[Factors influencing the development of chondrolysis in children treated for slipped capital femoral epiphysis]. / Facteurs de risque de chondrolyse chez les enfants traités pour épiphysiolyse fémorale supérieure.

INTRODUCTION: Chondrolysis is an infrequent but serious complication of the treatment of slipped capital femoral epiphysis. The objective of this study was to identify factors influencing the development of chondrolysis. PATIENTS AND METHODS: The medical records of the patients operated on between 1989 and 2009 at the Rabat Children's Hospital for treatment of slipped capital femoral epiphysis were retrospectively evaluated. The minimum follow-up was 24 months. The risk of development of chondrolysis was correlated with various parameters. Statistical analysis was performed using a logistic regression model (binary outcome). RESULTS: A total of 140 patients were included in this study. The average age was 13 years and 4 months. The incidence of chondrolysis was 11.4% (16 patients). Chondrolysis was significantly associated with obesity (25%, P<0.001) and with a delay in the diagnosis of slipped capital femoral epiphysis exceeding 60 days (75%, P=0.01) DISCUSSION: In this series, intra-articular pin penetration is not a risk factor for chondrolysis. The association of obesity and a diagnosis delay beyond 60 days increases the risk of occurrence of chondrolysis in children operated on for slipped capital femoral epiphysis. Chondrolysis can be prevented mainly through early diagnosis of slipped capital femoral epiphysis.

[Glomus tumor of the finger pulp: an unusual pediatric case]. / Tumeur glomique pulpaire de l'enfant : à propos d'un cas inhabituel.

Glomus tumor is a rare benign tumor. Diagnosis is often delayed because of the absence of specific symptoms and confirmation can only be made by histological study. Treatment is always surgical. We report a clinical case of glomus tumor of the thumb pulp in a 6-year-old girl, and we discuss clinical, radiological and histological aspects of this tumor.

[Risk factors of osteonecrosis of the femoral head following slipped capital femoral epiphysis]. / Nécrose de la tête fémorale chez les enfants traités pour épiphysiolyse fémorale supérieure. Quels sont les facteurs de risque?

UNLABELLED: Osteonecrosis is a serious complication of the treatment of slipped capital femoral epiphysis. The purpose of this study was to identify factors predisposing to the development of this complication. We reviewed retrospectively 127 patients (150 hips) treated for slipped capital femoral epiphysis in our institution between 1980 and 2004. Clinical and radiological data were analyzed before and after treatment, and at consecutive follow-up examination. Osteonecrosis was defined in the basis of radiological criteria. The risk of development of osteonecrosis was correlated with multiple clinical and radiographic parameters. RESULTS: 12 hips in 11 patients (8%) had development of osteonecrosis. Ten of them had an unstable slip. From 130 stable hips, regardless of grade, two had development of osteonecrosis. In patients who had presented with an unstable hip, the risk of osteonecrosis increased with the grade of the slip. Osteonecrosis was more likely to develop in hips that had been treated with multiple screws than in those who had been treated with a single screw. In conclusion, partial or complete reduction of an unstable slipped capital femoral epiphysis increases the risk of development of osteonecrosis. Pinning in situ without reduction with a single screw is the method of choice of the treatment of a slipped capital femoral epiphysis.

Displaced femoral neck fractures in children: are complications predictable?

INTRODUCTION: Serious complications can occur in the management of displaced femoral neck fractures in children. Are there ways to anticipate this risk and better define eventual contributing factors? PATIENTS AND METHODS: Twenty-one children (14 boys and 7 girls) were treated between 1999 and 2006 for displaced femoral neck fractures. Nine type II, 10 type III and two type IV fractures were observed according to the Delbet's classification. Anatomical open reduction was performed in 13 patients and closed reduction in eight patients. At a mean follow-up of 26.4 months, the outcome was assessed according to the Ratliff criteria. Postoperative complications were analysed according to the age, fracture type, time-to-surgery and open or closed reduction. RESULTS: The mean age was 12.1 years. The final outcome was defined as good in 14 patients(66.66%), fair in one patient (4.76%) and poor in six patients (28.58%). Complications occurred in seven patients (33.33%), avascular necrosis (AVN) of the femoral head being the most frequent one (28.58%). In all cases, necrosis was observed in children older than 12 years (p < 0.05) and when time-to-surgery exceeded 48 h (p < 0.05). Necrosis occurred in 44.44% of type II fractures and in 20% of type III fractures (p > 0.05). Only one materialised after closed reduction (p < 0.05). DISCUSSION: Various factors may contribute to the development of complications in children with femoral neck fractures. Our study supports the hypothesis that older age, late surgery and open reduction are definite predictors of avascular necrosis occurrence. LEVEL OF EVIDENCE: Retrospective study, level IV.

Pronator teres transfer to correct pronation deformity of the forearm after an obstetrical brachial plexus injury.

A pronation deformity of the forearm following an obstetric brachial plexus injury causes functional and cosmetic disability. We evaluated the results of pronator teres transfer to correct their deformity in 14 children treated over a period of four years. The mean age at surgery was 7.6 years (5 to 15). The indication for surgery in each case was impairment of active supination in a forearm that could be passively supinated provided that there was no medial contracture of the shoulder and normal function of the hand. The median follow-up was 20.4 months (8 to 42). No patient was lost to follow-up. Qualitative results were also assessed. The median active supination improved from 5 degrees (0 degrees to 10 degrees ) to 75 degrees (70 degrees to 80 degrees ) with no loss of pronation. A passively correctible pronation contracture can be corrected safely and effectively by the transfer of pronator teres.