Chiari Osteotomy in the Children: Mid-term Follow-Up Results.

Introduction The Chiari osteotomy enlarges the acetabulum to increase coverage of the femoral head. It is performed as a salvage procedure on a noncongruent, yet in-place, hip. This study aims to assess the clinical and radiographic outcomes of Chiari pelvic osteotomy for treating hip dysplasia in children. Methods This is a case series conducted in the pediatric orthopedic trauma department of the Centre Hospitalier Universitaire Hassan II, Fez, Morocco, over a 10-year period from January 2011 to December 2020. The study included patients who were being treated for hip dysplasia and had undergone a Chiari osteotomy. Two types of assessments were used to evaluate global hip function: a clinical assessment using the Merle d'Aubigné and Postel score, and a radiological assessment involving measurements taken from frontal pelvic radiographs. Results A total of 12 Chiari osteotomies were performed in nine patients. The mean age at surgery was 10.8 ± 1.7 years and the mean follow-up was 4.6 ± 2.78 years. The clinical assessment score improved statistically during the last follow-up compared with the preoperative measurements for pain (p< 0.001), mobility (p = 0.002), walking (p<0.001), and total score (p< 0.001), for which 3.8 ± 1.9 points could be gained. Surgically, the osteotomy line height was 5.4 ± 2.6 mm, the osteotomy angle was 12.5 ± 2.2°, and the translated distance was 18.5 ± 3.2 mm. Regarding radiological evaluation, the comparison of angle measurements between preoperative and final recoil was statistically significant for both the vertical center edge (VCE) angle (p<0.001) with a mean gain of 16.33 ± 4.79° and the high transverse edge (HTE) angle (p = 0.002) with a mean loss of 12.67 ± 10.88°. Conclusion Chiari pelvic osteotomy is a complex procedure that requires very precise techniques. However, it results in remarkable relief for patients, providing an immediate impact on the Merle d'Aubigné and Postel score, particularly with regard to pain.

Surgical treatment of developmental dysplasia of the hip in children - A monocentric study about 414 hips.

INTRODUCTION: No consensus exists about the open reduction of developmental dysplasia of the hip (DDH; age of surgery and the need for additional bone surgery). We report clinical and radiological outcomes of a large monocentric study. The objectives are to analyze outcomes and to give recommendations. MATERIALS AND METHODS: This was a retrospective review of 414 hips (301 patients) operated on for DDH between 2010 and 2018. The mean age at the time of surgery was 34.6 months (14-96 months). In all, 72 hips had open reduction (OR) alone, 130 had OR with femoral osteotomy, 37 had OR with pelvic osteotomy, and 175 hips OR was associated with femoral and pelvic osteotomy. The mean follow-up was 6.5 years (3-10 years). Clinical outcomes were evaluated according to Mckay's classification. The acetabular index was measured, and Severin classification was used for radiological outcomes. Reduction failure and residual dysplasia were noted, and avascular necrosis of femoral head (AVN) was assessed according to Kalamchi and MacEwen classification. RESULTS: At the last follow-up, 331 hips (80.2%) had good clinical results, and 319 (77%) had satisfactory radiological results. The AI measured on the last follow-up radiograph was ≤25° in 350 hips. AVN was noted in 83 hips (20%). Redislocation was founded in 53 hips (12%). Overall: 293 hips (72%) had stable reduction without AVN with good clinical and radiological outcomes. DISCUSSION: Clinical outcomes are better and the risk of AVN decreases significantly when a femoral osteotomy is performed. There were better radiological results when pelvic osteotomy was performed. The rate of residual dysplasia was higher when pelvic osteotomy was not performed. We recommend a femoral shortening osteotomy for high dislocations (Tönnis 3 or 4) for children over 18 months and a pelvic osteotomy for children over 36 months or over 18 months with an acetabular index > 25°.

Impact of the COVID-19 lockdown on the epidemiologic and clinic profiles of domestic accidents in children.

BACKGROUND: Domestic accident (DA) is any harmful accidental event that occurs suddenly in the home or its immediate surroundings. Our study aims to describe the impact of the COVID-19 lockdown in the epidemiological and clinical profiles of DAs in children and their management. MATERIALS AND METHODS: This was a mixed descriptive study, comparing DAs occurring during the COVID-19 lockdown and the same period of the previous year. We exhaustively included all children aged from 0 to 15 years admitted for DAs. RESULTS: The incidence of DAs remains above 50% in both groups. The average age was 7 years and boys were more affected. Before the COVID-19 lockdown, the most common mechanism encountered was accidents on the public highway 20.75%, while during the lockdown, it was represented by falls from a high place with a height of 2 m or more. During the lockdown, 33.86% of patients consulted after more than 24 h of the trauma. Supracondylar fractures and burns remained the most frequent. In all cases, the cumulative frequency of fractures decreased during the lockdown. The COVID-19 lockdown had no impact on patient's management. CONCLUSION: The COVID-19 lockdown has negatively increased the consultation delay. However, it has considerably reduced the incidence of fractures.

Paediatric osteoarticular infections caused by staphylococcus aureus producing panton-valentine leucocidin in morocco: Risk factors and clinical features.

OBJECTIVE: We aimed to estimate the prevalence of Staphylococcus aureus producing Panton-Valentine leucocidin (PVL) isolated from children diagnosed with osteoarticular infections (OAIs), and to examine risk factors and clinical features. METHODS: This prospective study was conducted from January 2017 to December 2018. All hospitalised children diagnosed with S. aureus OAI are included. Blood cultures, articular fluids, synovial tissues and/or bone fragments were collected for bacteriological culture. Antimicrobial susceptibility tests were determined by disk diffusion method. Genes encoding methicillin resistance (mecA) and PVL virulence factors (luk-S-PV and luk-F-PV) were detected by multiplex polymerase chain reaction. The demographic, clinical, laboratory, radiographic and clinical features were reviewed prospectively from medical records. RESULTS: A total of 37 children with S. aureus OAIs were included, 46% of them have PVL-positive infection and 70.6% were male. The mean age was 8.12 years (±4.57), and almost were from rural settings (76.5%). Children with Staphylococcus aureus producing Panton-Valentine leucocidin (SA-PVL) were significantly associated with type of infection (P = 0.005), location of infection (P = 0.037) and abnormal X-ray (P = 0.029). All strains SA-PVL+ are sensitive to methicillin, but one strain SA-PVL negative was methicillin-resistant S. aureus, confirmed by gene mecA positive. CONCLUSION: The prevalence of S. aureus infections producing PVL toxin was high in OAIs amongst Moroccan children, mainly due to methicillin-susceptible S. aureus. Type and location of infections and abnormal X-ray were significantly associated with SA-PVL. Routine diagnostic testing of PVL-SA, continuous epidemiological surveillance and multidisciplinary management of OAI is essential to prevent serious complications.

Local or distal flap in the management of digital trauma in children.

OBJECTIVES: We aim to describe the management of fingertip injuries treated by flaps in the paediatric surgery emergency ward and evaluate the long-term results. PATIENTS AND METHODS: Through a 2-year prospective study, we analysed all fingertip injuries treated by flaps in the paediatric emergency ward. We collected patients' data and the clinical and imaging characteristics of the lesions. The type of flap was chosen on a case-by-case basis. We evaluated aesthetic and functional results. RESULTS: Forty-two fingertip injuries required the use of flaps. The average age was 7 years, and boys were more affected. The smashed fingertip was the most common mechanism; pulp lesions and amputation were located mainly in zone I or II. We performed Atasoy flaps, palm flap, free skin grafts, McGregor flap and the cross finger flap. Our results were good to excellent in 66.67%. CONCLUSIONS: The best management of fingertip injuries in children remains prevention.

First report of Kingella kingae diagnosed in pediatric bone and joint infections in Morocco.

BACKGROUND: The progress of diagnostic strategies and molecular methods improved the detection of Kingella kingae in bone and joint infections, and now, Kingella kingae is being increasingly recognized as the most frequent cause of bone and joint infection BJI in early childhood. The main objective of this prospective study is to report the frequency of Kingella Kingae in negative culture bone and joint pediatric infections, and to describe the clinical and biologic features of these children. METHODS: From December 2016 to June 2019, we selected all hospitalized patients with suspected BJI. When culture was negative on the fifth day, children under 10 years were subsequently included in the study, and PCR assay was performed systematically for researching K. kingae specific gene cpn60. Microbial culture and identification were made using standard bacteriological methods. The demographics, clinical, laboratory, radiographic and clinical features were reviewed from medical records. RESULTS: We enrolled 65 children with culture negative BJI, 46 of them having under 10 years old have been screened for the cpn60 gene. Thus, the gene encoding Kingella kingae was positive for 27 BJI cases (58.7%). The mean age of children was 3.02 years, 55.6% were aged 6 months-4 years and 29.6% of them were aged 5-10 years. The male to female ratio was 1.7 and 16 cases (59.26%) occurred during the fall-winter period. The most frequent BJI type was septic arthritis (77.8%) and the most affected sites were knee (51.9%) and hip (37.0%). We recorded a mild clinical picture with normal to mildly raised inflammatory markers. All patients had good clinical and functional outcomes, with no serious orthopedic sequelae.. CONCLUSION: K kingae is an important pathogen of culture-negative BJI in Moroccan children. PCR testing should be performed in culture-negative cases of children not only in the typical age range of 6 months to 4 years. When implemented in the routine clinical microbiology laboratory, a specific K. kingae PCR assay can provide a better diagnostic performance of BJI.

[Acute appendicitis due to Claudius Amyand's hernia in a newborn with intestinal obstruction]. / Appendicite aigue sur hernie de Claudius Amyand chez un nouveau-né dans un tableau d'occlusion neonatale.

Claudius Amyand's hernia is defined as the incarceration of the vermiform appendix in the hernia sac. The first reported appendicectomy was performed in 1735. It is very rare among children, hence its frequency is not yet established. We report the case of a 22-day old new born with untreated simple inguinoscrotal hernia who had an urgent admission to the Emergency Department due to occlusive syndrome with no evacuation of faeces and no passing of flatus, inflammatory inguinoscrotal swelling and bilious vomiting persisting for 2 days. Treatment was based on the restoration to good health and on preanesthetic assessment. Intraoperative exploration showed necrotic bulging appendix in its distal half with false membranes. Appendectomy was performed with closure of the hernia sac. Patient's evolution was marked by resumption of intestinal transit 24h after surgery.

[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.

Congenital pseudarthrosis of the clavicle treated by Masquelet technique.

Congenital pseudarthrosis of the clavicle (CPC) is a very rare pathology of which over 200 cases have been reported. Usually discovered during the first months of life, CPC is characterised by a definitive bone defect in the middle third of the clavicle. Generally asymptomatic, the pseudarthrosis of the clavicle can cause aesthetic issues and functional symptoms indicating a surgical repair. Different reconstruction techniques have been reported with various complications. We present a 14-year-old boy diagnosed with CPC and concerned about the cosmetic aspect of a swelling of his right clavicle. We performed a two-stage surgical repair using the induced membrane technique described by Masquelet. A complete bone union has been obtained, and patient is satisfied with the cosmetic appearance. In our opinion, the Masquelet technique is a safe and reproducible procedure to treat CPC in high-risk older patients with long gap allowing a rapid and lasting bone union.

[Type III Monteggia lesion: a rare association, about a case]. / Lésion Monteggia du groupe III association rare, à propos d'un cas.

Type III Monteggia lesion is very rare, usually occurring within a context of violent trauma and often going unnoticed. We report the case of a 11-year old boy presenting to the Emergency Department with blunt trauma of the upper limb. The radiological evaluation showed olecranon fracture and radial epiphyseal separation associated with dislocation of the radial head. The patient underwent orthopedic treatment with good outcome after a mean follow-up of 3 months.

[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.

[Lipoblastoma detected in older children: an unusual case and literature review]. / Lipoblastome découvert chez le grand enfant: description rare et revue de la littérature.

Lipoblastoma is a relatively rare benign tumor. It derives from embryonic white fat cells. It almost exclusively affects children less than 3 years of age. We report a case of lipoblastoma of the left thigh detected in an older child (11 years) and a literature review. Diagnosis was based on histology while surgical treatment was based on total resection of the mass. The postoperative course was simple with a follow-up period of 9 months.

[Primary pseudotumoral calcinosis in children]. / Calcinose pseudo-tumorale primitive chez l'enfant.

Pseudotumoral calcinosis is a relatively rare benign tumor, characterized by calcium deposition in peri-articular soft tissues. We here report the case of a 15-year old boy with primary tumoral calcinosis of the left hip as well as a literature review. The patient underwent total mass resection. The postoperative course was simple. The patient showed no recurrence at 6-month follow-up.

[Tibial spine fractures in children]. / Fracture des épines tibiales chez l'enfant.

Tibial spine fractures are rare lesions which usually occur in adolescent athletes aged between 8 and 17 years. The treatment of displaced fractures requires surgical reduction and fixation in order to achieve adequate tension in the anterior cruciate ligament and to reduce the risk of laxity. This study aimed to report our experience in the treatment of tibial spine fractures in children. We conducted a retrospective study of 11 children with tibial spine fractures over a period of 7 years (2009-2016). The average age of our patients was 13 years and a half. A fall during sport was the main cause of tibial spine fractures in 73% of patients. Meyers and Mac Keever classification, modified by Zaricznyj, was used and allowed to classify the lesions into 4 types. Two cases were orthopedically treated while 9 cases underwent surgical reduction through arthrotomy and fixation using osteosuture. After an average follow-up of 3 years our results were good in 91% of cases, according to Lysholm functional score. Only one case with orthopedically treated type II fracture still had a mean Lysholm functional score. Surgical treatment for types II-IV fractures (with the exception of type I) should be used in order to ensure a good anterior cruciate ligament tonus. The prognosis of tibial spine fractures is good. Surgical reduction should be used when tibial spine fractures are associated with displacement in order to better verify anterior cruciate ligament integrity and to ensure a good knee stability.

[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.