Trochanteric arthroplasty in the treatment of sequelae after septic arthritis of the hip in infancy.

The authors describe 17 patients submitted to trochanteric arthroplasty between 1979 and 1999 at the Division of Pediatric Orthopaedics and Traumatology of the Rizzoli Orthopaedic Institute. There were 9 females and 8 males aged from 1 to 8 years (mean of 4) affected with the sequelae of septic arthritis of the hip with complete destruction of the epiphysis and of the femoral neck (types IVB and V according to the Hunka classification system). Mean follow-up was 9 years (minimum 1, maximum 23). Surgery is described and indications are discussed: this is the only type of treatment that may be offered in place of conservative treatment.

Involvement of the skull base and vault in chronic idiopathic hyperphosphatasia.

Chronic idiopathic hyperphosphatasia (CIH) is a rare generalised skeletal dysplasia in childhood. The clinical, radiographic and cerebral MR findings in a 5-year-old girl with the severe infantile form of CIH are reported. In spite of cranial enlargement, the intracranial space and the skull base were markedly reduced, the whole brain was compressed and a Chiari I malformation was present. Normal flow in the dural venous sinuses was documented. The patient showed no detectable cranial nerve involvement or hydrocephalus. Cranial MR in this patient enabled us to confirm that CIH involves the skull base and vault.

The correction of valgus knee by temporary epiphyseal stapling.

Unilateral temporary epiphysiodesis with Blount staples is a surgical method used to gradually correct axial deviations of the knee, slowing down the growth of one side of the conjugate cartilage. The authors analyse the results obtained with this method in the treatment of infantile valgus knee, in an attempt to determine an average monthly value of angular correction, based on which it is possible to plan the best time to perform this type of surgery. They affirm the effectiveness of the procedure, the success of which nonetheless appears to be related to the correct choice of the site of application and the number of staples used.

The Steindler method in the treatment of paralytic elbow flexion.

Based on an average follow-up of 8.6 years, the authors analyse the functional results obtained in 16 patients submitted to Steindler flexoroplasty of the elbow between 1975 and 1986. The absence of active flexion of the elbow produces a severe deficit in the upper limb even when there is good function of the shoulder and hand. Since 1921, the year in which Steindler published a report on his surgical method, numerous surgical methods have been described for the treatment of paralytic elbow. Clark (1946), Merle d'Aubigné et al. (1956), Brook and Sendon (1959) propose transposing pectoralis major by suturing it to the tendon of the biceps muscle. Le Coeur (1953) instead isolates pectoralis minor and then transposes it on the biceps tendon. Bunnel (1951) describes two methods: the first consists in isolating the sternocleidomastoid by lengthening it with the fascia lata and inserting it into the tendon of the biceps, the second proposes anteriorly transposing the distal triceps tendon. Hovnanian (1956) and Zancolli and Mitré (1973) transpose the latissimus dorsi by inserting it distally on the distal biceps tendon, while Axer et al. (1973) transpose part of the same muscle. It is the purpose of this study to report the experience obtained using the Steindler method in 22 patients affected with paralysis of the flexor muscles of the elbow.

Traumatic dislocation of the hip in children and adolescents.

The authors carried out a long-term review of 22 children and adolescents treated for traumatic dislocation and fracture dislocation of the hip with a view to ascertaining the factors responsible for unsatisfactory results. They considered the age of the patient, the severity of the trauma, the presence of associated fractures of the acetabular rim, the method of reduction, the time between injury and reduction, and the time between reduction and full weight-bearing. They stress the importance of early recognition of bone or soft tissue fragments included in the joint after closed reduction and immediate operation to remove them. Displaced fragments of the acetabular rim fracture should also be fixed. They also consider it important not to allow full weight-bearing until full hip movement has been restored, whatever the age of the patient and the time necessary to achieve it.

Trochanteroplasty in the treatment of infantile septic arthritis of the hip.

The aim of the present contribution is to explore the possible surgical solution of the problem of dislocation of the hip secondary to infantile septic arthritis, particularly in the form in which the femoral head is totally destroyed. The operation of trochanteroplasty is based on transposing the intact epiphysis of the great trochanter to act as a new femoral head and subsequently restoring the correct anatomical alignment by a trochanteric adduction osteotomy. Sixteen cases so treated over the 11 year period from 1969 to 1980 are reported.