20 years of functional treatment for clubfoot: advantages and limitations compared with the Ponseti method.

Currently, the Ponseti method has become the most popular technique for the management of congenital clubfoot. Besides this treatment, the functional method or the 'French method' (FFM) represents another treatment option. Throughout our study, we will describe this method, based on the 'Saint Vincent de Paul' protocol with some modifications that we bring progressively. Carried out over the last 20 years at our institution. In total 145 children (210 clubfeet) were treated using FFM. Our technique is based on the 'Saint Vincent de Paul' protocol from Paris. This method consists of daily manipulations of the feet by specialised physiotherapists associated with thermoformable orthotics devices. An evaluation of the patient at 5 year of age is performed. Gait analysis was introduced in 2011 as a complementary assessment tool. Less than 15% of the feet underwent a surgical procedure at walking age. Compliance to treatment was significantly higher than with the Ponseti method. At the last follow-up, 80% of the children had good to excellent results without major residual deformity. Totally 7% of the children required a later intervention either for recurrence or for major residual deformity. FFM is an alternative approach in the management of clubfoot that has proven to be successful due to the precision and modularity of its splinting system. Good compliance and low recurrence rate are other elements to consider. However, it requires a well-trained physical therapist. The main disadvantages of this method are the high cost compared to the Ponseti method and the difficulty of applying this method in developing countries.

Orthopaedic support with 3D printing in children : marketing effect or solution of the future?

In pediatric orthopaedics, the immobilization of a limb is traditionally done by a cast. The emergence of 3D technologies allows us to produce restraints specific to the anatomical characteristics of the patient. This paper aims to determine the feasibility of the process of developing these restraints. Descriptive study of the creation process involving 19 patients aged 2 to 14 years for whom a restraint was placed between April 2018 and November 2018. This was mainly post-traumatic pathology (12) and children having a clubfoot (7). This type of restraint has the following characteristics : use of recyclable material ; lightness ; ventilation ; visibility of the underlying skin tissue and its hydro-compatibility. The major limitations remaining are production time and printing errors. The emergence of 3D printing, allows us to extend its application to the medical world. When the therapeutic effectiveness of a restraint is achieved, quality of life becomes the main selection criterion. Based on observations already made in the past, we were able to develop a model that combines the advantages of the different approaches. New 3D printing technologies allow the creation of restraint devices with many advantages and customized adaptation possibilities.

Surgical management of rickets-like bone deformities (knock-knee and bow-leg) in children in sub-Saharan Africa.

Rickets-like deformities of the lower limb (knock- knee or bow-leg) are very frequent in sub-Saharan Africa. A prospective study was carried out over a period of 5 years. Forty-eight children were treated surgically for rickets-like deformities. The surgical technique was guided growth using a tension-band plate (eight plate). One patient was lost to follow- up. The technique failed in two cases (absence of correction in one case and hypercorrection in one case). Five patients are still under follow-up with progressive correction and were excluded from the study. A full correction was achieved in 40 patients (73 knees). There were 33 bilateral and 7 unilateral deformities. The deformities were knock-knees in 20 cases, bowlegs in 18 cases and there were 2 windswept deformities Good correction was obtained after a mean time of 11.4 months for genu varum and after a mean time of 12.4 months. The two windswept deformities were corrected after 8 and 9 months respectively. The guided growth technique using eight plate is effective as well in Africa. The needed material is not expensive if a two-hole tubular plate is used with two 3.5 screws.

Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report.

Bilateral simultaneous avulsion fractures of the anterior tibial tubercle (ATT) are extremely rare. Since the first description in 1954, 15 similar cases have been reported. We report a further case in a 16-year-old boy who sustained simultaneous bilateral tibial tubercle avulsion fractures (Watson-Jones Type III) from jumping during a gymnastics session. The right knee presented an associated partial avulsion of the patellar tendon. Both knees were treated successfully by open reduction and internal fixation with two cannulated screws. The recovery of the patient was complete; the screws were removed six months later. After one year follow-up, the patient had no complaint and had resumed his sporting activity.