Management of seat-belt syndrome in children. Gravity of 2-point seat-belt.

We present our experience with a management of seat-belt syndrome in three children and draw particular attention to the severity of two-point fixation seat-belt injuries after a motor vehicle accident with 5 passengers whose vehicle was struck head-on by an oncoming vehicle. The parents were sitting in front, Adeline had a 2-point lap seat-belt, the 2 other children had 3-point seat-belts. The parents both had humerus fractures. The 4-year-old brother suffered a cervical and abdominal trauma with renal and splenic contusions and intestinal perforations. Adeline suffered multiple injuries, notably to the head, spine and abdominal viscera with erosions at the site of lap-seat-belt contact. The spinal injury was an L2 angular Chance fracture associated with paraplegia on the 7th day. Operative findings included a transverse tear of the left rectus abdominus muscle, an incomplete transection of the stomach and perforation of the ileum. The injuries were ultimately fatal. Given associated abdominal pain, skin erosions at the site of seatbelt contact, spinal fracture, and rectal muscle disruption apparent on emergency laparotomy, early diagnosis is important for better prognosis.

Osteosynthesis of diaphyseal fracture by Ossatite experimental study in rat.

In order to develop a biodegradable interlocking nail for fracture fixation, hydoxylapatite pins and paste were implanted in the femoral bone of rats. A distal fracture was performed. The union and the tissue reaction to hydroxylapatite versus stainless-steel rods were studied after 15 days, 1, 2 and 6 months implantation. Metal pins induced a union. Hydroxylapatite pins (Ossatite) did not prevent callus formation, but did not lead to consolidation in all cases due to weakness of gelatin matrix binding the apatite particles together. The biocompatibility of material is satisfactory and the osteo-inductive properties of hydroxylapatite was confirmed. With injectable Ossatite , we could not obtain rat femoral fracture consolidation. We can confirm good biomaterial tolerance in bone which contrasts with important soft tissue reactions. Use of such material should be carefully limited to filling intra-osseous cavities.

Diaphyseal fractures treated by polylactide and hydroxyapatite pins. Experimental study in rat.

In order to develop a biodegradable interlocking nail for fracture fixation, polylactic acid (PLA) pins and hydoxyapatite pins were implanted in the femoral bone in rats. A distal fracture was performed. The union and the tissue reaction to PLA and hydroxyapatite versus stainless steel rods were studied after 15 days, 1, 2 and 6 months implantation. Metal and PLA pins induced a union. Hydroxyapatite pins (Ossatite) did not prevent callus formation, but did not lead to consolidation in all cases because of weakness of the gelatin matrix binding the apatite particles together. PLA and stainless steel pins induced the same union and a similar tissue reaction during the studied implantation of 6 months. The biocompatility of Ossatite is satisfactory and the osteo-inductive properties of hydroxyapatite was confirmed. With injectable Ossatite, we could not obtain rat femoral fracture consolidation. We can confirm good biomaterial tolerance in bone which contrasts with important soft tissue reactions. Use of such material should be carefully limited to filling intra-osseous cavities.

Meckel's diverticulum and laparoscopy of children. What's new?

Laparoscopy has not changed the diagnostic approach in Meckel's diverticulum (MD). Preoperative echography and scintigraphy are still indicated in case of symptomatic diverticulum. During each submesocolic laparoscopy we must meticulously look for Meckel's diverticulum. There are two surgical procedures for MD resection: 1. Short intestinal resection after exteriorization (celio-assisted surgery) is advocated in young patients or in complicated MD. 2. Laparoscopic resection by the Endo GIA stapler is advocated in older patients and latent MD with a narrow base.