[Gait disorders and lower leg deformities in children]. / Mon enfant marche mat les anomalies du morphotype des membres inférieurs.

Gait disorders and lower legs deformities in children are frequent causes of parental concern and of medical advice. These deformities should be analysed systematically as well as their consequences for daily activities. We should define precisely type, localisation and importance of the deformity: femoral or tibial torsion, knock knees, bow legs. The evaluation should always be done according to age of the child because these deformities are most often a step toward adult morphotype. Sometimes they could be the manifestation of some generalised or localised pathology that should be investigated and treated. Nevertheless patience and explanations, regular follow-up allow to reassure the parents. There is in the great majority of case no place for any conservatrice and especially surgical treatment for theses disorders spontaneously healing in 95% of cases.

[Painful total hip arthroplasty]. / La prothèse de hanche douloureuse.

The results of the total hip prostheses in terms of cost-efficiency make one of the surgical procedures the most efficient. Usually, the articular pains disappear completely and the patient function improves. Outside, turned out failures, which require a revision, some patients present residual pain persisting after the intervention or appearing secondarily. Considering the important number of total hip arthroplasties, this clinical situation is not so rare and the generalist, as the specialist, can be confronted there. The experience shows that the surgical revisions, in the absence of a precise diagnosis are disappointing and often do not improve the patient. This article presents the diagnostic and therapeutic steps advised to face this problem.

Prevention of ankle valgus after vascularized fibular grafts in children.

Ankle valgus after the use of vascularized fibular grafts is a specific complication of the donor site ankle in the growing child. Incidence of this deformity and prevention strategy are documented poorly. The goal of the current study was to evaluate the rate of such deformities and to analyze efficiency of two prevention methods. Charts of 20 children surgically treated for sarcomas of long bones with a mean followup of 4.1 years were studied retrospectively. Ankle valgus was considered if the tibiotalar angle on radiographs with the patient standing was 5 degrees or greater in valgus than that of the opposite ankle, and deformity was considered severe if it required surgical treatment. Prevention was done in some patients with a tibiofibular syndesmotic screw or with reconstruction of the fibula using a tibial autograft. Valgus occurred in nine patients (45%) and was severe in five (25%). Valgus prevention with a syndesmotic screw was efficient and lacking in complications, whereas patients with fibula reconstruction had a high incidence of deformity and relevant complications. The authors recommend using a tibiofibular screw in all patients whose growth plates are open in the lower limbs at the time of surgery.

Stress fracture of the ulna in a professional tennis player using a double-handed backhand stroke.

Stress fractures of the ulna are uncommon injuries, but they have been reported in athletes from various sports. In tennis players stress fractures of the ulna are described exclusively in the nondominant forearm of athletes using a two-handed backhand stroke. We report such a case in a 24-year-old tennis player, with special emphasis on diagnostic imaging, accurate grading of the injury, and specific treatment recommendations.

The value of early postoperative bone scan in slipped capital femoral epiphysis.

The purpose of this study was to evaluate the sensitivity and predictive value of early postoperative bone scan for detection of avascular necrosis (AVN) of the femoral head after surgical treatment of slipped capital femoral epiphysis. We reviewed records of 49 patients (64 hips) operated on between 1980 and 1997 with a mean follow-up of 3 years. Sixty-one out of 64 hips went through an early postoperative bone scan. The three hips that developed AVN showed significant loss of radionuclide uptake. There were neither false-positive or false-negative cases in this series. Early postoperative bone scan has an excellent sensitivity and predictive value for detection of AVN after surgical treatment of slipped capital femoral epiphysis.

[Strain gauge measurements on a one-side external fixation: a prospective series of 11 tibial shaft fractures]. / Fixateur externe monolatéral pour fracture diaphysaire du tibia avec mesures des contraintes sur le fixateur.

PURPOSE OF THE STUDY: External fixation is often the treatment of choice for open complex fractures of the tibia. For closed tibial shaft fractures, it is generally a second choice alternative. The purpose of this study was to determine whether fusion of closed and open fractures of the tibia can be successfully achieved with a one-side external fixator equipped with strain gauges and to evaluate complications of this type of treatment. MATERIAL AND METHODS: A consecutive series of 11 mid shaft fractures of the tibia (4 closed fractures and 7 Gustilo grade I and II open fractures) in 11 patients (mean age 29 years) were treated with a one-side external fixator. Strain was measured weekly to adjust the treatment. A Sarmiento walking cast was applied in all cases 4 weeks after removal of the external fixator. RESULTS: All 11 fractures healed without complications and without pin tract infection. Mean delay to consolidation was 20.5 weeks (range 13 - 29.5 weeks). One patient required a revision procedure for decortication and bone graft at 12 weeks. Weight bearing (50% of body weight on the injured limb) was achieved at 6.7 weeks (mean) and total weight bearing at 11.9 weeks. The external fixator's strain curves were compatible with normal healing in 3 cases, with slow healing in 3 and with retarded healing in 3 others. Two of the curves did not show recognizable patterns despite a favorable clinical and radiological course to healing. DISCUSSION: Early detection of a pathological pattern of fracture healing followed with a strain gauge enabled adaptation of treatment in all cases. Decortication with bone grafting was necessary in one patient. In two other cases, compression of the fracture with the external fixator or dynamic locking were sufficient to achieve a favorable healing pattern. This small series demonstrated that bone healing can be achieved within usual delays with external fixation and without major complications. Use of strain gauges on the external fixator allowed early detection of retarded healing and subsequent modification of the treatment protocol. This type of treatment might be an interesting therapeutic alternative for the treatment of closed fractures of the tibial shaft.

["My child walks on his tiptoes"]. / "Mon enfant marche sur la pointe des pieds".

Toe walking is a symptom that occurs frequently in the normal childhood population. The management of children who walk in a symmetrical and permanent way on the toes is presented. In most cases no etiology of toe walking is found. Idiopathic Toe Walking (ITW) is considered a diagnosis of exclusion and is employed only when all other possibilities have been eliminated with a meticulous clinical examination and various investigations. If any etiology is found, the treatment should be first non operative whereas heel cord lengthening is the treatment of choice in ITW. This surgical treatment should be limited to children with functional impairement and is ideally carried out as late as possible.

["Round back" in children and adolescents]. / Le "dos rond" de l'enfant et de l'adolescent.

The hyper-kyphosis or "the postural round back" is one of the most common complaints in orthopedic practice. In the majority of cases, the thoracic kyphosis are painless and flexible. The vertebral bodies are normal on radiograms. This is "the kyphotic attitude" or postural round-back. A medical treatment is not the necessary rule. Life hygiene, sports and simple supervision are needed. Nevertheless, there are still pathological fixed kyphosis, induced in the majority of cases by Scheuermann's disease. The other possible etiologies (congenital, paralytic, post-traumatic, Pott's disease, postradiation, or metabolic origin) are a lot rare ones and will be excluded by clinical examination and imaging studies. The structural hyper-kyphosis require treatment. We will approach successively steps of the diagnosis and treatment of the hyper-kyphosis of the adolescent.