[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.

[Supra and intercondylar elbow fractures in children]. / Les fractures sus- et intercondyliennes de l'humerus chez l'enfant.

Supra- and intercondylar elbow fractures are rare in children. The treatment of these fractures is controversial. The purpose of this report is to discuss diagnosis and treatment of this unusual injury. Our study looked at nine patients between six and 15 years old (average age: 11.5). In four patients, the fracture was T-condylar and in five patients, the fracture was epiphyseal-diaphyseal. Communition was noted in five cases. All fractures are secondary to high-energy trauma. All patients were treated by open reduction and internal fixation. Three patients had associated nervous lesions. Patients were reviewed at an average of 30 months follow-up and the results evaluated according to the criteria of Flynn. The results were good or excellent in six patients, fair in two patients and poor in one. Cubitus varus and limitation of elbow motion were the main complication. Supra- and intercondylar elbow fractures should be differentiated from the more common supracondylar humerus fractures. We recommended open reduction with internal fixation. Complications are due to the severity of the initial trauma and sometimes to defective treatment especially in the case of complex fracture.

[Congenital dermatofibrosarcoma of Darier and Ferrand: a pediatric case]. / Dermatofibrosarcome de Darier et Ferrand congénital : un cas pédiatrique.

INTRODUCTION: Dermatofibrosarcoma show an extremely aggressive tendency to invade surrounding tissue. It was first described in 1924. It usually occurs in young men. This type of tumor is exceptional in childhood. The authors report a case of congenital dermatofibrosarcoma diagnosed in a child. REPORT OF CASE: A two-year old female patient presented with a tumor of the vertex scalp since her birth. Biopsy revealed a dermatofibrosarcoma. The tumor was removed surgically with 3cm margins. The primary reconstruction was performed using a double temporoparietal flap (H). There was no recurrence at five years of follow-up. DISCUSSION: Congenital dermatofibrosarcoma is very rare. Only twenty cases have been reported.

False aneurysm of the radial artery: Unusual complication of both-bone forearm fracture in children: A case report.

False aneurysm or pseudo aneurysm of an artery in close proximity to fractured bone is a well-recognized entity, and fewer various cases, involving different sites have been reported in the literature. We report new case of a Moroccan's patient who had 10-year-old boy presented with a right non displaced both-bone forearm fracture; the patient was placed in a long arm splint. After, six weeks, the cast was removed. And a pulsatile mass on the volar-radial aspect of the forearm was decouvred. The mass was non-tender and the patient had radial and ulnar pulse. An Ultrasound and brachial angiography showed a false aneurysm of distal radial and the radial artery was ligated.In conclusion, pseudoaneurysm of the radial artery can be associated with any bone fracture despite non displacing fractures related to the elasticity of the bone in this age and orthopedic surgeons should be aware of this potential complication.

[Muscular tuberculosis: an unusual focus of Koch bacillus]. / La tuberculose musculaire isolée: localisation inhabituelle du bacille de Koch.

We report an exceptional case of tuberculosis in an 8-year-old girl. The focus of infection was situated in the anterior muscle compartment of the left thigh. Diagnosis was established on the basis of histological findings. A 12-month antituberculosis regimen was given. Outcome was good with no general or functional sequelae. Based on this case and data reported in the literature, we discuss the routes of dissemination of the Koch bacillus explaining this unusual sporadic localization.

[Centro-somatic staged tuberculous vertebral osteitis: a case report]. / L'ostéite tuberculeuse vertébrale centro-somatique étagée: á propos d'un cas.

Centro-somatic tuberculous vertebral osteitis is defined as tuberculous infection of the vertebral body with preserved integrity of the adjacent intervertabral disk. Other types of vertebral tuberculosis include Pott's spondylodiscitis and exceptional lesions of the posterior arch. We report a case of centro-somatic tuberculous vertebral osteitis in a 14-year-old boy who developed staged lesions of the L2 to S1 bodies, associated with a posterior epidural collection but without any deterioration of the intervertebral disk on plain x-rays and computed tomography. This atypical aspect of the lesions required a surgical biopsy which yielded a yellow-whitish fibro-oleagenous, friable product more suggestive of neoplasm than infection, but histology rectified the diagnosis, showing typical caseo-follicular tuberculosis. A 6-month anti-tuberculosis regimen was rapidly followed by symptom improvement. We emphasize the importance of modern imaging techniques for the diagnosis of vertebral lesions and for guided biopsy or drainage.

[Scoliosis and diastematomyelia: four cases and a review of the literature]. / Scoliose et diastématomyélie. A prpos de 4 cas et revue de la littérature.

We report four cases of scoliosis associated with diatematomyelia observed between 1984 and 1998. The patients were four girls aged 10 to 12 years. Skin lesions were found on the midline in 3 cases and 2 had a neurological disorder. A myeloscan was performed in two cases, tomomyelography in one and MRI in one. Three patients were operated on with good outcome. The fourth child is under orthopedic treatment. We reviewed the literature on scoliosis with diastematomyelia.

Hydatid cyst of the sacrum. Report of a case.

An unusual case of hydatid cyst of the sacrum revealed by low back pain and sciatica in a 16-year-old is reported. Computed tomography and a surgical biopsy provided the diagnosis. The outcome was favorable one year after mebendazole therapy initiation.

Craniocervical junction tuberculosis in children.

A case of tuberculosis of the craniocervical junction in an eight-year-old is reported. Presenting symptoms were painful torticollis, dysphagia, and tetraparesis. Computed tomography and magnetic resonance imaging findings strongly suggested the diagnosis, which was confirmed by peroral aspiration of a retropharyngeal collection. Management was by immobilization and antituberculous agents. Surgery was not performed. After one year, the outcome was highly satisfactory.