Successful early surgical treatment in neonatal compartment syndrome: case report.

Neonatal compartment syndrome is rare, and the diagnosis is often missed or delayed because other ischemic diseases can mimic clinical signs observed on the skin. A premature newborn infant presented with skin lesions during the first hours of life that were recognized as the sentinel finding in compartment syndrome of the newborn. We restored normal function by emergency surgery. The authors highlight the importance of effective collaboration between pediatricians and surgeons to improve the management of this neonatal condition.

Use of an iliac crest growth plate for the development of a neo-articulation for congenital transverse deficiencies at the wrist.

PURPOSE: Terminal congenital transverse deficiencies of the wrist and hand are rare malformations. They are usually treated with prosthetic devices. We describe here a surgical technique to create a neo-articulation that could provide mobility distal to the forearm and help children with terminal transverse deficiencies use orthotic devices. METHODS: This procedure involved an autologous, nonvascularized graft from the immature iliac crest. The graft was placed with its cartilaginous side facing the radial and ulnar articular surfaces. We studied the clinical, radiological, and functional outcomes of this technique in 2 pediatric cases 5 and 14 years after this procedure. RESULTS: The x-rays showed a mobile graft distally in the forearm. Magnetic resonance imaging showed a space between the graft and the radius and an intermediate signal on either side of the space highly suggestive of articular cartilage. These various elements were organized into a neo-articulation between the forearm and the graft. The functional ability at follow-up was greater compared with the absence of a graft. CONCLUSIONS: The results of basic research work on cartilage and chondrocytes may help explain the presence of persistent cartilaginous tissue on the articulated part of the graft. The good functional outcome provided by our surgical procedure may translate into reduced need for prosthesis acceptance. Our surgical procedure does not restore limb length, but does add a new functional ability. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Successful hemicondylar femoral allograft for traumatic bone loss: a paediatric case study with ten years of follow-up.

The management of massive traumatic defects of the knee joint is challenging, especially in children. Massive osteoarticular allograft may be an option in this kind of traumatic bone loss. We report on the case of a male patient who (at the age of 15) suffered an open grade III condylar femoral joint fracture, with a massive bone defect and a Schatzker V tibial plateau fracture. Ten years after first-line treatment with massive osteoarticular allograft of the lateral femoral condyle, the patient's knee was capable of full extension and 90° flexion. The patient reached a point of being pain free for nine years before he subsequently developed some pain with lateral arthritis progression.

Use of fast absorption material for skin closure in young children.

In pediatric surgery, skin closure is an important problem, given the need to avoid soiling by feces and urine and to have a good cosmetic result. Furthermore, the increasing number of surgical operations on outpatients or with a short period of hospitalization significantly reduce the number of medical consultations. Personal experience with a fast absorption material for skin closure in 65 children demonstrated a perfectly watertight suture, a satisfactory cosmetic result and a low cost. This procedure has another advantage: no removal of the stitches, eliminating the need for medical or paramedical care.

Management of abdominal contusion in polytraumatized children.

Management of abdominal contusion in polytraumatized children is based on the conservative treatment of spleen and liver lesions when it is possible. Ultrasonography and CTScan can give a good evaluation of splenic, liver, pancreas or kidney lesions. In some cases, if the haemodynamic conditions are good, a non-operative treatment may be proposed. We report our experience of conservative management of intra abdominal lesions in children, about 91 cases in ten years.

[Current aspects of the complications of acute appendicitis in children]. / Aspects actuels des complications de l'appendicite aiguë de l'enfant.

One thousand four hundred and ninety-one cases of acute appendicitis during infancy and childhood are reviewed, 137 were revealed by peritonitis. Complications following appendicitis with perforation (15%) are higher than acute appendicitis (2%). Many complications are reported, but the most serious of them are the 5th day syndrome after appendectomy. Early diagnosis, often difficult in infancy, and early operation before diffusion are the only means of prevention. Ultrasonography may reveal pelvic or intraperitoneal abscess. Treatment is a large drainage with antibiotics; enteral or parenteral nutrition may be associated.

[Post-traumatic hemarthrosis of the knee in children. Role of arthroscopy]. / Hémarthroses post-traumatiques du genou chez l'enfant. Place de l'arthroscopie.

The results of a method in treating the post-traumatic hemarthrosis of the knee in children have been analyzed in a retrospective study covering 31 cases. In the presence of obvious initial lesions (11 cases) arthroscopy has had an only therapeutic function in three cases. In the absence of obvious initial lesions (20 cases) from afar, and without any prejudice on the final result, arthroscopy, if it has only been performed 13 times, has been therapeutic in seven cases. Once a routine way in surgery, in our experience it is justified in only half of the cases. Its diagnosis and therapeutic indications in children can, on our part, be limited and depend on a previous and very accurate examination followed by a careful and sustained treatment afterwards.

[A review of 86 fractures of the lower end of the femur treated by internal fixation using A.O. blade-plates (author's transl)]. / Etude critique et résultats de 86 fractures de l'extrémité inférieure du fémur traitées par lame plaque monobloc.

The authors have treated 86 fractures of the lower end of the femur by internal fixation with an A.O. blade-plate. An adequate follow up was made in 71 cases. A classification of the fractures is given. Half of the fractures were either complex or involved the joint. The technique that was used is described. The authors consider that an immediate cancellous autogenous bone graft is worthwhile. 8 cases of non-union, 7 stiff knees and 31 malunions were seen; 70 per cent of cases achieved satisfactory function.

[Cavernous hemangioma of the bladder in children. Apropos of a case]. / Hémangiome caverneux de la vessie chez l'enfant. A propos d'un cas.

Benign tumours of the urinary bladder are very rare in children. A new case of cavernous haemangioma of the bladder is reported in a five year old boy presenting with macroscopic haematuria. This tumour is a hamartoma which usually presents with painless haematuria. In about 30% of cases, the bladder tumour is associated with angiomatous lesions in other parts of the body. The diagnosis may be suspected on intravenous urography or ultrasound examination, but it is generally made at cystoscopy. Biopsy and transurethral resection must be avoided because of the risks of haemorrhage. Partial cystectomy appears to be the most effective method of treatment.

[Contusions of the abdomen in children]. / Les contusions de l'abdomen chez l'enfant.

Marked progress in the treatment of abdominal contusions in children over the last few years is due to the development of conservative surgery to the spleen and even possible abstention from operation following splenic injuries. The reliability of paraclinical exploratory procedures has increased, and ultrasound and CT scan imaging have reduced the need for peritoneal puncture-lavage. However, and unresolved problem concerns associated visceral lesions, and although treatment of isolated splenic injuries is fairly well detailed that of hepatic lesions raises difficulties because of lack of data on exact location of lesions and the anatomical damage produced. Injuries provoked and treatment instituted are described in relation to children admitted for severe abdominal contusions between 1970 and 1985. Since 1984, 52 children have undergone initial ultrasound imaging and only 6 (8%) peritoneal puncture-lavage procedures were necessary. Ultrasound is of value for diagnosis of a hemoperitoneum but of very limited use for defining sites of lesions, a more refined diagnosis being established by computed tomography. Finally, routine simplified emergency intravenous urography is performed in any child with severe abdominal contusion with even microscopic hematuria to detect possible subadventitial rupture of renal artery.

Bone defect reconstruction in children using the induced membrane technique: a series of 14 cases.

INTRODUCTION: In pediatrics, Masquelet's induced membrane reconstructive technique has mainly been used in the context of cancer surgery reconstruction or congenital pseudarthrosis of the tibia. This retrospective study consisted of a series of pediatric patients where bone defects were reconstructed with this technique. MATERIALS AND METHODS: Between 2006 and 2011, 14 children underwent bone reconstruction using this technique in the context of trauma, tumor resection or congenital pseudarthrosis. The mean age was 10.6years (range: 12 to 17years) at the time of reconstruction. The length of the defect to be reconstructed relative to the length of the bone (index of reconstruction, expressed as a percentage) and bone healing was evaluated on standard radiographs. Complications were recorded. RESULTS: The mean index of reconstruction was 32.8% (range: 13.9 to 51%). The mean follow-up was 30months (range: 1 to 63). Bone union was achieved in 9.5months (range: 2 to 25). Complications mainly consisted of non-union in 35% of cases, which consolidated after grafting and rigid fixation. Two cases of wound dehiscence were noted. Massive graft resorption occurred in a single case. DISCUSSION: A technical error was identified in each non-union case (insufficient cement overlap of the bone ends or fixation not stiff enough). These long defects required a large volume of autograft, which constitutes the limiting factor especially in very young children. We used allograft bone chips or a tibial bone strut to increase the graft volume in the largest reconstructions. In this pediatric-only series, an average of one-third of the bone length was successfully reconstructed. Although the technique appears simple, it must be performed rigorously to ensure the cement sufficiently overlaps the bone ends and the defect is properly stabilized to prevent non-union, which is the main complication. LEVEL OF EVIDENCE: Level IV (retrospective study).

Early resection of congenital pseudarthrosis of the tibia and successful reconstruction using the Masquelet technique.

Congenital pseudarthrosis of the tibia remains one of the most difficult orthopaedic problems. We describe early excision and the use of the Masquelet technique to reconstruct the bone defect in a child aged 14 months. Consolidation sufficient for complete weight-bearing was achieved by seven weeks. After two and a half years, the child was asymptomatic with a fully reconstructed tibia and no leg-length discrepancy.

[Gastric rupture in children. Apropos of a case]. / Rupture gastrique chez l'enfant. A propos d'un cas.

We report the case of a ten-year-old who sustained a barotrauma during resuscitation that caused rupture of the stomach. Ruptures of the stomach are infrequent occurrences in children. Most cases consist in a tear of the lesser curvature due to excessive pressures being used during face mask ventilation. Clinical features always include gradual development of a pneumoperitoneum with persistence of respiratory distress. The plain film of the abdomen confirms the diagnosis and immediate surgery is required. Various etiologies reported in the literature are reviewed. The need for caution when ventilating and use of age-appropriate equipment is emphasized. Rupture of the stomach should be considered in every patient who develops acute distension of the abdomen while undergoing resuscitation.

[Vascular complications in pelvic injuries in children]. / Complications vasculaires des traumatismes pelviens chez l'enfant.

Vascular injuries due to pelvic trauma are unusual in children. They resulted from important pelvic injuries with section of external iliac vessels, or of a contusion with thrombosis. These lesions required an angiography witch indications are = four or more units of blood transfusion within 24 hours, or a half blood mass in one hour. Truncal vessel lesions are associated with important pelvic fractures and associated lesions, requiring a surgical treatment. They are revealed by an important bleeding or an ischemia, and confirmed by an angiography. Indications for retroperitoneal hematomas are less important, but an important bleeding, with hypotension require an angiography and a selective embolization. Percutaneous transcatheter embolization is the procedure of choice for controlling massive pelvic retroperitoneal hemorrhage. We reported 14 cases of vascular injuries; 9 required a surgical treatment for a truncal vessel section and 3 were associated with important pelvic lesion; 5 large retroperitoneal hemorrhage were treated by selective embolisation.

[A case of acute gastric volvulus in a newborn infant]. / Un cas de volvulus gastrique aigu du nouveau-né.

Gastric volvulus is a rare cause of respiratory distress and vomiting in neonates. This diagnosis was suspected in a 4 week old baby with acute respiratory distress accompanied with vomiting, from the results of an esophagogastroduodenal radiological examination. At operation a gastric volvulus was confirmed, associated with an anatomical malformation: absence of gastrosplenic omentum predisposing to gastric volvulus with mesenterio-axial rotation. Gastropexy was followed by an uncomplicated postoperative course. A literature review confirmed rarity of this affection and raised the problem of causes of repeated vomiting in the newborn and premature infant. An often incriminated lesion is gastric plicature, a radiological notion, whereas gastric volvulus is accompanied necessarily by an altered uptake of contrast in the stomach. Acute volvulus must be distinguished from other types of volvulus, notably that observed during hiatus hernia. Early diagnosis allows rapid surgical treatment by anterior gastropexy as recommended by most authors.

[Embryonal rhabdomyosarcoma diagnosed prenatally. Apropos of a case]. / Rhabdomyosarcome embryonnaire de découverte anténatale. A propos d'un cas.

A case report of congenital embryonal rhabdomyosarcoma of the superior extremity (right shoulder) is described. This patient was the first and only child of a 24 year-old woman who had been previously treated for sterility. The diagnosis was done by echography during the 36 th week of gestation. This full term white boy was born by cesarean section in reason of tumor size. First he was treated surgically. Then, a cyclic chemotherapy (VAC) was performed. After 4 courses, local recurrence led to a second surgical excision followed by a new cyclic chemotherapy (IVA). The treatment had an acceptable tolerance. Seven months later the child is free disease alive.

[Gardner syndrome treated by total colectomy with preservation of the internal sphincter. Apropos of 3 cases]. / Syndrome de Gardner traité par colectomie totale avec conservation du sphincter interne. A propos de trois cas.

Familial polyposis and more particularly Gardner's syndrome is a difficult affection to treat in children, due to the risk of degeneration of polyps. Two factors are accepted by all authors as being of major importance: the need for early treatment to avoid degeneration; the advantage of maximum mucosal excision to avoid repeated follow up examinations and removal of further polyps from the remaining rectum. Three cases of familial polyposis and Gardner's syndrome were treated by either total colectomy and rectal mucosectomy (2 cases) or a partial Reifferscheid procedure (1 case). Two problems related to prognosis appear to be solved by this procedure: the need to operate on a child lacking clinical symptoms, and to obtain valid continence with a minimum of suveillance after surgery.