Congenital dislocation of the hip: optimal screening strategies in 2014.

A prospective multi-centre nationwide study of patients with congenital dislocation of the hip (CDH) diagnosed after 3 months of age was conducted with support from the French Society for Paediatric Orthopaedics (Société Française d'Orthopédie Pédiatrique [SoFOP]), French Organisation for Outpatient Paediatrics (Association Française de Pédiatrie Ambulatoire [AFPA]), and French-Speaking Society for Paediatric and Pre-Natal Imaging (Société Francophone d'Imagerie Pédiatrique et Prénatale [SFIPP]). The results showed inadequacies in clinical screening for CDH that were patent when assessed quantitatively and probably also present qualitatively. These findings indicate a need for a communication and educational campaign aimed at highlighting good clinical practice guidelines in the field of CDH screening. The usefulness of routine ultrasound screening has not been established. The findings from this study have been used by the authors and French National Health Authority (Haute Autorité de Santé [HAS]) to develop recommendations about CDH screening. There is an urgent need for a prospective randomised multi-centre nationwide study, which should involve primary-care physicians.

[Use of muscle free flaps in lower limbs reconstruction in children]. / Utilisation de lambeaux libres dans la reconstruction des membres inférieurs chez l'enfant.

A series of 12 muscle free flaps was performed from 2000 to 2005 in 11 children 3 to 15 years of age (mean: 10.6): seven serratus anterior, four latissimus dorsi and one rectus abdominis. The defects (acute or as a result of sequelae) were always located in lower limbs: seven in feet, three in the lower third of the leg and one in the knee. None of the children was re-operated within 72 hours. Total necrosis due to venous thrombosis occurred at Day 5 in one case. After mean follow-up of 2.5 years (minimum: 1 year), the flaps show good integration. Functional or esthetic sequelae are considered acceptable by the health-care team as well as the children's parents. No repercussions on growth have been observed. Our series confirms the results of previous studies, indicating that free flaps should be part of the therapeutic arsenal in pediatric surgery.

[Organization of emergency pediatric surgery at the University Hospital in Nantes]. / Organisation des urgences chirurgicales pédiatriques au C.H.U. de Nantes.

A special emergency ward for paediatric patients was established at the University Hospital in Nantes on November 7, 1990. Both medical and surgical patients less than 15 years, 3 months of age are admitted. The initial organization of the ward (facilities personnel, on call duty) are described for the emergency paediatric surgery unit. The activity of the unit over a 4 month period (from June to September 1992) was retrospectively examined. During this period, 4,438 children were referred to the emergency ward and 2,905 (64.8%) involved a surgical pathology. The epidemiological characteristics of the patients (age, geographic origin, day and hour of admission), the causal pathology, the examinations and procedures performed, and outcome (length of stay in the ward long-term outcome) were studied. Based on these results, the authors analyzed the factors leading to dysfunction and proposed improvements in the organization of this emergency ward.

[Intraoperative and postoperative analgesia in pediatric surgery. 1 years' experience]. / Analgésie per et postopératoire en chirurgie pédiatrique. Expérience d'un an.

Operative and postoperative analgesia has become in a few years a major concern for pediatric anesthesiologists. The fact that pain can have dramatic metabolic and hemodynamic consequences has been well documented. This study shows the activity in our department in the field of analgesia during 1989. 82% of the 2,675 children having undergone surgery have received analgesia during the operative period either by the way of an i.v. narcotic or an regional block. No morbidity or mortality resulted from these techniques during the operative period. When a regional block was prolonged by the mean of a catheter, there were no major complication (2 seizures). The use of oral, rectal and i.v. analgesics follows the classic recommendations. Morphine by all routes of administration is used increasingly in our department. Two moderate respiratory depressions occurred in 1989 due to error in dosage with no consequence for the child. The authors underline the importance of well established protocols which have been discussed and approved by all, the importance of emergency procedures and treatment, which only can guaranteed the necessary safety.