Purpose: We reviewed our pre-puberty patients whose scoliosis or kyphoscoliosis involved a hemivertebra. The purpose of our work was to evaluate the surgical technique used and evaluate spinal static as well as functional outcome at skeletal maturity.

Material and methods: This retrospective analysis included 21 patients who underwent surgery before the age of 10 years and were followed to skeletal maturity. We excluded children with a multiple malformation syndrome or multiple vertebral malformations. The type and localisation of the hemivertebra was noted. Deformation, transversal balance, and radiographic measures were recorded preoperatively. Elements contributing to the indication for surgery, the type of procedure, and complications were also recorded. Events recorded during growth were the clinical course, complementary treatments, and possible surgical revision. Functional and aesthetic outcome was assessed at last follow-up. Spinal deviation was measured and compared with the preoperative angles.

Results: Twenty-one children (13 girls, 8 boys), mean age three years ten months (range 10 months – 10 years) met the inclusion criteria. These children had a hemivertebra of the thoracic spine (n=9), the thoracolumbar junction (n=4), the lumbar spine (n=4), or the lumbosacral region (n=4). Surgery was indicated to arrest clinical and radiographic degradation. Several surgical procedures were used: fusion without resection for thoracic vertebrae and resection associated with arthrodesis or epiphysiodesis for other localisations. There were five complications: neurological (n=2), infectious (n=2) and disassembly (n=1). The clinical and radiographic course led to revision in ten children, including two who required a new operation. At mean follow-up of 14 years (9–23 years), the functional outcome was good in 19 patients, poor in one patient with a lumbosacral hemivertebra and in another with a thoracic hemivertebra. The aesthetic result was good in 16 patients. Five of the nine patients with a thoracic hemivertebra remained unsatisfied with the outcome. Mean curvature correction ranged from 26% at the thoracic level to 50% at the thoracolumbar and lumbosacral levels and 75% at the lumbar level.

Discussion: The long follow-up of this series is exceptional. Treatment of evolving spinal malformations is a difficult challenge. Early surgery does not guarantee the final outcome and 50% of patients have to be reoperated at the end of growth. The good long-term functional and aesthetic outcome is however encouraging, particularly when hemivertebrectomy can be performed.

Purpose: Pelvic girdle fractures with vertical and horizontal instability (Tile classification class C) are classical indications for surgical stabilisation of the posterior and anterior lesions. There is general agreement concerning the anterior fixation, but several methods have been described for the posterior fixation: open or percutaneous sacroiliac screwing using fluoroscopic or computed tomographic guidance, sacral compression bar applied laterally on the posterior iliac masses, sacral screw for sacroiliac fixation using the Galveston technique, among others.

Material and methods: We propose a new sacroiliac fixation technique for fractures of the pelvic girdle associating vertical and horizontal instability (Tile classification class C). This fixation technique controls vertical displacement while authorising, if needed, a certain degree of mobility in the horizontal plane allowing easier reduction of the anterior fracture. This technique uses two sacral screws, one in S1 and the other in S2, and two iliac screws. The iliac screws are inserted in the posterior iliac crest passing through two sacroiliac connectors placed on a rod connecting the two sacral screws. Vertical displacement is controlled by blocking the two connectors on the screw heads. If needed, the connectors can be left unblocked allowing a certain degree of freedom for moving the half-pelvis in the horizontal plane.

Results: This technique was used in four cases. Anatomic reduction was achieved. There was no secondary movement of the osteosynthesis material and no secondary displacement. Because of the quality of the fixation, the sitting position was allowed rapidly as was full-weight bearing and walking. This type of fixation is reserved for type C12 fractures of the Tile classification.