Open fractures of the limbs in children and adolescents.

Open fracture is rare in children, raising dual issues of sepsis and mechanics. Here, we address certain practical questions regarding childhood open fracture. Should the recognized adult classifications be used in children? Two classifications exist for adults, without pediatric specificities; of these, we recommend Gustilo's, as being more precise in its description of severe grades. Is there any consensus on emergency prophylactic antibiotic therapy in children? The risks seem to be the same, and 24hours' prophylactic antibiotic therapy should be initiated as soon as possible, as in adults. What are the most recent guidelines on time to treatment, type of internal fixation and possible associated procedures in tibial fracture in children? Wound cleansing is indispensable. Treatment under anesthesia can be delayed up to 24hours in the absence of neurovascular complications on condition that antibiotic therapy is implemented immediately. In Gustilo grade I and II, or IIIA, external fixation is not systematic and non-operative treatment or intramedullary nailing is possible. In grades IIIB and IIIC, external fixation is the rule, although conversion is possible if indicated early enough. Do the particular cases of nail bed injury or lawn mower foot injury in children require specific management? Nail bed injury is not to be minimized and should be treated strictly. In case of serious accidents with garden equipment, initial wound care in surgery should be economic, but experienced practitioners should weigh the risk/benefit ratio between conservation and early amputation. LEVEL OF EVIDENCE: IV.

Functional and radiological outcome of subtalar arthroereisis for flexible pes planovalgus in children: A retrospective analysis.

INTRODUCTION: Pediatric idiopathic pes planovalgus can correct itself with growth. Otherwise, in the event of functional impairment and after failed conservative treatment, surgery can be considered. Based on a multicenter retrospective study, we report the functional and radiographic results obtained after subtalar arthroereisis. HYPOTHESIS: We hypothesized that this surgery improves functional and radiological parameters in childhood. MATERIAL AND METHOD: Forty-eight medical records of children (78 feet) operated on between 2010 and 2019 were studied. Functional (FAOS score) and radiographic (Djian angle, calcaneal slope, lateral talocalcaneal divergence and calcaneus/M5 alignment, talonavicular coverage measurement, AP talocalcaneal divergence) results were studied. The analysis of these different criteria was carried out between the preoperative period and the last follow-up. RESULTS: The functional outcome was satisfactory with an average FAOS questionnaire score of 95.5 out of 100 total points. All the radiographic parameters studied were significantly improved (p<0.001). The average age at the time of surgery was 11.3 years (range: 7 to 16) with a mean follow-up of 35 months (range: 18 months to 84). Spontaneous screw expulsion and subtalar pain were the main complications found. DISCUSSION: The results obtained are consistent with those in the literature. The age at the time of the surgery is an essential factor to consider with the goal of optimal correction. CONCLUSION: This technique is reliable and effective in the short term. It can be offered as first-line therapy in the management of symptomatic pes planovalgus in children. The follow-up is short, which necessitates longer term studies of this population. The ideal age for surgery remains to be determined. LEVEL OF EVIDENCE: IV.

[Bone lengthening by motorized centromedullary nail]. / L'allongement osseux par clou centromédullaire motorisé magnétique.

Bone lengthening surgeries are difficult procedures for both the patient and the professional. Complications are common and pediatric orthopedists have been working to reduce them. The discovery of progressive bone lengthening was a first step in improving these procedures, followed by the advent of external fixators. More recently, internal lengthening systems have emerged as one of the greatest technological advances in these procedures. Bone lengthening with an electromagnetic nail, which is becoming increasingly popular, has drastically reduced the complications of these surgeries.

Correlations between physical and ultrasound findings in congenital clubfoot at birth.

BACKGROUND: At birth, clinical classifications are the only available tools for evaluating the severity of congenital clubfoot. Ultrasound provides an assessment of the anatomical abnormalities. The objective of this study was to assess correlations between physical and ultrasound findings at birth. HYPOTHESIS: Physical and ultrasonography provide different findings in congenital clubfoot and should therefore be used in conjunction. MATERIAL AND METHOD: One hundred and forty-five clubfeet in 108 patients born between 2006 and 2010 were included in a retrospective study. Clubfoot severity was classified using two methods, the modified Dimeglio classification based on physical findings and an ultrasound score based on the talo-navicular angle (TNA) and metaphyso-talo-calcaneal angle (MTCA). Each of these two methods distinguished three severity grades. Agreement between the two methods was assessed by computing the coefficient. RESULTS: The results confirmed the hypothesis by showing low agreement between the clinical and ultrasound classifications. The severity grades were identical with the two methods for only 83/145 (57%) feet. The coefficient was 0.086. DISCUSSION: The two ultrasound views used to measure the TNA and MTCA, respectively, added an assessment of the three main deformities that characterise congenital clubfoot (equinus, adduction of the forefoot, and adduction of the calcaneo-pedal unit). Ultrasonography complements the physical examination at birth. In the future, using both physical examination and ultrasound scanning to monitor babies with clubfoot may allow early treatment adjustments aimed at optimising the outcome. LEVEL OF EVIDENCE: IV, retrospective observational study.

Kinematic motion abnormalities and bimanual performance in children with unilateral cerebral palsy.

AIM: To evaluate the relationship between the movement abnormalities of the impaired upper limb in children with unilateral cerebral palsy (CP) and bimanual performance. METHOD: Twenty-three children with unilateral CP (mean age 11y 10mo [SD 2y 8mo]) underwent evaluation of bimanual performance (Assisting Hand Assessment [AHA]) and a three-dimensional movement analysis to measure deviations in the movement of their affected upper limb, and compared with 23 typically developing children (TDC) (mean age 11y 11mo [SD 2y 5mo]). Kinematic indices, such as the Global Arm Profile Score (APS), which summarizes the global movement deviation of the upper limb from the norm, and the Global Arm Variable Score (AVS), which represent movement deviations for a given joint, were calculated and correlated to AHA. RESULTS: Values of kinematic indices were significantly higher in children with unilateral CP than in TDC. A strong correlation between Global-APS and AHA score (r=-0.75) was found. Other significant correlations were found with Global-AVS, especially in distal joints. INTERPRETATION: Children with unilateral CP had more movement deviations than TDC. The global movement deviation of the impaired upper limb was strongly correlated with bimanual performance. The influence of distal abnormalities confirms the importance of considering these limitations in therapeutics. WHAT THIS PAPER ADDS: Children with unilateral cerebral palsy had more movement deviations than typically developing children in unimanual tasks. A strong relationship was found between movement deviations of the impaired upper limb and bimanual performance.

Extensive Necrotic Skin Lesions Due to Post-varicella Protein S Deficiency.

Postvaricella protein S deficiency is a rare and severe disease. We report a case of extensive necrotic skin lesions of acute onset 7 days after varicella in a 4-year-old girl. Protein S antigen and activity were <10%, and antiprotein S antibodies were detected. She was treated with anticoagulation, plasmapheresis and fresh frozen plasma. She survived but required leg amputation.