[A lumbar vertebral eosinophilic granuloma with spinal instability in an adolescent]. / Granulome éosinophile vertébral lombaire isolé avec instabilité rachidienne chez un adolescent.

This is a case report of a rare isolated eosinophilic granuloma of vertebra L3, in a 15-year-old adolescent. Vertebral instability, due to aggravation of the osteolysis, occurred without neurological symptoms despite orthopedic treatment. Surgery was necessary to correct and stabilize the spinal deformation. Postoperative chemotherapy (vinblastine and corticoids) was given as recommended for Langerhans cell histiocytosis (HL2010). No recurrence was observed after 5 years of follow-up.

Limb lengthening using ankle joint distraction (arthrodiastasis) followed by arthrodesis. Experience with one case.

Tibial aplasias are difficult entities to manage and sometimes require significant limb lengthening. Preserving the joint is the preferred option in these cases. However, when function is not ensured, lengthening beginning in the joint can be attempted followed by arthrodesis. This report presents the clinical and radiological results of a patient treated with intra-articular lengthening (or arthrodiastasis) associated with talocrural arthrodesis. Although this original technique provided satisfactory results, this surgical program remains complicated.

High-grade child spondylolisthesis: a custom-made canulated screw to treat the so-called double instability.

STUDY OBJECTIVES: Describing and assessing of a new surgical procedure to achieve circumferential fusion and translumbosacral fixation using a custom-made canulated screw. PATIENTS AND METHODS: Seven patients aged 13-18 years old underwent surgery with this technique (mean age: 15). All patients had high-grade spondylolisthesis (Meyerding stage III or IV). There were five girls and two boys. A posterior surgical approach alone was used in all cases. The posterior neural arch of L5 was removed and a sacral laminectomy, extending to S2, was performed. Sacral nerve roots S2 and S3 were carefully dissected and transposed. A K-wire was placed medially across the vertebrae from the posterior edge of S2 extending to the anterosuperior corner of L5. Fluroscopic perioperative fluroscopic control confirmed correct K-wire placement. The custom-made 10mm diameter canulated screw was then inserted along the K-wire as a guide. Screw fixation was obtained by placing a specific large diameter screw head to obtain compression by a lag screw effect. Once fixation was obtained, the sacral dome was excised and interbody fusion was performed (tricorticocancellous graft on each side of the screw). Additional bilateral posterolateral fusion was then performed. A half body custom fit thoracolumbar orthosis brace was prescribed 3 months postoperatively, followed by a Lombostat flexible lumbar support for an additional 3 months period. RESULTS: One neurological complication occurred. A dural tear occurred during dissection requiring simple repair. All of the patients were on their feet on the fifth postoperative day and began walking. The half bodybrace was worn for 4 months in four patients and 2 months in the three others. At final follow-up patients had no residual pain. DISCUSSION: The lumbar spine in children with high-grade spondylolisthesis adapts to the new mechanical conditions after surgery. Therefore the principal goal of treatment is to obtain stable osseous fusion. Our treatment philosophy is based on the concept of a dual instability. We believe that a general instability exists which causes the development of spondylolisthesis; this must be respected by not attempting to correct the displacement beyond what can be obtained on the operating table with complete muscle release. The other, locoregional instability, must be stabilized during circumferential fusion. The custom-made, 10mm screw has been shown to be effective in neutralizing the mechanical stress during circumferential fusion with a posterior approach alone, thus avoiding the risks of an anterior approach. Long-term results show that the preoperative posture is not the sole mechanical determinant in children and adolescents but that this posture is largely a reaction to pain. LEVEL OF EVIDENCE: Level IV. Retrospective study.

Fatal lung metastasis secondary to index finger giant cell tumor in an 8-year-old child.

We report the case of a 7-year-old girl presenting with giant cell tumor (GCT) of the index finger, complicated by lung metastases. Index disarticulation, pulmonary metastasectomy and chemotherapy failed to produce a cure, and the child died at the age of 8 years after 1 year's evolution. The pulmonary metastases were discovered following hypoxia during initial biopsy. A review of the literature shows this observation to be original, in terms of the patient's age and of the location, onset and fatal outcome of metastasis. The hypoxic episode complicating biopsy raises the issue of early screening for lung metastases in GCT. Pulmonary dissemination of GCT is of severe prognosis.

Limb lengthening and deformity correction in children using hexapodal external fixation: preliminary results for 36 cases.

Limb deformities in children can be corrected using different techniques, notably external fixation following the Ilizarov principles. However, correction can be difficult in cases of multiple deformities. In 1994, Charles Taylor developed a new computer-assisted hexapodal external fixator system to treat these pathologies, the Taylor Spatial Frame. The objective of this study was to evaluate the results obtained with this technique in treating lower-limb deformities in children. Thirty-six patients were included in this prospective study, with a mean age of 11.1 years. The etiologies were distributed into six groups: congenital pathologies in 17 cases, fractures in five cases, post-traumatic pathologies in two cases, postinfectious sequelae in three cases, achondroplasia in three cases, and other causes in the last six cases. A total of 67 deformities in the three spatial planes were found in the entire group of patients. The procedure consisted of lengthening, correcting the axis, or both simultaneously. All the patients were managed with the same protocol: placement of an external fixator, AP and lateral X-rays, and planning of the correction using dedicated software. In this group of 36 patients, the fixator was worn for a mean 183 days; when lengthening was performed, a mean 4.3cm was gained with a healing index of 38.2 days/cm. Of the 67 initial deformities, 91% were corrected. The most frequently encountered complications were a superficial infection in 22.2% of the cases; one deep infection was also noted as well as three bone regenerate fractures. Use of this computer-assisted fixation system seems effective in treating complex deformities of the limbs in children, and allows treating several deformities simultaneously.

Surgical treatment of the symptomatic os trigonum in children.

Symptomatic os trigonum is a rare condition, well described in adults, that causes chronic ankle pain. To date there are no reported cases of successfully managed symptomatic os trigonum in the children population. We retrospectively reviewed four paediatric patients (11-17 years of age) successfully operated for a symptomatic os trigonum using an open excision through a posteromedial approach. One case was bilateral. Postoperative pain relief was obtained in all cases. All of the patients were able to return to unrestricted physical activities after three months. The average follow-up was 12 months. Symptomatic os trigonum may be held responsible for chronic ankle pain in children and adolescents as well as in adults. The surgical treatment is effective in children.

[Hip subluxation and coxa valga secondary to an osteoïd osteoma]. / Subluxation de la hanche et coxa valga secondaires à un ostéome ostéoïde.

SUMMARY: We report on the case of a 2-year-old child with extra-articular osteoïd osteoma of the proximal femur leading to subluxation and coxa valga deformity of the hip joint at 10 year follow-up. The osteoïd osteoma reccured twice after surgical excision and percutaneous drilling. Patient's clinical history also reported a prolonged use of medications as treatment for these two recurrences. Second recurrence was combined with migration of the femoral head and retraction of the adductors: surgical treatment consisted in varus osteotomy to facilitate excision of the lesion, combined with a tenotomy of the hip adductors. Functional outcomes were satisfactory after 4-year follow-up. Reviews of the literature report two cases of hip subluxation secondary to intra-articular osteoïd osteoma. From our experience, it seems that hip subluxation in the present case could have been avoided with early surgical management.

[Progressive correction of the hand in the congenital radial clubhand]. / Centralisation progressive de la main dans la main bote radiale congénitale.

The therapeutic objective of a congenital radial clubhand is to obtain, at the end of the growth, a functional hand, that is a hand with a thumb, in the axis of the forearm with the most cosmetic aspect as possible. The challenge lies in the fact that the hand is not in the axis of the forearm. Thus, some authors realize a surgical centralization or radialization by doing a direct release of the retracted soft tissues. On the other hand, it is possible to correct the hand without any invasive surgery by using an external fixator allowing to correct the hand progressively. The Taylor Spatial Frame fixator is a system of external fixation which allows, by using a software, to realize this correction accurately.

[Osteoid osteoma of the inferior articular process of L5 associated with a bilateral spondylosis: a case report]. / Ostéome ostéoïde de l'articulaire inférieure de L5 associé à une spondylolyse bilatérale: à propos d'un cas chez un enfant de 5 ans.

We report the case of an 8-year-old boy who presented an osteoid osteoma of L5 associated with bilateral spondylolysis involving the same vertebra. Diagnostic bone scintigraphy is highly contributive in children presenting back pain. For us, it is the first intention exploration in patients with isthmic lysis seen on the plain x-ray. Symptomatic spondylolysis is the most frequent cause of back pain in children and is much more frequent than vertebral osteoid osteoma. The presence of isthmic lysis associated with focal uptake on the bone scintigraphy is highly suggestive of symptomatic spondylolysis. In this context, magnetic resonance imaging should be performed for both diagnostic purposes and prognostic assessment. The degree of bone and soft tissue edema in the present case was unusual for symptomatic spondylolysis. Complementary computed tomography finally established the diagnosis of osteoid osteoma of the posterior vertebral arch. To our knowledge, the association of osteoid osteoma with bilateral spondylolysis on the same vertebra has not been described elsewhere. In children, the diagnosis of symptomatic spondylolysis can only be established after ruling out other causes of back pain. The diagnosis of osteoid osteoma must be kept in mind.