Non-vascularized fibular graft reconstruction after resection of giant aneurysmal bone cyst (ABC).

The aim of this study was to present the results of non-vascularized fibular graft for reconstruction of bone defects after en block resection of giant aneurysmal bone cyst (ABC) of the extremities. Between 1998 and 2006, three patients, aged 6, 8 and 23 years, with giant aneurysmal bone cysts were treated. The cysts were located in the humerus, proximal femur and metatarsal. All patients were given en bloc resection of the cyst followed by non-vascularized fibular bone graft, with the graft length ranging from 6 to 18 cm. All patients needed supplementary fixation with a single Kirschner wire or plate and screws. At the final follow-up, bony union was achieved in each case, and there was no recurrence, limitation of range of motion or disability. In addition, complete regeneration of the fibula at the donor site was seen in the two children. We propose a criterion for giant ABC, when the transverse diameter of the cyst is up to three times or more of the transverse diameter of the nearby bone, it is then called a giant ABC. Non-vascularized fibular graft is an optimal and valuable method for the reconstruction of bone defects after resection of giant ABC in the extremities.

Primary pyomyositis of the paraspinal muscles: a case report and literature review.

A case of non-tropical pyomyositis in a healthy, adolescent, 13-year-old boy, affecting the paraspinal muscles is presented. Computerised axial tomography scan (CT scan) of the spine provided valuable information on the nature, extent of the disease and helped to plan successful surgical management. None of the reported cases of such severity of paraspinal pyomyositis had involvement of quadratus lumborum muscle or compression on retroperitoneal organ as in our case.

Associated risk factors in children who had late presentation of developmental dysplasia of the hip.

PURPOSE: The purpose of this study was to assess the role of clinical examination, associated risk factors and plain radiograph of the pelvis in children who had late presentation of DDH. METHODS: We report on a 7-year prospective study, in children who had late presentation of developmental dysplasia of the hip (DDH). For this purpose, 740 hips in 370 referred children, age range 3-7 months (mean 3.44 months) were clinically and radiologically assessed, and the associated risk factors recorded. RESULTS: Female sex, first born, positive family history and breech presentation were confirmed as risk factors for DDH. Significant findings were an increased risk for vaginal delivery over caesarean section for breech presentation (P = 0.002). There was an increased risk for caesarean section in the absence of breech presentation. Multiple births and preterm births had a reduced risk. For breech presentation, the risk of DDH was estimated to be at least 1.6% for girls and 3.4% for boys; a combination of factors increased the risk. Limitation of abduction (43.2%) and asymmetry of the groin skin folds (72.7%) were found to be the two most common clinical findings associated with DDH. Bilateral acetabular dysplasia is more common than unilateral dysplasia. Foot deformities were rarely encountered in children with acetabular dysplasia. CONCLUSIONS: The percentage of first-born babies who had DDH is lower than reported in the literature (34%), but still shows significant risk. We did find that bilateral acetabular dysplasia is more common than unilateral dysplasia. Torticollis and foot deformities are rarely found to be associated with DDH. All these findings needs further evaluation in children who had surgical treatment for DDH, to see if they are different from dysplastic groups. Limitation of abduction is an important clinical finding, but is not always associated with DDH. Asymmetry of the skin folds in the groin were found to be an important clinical finding associated with DDH for all age groups. As clinical examination depends on many factors, and most DDH cases are of the dysplastic type, it is mandatory to depend on further diagnostic tools for confirmation of DDH.