Y. Glard

Limb lengthening and deformity correction in children using hexapodal external fixation: preliminary results for 36 cases.

Limb deformities in children can be corrected using different techniques, notably external fixation following the Ilizarov principles. However, correction can be difficult in cases of multiple deformities. In 1994, Charles Taylor developed a new computer-assisted hexapodal external fixator system to treat these pathologies, the Taylor Spatial Frame. The objective of this study was to evaluate the results obtained with this technique in treating lower-limb deformities in children. Thirty-six patients were included in this prospective study, with a mean age of 11.1 years. The etiologies were distributed into six groups: congenital pathologies in 17 cases, fractures in five cases, post-traumatic pathologies in two cases, postinfectious sequelae in three cases, achondroplasia in three cases, and other causes in the last six cases. A total of 67 deformities in the three spatial planes were found in the entire group of patients. The procedure consisted of lengthening, correcting the axis, or both simultaneously. All the patients were managed with the same protocol: placement of an external fixator, AP and lateral X-rays, and planning of the correction using dedicated software. In this group of 36 patients, the fixator was worn for a mean 183 days; when lengthening was performed, a mean 4.3cm was gained with a healing index of 38.2 days/cm. Of the 67 initial deformities, 91% were corrected. The most frequently encountered complications were a superficial infection in 22.2% of the cases; one deep infection was also noted as well as three bone regenerate fractures. Use of this computer-assisted fixation system seems effective in treating complex deformities of the limbs in children, and allows treating several deformities simultaneously.

Rotational profile of the lower limb in 1319 healthy children

Lower limb rotational profile in children may cause great concern to parents and relatives. In order to give parents clear information, there is a need for referential studies giving normative data of lower limb rotational profile and its normal changes expected over growth. Our aim was to collect a large clinical series of healthy children, out of a clinic, selected from a non-consulting population and to analyse Tibial Torsion and Femoral Anteversion according to age and gender. One thousand three hundred and nineteen healthy children underwent a clinical evaluation. Tibial Torsion was assessed using the method described by Staheli and Engel, whereas Femoral Anteversion was assessed using the method described by Netter. Our results showed that there was a significant difference between males and females in Femoral Anteversion, whereas there was no significant difference between the right side and the left side. Femoral Anteversion was higher in females, and was markedly correlated with age in both genders. There was no significant difference between males and females in Tibial Torsion, nor significant difference between the right side and the left side. Tibial Torsion was slightly correlated with age in both genders. Normative data were statistically defined in this work using the +/-2S.D. range. To our knowledge, there is no large and comprehensive series in the English speaking literature that gives normative data of Femoral Anteversion. Concerning Tibial Torsion, our results compared to those published in the literature.

Fatal lung metastasis secondary to index finger giant cell tumor in an 8-year-old child

We report the case of a 7-year-old girl presenting with giant cell tumor (GCT) of the index finger, complicated by lung metastases. Index disarticulation, pulmonary metastasectomy and chemotherapy failed to produce a cure, and the child died at the age of 8 years after 1 years evolution. The pulmonary metastases were discovered following hypoxia during initial biopsy. A review of the literature shows this observation to be original, in terms of the patients age and of the location, onset and fatal outcome of metastasis. The hypoxic episode complicating biopsy raises the issue of early screening for lung metastases in GCT. Pulmonary dissemination of GCT is of severe prognosis.

Surgical treatment of the symptomatic os trigonum in children

Symptomatic os trigonum is a rare condition, well described in adults, that causes chronic ankle pain. To date there are no reported cases of successfully managed symptomatic os trigonum in the children population. We retrospectively reviewed four paediatric patients (11-17 years of age) successfully operated for a symptomatic os trigonum using an open excision through a posteromedial approach. One case was bilateral. Postoperative pain relief was obtained in all cases. All of the patients were able to return to unrestricted physical activities after three months. The average follow-up was 12 months. Symptomatic os trigonum may be held responsible for chronic ankle pain in children and adolescents as well as in adults. The surgical treatment is effective in children.

Genu Valgum in Legg-Calvé-Perthes Disease Treated with Femoral Varus Osteotomy

AbstractFemoral varus osteotomy is one of the most common treatments for patients with symptomatic Legg-Calvé-Perthes disease with more severe deformities. We hypothesized knee valgus alignment at maturity in patients with Legg-Calvé-Perthes disease is an effect of the disease and not an effect of femoral varus osteotomy. We retrospectively compared matched groups of 28 patients with and without femoral varus osteotomy. The two groups were similar with respect to age at onset and classification of Herring et al. The distribution of valgus alignment among patients who had surgery and patients who did not have surgery was assessed at maturity and was similar between the operative and nonoperative groups. The data suggest valgus malalignment (genu valgum) is not a side effect of femoral varus osteotomy in patients with Legg-Calvé-Perthes disease, but rather an effect of the disease. Level of Evidence: Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Symptomatic os trigonum in children

BACKGROUND Symptomatic os trigonum is a rare condition well described in adults responsible for chronic ankle pain. To date there is no published case of successfully managed symptomatic os trigonum in children. METHODS We retrospectively reviewed 4 paediatric patients (11-17) successfully operated on for a symptomatic os trigonum through a postero medial approach. One case was bilateral. RESULTS Pain relief was postoperatively obtained in all cases. All of the patients were able to return to physical activities after 3 months. The mean follow up was 12 months. CONCLUSION Symptomatic os trigonum may be responsible for chronic ankle pain in children and adolescents as well as in adults. The surgical treatment is effective in children.

Trochleoplasty for Symptomatic Trochlear Dysplasia in the Skeletally Immature Patient with Review of Fetal Anatomy

Mechanical objective patellar instability may be related to an abnormal patellar course into the trochlear groove this may be due to trochlear dysplasia [3,4]. D. Dejour classified the trochlear dysplasia into four stages according to the shape of the trochlea [3]. In this classification, the B grade is defined as a flat trochlea. We have the conviction that a flat trochlea should be considered as a genetically determined and inherited condition. The lower extremity of the femur in human beings is characterized by an anterior groove in which the patella is held during motion. This groove separates the two lips of the trochlea. The lateral trochlear lip is more developed than the medial lip, creating an asymmetrical groove. An asymmetrical patellar groove with a protruding lateral side associated with an oblique femur is a specific mark of bipedal locomotion [6-9]. Apes present a wide and symmetrical groove on their distal femur, associated with a flat patella. In apes, the femoral shaft is vertical, showing no obliquity. In apes, there is no lateral dislocation stress applied to the patella during contraction of the quadriceps. In such mechanical conditions, there is no need for patellar containment in a deep groove, and no need for special lateral strengthening of the container. Tardieu and Dupont [7,8] have pointed out that femoral obliquity is acquired with the process of learning to walk and has no genetic determinism. It is an epigenetic feature. During hominid evolution, the protrusion of the lateral trochlear lip was probably acquired in response to femoral obliquity. We believe that it may have been selected and is genetically assimilated. Some studies have suggested that the shape of the lower extremity of the femur is determined early in development, long before standing and walking. Vries [10] described the foetal patella and showed that its morphology is comparable with that in adults from 16 weeks. Walmsley [11] described a patellar groove in the embryo, with the lateral trochlear lip more elevated than the medial lip. Gray & Gardner [5] showed that joint surfaces of the femoropatellar articulation are well shaped before both parts become properly fixed together. Doskocil [3] published the first series looking at the anatomy of the femoropatellar groove in the embryo. He established that the patellar groove is asymmetrical, with a lateral lip that is larger than the medial lip. Wanner published a biometric evaluation of the patellar groove in adults [12]. The biometry was achieved as shown in Fig. 39.1