Initial diagnostic approach of the irritable hip in childhood: is ultrasound really useful?

The acutely painful hip is a common complaint in childhood and has numerous significant causes. This prospective study explored the use of ultrasound as an adjunct to medical history and clinical examination in children with an irritable hip attending a department of orthopaedic emergencies over the course of 8 months. One hundred thirty four children met the inclusion criteria. A provisional diagnosis was made after history, clinical examination and ultrasound scan and this initial diagnosis was compared with the final diagnosis after a 3-year follow-up. The nature and number of further investigations required to reach the final diagnosis were reviewed. The use of ultrasound reduced the number of early radiographs by 84% and in conjunction with history and clinical findings had a diagnostic accuracy of 92%.

Late compartment syndrome of the hand due to wasp sting in a child.

We report a 6-year-old girl, with no history of previous anaphylactic reaction, who sustained a wasp sting to the volar aspect of her left hand. The child did not present any symptoms at the beginning. She was first examined at the emergency department with developed compartment syndrome, after more than 24 hours later and she was urgently taken to the operating theatre. The midpalmar, thenar, and hypothenar spaces were decompressed, and the transverse carpal ligament was released. At the 11-month followup, she presented with normal function of the hand and normal 2-point discrimination in all fingers. Although the accurate mechanism of the development of compartment syndrome after a wasp sting in children is not thoroughly clear, the treatment seems to be the same as in all other cases of compartment syndrome; urgent fasciotomy. It is very important to keep in mind the possibility, even if it is extremely low, of compartment syndrome after a wasp sting in children; even of those with no history of anaphylactic reaction.

Popliteal artery pseudoaneurysm secondary to osteochondroma in children and adolescents: a case report and literature review.

Osteochondroma is the most frequent bone tumor and can rarely cause vascular complications. False aneurysms of the popliteal artery due to an osteochondroma are not common in the pediatric population. The case of an 11-year-old boy who presented with a painful mass on the posterior aspect of his distal thigh is described. Radiologic studies revealed an osteochondroma of the distal femur and a pseudoaneurysm of the popliteal fossa. A combined orthopaedic and vascular surgery was undertaken. The exostosis was excised and the popliteal artery was repaired by performing a venous patch angioplasty technique. A review of the literature regarding this vascular complication in young patients is also reported.

Intraosseous pseudotumour of the talus in a child with severe haemophilia.

We report a case of a large pseudotumour in the right talus of an 11-year-old boy with severe haemophilia A. The described intraosseous lesion was treated with surgical curettage and autologous bone grafting. Twenty months postoperatively computed tomography scan showed no signs of recurrence. Forty months postoperatively radiological studies confirmed satisfactory incorporation of the graft, no evidence of bone growth disturbance and improvement of Pettersson score of the ankle joint. At the same time, regarding his clinical situation, he was able to fully participate in his daily activities, presenting painless and almost full range of motion of his right ankle joint. Surgical intervention seems to be the best option in treating a big pseudotumour of the talus during childhood. As conservative management in the treatment of large lesions may fail, disastrous complications like a pathological fracture may happen. Anatomical reconstruction of a talus when pseudotumour and pathological fracture coexist is a major challenge for an orthopaedic surgeon.

Correction of adolescent hallux valgus by proximal crescentic osteotomy of the first metatarsal.

Thirty nine surgical hallux valgus corrections in 32 adolescents (7 bilateral) performed between 1994 and 2001 were retrospectively studied. The mean age at the time of surgery was 14.2 years. The operation consisted of a proximal dome osteotomy of the first metatarsal, excision of the medial protuberance, lateral capsular and adductor release, and distal medial soft tissue plication. The patients were followed for an average of 42 months (range 32 to 62). Post-operative evaluation was based on the duPont bunion rating score. The result was excellent in 11 feet, good in 22 cases, fair in 5 and poor in 1 case. Using subjective criteria of the duPont score, such as cosmesis and discomfort, a satisfactory result was achieved in 35 feet (90%). Our opinion is that correction of the angle between the 1st and 2nd metatarsal as well as preservation of the length of the first metatarsal are of crucial importance in the surgical treatment of adolescent hallux valgus.