Search

Congenital radioulnar synostosis (CRUS) is rare upper limb malformation in which proximal portions of the radius and ulna fuse with each other and restricts the rotation of the forearm. In cases with severe deformity, performing activities of daily living is difficult, and a surgical intervention is recommended. We present a retrospective study including patient operated for CRUS between January 2009 and December 2017 by derotation in synostosis site. Ten patients were operated. Five was unilateral and five bilateral (only one patient was operated for both sides. Mean age was 5 years. Preoperative assessment revealed limitation of the activities of daily life in all patients with an average pronation deformity of 62o. Type III of Cleary and Omer classification was the most frequent. The average correction of the forearm angle was 54o. Nine patients were satisfied and showed improvements in the ability to perform the activity of daily life. We report one case of complication (compartmental syndrome with nonunion). In summary, CRUS is a rare deformity, frequently bilateral and more commonly seen in male patients. Indications for surgery are pronation deformity of 60o or more, bilaterality and pronation of 20o to 60o with disability. It has been reported that complications are more common in osteotomy in synostosis site.

L'ostéome ostéoïde rachidien est une lésion rare. Nous rapportons un cas d'ostéome ostéoïde rachidien chez une fille, qui consultait pour une scoliose raide douleureuse partiellement calmée par la prise de salicylés. La tomodensitométrie (TDM) centrée sur la région dorsolombaire montrait une lésion typique d'ostéome ostéoïde. Un curetage biopsique de la tumeur a été realisé par voie postérieure. L'anatomo-pathologie confirmait le diagnostic d'ostéome ostéoïde. L'évolution était favorable au recul de 3 ans.

Objectives: We aim to describe the management of fingertip injuries treated by flaps in the paediatric surgery emergency ward and evaluate the long-term results., Patients and Methods: Through a 2-year prospective study, we analysed all fingertip injuries treated by flaps in the paediatric emergency ward. We collected patients' data and the clinical and imaging characteristics of the lesions. The type of flap was chosen on a case-by-case basis. We evaluated aesthetic and functional results., Results: Forty-two fingertip injuries required the use of flaps. The average age was 7 years, and boys were more affected. The smashed fingertip was the most common mechanism; pulp lesions and amputation were located mainly in zone I or II. We performed Atasoy flaps, palm flap, free skin grafts, McGregor flap and the cross finger flap. Our results were good to excellent in 66.67%., Conclusions: The best management of fingertip injuries in children remains prevention., Competing Interests: None

Background: Langerhans cell histiocytosis previously known as histiocytosis X is a rare disease of children and young adults with a very broad clinical spectrum. In children, its annual incidence is estimated between 0.2-0.5 per 100,000., Case Representation: An 8-year-old Moroccan girl with no known personal or family history presented to our institution with painful swelling of both forearms. An X-ray and magnetic resonance imaging were inconclusive. We then performed a biopsy curettage (of her left forearm). Microscopic analysis followed by immunohistochemical analysis disclosed a diagnosis of Langerhans cell histiocytosis. No chemotherapy was necessary. Clinical and radiological improvement was achieved after 6 months., Conclusion: The particularity of this observation is the bilaterality of the lesion on both forearms and it has not previously been reported. Langerhans cell histiocytosis should be included in the differential diagnosis of osteomyelitis and Ewing's sarcoma.

Galeazzi fracture describes a fracture of the radial diaphysis in association with distal radioulnar dislocation (most often dorsal). We conducted a retrospective study in the Department of Pediatric Orthopedic Trauma at the Mother-Child Hospital CHU Hassan II in Fez (Morocco). The study involved five male children. Four children underwent orthopedic treatment while one child underwent surgical reduction. Mean follow-up was 24 months (8-30).

Tibial spine fractures are rare lesions which usually occur in adolescent athletes aged between 8 and 17 years. The treatment of displaced fractures requires surgical reduction and fixation in order to achieve adequate tension in the anterior cruciate ligament and to reduce the risk of laxity. This study aimed to report our experience in the treatment of tibial spine fractures in children. We conducted a retrospective study of 11 children with tibial spine fractures over a period of 7 years (2009-2016). The average age of our patients was 13 years and a half. A fall during sport was the main cause of tibial spine fractures in 73% of patients. Meyers and Mac Keever classification, modified by Zaricznyj, was used and allowed to classify the lesions into 4 types. Two cases were orthopedically treated while 9 cases underwent surgical reduction through arthrotomy and fixation using osteosuture. After an average follow-up of 3 years our results were good in 91% of cases, according to Lysholm functional score. Only one case with orthopedically treated type II fracture still had a mean Lysholm functional score. Surgical treatment for types II-IV fractures (with the exception of type I) should be used in order to ensure a good anterior cruciate ligament tonus. The prognosis of tibial spine fractures is good. Surgical reduction should be used when tibial spine fractures are associated with displacement in order to better verify anterior cruciate ligament integrity and to ensure a good knee stability.

Congenital pseudarthrosis of the clavicle (CPC) is a very rare pathology of which over 200 cases have been reported. Usually discovered during the first months of life, CPC is characterised by a definitive bone defect in the middle third of the clavicle. Generally asymptomatic, the pseudarthrosis of the clavicle can cause aesthetic issues and functional symptoms indicating a surgical repair. Different reconstruction techniques have been reported with various complications. We present a 14-year-old boy diagnosed with CPC and concerned about the cosmetic aspect of a swelling of his right clavicle. We performed a two-stage surgical repair using the induced membrane technique described by Masquelet. A complete bone union has been obtained, and patient is satisfied with the cosmetic appearance. In our opinion, the Masquelet technique is a safe and reproducible procedure to treat CPC in high-risk older patients with long gap allowing a rapid and lasting bone union., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Lipoblastoma is a relatively rare benign tumor. It derives from embryonic white fat cells. It almost exclusively affects children less than 3 years of age. We report a case of lipoblastoma of the left thigh detected in an older child (11 years) and a literature review. Diagnosis was based on histology while surgical treatment was based on total resection of the mass. The postoperative course was simple with a follow-up period of 9 months.

Type III Monteggia lesion is very rare, usually occurring within a context of violent trauma and often going unnoticed. We report the case of a 11-year old boy presenting to the Emergency Department with blunt trauma of the upper limb. The radiological evaluation showed olecranon fracture and radial epiphyseal separation associated with dislocation of the radial head. The patient underwent orthopedic treatment with good outcome after a mean follow-up of 3 months.

This study aims to describe the complications of elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm diaphyseal fractures in the child. Between January 2009 and December 2013, 87 children with both-bone forearm diaphyseal fractures were treated by elastic stable intramedullary nailing with Métaizeau nails. 76 boys and 11 girls, with an average age of 12 years, were enrolled in the study. Nailing was promptly performed in 50 cases and after secondary displacement during plaster-cast treatment in the other cases. Both bones were nailed in all cases. All patients underwent systematic plaster immobilization for a period of about one month. On average, nails were removed after about 6 months. Functional outcomes were studied over a mean follow-up period of 10 months. Complications were marked by 14 superficial infections (14 cases), osteitis associated with material (2 cases), refracture (3 cases), pseudarthrosis (3 cases), delayed fracture consolidation (2 cases) and proximal radioulnar synostosis (1 case). Although intramedullary nailing ideally is an osteosynthesis technique suitable for the treatment of fractures in children, it is more invasive than orthopaedic treatment.Indications for treatment should remain within well-established limits.

Circumscribed myositis ossificans (CMO) is a heterotopic ossification of the striated muscles. Its location at the level of the elbow is rare. It occurs in young patients, often following trauma as it can also develop without experiencing any traumatic event. Its predominant location is at the level of the larger muscles limbs root (gluteus, deltoid) or of the areas which are most exposed to direct shocks (the quadriceps in more than 40% of post-traumatic cases). Our study aims to highlight the aspects of a circumscribed myositis ossificans in conventional radiology and tomodensitometry to avoid potential diagnostic confusion with a malignant bone tumor., Competing Interests: Conflits d’intérêts Les auteurs ne déclarent aucun conflit d'intérêts.

Hydatid disease is a parasitic disease caused by the development in humans of the larval form of a tapeworm, namely a very small tænia called Echinococcus Granulosus. This anthropozoonosis is characterized by the presence of different types of anatomo-radiologic variants associated with various topographic and evolutionary aspects of the cysts. Bone hydatid disease is a rare condition, it accounts for only 0.9-2.5% of all locations. We report the case of a 9 year old child, who was admitted with febrile lameness and with a mass in the right iliac fossa, revealing a hydatid cyst at the level of the hip bone. Lesion assessment objectified a hydatid cyst of the hip bone with extension into adjacent soft tissues. An infected cyst was detected during surgery, hence the performance of a surgical excision of the cyst with drainage. Hydatic osteopathy is infiltrating, diffuse, slow and gradual, causing delays in diagnosis and compromising the quality of care., Competing Interests: Conflits d’intérêts Les auteurs ne déclarent aucun conflit d'intérêts.

Osteoarticular tuberculosis represents 1.7-2% of all tuberculosis (TB). The localization in the foot is rare and accounts for less than 10% of osteoarticular TB. The following report describes the case of a 7-year-old boy who presented with a gradually increasing inflammatory swelling over the lateral aspect of the right ankle. An X-ray of his right ankle showed an osteolytic image at the calcaneus. Diagnosis was confirmed by the presence of a tuberculoid granuloma with caseous necrosis on bone biopsy., (Copyright © 2014 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.)

The aneurysmal bone cyst is a pseudotumoral lesion that can take several aspects. This is a rare lesion representing 1% of bone tumors. It appears usually during the first 30 years of life. The pathogenesis is that of a process of "dysplasia/hyperplasia", favored by a circulatory deficiency and hemorrhage within the lesion and the phenomena of osteoclasis. The objective of this work is to illustrate with analysis, the specific forms and atypical aneurysmal bone cyst which often pose a diagnostic challenge requiring radiological investigation with histological confirmation. We report eight pediatric cases of aneurysmal cysts collected over a period of 3 years, 3 boys and 5 girls. All patients had standard radiographs. MRI was performed in three patients. The diagnosis was confirmed histologically. The atypia has been in the seat: fibula (1 case), metaphyseal (2 cases), diaphyseal (4 cases) and metatarsal (1 case). Aneurysmal bone cyst is a rare benign tumor with predilection to the metaphysis of long bones. Atypical forms even fewer are dominated by the atypical seat.

Human cystic echinococcosis, a zoonotic infection caused by Echinococcus granulosus, remains a largely extended public health problem in endemic regions. Hydatid cyst disease can occur in all viscera and soft tissues, although the liver and the lungs are the most commonly involved organs. Primary hydatid disease of the soft tissue is extremely rare, even in endemic areas, and accounts for 0.5-5.4 % of all hydatid disease cases, with very little data on the incidence of subcutaneous echinococcosis. The paper will be focused on analyzing this extremely rare disease. A 14-year-old girl came to our Department of pediatric Surgery with a painless, round, palpable mass in the subcutaneous tissue of the distal anteromedial side of the left thigh. Based on clinical and laboratory findings and imaging techniques, we suspected a hydatid cyst. She was treated successfully with complete cyst excision. The macroscopic appearance suggested a hydatid cyst. Histopathologic examination of the specimen revealed a hydatid cyst. No other organ involvement has been detected. Hydatid disease should be considered in the differential diagnosis of all cystic masses in all anatomic locations, especially in regions where the disease is endemic.

An aneurysmal bone cyst is rare in the patella. We report the case of a 9 year-old boy who presented with chronic pain and no previous trauma history. Treatment included curettage of the cyst and filling with a iliac bone graft. Ten months after surgery, the knee was mobile and painless and graft incorporation was good.

Volvulus of the caecum is a rare entity in childhood. We report on a case of caecal volvulus in a 6-year-old child, admitted with clinical symptoms of gut occlusion and shock. Outcome was favourable after surgical treatment. The epidemiological, clinical, radiological aspects and therapy are discussed in light of data of the literature.