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Adolescent idiopathic scoliosis (AIS) is the most common spinal disorder in children. A severity index was recently proposed to identify the stable from the progressive scoliosis at the first standardized biplanar radiographic exam. The aim of this work was to extend the validation of the severity index and to determine if curve location influences its predictive capabilities. AIS patients with Cobb angle between 10° and 25°, Risser 0–2, and no previous treatment were included. They underwent standing biplanar radiography and 3D reconstruction of the spine and pelvis, which allowed to calculate their severity index. Patients were grouped by curve location (thoracic, thoracolumbar, lumbar). Patients were followed up until skeletal maturity (Risser ≥ 3) or brace prescription. Their outcome was compared to the prediction made by the severity index. In total, 205 AIS patients were included; 82% of them (155/189, 95% confidence interval [74–90%]) were correctly classified by the index, while 16 patients were unclassified. Positive predictive ratio was 78% and negative predictive ratio was 86%. Specificity (78%) was not significantly affected by curve location, while patients with thoracic and lumbar curves showed higher sensitivity (≥ 89%) than those with thoracolumbar curves (74%). In this multicentric cohort of 205 patients, the severity index was used to predict the risk of progression from mild to moderate scoliosis, with similar results of typical major curve types. This index represents a novel tool to aid the clinician and the patient in the modulation of the follow-up and, for progressive patients, their decision for brace treatment. • The severity index of adolescent idiopathic scoliosis has the potential to detect patients with progressive scoliosis as early as the first exam. • Out of 205 patients, 82% were correctly classified as either stable or progressive by the severity index. • The location of the main curve had small effect on the predictive capability of the index.

International audience; Spine deformity during adolescent idiopathic scoliosis can induce a rib-cage deformity. This bone deformity can have direct consequences on the chest-wall muscles, including intercostal muscles, leading to respiratory impairments in individuals with severe cases. The aim of this study was to determine whether shear-wave elastography can be used to measure intercostal-muscle shear-wave speed (SWS) in healthy children and those with adolescent idiopathic scoliosis (AIS). Nineteen healthy participants and 16 with AIS took part. SWS measurements were taken by three operators, twice each. Average SWS was 2.3 ± 0.4 m/s, and inter-operator reproducibility was 0.2 m/s. SWS was significantly higher during apnea than in normal breathing (p < 0.01) in both groups. No significant difference was observed between groups in apnea or in normal breathing. Characterization of the intercostal muscles by ultrasound elastography is therefore feasible and reliable for children and adolescents with and without scoliosis.

Resume Introduction Dans la population pediatrique, les fractures du col du radius representent 1 % de l’ensemble des fractures et leurs consequences peuvent etre severes. Compte tenu de la popularite croissante de la pratique de l’equitation et des traumatismes a haute energie que celle-ci peut engendrer, nous avons cherche a evaluer le pronostic des fractures du col radial survenues en pratique equestre. Hypothese Les fractures, survenues a la suite d’un traumatisme equestre, sont plus severes et plus frequemment associees a d’autre lesions osteoarticulaires du membre superieur ipsilateral, grevant leur pronostic. Materiel et methode Nous avons realise une etude retrospective, multicentrique, comparative, dans une serie continue de 39 patients. Les criteres d’inclusion etaient l’existence d’une fracture du col du radius chez des enfants de moins de quinze ans. Les criteres de jugement principaux etaient l’existence de lesions associees au moment du traumatisme et l’arc de mobilite en pronosupination et en flexion/extension du coude au dernier suivi. Resultats Comparativement a celles causees par d’autres mecanismes, les fractures du col radial survenues a la suite d’un accident d’equitation etaient plus frequemment associees a d’autres lesions osteoarticulaires (p = 0,0002), necessitaient plus de chirurgie a ciel ouvert (p = 0,0409) et plus de reeducation postoperatoire (p = 0,041). Cependant, il ne fut pas constate de difference significative de mobilite au dernier recul, dans tous les mouvements etudies (p > 0,05). Discussion Les fractures du col du radius liees a la pratique de l’equitation chez l’enfant semblent plus severes que celle causees par d’autres mecanismes. Des campagnes de sensibilisation dans les centres equestres ainsi que le developpement de protections specifiques devraient etre envisages afin de limiter leur survenue. Niveau de preuve Therapeutique III – etude comparative retrospective.

Defined as the union of two adjacent digits, syndactyly is one of the most common congenital deformities. The severity of the malformation depends on the fusion level, the tissues involved in the union, and whether it is isolated or syndromic. In order to improve the hand's appearance and function, surgery is recommended in the great majority of cases, ideally during early childhood (i.e., before entering school). Web space reconstruction is done using local flaps. Depending on the flap design, digital resurfacing can be done with or without skin grafts. While graftless techniques have shorter operating times and no morbidity associated with skin harvesting, their cosmetic outcomes seem to be worse than those of traditional grafting techniques, with more postoperative complications; furthermore, such techniques cannot be used in all cases, especially those with osteoarticular fusions. When the fingertip is involved, paronychial reconstruction is carried out with pulp flaps. The prognosis for these deformities directly depends on their severity, with excellent outcomes in cases of cutaneous fusion, and much less predictable ones when osteoarticular and/or tendinous tissues are involved.

Introduction: Achilles tendon is the most frequently ruptured tendon, but its optimal treatment is increasingly controversial. The mechanical properties of the healing tendon should be studied further. Shear waves elastography (SWE) measures the shear modulus, which is proven to be correlated to elastic modulus in animal tendons. The aim of our study was to study whether the shear moduli of human cadaveric Achilles tendon, given by SWE, were correlated with the apparent elastic moduli of those tendons given by tensile tests. Materials and methods: Fourteen cadaveric lower-limbs were studied. An elastographic study of the Achilles tendon (AT) was first done in clinical-like conditions. SWE was performed at three successive levels (0, 3 and 6 cm from tendon insertion) with elastographic probe oriented parallel to tendon fibers, blindly, for three standardized ankle positions (25° plantar flexion, neutral position, and maximal dorsal flexion). The mean shear moduli were collected through blind offline data-analysis. Then, AT with triceps were harvested. They were subjected to tensile tests. A continuous SWE of the Achilles tendon was performed simultaneously. The apparent elastic modulus was obtained from the experimental stress-strain curve, and correlation with shear modulus (given by SWE) was studied. Results: Average shear moduli of harvested AT, given by SWE made an instant before the tensile tests, were significantly correlated with shear moduli of the same AT made at the same level, previously in clinical-like condition (p < 0.05), only in neutral position. There was a statistical correlation (p < 0.005) and a correlation coefficient R² equal to 0.95 ± 0.05, between shear moduli (SWE) and apparent elastic moduli (tensile tests), for 11 tendons (3 tendons were inoperable due to technical error), before a constant disruption in the correlation curves. Discussion: We demonstrated a significant correlation between SWE of Achilles tendon performed in clinicallike conditions (in neutral position) and SWE performed in harvested tendon. We also found a correlation between SWE performed on harvested tendon and apparent elastic moduli obtained with tensile tests (for 11 specimens). As a consequence, we can suppose that SWE of AT in clinical-like conditions is related to tensile tests. To our knowledge, the ability of SWE to reliably assess biomechanical properties of a tendon or muscle was, so far, only demonstrated in animal models. Conclusion: SWE can provide biomechanical information of the human AT non-invasively.

International audience; AbstractObjectives To determine lumbar intervertebral disc properties with shear wave elastography in adolescent idiopathic scoliotic(AIS) patients before and after surgery, and compare them with asymptomatic controls.Methods Twenty-five severe AIS patients with an indication for fusion surgery (15 ± 1.5 years old, the Cobb angle rangingbetween 40 and 93°) and fifty-nine asymptomatic adolescents (13 ± 2 years old) were included prospectively. Shear wave speed(SWS) was measured in the annulus fibrosus of L3-L4, L4-L5, and L5-S1 discs of each subject. In AIS patients, measurementstook place before surgery, and 3 months (N = 13) or 1 year after (N = 12).Results No difference was observed between disc levels in any group. When pooling disc levels, SWS was significantly higher inpreop AIS patients (4.0 ± 0.5 m/s) than in asymptomatic subjects (3.1 ± 0.5 m/s, p < 0.0001). SWS decreased 3 months postop(3.5 ± 0.3 m/s), and it decreased further towards normal values 1 year after (3.3 ± 0.4 m/s). SWS in preop AIS patients tended todecrease with the Cobb angle (Spearman’s rho = − 0.4, p = 0.05).Conclusion Shear wave elastography measurements showed that discs in AIS patients were altered relative to asymptomaticones, and this alteration tended to normalize 1 year post fusion surgery. Further studies should aim at determining if bracing ofmild scoliosis has an effect on disc properties.Key Points• Shear wave elastography shows alteration of annulus fibrosus in adolescent idiopathic scoliosis.• Disc elastography tends to normalize 1 year after surgery.

Purpose The origin of the deformity due to adolescent idiopathic scoliosis (AIS) is not known, but mechanical instability of the spine could be involved in its progression. Spine slenderness (the ratio of vertebral height to transversal size) could facilitate this instability, thus playing a role in scoliosis progression. The purpose of this work was to investigate slenderness and wedging of vertebrae and intervertebral discs in AIS patients, relative to their curve topology and to the morphology of control subjects. Methods A total of 321 AIS patients (272 girls, 14 ± 2 years old, median Risser sign 3, Cobb angle 35° ± 18°) and 83 controls were retrospectively included (56 girls, median Risser 2, 14 ± 3 years). Standing biplanar radiography and 3D reconstruction of the spine were performed. Geometrical features were computed: spinal length, vertebral and disc sizes, slenderness ratio, frontal and sagittal wedging angles. Measurement reproducibility was evaluated. Results AIS girls before 11 years of age had slightly longer spines than controls (p = 0.04, Mann–Whitney test). AIS verte- brae were significantly more slender than controls at almost all levels, almost independently of topology. Frontal wedging of apical vertebrae was higher in AIS, as expected, but also lower junctional discs showed higher wedging than controls. Conclusion AIS patients showed more slender spines than the asymptomatic population. Analysis of wedging suggests that lower junctional discs and apex vertebra could be locations of mechanical instability. Numerical simulation and longitudinal clinical follow-up of patients could clarify the impact of wedging, slenderness and growth on the biomechanics of scoliosis progression. The authors are grateful to the BiomecAM chair programme on subject-specific musculoskeletal modelling (with the support of ParisTech and Yves Cotrel Foundations, Société Générale, Covea and Proteor) and to the DHU MAMUTH for funding.

Objective: The aim of this study was to assess the feasibility and the effectiveness of a fetoscopic myelomeningocele (MMC) repair with a running single suture using a 2-port access in the sheep model. Methods: Eighteen fetuses underwent surgical creation of a MMC defect at day 75. Fetuses were then randomized into 3 groups. Four fetuses remained untreated (control group). In the other 14 fetuses, a prenatal repair was performed at day 90: 7 fetuses had an open repair (oMMC), and 7 fetuses had a fetoscopic repair (fMMC) using a single-layer running suture through a 2-port access. Lambs were sacrificed at term, and histological examinations were performed. Results: Hindbrain herniation was observed in all live lambs in the control group. A complete closure of the defect was achieved in all the lambs of the fMMC group. A complete healing of the defect and no hindbrain herniation were observed in all live lambs of the oMMC and fMMC groups. The durations of surgeries were not statistically different between the oMMC and the fMMC groups (60 vs. 53 min, p = 0.40), as was the risk of fetal loss (fMMC: 1/7, oMMC: 3/7, p = 0.56). Discussion: Fetoscopic repair of MMC can be performed using a single-layer running suture through a 2-port access and may be promising to reduce the risk of premature rupture of membranes.

International audience; OBJECTIVES:Fractures of the lateral humeral condyle are common in children. Nondisplaced fractures are managed with cast immobilization and frequent radiographic follow-up. Possibility of assessing the displacement and stability of such fractures may be helpful in planning the initial treatment and survey. Magnetic resonance imaging (MRI) could be a useful tool in determining the stability of lateral condyle in children. We propose to investigate the use of MRI in such indication.METHODS:Fourteen patients presenting with a minimally displaced or nondisplaced fracture were initially treated with a long arm cast and had an MRI within 5 days of injury.RESULTS:The MRI showed that 10 patients had an incomplete fracture without disruption of the cartilage hinge and 4 patients had a complete fracture with extension of the fracture through the cartilaginous epiphysis into the elbow joint. Three patients with such complete fracture had no evidence of lateral condyle displacement on MRI, and 1 patient had a displacement of the lateral condyle. The patients with incomplete fractures had a conservative treatment. The patient with a complete and displaced fracture had an open reduction and internal fixation. The 3 patients with a complete fracture and no evidence of lateral condyle displacement on MRI had a control MRI, 6 to 10 days after cast application, to detect a secondary displacement of the fracture.CONCLUSIONS:Because it seems difficult in minimally displaced or nondisplaced fractures to detect further displacement with radiographs, MRI was found mandatory to improve complete fracture visualization during the first phase of conservative treatment. In incomplete fractures, initial MRI investigation was consistent with a stable fracture and avoided further early radiographs or clinical survey. In such cases, we recommend a conservative treatment with late radiographs after long arm cast removal. We propose MRI routine use in the early evaluation of minimally displaced or nondisplaced lateral condyle fractures in children.

International audience; Pedicle screw fixation allows purchase of all three spinal columns without encroaching into the spinal canal improving fracture fixation, as well as deformity correction. Fortunately, neurologic injury associated with pedicle screw malposition is rare.Case presentationA 19-year-old boy was surgically treated for severe right thoracic scoliosis associated with a Chiari Type 1 malformation and a C6 to T7 syringomyelia. Six months after the initial surgery, the patient was referred to our institution after three weeks of gait disturbances and repeated falls. Imaging showed the gross misplacement of the left T5 pedicle screw, which crossed the center of the vertebral canal. The initial surgery used a freehand technique of pedicle screw insertion, with anteroposterior and lateral postoperative X-ray control. During the surgery, no SEP modifications were noted during pedicle screw placement. However, after insertion of the second rod and scoliosis correction by posterior translation technique, SEP responses decreased considerably. Revision surgery was performed to remove the misplaced screw. During the first three months after screw removal, repeated clinical examinations showed progressive recovery of the neurological deficits. Gait and bladder functions were normal six months after screw removal, and clinical signs of spasticity disappeared. SEP explorations performed at final follow-up showed similar responses to those performed before the initial surgery for scoliosis correctionDiscussion and evaluationNeurologic injury associated with pedicle screw malposition is rare. In early or delayed neurological status worsening, intraoperative or postoperative imaging must be done to detect pedicle screw misplacement. In the current case, thanks to cobalt-chromium and titanium use, MRI and CT scan allowed good visualization of the spinal canal and spinal cord. Experimental studies have shown that neurophysiological monitoring of the spinal cord does not detect moderate compression. In that way, neurophysiological monitoring is an all-or-nothing technique which can misdiagnose early stage of spinal cord injuries. Major penetration of the spinal canal by pedicle screw may conduct to hardware removal.ConclusionsIn early or delayed neurological status worsening, intraoperative or postoperative imaging must be done to detect pedicle screw misplacement. In the current case, thanks to cobalt-chromium and titanium use, MRI and CT scan allowed good visualization of the spinal canal and spinal cord. Major penetration of the spinal canal by pedicle screw may conduct to hardware removal.

International audience; Adolescent idiopathic scoliosis (AIS) is a threedimensional deformity of the spine, often progressing rapidly during the growth spurt. Severe scoliosis can lead to significant degradation of quality of life and functional impairment; the aim of early orthotic treatment is to slow down curvature progression until skeletal maturity. Efficacy of bracing has often been questioned (Negrini et al., 2010; Weinstein et al., 2013), and often relies on the orthotist’s experience since objective methods to design and predict brace action are still in development (Cobetto et al., 2014). A clinically-relevant method for the evaluation of brace simulation in AIS was recently presented (Vergari et al., 2015) and applied to preliminarily validate a finite element model (FEM) of the trunk.The aim of this work was to improve the simulation of brace action on scoliotic trunks and to validate the model on a larger cohort