Aims: In order to assess the potential pathologic inßuence of any Parathyroid Hormone (PTH) disturbances on the development of Slipped Capital Femoral Epiphysis (SCFE) during adolescence, we conducted a prospective clinical study. Methods: Nineteen patients in total were included in the study. Fourteen patients, 7 boys and 7 girls (16 hips), suffering from SCFE during the proceedings of this study, formed group ÔAñ. Another 5 patients that had been treated for SCFE a few years before the study, were used as a control group (group ÔBñ). We measured the level of I-PTH, along with serum Calcium (Ca) and Phosphorus (P) levels. Furthermore we checked all the necessary anthropometrical characteristics of the patients (age, height, weight and sexual maturation). Each patient of group ÔAñ was categorized from grade I to grade V according to the progress of the slipping. Results: An increased incidence (9 out of 14 patients), of serum PTH level abnormalities (both decrease and increase) in group ÔAñ was detected. Group ÔBñ patients had normal results. It is interesting that the detected I-PTH serum level abnormalities were not in any pattern related to the Ca and P serum levels. Conclusions: We believe that a temporary Parathyroid Hormone disorder or imbalance (along with others etiologic factors) during the early years of adolescence, may play a potentially signiþcant role in the development of SCFE.

Aims: The use of bio-absorbable þxation plates and screws, constructed of self-reinforced (SR) polylactic acid co-polymer for internal þxation of forearm fractures in children is described in this study. These plates (thickness:1,2 mm) and screws (diameter:2,4 mm) are usually used in reconstructive surgery in the mid-face and craniofacial skeleton. Methods: Eleven patients (aged 4–12 years old), who had suffered from fractures of the distal third of the forearm (7 cases) and isolated radial fractures (4 cases), were surgically treated in our Department with absorbable þxation plates and screws, during the last 3 years. As close-reduction attempts failed in all these fractures, surgical treatment was mandatory. The general principles of internal þxation were followed in all cases. The internal þxation, with the use of these plates and screws, was reinforced with the application of a long forearm cast for a period of 4–6 weeks. Antibiotics were administered for 7 days. Results:The follow-up time ranged from 1 to 2 years. No bone or soft tissue infections were noticed postoperatively. Callus formation appeared in the expected time. Conclusions: The use of absorbable plates and screws, as a means of internal þxation, in the surgical treatment of forearm fractures in children that cannot be treated conservatively, combined with the application of a long cast, provides sufþcient and adequate osteosynthesis. The use of these materials renders a second (extremely distressful for children) re-operation for the removal of metallic implants completely unnecessary.

Aims: This study was designed to evaluate the postural effects on nystagmus response, during caloric vestibular stimulation. Methods: 43 female patients with right thoracic idiopathic scoliosis (mean age =13.5, scoliotic curves:20û– 40û) and 31 non-scoliotic healthy subjects (mean age=13.1) entered the study. In all patients was performed an electronystagmographic study of labyrinthine function with caloric stimulation. We evaluated: the frequency, the amplitude, the slow phase velocity of nystagmus. The differences in labyrinthine sensitivity were evaluated with the use of unilateral weakness parameter, while differences in left- and right- beating nystagmus evaluated by estimating the directional preponderance parameter. Results: 19 patients from the study group (44.2%), revealed unilateral weakness of the left labyrinth, while 24 patients from the study group (55.8%) had normal caloric responses. On contrary, only one patient of the control group (3.2%) revealed unilateral weakness of the left labyrinth (> 20%). These differences were statistical signiþcant (p< 0.05, Chi-Square test).17 patients from the study group (39.5%) revealed directional preponderance of the right-beating nystagmus. All these patients had also left unilateral weakness. Conclusions: From the above results we can conclude that in 17 patients from the study group the right labyrinth was preponderant, while in other 2 patients there was signiþcant evidence for this. The results are discussed with special reference to aetiology in idiopathic scoliosis.

Aims: The underlying cause of Idiopathic Scoliosis (IS) remains enigmatic. Recently, an increasing number of studies disclosed Central Nervous System (CNS) abnormalities and asymmetries sometimes involving the corticospinal tracts. The present study was designed to investigate the motor system of scoliotic patients with transcranial magnetic stimulation. Methods:21 female patients with right IS (mean age=12.7, scoliotic curves:20û–40û) and 20 normal subjects (mean age=13.8) entered the study. Recordings were made with surface electrodes from 1st dorsal interosseous and abductor hallucis muscles. Corticomotor threshold (LT, UT, MT) was deþned at rest in 1% steps using the method of Mills & Nithi. Central motor conduction time (CMCT) was calculated using the F-wave method. Silent period (SP) measurements were done using a standardized protocol at 130% MT stimulus intensity. Other parameters included cortex to muscle latencies, F- and M-wave latencies, UT-LT range, amplitude and area of MEPs. Electrophysiological data were correlated with several clinical characteristics including handedness, degrees of the scoliotic curve and the Pedriolet and Nash indexes. Normality of data distribution was tested using the Kolmogorov-Smirnov test and thereafter appropriate statistical tests were used. Results: In 14 patients lower limbs were also tested and it was found that asymmetry of facilitated Cx-M was 1.4±0.75ms in IS (vs 0.71±0.47 in controls, p=0.059). It correlated signiþcantly with Nash & Moe and Perdriole indexes (Spearmanñs r=0,554 and 0.575 respectively, p< 0.05) and showed a trend towards signiþcance with degrees of scoliotic curve (Pearsonñs r=0.531, p=0.062). Conclusions: There are no signiþcant asymmetries or pathological alterations in the motor system of patients with IS. However, an increased asymmetry of facilitated

Objectives. The use of bio-absorbable fixation plates and screws, constructed of self-reinforced (SR) polylactic acid co-polymer for internal fixation of forearm fractures in children is described in this study. This type of plates (thickness:1,2 mm) and screws (diameter:2,4 mm) is usually used in reconstructive surgery in the mid-face and craniofacial skeleton.

Methods. Eleven patients (aged 4–12 years old), who had suffered from fractures of the distal third of the forearm (7 cases) and isolated radial fractures (4 cases), were surgically treated in our Department with absorbable fixation plates and screws, during the last 3 years. As close-reduction attempts failed in all these fractures, surgical treatment was mandatory. The general principles of internal fixation were followed in all cases. The internal fixation, with the use of these plates and screws, was reinforced with the application of a long forearm cast for a period of 4–6 weeks. Antibiotics were administered for 7 days post-operatively.

Results. The follow-up time ranged from 12 to 24 months. No case of bone or soft tissue inflammation was noticed post-operatively. Callus formation appeared in the expected time.

Conclusions. The use of absorbable plates and screws, as a means of internal fixation, in the surgical treatment of forearm fractures in children that cannot be treated conservatively, combined with the application of a long cast, provides sufficient and adequate osteosynthesis. The use of these materials renders a second (extremely distressful for children) re-operation for the removal of metallic implants completely unnecessary.

Aims. The assessment of the potential pathological influence of Growth Hormone (hGH), Testosterone, Estradiol, Follicle Stimulating Hormone (FSH) and Luteinizing Hormone in the development of SCFE and the re-evaluation of the Harris theory (increased quotient of hGH/sex hormones in patients suffering from SCFE).

Methods. Nineteen patients in total were included in the study. Fourteen patients (7 boys, 7 girls, 16 hips) suffering from SCFE during the proceeding of this study, formed group ‘A’. Another 5 patients (4 boys, 1 girl), that had been treated for SCFE a few years before the study, formed group ‘B’. We measured serum hGH, FSH, LH, Testosterone and Estradiol levels. Furthermore we checked all necessary anthropometrical and clinical characteristics (age, height & weight, sexual maturation, grade of slipping).

Results. Thirty six out of 95 in total measurements (37,9%) revealed pathological values. The majority of group A patients had pathological values (43% of measurements). The Harris theory seems to be true in 7 out of 19 in total patients: 5 group A patients (2 boys and 3 girls) and 2 group B patients (1 boy and 1 girl).

Conclusions. We believe that a temporary (?) disorder or imbalance of hGH and sexhormones, under the possible influence of FSH and LH (along with other etiologic factors) during the early years of adolescence, may play a potentially significant role in the development of SCFE.

The aim of our study is to present osteoid osteoma as a disease in preschool children. O O is a benign inflammatory process that is characterized from osteoid formation. It appears mainly in the second and third decade of life, while before 5 years of age usually as case reports. The clinical and radiological presentation must be differentiated from trauma, osteomyelitis, malignancy and other benign diseases.

We present three patients, aged ranging from 18 months to 4 years old, that were treated surgically for the removal of O O in the tibia and fibula. All patients presented with limping, pain mainly in the night, gradual restriction of activities. The clinical, hematological and radiological investigation revealed the general aspects of the disease. Bone scans were positive in all. CT scan confirmed the diagnosis in all three patients. Surgical treatment was done with fluoroscopic assistance, in order to remove the minimum possible amount of bone. In two patients the lesion was located in the distal metaphysis of the tibia and in one in the distal metaphysis of the fibula.

The diagnosis was confirmed with the typical nidus, in pathological specimens. In one patient the lesion was intracortical and in two in the medullary area. Despite the ages of our patients, there were not misleading findings, in the specimens. After surgery the patients were symptoms free, and with 1–4 years follow up, there are no recurrences.

We conclude that osteoid osteoma must be included in the differential diagnosis, in cases of pain and limping, in preschool children.

Introduction: The open reduction of C.D.H. (Congenital Dislocation of the Hip) during infancy associated with an incomplete osteotomy of the iliac bone in the roof of the acetabulum with a use of a wedge bone graft are described in this study.

Material and Methods: Ten children with C.D.H. (aged from 5 to 12 months) were surgical treatment under gone during the last 2 years in our department. Eight of them were boys and 2 girls. The left hip joint was involved in 7 and the right in 2 while one patient had bilateral C.D.H.Conservative treatment without success was performed in all patients until their admission in our hospital. The treatment’s method was the same in all the patients. By an anterior approach to hip joint with a Smith – Petersen’s skin incision open reduction of the dislocated hip was succeeded. We had to eliminate the teres ligament, cut the insertion part of the iliopsoas tendon and remove the inverted limbus to achieve reduction of the hip.

An incomplete innomitate osteotomy was followed above to the roof of the acetabulum. A corticotrabecular wedge human bone graft .human in 3 cases or a allograft in 7patients ( 8 hips) were used to reconform the acetabulum.

Results: The follow-up time ranged from 1 to 2 years. Normal range of movements was detected during clinical review. The radiological follow-up findings were shown that the bone roof of the acetabulum and the femoral neck anteversion was reconformed. No avascular necrosis of the femoral head was noticed.

Conclusion: The C.D.H. could be perfectly recostucted during infancy by open reduction associated with a use of a corticotrabecular wedge bone graft.

Introduction: Immature individuals with known neuromotor disorders are subject to the development of scoliosis; therefore a subclinical dysfunction or anatomic abnormality of the neurologic system has been hypothesized as a causative factor of adolescent idiopathic scoliosis.

In previous clinical studies, authors have tested a wide range of functions, including proprioception, postural equilibrium, oculovestibular complex and vibratory sensation and multiple techniques, including electronystagmography, electroencephalography and electromyography in select scoliotic patient populations

Material and Methods: The present study was designed to investigate the motor system of scoliotic patients with magnetic stimulation. female patients 12 to 14 years old (mean age=13.36) with right idiopathic scoliosis (curves:20–40°) (study group) and 20 normal subjects in the same age group (mean age=12.6) (control group) entered the study. Magnetic stimulation of the brain was performed with a figure of eight coil angled 45° to the parasagittal plane and positioned so as to overly the hand area.

Transcranial stimulation was performed with a Magstim 200 stimulator (Magstim Co, Dyfed, Wales). Stimulation was performed with a figure of 8 coil for upper limbs and a double cone coil for lower limbs. Recordings were made with surface electrodes from 1st dorsal interosseous and abductor hallucis muscles. Threshold measurements included upper (UT) and lower threshold (LT), defined as the stimulus intensities producing MEPs with a propability of 100 and 0%, respectively. Mean threshold (MT) was the mean of UT and LT. Cortical latencies of MEP’s during muscle activation were also measured.

Results: In the patients’ right hemisphere UT,MT and LT were 46.5±8.2, 41.6±7.6 and 36.6±7.3% respectively and the activated cortical latency was 18.6±l.lms.

In the left hemisphere UT, MT and LT were 45.9±9.8, 41.4±9.1 and 36.9±8.7%, respectively and the activated cortical latency was 18.3±0.8ms. These differences were not statistically significant (p> 0.05, t-test). The side-to-side difference of UT,MT and LT were 4.5±2.4, 4.3±2.8 and 4.4±3.7.

None of all the above parameters differed significantly from those of the control group (p> 0.05, t-test).

The differences in the corticomotor excitability in the upper and lower extremities were not statistical significant.

Conclusion: In the study group revealed asymmetries between left and right hemisphere in cortical latencies of MEP’s facillitated.

The type and the location of the fractures of the long bones in children that can be treated by elastic intra-medullary nailing are described in this study.

Fourty-one patients (aged from 5–18 years old) were treated in our department with fractures of the long bones located on the metaphysis or diaphysis (5 on the distal third of radious and ulna ,8 diaphyseal fractures of the forearm ,7 diaphyseal fractures of the tibia ,5 of the distal end of tibia ,6 of the femoral diaphysis,7 on the distal end of femur and 3 on the diaphysis of the humerus).

All operations were performed under radiological control ,to avoid any damage of the growth plates. Tibial , femoral and humeral fractures were fixed with 2 nails whereas forearm fractures were reducted with one nail.

Postoperative immobilization with a long cast was applied in forearm fractures at least for 4 weeks.

The follow-up time ranged from 1–3 years. The following clinical findings were noticed at the examination : skin infection at the point of the nail insertion area (3 patients), limitation of the range of movements at the carpal joint (2 patients).

Radiological findings showed satisfactory callus formation at an early stage in all cases and rotational deformity in 2 femoral obligue fractures due to insufficient stabilization.

According to our clinical and radiological findings the results were excellent in 34 cases and good in 7 cases.

Fractures of the diaphysis or metaphysis of the long bones in children are fully indicated for intramedullary nailing with elastic nails and the postoperative complications are minor when the fractures are not close to the growth plates.

The method is not indicated for comminuted or oblique fractures and fractures – separations.

The aim of this paper is to present our experience from the surgical treatment of lower limb fractures in the developing skeleton with the use of bio-absorbable PLLA implants as a means of internal fixation.

From 1997 until 2002, twenty-three patients (15 boys and 8 girls, ages ranging from 7 to 15 years old, mean of 12 years) who had suffered from 30 lower limb fractures were operated on in our department, with the use of PLLA screws as a means of internal fixation that followed the standard open reduction procedure.

We surgically treated 20 tibial fractures (distal metaphysis:1,medial malleolar:6,distal epiphysis lesions:9,tibial spine:2, lateral tibial condyle:1, tibial shaft:1), 8 fibular fractures (distal metaphysis:2, distal epiphysis lesions:5, fibular shaft:1), one transtrochanteric fracture and 1 patellar fracture.

All patients were operated on under constant radiographic control. A cast was applied, post-operatively, to all patients, for a period of 3–4 weeks. Gradual and assisted weight-bearing and ambulation, was commencing immediately after the cast removal.

All patient’s (with the exception of 1 case of delayed callus formation) post-operative period was completely normal. However, follow-up revealed the development of osteolytic lesions (bone absorption cysts) in 3 of our patients. All lesions were located in the border between epiphysis and metaphysis, at the exact position were the PLLA screws had been placed.

The use of PLLA implants in the treatment of fractures renders unnecessary a second operation for the removal of the osteosynthesis’ material. Nevertheless, we should be quite reluctant when deciding to use the PLLA screws in the treatment of these fractures in the developing skeleton, especially of the lower limbs, were the applied weight bearing forces are quite powerful.

Introduction: The cause of idiopathic scoliosis remains unknown, although research has possibly eliminated some hypothetical causes.

The fact that many patients with idiopathic scoliosis appear to be out of balance, has led many researchers to postulate that a brain stem abnormality involving the vestibular system in the cause of this condition.

Material and Methods: Forty – five female patients 12 to 14 years old (mean age 13.5) with right thoracic idiopathic scoliosis (scoliotic curves:20°–40°, study group) and 31 non-scoliotic healthy subjects in the same age group (mean age=13.1, control group) were included in this study.

An electronystagmographic study of labyrinthine function with caloric stimulation was performed in all patients. The nystagmus was recorded with the electronystagmographic technique (ENG) using Hartmann device. The recordings were performed in a dark, silent room with the tested subject in the supine position and with it’s eyes closed.

We evaluated: the frequency, the amplitude and the slow phase velocity of nystagmus.

The differences in labyrinthine sensitivity were evaluated with the use of unilateral weakness parameter, while differences in left – and right – beating nystagmus evaluated by estimating the directional preponderance parameter.

Results: No one children of the study presented spontaneous or positional nystagmus.

Nineteen patients from the study group (44.2%), revealed unilateral weakness (difference between left and right labyrinth > 20%) of the left labyrinth.

Seventeen patients from the study group (39.5%) revealed directional preponderance of the right-beating nystagmus. These differences were statistical significant (p< 0.05, Chi-Square test). Seventeen patients from the study group revealed both left unilateral weakness and directional preponderance of the right labyrinth, while two patients revealed only left unilateral weakness. A significant correlation was found between the degree of the curvature and the percentage of unilateral weakness.

Conclusion: It is very difficult to draw any conclusions as to whether a vestibular imbalance may be a contributory factor to adolescent idiopathic scoliosis or whether the vestibular findings are secondary to the spine deformity.