Solitary bone cyst: controversies and treatment.

The solitary bone cyst (SBC) has not yet revealed all its secrets. The pathogeny of the SBC is thus considered and also its evolutivity. Conservative treatment has been used in attempts to heal this tumor-like bone. In the case of surgery, an original technique is described. The SBC still remains mysterious in many of its aspects. At the time of this writing, nobody can predict the occurrence modalities of this benign bone tumor. In a similar way, the reality of this tumor-like lesion cannot be precisely described. This emphasizes the first controversial point about this lesion. Indeed, must we consider differently the bone cysts that remain close to the growth plate and those which located in the diaphysis? Must we regard the true unicameral bone cysts (UBCs) differently and those that are multilocular? Moreover, are the cysts located in the long bones identical to the those of the short cancellous bones? Alas, SBC was supposed to be a lesion in children that disappeared after growth ended. Is it still true since some cases have been reported more recently in adults? This study represents a long follow-up. It includes the different aspects of the SBC and emphasizes an original technique in case surgery becomes indicated.

[Patellar instability in children]. / Instabilités rotuliennes de l'enfant.

Current work on disease states involving the patella has led to increased interest in patellar instability. We reviewed a series of patellar luxations. True trauma-induced luxations are rare. Most cases are recurrent luxations in subjects with a morphological anomaly of the knee extensor system. Because of the growth cartilages, selective therapeutic techniques are needed to stabilize the patella. Recurrent or permanent luxations of the patella result from congenital malformations of the muscles or skeleton. A complete MRI study is highly indicated. The patella can be correctly realigned by surgical release. In cases with femoropatellar dysplasia, which is not specific for children, well conducted rehabilitation therapy often leads to favourable outcome.

Lower limb bone hemangiomas in children: report of two cases.

Hemangiomas of the bone are rare lesions, accounting for approximately 1% of all primary bone tumors. Hemangiomas occur fairly frequently in the vertebral bodies and the skull, but are unusual in other bones. We report two cases of unusual and fairly rare aspects of this vascular tumor in children. Both cases involved recurrences, which led to a wide bone resection in case 1 and to several curettages in case 2. In these two cases the histological type of hemangioma was capillary. In reviewing the literature we found no indication of wide resection of the benign forms in children.

Results of physical therapy for idiopathic clubfoot: a long-term follow-up study.

Physical therapy without anesthesia or plaster casts was used to treat 338 cases of clubfoot (CF). Our technique is based on progressive sequential manipulations at birth. We first reduce the varus and later the equinus component of the CF. The gentle stretches used in this technique are complemented by active physiotherapy stimulating the muscles, and then a simple splint is suited to the foot to fix its degree of realignment. When used alone, this technique achieves 77% good and fair results. In resistant cases, complementary surgery was used. We obtained 96% good and fair results.

Surgery in residual clubfoot: one-stage medioposterior release "à la carte".

A series of 142 clubfeet in 113 children were treated by a one-stage medioposterior release for deformity persisting after vigorous physical therapy. The talonavicular joint and hindfoot are released to achieve correct alignment. Long-term good results were seen in 73% of the entire series and in 87% of the idiopathic subgroup.

Atypical bone angiomas in children.

Bone angiomas can present in a variety of clinical, radiological and histological forms. The two cases reported illustrate unusual and fairly rare aspects of this vascular tumor.

[Therapeutic remarks on the congenital elevation of the scapula. Apropos of 16 cases]. / Réflexions thérapeutiques sur la surélévation congénitale de l'omoplate. A propos de 16 cas.

The authors review a series of 16 cases of congenital high scapula including 4 bilateral cases. The pathological aspects are detailed including investigations for scapular hypoplasia (3 cases), omovertebral bone (7 cases), loco-regional muscular anomalies (5 cases), and various deformities of the cervical spine (present in all cases). The entire spine and the thoracic cage was examined in all cases. The Woodward procedure was performed with some modifications described in the text. The operative results in 3 cases were judged to be failure based on cosmetic and functional criteria. The age of the patients at operation and the presence of an omovertebral bone did not influence the results, however, the presence of important deformities of the cervical spine had a poor prognosis. The authors insist on the loco-regional character of the deformity and on the importance of the reorientation of the scapulo-humeral joint. Results were judged on cosmetic and functional criteria with 79% excellent or fair results.

[De-epiphysiodesis and old traumata of the growth apparatus (author's transl)]. / Désépiphysiodèse et traumatismes anciens du cartilage de croissance. A propos de huit cas.

Basing themselves on eight cases treated over the past six years, the authors recount their experience of the operative elimination of partial closure of the epiphyseal plate. The closures were due to various causes and involved the lower extremities of the femur or tibia. Operative elimination alone was carried out in three cases, and associated with bone realignment in the remaining five. The results confirm the best prognosis for comparatively recent, localized peripheral epiphyseal plate closures.

[Evaluation of the treatment of the unicameral bone cyst in children (author's transl)]. / Bilan du traitement du kyste essentiel des os de l'engant.

Solitary bone cyst is characterized by its tenacity and the risk of recurrence. This fact led the authors to use a surgical procedure very different of the classic ways of treatment as they excluded any bone graft to the benefit of a muscle graft with wide resection. 35 cases have been operated on at several steps of childhood. The recurrence's rate decreased plainly and is no more than 9%. They concern only the wide humeral cysts which were active and close to the fertile plate of the humeral head. These recurrences have been very well tolerated and have not predisposed the child to some pathological fractures. Residual pseudo-cysts were seen in 20% of the cases; they related for us, to some gaps of rehabilitation. This procedure ay be considered as the complement of cortisone's local infection when this one is not able to heal the solitary bone cyst.

[Lumbar disc herniation in childhood (author's transl)]. / La hernie discale lombaire chez l'enfant.

Two cases of lumbar disc herniation are reported in children. The disease is very rare during growth and the authors describe the clinical aspect and discuss treatment. A new concept of the pathogenesis is proposed.

[Reflexion on thirty eight cases of Monteggia fracture of children (author's transl)]. / Réflexion à propos d'une série de 38 fractures de Monteggia chez l'enfant.

The authors report thirty eight cases of Monteggia fractures, seven of which being old dislocations of the head of the radius. They insist on early diagnosis and treatment of recent fractures, with a successful result if the ulnar hache become rightly alined. In late untreated luxations of the head of the radius, they occasionally use fascia lata transplant to repair the annular ligament, after correction of ulnar hache. However, early diagnosis and immediate full treatment are the best for successful result.

[Fractures of the spine in children without permanent neurological injuries]. / Les fractures du rachis de l'enfant sans lésions neurologiques définitives

Three cases of trauma of the spine are reported compared with dislocation of the cervical spine; these mixed lesions are especially rare. They usually produce various spinal disorders which result in irreversible paralysis. The young age of one of these children and the favourable course, shows the interest of emergency repair of the damage. Reduction of the dislocation followed by internal fixation, may lead to a favourable course.