Coronal STIR MRI sequences in unexplained limping in children under 6 years old: A single-center retrospective study of 130 cases.

INTRODUCTION: Limping is a common presenting symptom in young children. Clinical examination backed up by laboratory analysis, standard radiography, and/or ultrasound may fail to determine the diagnosis, and limping may prove persistent, requiring repeated consultation. Magnetic resonance imaging (MRI) can suggest the etiology or provide welcome reassurance when normal. We advocate the use of MRI in cases of persistent unexplained limping in young children. The study hypothesis was that coronal short TI inversion recovery (STIR) MRI has good negative predictive value (NPV) in unexplained limping in children under 6 years of age. MATERIAL AND METHOD: Coronal STIR MRI sequences were analyzed in 130 children younger than 6 years (84 boys, 46 girls) during the period April 2007 to May 2017. They extended from the lower thoracic spine down to the feet. Agreement was analyzed between the radiologist's initially suggested diagnosis and the pediatric orthopedic specialist's final diagnosis. RESULTS: Overall, 49 scans were normal (37.7%) and 81 abnormal (62.3%). The mean age at MRI was 32.3 months. Coronal STIR MRI had 98% NPV. There was 99.2% agreement between the radiologist's diagnosis and the final diagnosis. DISCUSSION: The recently reported contribution of STIR MRI in bone and joint infections was extended to unexplained limping. CONCLUSION: First-line MRI with coronal STIR sequences improved the diagnostic efficacy, thanks to its speed and relative lack of movement artifacts.

ACL reconstruction in 11 children using the Clocheville surgical technique: Objective and subjective evaluation.

INTRODUCTION: The over-the-top position of the femoral metaphyseal tunnel during extraphyseal ligament reconstruction of the anterior cruciate ligament (ACL) according to Clocheville may be responsible for negative anisometry. Until now, the follow-up of children operated using this pediatric technique was limited to screening for iatrogenic epiphysiodesis and the search for postoperative clinical instability. The objective of this study was to measure residual laxity using objective tests, to quantify muscle recovery, and to evaluate the quality of life of these patients in terms of the sports activities. MATERIAL AND METHODS: Eleven patients with a mean age of 13.5years were seen at a mean 2.1years of follow-up. They underwent objective clinical tests (GNRB(®) arthrometer and CON-TREX(®) dynamometer) as well as subjective questionnaires (IKDC and KOOS). RESULTS: No significant difference was found between the healthy knee and the operated knee for either the GNRB(®) at 134N (P=0.79) or at 200N (P=0.98). The CON-TREX(®) system allowed us to measure a median percentage of quadriceps recovery of 80.7% (range, 52.2-114.5) in terms of muscle power (60°/s) and 81.2% (range, 51.6-109.6) for muscle response (180°/s). The median subjective IKDC score was 94.73/100 (range, 73.68-98.93); 72.7% of the patients resumed competitive sports. DISCUSSION: This study's lack of statistical power did not show a significant difference in terms of residual laxity at rest of GNRB(®) transplants, while a mean differential of +0.4mm was observed. Although pediatric transphyseal ligament reconstruction techniques are increasingly used, the Clocheville technique remains, in our opinion, an attractive surgical alternative in the youngest subjects, with no major risk of iatrogenic epiphysiodesis even though it is theoretically anisometric. LEVEL OF EVIDENCE: IV.

[Peroneal nerve palsy in children: Uncommon diagnosis of a proximal tibiofibular synovial cyst]. / Paralysie du nerf fibulaire commun : diagnostic rare chez l'enfant d'un kyste synovial tibio-fibulaire supérieur.

Compression of the common peroneal nerve by synovial cysts of the tibiofibular joint is a rare disease. Two macroscopic forms may be encountered: extraneural cysts and intraneural cysts. In a review of the literature, we found only three pediatric cases of common peroneal nerve palsy due to extraneural cysts and about 60 cases reported in adults. Taking advantage of the clinical history of two children operated in our department for this disease, we describe this uncommon entity, which must be diagnosed and treated rapidly. Even in the presence of severe clinical and electrophysiological symptoms, a full clinical recovery is possible, as observed in these two children. However, follow-up is needed because recurrence is possible.

Minimally invasive harvesting of nonvascularized fibular graft in children.

Using a nonvascularized fibular graft is part of the therapeutic arsenal for filling bone loss defects. It is conventionally performed by open surgery. The authors propose a minimally invasive technique for harvesting a free fibular graft. The fibula was removed subperiosteally by two or three small incisions in five patients with a mean age of nine years and nine months. The mean surgical time was 21 min and 40.5% of the length of the fibula was harvested. At the donor site, we found no removal-related complications, regeneration of the fibula was observed in 80% of cases, and the cosmetic result was considered excellent by all patients with a mean 4.3 years follow-up. This minimally invasive technique is simple and fast, with very low morbidity in our experience.

Hereditary sensory and autonomic neuropathy type IV and orthopaedic complications.

Hereditary sensory and autonomic neuropathy type IV (HSAN-IV) is a very rare autosomal recessive disorder characterized by recurrent episodes of unexplained fever, extensive anhidrosis, total insensitivity to pain, hypotonia, and mental retardation. The most frequent complications of this disease are corneal scarring, multiple fractures, joint deformities, osteomyelitis, and disabling self-mutilations. We reported the case of a 12-year-old boy. The goal was to discuss our decision-making and compare this case with cases described in the literature.

Percutaneous hallux valgus surgery in children: short-term outcomes of 33 cases.

BACKGROUND: Many surgical procedures for hallux valgus correction have been reported, including percutaneous techniques. In children, the risk of recurrent hallux valgus after any type of surgical correction seems to deserve attention. To our knowledge, no studies have investigated the outcomes of percutaneous hallux valgus surgery in children. Here, we report a study on this topic. MATERIALS AND METHODS: We retrospectively reviewed 33 percutaneous surgical procedures to correct idiopathic hallux valgus in 18 children younger than 16 years of age. Radiographs obtained pre-operatively and at last follow-up were used to determine the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA). Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and a satisfaction score. RESULTS: Mean follow-up was 30 months. At surgery, mean age was 12.5 years and the growth plates were open in 20/33 (61%) cases. Mean HVA correction was 8.6° (from 28.06° to 19.45°, P<0.01) and mean DMAA correction was 7° (from 15.97° to 8.97°, P<0.01). At last follow-up, 20 (61%) feet had HVA values greater than 16°, but in half these cases the patients reported being satisfied with the procedure, leaving 30% of feet with symptomatic under-correction. Mean post-operative AOFAS score was 80.7. Patients were satisfied or very satisfied for 24/33 (73%) feet. DISCUSSION: We found a high-rate of radiographic under-correction. Studies of factors associated with recurrent hallux valgus would be expected to result in technical improvements and therefore in better outcomes. CONCLUSION: Our evaluation of short-term outcomes after percutaneous hallux valgus surgery without internal fixation showed both a high-rate of under-correction and a high-rate of patient satisfaction. Medium-term studies are needed to determine whether these results are sustained over time. The available data suggest a number of technical improvements. At present, we plan to continue to offer this procedure to children and their families. LEVEL OF EVIDENCE: Level IV, retrospective study.

[Thoracic outlet syndrome in a child: a rare pediatric diagnosis]. / Syndrome du défilé thoraco-brachial par côte surnuméraire : un diagnostic rare en pédiatrie.

Thoracic outlet syndrome (TOS) is a rare pediatric syndrome and few cases have been reported in the literature. The authors report the case of a 10-year-old boy with generalized arm pain and neck stiffness. The angiocomputed tomography revealed the presence of a TOS caused by an additional cervical rib and stenosis of the sub-clavian artery. The resection of this rib relieved the patient of his pain during a full year following surgery. This case reminds us that children can also be affected by TOS. When a cervical rib causes TOS, a resection is often necessary.

Idiopathic club foot treated with the Ponseti method. Clinical and sonographic evaluation of Achilles tendon tenotomy. A review of 221 club feet.

The Ponseti method applied to treating idiopathic club foot consists in placing successive corrective casts, possibly an Achilles tendon tenotomy, then derotation braces, a method that has proven its efficacy. This study compared 221 cases of club foot treated with this method between 2002 and 2007 divided into two groups, based on whether or not Achilles tendon tenotomy was performed. Assessment was both clinical and sonographic. We observed clear improvement of the results in the group that underwent Achilles tendon tenotomy and a significant difference in the rate of secondary surgery. The sonographic evaluation also showed improvement of the morphological results. We now systematically propose Achilles tendon tenotomy however severe club foot may be.

Discoid meniscus associated with agenesis of the anterior cruciate ligament in an 8-year-old child.

Among the congenital anomalies involving the lateral compartment of the knee, the combination of both a discoid meniscus and agenesis of the anterior cruciate ligament (ACL) is extremely rare and probably underestimated due to the presence of a meniscofemoral ligament often mistaken for an intact ACL. The therapeutic management of such abnormalities is not univocal and highly depends on their clinical impact. We report on the observations of an 8-year-old boy presenting with a cystic formation on a lateral discoid meniscus associated with agenesis of the ACL and the presence of an anterior lateral meniscofemoral ligament.

Irreducible developmental dysplasia of the hip due to acetabular roof cartilage hypertrophy. Diagnostic sonography in 15 hips.

INTRODUCTION: Irreducible developmental dysplasia of the hip (DDH) in newborns is a rare entity. The different obstacles preventing reduction have been described in the literature. HYPOTHESIS: A clinical form of DDH with hypertrophy of the cartilage of the acetabular roof (acetabular bulge) can be reliably identified on ultrasound and should probably be defined as a separate entity. MATERIALS AND METHODS: For the first time, the authors report their experience, a review of the literature and the radiographic description (ultrasound, arthrography MRI) of irreducible neonatal DDH due to hypertrophy of the cartilage of the acetabular roof (acetabular bulge) in 12 infants (15 hips). RESULTS: Neonatal sonography seems to be sufficient to identify this specific clinical entity without any additional work-up. This sonographic sign could help determine the therapeutic strategy earlier in this severe and complex form of DDH.