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The purpose of the study is to describe and analyse long-term results of the modified Grice procedure with specially prepared pre-shaped autograft from iliac crest. 54 patients (101 feet) who underwent modified Grice procedure, were retrospectively analysed. Before and after the surgery, talocalcaneal (TC) angle and calcaneal inclination (CI) angle were measured and compared with post-operative values. Furthermore, AOFAS score was assess pre-and postoperatively as well as the subjective evaluation of the patients or their parents. Detailed analysis was performed separately for patients with different forms of CP. Postoperatively, TC angle and subjective assessment decreased, and CI angle and AOFAS score increased significantly compared to pre-operative values. The significant difference was observed among different CP groups in all observed parameters. Severe complications were not observed. The modified Grice procedure with specially prepared pre-shaped autograft showed promising long-term results.

Objective: The aim of this study was to verify whether the Pirani and Dimeglio clinical scoring systems could predict results of Ponseti therapy., Methods: Forty-seven patients with clubfoot deformities treated with the Ponseti method were enrolled in the study. Clinical evaluation with the Pirani and Dimeglio scoring systems was performed before the treatment and after the second cast fixation. The number of fixations, necessity for achillotomy, and recurrence of the deformity were determined as parameters of the therapy results. The patients were divided into three groups according to the severity of their deformities, and the groups were compared with one another., Results: Clubfoot correction required an average of 6.8 casts. Five patients developed a recurrence. Comparing the therapy outcomes among the groups, we found statistically significant differences in the Pirani classification after the second fixation (the number of casts [p =.003] and necessity to perform an achillotomy [p =.014]) and in the Dimeglio scores before therapy (number of casts [p =.034]) and after the second fixation (number of relapses [p =.032])., Conclusion: Although clinical scoring systems showed some dependence on the parameters of treatment outcomes, their predictive function can be used in only a limited way. Level of evidence II, Prospective comparative study. , Competing Interests: All authors declare no potential conflict of interest related to this article.

Objective: The aim of this study was to assess the role of sonographic evaluation of Talar dysplasia in predicting the outcome of standard Ponseti method in the treatment of clubfoot deformity., Methods: A total 23 children (15 boys and 8 girls; mean age: 18.2 ± 5.4 days (8-32)) who underwent Ponseti treatment were included in the study. Before the treatment, maximal talus length of affected and non-affected feet were measured by US and relative talar dysplasia ratio (RTDR) was calculated. The patients were categorized 2 groups according to RTDR: group A - mild and group B - severe deformity. Pirani score was used for clinical evaluation. The groups were compared in terms of number of the applied casts, need of percutaneous tenotomy of Achilles tendon (AchT) and frequency of deformity recurrence., Results: Pirani score was 4.46 for population (4.33 for group A; 4.54 for group B). Number of casts significantly differed between groups (p < 0.001) and positive correlation was found (r = 0.851, p < 0.001). AchT was performed in 56% cases for group A and in 86% cases for group B; no statistically significant difference was obtained (p = 0.162). Recurrence occurred in 2 patients belonging to group B without significant difference compared to group A (p = 0.502)., Conclusion: Talar dysplasia assessment appeared as a promising prognostic factor for predicting the outcome of the Ponseti technique in treatment of clubfoot deformity., Level of Evidence: Level IV, diagnostic study., (Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.)

INTRODUCTION The clubfoot ranks among the most frequent paediatric structural deformities of the lower extremity. Currently, the Ponseti method is considered the gold standard for the treatment. To evaluate the degree and severity of the deformity, clinical classification systems have been developed, commonly used in clinical practice. This study aims to verify whether the Pirani and Dimeglio clinical scoring systems can be used to predict the results of treatment by the Ponseti method. MATERIAL AND METHODS The study included 31 patients. The patients had been referred from the neonatal departments to the Department of Paediatric Surgery, Orthopaedics and Traumatology in Brno with the diagnosed clubfoot deformity, where they were treated by an erudite orthopaedist experienced in this field according to the Ponseti treatment standards. The Pirani and Dimeglio clinical scoring of the deformity were performed always before the commencement of the therapy and after the second plaster cast fixation. The number of plaster cast fixations, the necessity to carry out achillotomy and the relapse rate were set as the parameters of treatment results. In the first stage of statistical analysis, the respective clinical systems were correlated with the treatment results, in the second part of the study the patients were based on the clinical evaluation divided into 3 groups depending on the severity of the deformity, and these groups were subsequently compared. RESULTS 22 patients from the group (71%) underwent percutaneous achillotomy and in 3 patients (9.7%) a relapse occurred. To correct deformities 7.1 corrective casts were used on average. The correlation between the number of plaster cast fixations and classification systems was significant in all the cases, with the strongest dependency shown by the correlation with the Pirani score after the second corrective cast (r = 0.594, p < 0.001). Positive correlation was found also between the necessity to perform achillotomy and both the classification systems. In this case the strongest correlation was established in the case of the Pirani clinical scoring after the second plaster cast fixation (r = 0.488, p = 0.003). Conversely, significant correlation was not established between the relapse rate and the used classification systems, not even in a single case (p ≥ 0.05). In the second stage of the statistical analysis, in the case of the Pirani scoring before the therapy no difference was found between the individual groups with diverse severity of clubfoot deformity during the evaluation of the aforementioned parameters of treatment results. In the Pirani classification after the second plaster cast fixation, a statistically significant difference was established in the number of plaster cast fixations (p = 0.003) and the necessity to perform achillotomy (p = 0.012). When the Dimeglio scoring was applied before the therapy, a statistically significant difference between the groups was found in the number of plaster cast fixations (p = 0.031) and after the second plaster cast fixation in the relapse rate (p = 0.035). DISCUSSION Although the clinical scoring systems belong to key indicators of severity of the deformity and are commonly used in clinical practice, the current literature provides only an inconsistent picture of their application in predicting the course and the results of treatment. Concurrently, the authors opinions on this issue differ. The scoring in later stages of treatment shows a better predictive value than the scoring at the beginning of the treatment, which was confirmed also by the results of our study. CONCLUSIONS Even though the clinical scoring systems show a certain dependency on the parameters of the treatment results, in practice their predictive function can be used to a limited degree only. The complexity of the evaluation of the deformity itself and subsequently of the results of treatment requires also the use of other parameters than the clinical classifications only so that the prediction of the course and results of the treatment of clubfoot according to Ponseti shows a higher degree of reliability. Key words:clubfoot, Ponseti, Pirani classification, Dimeglio classification.

Purpose of the Study: The aim of the study was to evaluate the mid-term results in a group of selected patients undergoing corrective surgery for juvenile hallux valgus, using double osteotomy of the first metatarsal., Material and Methods: The group included eight patients, seven girls and one boy, with a more severe form of this deformity treated by double osteotomy of the first metatarsal between 2010 and 2013. The indication for corrective surgery was serious pain when walking; all patients had previously undergone conservative treatment with no effect. All patients had pre-operative clinical examination, the affected foot was X-rayed with the patient standing and radiographic assessments of the intermetatarsal and hallux valgus angles were made. The evaluation of treatment outcomes was based on the scoring system of the American Orthopaedic Foot and Ankle Society (AOFAS) and X-ray images of the foot. The average follow-up was 37 months., Results: Post-operatively, none of the patients reported pain while walking, only two of them experienced pain during sports activities. The average post-operative AOFAS score was 92 points. Both the intermetatarsal angle and the hallux valgus angle improved after surgery in all patients, with two reporting only mild hallux valgus deformity. One patient showed postoperative restriction of motion at the first metatarsophalangeal joint. This was the only complication recorded in association with the surgery., Discussion: Almost all authors dealing with the treatment of hallux valgus deformity primarily prefer conservative therapy. However, this treatment is usually not very effective in severe forms of the disorder. Surgical management is indicated in symptomatic patients or in those with severe juvenile hallux valgus deformity. In paediatric patients it is necessary to respect the presence of an epiphyseal growth plate in the first proximal metatarsal and therefore it is often preferred to use distal first metatarsal osteotomy. At our department, Mitchell's osteotomy for hallux valgus deformity is usually used. However, post-operative outcomes are not satisfactory in severe forms of juvenile hallux valgus in which a high proportion of recurrent deformities is probably related to the growth potential of a juvenile bone. In such cases we use the Peterson and Newman procedure of double first metatarsal osteotomy, which can correct all three components of the deformity while maintaining functional first metatarsal length. This is a great advantage of the method. Although its authors have not reported any post-operative complications, the occurrence of restricted motion in the first metatarsophalangeal joint has been described in the relevant literature. The problem was also recorded in one patient of our group., Conclusions: Deformities of the forefoot and big toe are frequent orthopaedic disorders in children and adolescents. The results of this study confirm that the double first metatarsal osteotomy is an effective method of surgical treatment for serious hallux valgus deformities in paediatric and adolescent patients.

Purpose of the Study: The aim of this paper is to present our first experience with and the results of treating angular deformities and length discrepancies of the lower limbs in children and adolescents using the Eight-plate system, and to compare our results with the literature data., Material and Methods: A total of 22 patients underwent surgery for the correction of angular deformities or length discrepancies of the lower limbs in 2014. Using Eight-plates, temporary medial hemiepiphysiodesis was carried out in 13 patients with the diagnosis of genu valgum (group 1). In nine patients (group 2) the Eight-plate was used to correct milder forms of leg length discrepancy by epiphysiodesis involving the distal femur only or also the proximal tibia. The Eight-plate system consists of a plate with two or more holes and two screws. Under X-ray image intensifier guidance, the plate was inserted above the physis of the long bone through a minimally invasive approach. Pre-operative long-standing radiographs of the lower extremities were measured. Post-operatively, radiographic assessments and clinical examinations were done at 3-month intervals to monitor the effects of therapy., Results: In group 1, the average pre-operative intermalleolar distance (IMD) measured on standing radiographs was 15.2 cm. The average lateral distal femoral angle (LDFA) of 82° before surgery increased to 90° and the average pre-operative medial proximal tibial angle (MPTA) of 95° decreased to 88° at the time of plate removal. In all group 1 patients the therapy was completed successfully at an average of 9.2 months. The mean values of changes recorded at 3-month intervals of followup were 2.1° (± 0.9°) for LDFA and 1.5° (± 0.6°) for MPTA. The therapy in group 2 (average leg length inequality, 2.1 cm) was finished and evaluated in seven patients; in two patients it remained to be completed. The average Eight-plate guided growth treatment was 12.7 months, and the average reduction in leg-length discrepancy recorded at 3-month intervals was 4.9 mm. There were no complications., Discussion: All our results so far obtained are in agreement with those of the authors pursuing this topic for a longer time. Compared to the currently used Blount's staples, the Eight-plate is a growth-plate sparring method which avoids damaging the growing physis and is thus suitable for use in children under 10 years of age. It is also associated with a fewer number of complications., Conclusions: Our first results, although based on a short follow-up, clearly show that the Eight-plate guided growth method has several advantages; it is a great contribution to surgery and brings new options particularly for the correction of angular deformities in patients under 10 years.

Purpose of the Study: The aim of the study was to evaluate the outcomes of treatment in patients operated on in childhood for discoid meniscus, and to compare the results with those published in the relevant international literature., Material and Methods: The group evaluated consisted of 15 patients, 10 girls and five boys, who underwent surgery for symptomatic discoid meniscus in the period from 2000 to 2010. The average age at the time of surgery was 9 years and 2 months. The diagnosis was based on the patient's history of complaints, physical examination, X-rays of the knee joint taken in two planes, and ultrasonographic and magnetic resonance imaging of the knee. Arthroscopic verification of the diagnosis was done in all patients. They all had fibular discoid meniscus classified as type 1 in six and type 2 in nine patients according to the Watanabe classification system. Type 3 (Wrisberg variant) discoid meniscus was not recorded in this group. In six (40%) patients, the discoid meniscus had a tear in it. The patients were followed up on average for 8 years and 4 months. In addition to subjective evaluation by patients, the treatment outcome was assessed using the Ikeuchi and Lysholm scoring systems., Results: Arthroscopic partial meniscectomy was performed in 10 patients. In five patients conversion to open surgery was necessary and partial or subtotal fibular meniscectomy was carried out by minimally invasive arthrotomy from the lateral approach. Total meniscectomy was not required in any of our patients. The average value for treatment evaluation by the patients was 2.25 on a 1-to-5 scale. The average Lysholm pre-operative score of 80.8 points increased to 95.4 points after surgery. The long-term results assessed by the Ikeuchi system were excellent in nine, good in four and satisfactory in two patients. None of the patients showed poor results and no intraoperative or post-operative complications were recorded., Discussion: Discoid meniscus is a painful condition affecting the knee, particularly when a tear is also present. Meniscal lesions are found intra-operatively in many symptomatic patients. The majority of international authors prefer arthroscopic management of discoid meniscus. The team of our department also support this procedure unanimously. Arthroscopy is used as the primary method with the aim of preserving the largest possible margin of the meniscus. Some literature data suggest that there are no statistically significant differences between an open and an arthroscopic procedure. Accordingly, in our patients no differences in the evaluation of treatment results were recorded. However, the advantages of minimally invasive arthroscopy for the management for discoid meniscus are beyond any doubt., Conclusions: The long-term results of discoid meniscus management reported in the international literature are very good. The results of long-term follow-up in our group give support to active surgical treatment. We take care to avoid total meniscectomy which often results in early development of secondary gonarthrosis.

Purpose of the Study: An intercondylar eminence fracture is injury more common in children and adolescents than in adults. Also if it is considered a benign lesion, a displaced medial spine fracture can result in cruciate ligament laxity. We report the evaluation of long-term results of conservative and arthroscopic stabilisation in children and adolescents with different types of intercondylar eminence fracture., Material and Methods: Flirty-eight patients with intercondylar eminence fractures, 31 boys and 17 girls, were included in our retrospective study. Of them, 33 were at the end of skeletal growth. According to the Meyers and McKeever classification, 11 fractures were type I, 20 were type II and 17 were type III. The first step in the treatment was an attempt at conservative reduction. If it failed, arthroscopic reduction with crossed K-wire fixation was used. At clinical follow-up, the patients were examined for pain, range of motion, level of activity, and the laxity tests were done., Results: Conservative treatment was used in all type I cases (100 %), in eight type II cases (40%) and three type III cases (18%). The remaining patients were treated by arthroscopic reduction with crossed K- wires (type I, 0%; type II, 60%; type III, 82%). Six patients (12.5%) had symptoms of persistent anterior instability and five of them (10.4%) were indicated for anterior ligament reconstruction at the end of skeletal growth. We did not see serious complications., Discussion: Most of the authors recommend that type I and type II fractures should be treated conservatively; type III is better treated by arthroscopic reduction. Some of type II and type III fractures are indicated for minimally invasive surgical treatment at once. At the present time at our department, type II and some type III fractures are indicated first for conservative reduction and, when this fails, arthroscopic reduction with K-wire fixation is used., Conclusions: The aim of our report was to report the results of our study and present our relatively conservative way of treatment as the method of choice for treating intercondylar eminence fractures in children and adolescents.

Purpose of the Study: In this retrospective study we analysed the major indications for knee arthroscopy and the diagnoses made using it in children and adolescents who had sustained knee joint injuries., Material and Methods: A total of 731 knee joint artroscopies were performed and retrospectively evaluated in patients under 19 years of age. The group included patients with knee joint injuries treated at our department in the 2000-2010 period. There were 413 boys (58%) and 300 girls (42%) with an average age of 14 years and 2 months. The clinical diagnosis was compared with the arthroscopic diagnosis., Results: The results of our comparative study were divided into three groups. The clinical diagnosis was fully confirmed in 62%, partially confirmed in 17% (combined injuries) and was wrong in 21% of the patients. In this group, the most frequent diagnosis made by arthroscopy was injury to the lateral meniscus. Arthroscopy revealed patellar dislocations in 18%, osteochondral and cartilage lesions in 16%, plica injuries in 15 %, medial meniscus injuries in 14%, anterior cruciate ligament lesions in 12% and lateral meniscus injury in 8% of the patients., Discussion: With the number of knee injuries in children and adolescents increasing every year, the role of arthroscopy in their diagnosis and treatment is becoming increasingly important. The results of our analysis showed gradual improvement in clinical outcomes and subjective evaluation of the arthroscopic technique in children and adolescents with the history of knee injury. Some authors report difficulties with the pre-operative diagnosis at this age; our results were notably better., Conclusion: Knee arthroscopy is a safe and effective method of a high diagnostic and therapeutic value and its use in children and adolescents should be recommended.

Purpose of the Study: To review the current methods of operative management of post-traumatic chronic radial head dislocation in chronic Monteggia lesions in children., Material and Methods: Post-traumatic chronic dislocation of the proximal radius usually occurs following missed or ineffectively treated Monteggia fractures. The radial head is usually dislocated anteriorly. We performed open reduction of the radial head, reconstruction of the annular ligament and corrective osteotomy of the ulna in eleven patients. Three of our patients underwent ulnar lengthening via gradual distraction using an Ilizarov external fixator. This procedure was used in nine boys and five girls who were treated for complications following Monteggia lesions between 2000 and 2009. The average age at the time of surgery was 8 years and 4 months, the average injury-to-surgery interval was 19 months, and a prerequisite for surgery was a normal concave articular surface of the proximal radius. The patients were followed up for an average of 28 months and, at final follow-up, all were fully active and had no pain or instability., Results: The complications included: non-union of the ulnar osteotomy site in two patients, residual radiocapitellar subluxation in two patients, and one patient had revision surgery. Nine patients showed a full range of motion, two had a loss of extension, and three had a mean loss of pronation of 20 degrees and a mean loss of supination of 20 degrees., Discussion: The Monteggia lesion is a rare fracture in childhood, but its sequelae can be serious. So far a unified therapeutic approach has not been proposed. Most authors prefer reconstruction surgery. Our results are in full agreement with the published data., Conclusions: The operative treatment of consequences after Monteggia fractures in children has a relatively high rate of complications and unpredictable results. Indications for reconstruction involve a normal articular surface of the radial head and a normal alignment of the radius and ulna. Key words: Monteggia fracture, consequences, reconstruction surgery, childhood.

Purpose of the Study: Owing to advances in operative techniques and biotechnology, bone replacement biocompatible materials have recently come into focus for orthopaedic and trauma surgeons. Bone lytic lesions, such as tumorous bone defects, diseases simulating cancer, chronic inflammatory lesions or skeletal injuries, often require stabilisation of the skeleton and treatment of the bone affected. Juvenile bone cysts are benign lytic lesions posing a threat to bone compactness in childhood. They are benign, fluid containing bone cavities, lined with a membrane consisting of thin vascularised connective tissue with scattered osteoclast-like cells. These cysts are usually diagnosed between; five and twenty years of age outside this age range their occurrence is rare., Material: The group comprised the patients treated for juvenile bone cysts at the Department of Paediatric Surgery, Orthopaedics and Traumatology between 2001 and 2007. In the 2001-2003 period, 24 patients were treated with Depo-Medrol. Between January 2005 and December 2007, 31 patients with the same diagnosis were treated by minimally invasive application of chronOs Inject., Methods: The aim of the study was to compare these two methods of juvenile cyst therapy, i.e., the most widely used method of repetitive Depo-Medrol applications against the novel method based on filling the cyst with chronOs Inject, a synthetic biocompatible resorbable material. An alternative hypothesis assumed that the new method would result in fewer necessary operations in patients with juvenile cyst and better treatment outcomes, as evaluated by Neer's criteria for bone cyst therapy., Results: A total of 20 surgical interventions were performed in 18 patients treated by chronOs Inject and 100% cyst healing without necessity of additional surgery was achieved. Of the 24 patients treated with Depo-Medrol, 12 patients (50%) showed cyst healing wit no further surgery required. A total of 69 applications were needed., Discussion: An impetus to introduce the novel method of juvenile cyst treatment stemmed from the unsatisfactory results of the previous treatment with repetitive Depo-Medrol applications requiring additional open surgery and spongioplasty to fill the cyst. For filling cysts and other benign bone defects jeopardizing bone stability, such as deep metaphyseal fibrous defect, non-ossifying fibroma, enchondroma or fibrous dysplastic lesion, synthetic tricalcium phosphate in the form of chronOs granules was used, but without the possibility of minimally invasive percutaneous application. As soon s the resorbable chronOs Inject became available, the minimally invasive method of filling cysts with this material was adopted., Conclusions: The results showed that, in the patients treated by the chronOs Inject method, the outcomes achieved were significantly better than those in the patients treated with Depo-Medrol. The difference was in the number of operations needed, which were significantly fewer in the chronOs Inject method, as well as in the overall treatment outcome, with significantly more frequent excellent results in the chronOs Inject method.

Purpose of the Study: Treatment of leg length inequality via lengthening of the shorter extremity is an infrequent orthopedic procedure due to the requirement of special distraction devices and possible serious complications. Essential qualitative changes in operative technique development are associated with the name of G. A. Ilizarov, who paved the way for the autoregenerate gradual distraction method in the 1950s., Material and Methods: In the years 1990 through 2007 a total of 67 patients underwent femur lengthening via gradual distraction using various types of external fixators at the Department of Pediatric Surgery, Orthopedics, and Traumatology, Faculty Hospital in Brno. The quality of bone healing was monitored and a number of parameters followed and statistically evaluated using regularly scheduled X-ray examinations., Results: In 13 cases we had to remove the external fixator following the distraction phase, perform an osteosynthesis via a splint and fill the distraction gap via spongioplasty. The bone healing was satisfactory in the remaining 54 patients and the lengthened bone required no other fixation method. The analysis showed statistically significant deceleration in bone healing following distraction in female patients over 12 years of age, and in boys over 14 years of age. Lack of periosteal callus five weeks after surgery always signified serious problems in further healing. Severe complications were recorded in 11 cases during the distraction phase, and in 12 cases after the removal of the distraction apparatus., Discussion: Our results fully correspond with the data and experience of others cited authors. In addition our study showed deceleration in bone healing in girls over 12 years and in boys over 14 years of age and serious problem in healing when is lack of periostal callus five weeks after surgery., Conclusions: The aim of this report was to present the results of our study of distraction gap bone healing using the gradual lengthening approach. Key words: leg lengthening, gradual distraction, external fixation, leg discrepancy, complication.

The Aim of the Study: The aim of our study was to assess treatment results of angular deformities in distal radius by a system of the locking compression plates (LCP) at our clinic., Methods: Our source data was collected prospectively from the records of patients where the locking compression plate was used for angulation correction of distal forearm between 2006 and 2007. The patients were divided by sex, the age range was defined and two groups were formed based on the initial diagnosis: the group of posttraumatic deformities (2 patients; 29 %) and the group of no traumatic deformities (3 patients with congenital shortening of ulna, valgus deformity and overgrowth of radius and 2 patients with exostoses multiplices with shortening of ulna and overgrowth of radius with ulnar angulation). The following parameters were set: radial articular angle and carpal slip prior to and after angulation correction, the healing period, the range of movement of the surrounding joints and occurrence of complications., Results: We recorded only one case of delayed healing which was subsequently sustained by autospongioplastics and adjusted to normal. In the rest of the cases deformity correction occurred and the defined parameters were then corrected to normal. We observed no postoperative complications or permanent consequences., Conclusions: A two-year follow-up period monitoring treatment and therapeutic results of deformities in the forearm bones at our clinic, confirmed a minimal incidence of complications and a high percentage of successfully treated cases.

Introduction: The vertical talus is a rare congenital deformity of the foot. It is an isolated idiopathic deformity in about half of all cases. In the others, it is associated with abnormalities such as arthrogryposis, myelodysplasia, DDH., Material and Methods: The surgical correction may be carried out at 10 to 12 months of age by literature, but our cohort of patients involved older children too. We use one stage procedure sec Crawford with some additional procedures such as opening dorsal osteotomy, subtalar Grice procedure and muscle transfers., Results and Conclusion: Our procedures show excellent and good results (89.5% resp. 88.8%) in the treatment of this congenital deformity of the foot. We recommend this one stage procedure in the treatment of older patients too.

Aim: Traumas to the proximal tibial epiphyseal growth plate account for less than 2% of all physeal injuries, therefore, it may cause diagnostic or therapeutic difficulties. The authors studied a group of patients treated in the Clinic of pediatric surgery, orthopedics and traumatology of the Brno Faculty Hospital (FN Brno) during past 11 years, in order to assess its treatment outcomes and complication rates., Methodology: Based on the Salter-Harris (SH) classification, the studied patients with proximal tibia epiphyseolyses were assigned to groups using the following criteria: type of epiphyseolysis and treatment approach, and the authors identified associated complications in individual patients. The follow up assessment of the treatment course and results were performed for each of the groups. The studied parametres included: fixation duration, duration of subsequent rehabilitation care, knee joint mobility and complication rates (angulation, limb shortening, skeletal porosis and eventual reoperation)., Results: The studied complications were recorded in 2 subjects in the undislocated epiphyseolysis group treated conservatively, and a single complication was recorded in the traumatic fragment dislocation group. Out of the total of 19 patients, complications were recorded in 3 subjects (16%) and the remaining 16 patients (84%) had no complications or posttraumatic effects recorded., Conclusion: The study results correspond to the literature data. Therefore, minimum complication rates and high treatment success rates using standard treatment procedures were demonstrated.

Background: Treatment of leg length inequality via lengthening of the shorter extremity is an infrequent orthopedic procedure due to the requirement of special distraction devices and possible serious complications. Essential qualitative changes in operative technique development are associated with the name of G. A. Ilizarov, who paved the way for the autoregenerate gradual distraction method in the 1950s., Material and Methods: In the years 1990 through 2006 a total of 57 patients underwent femur lengthening via gradual distraction using various types of external fixators at the Department of Pediatric Surgery, Orthopedics, and Traumatology, Faculty Hospital in Brno. The quality of bone healing was monitored and a number of parameters followed and statistically evaluated using regularly scheduled X-ray examinations., Results: In 11 cases we had to remove the external fixator following the distraction phase, perform an osteosynthesis via a splint and fill the distraction gap via spongioplasty. The bone healing was satisfactory in the remaining 46 patients and the lengthened bone required no other fixation method. The analysis showed statistically significant deceleration in bone healing following distraction in female patients over 12 years of age, and in boys over 14 years of age. Lack of periosteal callus five weeks after surgery always signified serious problems in further healing. Severe complications were recorded in 11 cases during the distraction phase, and in 9 cases after the removal of the distraction apparatus., Conclusions: The aim of this report was to present the results of our study of distraction gap bone healing using the gradual lengthening approach.

Several last reports showed a very good utility of US visualisation in Legg-Calvé-Perthes disease especially in the assessment of the lateral extrusion of the femoral head and the subchondral fracture. Prospective analysis of 43 patients with 53 affected hip joints in this study showed that the hip joint effusion and synovitis have to be differentiated. Effusion occured only in the early stages of the disease. Sensitivity of US detection of the femoral head deformity was 87,3 % in this group compared with X-ray diagnosis. Assessment of the lateral extrusion seems to be rather inaccurate due to the high inter-observer error. A new approach which was suggested, posterior scanning of the flexed hip joint can be effective only if the femoral head is fragmented. US could replace classical X-ray, hopefully, only very partially. Key words: ultrasonography, Legg-Calvé-Perthes disease.

The authors discuss the diagnostic and prognostic problem of chronic recurrent osteomyelitis (CRMO) described for the first time in 1972 by Giedione. This relatively rare disease of unknown origin is characterized by a slow onset with oedema and pain at several sites of the locomotor apparatus which occur concurrently or consecutively and are followed by relapses. The body temperature is normal or slightly elevated. CRMO is sometimes associated also with palmoplantar pustulosis. The authors evaluate six patients wih CRMO treated in 1988-1994 (4 boys and 2 girls), age 7-13 years at the onset of the disease. There were at least 2 and not more the 4 foci per patient. The clinical symptoms before the first orthopaedic examination persisted for 1-5 weeks. Concurrent skin disease was not observed. Relapses of symptoms were described in the patients at 8 sites with remissions lasting 4-16 weeks. The most frequent site in the investigated group is the distal metaphysis of the femur and proximal metaphysis of the tibia (11 times), the medial portion of the clavicle (twice) and the short bones of the toes (three times). Classical X-ray diagnosis revealed skeletal changes consistent with the appearance of acute or chronic haematogenic osteomyelitis. All-body scintigraphy 99mTc revealed an increased cumulation of the radiopharmaceutical preparation in the focus sooner than the classical X-ray picture. Bacteriological examination of specimens obtained from blood and material from the osseous foci does not identify the causal agent. FW and CRP examination gave elevated values and frequently also leucocytosis. Antibiotics administered for 4-32 weeks produced no detectable effect, non-steroid antiphlogistics mitigated subjective complaints. Sequestration was not observed in the investigated patients. Post-inflammatory premature closing of the growth zones on the short bones of the feet are found as a rule. Key words: chronic multifocal recurrent osteomyelitis, child age.

The authors evaluated the state and behaviour of 18 growth cartilages in 16 patients lengthened by the method of distraction epiphysiolysis in 1974 to 1991 at the Clinic of Child Orthopaedics in Brno. Lengthening was performed in 8 boys and 8 girls in the area of the distal femur and/or proximal or distal tibia. The follow-up period of these patients was 2 to 8 years. The authors revealed that the bone age of the patient had a decisive effect on the state and behaviour of the lengthened epiphyseal growth plate. The mode and rate of release of the growth zone was the same, similarly as the rate of lengthening; despite this the patients could be divided into three defined groups: 1. The growth cartilage remained open, remained active and closed when the cartilages on the non-lengthened side closed. The bone age was on average 8 years. 2. The growth cartilage was apparent for a certain period (2 or more years) but closed sooner than on the non-lengthened side. The mean bone age was 10.35 years. 3. The growth cartilage disappeared already during distraction epiphysiolysis. The mean bone age was 14.3 years. The authors conclude that assessment of the bone age in patients where lengthening of bones by distraction epiphysiolysis is planned is very useful as it makes it possible to predict with a high probability further behaviour of the epiphyseal cartilage after its lengthening and thus the need of possible revision.