J. Leroux

Surgery for slipped capital femoral epiphysis in adolescents

The treatment of slipped capital femoral epiphysis (SCFE) in adolescents remains controversial. The goal of initial treatment is to prevent further slippage of the epiphysis. In mild forms, both stable and unstable, in situ fixation is widely accepted as the reference treatment. In contrast, several techniques are available for stable moderate-to-severe SCFE. In unstable moderate-to-severe SCFE, emergent reduction with decompression and internal fixation is currently the preferred method. Selection of the surgical technique rests on an appraisal of advantages versus drawbacks. The goal of this review is to discuss the various surgical methods available for SCFE in adolescents.

Legg-Calvé-Perthes Disease

Current knowledge of the causes and risk factors of Legg-Calvé-Perthesdisease (LCPD) does not allow effective preventive strategies. The outcome in adulthood is usually good. Hip osteoarthritis rarely develops before 50 years of age. The risk of osteoarthrosis depends chiefly on the final degree of joint incongruence. Age at onset and the lateral pillar classification are the two main outcome predictors and serve to guide the surgical indications based on the studies by Herrings group. Non-operative treatment is not effective. In contrast, femoral varus osteotomy and Salters innominate osteotomy provide good outcomes. In severe forms, however, combining these two techniques or performing a triple pelvic osteotomy seem preferable. Surgery is now performed considerably less often than in the past, as it is effective only in patients with lateral pillar group B or B/C disease with onset after eight years of age. In other situations, therapeutic abstention is recommended.

Sacro-iliac joint arthroscopy for arthrodesis after traumatic dislocation. Cadaver and clinical feasibility study

BACKGROUND Sacro-iliac arthrodesis usually requires an extended posterior approach, which is associated with a number of dreaded complications. Here, we assessed the feasibility of arthroscopic exploration of the dislocated sacro-iliac joint. MATERIALS AND METHODS In the first step of our study, we used ligament section to induce loss of sacro-iliac joint coaptation in a cadaver. We then studied 5 patients with Tile C pelvic ring injuries. Arthroscopy was used to clear the joint of fibrous tissue and to roughen the bone to subchondral level in order to induce sacro-iliac arthrodesis. In addition, posterior fixation was performed using a hinge system or an ilio-sacral screw. RESULTS The cadaver study confirmed the feasibility of sacro-iliac arthroscopy after disruption of the strong posterior inter-osseous ligament. In the clinical part of the study in 5 patients with Tile C pelvic ring injuries, arthroscopy allowed direct visualisation extending to the anterior part of the joint space. A power burr and synovial knife were introduced to remove the interposed fibrous tissue and to roughen the bone to subchondral level in order to induce joint fusion. In addition, percutaneous or open posterior fixation was performed in all 5 patients. No infectious complications were recorded. DISCUSSION An arthroscope cannot be introduced into the normal sacro-iliac joint. In contrast, after traumatic sacro-iliac dislocation, arthroscopy can be used to evaluate the intra-articular injuries and to roughen the bone to subchondral level.

Patología adquirida del esqueleto del niño

El proposito de este articulo es trazar las grandes lineas del diagnostico, de la clasificacion y de los principios terapeuticos de las patologias ortopedicas adquiridas del nino. Por definicion, se excluyen todas las patologias congenitas o las malformaciones (luxacion de cadera, deformaciones congenitas del pie, etc.). En cambio, se consideran las patologias congenitas o las malformaciones cuyo diagnostico puede establecerse de forma secundaria durante el desarrollo, en el marco de la evaluacion etiologica de una anomalia aparentemente adquirida (escoliosis, desigualdad de longitud de los miembros inferiores, etc.). Ademas, la clasificacion de los epigrafes se ha de basar, en la medida de lo posible, mas en las circunstancias de aparicion de las patologias (signos) que en dichas patologias. Asi se veran, de forma sucesiva, el diagnostico de las cojeras y otros trastornos de la marcha, los dolores de la rodilla, las deformaciones adquiridas del pie, las infecciones osteoarticulares y, por ultimo, las deformaciones de la columna vertebral y del torax.

Arthrite de Lyme chez l'enfant : un piège diagnostique.

Lyme disease incidence is diverse in France. It is rare in many regions but very frequent in Central and Eastern France. Arthritis is a late manifestation of Lyme disease. In children, the clinical and biological picture often resembles that of septic arthritis and juvenile rheumatoid arthritis, which are more frequent. This explains why diagnosis may be delayed, especially when patient lives in a region of low incidence. We report the case of an 8-year old girl with knee arthritis treated as septic arthritis in a region where Lyme disease is rare. Six days later, clinical and biological worsening suggested that the diagnosis had to be reconsidered. Lyme arthritis was confirmed by serology. Treatment was adapted and the progression was positive. This case reminds us that, in children, Lyme arthritis may look alike septic arthritis or juvenile rheumatoid arthritis and must be considered as a possible diagnosis, even in low-incidence areas.