Functional outcome following closed reduction and percutaneous osteosynthesis of distal tibia articular fractures in children.

Closed reduction and percutaneous osteosynthesis is an alternative to the open procedure for articular fractures of distal tibia of children. 38 patients were retrospectively reviewed. The measured parameters were : the score of Gleizes and the discrepancies between preoperative radiographic and CT scan measurements and postoperative radiographs. A significant correlation was found between the gap and the step-off in preoperative radiographic and CT scan. A significant decrease of the gap and step-off displacement was noticed after surgery. The Gleizes scoring showed 35 good results, 2 average results and 1 poor result. Percutaneous fixation of ankle articular fractures in children is a simple and effective treatment giving similar results to open techniques while minimizing the risk of joint stiffness and healing complications. Growth complications are comparable with both techniques.

Complications in pediatric spine surgery using the vertical expandable prosthetic titanium rib: the French experience.

STUDY DESIGN: Multicenter retrospective study of 54 children. OBJECTIVE: To describe the complication rate of the French vertical expandable prosthetic titanium rib (VEPTR) series involving patients treated between August 2005 and January 2012. SUMMARY OF BACKGROUND DATA: Congenital chest wall and spine deformities in children are complex entities. Most of the affected patients have severe scoliosis often associated with a thoracic deformity. Orthopedic treatment is generally ineffective, and surgical treatment is very challenging. These patients are good candidates for VEPTR expansion thoracoplasty. The aim of this study was to evaluate the potential complications of VEPTR surgery. METHODS: Of the 58 case files, 54 were available for analysis. The series involved 33 girls and 21 boys with a mean age of 7 years (range, 20 mo-14 yr and 2 mo) at primary VEPTR surgery. During the follow-up period, several complications occurred. RESULTS: Mean follow-up was 22.5 months (range, 6-64 mo). In total, 184 procedures were performed, including 56 VEPTR implantations, 98 expansions, and 30 nonscheduled procedures for different types of complications: mechanical complications (i.e., fracture, device migration), device-related and infectious complications, neurological disorders, spine statics disturbances. Altogether, there were 74 complications in 54 patients: a complication rate of 137% per patient and 40% per surgery. Comparison of the complications in this series with those reported in the literature led the authors to suggest solutions that should help decrease their incidence. CONCLUSION: The complication rate is consistent with that reported in the literature. Correct determination of the levels to be instrumented, preoperative improvement of nutritional status, and better evaluation of the preoperative and postoperative respiratory function are important factors in minimizing the potential complications of a technique that is used in weak patients with complex deformities.

[The limping child with a painful hip]. / Boiterie et douleur de la hanche chez l'enfant.

Hip pain is a frequent cause for limping in children. Etiology work out is oriented by the age of the child, the existence of a traumatic or infectious background, the child's morphology and ethnic origin, and most of the diagnoses will require only a standard X-ray and an ultrasound to be confirmed. In this way, the three main causes to be considered in children of less than 10 years of age are septic arthritis, transient synovitis and Perthes disease. Septic arthritis will require an urgent treatment, whereas Perthes disease will need a long care and follow up in order to watch for a poor outcome that will necessitate a surgical treatment to restore containment of the femoral head. In the adolescent, especially in case of overweight, the first etiology to be considered is slipped femoral capital epiphysis, a condition that requires an early and adequate surgical treatment (in situ screw fixation), in order to avoid further displacement and femoral head deformity of poor prognosis.

Treatment of epiphyseo-metaphyseal fractures in children with an original implant. The threaded pin with an adjustable lock (Fixano).

OBJECTIVE: Improvement of stability of internal fixation of epiphyseo-metaphyseal fractures in children with an implant characterized by its small diameter, easy utilization and its versatility. It avoids the drawbacks of screw fixation particularly in respect to the growth plate. INDICATIONS: Potentially all epiphyseo-metaphyseal fractures in children. CONTRAINDICATIONS: None. Crossing of the growth cartilage by small pins (< 2 mm) is without consequences under the condition that no compression is applied and that correction of a faulty pin position is limited to one. SURGICAL TECHNIQUE: In general, two threaded pins are used. They are inserted in a divergent fashion after the fracture has been reduced. Percutaneous insertion is possible. An adjustable lock screwed on a special key is slid over the end of the pin and put in contact with bone. It is squeezed until the key breaks off. The pins are then shortened. RESULTS: Since November 1999 these pins have been used for six olecranon fractures. In January 2002 we extended the indication to other fracture sites. Between January 2002 and July 2003 this system has been used 37 times (six olecranon fractures, eleven lateral condylar fractures and 13 medial epicondylar fractures of the elbow, and seven fractures of the ankle). A total of 43 fractures were treated (20 girls, 23 boys, average age 9.8 +/- 3.6 years) Average duration of follow-up 16.8 +/- 4.7 months. The assessment of results was based on technical, radiographic, and functional aspects. The overall results were good, in particular in respect to the stability of implants and the functional results. No secondary displacement, nor nonunion were observed; the pins were removed in all children at 6 weeks. The ease of handling the implants and the good clinical and radiologic results led us to propose these pins for routine use in epiphyseal and epiphyseo-metaphyseal fractures in children. Some improvements, however, are indicated principally, in particular in respect to the control of compression achieved by the adjustable lock.

Problems of operative and non-operative treatment and healing in tibial fractures.

Based on the experience of the department of pediatric surgery at the Strasbourg University Hospital, the authors present indications and limitations of various treatment techniques for tibial shaft fractures in children. Two retrospective series are reported on: one group of patients treated with the Sarmiento technique and one group of patients treated with Elastic Stable Intramedullary Nailing (ESIN or Métaizeau technique). The main problem in treatment is restoration of the mechanical axis of the tibia, especially in isolated fractures treated conservatively. Residual varus deformity is frequent, although it is usually within an acceptable range. ESIN has given better results than conservative treatment in this specific case, but valgus malunion shave been noticed when both bones were fractured, due to insufficient bending of the medial nail. ESIN is perfectly suited for treating polytrauma patients,especially those with multi level or open fractures (Gustilo 1 or 2), as it makes monitoring and nursing easier. Treatment of tibia fractures in children remains principally conservative. ESIN is indicated in cases of failure of conservative treatment, especially in isolated tibia fractures or polytrauma patients. For high grade open fractures (Gustilo 3)or extended comminuted fractures, external fixation remains the gold standard.

Surgical technique and preliminary results of a new fixation concept for olecranon fractures in children.

The authors report preliminary results of an original fixation technique used for the treatment of olecranon fractures in six children. This technique uses two threaded pins fitted with an adjustable lock, introduced through a minimal skin incision. With a mean follow-up of 14 months, clinical results are excellent in five cases and good in one case. Radiologic results are satisfying, with five anatomic reductions and without any secondary displacement. No growth impairment has been observed, but the follow-up period is still too short to conclude that this technique is superior, as far as this factor is concerned. However, the simplicity of the technique and its efficiency have led the authors to use it routinely for this fracture type.

Biomechanical analysis of olecranon fracture fixation in children.

The authors present an original fixation technique for olecranon fractures in children, achievable without opening the fracture site. The standard method of Kirschner wire fixation with tension band wiring is replaced by a threaded pin stabilization with adjustable lock effect. An olecranon fracture model was used to compare the mechanical properties of this new system with the tension band wiring technique, and with a simple pin fixation. No significant difference was found between the two first techniques, whereas the simple pin fixation had much poorer mechanical properties.