Impact of Legg-Calve-Perthes disease in a Mediterranean health area. / Impacto de la enfermedad de Legg-Calvé-Perthes en un área de salud mediterránea.

INTRODUCTION: Several socioeconomic population factors have been related to the aetiology of Legg-Calve-Perthes disease (LCPD), such as its higher incidence in the urban population, living on the periphery of urban centres or residing at a certain latitude with respect to the world equator. The incidence in some other countries is known but the incidence of the process in our environment is unknown an important fact to allocate the social and health resources necessary for the treatment of the disease. Therefore, the aim of the present study is to determine the incidence of LCPD in Health Area 2 of Madrid. MATERIAL AND METHODS: The incidence of LCPD is analysed in Healthcare Area 2 of Madrid because it is the Mediterranean area that has been scarcely studied. It is an area with very low geographic mobility, a medium-low socioeconomic level, and mostly composed of workers in companies in the secondary and tertiary sectors. The data were obtained from the hospital databases of Area 2 between the years 1994 and 2010. The inclusion criteria were the presence of LCPD and the territorial distribution of the population in Area 2 of Madrid. CONCLUSIONS: The incidence of LCPD in this Mediterranean population of an industrial area was 1.59 cases/year and 100,000 inhabitants, close to that found in populations of similar latitudes, but nevertheless it is an industrial area and socioeconomic level similar to United Kingdom populations with a much higher incidence.

Impacto de la enfermedad de Legg-Calvé-Perthes en un área de salud mediterránea / Impact of Legg-Calve-Perthes disease in a Mediterranean health area

Introducción: Se han relacionado varios factores poblacionales socioeconómicos en la etiología de la enfermedad de Legg-Calvé-Perthes (ELCP), como son su mayor incidencia en población urbana, vivir en la periferia de núcleos urbanos o residir a una determinada latitud con respecto al ecuador terráqueo. Es conocida la incidencia en algunos otros países, pero se desconoce la incidencia del proceso en nuestro medio, hecho importante para acomodar los recursos sociosanitarios necesarios para el tratamiento de la enfermedad. Por todo ello, el objetivo del presente estudio es determinar la incidencia de la ELCP en el Área de Salud 2 de Madrid. Material y métodos: Se analiza la incidencia de ELCP en el Área de Salud 2 de Madrid por ser el área mediterránea una zona poco estudiada. Se trata de una zona con muy escasa movilidad geográfica, de nivel socioeconómico medio-bajo, e integrada en su mayoría por trabajadores de empresas del sector secundario y terciario. Los datos se han obtenido a partir de las bases de datos hospitalarias del Área 2 entre los años 1994 y 2010. Los criterios de inclusión fueron padecer la ELCP y la distribución territorial de la población en el Área 2 de Madrid. Conclusiones: La incidencia de ELCP en esta población mediterránea de un área industrial fue de 1,59 casos por 100.000 habitantes-año, próxima a la encontrada en poblaciones de latitudes similares; pero, sin embargo, se trata de un área industrial con un nivel socioeconómico parecido al de las poblaciones de Reino Unido con una incidencia mucho mayor.(AU)

Introduction: Several socioeconomic population factors have been related to the aetiology of Legg-Calve-Perthes disease (LCPD), such as its higher incidence in the urban population, living on the periphery of urban centres or residing at a certain latitude with respect to the world equator. The incidence in some other countries is known but the incidence of the process in our environment is unknown an important fact to allocate the social and health resources necessary for the treatment of the disease. Therefore, the aim of the present study is to determine the incidence of LCPD in Health Area 2 of Madrid. Material and methods: The incidence of LCPD is analysed in Healthcare Area 2 of Madrid because it is the Mediterranean area that has been scarcely studied. It is an area with very low geographic mobility, a medium-low socioeconomic level, and mostly composed of workers in companies in the secondary and tertiary sectors. The data were obtained from the hospital databases of Area 2 between the years 1994 and 2010. The inclusion criteria were the presence of LCPD and the territorial distribution of the population in Area 2 of Madrid. Conclusions: The incidence of LCPD in this Mediterranean population of an industrial area was 1.59 cases/year and 100,000 inhabitants, close to that found in populations of similar latitudes, but nevertheless it is an industrial area and socioeconomic level similar to United Kingdom populations with a much higher incidence.(AU)

Impact of Legg-Calve-Perthes disease in a Mediterranean health area / Impacto de la enfermedad de Legg-Calvé-Perthes en un área de salud mediterránea

Introduction: Several socioeconomic population factors have been related to the aetiology of Legg-Calve-Perthes disease (LCPD), such as its higher incidence in the urban population, living on the periphery of urban centres or residing at a certain latitude with respect to the world equator. The incidence in some other countries is known but the incidence of the process in our environment is unknown an important fact to allocate the social and health resources necessary for the treatment of the disease. Therefore, the aim of the present study is to determine the incidence of LCPD in Health Area 2 of Madrid. Material and methods: The incidence of LCPD is analysed in Healthcare Area 2 of Madrid because it is the Mediterranean area that has been scarcely studied. It is an area with very low geographic mobility, a medium-low socioeconomic level, and mostly composed of workers in companies in the secondary and tertiary sectors. The data were obtained from the hospital databases of Area 2 between the years 1994 and 2010. The inclusion criteria were the presence of LCPD and the territorial distribution of the population in Area 2 of Madrid. Conclusions: The incidence of LCPD in this Mediterranean population of an industrial area was 1.59 cases/year and 100,000 inhabitants, close to that found in populations of similar latitudes, but nevertheless it is an industrial area and socioeconomic level similar to United Kingdom populations with a much higher incidence.(AU)

Introducción: Se han relacionado varios factores poblacionales socioeconómicos en la etiología de la enfermedad de Legg-Calvé-Perthes (ELCP), como son su mayor incidencia en población urbana, vivir en la periferia de núcleos urbanos o residir a una determinada latitud con respecto al ecuador terráqueo. Es conocida la incidencia en algunos otros países, pero se desconoce la incidencia del proceso en nuestro medio, hecho importante para acomodar los recursos sociosanitarios necesarios para el tratamiento de la enfermedad. Por todo ello, el objetivo del presente estudio es determinar la incidencia de la ELCP en el Área de Salud 2 de Madrid. Material y métodos: Se analiza la incidencia de ELCP en el Área de Salud 2 de Madrid por ser el área mediterránea una zona poco estudiada. Se trata de una zona con muy escasa movilidad geográfica, de nivel socioeconómico medio-bajo, e integrada en su mayoría por trabajadores de empresas del sector secundario y terciario. Los datos se han obtenido a partir de las bases de datos hospitalarias del Área 2 entre los años 1994 y 2010. Los criterios de inclusión fueron padecer la ELCP y la distribución territorial de la población en el Área 2 de Madrid. Conclusiones: La incidencia de ELCP en esta población mediterránea de un área industrial fue de 1,59 casos por 100.000 habitantes-año, próxima a la encontrada en poblaciones de latitudes similares; pero, sin embargo, se trata de un área industrial con un nivel socioeconómico parecido al de las poblaciones de Reino Unido con una incidencia mucho mayor.(AU)

Legg-Calvé-Perthes' disease. Congruent aspherity caused by physeal injury. / Enfermedad de Legg-Calvé-Perthes. Estudio de la anesfericidad congruente causada por la lesión fisaria.

INTRODUCTION: Perthes disease often produces a congruent nonspherical coxa. The most widely accepted cause is initial bone collapse, but some authors refer to physeal injury as the cause of this deformity. We analyze this elliptical process in cases of congruent nonspherical Perthes. METHODS: Retrospective case-control study of 49 unilateral class III-IV Perthes cases that were not operated on. Results were compared with 49 healthy contralateral hips. The following radiological variables were determined both in AP and lateral projection, and at 4 points in time of the disease: ovalization index (OI), arthrotrochanteric distance, intraphysial angle, physeal narrowing, presence of double epiphyseal reosification nucleus, physeal length and Reimers index. RESULTS: The initial OI was 1.7 in the early reosification phase and final OI was 2.07 at physeal closure. The OI in the control cases was invariably 1.4. There was a direct relation between a high index and the initial appearance of a double epiphyseal ossification nucleus, asymmetric physeal effacement and the increase of the intraphyseal angle in both radiographic projections. CONCLUSIONS: The elliptical process of the femoral head occurs progressively throughout the disease and not only during bone collapse. It starts in the reosification phase and ends when growth stops. The initial risk signs found were the appearance of the double nucleus of reosification, the progressive angulation of the physis and the progressive increase in the rate of ovalization.

Hip arthrodiastasis in Legg-Calvé-Perthes disease. / Artrodiastasis de cadera en la enfermedad de Legg-Calvé-Perthes.

INTRODUCTION AND OBJECTIVE: Arthrodiastasis consists of the mobilisation of the hip while distracted by a hinged distractor. The aim of our study is to show the results of the treatment of late-onset Perthes disease with this technique in our institution. MATERIAL AND METHODS: Ambispective review of all the cases that underwent this surgery in our Department of Paediatric Orthopaedics between 2010 and 2014 with the following inclusion criteria: patients over 8 years old, with minimal deformity, and poor prognosis. Mobility, pain, Trendelenburg sign, radiographic sphericity, and complications were assessed. RESULTS: A total of 13 patients (9 male, 4 female) were included. The mean age was 11.93 years. Radiographic risk signs were present in 7 cases. The mean decrease in pain measured with a visual analogue scale (VAS) after the surgery was 3.83 points (P<.05). Cephalic sphericity was maintained in 11 cases during follow up (1.75 years). Complications were observed complications in 84.6% of the patients, with infection of the screw tract being the most frequent. All of them were easy to treat. CONCLUSIONS: Arthrodiastasis is a minimally invasive technique, useful in the treatment of late onset Perthes disease. It improves clinical results and maintains cephalic shape when applied in early stages. However, it is not free of complications, which can involve as many as 8 out of 10 patients treated with the technique.

Síndrome de DRESS como complicación de la antibioterapia en niños tratados por infecciones ortopédicas. A propósito de 2 casos / DRESS syndrome due to antibiotic therapy of osteoarticular infections in children: two case reports

La infección osteoarticular en el niño es frecuente por debajo de los 10 años. El tratamiento consiste en la administración de antibióticos y en algunos casos tratamiento quirúrgico. El tiempo de antibioterapia varía, desde 2 semanas para las artritis, hasta 6 semanas en casos de osteomielitis más abigarradas. Algunos de estos medicamentos poseen complicaciones individuales directas con baja repercusión clínica. Existen diferentes cuadros de hipersensibilidad a drogas descritos en la población infantil. El síndrome de DRESS consiste en una toxicodermia grave, que en ocasiones incluso puede comprometer la vida. Se caracteriza por fiebre elevada, mal estado general, adenopatías, y exantema. Desde el punto de vista clínico son síntomas superponibles a una exacerbación del proceso infeccioso previo por el que el paciente inició el tratamiento. Generalmente aparece afectación de órganos internos (sobre todo el hígado) y alteraciones hematológicas, que pueden hacer pensar en un cuadro séptico general. Presentamos dos casos de infección osteoarticular bacteriana en niños que fueron tratados con antibióticos y que presentaron este cuadro. Ambos regresaron tras la retirada de la medicación antibiótica (AU)

Osteoarticular infection in children frequently occurs before 10 years of age. Surgical drainage is sometimes required, whereas acute osteomyelitis can be treated with antibiotic therapy alone. The duration of antibiotic therapy varies, 2 weeks is sufficient for septic arthritis, whereas 6 weeks is often required for complicated cases. Some of these antibiotic drugs present direct complications with low clinical impact in certain individuals. Hypersensitivity to these drugs causes different reactions in children. DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe and potentially life-threatening drug reaction. It is characterised by high fever, malaise, lymphadenopathy and skin rash. From a clinical perspective, these symptoms can lead to an exacerbation of the initial infectious process for which treatment was commenced. The liver is the organ most often affected in DRESS syndrome associated with haematological changes, potentially similar to sepsis. We present two cases of children with osteoarticular infections who developed DRESS syndrome after antibiotic therapy. Both patients made a complete recovery after cessation of the antibiotic drugs used (AU)

DRESS syndrome due to antibiotic therapy of osteoarticular infections in children: two case reports.

Osteoarticular infection in children frequently occurs before 10 years of age. Surgical drainage is sometimes required, whereas acute osteomyelitis can be treated with antibiotic therapy alone. The duration of antibiotic therapy varies, 2 weeks is sufficient for septic arthritis, whereas 6 weeks is often required for complicated cases. Some of these antibiotic drugs present direct complications with low clinical impact in certain individuals. Hypersensitivity to these drugs causes different reactions in children. DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe and potentially life-threatening drug reaction. It is characterised by high fever, malaise, lymphadenopathy and skin rash. From a clinical perspective, these symptoms can lead to an exacerbation of the initial infectious process for which treatment was commenced. The liver is the organ most often affected in DRESS syndrome associated with haematological changes, potentially similar to sepsis. We present two cases of children with osteoarticular infections who developed DRESS syndrome after antibiotic therapy. Both patients made a complete recovery after cessation of the antibiotic drugs used.

Tratamiento de los puentes fisarios centrales postraumáticos mediante resección-interposición asistida por artroscopio / Arthroscopy- assisted resection-interposition of post-traumatic central physeal bridges

Introducción. La resección-interposición de los puentes fisarios presenta tasas de éxito variables en la literatura. Respecto al uso de escisión asistida por artroscopio, se han descrito buenos resultados. El objetivo ha sido valorar los resultados del tratamiento de puentes fisarios centrales postraumáticos mediante resección asistida por artroscopio e interposición de grasa. Background. Estudio retrospectivo sobre 5 pacientes (6 procedimientos), los cuales desarrollaron puentes fisarios tras una fractura fisaria. En todos los pacientes se realizó de forma preoperatoria RMN o TAC para cuantificar el tamaño del puente óseo, y se utilizó la clasificación de Peterson para definir el tipo (periférico, alargado o central). Los criterios de inclusión fueron: puentes fisarios < 50% del cartílago fisario total, deformidad progresiva o discrepancia de longitud, y un crecimiento potencial restante de al menos 2 años. Los resultados se evaluaron mediante los criterios de Marsch y Polzhofer en excelentes, buenos o malos. SCAD is a rare but challenging clinical entity. Resultados. Se obtuvieron resultados excelentes en 2 pacientes, bueno en uno, y malos resultados en los 2 casos restantes. Respecto a los pacientes con mal resultado, hemos identificado la asociación de mecanismos de alta energía en ambos casos, asociándose también un incorrecto tratamiento inicial o resección del puente de forma tardía. Conclusiones. La asociación de un artroscopio a la resección de un puente fisario permite una excelente visualización con baja morbilidad. Los resultados obtenidos no son tan positivos como los mostrados por otros autores, si bien no podemos atribuir los malos resultados a la técnica propiamente dicha al haber asociación de factores de mal pronóstico(AU)

Introduction: Physeal bridge resection and insertion of interposition material has had mixed success rates in the literature. Using the arthroscopic approach, some authors have reported good results in their patients. The aim of the study was to evaluate the treatment of post-traumatic central physeal bridges with arthroscopically assisted resection and fat interposition. Material and methods: A retrospective study was conducted on 5 patients (6 procedures), who developed a physeal bridge after a traumatic injury. A CT or MRI scan was performed preoperatively in all patients to assess the size of the physeal bridge. Inclusion criteria were patients with documented existing or developing deformities, a physeal bridge <50% of the physeal area, and with at least 2 years of growth remaining. Clinical outcomes were classified according to Marsch and Polzhofer criteria (excellent, good or poor). Results: Excellent results were obtained in two patients, good in one, and the other two cases were rated as poor. In patients with a poor outcome, high energy trauma mechanisms were identified in both cases. Moreover, incorrect initial treatment or delayed physeal bridge resection was identified. Conclusions: The arthroscopically assisted technique provides best visualization with minimal morbidity. Although our results are not as good as previous studies, it cannot be considered that the technique itself is the cause of the failure, as several risk factors associated to bad prognosis of these injuries were found (AU)

[Arthroscopy- assisted resection-interposition of post-traumatic central physeal bridges]. / Tratamiento de los puentes fisarios centrales postraumáticos mediante resección-interposición asistida por artroscopio.

INTRODUCTION: Physeal bridge resection and insertion of interposition material has had mixed success rates in the literature. Using the arthroscopic approach, some authors have reported good results in their patients. The aim of the study was to evaluate the treatment of post-traumatic central physeal bridges with arthroscopically assisted resection and fat interposition. MATERIAL AND METHODS: A retrospective study was conducted on 5 patients (6 procedures), who developed a physeal bridge after a traumatic injury. A CT or MRI scan was performed preoperatively in all patients to assess the size of the physeal bridge. Inclusion criteria were patients with documented existing or developing deformities, a physeal bridge <50% of the physeal area, and with at least 2 years of growth remaining. Clinical outcomes were classified according to Marsch and Polzhofer criteria (excellent, good or poor). RESULTS: Excellent results were obtained in two patients, good in one, and the other two cases were rated as poor. In patients with a poor outcome, high energy trauma mechanisms were identified in both cases. Moreover, incorrect initial treatment or delayed physeal bridge resection was identified. CONCLUSIONS: The arthroscopically assisted technique provides best visualization with minimal morbidity. Although our results are not as good as previous studies, it cannot be considered that the technique itself is the cause of the failure, as several risk factors associated to bad prognosis of these injuries were found.

Epifisiolisis de la cabeza femoral / Slipped capital femoral epiphysis

La epifisiolisis de la cabeza femoral (ECF) se describe como el desplazamiento de la epífisis (cabeza femoral) respecto a la metáfisis (cuello) a través de la fisis. El término es confuso ya que es la metáfisis la que se desplaza en dirección anterosuperior mientras que la epífisis no se mueve y mantiene su posición respecto al acetábulo. La ECF se considera estable cuando el paciente es capaz de caminar e inestable cuando no puede hacerlo ni siquiera con ayuda de bastones. Los pacientes con ECF son adolescentes que presentan dolor en la región inguinal y/o en la rodilla asociado a cojera. El tratamiento de elección en las estables es la fijación in situ con un tornillo (AU)

Slipped capital femoral epiphysis (SCFE) is characterized by displacement of the capital femoral epiphysis from the metaphysis through the physis. The term is confusing, because the metaphysis moves upward and outward while the epiphysis remains in the acetabulum. The SCFE is considered stable when the child is able to walk with or without crutches, and it is considered unstable when the child cannot walk with or without crutches. Patients with SCFE present with pain in the groin, knee and limp. The current treatment of stable SCFE is in situ stabilization with a single screw (AU)

[Slipped capital femoral epiphysis]. / Epifisiolisis de la cabeza femoral.

Slipped capital femoral epiphysis (SCFE) is characterized by displacement of the capital femoral epiphysis from the metaphysis through the physis. The term is confusing, because the metaphysis moves upward and outward while the epiphysis remains in the acetabulum. The SCFE is considered stable when the child is able to walk with or without crutches, and it is considered unstable when the child cannot walk with or without crutches. Patients with SCFE present with pain in the groin, knee and limp. The current treatment of stable SCFE is in situ stabilization with a single screw.

[Adjuvant treatment with phenol of aggressive benign and low grade malignant bone tumors in patients with immature skeleton]. / Tratamiento adyuvante con fenol en tumores óseos benignos agresivos y malignos de bajo grado en pacientes con esqueleto inmaduro.

INTRODUCTION: The surgical treatment of aggressive benign bone tumors is based on intralesional resection associated with local adjuvant treatment to avoid local relapses. The purpose of this study is to assess the effectiveness of adjuvant treatment with phenol in aggressive, low grade, malignant and benign bone tumors in young patients. MATERIAL AND METHODS: We conducted a descriptive retrospective study of 37 patients, 13 girls and 24 boys, with bone tumors. They were treated with curettage and intralesional phenol between January 1989 and January 2006. The study included 35 Campanacci grade III benign tumors and 2 low grade malignant tumors, Enneking IA. RESULTS: Minimum follow-up was 5 years. The local relapse rate was 13.5%. Mean age at the time of surgery was 10.7 years (SD +/- 4.4). Mean patient follow-up was 104.9 months (SD +/- 41.9). Mean time between surgery and relapse was 18.8 months (SD +/- 11.81). Complications during the follow-up period occurred in 18.9% of the patients. The MSTS score was 28.7 points (SD +/- 1.7). DISCUSSION: The treatment of bone tumors with phenol shows low relapse and complication rates, so it is indicated for the management of locally aggressive bone tumors.

Menisco discoideo: valor pronóstico del grosor meniscal / Discoid meniscus: prognostic significance of meniscal thickness

Objetivo. Estudiar la influencia del grosor meniscal en la supervivencia del menisco discoideo en niños. Material y método. Se revisaron retrospectivamente 33 pacientes con menisco discoideo diagnosticados entre los años 1992 y 1999. Se analizó la edad del paciente en el momento de la aparición de los síntomas, así como el tipo y número de roturas meniscales. El diagnóstico se basó en los hallazgos detectados en la resonancia magnética (RM) y en la artroscopia. Se emplearon dos clasificaciones, la clásica de Watanabe y la propuesta por los autores que los divide en dos tipos, tableta y cuña, dependiendo del grosor meniscal en su borde libre. Los resultados clínicos de los casos operados se valoraron con la escala de Ikeuchi. El seguimiento medio fue de 33 meses. Resultados. Se diagnosticaron 22 meniscos discoideos completos y 11 incompletos, no se encontró ningún tipo Wrisberg. Dieciocho meniscos fueron tipo tableta y 15 tipo cuña. En el tipo tableta la edad media en el momento de la rotura fue de 8 años, y en el tipo cuña de 11 años (p < 0,05). Sufrieron una rotura horizontal intrameniscal 20 pacientes, 15 de ellos fueron tipo tableta y 5 tipo cuña (p < 0,05).Según la escala de Ikeuchi se obtuvieron 18 casos con resultado excelente, tres buenos y uno malo. Conclusiones. La clasificación meniscal según su grosor, cuña y tableta, tiene un valor pronóstico en cuanto a la supervivencia del menisco. El mayor grosor meniscal en el discoideo tipo tableta condiciona una mayor predisposición a sufrir roturas con una edad más temprana (AU)

An intraarticular hip process with chondrolysis simulating Perthes disease: a report of five cases.

Radiographic findings in Legg-Calvé-Perthes disease (LCPD) are well known. Four classic stages have been described: incipient stage, avascular stage, fragmentation stage, and residual stage. Final femoral morphology is normally coxa magna, which is associated frequently with hypertrophy of the articular cartilage. We describe five patients with a hip process that initially presented clinical and radiographic findings compatible with LCPD. However, none of these patients showed the typical sequence of the radiographic stages. Instead, the early signs were the formation of rounded areas of rarefaction in the epiphysis and/or the metaphysis with considerable surrounding osteoporosis, early narrowing of the articular space, and final coxa breva morphology with signs of osteoarthritis. No condensation or fragmentation stages were observed. The pathologic study showed complete atrophy of the synovial villi with hyaline cartilage and bone necrosis. The patients described herein presented an intraarticular hip process, initially with signs and symptoms similar to LCPD but with an ultimate clinical evolution that differs from ordinary LCPD.

Concordance between hip ultrasonography and hip arthrography in the assessment of developmental dysplasia of the hip.

Controversy exists regarding the possibility of predicting hip reducibility in the congenitally dislocated hip, with arthrography still regarded as the gold standard in this situation. This study aims at assessing the degree of concordance between ultrasonography and arthrography in the detection of anatomic elements obstructing hip reduction. Forty-nine hips were studied both by ultrasonography and arthrography. Three anatomic sources of obstruction to reduction were assessed in each hip: ligamentum teres hypertrophy, inverted labrum, and the presence of soft tissue in the acetabulum. For each variable, congruence between ultrasound and arthrography was measured by kappa analysis. Values > 0.40 expressed sufficient concordance, and they were detected with regard to inverted labrum and the presence of soft tissue in the acetabulum. The results of this study suggest that ultrasonography may be considered a reliable technique for the prediction of the main causes of obstruction in the congenitally dislocated hip, such as inverted labrum and soft tissue in the acetabulum.

Unusual finding after contrast injection of a solitary bone cyst. A case report.

Injection of radiopaque contrast into a solitary bone cyst (SBC) prior to methylprednisolone acetate (MPA) injection has been previously reported. We report an unusual finding during the injection of radiopaque contrast in the treatment of one case of SBC of the femur: a bicameral appearance of the cyst was observed; no filling of the proximal cavity occurred and immediate perfusion of the femoral vein with contrast was noted. In cases of SBC such as this one, percutaneous autologous marrow or corticosteroid injection may fail to be effective. Furthermore there exists the potential risk of fat embolus secondary to bone marrow injection. Based on these findings in the case reported, we suggest that contrast injection should be performed prior to bone marrow or corticosteroid injection in order to evaluate both the venous drainage of the cyst and its degree of loculation.

Patellar height ratios in children: an interobserver study of three methods.

Several indices for patellar height measurement have been described to relate patellofemoral instability and maltracking. No known study has proved interobserver reliability of these indices when applied to growing knees. This study included comparisons of three of these indices: Caton-Deschamps, Blackburne-Peel, and Koshino. Three observers measured patellar height on 36 lateral radiographs of children's knees. The best interobserver agreement was achieved by the Caton-Deschamps method, a simple, reliable, and reproducible index that is not affected by skeletal maturation.

Chondrolysis of the hip after transfer of the greater trochanter.

Transfer of the greater trochanter is a surgical technique that is used for overgrowth of the greater trochanter arising from disturbance of the growth plate of the proximal femur. Few complications have been described, and to our knowledge, necrosis of the cartilage has not been reported. Herein we describe four cases of chondrolysis in three patients who underwent this surgical procedure. In our view, immobilization with plaster associated with the increased pressure produced by the descent of the gluteal attachment may have contributed to the development of chondrolysis.