'What sport do you prefer to do?' Improving knowledge of adolescents' preferred sports within the sport participation decline framework.

BACKGROUND: Sport participation is declining in some European countries. Previous findings recommended considering territorial specificities to adapt local sports promotion programs. However, in France, little is known about adolescents' preferences and their changes across time. This study aimed to measure preferred sports and their changes among a representative sample of adolescents of the third biggest French département. METHODS: Data were extracted from a previous cross-sectional study that used a quota sampling design to respect the proportions of advantaged and disadvantaged schools. The present study involved 744 and 938 participants, in 2001 and 2015, respectively. Adolescent preferences were calculated by sex and socioeconomic status (SES). Multiple binary logistic regressions were performed to measure changes between 2001 and 2015 by sex and SES. RESULTS: Sports preferences and their evolution differed by sex and SES. Three cases were observed: no significant change in sports preferences (low-SES boys), a sharp loss of interest for some sports (low-SES girls and high-SES boys) and a sharp loss of interest for some sports whilst others gained significant interest (high-SES girls). CONCLUSIONS: This knowledge may help the development of sport promotion programs. Future sport policies could choose to develop sports that are preferred and increasingly appreciated by adolescents.

Sport injury prevalence and risk by level of play and sports played among a representative population of French adolescents. A school-based study.

BACKGROUND: Sports practice has both benefits and physical risks. In France, data related to adolescent sports injury are rare. The main purpose of this article is to study the prevalence and risk of injuries by level of play and sports in the southeast of France. METHODS: Data collection was conducted in French schools among adolescents in 2015 and 2017 (n=1849; aged 14-19). Only sports players were included (n=1366). Two level of play were created. The low-level group included adolescents playing sport either outside or within a club, at the local level of competition or below. The high-level group included adolescents playing sport within a club at the state (regional) level of competition or higher. Odds-ratios and their 95% confidence intervals adjusted for variables selected using stepwise regression procedures were calculated to determine the injury risk of high-level athletes compared with those at low-level, in each sport. We also calculated the injury risk of each sport compared to all the other sports, by level of play. RESULTS: In almost all sports activities, the prevalence of injured athletes was higher in the high-level of play than in the low-level of play. The increase in injury risk was the highest in tennis, basketball, dance, athletics and volleyball. When comparing sports, at the lowest level, handball, boxing, soccer and gymnastics practitioners were more at risk than the rest of the sample. At the highest level of play, only basketball players were more at-risk. Dancing is the less dangerous sport in terms of injury outcome, regardless the level. CONCLUSION: From the state level of competition, injury risk increases significantly across most of the sports. Meanwhile, differences appeared regarding the prevalence, severity and nature of the sustained injuries. It would be useful to perform such analysis on a greater sample size, ideally representative of the national population of adolescents.

Early outcomes of spinal growth tethering for idiopathic scoliosis with a novel device: a prospective study with 2 years of follow-up.

QUESTIONS/PURPOSES: Adolescent idiopathic scoliosis is a 3D spine deformity that worsens during the whole growth. New methods for spinal growth modulation with flexible spinal implants have been described to avoid progression of the deformity during growth spurt. The main limitations are that no specific ancillaries and devices are available, which makes the surgery technically demanding. METHODS: We have developed a new method of spinal growth tethering using minimal invasive videothoracoscopic approach. Fixation is performed with staples and synthetic ligament on the lateral aspect of vertebral bodies on main curvature convexity. Patients with progressive thoracic idiopathic scoliosis despite the brace treatment were included. The clinical and radiological examinations were compared before and 2 years after surgery. RESULTS: Six patients with flexible thoracic curves with a mean age 11.2 ± 1.2 years and a mean Cobb angle 45° ± 10° (35-60) were operated. All were skeletally immature. At last follow-up, the Cobb angle was stable. None of the patient underwent fusion. CONCLUSIONS: The procedure allowed a stabilization of the deformity during growth spurt. Validated devices and further studies with longer term follow-up are needed to confirm the efficiency of this technique. This small cohort of patients is a source of reflection for further medical devices developments. LEVEL OF EVIDENCE: Level 4 case series comparing to not randomized studies.

Spica cast as an alternative to general anesthesia for lower limb MRI in young children.

BACKGROUND: The conventional approach for MRI procedures in very young children is to use general anesthesia which comes with inherent risks. Non-pharmacological strategies to reduce anxiety in children have also been described, but they all require patient cooperation. The purpose of the study was to evaluate the ability to complete diagnosis using temporary spica cast immobilization (TSCI) in children less than 3 years old undergoing MRI procedures for lower limb disorders. MATERIALS AND METHODS: A retrospective review identified 14 children under 3 years old that had required an MRI for a lower limb disorder, using TSCI. The MRI procedure was performed for evaluation of hip dysplasia, bone infections, limping, evaluation of soft tissue tumor and femoral head osteonecrosis. A spica cast was fitted by the pediatric orthopedic team. The MRI procedure was subsequently performed. RESULTS: Diagnosis was achieved in all cases. The radiologist identified movement artifacts (14 %) that did not impair the image quality enough to prevent interpretation. CONCLUSION: TSCI is a safe, effective and costless procedure avoiding general anesthesia for young patients under 3 years old who require MRI for pelvis or lower limb disorders. LEVEL OF EVIDENCE: IV.

Governmental interventions and youth physical activity in France.

Data from a representative sample of 2474 French youth show that, despite a 7-year French Ministry of Health strategy for nutrition and physical activities, adolescents' motivation to practise sports and physical activities decreased significantly between 2001 and 2008. While this paper focuses on the context of physical activity in France, the general discussion may be applicable to other countries concerned with the obesity pandemic.

Functional impact of osteosuture in medial bilateral clavicular physeal fracture in teenagers.

INTRODUCTION: Proximal physeal fracture of the medial clavicular physis is a rare specific injury occurring in the immature skeletal. Several studies describe unilateral cases with posterior or anterior displacement and the following complications (vascular and mediastinal compression). An immediate diagnosis and management are necessary to avoid complications. The clinical diagnostic might be obvious or difficult, pain and swelling in the sternoclavicular joint area, sometimes a deformity and focal tenderness. A chest X-Ray may help and a three-dimensional reconstructed computed tomography scan has to be done to evaluate the lesions before surgery. The imaging is useful to confirm and specify the diagnostic and the displacement. PRESENTATION OF CASE: This case report presents 4 cases of proximal physeal fracture of the medial clavicular physis in 2 male-teenagers with bilateral displacement, one posterior and the other asymmetric. DISCUSSION: After reviewing the literature of the unilateral clavicular physeal fracture, we can conclude that the ideal management of these injuries has not been well described. An open reduction associated an osteosuture with non-resorbable suture was performed. One-year follow-up, both of them had full recovery without any functional impact or any complains. This management of the proximal physeal fracture of the medial clavicle on children shows an excellent result according our cases and the literature. CONCLUSION: The purpose of this study is to evaluate the functional impact of osteosuture in medial bilateral clavicular physeal fracture in teenagers after 1-year follow-up.

Modification of knee flexion during walking with use of a real-time personalized avatar.

Visual feedback is used in different research areas, including clinical science and neuroscience. In this study, we investigated the influence of the visualization of a real-time personalized avatar on gait parameters, focusing on knee flexion during the swing phase. We also studied the impact of the modification of avatar's knee amplitude on kinematic of the knee of healthy subjects. For this purpose, we used an immersive reality treadmill equipment and developed a 3D avatar, with instantly modifiable parameters for knee flexion and extension (acceleration or deceleration). Fourteen healthy young adults, equipped with motion capture markers, were asked to walk at a self-selected pace on the treadmill. A real-time 3D image of their lower limbs was modelized and projected on the screen ahead of them, as if in a walking motion from left to right. The subjects were instructed to continue walking. When we initiated an increase in the knee flexion of the avatar, we observed a similar increase in the subjects' knee flexion. No significant results were observed when the modification involved a decrease in knee flexion. The results and their significance are discussed using theories encompassing empathy, sympathy and sensory re-calibration. The prospect of using this type of modified avatar for stroke rehabilitation is discussed.

Efficacy of nighttime brace in preventing progression of idiopathic scoliosis of less than 25°.

INTRODUCTION: The objective of the present study was to assess, at skeletal maturity, the efficacy of non-operative treatment by isolated nighttime brace in the prevention of progression of progressive idiopathic scoliosis of less than 25°. HYPOTHESIS: Isolated nighttime brace treatment is effective in the prevention of progression of mild progressive idiopathic scoliosis (Cobb<25°). MATERIAL AND METHODS: A single-center retrospective study included 142 patients managed by nighttime brace for progressive idiopathic scoliosis with Cobb angle<25°, with assessment at skeletal maturity. Mean Cobb angle at start of treatment was 15.5° (range, 10-25°). Mean values for Cobb angle and sagittal parameters before treatment and at skeletal maturity were compared on Student t-test. Change in Cobb angle over time was also analyzed. RESULTS: Mean Cobb angle at skeletal maturity was 16.3°, showing significant increase over baseline (15.5°; P=0.04), although the difference was less than the uncertainty of measurement (±6°). In baseline Risser 0 or 1, mean change in Cobb angle at skeletal maturity (16.2°) was not significant (P=0.1). Cobb angle diminished in 26 cases (18%), increased in 24 (17%) and was unchanged in 92 (65%). CONCLUSION: The present study confirmed the efficacy of non-operative treatment by nighttime brace in mild progressive idiopathic scoliosis (<25°) in a large majority of cases. A nighttime brace thus seems to be an effective option for the treatment of adolescent scoliosis, ensuring a safe curve of around 20°. LEVEL OF EVIDENCE: Level IV, retrospective study.

[Risks linked to mobile phone use and how they are portrayed in the media: examples from three daily newspapers]. / Les risques liés à l'usage du téléphone portable et leur représentation médiatique: l'exemple de trois quotidiens français.

This study analyses how three French daily newspapers (Liberation, Le Monde, Le Figaro) convey information on the risks associated with mobile phone use in the period from 1995 to 2002. Quantitatively, the physical risks inherent to the low-intensity, electro-magnetic waves are most frequently reported, followed by those linked to mobile phone use while driving. "Social" risks, such as those related to noise or uncivil behaviour, are amongst the most rarely communicated. In general, the media present two types of physical risks connected to mobile phone use: the collective ones, which cover the low-intensity electro-magnetic waves which are emitted from the antennas on signal base stations, and the individual ones, which concem the waves produced by the mobile phone itself, and the danger associated with its use by a driver while operating a motor vehicle. Controversy surrounding the current scientific studies and the uncontrollable character of the risks linked to the low-intensity, electro-magnetic waves instill much more fear and debate than around those related to the combination of driving while talking on the telephone. While this latter point is scientifically proven, it is also subjectively under control.

Amputation and prosthesis fitting in paediatric patients.

Amputation of a limb is always perceived as a catastrophe. The principles underlying creation of a stump adapted to modern prosthetic fittings must be fully understood and the patient managed by a multidisciplinary team. In paediatric patients, preserving residual limb length is a crucial point that should be assessed according to the expected growth potential. Advances in prosthetic fittings have led to changes in the overall concept of socket design, which seeks to achieve three objectives: to maximise the weight-bearing surface area, to eliminate friction of the skin on the socket, and to eliminate lever-arm effects. The introduction on the market of new materials has contributed substantially to advances in prosthetic fittings. These advances require the use of new criteria for stump quality and optimisation, which exert a considerable influence on prosthesis function. Prosthetic fitting and specific management of psychological and social problems are provided during an inpatient stay in a physical medicine department, by a team of physicians, other healthcare professionals, social workers, and educators. Three-dimensional imaging and gait analysis provide valuable information.

[Pitfalls in the diagnosis of occult elbow fractures in children]. / Pièges diagnostiques de la traumatologie du coude le l'enfant.

Elbow injuries are frequent but occult fractures are difficult to diagnose on x-rays. However, any delay in the diagnosis may severely impair the prognosis of some fractures. Simple tips may help the clinician read x-rays properly and avoid the classical pitfalls of elbow injuries in children. The chronology of appearance of ossification nuclei around the elbow is important to distinguish normal features from abnormality. Drawing simple geometric constructions on the x-rays may clarify most occult elbow fractures in children.

[Pediatric management by mobile intensive care units in the northern French Alps emergency network]. / Activité pédiatrique des SMUR du réseau nord-alpin des urgences.

INTRODUCTION: The northern French Alps emergency network (RENAU) manages emergent care and patient treatment pathways in a three-county area in the French Alps. The aim of the study was to describe the pediatric activity in mobile intensive care units (MICUs). METHOD: This retrospective observational study was conducted from 1 January to 31 December 2012. Data were obtained from patients' medical records in seven representative MICUs of the RENAU. Consecutive patients between 1 month and 18 years of age were enrolled. RESULTS: During the study period, MICUs carried out 11,951 primary transports and 3087 secondary transfers. A total of 1325 patients were enrolled: 1087 primary transports and 238 secondary transfers. In primary interventions, 531 (48.9%) patients were managed for a trauma, 118 (11%) children were discharged and stayed home, 427 (39.9%) underwent an intravenous cannulation and 27 (2.5%) on-scene intubation. A pediatrician was in charge of 64 (26.9%) secondary transfers. Among 1649 (18%) mountain rescues, 296 (18.7%) involved a child. CONCLUSION: Emergency physicians in MICUs are involved with children's prehospital care and need dedicated materiel and special training.

Osteosynthesis of diaphyseal fracture by Ossatite experimental study in rat.

In order to develop a biodegradable interlocking nail for fracture fixation, hydoxylapatite pins and paste were implanted in the femoral bone of rats. A distal fracture was performed. The union and the tissue reaction to hydroxylapatite versus stainless-steel rods were studied after 15 days, 1, 2 and 6 months implantation. Metal pins induced a union. Hydroxylapatite pins (Ossatite) did not prevent callus formation, but did not lead to consolidation in all cases due to weakness of gelatin matrix binding the apatite particles together. The biocompatibility of material is satisfactory and the osteo-inductive properties of hydroxylapatite was confirmed. With injectable Ossatite , we could not obtain rat femoral fracture consolidation. We can confirm good biomaterial tolerance in bone which contrasts with important soft tissue reactions. Use of such material should be carefully limited to filling intra-osseous cavities.

Pedicled greater omentum transferred to the spine in a case of postoperative infection.

An alternate surgical treatment was proposed in a case of vertebral postoperative chronic infection. The combination of an anterior omental flap with a posterior internal fixation plus bone grafting was successful, allowing the patient to walk 8 weeks after surgery. This relatively short recovery period compares favorably with the long months of confinement to bed usually required after an all-anterior approach with bone grafting only.

Presentation of GTB orthoses for hyperlordotic treatment of idiopathic scoliosis.

Screening of scoliosis means it is possible to make an early diagnosis. Treatment is started when the angle reading is still quite low but as soon as it has been proven that the scoliosis is progressive. A 3-D examination of the scoliosis makes it possible to have a better understanding of its development, which is in kyphosis at lumbar level and in lordosis at thoracic level. It would seem logical that in order to prevent a lumbar scoliosis becoming kyphotic, lordosis must be maintained and if necessary, a hyperlordosis created. The same applies to the thoracic curve when attempting to restore a thoracic kyphosis with a lumbar hyperlordosis. We have developed new orthoses with the correction principle based on creating a lumbar hyperlordosis. Correction of the translation is the second correction principle. In theory, correction involves: a translation (convex lateral pressure) and a hyperlordosis which puts back in place the convex articular facet (posterior pressure). With these two principles in mind, the aim of the orthosis is to invert the torsion movement and to avoid pressure in the opposite direction of the deformity. We have maintained the principle of a single shell made of ribbed polypropylene to produce a brace which is both light and strong. There are three types of models depending on the spine curve: the short GTB 1 brace for lumbar curves, the long GTB 2 brace for thoracic and double curves, the long or short GTB 3 brace depending on the upper end vertebra for thoraco-lumbar curves.

Melorheostosis: complications of a tibial lengthening with the Ilizarov apparatus.

Melorheostosis is a rare bone dysplasia, exceptionally described in childhood. It has been discovered in a 12-year-old boy who had a hemimelic affection associated with straw-berry skin marks. A 25 mm inequality of length of the lower limbs and a valgus deformation of the ankle resulting in a claudication and gonalgia requiring surgical correction. A reaxation and a progressive lengthening with the Ilizarov apparatus has been performed. Non-consolidation and a secondary bone infection led to the necessity of formation of a soleus flap. Consolidation and healing were finally obtained. In addition to vascular complications to be feared in this disease during surgical treatment, we have to take into consideration the absence of consolidation when the osteotomy is not performed on a safe bone.

Management of seat-belt syndrome in children. Gravity of 2-point seat-belt.

We present our experience with a management of seat-belt syndrome in three children and draw particular attention to the severity of two-point fixation seat-belt injuries after a motor vehicle accident with 5 passengers whose vehicle was struck head-on by an oncoming vehicle. The parents were sitting in front, Adeline had a 2-point lap seat-belt, the 2 other children had 3-point seat-belts. The parents both had humerus fractures. The 4-year-old brother suffered a cervical and abdominal trauma with renal and splenic contusions and intestinal perforations. Adeline suffered multiple injuries, notably to the head, spine and abdominal viscera with erosions at the site of lap-seat-belt contact. The spinal injury was an L2 angular Chance fracture associated with paraplegia on the 7th day. Operative findings included a transverse tear of the left rectus abdominus muscle, an incomplete transection of the stomach and perforation of the ileum. The injuries were ultimately fatal. Given associated abdominal pain, skin erosions at the site of seatbelt contact, spinal fracture, and rectal muscle disruption apparent on emergency laparotomy, early diagnosis is important for better prognosis.

Intramedullary nailing of forearm fractures in children.

Forearm fractures are very common in children. They are usually treated orthopedically. For the last few years, Métaizeau's elastic stable nailing has been used in the authors' hospital. This study is based on 80 children with forearm fractures treated with intramedullary nailing: 64 boys and 16 girls, aged 6 to 16 (23 right sides, 58 left sides: 81 fractures). Nailing was performed 67 times for a displaced fracture, 3 times for a recurrent fracture, 3 times after a secondary displacement, and 7 times in patients with multiple injuries. Sound union was normally achieved in 78 patients, and normal motion in 79. Ten children experienced complications, but only complications involving the skin and sepsis were due to the technique. The seven skin complications (three in the ulnar fractures, and four in the radial fractures) consisted of three major local infections, one radial osteomyelitis, and three minor local nonunion of skin. One patient had limited thumb extension, and two patients fell a second time. One advantage of the method described here is that plaster casts are avoided, allowing children to go back to school early. Sound union is achieved as quickly as with orthopedic treatment, and recovery is excellent.

Absence of congenital prethrombotic disorders in children with Legg-Perthes disease.

Resistance to activated protein C (RPCA) and other congenital prethrombotic disorders have been recently reported to be strongly associated with Legg-Perthes disease. RPCA and deficiencies of protein C, protein S, and antithrombin III were sought in 22 children with Legg-Perthes disease. Detection of the factor V Leiden mutation was found in children with RPCA. Twenty-two healthy children paired by age and sex served as controls. The prevalence of congenital prethrombotic disorders was not found to differ significantly among patients with Legg-Perthes disease and among control subjects. Only one patient had RPCA; this patient was heterozygous for the factor V Leiden mutation. Twenty patients and all the control subjects had entirely normal coagulation results. The authors conclude that unless more data become available, RPCA and deficiencies of protein C, protein S, and antithrombin III should not be considered associated with Legg-Perthes disease.

Duplication of the leg--renal agenesis: congenital malformation syndrome.

A case is given of a male born with a duplication of the left leg and ipsilateral kidney agenesis. Although the etiology is unknown, we believe this association represents a congenital malformation syndrome. It is a polytopic developmental field defect. The growth factor IGF-I produced by the intermediary mesoderm or mesonephros (embryonary kidney) could be implicated in the induction limb development and the application of FGF-8 protein to the flank of young chick embryos inducing the development of additional limbs. It is possible that one or more of the growth factors produced by the mesonephros take some cells of the intermediary mesoderm out of their renal way to form a supernumerary limb.