[Corrective surgery for lower limb length discrepancy and malalignment in paediatric orthopaedics]. / Corrections d'axes et allongements des membres inférieurs en orthopédie pédiatrique.

Lower limb length discrepancy and malalignment in paediatric orthopaedics constitute a set of acquired or malformative structural pathologies. These anomalies, which may alter statics of lower limbs, are susceptible to engender an asymmetry of mechanical constraints' distribution across joints, and thus to promote the onset of arthritic phenomenons. The purpose of this review's article is to define the limits of tolerance of the various malformations and describe the innovative techniques available in order to correct them.

Les inégalités de longueur et les troubles d'axe des membres inférieurs constituent un ensemble de pathologies structurelles acquises ou malformatives. Ces anomalies, qui altèrent la statique des membres inférieurs, vont engendrer une asymétrie de répartition des contraintes mécaniques sur les différentes pièces osseuses et sur les articulations et, de ce fait, faciliter la survenue de phénomènes dégénératifs arthrosiques. Le but de cet article de synthèse est de définir les limites de tolérance des différentes malformations et de décrire les différentes techniques novatrices pour les corriger.

From prevention of pin-tract infection to treatment of osteomyelitis during paediatric external fixation.

Pin-tract infection (PTI) is the most commonly expected problem, or even an almost inevitable complication, when using external fixation. Left unteated, PTI will progress unavoidably, lead to mechanical pin loosening, and ultimately cause instability of the external fixator pin-bone construct. Thus, PTI remains a clinical challenge, specifically in cases of limb lengthening or deformity correction. Standardised pin site protocols which encompass an understanding of external fixator biomechanics and meticulous surgical technique during pin and wire insertion, postoperative pin site care and pin removal could limit the incidence of major infections and treatment failures. Here we discuss concepts regarding the epidemiology, physiopathology and microbiology of PTI in paediatric populations, as well as the clinical presentations, diagnosis, classification and treatment of these infections.