Reconstruction of metatarsal bone after giant cell tumor resection with no vascularized fibular graft in a pediatric patient: Case report and review of literature.

The Giant Cell tumor (GCT) is a benign, locally aggressive lesion that cause bone destruction and shows a malignant potential. It is a relatively common skeletal tumor that is therefore typically seen in young adults. Few cases are described in literature of GCT in the immature skeleton, and the metatarsal is an unusual location for a primary bone GCT, especially in pediatric age. Therefore, there are very few data reported regarding the management protocol of GCT in metatarsal bones. We report a case about the use of no vascularized fibular graft for an original Y-shaped reconstruction of the metatarsal bone after Giant Cell Tumor resection in a 9 years-old patient, and performed a literature review about metatarsal bone reconstruction in skeletally immature patient.

Managing of musculoskeletal infections in children.

OBJECTIVE: Epidemiological features of musculoskeletal infections are in continuous evolution. The incidence of emerging causative pathogen is arising. Nevertheless, up to 50% of osteoarticular infections shows negative cultures. Septic arthritis, with or without concurrent osteomyelitis, are most common in newborn while osteomyelitis frequently affects older patients. We retrospectively analyzed all the children affected by musculoskeletal infections treated at the Children's Hospital Bambino Gesù in ten years, focusing on the results of an early diagnostic and therapeutic management. MATERIALS AND METHODS: The study population consists of 150 children with acute septic arthritis, osteomyelitis and discitis, treated from 2006 to 2016, excluding patients with less than 12 months of follow-up and previous treatment sustained in others hospitals. A wide spectrum of data has been extracted from clinical charts, laboratory studies and imaging. Patients were categorized into 3 groups on the base of their age. The diagnostic and therapeutic protocol consisted of intravenous empirical treatment while diagnosis was ongoing then switched to oral treatment, according to the pathogen and the systemic symptoms. RESULTS: Only 31% of pathogens were identified. The most common was Staphylococcus aureus methicillin-sensible (MSSA) but an increase of cases caused by Kingella Kingae and Staphylococcus aureus methicillin-resistant (MRSA) was observed. The mean antibiotic treatment was 6.8 weeks. It's important to underline a significant correlation between age and C-reactive protein serum levels. CONCLUSIONS: Among others frequent pathogens, MRSA shows a high rate of physis involvement. Musculoskeletal infections represent a challenge in skeletally immature patients because of their potential severe complications. Timing of diagnosis and consequent targeted treatment is fundamental to avoid complications and functional sequelae.

[Considerations on the role of echography in the study of hip dysplasia]. / Considerazioni sul ruolo dell'esame ecografico nello studio della displasia dell'anca.

The authors explain the general criteria in performing an ultrasound exam and the pathological finding of congenital dislocation of the hip. They based the study on the screening of 500 patients between the ages of ten days and eight months (2% of which resulted pathological) and on evaluation of 80 cases of dislocated hip not included in the original sample group. The ultrasound test in dislocated hip pathology proved to be superior to traditional x-ray tests for viewing the muscular and cartilaginous elements, obtaining a dynamic view of the anatomical structures and, in particular, studying the morphological aspect and the development of the acetabulum. Thus it is possible diagnose different types of CDH at very early stage. The authors, however, consider an easier classification more useful than the original one suggested by Graf and propose division of the abnormal hip into three pathological types based on clinical, radiological and ultrasound findings: primary sub-luxation or "non-dislocatable" hip; pre-dislocation or "dislocatable" hip; dislocation or "dislocated" hip. This is extremely important in order to better understand and evaluate each singular case and then set up adequate therapy.

[Rare skeletal pathology: the diagnostic problems in the first year of life]. / Patologia rara dello scheletro: problemi diagnostici nel primo anno di vita.

The authors report a series of affections which determine diffused modifications of the skeleton during early childhood. More common pathological forms are dealt with, of relatively simple diagnosis, and having pathological pictures which based on frequency, means of occurrence, and clinical-radiographic aspects, are rarely observed, and difficult to diagnose. Based on several clinical cases, the authors report problems related to diagnosis, emphasising the meaning of various radiographic pictures and the value and choice of hematochemical tests aimed at selecting patients in whom biopsy is required.

[Torsional changes in the lower limbs in childhood]. / Le alterazioni della torsione degli arti inferiori in età pediatrica.

Based on their observation of approximately 1000 patients aged from 4 to 14 years and on a comparison of their experience with the data reported in the literature, the authors discuss the problem of modifications in torsion of the lower limbs during pediatric age. After a brief discussion of anatomy and the natural progression of the angle of femoral anteversion and tibial torsion, they stop to accurately describe the most frequently occurring defects in torsion, both isolated and combined. After affirming the contribution that axial vision has made to an understanding of the subject, they emphasise the current usefulness of the method in cases in which a clinical examination allows for doubts to persist and, in particular, if qualitative and quantitative diagnosis is required in relation to the therapeutic protocol. The authors conclude by suggesting that therapy be carried out during the growth age (much before 14 years of age) while they suggest waiting until skeletal maturity in order to make a general evaluation and to decide on treatment of combined defects.

[The Freeman-Sheldon syndrome]. / La sindrome di Freeman-Sheldon.

The authors report two cases of Freeman-Sheldon syndrome, characterised by recessive autosomic transmission, affecting a brother and a sister born of parents who were not blood relations. The syndrome, for which 50 cases are described in the literature, takes its name from the authors who were the first to describe it in 1938. The typical picture is based on congenital deformity involving the cranium, the face and the locomotor apparatus, with a particular aspect of the subject affected related to his or her expression, resembling that of someone whistling ("whistling face", Burian, 1963). In addition to the descriptive aspect of the syndrome and to the means of its transmission, the authors report orthopaedic aspects concerning the locomotor apparatus and problems related to the type of surgery performed.