Background: Fractures of the distal femur include metadiaphyseal fractures and physeal injuries. Treatment with cast alone is often excluded because of the inability to achieve and maintain reduction, polytrauma, and pathological fractures. Furthermore, operative treatment can also be challenging as the physis is still open and can be damaged by the fracture itself or by the fixation device, the metaphyseal fragment is short and problematic to fixate, and some of the fractures are intraarticular.

The goal of the study was to review the pattern of these fractures and report the midterm outcomes of various treatment options.

Study design: Inclusion criteria for this retrospective study were: age 9–16 years, fracture in the distal third of the femur treated surgically, growth plates open and availability to follow-up. From 2003–2006, fourteen children (mean age 11.5 years) met inclusion criteria. Over the same period, a search based on ICD-9 codes identified 49 patients with femur fractures that had undergone surgery.

Patient charts and radiographs were reviewed and the children were evaluated by an orthopedic surgeon not involved in the patient management. Parameters recorded included: time to union, time to achieve 0–110° knee range of motion (ROM), and emergency surgery, limited knee ROM and premature physeal arrest.

Results: Fractures of the distal femur were frequent among teenagers accounting for 28% of all femoral fractures. a) Injury was related to sport activities (n=10), motor vehicle accidents (n=3) and blast injury (n=1). b) Fracture types: Salter-Harris physeal injuries (n=6) and metaphyseal fractures (n=8). Three of the meta-diaphyseal fractures were pathological fractures through bone cysts.

Treatment: The following methods were employed: a) external fixators (n=2), b) screws, pins and cast (n=6), c) Plates (n=5), and d) Titanium elastic nails (n=1). The mean follow-up was 16 months (range 3–38 months). d) There were no major complications. The knee ROM at 6 weeks was 35° after pins and cast, and 80° after other methods. The knee ROM was at least 110° at 3 months after plate fixation and at six months after pins and cast.

Conclusions: We identified two main subgroups of treatment in teenagers: plates in 5, and screws or Kirschner wires with cast augmentation in 6. The teenagers treated with plates had better short-term outcomes but, at 6 months, there was no difference between the groups. It appears that, if fracture configuration allows, the percutaneous locking plates should be the first treatment option. Bone cysts appear to be a significant risk factor in this age group. The midterm outcome of distal femur fractures was overall good without physeal arrest or malalignment.

Introduction: Congenital insensitivity to pain and anhydrosis (CIPA) is a rare genetic disease transmitted through an autosomal recessive mode. It is known also as HSAN (Hereditary Sensory and Autonomic Neuropathy) type 4. Affected patients suffer from: anhydrosis, mental retardation, poikilothermia and musculo-skel-etal anomalies. The actual knowledge on musculo-skel-etal aspects in CIPA is based on case reports.

Aim of the study: To describe systematically the musculo-skel-etal aspects related to CIPA in a large group of patients followed over the years.

Material and Methods: 40 patients with CIPA were followed in our institution. The age range was 3 months to 19 years of age, and the mean follow up was 8 years. There was some degree of relationship between the parents Their charts were reviewed, radiographs, and bacterial cultures were examined.

Results: The main features that we observed: a) Joint instability with a spectrum that varies from positive provocative test to recurrent dislocation. b) Bone and Joint infection-often with high production of purulent discharges and associated with subluxation of affected joint or with pathologic fractures. Infections can be multimicrobial, are difficult to eradicate and lead to bacteremia episodes. c) Wound healing problems. Wounds hardly heal in CIPA patients. The scar is formed slowly if at all. Chronic sinus drainage and frequent wound dehiscence is the rule. d) Radiological abnormalities: osteomyelitis, pathological fractures with giant callus formation, vanishing bones, heterotrophic ossification, and pseudo-arthrosis were observed.

Conclusions: There is a wide spectrum of musculo-skel-etal pathologies in CIPA affected children. Their orthopedic conditions determine ambulation capacity, life quality and life expectancy and influence dramatically on their families. Complications both mechanical and infectious are very often. A multidisciplinary approach to this chronic illness is needed.

Introduction: Fracture of the lateral condyle of distal humerus in the pediatric population is a common problem. In children less than 13 year the distal humerus is only partially ossified and it is sometimes impossible to assess whether a fracture extends to the articular surface of distal humerus and whether or not there is a step off. Classic recommendations were to perform an open reduction in order to ensure perfect reduction. There are sporadic reports on use of arthrography or MRI studies

Aim of the Study: Retrospective study- intended to evaluate the clinical and radiographic outcome in children in whom the articular surface of distal humerus was evaluated by arthrography . Uppon arthrography results undisplaced fractures were percutaneously pinned and displaced fractures underwent formal open reduction and internal fixation.

Patients and Methods: 11 children mean age 7.8 (1.5–15) were enrolled in the study. Inclusion criteria was a fracture of lateral condyle of humerus suspected to be type II according to Jakob (the fracture is complete but is not diplaced out of the elbow joint). The mean follow up was 2.4y (13m-5.2y). Range of motion. Carrying angle were and neurovascular status were noted and compared with controlateral elbow. Actual X-rays were reviewed.

Results: The patient sample represent around 8% of the whole number of children treated in our Institution during 2000–2005. In 7 patients we were able to avoid open reduction and still to achieve excellent results. In 4 cases that were finally managed by open reduction the intraoperative findings fitted the arthrographic findings.

In Conclusion: Arthrography may prevent unnecessary open reductions for lateral condyle fractures in children.

Study Design: The lumbar spine of children an adolescents with suspected spondylolysis was assessed by magneting resonance imaging.

Objectives: To evaluate the value of MRI in diagnosis and after nonoperative treatment of incipient spondylolysis in children and adolescents.

Summary of Background Data: The diagnosis of incipient spondylolysis in children and adolescents is difficult. Radiographs have a low sensitivity and the use of bone scans, computer tomography and MRI controversial.

Methods: The study is prospective. The lumbar spine was assessed by MR imaging in children (n=14, mean age 12.4 years) with unspecific low back pain for more than 3 weeks and normal plain radiographs at presentation. Six of the seven children were involved in moderate to severe sport activities.

Incipient spondylolysis was diagnosed when on T1 sequences a hypointense area was found within the pars interarticularis of any lumbar vertebra while on T2 sequences a corresponding hyperintense zone was detected. Brace and activity restriction was recommended. Follow-up MRI studies were performed after treatment at 3 months interval.

Results: Seven of 14 patients presented with pars edema (T1 hypointense, T2 hyperintense), six at L5 vertebra, one at L4 and L5 vertebra, respectively. After 3 months healing was demonstrated both clinically and by imaging in six children in another child healing was observed after 6 months.

Conclusions: MRI showed promising results in detecting and monitoring the early onset of spondylolysis. In our cases early treatment prevented pars defects.