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Bone & Joint Open
Vol. 5, Issue 7 | Pages 581 - 591
12 Jul 2024
Wang W Xiong Z Huang D Li Y Huang Y Guo Y Andreacchio A Canavese F Chen S

Aims

To investigate the risk factors for unsuccessful radial head reduction (RHR) in children with chronic Monteggia fractures (CMFs) treated surgically.

Methods

A total of 209 children (mean age 6.84 years (SD 2.87)), who underwent surgical treatment for CMFs between March 2015 and March 2023 at six institutions, were retrospectively reviewed. Assessed risk factors included age, sex, laterality, dislocation direction and distance, preoperative proximal radial metaphysis width, time from injury to surgery, reduction method, annular ligament reconstruction, radiocapitellar joint fixation, ulnar osteotomy, site of ulnar osteotomy, preoperative and postoperative ulnar angulation, ulnar fixation method, progressive ulnar distraction, and postoperative cast immobilization. Independent-samples t-test, chi-squared test, and logistic regression analysis were used to identify the risk factors associated with unsuccessful RHR.


The Bone & Joint Journal
Vol. 101-B, Issue 9 | Pages 1160 - 1167
1 Sep 2019
Wang WT Li YQ Guo YM Li M Mei HB Shao JF Xiong Z Li J Canavese F Chen SY

Aims

The aim of this study was to clarify the factors that predict the development of avascular necrosis (AVN) of the femoral head in children with a fracture of the femoral neck.

Patients and Methods

We retrospectively reviewed 239 children with a mean age of 10.0 years (sd 3.9) who underwent surgical treatment for a femoral neck fracture. Risk factors were recorded, including age, sex, laterality, mechanism of injury, initial displacement, the type of fracture, the time to reduction, and the method and quality of reduction. AVN of the femoral head was assessed on radiographs. Logistic regression analysis was used to evaluate the independent risk factors for AVN. Chi-squared tests and Student’s t-tests were used for subgroup analyses to determine the risk factors for AVN.


The Bone & Joint Journal
Vol. 96-B, Issue 11 | Pages 1556 - 1560
1 Nov 2014
Canavese F Charles YP Dimeglio A Schuller S Rousset M Samba A Pereira B Steib J

Assessment of skeletal age is important in children’s orthopaedics. We compared two simplified methods used in the assessment of skeletal age. Both methods have been described previously with one based on the appearance of the epiphysis at the olecranon and the other on the digital epiphyses. We also investigated the influence of assessor experience on applying these two methods.

Our investigation was based on the anteroposterior left hand and lateral elbow radiographs of 44 boys (mean: 14.4; 12.4 to 16.1 ) and 78 girls (mean: 13.0; 11.1 to14.9) obtained during the pubertal growth spurt. A total of nine observers examined the radiographs with the observers assigned to three groups based on their experience (experienced, intermediate and novice). These raters were required to determined skeletal ages twice at six-week intervals. The correlation between the two methods was determined per assessment and per observer groups. Interclass correlation coefficients (ICC) evaluated the reproducibility of the two methods.

The overall correlation between the two methods was r = 0.83 for boys and r = 0.84 for girls. The correlation was equal between first and second assessment, and between the observer groups (r ≥ 0.82). There was an equally strong ICC for the assessment effect (ICC ≤ 0.4%) and observer effect (ICC ≤ 3%) for each method. There was no significant (p < 0.05) difference between the levels of experience.

The two methods are equally reliable in assessing skeletal maturity. The olecranon method offers detailed information during the pubertal growth spurt, while the digital method is as accurate but less detailed, making it more useful after the pubertal growth spurt once the olecranon has ossified.

Cite this article: Bone Joint J 2014;3:1556–60


The Bone & Joint Journal
Vol. 96-B, Issue 3 | Pages 354 - 359
1 Mar 2014
Khan A Samba A Pereira B Canavese F

The ideal treatment for traumatic anterior dislocation of the shoulder in the skeletally immature patient is controversial. The aim of this study is to evaluate the outcomes after either conservative and/or surgical treatment using the Latarjet technique. A retrospective series of 49 out of 80 patients were reviewed. We found no significant differences between either treatment method regarding functional scores and pain levels. Although not statistically significant, post-surgical patients showed better signs of shoulder stability than others who have a higher rate of recurrence. Further, 92% of the post-surgical group had returned to the same level of activity versus 52% in the non-surgically treated group. We found no contraindications to operate on a skeletally immature patient.

Cite this article: Bone Joint J 2014;96-B:354–9.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 237 - 237
1 Jul 2008
DIMEGLIO A CANAVESE F
Full Access

Purpose of the study: Special care is warranted only for severe forms of Legg-Perthes-Calvé disease (LPCd) (Catterall 4, Herring B and C, Salter B, involvement > 50%). Should we propose specific treatment or simply monitor the inevitable disease course?

Material and method: Among a series of 485 hips with LPCd, 148 (30.5%) with massive involvement were identified. Ninety-six (64.9%)severe forms were analyzed at the end of growth. Magnetic resonance imaging, scintigraphy and arteriography were used to better assess the femoral head and identify hips at risk. These hips were treated surgically: Salter osteotomy (SA), triple pelvis osteotomy (TO), or varus osteotomy (VA). Three groups of infants were identified according to age at diagnosis of LPCd: less than 6 years, 6–9 years, more than 9 years. Outcome was considered good (Stulberg 1 and 2, Mose good), fair (Stulberg 3, Mose fair), or poor (Stulberg 4 and 5, Mose poor).

Results: There were 54 hips (56.3%) in the less than 6 years group, 26 (27.1%) in the 6–9 years groups, and 16 (16.6%) in the greater than 9 years group. Outcome was good for 45 hips (46.9%), fair for 22 (22.9%) and poor for 29 (31.2%) hips and was independent of age at onset of treatment. In the less than 6 years group, 54 hips (56.3%) were Catterall 4, Herring B or C, Salter B. Among the 24 Catterall 4 hips (44.4%) treated orthopedically, outcome was good for 15 (62.5%), fair for 7 (29.2%) and poor for 2 (8.3%). Among the 30 Cartell 4 hips treated surgically, outcome was good for 16 (53.3%), fair for 9 (30%) and poor for 5 (16.7%). In the 6–9 year group, 26 hips (27.1%) were Catterall 4, Herring B or C, Salter B. Among the 10 Catteral 4 hips treated orthopedically (38.5%), outcome was good for 3 (30%), fair for 2 (20%) and poor for 5 (50%). For the 16 Catterall 4 hips treated surgically, outcome was good for 8 (50%), fair for 2 (12.5%) and poor for 6 (37.5%). In the greater than 9 years group, there were 16 (16.6%) Catterall 4, Herring B or C, Salter B hips. Among the 10 Catterall 4 hips treated orthopedically, outcome was good for 1 (10%), fair for 2 (20%) and poor for 7 (70%). Among the 6 Catterall hips treated surgically, outcome was good for 2 (33.3%), fair for 0 and poor for 4 (66.7%).

Conclusion: Good outcome decreases with age. Surgery increases the rate of good outcome in all age groups, but before the age of six years, there is no significant difference between orthopedic and surgical treatment. Before six years, spherical heads (Stulberg 1 and 2) were achieved in six out of ten hips in the 6–9 year group and in only two of ten in the group aged over 9 years.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 7 | Pages 940 - 945
1 Jul 2008
Canavese F Dimeglio A

Children presenting with Perthes’ disease before their sixth birthday are considered to have a good prognosis. We describe 166 hips in children in this age group. The mean age at onset of the disease was 44 months (22 to 72). Mild forms (Catterall I and II) were treated conservatively and severe forms (Catterall III and IV) either conservatively or operatively. The aim of the former treatment was to restrict weight-bearing. Operative treatment consisted of innominate osteotomy and was indicated by a Conway type-B appearance on the bone scan. All the patients were followed to skeletal maturity with a mean follow-up of 11 years (8 to 15).

The end results were evaluated radiologically using the classifications of Stulberg and Mose. A total of 50 hips were Catterall grade-I or grade-II, 65 Catterall grade-III and 51 Catterall grade-IV. All hips with mild disease had a good result at skeletal maturity. Of the hips with severe disease 78 (67.3%) had good (Stulberg I and II), 26 (22.4%) fair (Stulberg III) and 12 (10.3%) poor results (Stulberg IV and V). Of the Catterall grade-III hips 38 were treated conservatively of which 31 (81.6%) had a good result, six (15.8%) a fair and one (2.6%) a poor result. Operative treatment was carried out on 27 Catterall grade-III hips, of which 21 (77.8%) had a good, four (14.8%) a fair and two (7.4%) a poor result. By comparison conservative treatment of 19 Catterall grade-IV hips led to ten (52.7%) good, seven (36.8%) fair and two (10.5%) poor results. Operative treatment was carried out on 32 Catterall grade-IV hips, of which 16 (50.0%) had a good, nine (28.1%) a fair and seven (21.9%) a poor result.

We confirm that the prognosis in Perthes’ disease is generally good when the age at onset is less than six years. In severe disease there is no significant difference in outcome after conservative or operative treatment (p > 0.05). Catterall grade-III hips had a better outcome according to the Stulberg and Mose criteria than Catterall grade-IV hips, regardless of the method of treatment.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 237 - 237
1 Jul 2008
CANAVESE F DIMEGLIO A
Full Access

Purpose of the study: The appropriate treatment for Legg-Perthes-Calvé disease (LPCd) remains a subject of debate. Certain teams consider orthopedic treatment adequate. Others advocate surgery to improve prognosis. Is surgery necessary? When is the proper time? We reviewed retrospectively 91 surgically treated hips (Salter osteotomy or triple pelvis osteotomy) at the end of growth.

Material and methods: Among 485 hips with LPCd, 349 (71.9%) presented massive involvement (Catterall 3 and 4, Herring B and C, Salter B). Ninety-one patients with severe disease were reviewed at the end of growth. Complementary explorations included magnetic resonance imaging, scintigraphy and arteriography using the Dias protocol which enables an assessment of the excentration and the femoral head deformation and identifies hips at risk. Surgical treatments were Salter osteotomy (SA) or triple osteotomy (TO). Three groups were identified depending on the age at disease diagnosis: less than 5 years, 5–9 years, more than 9 years. Using the Stulberg and Mose classifications, outcome was considered good (Stulberg 1 and 2, Mose good), fair (Stulberg 3, Mose fair), or poor (Stulberg 4 and 5, Mose poor).

Results: There were 50 Carttell 3, Herring B, Salter B hips and 41 Catterall 4, Herring B and C, Salter B hips (80% boys). Distribution by group of age at diagnosis was: 34 (37.4%) less than 5 years, 48 (52.7%) 6–9 years, 9 (9.9%) more than 9 years. Salter osteotomy was performed on 32 hips (35.2%) and triple pelvic osteotomy on 59 (94.8%). Outcome at end of growth was: less than 5 years Catterall 3: 77% good, 15.4% fair, 7.6% poor; Catterall 4: 52.4% good, 33.3% fair, 14.3% poor; 6–9 years: Catterall 3: 70% good, 20% fair, 10% poor; Catterall 4: 55.5% good, 22.2% fair, 22.2% poor; more than 9 years: Catterall 3: 42.9% good, 42.9% fair, 14.2% poor; Catterall 4: 50% good, 50% poor.

Conclusion: Outcome worsens with increasing age at diagnosis. Despite surgery, a spherical femoral head (Stulberg 1 or 2) is achieved in only one hip Catterall 4 hip out of two. This result is observed in Catterall 3 hips only in children whose diagnosis is established after the age of nine years. Prognosis is better in Catterall 3 hips.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 3 | Pages 377 - 381
1 Mar 2008
Canavese F Gupta S Krajbich JI Emara KM

Our aim was to review the efficacy of the wound vacuum-assisted closure (VAC) system in the treatment of deep infection after extensive instrumentation and fusion for spinal deformity in children and adolescents.

A total of 14 patients with early deep spinal infection were treated using this technique. Of these, 12 had neuromuscular or syndromic problems. Clinical and laboratory data were reviewed. The mean follow-up was 44 months (24 to 72). All wounds healed. Two patients required plastic surgery to speed up the process. In no patient was the hardware removed and there was no loss of correction or recurrent infection.

We believe that the wound VAC system is a useful tool in the armamentarium of the spinal surgeon dealing with patients susceptible to wound infections, especially those with neuromuscular diseases. It allows for the retention of the instrumentation and the maintenance of spinal correction. It is reliable and easy to use.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_III | Pages 423 - 423
1 Oct 2006
Dimeglio A Canavese F
Full Access

Poor results increase in older patients. After Orthopaedic treatment 60% of hips in children with LPC Disease appearing before the age of 6 find again its sphericity (Stulberg 1 or 2). About 30 % of hips in children with LCP Disease appearing between 6 and 9 years of age became “normal” (Stulberg 1 or 2) at the end of growth/Only 1 hip out of 10, in the oldest group of children (over 9 years), became spherical at the end of growth. Surgery increases the percentage of good results in all groups of patients.