Spontaneous healing of fractures and osteotomy within intercalary allograft reconstruction after distal femur osteosarcoma resection in a child.

Intercalary biologic reconstructions using allogenic bone grafts remain a useful option in orthopedic oncology; however, these reconstructions are prone to fractures, and treatment is usually required involving surgical interventions. Biologic activity of the implanted allografts remains minimal, but in some cases, spontaneous healing of the graft may occur. We present a report and discussion on two fractures and corrective osteotomy within the implanted allograft that healed with abundant callus without the need for additional surgery. In selected patients, allograft incorporation can be completed to a degree allowing for its biologic activity and spontaneous healing of fractures or osteotomy.

Expansion of Carraro syndrome or a new disorder?

A 6-year-old girl is described with a unique, rare type of tibial hemimelia known as Carraro syndrome (OIMI 275230). There are only two previous reports of this condition in the literature. In our patient, the tibia anomaly was associated with other skeletal abnormalities, hemivertebra and tetralogy of Fallot. This association of malformations has not previously been reported. We conclude that this girl has either a variant of Carraro syndrome or a new syndrome.

[Nonspecific sacroiliac joint arthritis in children]. / Nieswoiste zapalenie stawu krzyzowo-biodrowego u dzieci.

The authors present their experiences in diagnosis and treatment of sacroiliac joint arthritis in 7 children, that were admitted to Orthopaedic Ward of University Children's Hospital in Cracow, Poland in years 2000-2004. The mean age at the time of admission was 11,6 years (6-17). Main complaints given by patients were as follows: affected side buttock pain (3 patients), sacroiliac pain (2 patients) and hip pain (2 patients). All patients presented antalgic walk. Four patients were pyretic with temperature over 38 degrees C. On examination, symptoms in all patients included pain on palpation over affected sacroiliac joint and painful hip movements in flexion, abduction and external rotation (positive FABER sign). No hip flexion contracture was noted. The mean time of complaints duration was 20 days to the time of admission. Inflammatory markers were elevated in all cases, positive blood culture was found in 3. Diagnosis was confirmed by positive Technetium bone scan in all patients. Additionally, arthritic changes were found in CT scan in 4 cases and MRI in 1. All patients were treated with intravenous antibiotics for mean time 4.8 weeks (3-8), until CRP reached normal level and remained stable. Treatment result in all patient was good, with no negative consequences after.

[Reconstructions of the teratogenic hip dislocation in childrens with AMC]. / Rekonstrukcja teratologicznego zwichniecia stawu biodrowego u dzieci w przebiegu Arthrogryposis multiplex congenita.

UNLABELLED: Hip diclocation is the cause of the mobility impairment in children with arthrogryposis. Hip joint reconstruction is a commonly accepted treatment method in unilateral dislocations, but opinions are divided in bilateral. AIM OF THE STUDY: Hip joint function assessment after reconstruction due to teratogenic dislocation in arthrogryposis. MATERIAL AND METHODS: In years 1988 to 2005 we performed 9 reconstructions of the teratogenic hip dislocation in 8 children with AMC (Arthrogryposis multiplex congenita). Mean age of children at the time of procedure was 3.5 years. Mean follow-up was 9.5 years. At final outcome the movement and the mobility were assessed according to modified Harris scale, as well as influence of other factor on ambulatory status. Radiological result was assessed according to Severin classification. RESULTS: Mean ROM in hip joint after operation decreased in all children comparing to preoperative assessment in all planes, except for adduction. In all ROM of the hip remained functional. At the final check up there was mobility improvement in 7 patients. The knee flexion contracture ipsilateral to the dislocated hip was stated only in 1 patient. There was no isolated relation between ambulatory status and hip and knee extensor muscles strength, residual deformities of the lower extremities and involvement of the upper extremities. There was no relation between radiological result and mobility. CONCLUSIONS: Decrease of hip ROM after the reconstruction in patients with AMC does not influence the mobility. The factor that influence that mobility ought to be considered altogether. Hip dislocation in patients with AMC may prevent occurrence of the knee flexion contracture deformity.

[The treatment of the hip cotructure with intertrochanteric osteotomy of the femur in children with Arthrogryposis multiplex congenita]. / Osteotomia miedzykretarzowa kosci udowej w leczeniu przykurczu stawu biodrowego u dzieci w przebiegu Arthrogryposis multiplex congenita.

BACKGROUND: The flexion contractures of the hips affect mobility in patients with Arthrogryposis Multiplex Congenita (AMC). There are only a few reports concerning correction of those deformities with femoral intertrochanteric osteotomy. AIM: The results' analysis of fixed hip flexion deformity correction with femoral intertrochanteric osteotomy in AMC patients. MATERIAL: 16 femoral intertrochanteric osteotomies were performed for hip contracture between 1992 and 2002 in 7 AMC patients. Mean follow up period was 6.5 years postoperatively. The hip contractures between 20 and 110 degrees making mobility impossible or difficult fulfilled the criteria for surgery. In 7 cases knee flexion deformity correction was performed simultaneously with the hip procedure. At the final check up, the hip ROM, the rate of deformity recurrence and patients' mobility were assessed. RESULTS: The mobility was affected in all children preoperatively. The range of deformity correction during the procedure was average 53 degrees. In 10 cases the improvement of mobility status was estimated postoperatively. The deformity recurrence occurred in 13 cases, in 4 of them required procedure to be repeated. The age in the recurrence group was lower and the contractures measured preoperatively more severe in comparison to the non recurrence group. CONCLUSIONS: Femoral intertrochanteric osteotomy tends to be efficient method of treatment of hip flexion contracture in children with AMC. Deformity correction has been achieved in all patients. The mobility status improvement is noted in majority of the patients, despite high rate of deformity recurrence postoperatively.

[Percutaneous tenotomy of achilles tendon in the treatment of congenital clubfeet--a preliminary report]. / Przezskórna tenotomia sciegna Achillesa w leczeniu wrodzonych stóp konsko-szpotawych-- doniesienie wstepne.

The authors present early results of conservative treatment in congenital clubfeet connected with the percutaneous tendon Achilles tenotomy in 10 children (16 feet). 9 feet were of type III and 7 of type IV according to the Dimeglio scale. Minimum follow up was 6 months, with an average follow up period of 10 months. All cut Achilles tendons regenerated completely. On follow up 9 feet were completely corrected, 5 presented with mild forefoot adduction and 2 feet required surgery because of recurrent equinovarus deformity. The authors claim that the percutaneous tendon Achilles tenotomy is a safe and valuable procedure which allows to avoid early surgery in 88% of clubfeet.

[Fractures of the proximal tibial epiphyseal cartilage]. / Zluszczenie nasady blizszej kosci piszczelowej w materiale wlasnym.

The authors present 9 children who sustained 10 fractures of proximal tibial epiphyseal cartilage (7--left tibia, 3--right tibial), and were treated in Children's University Hospital in Kraków between years 1994-2001. Mean age in the time of trauma was 12.7 years (6-17 years), the mean follow-up time was 17.4 months (8-48 months). According to Salter-Harris classification there was 5 fractures of type I, 4 of type II, 1 of type III. One child was treated by closed reduction and percutaneous Kirschner wires fixation. One child was treated by traction. The rest of the children were treated by casting, in knee flexion about 30 degrees. In one child there was premature closing of epiphyseal cartilage, shortening 1.5 cm and posterior curvature of tibia. In this child we performed flexion tibial osteotomy. In one child few months later we recognized meniscal tears (the patient was operated on). The results in the rest of children were good and there were not complications. The authors discuss the literature connecting to proximal tibial epiphyseal fractures.