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.
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.
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
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.
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.
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.
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.
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.
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.