[Orthopedic treatment of the child with multiple injuries and its current progress]. / Le traitement orthopédique de l'enfant polytraumatisé et ses progrès récents.

We regularly use the Elastic Stable Intramedullary Nailing (ESIN) for children over seven years old with shaft limb fractures. This technique is especially adapted to pediatric traumatology, and is to be preferred to rigid osteosynthesis or osteotaxis in closed fractures. We use ESIN as a rule for femoral shaft fractures. Unstable fractures of shaft forearm, tibia and humerus are treated following this technique, as for multiple fractures of the lower limbs. Because of immediate and complete fracture stability. ESIN is especially useful in multiple trauma patients, where nursing facilities and easy transport are helpful. Moreover, re-education can be performed immediately, with a very early walk recovery.

Orthopaedic treatment of paediatric multiple trauma patients. A new technique.

In multiple trauma, skeletal injuries are generally responsible for long hospital stays, with concomitant nursing inconveniences and for most of the sequelae. A new operating technique has been perfected, especially adapted to paediatric traumatology: stable elastic rodding, precise and less aggressive technique. It avoids plastering and traction systems, and rapidly restores sufficient independence for a return to school. It is especially useful in multiple trauma patients, where nursing facilities and easy transport may be very helpful. The hospital regularly uses this technique for patients over six years old with femur fractures, tibia fractures associated with a contralateral lower limb injury, and forearm fractures where conservative treatment has failed.

Shaft forearm fractures in children: intramedullary nailing with immediate motion: a preliminary report.

Nailing is a good solution for shaft forearm fractures in children who require surgery. A closed reduction is very often possible owing to the bent tip of the pins. The procedure avoids extensive dissection, unlike epiphyseal plates. When a nailing is performed, the distal approach for both bones is the most convenient, avoiding elbow pain on the proximal ulnar incision. Six children of 57 had unacceptable reduction following conservative treatment and underwent intramedullary fixation. An immediate mobilization was possible in all patients. We observed neither delays in union nor recurrent fractures. The range of motion was normal in the postoperative period and at the 1 year follow-up.

Falciform ligament: a cause of extrinsic antral obstruction in the neonatal period.

We are describing two cases of neonatal antral obstruction due to the presence of an abnormal falciform ligament. Abdominal palpation revealed a cord in the right hypochondrium. In one case, a barium swallow revealed a very short extrinsic compression of the antrum. Division of the abnormally wide fibrous falciform ligament cured the babies.

Progressive upper limb lengthening in children: a report of two cases.

A 10-year-old girl presenting with idiopathic humerus varus underwent variation osteotomy of the neck of the humerus followed by humeral lengthening, resulting in 70 mm of lengthening over a 6-week period. Two successive lengthenings of the radius, each approximately 20 mm, were performed on a young girl presenting with radial growth abnormalities, progressively degenerating into a radial clubhand. In both cases, functional and cosmetic improvement followed the surgical procedures, which were devoid of postoperative complications.

Unusual association of upper gastro-intestinal anomalies in a newborn.

We are describing one case of persistent nonbilious post-prandial vomiting in a newborn due to hypertrophic pyloric stenosis, intestinal malrotation and gastric antral diaphragm. Those three anomalies were successively diagnosed as causes of persistent upper gastrointestinal subobstruction.

[Inguinal hernia in infants and children]. / La hernie inguinale chez le nourrisson et l'enfant.

Inguinal hernia is a rather common pathology encountered in children, present in 1 to 3% of full term newborns and in 3 to 5% of premature babies. Between January 1982 and January 1983, we operated upon 134 children with inguinal hernia, more than half of them were under 6 months of age. In most cases, the history of the patient would suffice to make the diagnosis, indeed, in 99 cases, the history would reveal the transient presence of an inguinal mass often absent during the examination at the clinics. In every other case we palpated an inguinal mass. Among these, 15 cases of indirect inguinal hernia were found, 4 were spontaneously reduced by soft manipulations, 10 were reduced under premedication and only one was irreducible. The other cases of irreducible inguinal mass appeared to be hydrocele and cysts of the cord. All our patients were in a good state of health, but one child suffering from a strangulated inguinal hernia causing intestinal obstruction. He was the only one to undergo an emergency operation, the others were operated upon within 24 to 72 hours after reduction of the mass. No relapse was ever observed. We advocate systematic surgery for any diagnosed hernia. The surgical treatment consists in the closing of the peritoneal vaginal duct. This operation is to be performed regardless of the child's age, height or weight and therefore avoiding complications a strangulated irreducible inguinal hernia would bring. Optimal operation conditions are gathered in a paediatric surgery unit where one is used to the anesthesia and to the delicate postoperative supervision of very young children.