Arthroscopy for hip septic arthritis in children.

BACKGROUND: Hip arthroscopy for treatment of septic arthritis in children has previously been reported with excellent short-term results. The purpose of this study was to evaluate the long-term results of hip arthroscopy for hip septic arthritis (HSA) in paediatric patients. HYPOTHESIS: Arthroscopy still is a useful tool in the treatment of HSA, and may be superior to simple hip aspiration. MATERIALS AND METHODS: Twelve patients with a median age of 6 years, with community-acquired infections, were diagnosed as HSA. All of them were treated using arthroscopic drainage. The duration of symptoms at presentation were a median of 3,5 days (2-20). In the younger patients (<8 years), hip joint distension was used instead of hip traction. At final check-up, the Hip Harris Score (HHS) was used and a radiographic study done. RESULTS: Two patients required a repeat arthroscopy. All, except for one patient, achieved excellent clinical results. Two patients presented radiological changes at the last check-up. The poor results were related to late presentation for medical treatment. There was no difference between early and late results. DISCUSSION: Hip arthroscopy for child HSA is a feasible technique even for the youngest patients, moreover the positive clinical results initially obtained are maintained over time. LEVEL OF EVIDENCE: Level IV: retrospective series.

Is Autologous Blood Transfusion cost effective in Adolescent Idiopathic Scoliosis?

The purpose of this study has been to evaluate the use of preoperative autologous blood donation (PABD) in the surgical treatment of adolescent idiopathic scoliosis (AIS). The surgical records of 37 AIS patients, Lenke type 1, were reviewed. Patients were classified according to whether they had entered the PABD (Program of Autologous Blood Donation) (25 patients) or had been rejected to join (12 patients non-donors). Both groups were comparable. All but one of the PADB patients (96%) as compared to only 2 non-donors patients (16.7%) required post-operative transfusion. Moreover, 12 of the PABD patients (48%) did not require the whole stored blood. At discharge both groups had similar haemoglobin levels. The risk of transfusion was much higher in the PABD group. The patients in this group received blood even with high haemoglobin levels (>8 g/dl). Furthermore, 31.4% of the collected blood was never used. Therefore, PABD resulted in an increase in procedure costs and lead to unnecessary blood transfusions.

Rebound growth after hemiepiphysiodesis: An animal-based experimental study of incidence and chronology.

Rebound growth after hemiepiphysiodesis may be a normal event, but little is known about its causes, incidence or factors related to its intensity. The aim of this study was to evaluate rebound growth under controlled experimental conditions. A total of 22 six-week-old rabbits underwent a medial proximal tibial hemiepiphysiodesis using a two-hole plate and screws. Temporal growth plate arrest was maintained for three weeks, and animals were killed at intervals ranging between three days and three weeks after removal of the device. The radiological angulation of the proximal tibia was studied at weekly intervals during and after hemiepiphysiodesis. A histological study of the retrieved proximal physis of the tibia was performed. The mean angulation achieved at three weeks was 34.7° (standard deviation (sd) 3.4), and this remained unchanged for the study period of up to two weeks. By three weeks after removal of the implant the mean angulation had dropped to 28.2° (sd 1.8) (p < 0.001). Histologically, widening of the medial side was noted during the first two weeks. By three weeks this widening had substantially disappeared and the normal columnar structure was virtually re-established. In our rabbit model, rebound was an event of variable incidence and intensity and, when present, did not appear immediately after restoration of growth, but took some time to appear.

Infeccions osteoarticulars / No disponible

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The prognosis for walking in osteogenesis imperfecta.

We report a postal survey of 59 families of children with osteogenesis imperfecta. From the 51 replies we collected data on developmental milestones and walking ability and related them to the Sillence and the Shapiro classifications of osteogenesis imperfecta. Twenty-four of the patients had been treated by intramedullary rodding. Both classifications helped to predict eventual walking ability. We found that independent sitting by the age of ten months was a predictor for the use of walking as the main means of mobility with 76% attaining this. Of the patients who did not achieve sitting by ten months, walking became the main means of mobility in only 18%. The developmental pattern of mobility was similar in the rodded and non-rodded patients.

Knee in congenital short femur.

The abnormalities of the knee associated with congenital short femur (CSF) and proximal femoral focal deficiency (PFFD), have been recognized for many years. The emergence of new and more effective lengthening techniques that can correct major congenital leg length discrepancies has made the abnormalities of the knee much more relevant. Some investigators have reported a high incidence of knee subluxation and dislocation during lengthening procedures in patients with CSF, attributing the incidence to knee anomalies. We assessed knee function in a group of 24 patients with CSF. Detailed evaluation of knee stability showed that not all knees were unstable; even when knees were unstable, the degree of instability was highly variable. No patient complained of knee pain or other knee symptoms.

Injuries to the physis by extravasation. A rare cause of growth plate arrest.

We report two cases of deformity of the ankle caused by physeal damage secondary to extravasation of an intravenous infusion in infancy. The possible mechanisms of injury to the physis are discussed.

Proximal femoral focal deficiency: does a radiologic classification exist?

Many attempts have been made to establish a radiological classification of proximal femoral focal deficiencies (PFFDs), which allow early decisions to be made concerning the prognosis and management of this condition. We reviewed the radiographs of 27 patients with 35 involved femurs. Each femur was staged using five different classifications at various ages. In many cases, the stages varied during growth. The radiological parameters described by Fixsen and Lloyd-Roberts were eventually found to be the most reliable factors for predicting future outcome of the femur.

Brachial plexus injury after median sternotomy.

Serious brachial plexus injury after median sternotomy is uncommon. However, affected patients experience considerable morbidity and their return to regular employment is often delayed. The pathogenesis of the injury is multifactorial. Wide sternal retraction is the major etiologic factor. Management is primarily conservative and should be guided by a team experienced in upper limb and hand surgery. Our experience at a major referral center during a 3-year period is described.

[Grice subtalar arthrodesis: a long-term follow-up in poliomyelitis sequelae]. / Arthrodèse sous-astragalienne de Grice: Etude à long terme dans les séquelles de poliomyélite.

A retrospective review was done of 19 poliomyelitis feet on which the standard Grice subtalar arthrodesis was performed for correction of valgus feet deformity. The average time of follow-up was 12.1 years. Seventy-nine per cent of the feet had satisfactory results, and all the failures were due to technical errors of graft placement. The calcaneo-first-metatarsal angle on the standing lateral radiograph was found to be the most objective angle and correlated best with the clinical results. The long term effects on the rest of the foot was negligible, with only 3 of the 10 feet, with a follow-up longer than 12 years showing minimal talonavicular arthritis and only 1 ankle developing a ball and socket joint. Ankle valgus was not a significant problem.

Results of operation for lumbar disc protrusions in children.

Intervertebral disc protrusions are rare in children and adolescents, and we report our experience of 9 cases, all of whom were girls. Diagnostic problems are common and objective findings dominate the clinical picture at this age. Eight patients were treated by operation; no spinal fusions were carried out. Six patients with a follow up of from 6 to 15 years were reviewed. There were no recurrences, but episodes of low back did occur. Radiographs showed a variable diminution in the height of the disc in every case.

Incomplete lateral dislocation of the elbow in children. A report of a case and review of the classification.

The authors report a case of incomplete lateral dislocation of the elbow in a seven year old girl. Review of the literature.