Hip arthrodiastasis in Legg-Calvé-Perthes disease. / Artrodiastasis de cadera en la enfermedad de Legg-Calvé-Perthes.

INTRODUCTION AND OBJECTIVE: Arthrodiastasis consists of the mobilisation of the hip while distracted by a hinged distractor. The aim of our study is to show the results of the treatment of late-onset Perthes disease with this technique in our institution. MATERIAL AND METHODS: Ambispective review of all the cases that underwent this surgery in our Department of Paediatric Orthopaedics between 2010 and 2014 with the following inclusion criteria: patients over 8 years old, with minimal deformity, and poor prognosis. Mobility, pain, Trendelenburg sign, radiographic sphericity, and complications were assessed. RESULTS: A total of 13 patients (9 male, 4 female) were included. The mean age was 11.93 years. Radiographic risk signs were present in 7 cases. The mean decrease in pain measured with a visual analogue scale (VAS) after the surgery was 3.83 points (P<.05). Cephalic sphericity was maintained in 11 cases during follow up (1.75 years). Complications were observed complications in 84.6% of the patients, with infection of the screw tract being the most frequent. All of them were easy to treat. CONCLUSIONS: Arthrodiastasis is a minimally invasive technique, useful in the treatment of late onset Perthes disease. It improves clinical results and maintains cephalic shape when applied in early stages. However, it is not free of complications, which can involve as many as 8 out of 10 patients treated with the technique.

[Arthroscopy- assisted resection-interposition of post-traumatic central physeal bridges]. / Tratamiento de los puentes fisarios centrales postraumáticos mediante resección-interposición asistida por artroscopio.

INTRODUCTION: Physeal bridge resection and insertion of interposition material has had mixed success rates in the literature. Using the arthroscopic approach, some authors have reported good results in their patients. The aim of the study was to evaluate the treatment of post-traumatic central physeal bridges with arthroscopically assisted resection and fat interposition. MATERIAL AND METHODS: A retrospective study was conducted on 5 patients (6 procedures), who developed a physeal bridge after a traumatic injury. A CT or MRI scan was performed preoperatively in all patients to assess the size of the physeal bridge. Inclusion criteria were patients with documented existing or developing deformities, a physeal bridge <50% of the physeal area, and with at least 2 years of growth remaining. Clinical outcomes were classified according to Marsch and Polzhofer criteria (excellent, good or poor). RESULTS: Excellent results were obtained in two patients, good in one, and the other two cases were rated as poor. In patients with a poor outcome, high energy trauma mechanisms were identified in both cases. Moreover, incorrect initial treatment or delayed physeal bridge resection was identified. CONCLUSIONS: The arthroscopically assisted technique provides best visualization with minimal morbidity. Although our results are not as good as previous studies, it cannot be considered that the technique itself is the cause of the failure, as several risk factors associated to bad prognosis of these injuries were found.

[Slipped capital femoral epiphysis]. / Epifisiolisis de la cabeza femoral.

Slipped capital femoral epiphysis (SCFE) is characterized by displacement of the capital femoral epiphysis from the metaphysis through the physis. The term is confusing, because the metaphysis moves upward and outward while the epiphysis remains in the acetabulum. The SCFE is considered stable when the child is able to walk with or without crutches, and it is considered unstable when the child cannot walk with or without crutches. Patients with SCFE present with pain in the groin, knee and limp. The current treatment of stable SCFE is in situ stabilization with a single screw.

[Adjuvant treatment with phenol of aggressive benign and low grade malignant bone tumors in patients with immature skeleton]. / Tratamiento adyuvante con fenol en tumores óseos benignos agresivos y malignos de bajo grado en pacientes con esqueleto inmaduro.

INTRODUCTION: The surgical treatment of aggressive benign bone tumors is based on intralesional resection associated with local adjuvant treatment to avoid local relapses. The purpose of this study is to assess the effectiveness of adjuvant treatment with phenol in aggressive, low grade, malignant and benign bone tumors in young patients. MATERIAL AND METHODS: We conducted a descriptive retrospective study of 37 patients, 13 girls and 24 boys, with bone tumors. They were treated with curettage and intralesional phenol between January 1989 and January 2006. The study included 35 Campanacci grade III benign tumors and 2 low grade malignant tumors, Enneking IA. RESULTS: Minimum follow-up was 5 years. The local relapse rate was 13.5%. Mean age at the time of surgery was 10.7 years (SD +/- 4.4). Mean patient follow-up was 104.9 months (SD +/- 41.9). Mean time between surgery and relapse was 18.8 months (SD +/- 11.81). Complications during the follow-up period occurred in 18.9% of the patients. The MSTS score was 28.7 points (SD +/- 1.7). DISCUSSION: The treatment of bone tumors with phenol shows low relapse and complication rates, so it is indicated for the management of locally aggressive bone tumors.

Concordance between hip ultrasonography and hip arthrography in the assessment of developmental dysplasia of the hip.

Controversy exists regarding the possibility of predicting hip reducibility in the congenitally dislocated hip, with arthrography still regarded as the gold standard in this situation. This study aims at assessing the degree of concordance between ultrasonography and arthrography in the detection of anatomic elements obstructing hip reduction. Forty-nine hips were studied both by ultrasonography and arthrography. Three anatomic sources of obstruction to reduction were assessed in each hip: ligamentum teres hypertrophy, inverted labrum, and the presence of soft tissue in the acetabulum. For each variable, congruence between ultrasound and arthrography was measured by kappa analysis. Values > 0.40 expressed sufficient concordance, and they were detected with regard to inverted labrum and the presence of soft tissue in the acetabulum. The results of this study suggest that ultrasonography may be considered a reliable technique for the prediction of the main causes of obstruction in the congenitally dislocated hip, such as inverted labrum and soft tissue in the acetabulum.

Unusual finding after contrast injection of a solitary bone cyst. A case report.

Injection of radiopaque contrast into a solitary bone cyst (SBC) prior to methylprednisolone acetate (MPA) injection has been previously reported. We report an unusual finding during the injection of radiopaque contrast in the treatment of one case of SBC of the femur: a bicameral appearance of the cyst was observed; no filling of the proximal cavity occurred and immediate perfusion of the femoral vein with contrast was noted. In cases of SBC such as this one, percutaneous autologous marrow or corticosteroid injection may fail to be effective. Furthermore there exists the potential risk of fat embolus secondary to bone marrow injection. Based on these findings in the case reported, we suggest that contrast injection should be performed prior to bone marrow or corticosteroid injection in order to evaluate both the venous drainage of the cyst and its degree of loculation.

Chondrolysis of the hip after transfer of the greater trochanter.

Transfer of the greater trochanter is a surgical technique that is used for overgrowth of the greater trochanter arising from disturbance of the growth plate of the proximal femur. Few complications have been described, and to our knowledge, necrosis of the cartilage has not been reported. Herein we describe four cases of chondrolysis in three patients who underwent this surgical procedure. In our view, immobilization with plaster associated with the increased pressure produced by the descent of the gluteal attachment may have contributed to the development of chondrolysis.

Five additional cases of local fibrocartilaginous dysplasia.

Focal fibrocartilaginous dysplasia has previously been described as an etiology of genu varum deformity in children at about walking age. We have found 20 cases in the literature, and all of them were located in the medial proximal tibial metaphysis. We report five additional cases of this entity. The patients had a genu varum deformity, and the angulation was at the site of the bone lesion. Four cases were in the tibia, and one case was in the distal medial femoral metaphysis. Age at diagnosis ranged from 13 to 24 months. A cortical defect with surrounding sclerosis was observed on radiographs. The angulation usually progressed initially, and spontaneous resolution was observed in two cases at last follow-up. Open biopsy and tibial valgus osteotomy were performed in two cases. The unusual femoral case was also treated with open biopsy and medial hemicircumferential periosteal release. Spontaneous remodeling of varus angulation and resolution of bony defect may be expected in most cases, and osteotomy can be avoided.

Osteoid osteoma with a multicentric nidus.

A case is reported of a 16-year-old boy who presented with continuous pain in his right leg. Cortical thickening and diffuse medullary sclerosis was revealed on x-ray of the distal tibia. CT imaging showed a circumscribed annular pattern extending some 2.5 cm-s and indicating the multifocal nature of the lesion. The diagnosis of multifocal osteoid osteoma was confirmed after histological examination of the block of resected bone.

[Hip screening in children. Comparison of various ultrasonographic methods]. / Hüftscreening bei Kindern. Ein Vergleich verschiedener sonographischer Methoden.

750 Hips of 375 babies under 5 months were sonographically examined. We used the procedures following Graf and Suzuki and compared the methods and the results. The authors suggest that the ultrasound study following Graf provides more advantages and today is the best procedure in the screening of hip dislocation.

Chronic recurrent multifocal osteomyelitis after acute lymphoblastic leukaemia.

We describe an 8 year old girl who developed chronic recurrent multifocal osteomyelitis (CRMO) in the ilium and clavicle. Treatment for an acute lymphoblastic leukaemia had been finished two months before. After antibiotic therapy, the clinical symptoms improved and no fresh lesions appeared. The aetiology of CRMO is unknown, but we feel that infection may precipitate an immunological reaction.