Secondary (Late) Developmental Dysplasia of the Hip with Displacement: From Case Studies to a Proposition for a Modified Diagnostic Path.

(1) Background. This paper presents a case of hip joints that were initially described as either normal or physiologically immature in four successive ultrasound examinations using the static method by Graf; however, the final treatment of the patient involved multiple hip reconstruction surgeries. (2) Case presentation. The patient was born with an Apgar score of 10 and did not exhibit neurological diseases that could deform and lead to pathological dislocation of the right hip joint. The subsequent analysis of medical data revealed that the hip luxation was due to secondary (late) developmental dysplasia of the right hip. (3) Conclusion. The article emphasizes the importance of early diagnosis and treatment standards for developmental dysplasia of the hip (DDH). The development of uniform international medical guidelines for the diagnosis, treatment, and prevention of hip dysplasia, along with the unification of DDH-related terminology, would allow for more effective management of DDH cases and reduce the cost of patient treatment.

Patient-reported effectiveness and safety of Pamidronate in NSAIDs-refractory chronic recurrent multifocal osteomyelitis in children.

To evaluate patient-reported effectiveness, safety and social influence of Pamidronate in the therapy of NSAIDs-refractory Chronic Recurrent Multifocal Osteomyelitis in children. Authors reviewed self-created questionnaires, which asked patients for symptoms alleviation, adverse drug reactions frequency and degree of severity and daily activities self-reliance. Only surveys with complete answers, which were returned to authors by an e-mail from juvenile patients treated for NSAIDs-refractory Chronic Recurrent Multifocal Osteomyelitis at the University Children's Hospital of Cracow were analyzed. Between 2010 and 2019, 61 children were diagnosed with NSAIDs-refractory Chronic Recurrent Multifocal Osteomyelitis at our department. Out of 61 requests sent, 42 complete replies (33 females, 9 males) were gathered and analyzed. All patients included in this research were administered with at least one set of Pamidronate intravenously in the dose of 1 mg/kg/day for 3 consecutive days. Our analysis shows remarkable in terms of patient's impressions decrease of pain intensity after 2.5 series of Pamidronate on average, and total pain resolution after 5.9 series on average. Overall number of adverse drug reaction events reported by responders was 105. One patient developed drug-dependent renal insufficiency in the course of therapy. Outcome assessment indicates that nearly 50% of the studied population was more eager to participate in social life just after the first infusion of the drug. 95% of the surveyed unanimously agreed to recommend Pamidronate therapy to cure NSAIDs-refractory CRMO. 39 out of 42 (93%) patients considered Pamidronate effective at the end of the treatment. Onset of Pamidronate's action is gradual and differs in terms of symptoms alleviation between sexes. The therapy can induce considerable number of adverse drug reactions (2.5 per patient). Only 3 out of 42 (7%) patients were free from any ADRs. To demonstrate the impact of the use of Pamidronate on daily activities more precisely, further research with quantification of the quality of life is warranted.

Problems, Complications, and Factors Predisposing to Failure of Fassier-Duval Rodding in Children With Osteogenesis Imperfecta: A Double-center Study.

BACKGROUND: Although Fassier-Duval (FD) rods have been used for almost 2 decades, knowledge of factors predisposing to their failure is limited. Thus, the purpose of this study was to: (1) present the most common complications of FD rodding, (2) present tips on how to avoid or overcome them, and (3) identify factors predisposing to treatment failure. METHODS: Fifty-eight rod segments in 19 patients with osteogenesis imperfecta (mainly type III) underwent analysis with a median follow-up (FU) time of 4.4 years. We assessed the total number of complications clinically and radiographically. Next, the possible predisposing factors leading to failure were assessed using the Mann-Whitney U test. In addition, we evaluated the cutoff age for the increased rate of complications using the Youden index. A P<0.05 was considered significant. RESULTS: The total number of complications reached 44.8%. The most common complications included: migration of the male or female implant (45.7% and 25.7% out of the total number of complications, respectively), bone fracture with bending of the rod (8.6%), and rotational deformities (8.6%). Significant differences in patients' ages at the time of surgery were found between the group with and without complications (P=0.04), while sex, segment treated, preceding surgeries, length of FU, FD rod diameter, and length of bisphosphonate treatment were not significant. The Youden index showed that the risk of complications rose significantly in patients treated when younger than 5.5 years of age (P<0.05). CONCLUSIONS: This series displays the effectiveness and utility of FD rods at a median FU of over 4 years. Complication rates were comparable with the existing literature, with a notable increase in the number of side effects observed in younger patients (below the age of 5). LEVEL OF EVIDENCE: Level IV-therapeutic study.

Limitations in Use of Elastic Stable Intramedullary Nailing (ESIN) in Children with Disorders of Bone Mineralization.

BACKGROUND: Elastic intramedullary nails (ESIN) have been the treatment of choice in many long bone fractures in children for more than 20 years. The introduction of ESIN has drastically reduced tissue traumatization during fracture fixation procedures and decreased the risk of growth cartilage damage, as well as allowing for preservation of the natural biology of closed fracture healing. The objective of the present report is to draw attention to a small group of patients with bone mineralization disorders, who consequently demonstrate decreased mechanical resistance of the skeletal system, in whom indications for using ESIN fixation are limited. MATERIAL AND METHODS: The study group consisted of 6 patients who met the criteria for using ESIN fixation, but did not demonstrate a satisfactory outcome. The inclusion criteria included age below 18 years, appropriate ESIN nail insertion technique with correct calculation of nail diameter (2/5 of the medullary canal diameter), body mass < 50 kg and achieving appropriate prebending that is the prerequisite of three-point intramedullary support. The patients' medical records and radiographs were analyzed and they were invited for clinical and radiological follow-up examinations. RESULTS: All six patients demonstrated a gradually increasing bending deformity of the long bone axis. Additionally, in three patients, there was intrusion of terminal parts of the nails into the bone. In one patient with bone fibrous dysplasia, the proximal epiphysis was perforated by the flattened ends of the nails. In all patients, the removal of the ESIN fixation was followed by single or double-level corrective osteotomies and Rush pin fixation. CONCLUSION: In cases of long bone fractures in children with metabolic bone disorders in whom the bone structure is weakened and the bones themselves are easily deformed, more rigid intramedullary fixation with Rush or Fassier-Duval type nails as primary osteosynthesis should be considered.

Treatment of chronic recurrent multifocal osteomyelitis with bisphosphonates in children.

OBJECTIVES: Assessment of bisphosphonates efficiency in the therapy of NSAIDs-refractory Chronic Recurrent Multifocal Osteomyelitis. METHODS: Retrospective analysis of records of patients treated for Chronic Recurrent Multifocal Osteomyelitis between 2012 and 2018. RESULTS: Between 2012 and 2018, 76 children and adolescents were diagnosed with Chronic Recurrent Multifocal Osteomyelitis in our department. All patients underwent an initial course of NSAIDs therapy that provided a remission in 46% of cases. Of 41 NSAIDs-resistant cases, 7 patients were male and 34 were female. Disease started meanly in the age of 10. Most frequently pain localised in foot, clavicle and hip. In presented group, pamidronate was administered intravenously in the dose of 1mg/kg/day for 3 days. Patients received 6 series (1-17 series) on average with mean interval of 10 weeks (4-14 weeks). Our observations demonstrated rapid decrease of symptoms intensity after first dose of pamidronate with relapse of pain after 3-4 weeks. The frequency of pamidronate dosage was dependent of patient's symptoms. No serious adverse effects were reported. We finished the therapy after complete remission of symptoms and complete bone remodelling in imaging. Of 41 patients, 32 achieved remission and 9 continue their therapy. In remission group patients received 7 series of pamidronate on average and their treatment lasted meanly 20 months. CONCLUSIONS: Pamidronate is a safe and efficient method of CRMO therapy, particularly in cases refractory to NSAIDs treatment. Treatment with pamidronate provides both symptomatic relief as well as normalisation of bone morphology.

Physeal fractures of the lower leg in children and adolescents: Therapeutic results, pitfalls and suggested management protocol - based on the experience of the authors and contemporary literature.

PURPOSE: Physeal fractures in children frequently give rise to concerns about the condition of the growth plate. Our observations have proven that the dysfunction of the growth plate is less frequent complication in those cases than misdiagnosed interposition of the periosteum. The aim of this paper is to familiarize the readers with the issue of treatment of physeal fractures of the distal tibia and fibula in the growing skeleton. MATERIALS AND METHODS: We analyzed the group of 75 patients - children and adolescents - with surgically treated physeal fractures of the lower leg. The analysis included age, sex, circumstances of trauma infliction, type of sustained damage, employed therapeutic technique, timing of surgical procedure, duration of hospitalization, complications, duration of follow-up, radiological and functional results according to the AOFAS scale. RESULTS: The group consisted of 23 girls and 52 boys. The mean age was 13.6 years. The most frequent cause of trauma was same-level fall, usually during sports activities (35 cases). The most common type of damage was Salter-Harris type II fracture (35 cases). Among the employed surgical techniques, open reduction and stabilization with K-wires was the most often used (52 cases). A group of four patients attracted our attention, in whom after a closed reduction, signs of periosteum interposition were noted. These patients required a second procedure. In one patient, the growth plate arrest occurred; it was directly caused by local osteomyelitis. CONCLUSIONS: With adequately conducted treatment of distal tibia and distal fibula physeal fractures, the results are good. Misdiagnosed periosteum interposition poses a more serious clinical problem as opposed to the commonly anxiety-provoking post-traumatic growth plate dysfunction.

Pelvic fracture of the sacroiliac joint region in a child - a case study and literature review.

The aim of the paper is to present the case of a 3-year-old boy with an unaligned fracture of the sacroiliac joint region to propose a minimally invasive method of fracture fixation without using metal implants and to review the literature addressing this injury, which is uncommon in children. The patient was hit by a car; he suffered a fracture of the iliac ala with a complete traumatic damage to the L4-L5 nerve roots. The fracture was fixated by osteosuture and normal bone fusion was achieved. The follow-up period was 4 years. The boy manifested persistent flaccid paresis of the right foot and symptoms of a neurogenic bladder. Late radiological follow-up indicated disturbances of pelvic bone development and shortening of the lower extremity at the side of the injury.

Evaluation of stomatognathic problems in children with osteogenesis imperfecta (osteogenesis imperfecta - oi) - preliminary study.

According to epidemiological data, muscular dysfunctions of the masticatory system occur in 15-23% of the population. Preventive examinations of functional disorders of the stomatognathic system are, therefore, of particular importance. A distinct group of patients exposed to dysfunctions in the area of the masticatory organ locomotor apparatus comprises those with genetic diseases characterised by disorders in collagen formation. One of such diseases is osteogenesis imperfecta (OI) and dentinogenesis imperfecta that usually goes together with the former. AIM: The objective of this work was to evaluate the frequency with which particular disorders of the masticatory organ locomotor apparatus occur within the group of patients with osteogenesis imperfecta. MATERIAL AND METHODS: The study was performed on patients of the Orthopaedic Clinic of the Polish-American Paediatric Institute in Kraków. The mean age of the children was 7.9 years. In all the cases, a genetic diagnosis of OI has been confirmed. The research methods were based on an in-depth interview on family diseases, pregnancy, postnatal period, feeding, subjective assessment of dysfunctions in the stomatognathic system. An examination of the deformations in the stomatognathic system and the skeleton was conducted, as well as an examination of the trauma and tone of the jaw. The relationship between breastfeeding and swallowing and speech disorders was also evaluated. The impact of intubation on mandibular ranges was investigated. RESULTS: The results obtained were subjected to statistical analysis on the basis of which conclusions were drawn concerning disorders in the stomatognathic system which tend to occur in children with OI. The renunciation of breastfeeding significantly contributes to sucking and swallowing disorders, rumen disorders, as well as biomechanical disorders in the temporomandibular joint. A significant dependence between breastfeeding and swallowing problems was found, whereas there was no such dependence with respect to speech impediments. CONCLUSIONS: The results of the research conducted led to the following conclusions: 1. Among pediatric patients with OI there are disorders in the stomatognathic system. The most common dysfunctions are: abdominal, swallowing and sucking disorders, abnormal muscle structure of the rumen and biomechanical disorders in the temporomandibular joints. Breastfeeding significantly contributes to swallowing disorders. 2. The therapeutic process involving children with OI requires the cooperation of specialists in orthopedics, pediatrics, physiotherapy, orthodontics and neurologopedics to carry out comprehensive diagnostics and treatment tailored to the individual needs of the patient. 3. In order to draw final conclusions, there is a need for more research by means of objective tools, such as EMG and a condensate recorder.

Severe Thoraco-lumbar Kyphoscoliosis Associated with Osteoporosis in Siblings - Case study.

The incidence of scoliosis among patients with certain systemic diseases is much higher than in the general population. Moreover, the onset of the scoliosis is in early childhood before the age of 5 and the deformity reaches extreme values. We present the clinical course of two siblings with multiple musculoskeletal deformities, osteoporosis, severe kyphoscolisis and an undiagnosed systemic disease. The onset of scoliosis was in the first months of life of both children, with a marked progression about the 8th month of life. Due to lower limb deformities, ambulation was delayed until the 5th year of life in the male sibling, and the girl remains non-ambulant. Both children had osteoporosis, which caused numerous fractures of the upper and lower limbs. Due to progression of the spinal deformity the boy underwent a posterior hemispondylodesis with instrumentation at the age of 7. The girl also underwent surgery at the age of 7, but instrumentation could not be placed successfully due to inadequate bone quality. The last follow-up to date has been at the age of 12 years for the female patient and 20 years for the male patient. The spinal deformity in the female has not progressed during the last 2-3 years. She has been on bisphosphonate therapy for two years and no new fractures have been noted. The male patient has undergone multiple surgeries for lower limb deformities and is an independent walker. His scoliosis remains stable, but a minor progression of kyphosis has been noted in the last year. The history of the two patients shows that not all early-onset deformities can be effectively treated and that osteoporosis is a crucial obstacle to this treatment.

Advantages and Complications Following Fassier-Duval Intramedullary Rodding in Children. Pilot Study.

BACKGROUND: The report presents the authors' experience with Fassier-Duval rods in children and an analysis of advantages and complications. MATERIAL AND METHODS: Over a period of 15 months, the authors operated on 10 children and 18 rod implantation procedures were performed. In five cases, the implantation was a primary procedure, while in the remaining 13 cases Fassier-Duval rods were used to replace short Rush rods. RESULTS: The mean follow-up was 18 months. Four children developed the following complications: lateral rod displacement within the distal epiphysis, male rod displacement outside the epiphysis ("negative telescoping"), retrograde displacement of the male rod from the distal epiphysis to the metaphysis and retrograde displacement of the female element beyond the greater trochanter. CONCLUSIONS: 1. FD rodding allows for decreasing the number of operations because the nails need not be replaced as the child grows older. 2. FD rod implantation is limited by the size of the medullary cavity of the bone, and thus the age of the patient.

Chronic recurrent multifocal osteomyelitis (CRMO) in children - single-centre clinical observations and experience.

BACKGROUND: CRMO is characterized by chronic bone pain of recurrent nature. The onset is usually at the beginning of the second decade of life. Bony lesions may be visible on radiographs, although sometimes a CT or MRI scan is necessary to visualise them. The aim of study was analyse symptoms, diagnostic difficulties and results of accessory investigations in patients suffering from CRMO. MATERIAL AND METHODS: Medical records of 42 patients with CRMO were analysed to assess: age at onset of the disease, symptoms reported, location of lesions and abnormalities in laboratory and imaging studies. RESULTS: The medical records of 42 children, including 16 boys (38%) and 26 girls (62%), were analysed. The median age at onset was 10.5 years. The first symptom was bone pain in 34 patients (81%), with the remaining 8 (19%) presenting with widened bone contour in the absence of pain. Initially, only 5 (12%) subjects had multiple foci, whereas the vast majority (88%) presented with a single lesion. During exacerbations, osteocalcin levels were significantly elevated, increasing to a mean of 34 ng/ml (max. 68, min.14.6) against a reference upper limit of 13.7 ng/ml. Diagnostic difficulties and complications were found in 18 children. CONCLUSIONS: 1. Familiarity with CRMO in orthopaedic clinical practice is indispensable in differential diagnosis with other bone diseases, including those suggestive of malignancy. 2. Correctly diagnosed CRMO is managed conservatively as a treatment of choice.

Dysplasia epiphysealis hemimelica - diagnostics and treatment in pediatric patients.

BACKGROUND: Dysplasia epiphysealis hemimelica, also known as Trevor-Fairbanks disease, is a rare developmental disorder The objective of this article is to present own observations and experience in treating patients with dysplasia epiphysealis hemimelica. MATERIAL AND METHODS: Six children with dysplasia epiphysealis hemimelica were treated in years 1990-2007. The mean age of observation was 8.5 years (from 3 to 19 years). Analysis of medical and radiological documentation of patients was performed to collect data on symptoms, disease location, management and outcomes. RESULTS: The main symptoms reported by patients included limited range of motion of the affected joints with pain (66%) and deformed joint outline (34%). Four patients were subjected to surgical treatment while conservative treatment was applied in the other two. Lated complications were observed in two patients after surgical intervention (50%). In patients undergoing conservative treatment, one positive outcome and one negative outcome involving complete hip ankylosis, were observed. CONCLUSIONS: Correct diagnosis is very important as it may save the patient from unnecessary surgery and, if the surgery is necessary, it may help in performing it correctly. In patients presenting with joint pains, joint deformations, and tuberous lesions in joints possibility of dysplasia epiphysealis hemimelica should be taken into account. The treatment should start with conservative treatment, particularly physical therapy applied in the region of pain. If pain, joint deformation or limited range of motion of the affected joint persist, surgical treatment consisting of complete excision of the lesion should be taken into account.

Capitellar fractures in children.

BACKGROUND: Capitellar fractures are extremely rare. The Polish literature does not provide any reports on the treatment of these fractures. The aim of this paper is to present our treatment results and to compare them with reports from other authors. MATERIAL AND METHODS: We investigated a group of 9 patients aged 7-17 years (mean age 14 years). One patient (11%) had sustained a non-displaced fracture, while 8 (89%) had sustained fractures with more than 2 mm displacement. According to the type of fracture, one patient was treated conservatively and the others underwent surgical treatment. In the children who were operated on, the humeral capitulum was fixed with a bioabsorbable pin in one patient and with K-wires in seven patients. Objective elbow function was evaluated using the Mayo Elbow Score (MES). Subjective elbow function was evaluated by patients on the basis of the Oxford Elbow Score (OES). CONCLUSIONS: 1. Non-displaced capitellar fractures should be treated conservatively. 2. Fractures with more than 2 mm displacement should be reduced surgically with percutaneous fixation with K-wires.

Fibular hemimelia - diagnostic management, principles, and results of treatment.

The objective of this study is to present treatment of fibular hemimelia along with the complications, results, and an algorithm for treatment indications on the basis of authors' experience. A group of 31 patients was studied. In patients fulfilling the criteria for amputation, Syme's amputation should be performed. Elongation should be performed in case of type IA or IB fibular hemimelia, with a functional foot with more than three rays, leg shortening less than 5 cm at birth, and less than 10 cm at 9 years of life. The combination of epiphysiodesis with elongation produces the best outcome and is best accepted by the patients.

Diagnostic difficulties: chronic recurrent multifocal osteomyelitis and lymphoma. One or two diseases?

This paper presents a case report of a 15-year-old boy admitted to the hospital for persistent right knee pain and limping. The clinical appearance of his condition was the basis on which diagnosis of chronic recurrent multifocal osteomyelitis was made. Continuous deterioration in the clinical status also led to a suspicion of the presence of other pathological processes. A bone biopsy was performed and the results of histopathology showed diffused large cell B lymphoma. Chemotherapy was initiated; nevertheless, the patient's general state worsened gradually and subsequent pancytopenia resulted in septicemia and multiorgan failure that led to the patient's death. This paper reports the exceptional diagnostic challenges that emerged from the obscure course of the disease.

Stress fractures in children.

BACKGROUND: Presentation of own experiences, observations and results of treatment of patients with stress fractures treated in the Department of Paediatric Orthopaedics. The authors present an algorithm of diagnosing and treatment of stress fractures. MATERIAL AND METHODS: Over the period 1998 - 2010, 38 patients were hospitalised (40 fractures) with the final diagnosis of stress fracture. Personal patients' data, case histories and management preceding the diagnosis of the disease, diagnostic and therapeutic methods, as well as the results of treatment were collected on the basis of medical documentation. Standard diagnostic procedure consisted of: clinical and radiological examination, laboratory tests as well as computed tomography (CT). In 11 cases, the procedure included also scintigraphy and in two children MRI scan was performed. RESULTS: Complete healing of fractures was finally achieved in all patients CONCLUSIONS: In case of suspected stress fracture, it is necessary to perform a series of radiograms, which should present the picture of bone rebuilding and incorporation of the periosteal callus. If plain radiograph is inconclusive we should consider MRI , CT or scintigraphy scan. The results of laboratory tests should not show any abnormalities. In case of confirmed stress fracture nonweight-bearing of the affected extremity is recommended as well as introducing of close clinical-radiological monitoring. The results of MRI examination should be interpreted very cautiously, be cause it can be misleading. The observation strategy ("wait and see") should be implemented. However, the lack of the regression of pain sensation, bone rebuilding features and incorporation of periosteal callus or the appearance of visible bone destruction (lysis) should raise questions and present an indication for taking biopsy of the laesion.

[Ischial tuberosity fractures in children]. / Zlamania guza kulszowego u dzieci.

BACKGROUND: Ischial tuberosity fractures in children are a form of avulsion fractures caused by the strong thigh muscles of the back group (ischiotibial muscles). OBJECTIVE: Presentation of observations covering the diagnostic difficulties, treatment and follow-up of ischial tuberosity fractures in children. MATERIAL AND METHODS: 6 children (one girl and five boys), average age at the time of injury - 13.6 years (12-15.5 years). An analysis of medical and radiological documentation of patients. RESULTS: Two patients with chronic pain were suspected of ischial bone tumor, one was suspected of Perthes disease, and only 3 were sent to the Traumatology Department immediately after the football injury. All patients were treated conservatively. Complete healing of fractures was finally achieved in all patients - (fibrous union in two cases) and finally, after an average period of 9 months, the pain subsided. CONCLUSIONS: There is a discussion in medical literature about the difficulties in the diagnosis of ischial tuberosity fractures, which were primarily unrecognized. Radiological picture of significant bone rebuilding may suggest neoplastic lesions. In the literature dominates the attitude of conservative treatment. Only in cases of large displacement of fracture and chronic ailments caused by pressure on the sciatic nerve, surgery should be considered.

[Intervertebral disc calcification in children]. / Zwapnienia krazka miedzykregowego u dzieci.

THE AIM: Evaluation of children with intervertebral disc calcification (IDC) and own experience. MATERIALS AND METHODS: A retrospective analysis of 7 patients (2 girls and 5 boys) with detected, in the years 1990-2009, IDC. Age at the onset of symptoms (neck pain in 6 patients, torticollis in 4, hip pain in one) was on average 8.7 years (5-13 years). The diagnosis was based on review of radiographs of the spine, which revealed the presence of calcifications within the intervertebral discs in the cervical (4 patients), cervical and thoracic (2 patients) and thoracic spine (1 patient). The mean level of IDC on average was 3.3 spaces (1-6). RESULTS: After conservative treatment, including use of nonsteroidal anti-inflammatory drugs and rest, the symptoms subsided within 1-2 weeks. 4 patients had a return of pain in the neck, in one year, but the symptoms were milder and resolved within a few days. The mean observation period was 9 years (3.5-16 years). In 4 patients, changes disappeared completely, while in the remaining three there was a very discrete calcifications. One patient, after 6 years, had a pain in the neck, and CT showed minor lytic changes on the surface of the vertebral bodies between which calcification occurred. DISCUSSION: s IDC is a rare disease of the spine in children, but should be taken into account in cases of vertebral pain. Usually the disease affects children before the age of 10 and locates in the cervical spine. But it can be located in every segment of the spine. Most patients have multilevel location. Acute phase of the disease requires conservative treatment. Rarely used surgical treatment should be considered only in patients with persistant neurological symptoms. The natural course of the disease is mild, and over the years calcification gradually disappear spontaneously.

[Iliac spine fractures in children]. / Zlamania kolców biodrowych miednicy u dzieci.

INTRODUCTION: Iliac spine fractures in children are a form of avulsion fractures at mechanically weak spot caused by the presence of the growth plate. OBJECTIVE: Presentation of observations concerning treatment and results of iliac spine fractures in children. MATERIAL AND METHODS: 49 children (1 girl and 48 boys). Age, at the time of injury, average 15.1 years (10.6-18 years). We analyzed medical and radiological documentation of patients. RESULTS: 17 patients sustained anterior superior iliac spine fractures (ASIS), 32 fracture of the inferior iliac spine (AIIS). Most of injuries happened during sport activities--27 patients suffered fracture while playing football. 37 patients asked for medical advice immediately after the injury. Rest of patients, who came late--sustained AIIS fracture. We hospitalized 26 patients (53%), all of them suffered significant pain. The average length of stay in hospital was 8 days. All patients were treated conservatively. All of the fractures healed without complications. DISCUSSION: Larger study than ours group, concerning 84 patients with iliac spine fractures, was presented only by Italian authors who analyzed injures of professional athletes. In literature reviewed conservative treatment strongly predominates. Only a small group of patients were treated surgically (including athletes treated by Croatian surgeons). CONCLUSIONS: The treatment of iliac spines in children should be conservative, consisting of a couple days of bed rest and then for 2-3 weeks walking on crutches with only toe touching until the pain resolves. We recommend return to full activities after 2 months.