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In diplegic patients, the orientation of foot progression depends on multiple factors. We investigated the relationship between foot progression alignment, hip and pelvic rotations during gait, femoral anteversion, and tibial torsion. Kinematic and clinical parameters were evaluated for 114 children who walked independently and had not undergone previous surgery. Causes of intoeing presented combined in 72% of cases. Internal foot progression correlated with internal hip rotation and showed an inverse correlation with tibial torsion. Our results indicate that data from clinical examination and gait analysis should be evaluated carefully before making treatment recommendations, especially in terms of the correction of torsional problems, in patients with cerebral palsy.

Gait characteristics of a healthy adult population have been used to develop the Functional Ambulation Profile (FAP) score to evaluate gait in patients with neuromuscular or musculoskeletal involvement (A. J. Nelson, 1974). Further technological progress allowed a more precise recording of walk parameters and propitiated the development of the Functional Ambulation Performance Score (FAPS). The authors aimed to explore the evolution of the FAPS in healthy children to determine what the lower limit of age would be to ensure reliability of this score. Participants were 32 children with normal development. A GAITRite® walkway was used to log the spatiotemporal parameters. Compared with values obtained in adults, the average FAPS was significantly lower for children under 12 years old. The interparticipant variability was particularly high for the younger children and decreased with age. Similar trends were observed regarding the intraparticipant variability. In conclusion, the authors observed that the FAPS is not suitable to compare the gait of different children younger than 12 years old. At least, the adult standards used to calculate FAPS would need to be modified if the score has to be applied to a pediatric population.

The authors report three cases of skin ulcer, called Buruli's ulcer. This is a tropical disease, caused by Mycobacterium ulcerans. The diagnosis is often belated, because the infection is rare in Europe. Diagnosis is based on the clinical aspects, and can be confirmed by a biopsy and a molecular study. A culture is needed to test antibiotics. Treatment is always surgical, including a wide excision of all lesions, and specific oral antibiotics for 6 months.

Congenital high scapula is also known as Sprengel's deformity. The elevation of the scapula is accompanied by its rotation to a varus position. A series of 19 cases is presented, with 4 bilateral cases. A modified Woodward procedure was performed in all the surgical cases using the basic Woodward technique modified by correcting the tilting of the glena. The operative results were judged on cosmetic and functional criteria. The age of the patients and the presence of an omovertebral bone did not influence the results. Associated cervical spine anomalies were of negative prognosis. Results in this series showed only three fair or poor results; the other cases (79%) were all improved cosmetically and functionally with normal shoulder abduction following reorientation of the scapulo-humeral joint.

The authors reviewed 102 unstable patellas which had been observed and treated from 1964 to 1990. They were divided according to whether they suffered from traumatic dislocations, recurrent dislocations or malformative instability. The clinical findings were the major stage of the check up. In the field of imaging, standard X-rays had to be performed in all cases. MRI was of interest in the congenital dislocations, in order to thoroughly investigate the soft tissue anomalies. Two types were described: Type 1 was observed in children with joint laxity, but without major X-ray anomalies; Type 2, a major femoropatellar dysplasia could be formed with some bone deformity. The latter was observed in the malformative instability. Four different surgical procedures have been used, from the release of the retinacula of patella to the medial displacement of the patellar tendon or the tibial tuberosity. This study emphasises the concept of a true development dysplasia of patella (DDP) which can gather the different varieties of the instability of patella.

The solitary bone cyst (SBC) has not yet revealed all its secrets. The pathogeny of the SBC is thus considered and also its evolutivity. Conservative treatment has been used in attempts to heal this tumor-like bone. In the case of surgery, an original technique is described. The SBC still remains mysterious in many of its aspects. At the time of this writing, nobody can predict the occurrence modalities of this benign bone tumor. In a similar way, the reality of this tumor-like lesion cannot be precisely described. This emphasizes the first controversial point about this lesion. Indeed, must we consider differently the bone cysts that remain close to the growth plate and those which located in the diaphysis? Must we regard the true unicameral bone cysts (UBCs) differently and those that are multilocular? Moreover, are the cysts located in the long bones identical to the those of the short cancellous bones? Alas, SBC was supposed to be a lesion in children that disappeared after growth ended. Is it still true since some cases have been reported more recently in adults? This study represents a long follow-up. It includes the different aspects of the SBC and emphasizes an original technique in case surgery becomes indicated.

We reviewed 91 hips with slipped capital femoral epiphysis (SCFE) after an average follow-up period of 6 years 6 months. Different treatment methods used, according to types and stages of slipping, are discussed. In situ fixation appears to be the best procedure for SCFE with < 60% displacement. Careful reduction-fixation is indicated in acute and acute-on-chronic SCFE > 60%. Primary rotation osteotomies are associated with a high percentage of complications. Secondary osteotomies should be simple (preferably a subtrochanteric derotation osteotomy) to reduce the risk of necrosis. Preventive contralateral fixation is indicated when the growth cartilage is still open.

Current work on disease states involving the patella has led to increased interest in patellar instability. We reviewed a series of patellar luxations. True trauma-induced luxations are rare. Most cases are recurrent luxations in subjects with a morphological anomaly of the knee extensor system. Because of the growth cartilages, selective therapeutic techniques are needed to stabilize the patella. Recurrent or permanent luxations of the patella result from congenital malformations of the muscles or skeleton. A complete MRI study is highly indicated. The patella can be correctly realigned by surgical release. In cases with femoropatellar dysplasia, which is not specific for children, well conducted rehabilitation therapy often leads to favourable outcome.

The present study compares two methods of haemoglobin measurement during surgery in 40 patients aged 1 to 85 years. The reference method is the Coulter STKS based on red cell count and mean cellular content in haemoglobin measurement. The method tested (Hemocue-Diagnostics Transfusion) allows instantaneous determination of haemoglobin on a 10 mu sample by measuring infrared absorption by haemoglobin in the 565 and 880 nm wavelengths. These methods have been compared using the method of assessment of agreement described by Bland and Altman. As previous reports suggested that the precision of haemoglobin measurement by Hemocue could depend on the capillary or venous site of sampling, we assessed agreement of the two methods of measurement of haemoglobin at both sites. In addition, the relationship between hematocrit and haemoglobin measured by either method has been assessed. On venous samples, there was a good agreement between the two methods of measurement of haemoglobin (n = 47), with a mean difference of -0.166 g/dl-1 and agreement limits of -1.041 g/dl-1 and +0.195 g/dl-1. Ninety six percent of the observed differences to two methods were within the 95% confidence interval. On capillary samples, there was a poor agreement between Hemocue and Coulter since the mean difference was -0.272 g/dl-1 with the following limits of agreement: -2.356 g/dl-1 and +1.812 g/dl-1. Only 92% of the observed differences were within the 95% confidence interval, with 17% of these being greater than the clinically accepted limit of 1 g/dl-1. The precision of Hemocue measurement of capillary blood haemoglobin was only +/- 16%.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors performed 12 femur progressive lengthenings on rabbits during growth period. The lengthening was effected with a small distractor after a transversal bone section. The lengthening was 7,5 mm on 4 rabbits in 5 days (group 1) 10,5 mm on 4 rabbits in 7 days (groups 2), 15 mm on 4 rabbits in 10 days (group 3. At the end of the lengthening, the authors compared the non operated limb with arteris, veins, nerves, muscles and growth cartilage of the operated side. They found no modification of the muscular structure in the 3 groups. They substantieted few arterial and veinous modifications in group 1 and 2 the arteriel modifications were minimal but veinous modifications were important in group 3. The nervous anomalies wer evident in the 3 groups; the more important the lengthening, the more severe the anomalies; ranging from nerve ondulations in group 1, to vacuolar degenerscence and fibres ruptur in group 3. The authors studied the growth cartilage modificate at the furthest extremity from the femur by counting the cells in the various layers of the cartilage. They noted a significant descrease of the cell in the proliferative zone. This descrease might be due to a cartilage suffering. The modifications in the hypertrophic zone are less important, inconstant and result in a increase of the number of the cells. The authors think that the consequences of those important modifications on the nerve and on the growth cartilage are constant enough to complete this study by other lengthenings. This study coroborates their theory that all the consequences of a lengthening performed in a child are far from being perfectly known.

A roentgenographical study of the supposedly normal cervical spine in 40 children is reported. At the upper cervical level, the validity of the criteria in the literature (especially the atlantodental distance on the lateral view) was confirmed, and an upper limit was determined for children. A study of the atlantoaxial relationship on the anteroposterior view in neutral position and in lateral position was performed. At the lower cervical level, measurements according to Penning (Am J Roentgenol 1978;30:317-26) and Cattel and Filtzer (J Bone Joint Surg [Am] 1965;47:1295-308) were applied to children and compared level by level at each age. This study allows a better comprehension of the mobility of the cervical spine in children and offers an explanation for suspicious roentgenographical features after trauma.

The authors study the anomalies of the cranio-vertebral junction in the Morquio disease. The first 6 cases reported, in addition to the usual vertebral anomalies, suffered from a junctionnal malformations that were operated by posterior decompression and occipito-vertebral arthrodesis. In these cases, they especially study: --the neurological repercussion in 5 cases that could only be evidenced by a very careful examination after a stress test; --the simple roentgenographic examination, in forced position, and gaseous myelography proved on one band, that the instability, which is supposed to be responsible for the neurological symptoms, is actually inconstant (2 case out of 6). But on the other hand a narrow canal was present in every cases; --the surgical procedure performed in the 6 cases consisted of a removal of the posterior arch of the Atlas, of a widening of the occipital foramen if necessary (4 cases) and of an occipito-vertebral arthrodesis. There has been no aggravation compared to the previous state. Three indisputable improvements in the cases with a pyramidal syndrome. The authors compared their cases to those published in the literature and on which most of the time only a simple stabilisation was performed. For the authors this stabilisation can only be considered as a complementary procedure to the decompression which remains the main part of the treatment. The indications are discussed: they are based on the neurological examination and the myelography.

The authors have observed forty-two cases of fractures and dislocations of the spine in children. In twenty-eight cases there was a complete spinal cord lesion and in four cases a partial cord lesion with some recovery. Ten children had no neurological lesion. Fifteen progressive kyphoses and twenty-two progressive scolioses were noted and analysed. The kyphotic deformities were more severe at cervical levels and seem to be aggravated by laminectomies. They were stabilised at the time of bone maturity. To prevent this deformity, the authors recommend long-term plaster cast immobilisation associated with posterior fusion. In scoliotic deformities, the authors distinguish those due to neurological involvement and those arising at the level of the fracture due to disturbance of vertebral growth. Indications for treatment are discussed in relation to the age of the patient and the level of the fracture.

Sixteen cases of dislocation and ligamentous disruptions of the cervical spine in children are reported. In five cases resulting from injury to the upper cervical spine, the roentgenographical features of the instability at the C1-C2 level are documented and their therapeutic orientation is defined. Eleven injuries were of the lower cervical spine: three dislocations, two of which were old cases, and eight serious ligamentous disruptions. Diagnosis of serious ligamentous disruptions was based on precise radiographic criteria: increase of the interspinous distance, loss of parallelism between the articular processes, and posterior widening of the disc space. The indications for surgical fixations in serious ligamentous disruptions depend on persistence of the clinical and radiological signs after a long orthopedic immobilization.