Journal of Children's Orthopaedics

Pathologic or spontaneous fractures are recognised causes of morbidity in children. There is a paucity of data on their aetiology and patterns in African children. A combined retrospective and prospective study of 47 children aged 15 and below with pathologic fractures of long bones seen from January 2000 to December 2006. The setting was the Orthopaedic and Traumatology department of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. A total of 47 patients with a mean age of 5.3 years ± SD with pathologic fractures of 50 long bones were seen and treated. The most commonly affected bones were the femur (28%), tibia (28%) and humerus (26%). Chronic osteomyelitis following inadequately treated acute haematogenous osteomyelitis was the commonest cause of pathologic fractures (74.5%). The mean duration of fracture union was 6.8 ± 2.3 months and the outcome was satisfactory in 91.4% of cases. The aetiology of pathologic fractures in the African population is different from their causes in Caucasian children. Chronic osteomyelitis following inadequately treated acute haematogenous osteomyelitis continues to plague many children in our environment.

Gãy xương cánh tay kiểu III supracondylar là nguyên nhân phổ biến dẫn đến nhập viện khẩn cấp ở trẻ em cần điều trị phẫu thuật. Cấu hình của vật liệu cố định bên trong, kỹ thuật phẫu thuật và thời điểm phẫu thuật tối ưu (TS) luôn là những chủ đề được tranh luận. Thời gian phẫu thuật trong các trường hợp không phức tạp thường do các bác sĩ phẫu thuật quyết định. Trong nghiên cứu này, chúng tôi đã theo dõi một cách triển khai các bệnh nhi với gãy xương cánh tay kiểu III. Mục tiêu của chúng tôi là làm rõ ảnh hưởng của bên gãy xương, giới tính và thời gian trễ sau chấn thương đến việc chuyển sang phẫu thuật mở và sự dễ dàng trong việc giảm thiểu gãy. Dựa trên kết quả, xác suất chuyển sang phẫu thuật mở tăng gấp 4 lần mỗi 5 giờ bắt đầu từ 15 giờ sau chấn thương. Phẫu thuật mở là cần thiết sau 32 giờ. Việc giảm thiểu trở nên khó khăn về mặt kỹ thuật khi thời gian phẫu thuật tăng.

To determine the most up-to-date theory on the aetiology of Panner’s disease, to form a consensus on the assessment of radiographs and to evaluate clinical outcome in order to summarise the best available evidence for diagnosis and treatment. A review of studies to date on Panner’s disease. Studies were eligible if: (1) the study provided criteria for defining Panner’s disease in order to eliminate confounding data on other radiographic entities that were mistakenly grouped and presented as Panner’s disease; (2) original data of at least one patient was presented; (3) manuscripts were written in English, German or Dutch; and (4) a full-text article was available. Animal studies, reviews and expert opinions were not included. Because the majority of the studies were case reports, we did not use an overall scoring system to evaluate methodological quality. Twenty-three articles reporting on Panner’s disease were included. Most cases of Panner’s disease were unilateral in distribution and occurred in boys during the first decade of life. In general, conservative treatment is advised for Panner’s disease. Panner’s disease is a self-limiting disease and the majority of patients heal without clinical impairment. Based on the results of this review, Panner’s disease should be treated conservatively. Uniform names and descriptions of signs on radiographs would help to make the correct diagnosis. Since Panner’s disease is very rare, higher quality studies are not likely to be performed and, thus, this review provides the best level of evidence on the current knowledge about Panner’s disease.

Study of a biplanar crossed pin construct by two crossed Kirschner wires in the management of displaced extension type supracondylar humeral fractures in children. Sixty-four patients with such fractures were included and treated according to the study protocol: after achieving closed reduction under general anesthesia with fluoroscopic control, two crossed Kirschner wires of equal diameter were inserted percutaneously. The first lateral wire tracts from the posterolateral corner of the epicondyle to the anteromedial cortex proximally. Then, the medial wire is inserted from the anteromedial corner of the epicondyle to the posterolateral cortex proximally after crossing the fracture site. Thus, a biplanar crossed pin construct was achieved, as each wire had two separate fixation points and the crossed construct was achieved not only in the coronal plane but also in the sagittal plane. Every effort was made to get this construct right at the very first attempt without repetition. Two patients were lost to follow-up during the first postoperative year. The mean follow-up for the remaining 62 patients was 14.5 months (range 6–24 months). At the final follow-up, using Flynn’s overall modified classification, the clinical result was considered to be satisfactory in 60 (96.8 %) patients and unsatisfactory with poor result in two (3.2 %) patients. Technical error was thought to be the cause of the poor results. There were no postoperative neural or vascular complications. A biplanar crossed pin construct achieved by two Kirschner wires crossed in the coronal and sagittal planes is efficient to stabilize a displaced extension type supracondylar fracture of the humerus in children.

To investigate both volume and length of the three muscle compartments of the normal and the affected leg in unilateral congenital clubfoot. Volumetric magnetic resonance imaging (VMRI) of the anterior, lateral and postero-medial muscular compartments of both the normal and the clubfoot leg was obtained in three groups of seven patients each, whose mean age was, respectively, 4.8 months, 11.1 months and 4.7 years. At diagnosis, all the unilateral congenital clubfeet had a Pirani score ranging from 4.5 to 5.5 points, and all of them had been treated according to a strict Ponseti protocol. All the feet had percutaneous lengthening of the Achilles tendon. A mean difference in both volume and length was found between the three muscular compartments of the leg, with the muscles of the clubfoot side being thinner and shorter than those of the normal side. The distal tendon of the tibialis anterior, peroneus longus and triceps surae (Achilles tendon) were longer than normal on the clubfoot side. Our study shows that the three muscle compartments of the clubfoot leg are thinner and shorter than normal in the patients of the three groups. The difference in the musculature volume of the postero-medial compartment between the normal and the affected side increased nine-fold from age group 2 to 3, while the difference in length increased by 20 %, thus, showing that the muscles of the postero-medial compartment tend to grow in both thickness and length much less than the muscles of the other leg compartments.

The majority of paediatric tibial fractures can be managed conservatively. However, there is a small but significant group of patients that require surgical intervention for several indications, most notably, unstable fractures. There are various surgical options, each with its own advantages and risks. This review establishes the current available evidence for the use of elastic intramedullary nails in this group. A systematic review of the currently available literature was performed. The relevant studies were then critically appraised. Seven applicable retrospective case series were identified, with the outcomes from a total of 210 (range 16–60) patients considered. The mean time to union ranged from 7 to 21 weeks. Reported complications included small numbers each of delayed union, non-union, malunion, leg length discrepancy and infection. There is only a small body of evidence currently published on this topic. The evidence published so far concludes that elastic intramedullary nailing represents an effective and reliable method to treat an unstable fracture of the tibial diaphysis in the paediatric patient, where conservative management is not appropriate.

Children with spastic diplegic and hemiplegic cerebral palsy frequently ambulate with flexed knee gait. There has been concern that hamstring lengthening used to treat this problem may weaken hip extension. This study evaluates the primary outcome of hamstring transfer plus lengthening in comparison with traditional hamstring lengthening in treating flexed knee gait in ambulatory patients with cerebral palsy. A total of 47 children (67 lower limbs) ranging in age from 5 to 17 years old were included in this study. All subjects underwent a variety of additional surgeries at the time of the hamstring surgery as part of a multilevel treatment plan. All patients who met the inclusion criteria were divided into two groups, the hamstring lengthening alone group (HSL) and the hamstring transfer plus lengthening group (HST). Full gait analysis studies were done for all subjects pre-operatively and 1 year post-operatively. There were 25 patients (35 limbs) in the HSL group and 22 patients (32 limbs) in the HST group. There was no significant difference in age, gender, or the time from surgery to post-operative gait analysis between groups. On physical examination, both HSL and HST groups showed improvement in passive knee extension, popliteal angle, and straight leg raise. Maximum knee extension in stance phase was improved in both groups. The maximum hip extension in late stance phase was significantly improved only in the HST group. The peak hip extension power in stance phase showed significant improvement only in the HST group and a significant decrease for the HSL group. The findings of this study demonstrated that both the HSL and HST procedures resulted in similar amounts of improvement in passive range of motion of the knee, as well in knee extension in stance during gait at 1 year post-operatively. However, with the HST procedure, there was better preservation of hip extension power and improved hip extension in stance. The HST procedure should be considered when hamstring surgery is performed.