We present two children with massive defects of the tibia and an associated active infection who were treated by medial transport of the fibula using the Ilizarov device. The first child had chronic discharging osteomyelitis which affected the whole tibial shaft. The second had sustained bilateral grade-IIIB open tibial fractures in a motor-car accident. The first child was followed up for three years and the second for two years. Both achieved solid union between the proximal and distal stumps of the tibia and the fibula, with hypertrophy of the fibula. The first child had a normal range of movement at the knee, ankle and foot but there was shortening of 1.5 cm. The second had persistent anterior angulation at the proximal tibiofibular junction and the ankle was stiff in equinus

Aim

Case Report presentation of traumatic cartilage loss in a child.

Abstract. The specific methods of skeletal reconstruction of massive bone loss remains a topic of controversy. The problem increased in case of massive bone loss, extensive soft tissue scar, vascular compromise, and short tibial remnants. Aim of the work. We evaluate the use of fibula in association of Ilizarov external fixator in management of massive post traumatic bone loss of tibial shaft. Materials and methods. Between December 1999 and 2004, we treated 8 adult patients with bone loss 10 cm and more. The indication was massive bone loss, extensive soft tissue scar, vascular compromise, and short tibial remnants. Whole fibula was used in 6 conditions and partial fibula in 2. The average age was 30.5 years (range: 25:51). The fibulas were prepared for transfer either as a whole or partially transfer. Ilizarov device was applied with a special construct for each condition accordingly. Free latismus dorsi was applied in 1 patient, and fasciocutanious flaps in 2. Four patients with whole fibula transfer continued to wear orthosis for outdoor activities. Results. The mean follow-up period was 40 months (range: 24:96) after healing. All fractures heeled between 8 and 24 months. Conclusion. We concluded that the Ilizarov external fixator is effective in management of management of massive post traumatic bone loss of tibial shaft. It provides advantages of compensation of bone defects, length, and early rehabilitation. It has the disadvantages of long healing time, long orthotic support. Its advantages are clear in case of massive bone loss, extensive soft tissue scar, vascular compromise, and short tibial remnants

Aims

The aim of this study was to explore clinicians’ experience of a paediatric randomized controlled trial (RCT) comparing surgical reduction with non-surgical casting for displaced distal radius fractures.

In 1994, a register for cerebral palsy and a health-care programme were started in southern Sweden with the aim of preventing dislocation of the hip in children with cerebral palsy. It involved all children with cerebral palsy born in 1992 or later.

None of the 206 affected children born between 1992 and 1997 has developed a dislocation following the introduction of the prevention programme. Another 48 children moved into the area and none developed any further dislocation. Of the 251 children with cerebral palsy, aged between five and 11 years, living in the area on January 1, 2003, only two had a dislocated hip. One boy had moved into the area at age of nine with a dislocation and a girl whose parents chose not to participate in the programme developed bilateral dislocation. One boy, whose condition was considered to be too poor for preventative surgery, developed a painful dislocation of the hip at the age of five years and died three years later.

Eight of 103 children in a control group, consisting of all children with cerebral palsy living in the area between 1994 and 2002, and born between 1990 and 1991, developed a dislocation of the hip before the age of six years.

The decreased incidence of dislocation after the introduction of the prevention programme was significant (p < 0.001). Dislocation of the hip in cerebral palsy remains a serious problem, and prevention is important. Our screening programme and early intervention when lateral displacement of the femoral head was detected appear to be successful.