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Resume Introduction La chondrolyse est une complication rare mais redoutable du traitement de l’epiphysiolyse femorale superieure (EFS). Le but de ce travail etait d’identifier les facteurs de risque de survenue de la chondrolyse. Patients et methodes Les dossiers des enfants operes entre 1989 et 2009 a l’hopital d’enfants de Rabat pour EFS ont ete etudies retrospectivement. Les elements radio cliniques, therapeutiques et evolutifs du glissement ont ete notes. Le recul minimum etait de 24 mois. Le risque de developpement de la chondrolyse a ete etudie en fonction de nombreux parametres en utilisant le modele statistique de regression logistique binaire. Resultats Cent quarante enfants dont l’âge moyen etait de 13 ans et 4 mois, avaient ete operes pour une EFS. La chondrolyse avait ete notee chez 16 enfants (11,4 %) et observee de maniere significative chez des enfants obeses (25 %, p p : 0,01). Discussion Dans notre serie, la penetration intra-articulaire du materiel d’osteosynthese n’etait pas un facteur de risque de chondrolyse. L’association d’une obesite et d’un delai diagnostique au-dela de 60 jours augmentaient le risque de survenue d’une chondrolyse. La prevention de celle-ci est possible surtout grâce a un diagnostic precoce de l’EFS.

Le kyste osseux essentiel metatarsien est tres rare. Nous avons traite un garcon de 11 ans presentant une lesion lytique du deuxieme metatarsien. Les elements radiocliniques, la ponction et l’histologie ont permis d’evoquer le diagnostic. L’enfant fut traite avec succes par injection intralesionnelle repetee de methylprednisolone. Les particularites diagnostiques et therapeutiques de cette localisation exceptionnelle sont discutees a l’aide d’une revue de la litterature.

Resume Introduction La fracture de Tillaux chez l’enfant est une fracture articulaire de type III de Salter et Harris, emportant la partie antero-laterale de l’epiphyse tibiale inferieure. Le but de cette etude est d’analyser le traitement chirurgical et le devenir clinique et radiologique a long terme de cette lesion de la cheville. Patients et methodes Nous avons revu de maniere retrospective les dossiers de 11 patients traites chirurgicalement pour une fracture de Tillaux. Resultats L’âge moyen etait de 13,5 ans. Les patients ont tous ete traites par reduction a ciel ouvert et osteosynthese par vis. Les resultats ont ete bons chez neuf patients avec un recul moyen de 28 mois. Conclusion Le pronostic de la fracture de Tillaux chez l’enfant est bon dans notre serie comme cela a ete rapporte dans la litterature.

SummaryIntroductionSerious complications can occur in the management of displaced femoral neck fractures in children. Are there ways to anticipate this risk and better define eventual contributing factors?Patients and methodsTwenty-one children (14 boys and 7 girls) were treated between 1999 and 2006 for displaced femoral neck fractures. Nine type II, 10 type III and two type IV fractures were observed according to the Delbet's classification. Anatomical open reduction was performed in 13 patients and closed reduction in eight patients. At a mean follow-up of 26.4 months, the outcome was assessed according to the Ratliff criteria. Postoperative complications were analysed according to the age, fracture type, time-to-surgery and open or closed reduction.ResultsThe mean age was 12.1 years. The final outcome was defined as good in 14 patients (66.66%), fair in one patient (4.76%) and poor in six patients (28.58%). Complications occurred in seven patients (33.33%), avascular necrosis (AVN) of the femoral head being the most frequent one (28.58%). In all cases, necrosis was observed in children older than 12 years (p0.05). Only one materialised after closed reduction (p

Resume Introduction Les auteurs evaluent les complications du traitement des fractures deplacees du col femoral chez l’enfant et leurs principaux facteurs de risque. Patients et methodes Vingt et un enfants (14 garcons et sept filles) ont ete traites entre 1999 et 2006 pour une fracture deplacee du col femoral. Selon la classification de Delbet, neuf fractures etaient de type II, dix etaient de type III et deux de type IV. Le traitement a ete realise a ciel ouvert chez 13 patients et a ciel ferme chez huit patients. Apres un recul moyen de 26,4 mois, le resultat final a ete apprecie selon les criteres de Ratliff. Les complications post-operatoires ont ete analysees selon l’âge, le type de fracture, le delai d’intervention et le caractere ferme ou ouvert de la reduction. Resultats L’âge moyen etait de 12,1 ans. Le resultat final etait bon chez 14 patients (66,66 %), moyen chez un patient (4,76 %) et mauvais chez six malades (28,58 %). Les differentes complications ont ete notees chez sept patients (33,33 %). La necrose de la tete femorale a ete la complication la plus frequente (28,58 %). Toutes les necroses ont ete notees chez des enfants de plus de 12 ans (p 0,05). Cinq necroses (87,33 %) ont succede a une reduction a ciel ouvert. Une seule a complique une reduction a ciel ferme (p Discussion De nombreux facteurs contribuent au developpement des complications apres fracture du col femoral chez l’enfant. Notre etude prouve que l’âge, la chirurgie tardive et le caractere ouvert de la reduction sont des facteurs significatifs. Etude retrospective Niveau de preuve : IV.

Resume Le traitement des fractures deplacees du col radial chez l’enfant est assez difficile lorsque la bascule depasse 30°. Nous rapportons notre experience de reduction a ciel ferme de ces fractures, decrite par Metaizeau. Patients et methodes Les auteurs ont utilise la classification de Metaizeau chez cinq patients (trois garcons et deux filles) entre 2000 et 2007, et ont decrit la technique operatoire. Resultats L’âge moyen etait de dix ans (8–12 ans). Quatre fractures etaient classees de stade 3 et une seule de stade 4. Apres un recul moyen de 16,2 mois, le resultat fonctionnel a ete bon chez quatre patients et moyen chez un seul. Discussion La technique de Metaizeau peut reduire la plupart des fractures deplacees du col radial chez l’enfant. Nos resultats rejoignent ceux de la litterature. Nous recommandons cette technique relativement simple et associee a des resultats encourageants.

La maladie de Trevor est un trouble tres rare de la croissance du tissu osseux epiphysaire de l’enfant. La maladie se localise principalement au niveau du membre inferieur et touche une ou plusieurs epiphyses. Nous presentons deux nouveaux cas de dysplasie epiphysaire hemimelique (DEH) du genou et de la cheville chez des garcons âges respectivement de 8 et 14 ans. Les deux patients ont ete traites chirurgicalement. A travers ces deux cas et une revue de la litterature, nous discutons les difficultes diagnostiques et les modalites therapeutiques devant cette affection rarissime

Resume Les fractures sus- et intercondyliennes de l’humerus sont rares chez l’enfant. Le traitement est un sujet soumis a controverses et le risque de complications et de sequelles reste reel. L’interet de cette etude est de discuter les modalites diagnostiques et therapeutiques de ce type de lesion. Nous rapportons neuf cas de fractures sus- et intercondyliennes. Il s’agissait de quatre fractures en T et cinq fractures diaphysoepiphysaires survenues constamment suite a un traumatisme de haute energie. Cinq fractures etaient comminutives. L’âge moyen etait de 11,5 ans (extremes : 6–15 ans). Tous les patients ont ete traites chirurgicalement avec une osteosynthese par broches de Kirchner dans six cas, vissage avec brochage dans un cas et par plaque vissee dans deux cas. Les lesions nerveuses associees ont ete notees chez trois patients. Les resultats ont ete evalues selon Flynn avec un recul moyen de 30 mois. Les resultats etaient bons ou excellents chez six patients, moyens chez deux patients et mauvais chez un seul patient. Les deviations axiales et le deficit de mobilite surtout en extension ont ete les principales complications apres traitement. Les fractures sus- et intercondyliennes de l’humerus doivent etre differenciees des fractures supracondyliennes usuelles. Nous recommandons comme la plupart des auteurs un abord chirurgical a ciel ouvert et une osteosynthese adaptee a l’âge de l’enfant. Les complications sont relativement frequentes (deviations axiales et raideurs du coude) et sont dues a l’importance du traumatisme initial et parfois a l’imperfection du traitement d’autant plus que la fracture est complexe.

Resume Le traitement chirurgical des fractures du tibia est rarement indique chez l’enfant. Le but de ce travail est de determiner l’interet de l’embrochage centromedullaire elastique stable (ECMES) et ses complications dans le traitement des fractures de la diaphyse tibiale. Nous avons revu de facon retrospective 12 fractures du tibia chez 11 enfants âges entre sept et 14 ans, tous traites par ECMES entre 2000 et 2007 dans notre institution. Dix fractures etaient fermees et deux ouvertes. Le delai moyen de consolidation a ete de 11 semaines. Quatre patients (36 %) ont presente cinq complications dont une majeure (cal vicieux superieur a 10°) et quatre mineures : une infection superficielle, un cal vicieux inferieur a 10°, un retard de consolidation et une inegalite de longueur du membre a 12 mm. Nous estimons que l’ECMES est le traitement de choix des fractures de la diaphyse du tibia chez l’enfant lorsque l’indication chirurgicale est presente.

Resume Les auteurs rapportent le cas exceptionnel d’une tuberculose musculaire isolee interessant les muscles de la loge anterieure de la cuisse gauche chez une patiente âgee de huit ans. Le diagnostic a repose essentiellement sur l’histologie et l’enfant a ete mise sous traitement antituberculeux pendant 12 mois. L’evolution a ete bonne sans aucune sequelle fonctionnelle ou generale. A travers ce cas et une revue de la litterature, les auteurs revoient les modalites d’essaimage qui expliquent la survenue de cette localisation sporadique.

Resume Introduction. – Les auteurs rapportent une experience de 21 ans, a travers une serie de 106 enfants atteints de localisations osteoarticulaires de la tuberculose (le mal de Pott est exclu de cette etude). Patients et resultats. – Il s’agit de 55 garcons et 51 filles, d’âge moyen de 8 ans. La hanche et le genou representent 63 % des localisations tuberculeuses dans cette serie, 32 localisations viscerales associees ont ete recensees. Le delai moyen de consultation est de 10 mois ce qui explique un taux de sequelles aux alentours de 22 %, a type d’ankylose articulaire et d’inegalite de longueur des membres. Conclusion. – La tuberculose osteo-articulaire (TOA), represente donc une source d’handicap fonctionnel qui doit etre reconnue et traitee precocement surtout en milieu pediatrique ou un traitement bien conduit peut amener une disparition complete des lesions (14 cas de notre serie).

The authors reviewed a series of 36 progressive lengthenings of the lower member by callotasis (22 femur and 14 tibia) in 33 patients with an inequality of length of the lower member (ILLM). Median age was 13 years; etiology was dominated by infection, congenital defects, and trauma. The lengthening procedure was completed in 26 children; it was necessary to abandon seven lengthening attempts. Median lengthening achieved was 45 (range 30–100) mm. Complications were frequent, with 66 during the different stages (184%). Most were benign (40); seven were determined to be grave, requiring abandonment of the lengthening; while 17 were judged as serious and required an unforeseen supplementary general anesthesia. Upon review of these results, it appears that progressive lengthening is an attractive technique with considerable benefits. However, management is not simple and complications are frequent, requiring close collaboration between the nursing team, the child, and the child's parents. For patient and family, the psychological benefits of this procedure are considerable.

Glomus tumor is a rare benign tumor. Diagnosis is often delayed because of the absence of specific symptoms and confirmation can only be made by histological study. Treatment is always surgical. We report a clinical case of glomus tumor of the thumb pulp in a 6-year-old girl, and we discuss clinical, radiological and histological aspects of this tumor.

Resume L'arthrite septique est definie par une inflammation d'origine bacterienne de la synoviale articulaire, c'est une affection frequente chez le nourrisson et l'enfant. Les auteurs rapportent leur experience dans cette pathologie a travers une serie de 554 enfants colliges sur une periode de dix ans, a l'hopital d'Enfants de Rabat au Maroc. Il s'agit de 369 garcons et 185 filles, âges de sept jours a 15 ans avec une moyenne de six ans et demi ; une porte d'entree a ete retrouvee chez 107 d'entre eux. La localisation la plus frequente est le genou qui represente avec la hanche plus de 79 % des localisations. La douleur et l'impotence fonctionnelle ont ete les principaux signes revelateurs de la maladie. Un traitement antibiotique et une immobilisation du membre chez tous les malades ont conduit a une guerison complete chez 543 enfants, chez 66 une arthrotomie a ete indispensable. L'evolution vers l'arthrite chronique ou recidivante a ete observee dans 11 cas. L'arthrite septique chez l'enfant est une urgence diagnostique et therapeutique qui repond favorablement a un traitement bien conduit, tout retard peut entrainer des sequelles graves.

Neglected trauma of the elbow in the child is not rare, especially in countries where traditional treatment is still practiced. The authors report a study of 57 neglected elbow trauma in children and the complication of stiffness managed in the pediatric orthopedics department in Rabat, Morocco, between 1996 and 2002. Average patient age was 11 years, location predominated at the right elbow, and the average delay of consultation was 7 months after the trauma. Clinical examination found 36% of stiffness in bending, 29% in extension, and 35% mixed. Of these, 43% were judged very serious, 20% serious, and 37% moderate. Radiological finding showed 35 neglected elbow dislocations (61%), ten supracondylar humeral fractures (17%), and 12 posterior lesions difficult to determine. Abstention from surgery was recommended for 12 patients; 45 were operated on. The end result was 53% with minimal and moderate stiffness. The authors analyzed clinical and therapeutic aspects of all lesions, insisting on abstention from surgery according to the variable and unforeseen character of surgery results.

Authors report an exceptional localization of tuberculosis in children. Tuberculosis became a pathology of high incidence in the last 20 years, even in industrialized countries. Localization in the talus is rarely reported (less than 100 pediatric cases worldwide). The authors report on observation of isolated bone tuberculosis of talus in a 20-month old boy. Isolated infection of the talus by Koch's bacillus (KB) is extremely rare; only a few rare cases in the child and at the adult have been reported in the literature. In our observation, a delay of 6 week was necessary to make diagnosis of bone tuberculosis. Reasons for this delay, and some diagnostic and therapeutic aspects of this disease, are discussed here. Tuberculosis of the talus must be considered before any other inflammatory ankle disease.

Glomus tumor is a rare benign tumor. Diagnosis is often delayed because of the absence of specific symptoms and confirmation can only be made by histological study. Treatment is always surgical. We report a clinical case of glomus tumor of the thumb pulp in a 6-year-old girl, and we discuss clinical, radiological and histological aspects of this tumor.

Resume Le torticolis musculaire congenital (TMC) est une affection rare due a une retraction du muscle sternocleidomastoidien et qui est diagnostiquee le plus souvent chez le nourrisson et l'enfant. Les auteurs rapportent une etude retrospective de 33 enfants, pris en charge pour un TMC sur les dix dernieres annees. L'âge des malades varie de 40 jours a 15 ans; 27 malades ont beneficie d'un traitement chirurgical alors que chez six malades un traitement a base de reeducation a ete suffisant. Le resultat global est tres satisfaisant, trois enfants ont ete repris pour des recidives apres la chirurgie. A travers cette serie les auteurs analysent et discutent, les differents aspects pathologiques et therapeutiques de cette affection.

Osteonecrosis is a serious complication of the treatment of slipped capital femoral epiphysis. The purpose of this study was to identify factors predisposing to the development of this complication. We reviewed retrospectively 127 patients (150 hips) treated for slipped capital femoral epiphysis in our institution between 1980 and 2004. Clinical and radiological data were analyzed before and after treatment, and at consecutive follow-up examination. Osteonecrosis was defined in the basis of radiological criteria. The risk of development of osteonecrosis was correlated with multiple clinical and radiographic parameters.12 hips in 11 patients (8%) had development of osteonecrosis. Ten of them had an unstable slip. From 130 stable hips, regardless of grade, two had development of osteonecrosis. In patients who had presented with an unstable hip, the risk of osteonecrosis increased with the grade of the slip. Osteonecrosis was more likely to develop in hips that had been treated with multiple screws than in those who had been treated with a single screw. In conclusion, partial or complete reduction of an unstable slipped capital femoral epiphysis increases the risk of development of osteonecrosis. Pinning in situ without reduction with a single screw is the method of choice of the treatment of a slipped capital femoral epiphysis.

Serious complications can occur in the management of displaced femoral neck fractures in children. Are there ways to anticipate this risk and better define eventual contributing factors?Twenty-one children (14 boys and 7 girls) were treated between 1999 and 2006 for displaced femoral neck fractures. Nine type II, 10 type III and two type IV fractures were observed according to the Delbet's classification. Anatomical open reduction was performed in 13 patients and closed reduction in eight patients. At a mean follow-up of 26.4 months, the outcome was assessed according to the Ratliff criteria. Postoperative complications were analysed according to the age, fracture type, time-to-surgery and open or closed reduction.The mean age was 12.1 years. The final outcome was defined as good in 14 patients(66.66%), fair in one patient (4.76%) and poor in six patients (28.58%). Complications occurred in seven patients (33.33%), avascular necrosis (AVN) of the femoral head being the most frequent one (28.58%). In all cases, necrosis was observed in children older than 12 years (p0.05) and when time-to-surgery exceeded 48 h (p0.05). Necrosis occurred in 44.44% of type II fractures and in 20% of type III fractures (p0.05). Only one materialised after closed reduction (p0.05).Various factors may contribute to the development of complications in children with femoral neck fractures. Our study supports the hypothesis that older age, late surgery and open reduction are definite predictors of avascular necrosis occurrence.Retrospective study, level IV.

Supra- and intercondylar elbow fractures are rare in children. The treatment of these fractures is controversial. The purpose of this report is to discuss diagnosis and treatment of this unusual injury. Our study looked at nine patients between six and 15 years old (average age: 11.5). In four patients, the fracture was T-condylar and in five patients, the fracture was epiphyseal-diaphyseal. Communition was noted in five cases. All fractures are secondary to high-energy trauma. All patients were treated by open reduction and internal fixation. Three patients had associated nervous lesions. Patients were reviewed at an average of 30 months follow-up and the results evaluated according to the criteria of Flynn. The results were good or excellent in six patients, fair in two patients and poor in one. Cubitus varus and limitation of elbow motion were the main complication. Supra- and intercondylar elbow fractures should be differentiated from the more common supracondylar humerus fractures. We recommended open reduction with internal fixation. Complications are due to the severity of the initial trauma and sometimes to defective treatment especially in the case of complex fracture.

Dermatofibrosarcoma show an extremely aggressive tendency to invade surrounding tissue. It was first described in 1924. It usually occurs in young men. This type of tumor is exceptional in childhood. The authors report a case of congenital dermatofibrosarcoma diagnosed in a child.A two-year old female patient presented with a tumor of the vertex scalp since her birth. Biopsy revealed a dermatofibrosarcoma. The tumor was removed surgically with 3cm margins. The primary reconstruction was performed using a double temporoparietal flap (H). There was no recurrence at five years of follow-up.Congenital dermatofibrosarcoma is very rare. Only twenty cases have been reported.

We report an exceptional case of tuberculosis in an 8-year-old girl. The focus of infection was situated in the anterior muscle compartment of the left thigh. Diagnosis was established on the basis of histological findings. A 12-month antituberculosis regimen was given. Outcome was good with no general or functional sequelae. Based on this case and data reported in the literature, we discuss the routes of dissemination of the Koch bacillus explaining this unusual sporadic localization.

Introduction . – We retrospectively reviewed 106 pediatric cases of peripheral osteoarticular tuberculosis (OAT) seen over a 21-year period in Morocco. Patients with vertebral tuberculosis were excluded from the study. Patients and results . – The 55 boys and 51 girls had a mean age of 8 years. The hip and knee together contributed 63% of the osteoarticular foci. Organ involvement was documented in 32 cases. Mean time from symptom onset to evaluation was 10 months. This resulted in diagnostic delay, which contributed to the 22% rate of residual abnormalities consisting of joint ankylosis and leg length inequality. Conclusion . – OAT is a source of functional disability that should be recognized and treated early, particularly in children, given that appropriate management can lead to a full recovery (14 patients in our series).

Centro-somatic tuberculous vertebral osteitis is defined as tuberculous infection of the vertebral body with preserved integrity of the adjacent intervertabral disk. Other types of vertebral tuberculosis include Pott's spondylodiscitis and exceptional lesions of the posterior arch. We report a case of centro-somatic tuberculous vertebral osteitis in a 14-year-old boy who developed staged lesions of the L2 to S1 bodies, associated with a posterior epidural collection but without any deterioration of the intervertebral disk on plain x-rays and computed tomography. This atypical aspect of the lesions required a surgical biopsy which yielded a yellow-whitish fibro-oleagenous, friable product more suggestive of neoplasm than infection, but histology rectified the diagnosis, showing typical caseo-follicular tuberculosis. A 6-month anti-tuberculosis regimen was rapidly followed by symptom improvement. We emphasize the importance of modern imaging techniques for the diagnosis of vertebral lesions and for guided biopsy or drainage.

Introduction La calcinose est une complication connue de la dermatomyosite, habituellement tard dans l’evolution de la maladie. Materiel et methode enfant de 10 ans, qui presente une dermatomyosite juvenile compliquee d’une calcinose universelle invalidante malgre un traitement adequat de sa dermatomyosite Resultats Dans notre observation,. L’atteinte musculaire regressait sous corticoides, mais ce traitement n’a pas empeche l’apparition tardive d’une calcinose severe, tres extensive et invalidant dont la pathogenie n’est toujours pas completement identifiee. Apres un an de traitement, l’evolution a ete defavorable avec des indurations cutanees et souscutanees ayant beneficiees d’exereses chirurgicales. De nouvelles masses se sont constituees en post operatoire aux sites operes et a distance, avec chirurgie iterative. Un traitement par biphosphonates a ete entrepris chez la patiente a la lumiere des donnees de la litterature Une amelioration spectaculaire des signes cliniquesa debute deux mois apres l’introduction du pamidronate. A la fin du traitement, toutes les calcifications visibles ont disparu. Conclusion les bisphosphonates peuvent entrainer une disparition complete des depots calciques dans la calcinose compliquant la dermatomyosite juvenile, y compris dans les formes severes.

Introduction L’histiocytose langerhansienne est une affection enigmatique. Son large spectre clinique est caracteristique, des formes agressives se presentant comme une hemopathie au granulome eosinophile osseux solitaire. L’histiocytose langerhansienne est une proliferation clonale d’histiocytes proches des cellules presentatrices d’antigenes de la peau, les cellules de Langerhans Observation M.C âgee de 6 ans avait consulte pour douleur abdominales recidivantes, associees a une alteration progressive de l’etat generale. Le bilan comprenait biologie et imagerie avait oriente le diagnostic vers une lyse osseuse massive, visceromegalie et trouble hematopoietiques, faisant discuter une etiologie maligne. L’analyse clinique et radiologique orientees, avaient fait suspecter une histiocytose langerhansienne systemique. La biopsie etait la cle du diagnostic Conclusion c’est une maladie tres rare dont l’etiopathogenie se rapproche de la maladie de Paget juvenile, son diagnostic repose sur une etude semiologique clinique et radiologique exhaustive, a distinguer d’un point de vue nosologique et histologique de la dysplasie fibreuse panostotique dont elle partage les difficultes therapeutiques.

Synovial hemangioma is a rare benign vascular malformation. We report a case of chronic swelling in the left knee of a 7-year-old boy. An intra-articular tumor of synovial origin could was detected after a magnetic resonance imaging scan. Surgical excision of the mass associated with partial synovectomy was carried out. A histologic examination confirmed the diagnosis of synovial hemangioma. After 36 months of follow-up, there was no sign of recurrence. We review the literature and discuss the current case, along with noting the diagnostic methods and the therapeutic aspects of this rare and benign lesion.

False aneurysm or pseudo aneurysm of an artery in close proximity to fractured bone is a well-recognized entity, and fewer various cases, involving different sites have been reported in the literature. We report new case of a Moroccan's patient who had 10-year-old boy presented with a right non displaced both-bone forearm fracture; the patient was placed in a long arm splint. After, six weeks, the cast was removed. And a pulsatile mass on the volar-radial aspect of the forearm was decouvred. The mass was non-tender and the patient had radial and ulnar pulse. An Ultrasound and brachial angiography showed a false aneurysm of distal radial and the radial artery was ligated. In conclusion, pseudoaneurysm of the radial artery can be associated with any bone fracture despite non displacing fractures related to the elasticity of the bone in this age and orthopedic surgeons should be aware of this potential complication.