Subperiosteal hematoma of the iliac bone: imaging features of acute and chronic stages with emphasis on pathophysiology.

PURPOSE: The goal of this work is to describe the radiological appearance and clinical presentation of subperiosteal iliac hematoma and present a review of the literature. MATERIALS AND METHODS: We retrospectively reviewed the radiological and clinical files of 19 patients (age range: 12-75; mean: 47) who presented with acute or chronic subperiosteal iliac hematomas. Imaging findings and relevant clinical information were recorded. A thorough literature search was performed to find additional cases of this rare condition. RESULTS: Three young patients presented with acute subperiosteal iliac hematoma following a fall. Clinical presentation was characterized by pain and gait disturbance presumed to result from crural nerve compression. Unilateral or bilateral lenticular hematomas deep in the iliacus muscle were demonstrated by CT for all patients while MRI was also available for two of them. In 16 asymptomatic patients, chronic ossified subperiosteal iliac hematomas were incidentally detected by CT. Progressive ossification of acute hematoma was demonstrated at follow-up in two patients. CONCLUSIONS: Subperiosteal iliac hematoma is rare but has typical imaging findings that may present acutely in adolescents or chronically in asymptomatic adults.

Childhood delayed septic arthritis of the knee caused by Serratia fonticola.

We report a first documented case of Serratia fonticola infection in a child with septic arthritis, after falling off his bicycle and an infection with hawthorn thorns. The aetiologic agent was found to be a S. fonticola strain which was first isolated from two synovial fluid samples, only after culture enrichment, with failure of DNA amplification. Accurate diagnostic was done, despite S. fonticola is often considered as an opportunistic pathogenic bacterium. Alone ciprofloxacin treatment was not sufficient to counteract the infection, which was eradicated only after surgical drainage performed twice successively, with secondary removal of a remaining thorn, and treatment with third generation cephalosporin combined with ciprofloxacin for another three months.

Cervical spine stenosis in chondrodysplasia punctata.

Chondrodysplasia punctata (CDP) is a rare skeletal dysplasia characterized by stippled epiphyses during infancy. The frequency is probably underdiagnosed because of the large heterogeneity in this group. Many genotypic variations exist. Although cervical instability is commonly seen in many skeletal dysplasias, cervical spine stenosis associated with CDP is very rare. We report a boy with phenotypic features of brachytelephalangic chondrodysplasia punctata (BCDP) who had severe cervical spine stenosis successfully corrected by vertebrectomies of C6 and C7 with a fibular strut graft. We discuss the significance of this association.

Ultrasound: a helpful technique in the analysis of congenital vertical talus. A case report.

Congenital vertical talus is a rare condition. In newborns, the diagnosis is evident in severe forms, but it can be difficult to confirm in mild ones. Non-ossified tarsal navicular cannot be visualized on standard roentgenograms until it is ossified. This work demonstrates that ultrasound is helpful in the early diagnosis of congenital vertical talus and in the evaluation of the therapeutic concept and effects.

Simple bone cysts of the proximal humerus complicated with growth arrest.

A simple bone cyst of the proximal humeral metaphysis was found to cause growth disturbance with shortening and deformity in four patients. All had one pathological fracture. Three of them were treated with cortisone injections; the fourth patient, who presented an erosion of the physis, was treated with saline solution irrigation. Four hypotheses about the aetiology of growth arrest in the evolution of this benign lesion, are discussed: iatrogenic lesion of the physis, growth plate involvement by fracture, cortisone injection, and increased cyst pressure leading to erosion and even perforation of the growth plate.

Local autograft bone in the surgical management of adolescent idiopathic scoliosis.

STUDY DESIGN: A retrospective study. OBJECTIVES: The study was performed to determine the efficacy of local autograft bone in idiopathic scoliosis surgery on patients who had had spinal fusion with a Cotrel Dubousset device between 1990 and 1995. SUMMARY OF BACKGROUND DATA: Studies seemed to promote the used of autograft bone (iliac crest, ribs), allograft bone, or bone graft substitutes in adolescent idiopathic surgery. To the authors' knowledge, there have been no previous articles concerning in situ local auto graft bone in idiopathic scoliosis surgery in the literature. MATERIALS AND METHODS: Twenty five patients with idiopathic scoliosis, aged 11 to 18 years, were treated by posterior correction and arthrodesis using Cotrel-Dubousset instrumentation. Posterior spinal fusion was performed using only local bone grafts. The patients were reviewed with a mean postoperative observation time of 6 years (5-9). The results were assessed clinically and radiographically. RESULTS: Preoperative single curves averaged 56 degrees in the frontal plane with an average postoperative curve of 16 degrees. Preoperative double curves in the frontal plane averaged 55 degrees in thoracic curves and 49 degrees in lumbar curves with an average postoperative curve of 18 degrees in thoracic and 13 degrees in lumbar. At the final follow-up, there was no losing in the correction. There was no pseudarthrosis clinically or radiographically. CONCLUSIONS: In adolescent idiopathic scoliosis surgery, local autograft bone allows to avoid the necessity of any over graft.