Tarik El Madhi

Peripheral osteoarticular tuberculosis in children: 106 case-reports.

INTRODUCTION We retrospectively reviewed 106 pediatric cases of peripheral osteoarticular tuberculosis (OAT) seen over a 21-year period in Morocco. Patients with vertebral tuberculosis were excluded from the study. PATIENTS AND RESULTS The 55 boys and 51 girls had a mean age of 8 years. The hip and knee together contributed 63% of the osteoarticular foci. Organ involvement was documented in 32 cases. Mean time from symptom onset to evaluation was 10 months. This resulted in diagnostic delay, which contributed to the 22% rate of residual abnormalities consisting of joint ankylosis and leg length inequality. CONCLUSION OAT is a source of functional disability that should be recognized and treated early, particularly in children, given that appropriate management can lead to a full recovery (14 patients in our series).

Stiffness after neglected elbow trauma in children: a report of 57 cases

Neglected trauma of the elbow in the child is not rare, especially in countries where traditional treatment is still practiced. The authors report a study of 57 neglected elbow trauma in children and the complication of stiffness managed in the pediatric orthopedics department in Rabat, Morocco, between 1996 and 2002. Average patient age was 11 years, location predominated at the right elbow, and the average delay of consultation was 7 months after the trauma. Clinical examination found 36% of stiffness in bending, 29% in extension, and 35% mixed. Of these, 43% were judged very serious, 20% serious, and 37% moderate. Radiological finding showed 35 neglected elbow dislocations (61%), ten supracondylar humeral fractures (17%), and 12 posterior lesions difficult to determine. Abstention from surgery was recommended for 12 patients; 45 were operated on. The end result was 53% with minimal and moderate stiffness. The authors analyzed clinical and therapeutic aspects of all lesions, insisting on abstention from surgery according to the variable and unforeseen character of surgery results.RésuméLes traumatismes du coude négligés chez l’enfant sont loin d’être rares, surtout dans les pays où le traitement traditionnel est encore pratiqué. Les auteurs rapportent une série de 57 cas de traumatismes du coude négligés et compliqués de raideurs, colligée au service d’orthopédie pédiatrique de Rabat au Maroc entre 1996 et 2002. L’âge moyen des patients est de 11 ans, l’atteinte prédomine au niveau du coude droit, et le délai moyen de consultation est de 7 mois après le traumatisme. Le bilan clinique a objectivé 36% de raideurs en flexion, 29% de raideurs en extension et 35% de raideurs mixtes. 43% de ces raideurs sont jugées très graves, 20% graves et 37% jugées modérées. Le bilan radiologique a montré 35 luxations négligées du coude (61%), 10 fractures de la palette humérale (17%), et 12 lésions impossibles à déterminer a posteriori. Sur le plan thérapeutique, l’abstention thérapeutique a été préconisée chez 12 patients et 45 ont été opérés, le résultat global obtenu est de 53% de raideurs minimes et modérées. A travers cette série les auteurs analysent divers aspects cliniques et thérapeutiques de ces lésions, tout en insistant sur l’intérêt de l’abstention thérapeutique devant le caractère variable et imprévisible des résultats de la chirurgie.