Arthroscopic anterior cruciate ligament reconstruction in a patient with multiple hereditary exostoses.

Background Multiple hereditary exostoses (MHE) also known as Multiple Osteochondromas is a rare benign bone tumour disease, characterized by multiple osteocartilaginous masses. The knee is one of the most affected sites. Anterior cruciate ligament (ACL) surgery is the most common and generally most successful surgical knee procedure; however, the association between MHE and ACL reconstruction is very rare and may represent a challenging procedure because of the anatomical anomaly related to presence of multiple masses around the knee. Here, we present a case report of ACL reconstruction in a patient affected by multiple exostoses. Case report The patient was a 30-year-old woman affected by MHE, with an ACL tear arising after knee trauma. As the patient complained of pain, swelling and the knee "giving way", she successfully underwent arthroscopic-assisted ACL reconstruction using quadrupled hamstring tendon grafts, with femoral suspension and double tibial fixations. Conclusion Symptomatic ACL tears in a patient affected by MHE should be considered for arthroscopic reconstruction, which requires that particular attention be paid to tendons harvesting, tunnel placement and the choice of graft fixation system, given the presence of multiple masses around the knee.

Trochanteroplasty to treat sequelae of septic arthritis of the hip in infancy. Case series and review of the literature.

The authors report a series of 11 patients treated surgically by trochanteroplasty for septic arthritis of the hip at our institution from 1974 to 2010. Trochanteroplasty was indicated due to the absence of a valid alternative, and because it does not rule out the option of total hip arthroplasty at a later stage.

A modified technique for reconstruction of the femoral neck in paediatric patients.

Hip deformities during early childhood following Perthes' disease, congenital dislocation or septic arthritis are not rare, causing limitation of motion and limping. A number of proximal femoral osteotomies to address residual deformities have been described, but the outcome has been variable. We describe a proximal femoral osteotomy aimed at restoring a more anatomic insertion of the gluteus medius. The clinical and radiographic results thus far are promising. We believe that the technique improves both the anatomy and biomechanics of the hip.

Fractures of the proximal humerus in children.

Ninety-one children who had been treated for fractures of the proximal humerus (59 metaphyseal fractures; 32 epiphyseal fractures) from 1980 to 1992 at an average age of 10.7 years (range 3 to 14 years) were reviewed. In 82 cases a nonsurgical treatment (Desault bandage in 11 cases, hanging cast in nine cases, closed reduction and shoulder spica cast in 62 cases) was performed. At a mean time of 7.2 months (range 1 to 156 months), 96% of patients showed good/excellent clinical results. In 15 cases, radiographs were reviewed at a mean follow-up of 8 years (range 1 to 23.5 years): just a slight metaphyseal or meta-diaphyseal varus deformity was found in three cases. In nine cases surgery was required. Patients were reviewed by clinical examination at a mean time of 34.8 months (1-150 months), and in six cases radiographs were reviewed at a mean time of 5 years and 5 months (range 1 to 12.5 years) after surgery. In one case, a septic process occurred, that caused a severe deformity of the epiphysis and a noticeable functional deficit. Good/excellent clinical and radiographic results were achieved in the other patients. Conservative treatment of fractures of the proximal humerus in children is recommended. Surgery should be reserved for specific cases.