Multicentre collaborative cohort study of the use of Kirschner wires for the management of supracondylar fractures in children

Purpose Supracondylar fractures of the humerus cause significant morbidity in children. Nerve damage and loss of fracture reduction are common recognised complications in patients with this injury. Uncertainty surrounds the optimal Kirschner wire configuration and diameter for closed reduction and pinning of these fractures. This study describes current practice and examined the association between wire configuration or diameter and outcomes (clinical and radiological) in the operative management of paediatric supracondylar fractures. Methods Children presenting with Gartland II or III supracondylar fractures at five hospitals in south-west England were eligible for inclusion. Collaborators scrutinised paper and electronic case notes. Outcome measures were maintenance of reduction and iatrogenic nerve injury. Results Altogether 209 patients were eligible for inclusion: 15.7% had a documented neurological deficit at presentation; 3.9% who were neurologically intact at presentation sustained a new deficit caused by treatment and 13.4% experienced a clinically significant loss of reduction following fixation. Maintenance of reduction was significantly better in patients treated specifically with crossed ×3 Kirschner wire configuration compared to all other configurations. The incidence of iatrogenic nerve injury was not significantly different between groups treated with different wire configurations. Conclusion We present a large multicentre cohort study showing that crossed ×3 Kirschner wires are associated with better maintenance of reduction than crossed ×2 or lateral entry wires. Greater numbers would be required to properly investigate nerve injury relating to operative management of supracondylar fractures. We found significant variations in practice and compliance with the British Orthopaedic Association Standard for Trauma (BOAST) 11 guidelines.</p

L'osteotomie haute de l'Ulna dans la prise en charge des lésions de Monteggia négligées chez l'enfant

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Pied bot varus équin congénital idiopathique sévère (quelle stratégie thérapeutique ?)

Le traitement du pied bot varus équin congénital (PBVEC) idiopathique suscite des controverses mais il a beaucoup évolué grâce à l'introduction de nouvelles méthodes fonctionnelles. Le but de ce travail est d'évaluer les résultats à long terme de la méthode fonctionnelle Palavas et de la libération postéro-médiale. L'étude rétrospective porte sur 122 patients avec 181 PBVEC sévères (>15/20) de 1974 à 2008. L'âge moyen au moment de la chirurgie est de 12 mois. L'évaluation clinique et radiographique en fin de croissance est basée sur les scores de Ghanem et Seringe, et de Laaveg et Ponseti. Au recul moyen de 16 ans, les résultats de la méthode fonctionnelle de 122 PBVEC sont classés bons dans 25%, moyens dans 10% et mauvais dans 64% des cas. Parmi ces pieds, 95 (77%) ont nécessité une chirurgie complémentaire. Quatre vingt pour cent des patients conservent une activité sportive. En fin de croissance, les résultats sont: bons dans 20%, moyens dans 24.5% et mauvais dans 55% des cas. L'hypercorrection dans 80% des pieds est la rançon de la chirurgie extensive. L'arthrose (talo-crurale et médio-tarsienne) est présente dans 28% des pieds. Les déformations sont fréquentes: aplatissement du dôme talien (96%), horizontalisation ca1canéenne (81 %), metatarsus elevatus Ml (65%), luxation dorsale naviculaire (50%) avec nécrose (42%). La libération postéro-médiale est responsable de complications importantes. Les meilleurs résultats à long terme de notre méthode fonctionnelle ont fait disparaître la chirurgie de libération extensive de nos indicationsMONTPELLIER-BU Médecine UPM (341722108) / SudocSudocFranceF

Esophageal perforation caused by a thoracic pedicle screw

International audienceThis grand round raises the risk of a rare complication that can be avoided with the knowledge of the particular anatomy of scoliosis vertebra. Transpedicular screws have been reported to enhance the operative correction in scoliosis surgery. The narrow and inconsistent shape of the thoracic pedicles makes the placement of pedicle screws technically challenging. Furthermore, in thoracic curves, the close proximity of the spinal cord and major soft tissue structures also adds a greater risk to the procedure. The esophagus lies close to the upper thoracic vertebras and, an anterior cortical perforation can cause esophageal injury. We report a case of anterior cortical perforation by a T4 pedicle screw complicated by an esophageal perforation in a 15-year-old girl with convulsive encephalopathy. She was operated for a severe neurological scoliosis (Rett syndrome). Her neurological condition deteriorated 3 years after the posterior spinal surgery, requiring a percutaneous gastrostomy. An intra-esophageal screw was discovered incidentally during an endoscopy. We decided not to remove this screw, because the patient's health status presented a surgical contraindication. The patient showed no apparent discomfort at the 10-year follow-up examination after spinal arthrodesis. Esophageal perforation caused by a posterior pedicle screw is very rare. We highlight the risk of injury to esophagus from pedicle screws in upper thoracic vertebra. The systematic removal of a malpositioned screw must be discussed, on a case-to-case benefit-risk basis, especially if the patient has numerous comorbidities, given the long-term tolerance of a number of these improperly positioned implants

Mosaicplasty for femoral osteochondritis dissecans

International audienceThe authors describe a surgical mosaicplasty technique, with an anterior surgical dislocation approach without trochanterotomy, for osteochondritis dissecans of the hip. A graft was taken from the lateral condyle of the knee. Two adolescents underwent this procedure with good results. No osteonecrosis was observed at the longest follow-up. Mosaicplasty is a useful treatment method for small osteochondritis dissecans (<2cm(2))

Nouveaux colorants organiques pour cellules hybrides sensibilisées à colorant : transposition aux cellules à l'état solide

National audienc