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Background The New Zealand Māori and Pacific ethnicities have the highest burden of slipped capital femoral epiphysis (SCFE) worldwide. Therefore, New Zealand provides a rich and unique therapeutic and research environment for this devastating hip condition. Methods A systematic literature review was performed using MEDLINE, PubMed, and Google Scholar from January 1, 1900, to December 31, 2019, with the following keywords: New Zealand, SCFE, slipped capital femoral epiphysis, SUFE, and slipped upper femoral epiphysis. The references were also screened. Results Eight original scientific research articles that had been published in peer-reviewed journals were identified, as well as 4 published abstracts from conference proceedings; we summarized the key findings. The New Zealand Māori and Pacific ethnicities have the highest reported burden of SCFE, with 4.2 and 5.6 times the prevalence, respectively, when compared with New Zealand European (Caucasian). Māori children are younger at presentation (p = 0.002) and more frequently present with bilateral SCFE (p = 0.05), and there is a strong link with childhood obesity. A contralateral posterior sloping angle (PSA) of ≥14° may be used as an adjunct threshold for decision-making regarding prophylactic pinning. A PSA of ≥40° was found to correlate with a higher likelihood of unsatisfactory functional outcome following SCFE pinning in situ. When conversion to total hip arthroplasty is eventually required due to SCFE, early functional outcomes are similar to those of patients with primary osteoarthritis, and revision rates and mortality rates are not significantly different. Conclusions Landmark literature from New Zealand has been published on SCFE management, and there is a promising future of quality, impactful research. Level of evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Introduction: The application of an external fixator for unstable pelvic fractures is an important component of many resuscitation protocols. Moreover, certain pelvic fractures may be treated with an external fixator without requiring further internal fixation. We report our initial clinical results with an alternate pelvic external fixator site, the lateral posterior external fixator (LPEF), and describe the surgical technique.Methods and Materials: From 2010 to 2013, we identified 27 consecutive patients (mean age 44.6 years, range 18–80 years) treated by the same surgeon (MKR) with an LPEF in a level 1 trauma center. Retrospective data collection included mechanism of injury, surgical interventions, and complications.Results: The LPEF was used in 16 patients as acute pelvic stabilization and converted at a median of 2 days (interquartile range 1–3.5) to internal fixation, whereas in 10 patients, it was used as definitive treatment and removed at a median of 48 days (interquartile range 37–64). One patient died on day 14, secondary to his severe closed head injury. The only surgical complications were two wound infections (20%, 2/10 in the group of definitive LPEFs), which resolved without sequelae after the removal of the LPEF (at 36 and 50 days) and antibiotics, one case of loss of fixation leading to the removal of the LPEF at 71 days, and one patient who had hypergranulating external fixator sites and eventually healed without any cutaneous sequelae. All fractures consolidated in a good position.Discussion: The described techniques of pelvic external fixation include the anterosuperior (iliac wing), supra-acetabular (anteroinferior), and subcristal (anterior superior iliac spine) insertion sites. The reported infection rates in definitive pelvic fracture treatment range from 20 to 40%. Due to the localization of the insertion sites, the lateral femoral cutaneous nerve is potentially at risk with the last two techniques. On the other hand, the LPEF insertion site is quite safe, as it is anatomically far from any nerves and the inguinal region, and allows easy access for laparotomy. The results in this series suggest that the lateral posterior pelvic external fixator technique is an alternative to previous techniques with a low risk of complications.

CASE We report the case of a pediatric terrible triad injury of the elbow consisting of an ulnohumeral dislocation, a radial neck fracture, and a coronoid chondral injury, which was diagnosed at 14 days following injury. We describe our surgical technique and provide details of the postoperative course, including the development of a rotational contracture following heterotopic ossification. CONCLUSION We describe a rare and challenging injury that should be recognized early and managed surgically to maintain acceptable elbow function.

OBJECTIVES To evaluate patient-independent risk factors for aseptic femoral hypertrophic nonunion requiring exchange nailing, with particular reference to the fit of the nail at the isthmus within the canal. DESIGN Retrospective case control study. SETTING Level 1 trauma center. MAIN OUTCOME MEASUREMENTS Between 2008 and 2012, 211 patients without any patient-dependent risk factors for nonunion were treated with a locked reamed intramedullary nail for a femoral shaft fracture. Twenty-three cases went on to hypertrophic nonunion requiring exchange nailing (treatment group) and 188 cases went on to union (control group). Patient-independent risk factors for exchange nailing were documented. RESULTS Patient-independent risk factors for exchange nailing were poor fracture reduction [Odds ratio (OR): 11.5, 95% confidence interval (CI), 4.0-33.4, P < 0.001], open fracture (OR: 7.6, 95% CI, 3.0-19.6, P = 0.004), Winquist classification of 4 (OR: 4.4, 95% CI, 1.9-6.7, P = 0.016), and poor nail fit (OR: 10.3, 95% CI, 5.1-28.4, P < 0.001). Multivariate analysis revealed nail fit as an independent predictor of femoral nonunion requiring exchange nailing (OR: 11.4, 95% CI, 6.9-15.2, P < 0.001). Moreover, we found a direct relationship between increasingly poor nail fit and increased risk of exchange nailing, with the criterion occurring at a nail fit ratio

INTRODUCTION Actinomycosis is known to mimic several types of neoplasms, leading to morbid surgical interventions. PRESENTATION OF CASE We report the particular case of an extensive right para-iliac actinomycetoma presenting as a sarcoma, which to our knowledge has not yet been described in the literature, in a patient with previous ruptured appendicitis. Thanks to the collaborative work between the orthopedic and general surgeons, pathologist and microbiologist, the diagnosis of actinomycosis was made pre-operatively, saving this 15-year-old patient from a tumor resection protocol. DISCUSSION Actinomycetomas have often been reported to present in the same way as several abdominal and gynecological neoplasms, and on rare occasions been described as mimicking other soft-tissue sarcomas, leading to unnecessary morbid tumor resection protocols. The most common cause of abdominal actinomycosis is perforated appendicitis, and may present several years later. CONCLUSION While faced with a soft tissue mass transgressing tissue planes and possibly extending to the region of the right lower quadrant, especially with a history of previous perforated appendicitis, one should consider the possibility of an abscess caused by pathogens of intestinal origin, including the gram positive anaerobe Actinomycosis israelii . Failure to actively search for this pathogen, which is not detectable with routine staining techniques and may take up to 1–2 weeks to isolate, may lead to unnecessary morbid surgical procedures.

CASE Congenital vertical talus (CVT) is a rare rigid flatfoot disorder with a rocker-bottom flatfoot appearance. It is characterized by hindfoot valgus and equinus, with associated midfoot dorsiflexion and forefoot abduction. We describe a patient who was born with dysmorphic features and subsequently was diagnosed with Beals contractural arachnodactyly. After the diagnosis of bilateral CVT was made, it was treated with a single-stage open reduction. There was a unilateral recurrence, which was treated with revision surgery. The patient had an excellent functional outcome. CONCLUSION CVT often requires surgical management and may recur. To our knowledge, this is the first reported case of CVT associated with Beals contractural arachnodactyly.

Fracture of the femoral head (OTA 31-C1.3) following anterior obturator dislocations are a challenging problem as the fractures are often communited, impacted and with loose osteochondral fragments, making surgical fixation difficult. This can result in residual articular defects if the fragments cannot be internally fixed and need be excised, predisposing to secondary osteoarthritis. Treatment options for these defects are limited, have variable results and with limited literature to guide us on outcomes due to the rarity of these injuries. Here, we describe the first use of the technique of partial femoral head resurfacing in two patients with such fractures and report on their long term outcomes.

Background Tuberous sclerosis has been associated with lower extremity lymphoedema in rare cases, only in females. Our objective was to increase present knowledge about this condition by describing this association of lower limb lymphoedema and tuberous sclerosis, however, in a male patient. Methods We report the case of a 5-year-old boy who presented with left lower limb congenital lymphoedema and was diagnosed with tuberous sclerosis 9 days after birth based on adequate clinical criteria. This patient's lymphoedema was severe and caused compartment syndrome requiring fasciotomies at 2 days after birth, numerous surgical interventions for chronic wounds and eventually necessitating several toe amputations. A biopsy confirmed benign vascular lymphatic malformation and genetic analysis confirmed the TSC2 mutation. A thorough literature review using the Medline database from 1948 to August 2013 was conducted to investigate the possible association between lower extremity lymphoedema and tuberous sclerosis. Results Our literature review confirms that the 5 reported cases of the association between lower extremity lymphoedema and tuberous sclerosis were all in female patients. Our case is the first, to our knowledge, to identify that the cause of lymphoedema is biopsy-proven benign vascular lymphatic malformation and to confirm that this association may occur in male patients as well. Conclusions Although the true incidence is unknown, there exists a rare association between tuberous sclerosis and lower extremity lymphoedema, both in female and male patients, which may be severe and lead to compartment syndrome as well as other complications throughout development, including chronic wounds, eventually requiring amputations. A multidisciplinary team approach should be strongly considered. Level of evidence Level V (case report).

A system for automatic, reliable, semi-instantaneous estimation of avalanche activity is presented in an attempt to check deterministic models and improve the surveillance of risk zones. The principle is the seismic detection of avalanches. Two experimental sites equipped with standard seismological equipment are described. Avalanche seismic signals are recorded, as well as many extraneous signals of natural or human origin. After several years of a posteriori identification of the signals, we are now able to set up criteria for the automatic recognition of non-avalanche signals. We have therefore developed an automatic analysis/decision system to discriminate between avalanche signals and others. This system worked satisfactorily in pre-operational conditions during the winter of 1995-96. The results are presented and compared with other data related to avalanche activity. Although there is still room for improvement, our system seems to be able to estimate avalanche activity better than human visual observations.

Objective: Also named Caffey disease, infantile cortical hyperostosis is a rare disease that usually affects children of a few weeks of age. The clinical picture is that of irritability, soft tissue swelling at various sites (mandible, clavicle, limbs) with local warmth, and pain on palpation. Radiographs demonstrate an important cortical thickening of the affected bony structures. There is generally spontaneous resolution of the inflammatory signs within the first few months or years of life, without future recurrence. We report the case of a recurrence in the adolescent period and conducted a thorough review of the literature to confirm this rare possibility. Methods: We report the case of a 12-year-old female patient, presenting symptoms of pain and swelling of both forearms and legs, similar to her initial clinical picture at 1 month of age when the diagnosis of Caffey disease was made. Genetic analysis confirmed the COL1A1 mutation, the classic mutation described in the familial form of this disease. Radiologic investigation revealed new periosteal bone formation of the right and left ulnae and the left fibula, suggesting a recurrence of cortical hyperostosis. A thorough review of the literature was conducted, using the Medline database between 1948 and 2011, to confirm this hypothesis. Results: The literature confirms the possibility but also the rarity of a recurrence of cortical hyperostosis in an adolescent who was diagnosed with Caffey disease in infancy. We have identified less than a dozen cases in the literature describing such a recurrence and in the majority there are no medical photographs or radiographs to support the clinical diagnosis. Our case is well documented both clinically and radiologically regarding the initial presentation and the recurrence in adolescence. Conclusions: Although very rare and poorly recognized, the diagnosis of recurrent cortical hyperostosis must be evoked in a patient who suffered from Caffey disease in infancy, and presents similar clinical characteristics in the adolescent period. Level of Evidence: Level V—case report.

International audience; A three-dimensional model developed for the slow deformation, without macroscopic failure, of a stratified snow cover has been used to simulate laboratory mechanical tests performed on sieved snow. The model is based on a non-linear visco-elastic constitutive law for snow whose parameters depend on the snow temperature and density. Snow densification is derived from the bulk viscous strain. The model has been implemented in the Flac3D finite-difference code. The experimental device is a convergent channel in which snow is forced at a constant velocity in the range 1–100 μm s− 1. Although snow is compressed under plane strain conditions, the channel geometry allows obtaining a multi-axial stress-state. Since the testing conditions involve ranges of variation of both the snow density and the strain-rate wider than those encountered for a natural snowpack, the constitutive relations of the model had to be modified. In this paper we present the constitutive model for snow, some details about its implementation into the Flac3D code, and its application to the numerical simulation of the mechanical tests. The comparison of the model and experimental results shows a relatively good agreement, although snow microstructure is accounted for only through its density. However, the treatment of the non-linearity of the viscosity must be improved. This 3D numerical model can be regarded as an interesting tool for assessing a constitutive law for snow on the basis of cold-room experiments, as well as for studying natural snow covers.

Xenopus oocytes injected with rat cerebellar mRNA expressed functional voltage-dependent Ca channels detected as an inward Ba current (IBa). The pharmacological resistance to dihydropyridines and omega-conotoxin together with the blockade obtained with Agelenopsis aperta venom suggest that these channels could be somehow assimilated to P-type Ca channels. The precise nature of the transplanted Ca channels was assessed by hybrid-arrest experiments using a specific oligonucleotide antisense-derivated from the recently cloned alpha 1-subunit of P channels (BI-1 clone). In addition, we demonstrate that exogenous Ca channel activity was enhanced by two different PKC activators (a phorbol ester and a structural analog to diacylglycerol). The general electrophysiological and pharmacological properties of the stimulated Ca channels remain unchanged. This potentiation induced by PKC activators is antagonized by a PKC inhibitor (staurosporine) and by a monoclonal antibody directed against PKC. It is concluded that P-type Ca channels are potentially regulated by PKC phosphorylation and the functional relevance of this intracellular pathway is discussed.