We conducted a retrospective study in the Department of Pediatric Orthopedic Trauma at the Mother-Child Hospital CHU Hassan II in Fez (Morocco). The study involved five male children. Four children underwent orthopedic treatment while one child underwent surgical reduction. Mean follow-up was 24 months (8-30).

[Slipped capital femoral epiphysis in a patient with cerebral palsy due to seizure]. / L'épiphysiolyse fémorale supérieure chez un malade en paralysie cérébrale suite à une crise convulsive.

Slipped capital femoral epiphysis (SCFE) is a slippage of the femoral epiphysis (femoral head) on the femoral neck. Femoral epiphysis usually slips backward and inward because of body weight. This disorder mainly occurs during puberty. We report the very rare case of a child with cerebral palsy associated with spasticity of the limbs.

[Elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm fractures in the child: about 87 cases]. / Les complications de l'ECMES dans le traitement des fractures des 2 os de l'avant-bras chez l'enfant (à propos de 87 cas).

This study aims to describe the complications of elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm diaphyseal fractures in the child. Between January 2009 and December 2013, 87 children with both-bone forearm diaphyseal fractures were treated by elastic stable intramedullary nailing with Métaizeau nails. 76 boys and 11 girls, with an average age of 12 years, were enrolled in the study. Nailing was promptly performed in 50 cases and after secondary displacement during plaster-cast treatment in the other cases. Both bones were nailed in all cases. All patients underwent systematic plaster immobilization for a period of about one month. On average, nails were removed after about 6 months. Functional outcomes were studied over a mean follow-up period of 10 months. Complications were marked by 14 superficial infections (14 cases), osteitis associated with material (2 cases), refracture (3 cases), pseudarthrosis (3 cases), delayed fracture consolidation (2 cases) and proximal radioulnar synostosis (1 case). Although intramedullary nailing ideally is an osteosynthesis technique suitable for the treatment of fractures in children, it is more invasive than orthopaedic treatment.Indications for treatment should remain within well-established limits.

[Rare anorectal malformation with recto-uretrobulbar fistula: about a case]. / Forme rare de malformation anorectale avec une fistule recto urethrobulbaire: à propos d'un cas.

We here report the case of a male newborn admitted immediately after birth with imperforate anus. Physical examination of the anal margin showed imperforate anus; the examination of the external genitalia objectified scrotal bifidity with a fistula filled with meconium at the level of the penis root. During urinary catheterization the catheter passed through the fistula (A), suggesting a rare anorectal malformation with recto-uretrobulbar fistula. Malformation assessment was without abnormalities. The newborn was admitted to the operating room and clouding was performed during surgery by catheterization of the fistula using two 6 CH (1.98mm) Foley catheters, one passing through the rectum and the other passing through the bladder; a third foley catheter passed through the urethral meatus, objectifying the communication among the three catheters at the level of the recto-uretrobulbar fistula (B). The diagnosis of rare intermediate anorectal malformation was retained and colostomy was performed. The newborn underwent treatment based on perineal anorectoplasty with fistula closure at the age of 3 months. Anal dilatation was performed for 6 months. Colostomy closure was performed at the age of 9 months. Patient's evolution was favorable at 2-year follow-up.

[Bone hydatid cyst: a rare localization at the level of the hip bone]. / Un kyste hydatique osseux: une localisation rare au niveau de l'os iliaque.

Hydatid disease is a parasitic disease caused by the development in humans of the larval form of a tapeworm, namely a very small tænia called Echinococcus Granulosus. This anthropozoonosis is characterized by the presence of different types of anatomo-radiologic variants associated with various topographic and evolutionary aspects of the cysts. Bone hydatid disease is a rare condition, it accounts for only 0.9-2.5% of all locations. We report the case of a 9 year old child, who was admitted with febrile lameness and with a mass in the right iliac fossa, revealing a hydatid cyst at the level of the hip bone. Lesion assessment objectified a hydatid cyst of the hip bone with extension into adjacent soft tissues. An infected cyst was detected during surgery, hence the performance of a surgical excision of the cyst with drainage. Hydatic osteopathy is infiltrating, diffuse, slow and gradual, causing delays in diagnosis and compromising the quality of care.

[Circumscribed myositis ossificans of the elbow: about a case]. / La myosite ossifiante circonscrite du coude: à propos d'un cas.

Circumscribed myositis ossificans (CMO) is a heterotopic ossification of the striated muscles. Its location at the level of the elbow is rare. It occurs in young patients, often following trauma as it can also develop without experiencing any traumatic event. Its predominant location is at the level of the larger muscles limbs root (gluteus, deltoid) or of the areas which are most exposed to direct shocks (the quadriceps in more than 40% of post-traumatic cases). Our study aims to highlight the aspects of a circumscribed myositis ossificans in conventional radiology and tomodensitometry to avoid potential diagnostic confusion with a malignant bone tumor.