Purpose: To study the development of the hip and the relationship of radiological angles between acetabulum and proximal femur in children 0–3 years and thus the influence of walking and weight bearing on hip development.

Material and Methods: A study mesuring radiological angles in antero-posterior X-rays of pelvis in 334 children between 0 a 3 years of age (1997–2005), including acetabular index (AI) and physeal proximal angle (PPA (Alsberg’ angle) with goniometer (error ± 1°). Patients with pelvis or femur fractures or inflammatory diseases were excluded. Age distribution was of 1 (69.2%), 2 (22.2%) and 3 years (8.7%). 36.8% were males and 63.2% females. Descriptive statistics, T- test, Spearman correlation and ANOVA were used. Level of significance p< 0.05.

Results: The mean AI was 20.2°, 19.9° and 17.3°, in 1, 2 and 3 years. The AI angle diminishes significatively in children older than 2 years of age (p = 0.002). The mean PPA was 79.5°, 74.9° and 74.2°, in 1,2 y 3 years respectively. The Alberg’s angle reduced significatively at 1 year of age (p = 0.0005). AI and PPA was higher in females after 1 year of age (p = 0.02 and p = 0.04). There are not significative correlation between AI and Alsberg’ angle in different groups of children (r = 0.03). The age was important factor in both angles changes (p = 0.0005), but female patients (p = 0.002) and left side (p = 0.02) influenced only in AI.

Conclusions: AI and PPA angles reduced with age specially in 2 and 1 year, respectively, suggesting the effect of weight bearing and walking on hip shape. There was not relation between both angles in different groups of age.

Purpose: In paediatric patients, autografts are limited by the quantity of available bony tissue in donor regions, the need for a second incision, the longer surgical time, and donor site morbidity. Bone substitutes would be an advantage in many cases. Serum and platelet autologous growth factors favouring osteo-induction can be obtained readily. When used in conjunction with osteoconductive materials, they can favour bone growth. The purpose of this work was to evaluate the use of combined autologous growth factors (AGF) and hydroxyapatite (HA) in paediatric patients instead of autologous grafts.

Material and methods: This prospective study was conducted in 14 children (16 grafts), nine boys and six girls, mean age 9.4 years. These children required bone grafting related to femoral osteotomy, osteomyelitis, benign cystic tumours, bone nonunion, triple arthrodesis with osteopenia, and insufficient autologous graft material. The AGF-HA combination with human thrombin was used in all cases. AGF was prepared after fractioning autologous blood according to the child’s blood volume, height and weight. A platelet ultraconcentrate was added to thrombin (500 IU) and HA (500 R) at the time of implantation. Mean preparation time was 20 minutes. An autologous graft was not used in any of the children.

Results: There were no cases of superficial or deep infection after implantation. Bone healing as assessed clinically and radiologically was obtained in eleven weeks on average (range 8–16) except in two cases (11%).

Discussion: The AGF-HA combination is a useful alternative to autologous bone grafting in children. It is a simple technique which accelerates bone healing and HA integration. There were no cases of rejection.

Conclusion: 1) In children, this method is a valid alternative which avoids the need for bone harvesting and the corresponding morbidity. 2) Use of AGF-HA in combination does not transmit infection, does not lengthen surgery time, and is an interesting alternative to autologous or heterologous bone grafting.

Aims: To study the clinical and radiological result of arthroreisis with Giannini’s endo-orthotic implant in the treatment of paediatric flat-foot. Methods: 65 cases were studied in 37 patients, 60% were males and 40% females. The follow-up was 26.5 months. The total average age was 9.4, range of 5 and 14 years old. Surgery in patients that had suffered fractures, inflammatory, rheumatic or neurological processes was contraindicated. We studied: pain, functional and sport activity, as well as the development of radiographic measurements at 3, 6 and every 12 months after the operation. Results: Pain improved from preoperative 60% to postoperative 6.2%. The percentage of postoperative footprint was normal in 58.5% of the cases and first degree flatfoot in 41.5%. Postoperative sport activities were taken up by 49.2% of the patients. The 8 mm endoorhotic implant was the most used (66%). We performed Achilles tenotomy in 58.5% of the cases. The radiographic angles whose correction was greater with regard to the preoperative angle were: talar- first metatarsal (96%) and calcaneal- pitch (34%). Postoperatively the endo-orthotic implant-talus angle had an influence on the rest of the radiographic measurements. There was no postoperative deterioration in any of the radiographic angles measured in the monitoring period. Complications: we had 10.7%, with postoperative pain as a most frequent (6.2%). There was no infection or local reaction to a foreign body. We did not remove the endoorthotic implant systematically. Conclusions: 1) Footprint became normal in over half the cases; 2) radiological morphology was corrected 2/3 of the cases and it did not alter throught follow-up; 3) surgical technique respect anatomical structure of the foot, without medial surgical time.