Can early MRI distinguish between Kingella kingae and Gram-positive cocci in osteoarticular infections in young children?

Background: K. kingae is a common causative organism in acute osteoarticular infections (OAIs) in children under 4years of age. Differentiation between K. kingae and Gram-positive cocci (GPC) is of great interest therapeutically. Objective: Our aim was to identify early distinguishing MRI features of OAIs. Materials and methods: Thirty-one children younger than 4years of age with OAI underwent MRI at presentation. Of these, 21 were caused by K. kingae and ten by GPC. Bone and soft tissue reaction, epiphyseal cartilage involvement, bone and subperiosteal abscess formation were compared between the two groups. Interobserver agreement was measured. Results: Bone reaction was less frequent (P = 0.0066) and soft tissue reaction less severe (P = 0.0087) in the K. kingae group. Epiphysis cartilage abscesses were present only in the K. kingae group (P = 0.0118). No difference was found for bone abscess (P = 0.1411), subperiosteal abscess (P = 1) or joint effusion (P = 0.4414). Interobserver agreement was good for all criteria. Conclusion: MRI is useful in differentiating K. kingae from GPC in OAI. Cartilaginous involvement and modest soft tissue and bone reaction suggest K. kinga

Treatment of congenital thoracic scoliosis with associated rib fusions using VEPTR expansion thoracostomy: a surgical technique

Abstract : Introduction: Untreated growing patients with congenital scoliosis and fused ribs will develop finally thoracic insufficiency syndrome. The technique of expansion thoracoplasty with implantation of a vertical expandable prosthetic titanium rib (VEPTR) was introduced initially to treat these children. Methods: This article attempts to provide an overview of the surgical technique of opening-wedge thoracostomy and VEPTR instrumentation in children with congenital thoracic scoliosis and fused ribs. Results: Our modification of the surgical approach using a posterior midline incision rather than the modified thoracotomy incision initially described could potentially help to diminish wound dehiscence and secondary infection, while preserving a more acceptable esthetic appearance of the back. Conclusions: Vertical expandable prosthetic titanium rib-based treatments should be undertaken only with a good knowledge of its numerous specific complications. Every aspect of the treatment should be oriented to minimize these complications. At the same time it should be kept in mind that the ultimate step of this long-term fusionless treatment strategy will be a technically demanding spine fusion

Decrease of physical activity level in adolescents with limb fractures: an accelerometry-based activity monitor study

<p>Abstract</p> <p>Background</p> <p>Immobilization and associated periods of inactivity can cause osteopenia, the physiological response of the bone to disuse. Mechanical loading plays an essential role in maintaining bone integrity. Skeletal fractures represent one cause of reduction of the physical activity (PA) level in adolescents. The purpose of this study was to quantify the reduction of PA in adolescents with limb fractures during the cast immobilization period compared with healthy controls.</p> <p>Methods</p> <p>Two hundred twenty adolescents were divided into three groups: those with upper limb fractures (50 cases); lower limb fractures (50 cases); and healthy cases (120 cases). Patients and their healthy peers were matched for gender, age, and seasonal assessment of PA. PA level was assessed during cast immobilization by accelerometer. Time spent in PA in each of the different intensity levels - sedentary, light, moderate, and vigorous - was determined for each participant and expressed in minutes and as a percentage of total valid time.</p> <p>Results</p> <p>Reduction in PA during cast immobilization was statistically significant in patients with limb fractures compared to healthy controls. The total PA count (total number of counts/min) was significantly lower in those with upper and lower limb fractures (-30.1% and -62.4%, respectively) compared with healthy controls (p < 0.0001 and p = 0.0003, respectively). Time spent in moderate-to-vigorous PA by patients with upper and lower limb injuries decreased by 36.9% (<it>p </it>= 0.0003) and 76.6% (<it>p </it>< 0.0001), respectively, and vigorous PA was reduced by 41.4% (<it>p </it>= 0.0008) and 84.4% (<it>p </it>< 0.0001), respectively.</p> <p>Conclusions</p> <p>PA measured by accelerometer is a useful and valid tool to assess the decrease of PA level in adolescents with limb fractures. As cast immobilization and reduced PA are known to induce bone mineral loss, this study provides important information to quantify the decrease of skeletal loading in this patient population. The observed reduction of high intensity skeletal loading due to the decrease in vigorous PA may explain osteopenia due to disuse, and these data should be kept in mind by trauma practitioners to avoid any unnecessary prolongation of the cast immobilization period.</p

Do bone mineral content and density determine fracture in children? A possible threshold for physical activity

BackgroundRelations between bone parameters, physical exertion, and childhood fractures are complex. We aimed to estimate the associations between fracture history and bone mineral content (BMC) and areal bone mineral density (aBMD) at 7 years of age, by levels of physical activity, as a proxy for trauma frequency.MethodsWe used data collected from 2,261 children of the Generation XXI birth cohort, assembled in 2005/6 in Porto, Portugal. At the age of 7 years (2012/4), fracture history, time spent per week in active play, and sports practice were reported by parents. Subtotal and lumbar spine (LS) BMC and aBMD were measured using whole-body dual-energy X-ray absorptiometry.ResultsBoys and girls in the highest categories of time spent in sports practice or active play generally had higher BMC and aBMD. Among girls, BMC and aBMD were protective of fracture only in the highest quarter of active play (>660 min/week)-odds ratios (OR; 95% confidence interval (95% CI)) for subtotal BMC=0.27 (0.11-0.67), subtotal aBMD=0.18 (0.06-0.49), and LS aBMD=0.41 (0.22-0.75). For boys in the highest quarter of sports practice (>240 min/week), subtotal and LS BMC were protective of fracture-OR=0.39 (0.16-0.98) and 0.51 (0.27-0.96), respectively.ConclusionIn prepubertal children, BMC and aBMD predicted fracture history only in the highest levels of physical activity.info:eu-repo/semantics/publishedVersio

Mechanism and predisposing factors for proximal tibial epiphysiolysis in adolescents during sports activities

Proximal tibial epiphysiolysis (PTE) can have debilitating consequences for young athletes. The mechanism and predisposing factors for this lesion have yet to be determined. To find a common denominator and a biomechanical explanation for PTE, we were using a retrospective analysis of 15 cases in combination with a systematic review of literature

L'ostéochondrite primitive de la hanche ou maladie de Legg-Calvé-Perthes : quel bilan ? quelle prise en charge ?

Legg-Calvé-Perthes disease remains indefinite from an etiologic point of view and unforeseable in its evolution. The evolution depends on the extent of epiphyseal involvement and the age of the child. It may safely be stated that the more extensive the epiphyseal involvement, the more compromised is the prognosis. Also the older the child, the more the femoral head remoulding will be limited. Preserving articular mobility and containing the head within the depth of acetabulum constitute the mainstay of treatment aiming for a femoral head as spherical as possible upon completion of growth. At the end of growth spherical or ovoid heads will cause no or few problems, however strongly deformed femoral heads will evolve into early hip arthritis. The early recognition of which hip will profit from which treatment, constitutes the major difficulty of the therapeutic process

Luxation de la rotule: rôle du ligament fémoro-patellaire médial

Patella dislocation is an injury affecting teenagers. This pathology is associated in the majority of the cases with a dysplasia of the femoro-patellar joint. MFPL is a passive restraint to patellar lateral displacement. Rupture of the MFPL would predispose the patients to redislocate their patella. Therefore, a reconstruction of this ligament seems to be a logical proposal for the treatment of recurrent patellar instability. This surgery, carried out with three incisions of small size, would decrease the recurrent dislocation. However, a long-term analysis of the results of this surgery is recommended