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Introduction: The Atasoy flap is considered simple and reliable for covering distal digital defects in adults. Various studies in children have shown more contrasting results, particularly in terms of aesthetics and function. The aim of this study is to evaluate the long-term results of this flap specifically in children, in order to determine its limitations and indications., Hypothesis: The Atasoy flap is reliable and reproducible for coverage of distal digital substance loss up to zone 2 in children., Materials and Methods: Fifty-six children who benefited from an Atasoy flap operated on between January 2017 and January 2020 were included. Lesion area, operative technique, postoperative complications (infection, healing difficulties, necrosis), and ultimately nail appearance, cold intolerance or finger pain, finger eviction, extension defect, and final parental satisfaction were analyzed., Results: Forty-nine children were evaluated with a mean follow-up of 18 months (min = 3 months, max = 38 months, SD = 11.3 months). Eighteen children had a hook nail, resulting in 6 of them having their finger excluded. The majority of hook nails were found in zone III and in proximal zone II lesions (12 cases). Eighty-nine percent of children with distal suture fixation to the nail bed (8 children) had this complication. Cold intolerance was present in 9 children. There were no cases of extension failure or early post-operative complications. Final parent satisfaction was 9.1/10 (min = 5, max = 10, SD = 1.3)., Conclusion: The Atasoy flap in children appears reliable for covering loss of distal digital substance. The main complication is the occurrence of hook nails. Compliance with its indications (transverse substance loss not exceeding the proximal third of zone II) and a precise surgical technique (distal needle fixation without suturing to the nail bed, deep flap lift, non-closure of the donor site) help limit this risk., Level of Evidence: IV; retrospective study., (Copyright © 2024. Published by Elsevier Masson SAS.)

Introduction: The study of tumor extension in knee osteosarcomas is an essential diagnostic tool that helps determine the surgical approach. Magnetic resonance imaging (MRI) is the key component in this decision-making process, but the interpretation of signals can be difficult because peritumoral edema and inflammation may be mistaken for the tumor., Hypothesis: There is a discrepancy between MRI and histopathology findings in the assessment of joint involvement in pediatric osteosarcomas of the knee., Materials and Methods: All children who underwent an extra-articular resection for an osteosarcoma of the knee between 2007 and 2016 were included. This was indicated if there was at least one of the following MRI signs: presence of articular effusion, involvement of either the peripheral capsuloligamentous structures, central pivot or patella, or lesion abutting the articular cartilage., Results: Nine patients were operated on with a mean age of 13±2.7 years. There were at least two of the described signs, mainly the involvement of the peripheral capsuloligamentous structures (78%) and central pivot (56%). The histopathology confirmed that the resection margins were healthy in all cases, but the indication for extra-articular resection could have been avoided in 89% of them., Discussion: MRI is the current gold standard for assessing tumor extension, but the signs contraindicating the transarticular approach remain poorly defined. Joint effusion detected by clinical or radiological assessment is the least reliable one. It seems that the tumor's proximity to the articular cartilage, as long as there is no loss of continuity in the latter, or its extension into the central pivot should no longer be considered as relevant signs. The involvement of the peripheral capsuloligamentous structure remains an indication criterion because oncologic resection is otherwise impossible, and the risk of false-negative histopathologic diagnoses is higher. Other MRI sequences could better assess the true extension into the joint space., Level of Evidence: IV, retrospective study., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Introduction: Lockdown involved strict confinement of children at home, radically affecting their way of life, with increased risk of domestic accidents and the temptation to step outside of the legal framework. The aim of the present study was to analyze the impact of lockdown on pediatric emergency turnover in a university reference center situated in a high-risk "red zone" and to describe specific management measures., Hypothesis: Pediatric emergency turnover and the corresponding lesion mechanisms were altered by lockdown., Materials and Methods: All children undergoing emergency orthopedic surgery during lockdown (group 1) were prospectively included, then retrospectively compared to series operated on during the same period in the previous 3 years. Demographic and surgical data were analyzed, and the pathway changes that were developed were detailed., Results: Turnover fell by a mean 33.5%, without change in indications. The most frequent lesions were wounds (54.3%), followed by fractures (34.3%) and infections (11.4%); the upper limbs were involved in 84.6% of cases. Lockdown had been infringed in 9.7% of traumas, mainly concerning fractures (55%). Postoperative management was modulated during lockdown in 34% of cases, without complications at the time of writing., Discussion: Pediatric emergency turnover decreased, without major change in lesion mechanisms. Accidents associated with lockdown infringement were rare (<10%), demonstrating good adaptation on the part of these children living in an urban area. The adapted care pathway was beneficial, and will no doubt continue to optimize management in future, with accelerated circuits and use of telemedicine., Level of Evidence: IV, comparative retro-prospective study., (Copyright © 2021. Published by Elsevier Masson SAS.)

Background: Primary and revision surgery for complete complex congenital syndactyly (CCCS) of the hand carries a risk of complications such as web maceration, which can result in flap or graft loss and alter the final appearance. No consensus emerges from the scant published data on postoperative care after CCCS surgery. The objective of this study was to assess the role for temporary external fixation in stabilising the commissure and facilitating surgical wound care., Hypothesis: Using external fixation after CCCS release facilitates postoperative wound care and decreases the complication rate., Material and Methods: Eighteen patients requiring primary CCCS surgery or revision CCCS surgery due to adhesions or web creep were included in a single-centre retrospective study. After release, an external fixator made of Kirschner pins was installed to temporarily immobilise the inter-phalangeal joints. The dressing was changed every 3 days for 3 weeks, and the external fixator was then removed. The parents and nurses completed questionnaires that used 0-10 point scales to assess ease and duration of dressing changes and perceptions and apprehensions experienced by parents and nurses, as well as pain by patients, during dressing changes., Results: No patient experienced maceration or failure of a graft or flap. Pin site discharge was noted in 1 patient and resolved fully after pin removal. Pain intensity was estimated at 4.2/10 during the first dressing change and 1.3/10 during the last dressing change. In the parents, apprehension was 9.6/10 and 5.1/10 during the first and last dressing changes, and stress was 8.1/10 and 4.1/10, respectively. Dressing change difficulty was rated 1.1/10 at the first and 0.9/10 at the last dressing change. Dressing change duration decreased from 13 to 10minutes., Conclusion: These encouraging results support temporary commissure stabilisation by an external fixator to decrease postoperative complication rates and facilitate dressing changes after CCCS release., Level of Evidence: IV, retrospective observational study., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)