Outcome of physeal and epiphyseal injuries of the distal tibia with intra-articular involvement.

The authors reviewed 83 physeal and epiphyseal injuries of the distal tibia with intra-articular involvement. The children, aged 11 to 14 years, were treated in the authors' department during 1987 to 1999. Treatment was nonoperative for 72.25% (60/83) and surgical for 27.75% (23/83) according to specific indications. This gives the basis for a classification of these injuries. The main purpose of the study was to investigate the long-term results of these injuries according to a radiologic classification. The parameters considered were the patient's age, the mechanism of injury, and the possibility of growth deformities or functional disorders. They were studied relative to the long-term results, with a follow-up of 2 to 13 years. Regardless of treatment, varus deformity, ranging from 10 to 15 degrees in relation to the normal opposite leg, occurred in four cases. In only one case was there painful limitation of ankle joint movement; in two other children an overgrowth of the medial malleolus was detected, with no functional impairment.

Surgical treatment of developmental dysplasia of the hip in the periadolescent period.

The surgical management of patients with neglected developmental dysplasia of the hip (DDH) after the age of 6 years has been the subject of controversy. We present 11 cases (16 hips) of neglected DDH that were treated operatively by means of open reduction and derotational subtrochanteric osteotomy. Patient age ranged between 10 and 17 years (mean, 12 years). Follow-up ranged from 5 to 13 years (mean, 8.7 years). The results have been satisfactory both clinically (evaluated using the modified Harris hip score) and radiographically (evaluated using Severin's classification). Our data suggest that neglected DDH cases, not only during early childhood, but also in the periadolescent period, should be considered for surgical treatment.

A novel surgical option for the operative treatment of clubfoot.

Clubfoot (talipes equinovarus) is a condition well known since the time of Hippocrates. Numerous conservative treatments have been introduced for this condition; few are still in favour. Conservative treatment was used in our department up to the third month of age. The indication for surgery was failure to correct or maintain the correction after conservative treatment. We report on 134 children (206 feet) who had operative treatment for clubfoot in our department during the period 1990-1996, using a novel surgical technique based on extensive posteromedial release combined with the lateral spread of the "extensor forces" of the foot. This new technique has produced excellent results.

Rotational injuries of the distal tibial growth plate.

Nine rotational injuries of the distal tibial growth plate in combination with spiral fracture of the fibula were treated in our department between 1993 and 2000. The average age of the patients was 12 years. The injury was a result of sudden, forceful external rotation of the ankle and foot. Pain and slight swelling of the ankle and external rotation of the distal tibia of 20 degrees -40 degrees were present. Radiologically, irregularity and widening of the growth plate of the distal tibia were obvious. In all these cases we noted, on lateral views, the characteristic sign of an "open fish mouth," due to the changes in the shape of the physeal plate. The spiral fracture of the fibula was not obvious in all radiographic views. The treatment in all eight fresh cases was closed reduction and manipulation by reversing the mechanism of injury and long leg cast application in all nine cases (including the one neglected case) for 6-8 weeks. The final results were either excellent or very good in all nine patients after a mean follow-up of 6 years.

Talus fracture associated with a fracture dislocation of the distal tibia in an immature skeleton.

A 12-year-old boy with a severe injury of his right ankle was treated in the accident unit. The local condition was an extensive open wound with parts of the fractured bones prominent. Radiographs showed a severely displaced fracture of the body of the talus associated with a Salter-Harris IV injury of the distal tibia and subluxation of the ankle. After proper debridement the fractured bones were reduced and fixed. Eleven years later both fractures are completely healed without any sign of avascular necrosis, the patient has full painless ankle movement and he can perform his demanding occupation without any problem.

Posteromedial dislocation of the elbow with lateral condyle fracture in children.

Posteromedial dislocation of the elbow in children is an extremely rare injury. The current study describes four boys with posteromedial dislocation of the elbow associated with a displaced fracture of the lateral humeral condyle. The patients ranged in age from 6 to 12 years (average age, 9 years 6 months). Closed reduction of the elbow dislocation and open reduction of the lateral humeral condyle fracture with fixation by Kirschner wires by a lateral approach was done in each patient. This was followed by 4 weeks immobilization wearing a long-arm cast. There were three excellent results and one good result. Healing and return of normal function occurred in all but one patient who had minor loss of full extension. Average duration of followup was 7 years 6 months (range, 3-13 years). Dislocation of the elbow associated with a displaced fracture of the lateral humeral condyle can be treated by closed reduction of the elbow dislocation and open anatomic reduction and fixation of the lateral condyle fracture with good results.