Confirmation of the early prognostic value of bone scanning and pinhole imaging of the hip in Legg-Calvé-Perthes disease.

UNLABELLED: In about half of all patients with Legg-Calvé-Perthes disease (LCP), severe hip disorders that could be prevented by early surgery will develop. A prognostic test for this complication is also needed as part of routine care to help the surgeon manage LCD. The purpose of this study was to confirm the prognostic value of the bone scanning and pinhole imaging of the hip in LCP that Conway's group proposed in 1997 and to define accurate prognostic scintigraphic patterns. METHODS: Fifty-eight patients with LCP were recruited at initial presentation and followed for 1 y. Each patient underwent bone scanning initially and after 5, 8, and 12 mo of disease. The severity of the disease was assessed by radiography (the Catterall classification), MRI, and arthrography. Retrospectively, initial scintigraphic findings were correlated with severity. RESULTS: Among the 60 hips studied (2 patients had bilateral disease), severe hip disorders developed in 36. The positive predictive value of the scintigraphic classification proposed by Conway's group was 97% for the B pathway (absence of lateral column formation) and 85% for the A pathway (presence of lateral column formation). The hyperactivity of the metaphyseal growth plates was a sign of poor prognosis. The sensitivity was only 33%, but the positive predictive value was 92%. This prognostic information was obtained in as few as 5 mo after initial presentation. CONCLUSION: This study confirms the high prognostic value of bone scanning in LCP as reported by Conway's group not only in terms of the accuracy of the classification but also in terms of the short time in which the prognostic information can be obtained. Thus, we propose that bone scanning be used as part of routine care for the management of LCP.

Apophyseal avulsion fracture of the greater trochanter after slipped capital femoral epiphysis: a case report.

A 13-year-old boy sustained an avulsion fracture of the left greater trochanter eight months after surgical stabilisation of a slipped capital femoral epiphysis on the same side. In this specific case, avulsion of the greater trochanter after slipping of the capital femoral epiphysis may have been facilitated by weakening of the trochanteric physis.

Cuboid nutcracker fracture due to horseback riding in children: case series and review of the literature.

We report 4 cases of nutcracker fractures of the cuboid resulting from equestrian sport in pediatric population. These lesions are often consistent with a trauma in forced abduction of the forefoot. The particular mechanism of the cuboid fracture due to horseback riding in children is discussed. The methods used to radiographically evaluate the compression fracture of the cuboid and its associated injuries are presented. Left untreated, these fractures can lead to severe alterations in foot mechanics and function, such as to severe pain. In addition, the surgical treatment to correct the nutcracker fracture of the cuboid in our patients is presented.

The importance of proper shoe gear and safety stirrups in the prevention of equestrian foot injuries.

The aim of this study was to compile specific foot injuries occurring in pediatric patients that result from equestrian sports and to highlight the importance of wearing adequate riding boots to protect the feet. During a 12-year period, 258 children were admitted to Children's Hospital of Geneva for injuries resulting from horseback riding. Amongst these children, 8 sustained foot lesions that required hospital admission. Four children had compression-type fractures of the cuboid (nutcracker fracture of the cuboid) associated with other complex midfoot fractures, 2 had Lisfranc fracture dislocations, 1 had a fracture of the talus with associated intern malleolar fracture, and the last had a fracture of the 5 metatarsals with lateral displacement. All the noted lesions complied with the same traumatic mechanisms. The horse fell on the patient, and the child's foot, entrapped in the stirrup, was caught in between the animal and the ground. The forefoot was bent by indirect violence in abduction by the stirrup, which acted as a fulcrum. Serious foot injuries may occur in children during equestrian activities. These lesions may be very disabling. Therefore, it is important for doctors, instructors, and parents to promote the use of appropriate safety equipment, including strengthened riding boots and safety stirrups.