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.

The cause of Legg-Calve Perthes disease, 97 years after its original description remains undefined. In the present study we examined factors, which were correlated with a favourable or negative impact on the outcome of surgical treatment.

From a total of 98 children, treated during the period 1994–2006, we studied 20 cases (classified as Catterall III and IV), treated surgically. The average age was 7.4 years (4–13 years). We studied in comparison the most common procedures performed: these were the varus femoral osteotomy (12) and the lateral shelf acetabuloplasty (7). The subtrochanteric osteotomy yielded superior radiological results Stuhlberg I–II (I:6, II:6), than the lateral shelf procedure Stuhlberg II–IV (II:3, III:3, IV:1). The clinical results were similar between the two groups according to the Barrett scale, excellent or good.

Regarding the subtrochanteric osteotomy the most important factor was the precise varisation of the femoral neck and secondly the timing of surgical treatment early during the fragmentation stage of the disease, before the femoral head is significantly distorted. The most important positive factor regarding the lateral shelf procedure appears to be the accuracy of the surgical technique, in order that the graft coverage of the femoral head is accurately placed on the hip capsule. Negative factor for the lateral shelf procedure in one case was early weightbearing, which resulted in collapsing of the femoral head. It appears that with extensive necrosis (Caterall IV) the femoral head isn’t biomechanically enough resistant with this procedure to resist loads that result from early ambulation.

Pes equinovarus is a multi-factorial congenital disease that involves 1/1000 births, is bilateral in half of the cases and affects usually male children.

From 1995 – 2008 we have treated in total 172 children with pes equinovarus, 116 male and 56 female with age from 1 week to 4 years-old. There was bilateral pes equinovarus in 36 children whereas unilateral disease revealed equal rate of incidence. All children were treated initially with corrective casts and sequentially 122 children had surgery consisting of Achilles tendon lengthening and posterior capsulotomy, whereas in the rest of the cases was necessary medial hind foot structures and tendons release.

Final correction with only one operation were achieved in 108 children, there were pes equinovarus recurrence in 18 children that was treated with new soft tissue operation whereas 3 children had to undergo some kind of osteotomy in a later time. The recurrence time varied from 30 months to 13 years. The treatment was successful in 70% of the cases and 30% of them needed more than one operation for achieving a satisfactory functional result.

Pes equinovarus is a severe condition that now-a-days can be early diagnosed even in fetal life, but leads to significant handicap if left without treatment. In our department there were successful rates similar to international reports. The importance of an established long-term follow up of children that were operated for pes equinovarus is the keystone of a successful outcome and the early treatment is mandatory.

The purpose of our study is to report the incidence of osteomyelitis during the last 10 years in our department. Diagnosis, management and follow-up are also discussed.

We carried out a retrospective study on 40 children who were hospitalised in our clinic between the years 1995–2006 suffering from osteomyelitis. There were 29 male and 11 female children with a mean age 6.8 years. A full blood count, CRP, ESR were measured and X-rays and ultrasound were performed in all patients. Blood cultures were also taken. Additionally, bone scan and CT scan were also performed in 6 and 3 children respectively. The lesion involved in 7 cases the tibia, 9 cases the lower end of the femur and the knee joint, 4 cases the head of the femur and the hip, 7 cases the patella, 4 cases the neck of the humerus, 3 cases the lower end of the fibula, 3 cases the 5th finger of the hand, 2 cases the 4th and 5th metatarsal bones and in 1 case the clavicle. All patients were initially commenced to double antibiotic scheme iv. The microorganisms isolated were Staphylococcus Aureus (27 children-67.5%), Pseudomonas Aeruginosa (9 children-22.5%), Streptococcus Pneumoniae (4 children-10%)

The majority of children (80%) were managed conservatively with intravenous and then oral antibiotic therapy. In 8 cases (20%) surgical debridement was performed due to persisting symptoms and/or aggressive radiologic appearance of the lesion. The mean days of hospitalisation were 17.4 days/patient. A 1.2 year mean follow-up was achieved in all the above patients. All children gradually improved and became pain free, while complete bone resolution appeared in the X-Rays.

Staphylococcus aureus remains the most common organism causing acute osteomyelitis. If left untreated the condition can lead to serious sequelae. The optimal approach in uncomplicated cases may be a combination of aspiration for diagnostic purposes and prolonged antibiotic therapy. A patient’s lack of response to antibiotic treatment and evidence of aggressive radiologic features are indications for surgery.

Acute osteomyelitis (OM) and septic arthritis (SA) are two issues of great concern and debate for the pediatric orthopaedic surgeon.

Our purpose is to study the frequency of both diseases in the current years in comparison to the past, as well as other parameters that affect their progress such as time between the onset of the disease and the admission to the hospital, and pathogens that are found in pus and types of therapy.

Three periods were studied: Period A: years 1963–1975, Period B: years 1975–1983, Period C: years 2000–2005. In total, there were 451 patients suffering from OM and SA in Period A, 208 cases in Period B and 95 cases in Period C.

OM is found most often in the femur (A: 34.91%, B: 32.32%, C: 54.54%) and the tibia (A: 43.27%, B: 43.43%, C: 13.63%). SA is found mostly at the knee (A: 17.46%, B: 42.70%, C: 47.76%) and the hip (A: 50%, B: 37.50%, C: 41.79%) joints. A great percentage of patients in Period A (36.80%) are admitted to hospital very late (> 20 days from the onset of the disease); this number falls dramatically in Period C. There is, on the other hand, early admission to hospital (< 3 days) in period C (C: 74.73% versus A: 13.08%). No significant difference among age groups is apparent; 6–11 years of age are the most frequent. Staph. aureus has always been the most usual pathogen found in pus in the majority of cases. A great number of patients in Period A are admitted to hospital being already under antibiotic therapy (60.58%). This percentage falls in Period C (11.57%).

A decrease in the frequency of OM and SA in the recent years is obvious. Most of the patients are admitted early to hospital and due to this event, there is significant improvement concerning the complications from the diseases, in comparison to the past.

The purpose of this paper is the overview of 92 cases with slipped capital femoral epiphysis (S.C.F.E.), treated in inic within the last 18 years (1985–2003).The paper reports the method of treatment and early complications concerning ischaemic necrosis and chondrolysis.

During this time, 80 children with S.C.F.E. aged 10–14 years, were treated in our clinic.Of our patients, 50 were boys and 30 girls.With regard to the degree of the slippage, 59 cases 1st degree, 32 were 2nd degree and 1 was 3rd degree;as regards the type, 63 cases were chronic, 17 acute and 12 chronicacute.They were treated surgically by pinning (use of 2 or 3 Moore-Knowls, Steinmann pins and cannulated screws) while in one case osteotomy of the femoral neck was performed.In 11 cases with 2nd degree slippage, total or partial reduction took place on the surgical table,with mild traction and strong internal rotation of the limb.In addition, in 20 cases cannulation was performed.

There has been a follow-up period of 1–10 years after surgery.

Complications: In 11 hips (in most of which Steinmann pins had been used) occurred slippage of the material inside the joint and the pin was removed (within 2 weeks).During follow-up no signs of either vascular necrosis or chondrolysis were present, with the exception of one case with 2nd degree S.C.F.E. where reduction was also attempted.

In total, 2 cases of chondrolysis occurred, in one of which signs of chondrolysis were present even before surgery, and 2 cases of vascular necrosis.The results were evaluated on clinical criteria (limping, pain, reduction in length, range of movement of hip joint) and radiological criteria (articular space, appearance of the femoral head, neck-femoral angle).

Conclusion: It seems to be that any attempt of reduction, even with mild traction, is responsible for serious complications. On the contrary, pin slippage inside the joint does not seem to lead to a poor result, provided that there is early diagnosis and immediate removal of the pin. Finally, it must be stressed that the complications in the 4 cases of either chondrolysis or vascular necrosis, occurred in patients whose weight exceeded by 25–30 % what is normally expected at their age and height.

Fracture separation of the distal epiphysis of the tibia constitutes 10% of all epiphyseal fractures occurring in children. We studied 120 cases, which were treated stationary at our Department over the 10 year period between 1990 – 2000. The ratio between boys and girls was 2:1. The average age was 12,5 years (8–15 years). In 96 cases (80%) the injury occurred after a fall on the playground, in 12 cases (10%) after a roadtraffic accident and in 12 cases (10%) after a fall from a height. The average follow up is 7,2 years (2–12 years). According to the Salter-Harris classification 6 cases (5%) were Salter I, 90 cases (80%) were Salter II, 9 cases (9%) were Salter III and 6 cases (5%) were Salter IV. In all cases a closed reduction under general anaesthesia was attempted. If the reduction was succesful a whole leg plaster was applied. If the reduction was unstable a transcutaneous stabilisation or open reduction and internal fixation was performed. If a reduction could not be acchieved open reduction and internal fixation (ORIF) was performed using Kirschner wires or screws. Closed reduction was performed in 94 cases (78,34%), transcutaneous osteosynthesis in 2 cases (1,66%) and ORIF in 24 cases (20%).

We conclude that sports and for instance football is the main cause, where this injury occurs. The treatment is mainly conservative and complications are rare, when anatomical reduction is acchieved. The most common complication is angulation resulting from the injury at the epiphyseal plate, for instance varus angulation, which occurs from supination injuries mainly of Salter-Harris type III and IV.

Fracture of the lateral humeral condyle accounts for approximately 15% of all elbow fractures in children.

We studied 68 fractures of the lateral humeral condyle, which were treated surgically over a period of six years during 1994 to 2000. There were 49 boys and 19 girls. The average age was 6,5 years (2,5 – 13 years). All cases were treated with open reduction and internal fixation with two divergent K-wires for safer stabilisation of the fracture. Subsequently a cast was applied for 4–6 weeks to the radiological union of the fracture, where the K-wires were removed.

The patients were evaluated with clinical and radiological criteria. Sixty-five cases were classified as Milch type II fractures and three were Milch type I fractures. According to the Jacob classification, which records the degree of displacement, 23 cases were type II fractures and 45 cases were type III fractures. The mean follow up was 4 years (2–8 years). Analysis of the postoperative radiographs showed that radiological union was achieved in all cases. The mean time to radiological union of the fracture was 4,5 weeks (3–8 weeks). At latest follow up we observed abnormalities of the shape of the distal humerus due to overgrowth of the lateral humeral condyle in 40% of the cases. In 4 patients we observed pseudocubitus varus due to overgrowth of the lateral humeral condyle and in 3 patients we observed mild cubitus varus (< 5°). Clinically in all cases there was painless free movement of the elbow.

We conclude that satisfactory anatomical reduction of the fracture gives good clinical results. The radiological abnormalities observed seem not to play an important role in the final result.