Purpose

Ultrasound of the neonatal and infantile hip is a useful tool in diagnosis and treatment of the developmental dysplasia of the hip (DDH), especially given the fact that numerous cases of DDH do not present any findings in the clinical examination.

Introduction

Early identification and conservative management of paediatric Monteggia fractures has been shown to correlate with good results. Nevertheless, several authors advocate more aggressive management with open reduction and internal fixation (ORIF) for unstable fractures. We herein present the experience of a tertiary paediatric hospital in the management of Monteggia fractures.

Introduction

Lateral humeral condyle fractures account for 17% of the distal humeral condyle fractures. They affect children between 5 and 10 years of age. Recent reports advocate closed reduction and internal fixation for the less displaced fractures.

Introduction

The incidence of spondylolysis is estimated about 5–6% in the general population and accounts for one of the most frequent cause of backpain in the adolescent. The purpose of this study is to present our results from the management of these patients.

Grice-Green subtalar arthrodesis was initially reported to correct valgus hindfoot deformities in patients with poliomyelitis. Nowadays, the indications of the Grice-Green arthrodesis have been significally broadened. The aim of this study is to analyse the indications of treatment and evaluate the results of the Grice-Green arthrodesis in children.

During the period 1986–2006, 17 children with valgus hindfoot deformities were treated in our department. In 12 of them the procedure was performed in both feet and in the rest (5 patients) unilaterally. The mean age at operation was 8.8 years. The most common group of patients suffered from cerebral palsy (10 patients), followed by the patients suffering from myelomeningocele (4 patients), 2 patients suffered from overcorrection following treatment of congenital equinovarus and one patient from Charcot Marie Tooth disease. In neine patients the operation was combined with Achilles tendon lengthening, capsulotomies, tendon transfers, tendonotomies, and Evans arthrodesis. In all operations bone graft from the tibia or the fibula was used. Postoperatively a balow knee non weightbearing cast was applied for 8 weeks followed by a weightbearing cast for 4 weeks. The results were avaluated according to Alman and Zimbies criteria. The mean follow up of the patients was 4.2 years. The results in 24 feet were considered excellent and in 5 cases satisfactory. In all cases subtalar arthrodesis was achieved.

Grice-Green arthrodesis is a very useful operative technique for the correction of severe valgus hindfoot deformities in children. The results of the technique are usually good and the operation does not influence the normal growth of the foot. An accurate preoperative planning and a good surgical technique is neccesary for good results.

Since the commencement of the Neuromuscular-Unit in the Children’s-Hospital “Agia Sofia”, from December 2002 until December 2008, 306 patients were examined suffering from different neuromuscular diseases (ND). In the present study we examined

the frequency of spine deformities,

From the analysis of our material we found that 152 patients were suffering from Duchenne’s-Becker muscular-dystrophy, 59 patients from spinal-muscular-atrophy I-III, 13 patients from fascioscapulohumeral muscular-dystrophy, 15 patients from hereditary motorsensory-neuropathies, 5 patients from Friedreich’s Ataxia and 62 patients from different types of dystrophinopathies–myopathies. The ages of the patients varied between 8 months and 37 years.

From the total, 89% of the patients above 10 years presented with spine deformities. Most of them were managed with wheelchairseating modifications and 33 patients were fitted with braces in an attempt to slow curve progression. Surgically were managed 24 patients with spine arthrodesis, 5 of them abroad (USA-Eng-land-France). The older patients (> 17 years wheelchair-bound) were frequently, because of impaired general health, not suitable candidates for surgery.

Pulmonary function was examined in 84 patients suffering from Duchenne’s muscular dystrophy. The crucial age, were pulmonary function has fallen dramatically (FVC< 40%), was between ages 12–15 years.

In conclusion spine deformities are very common in patients suffering from neuromuscular diseases. Because of the rapid deterioration of the general health of these patients spine arthrodesis should be performed early, in the patients severely affected, between ages 12–15 years

Purpose: There is great interest recently,among Orthopaedic surgeons about Minimally Invasive Surgery (MIS) in knee arthroplasty.We present a retrospective,randomized review of 50 patients,who had their knees replaced during a period of a year and show our experience in indications,surgical technique,early results and comparison to conventional surgery.

Method: Using regional anaestesia and an incision of about 9cm (7–11cm), the components are placed without patellar eversion.We briefly describe regional anatomy in relation to surgical technique.We compare early results using MIS to standard procedure,regarding pain,function and rehabilitation and describe pros and cons of the method.

Results: Early results show faster recovery time, less post-operative pain and effusion and quicker return to normal activities.There were no skin problems. 96% of the knees that recieved MIS had good to excellent KSS and KS scoring Systems score.We certainly need longer results and better experience because the method is technically challenging. Smaller surgical tools are also needed in order the technique becomes better and easier for the surgeon.

Purpose: To evaluate the diagnostic parameters for detection of pelvic bone infections and to present the results of conservative and operative treatment.

Materials-methods: 17 children with acute osteomyelitis of the pelvis or septic sacroiliitis were treated from 1992 to 2000. They were followed-up for 1,5 to 8 years.

10 patients presented with leukocytosis. In 15 patients ESR exceeded 40 mm and in 10 patients CRP exceeded 20 mg%. Blood cultures yielded Staphylococcus aureus in 6 cases and Streptococcus in one. In only 2 cases were plain X-Rays suggestive of infection. Every patient had a positive Tc99m MDP bone scan (increased absorption), which permitted localization of the infection. Furthermore, MRI was performed on 12 patients, yielding abnormal findings in all cases.

All patients received antistaphylococcal antibiotics intravenously for 10–14 days, followed by a further 3–8 week course per os, depending upon the response to treatment. Treatment started with considerable delay for 3 patients; they all were submitted to surgical drainage and debridement.

Results: All patients were normal at clinical follow-up by the end of treatment. By the end of follow-up no signs of osteomyelitis or residual deformity appeared.

Conclusions: The usual laboratory and radiological investigations can be misleading. Tc99m MDP bone scan and MRI permit prompt diagnosis and localization of the infection. With the appropriate antibiotics the clinical results are usually excellent, provided that the disease is diagnosed without delay. Surgical drainage and debridement is necessary in cases of delayed or missed diagnosis.

In many cases, treatment of intercondylar T- or Y- fractures of numerous is complex, technically difficult and consideration to many factors is needed.

The purpose of this study was to review the results of treatment in 20 isolated fractures in 20 patients that were operated between 1991 and 2001. All patients were operated as soon as possible after the laboratory studies were completed. In no case there was a delay beyond the 5th fracture day. The mean age of the patients was 48.4 years and men to women ratio was 6/1. The fractures were closed, type III according to Riseborough and Radin classification. In 8 cases the fracture was fixed with one 3.5 compression plate with lag screws. In 12 cases two 3.5 compression plates oriented in two planes at 90° angles to each other were needed for fixation. The posterior approach included chevron osteotomy of the olecranon and exposure of the ulnar nerve. Minimum follow up period was 9 months. The time needed for the sound union of the fracture, range of motion and elbow axis were some of the factors that were examined.

Five of the eight fractures that were fixed with one plate achieved union in the expected period of time. In two cases delayed union and malalignment was noticed without the need for surgical intervention. In one case grafts were needed to help the union of the osteotomy site. We had one case of myossitis ossificans. All fractures that were fixed with two plates achieved union without any complications. In one case there was a 30° extension lag of the elbow. The rest of the patients, in both groups had a satisfactory range of motion with an extension lag less than 10°.

Conclusions: dual plate fixation of these fractures has a lower non union rate, permits secure fixation, earlier rehabilitation and generally, is superior than one plate fixation.

Achilles tendinitis can result, through inflammatory procedures, to tendon degeneration with microtears and nodules. Current conservative or surgical treatment of this lesion proved to be not effective enough. The reason for this is the absence of sufficient oxygenation in the area. In this study we report the results of a novel technique which tries to improve local vascularity.

We operated on 15 mature rabbits after they were anasthetized. Soleus fibers were trasplanted in the right achilles tendon. A lesion, 10mm long and 2mm wide was created in the inner band of the tendon simulating tendinitis. In the left achilles tendon the same procedure was done without transplantation. The rabbits were divided in three equal groups and were sacrificed in the first week, the 2nd and 3rd month after the operation. Histopathologic examination was done in both achilles tendons. The following parameters were assessed: transplanted muscle viability, inflammation and neoangiogenesis. We also evaluated the contact between muscle and tendon and the quality of tissue that was formed in the tendinitis simulating area.

Inflammatory process was noticed only in the 1st week after surgery. In the other groups viable muscle fibers and tendon tissue was observed. Muscle fibers were in contact with the tendon. The quality of tissue in the tendinitis simulating area was of better quality than in the control group.

We conclude that soleus transplanted muscle fibers in the rabbits achilles tendon seem to be oxygen carriers and improve the healing potential of the area. This fact results in tendon reinforcement.