[The proximal humeral osteotomy associated with the transfert of Latissimus Dorsi and Teres major in treatment of sequelae of the obstetrical brachial plexus]. / L'ostéotomie humérale proximale associée au transfert du latissimus dorsi et teres major dans le traitement de certaines séquelles tardives de la paralysie obstétricale du plexus brachial.

BACKGROUND: Shoulder sequelae of obstétrical brachial plexus palsy put a different problem of coverage according to the age of the patients and the presence or not of ostéo-articular deformations. At an advanced age and in the presence of ostéo-articular deformations, the muscles liberation and transfers tendineux only are insufficient for the restoring of a satisfactory function to the paralytic shoulder. AIM: The purpose of this study is to report an original technique by the association of libertation of retracted muscles and a humeral osteotomy to improve the abduction and to acquire an active external rotation in internal rotation retraction of the shoulder sequelae of obstétrical brachial plexus palsy. METHODS: This retrospective study concerned twelve patients admitted in the service of Childish Orthopaedics of Children's hospital of Tunis between 1997 and 2003. The average age of the patients are 11 years. All the patients have a proximal humeral osteotomy above the deltoïdien V with a desinsertion of the Subscapularis and to the transfer of the Latissimus Dorsi and Teres Major, realized by a single posterior approch. RESULTS: After a mean follow up of 48 month a frank aesthetic and functional improvement was noted in every case. CONCLUSION: The importance of retraction for an advanced age, made that an humeral osteotomy of external derotation is necessary. Have a practice above the deltoïdien V it allows to improve at the same time the external rotation and the abduction due to the lateral translation of the deltoid. This last one is strengthen by the désinsertion of a retracted Subscapularis and levying of the co-contractions of the Latissimus Dorsi and Teres major with the deltoid almost constant.

[Comparative study of two Tramadol prescription protocols for postoperative analgesia in children]. / Etude comparative de deux protocoles de prescription du Tramadol pour l'analgésie post opératoire de l'enfant.

We reported the result of a prospective study concerning the use of Tramadol for postoperative analgesia in children. Seventy-two children 1 to 6 year's old were enrolled. Tramadol was given at a dose of 1 mg/kg for 30 minutes and Oral regimen started 4 hours after at a dose of 0.5 mg/kg/6 hours for 24 hours in 40 child. Only one dose of Tramadôl, 2 Mg/kg, was used in other 32 children. We assessed every 3 hours: pain scale (CHEOPS), respiratory rate, and cardiac rate, blood pressure and sedation scale. We obtained satisfactory analgesia in 70% of children since the first hour postoperatively with 2 mg/kg Tramadol and in 60% of them who received 1 mg/kg. In the first group, analgesia had lasted for 24 hours in 62.5% of children and in 80% of children with oral Tramadol. The main side effect was vomiting as reported in 25% of children especially after intravenous Tramadol and mild sedation in 34% of them. Tramadol is a safe and efficient analgesic molecule in children.