Purpose of Study:

To review the outcome of paediatric patients with radius and ulna fractures treated with titanium elastic nails.

Between 1997 and 2003, five patients with acquired knee flexion contractures were treated by gradual soft tissue distraction using the Ilizarov external fixator.

Two patients presented following burns, two following septic arthritis of the knee and one after poliomyelitis. The mean age was 8.2 years (5 to 12). All patients had a fixed flexion contracture of the knee of 90°. The mean duration of fixator application was 4 months. No soft tissue releases or bony surgical procedures were performed. When the external fixator was removed, the mean residual knee flexion deformity was 2°. Follow-up after removal of the fixator averaged 5 months. The mean loss of correction was 15° (0° to 30°). Two patients developed mild pin-tract sepsis, which was successfully treated with oral antibiotics. Compared to preoperative status, energy-efficient mobility was markedly improved in all patients.

Between 1980 and 2003, 600 patients with idiopathic clubfoot attended our clinic.

Until 1989, we manipulated the feet according to the Robert Jones method. After that we changed to the Ponseti method. Depending on the residual deformity at age 3 months, patients underwent either percutaneous Achilles tenotomy or full posteromedial release, as described by McKay, and were supplied with a thermoplastic splint until walking age. Minor changes to the surgical technique were made over the years. At follow-up, a minimum of 2 years postoperatively, the feet were evaluated both according to the McKay scoring method and by a simpler method that correlated well with it.

Although our results compare unfavourably with those of Ponseti (80% non-surgical correction), we had excellent overall outcomes, with low revision and complication rates.

Between 1997 and 2002, seven talipes equino varus deformities in six patients were treated using gradual distraction and correction with the Ilizarov external fixator. Three patients had poliomyelitis, four patients had neglected clubfeet and two patients had relapsed club-feet. The mean age of patients was 13.3 years (5 to 21) and the mean duration of fixator application was 3.25 months. When the plantigrade position was achieved the fixator was removed and a below-knee walking cast was applied. Four months after fixator removal, additional bony correction surgery (triple arthrodesis) was done in three patients. At the time of fixator removal, a plantigrade foot was achieved in all patients.

The mean follow-up time from surgery was 26 months. Pin-tract sepsis in two patients was treated effectively with oral antibiotics. Other complications included meta-tarsophalangeal subluxation from flexor tendon contractures in one foot. There have been no recurrences of deformities.

Compared to preoperative status, gait was subjectively improved in all patients. Correction of the deformity in the patients who had a triple arthrodesis of the foot was achieved with less bone loss than in patients who had undergone a primary triple arthrodesis. These results suggest that treatment with Ilizarov frames is effective in the management of neglected and relapsed clubfoot deformities.

Purpose: A modification of the arthrodesis as described by F R Thompson is reviewed in ten children.

Method: Between September 1997 and July 2001, six patients ranging from 6 to 13 years underwent hip arthrodesis. Indications included trauma (one), idiopathic chondrolysis (one) post-septic arthritis (four) and tuberculosis of the hip joint (four). The subtrochanteric osteotomy was performed as a coronal chevron, differing from the previously described techniques. Patients were immobilized in a spica (six) and external fixation (four) in a functional position of 20 degrees flexion and neutral position (1degree abduction per year of growth left) for six weeks postoperatively.

Conclusion: This review re-establishes hip arthrodesis as an acceptable treatment for children with destroyed joints and intractable pain. The modification used provides an attractable alternative in preventing the displacement of the subtrochanteric osteotomy, but allows correct positioning of the limb. The use of the external fixation allows lengthening if needed.

In a four-year retrospective study, we assessed the use of ultrasonography in diagnosing hip dysplasia in 86 high-risk babies. Dysplasia was graded on the Harcke classification.

Risk factors included breach presentation, positive family history, foot abnormalities, caesarean section and genu recurvatum. If the ultrasonography at birth showed abnormalities, follow-up ultrasonography was done at three and six weeks. If there were abnormal findings at six weeks, the patient entered the treatment protocol. Whether or not ultrasonography showed abnormalities at six weeks, the acetabular index was measured radiologically at 12 weeks.

There were 17 Harcke-III hips, 30 Harcke-IV hips and four Harcke-V hips. The Harcke-V hips were treated in a Pavlik splint from birth. Three babies underwent closed reduction at 12 weeks, followed by application of a spica cast. At six weeks, 10 of the Harcke-IV hips and 12 of the 17 Harcke-lll hips were normal. The mean acetabular index at 12 weeks was 28°.

Ultrasonography provides an effective way of screening for hips at risk and the efficacy of treatment can easily be measured.

The senior author performed Kawamura Dome Chiari pelvic osteotomy on four patients with hip dysplasia, an incongruent hip joint and a weakly developed posterior wall that caused posterior instability.

Although follow-up has not been long term, the uncomplicated postoperative course and improved hip stability of all four patients suggest that this operation offers a solution to a selected group of patients.

Between September 1997 and April 2000 hip arthrodesis was performed on six patients, using a modification of the techniques described by F.R. Thompson. The ages of patients ranged from 11 to 13 years, and indications included trauma (one patient) post-septic arthritis (two patients) and tuberculosis of the hip joint (three patients).

The subtrochanteric osteotomy was performed as a coronal chevron, differing from previously described techniques. Patients were immobilised in a spica in a functional position of 20° flexion and the zero position (1° abduction per year of growth left) for six weeks postoperatively. The follow-up period ranged from 16 to 40 months.

Union was achieved within six weeks. All patients achieved a pain-free gait, with minimal signs of disability.

We believe that hip arthrodesis is an acceptable way of treating children with destroyed joints and intractable pain. The modification we used prevents displacement of the sub-trochanteric osteotomy but allows correct positioning of the limb.

We studied the outcome of displaced supracondylar fractures in 98 children treated over three years to December 2000. In 74 patients fractures were treated by closed reduction and percutaneous K-wire fixation. Through a direct posterior approach, open reduction was obtained in the other 24. Postoperatively the elbow was immobilised in a posterior cast in 30° flexion for three to four weeks. The cast and K-wires were removed in the clinic and the elbow mobilised.

In patients treated by closed reduction, the mean range of movement (ROM) was 10° to 120° at the one-month follow-up. There was a cubitus varus deformity in four patients. One patient developed pintract infection. There were five neurological complications, of which only one (ulnar nerve) was surgical. The mean ROM of patients treated by open reduction was 15° to 110° at the one-month follow-up. Pre-operatively two patients in this group had a neurological deficit (one median and one radial nerve), which had improved at follow-up.

Treatment of supracondylar humeral fractures in children by closed reduction and percutaneous K-wires is safe and reliable. Where open reduction is necessary, a posterior approach is more acceptable cosmetically and does not lead to functional loss.