Introduction

Early identification and conservative management of paediatric Monteggia fractures has been shown to correlate with good results. Nevertheless, several authors advocate more aggressive management with open reduction and internal fixation (ORIF) for unstable fractures. We herein present the experience of a tertiary paediatric hospital in the management of Monteggia fractures.

Introduction

Lateral humeral condyle fractures account for 17% of the distal humeral condyle fractures. They affect children between 5 and 10 years of age. Recent reports advocate closed reduction and internal fixation for the less displaced fractures.

Introduction

The incidence of spondylolysis is estimated about 5–6% in the general population and accounts for one of the most frequent cause of backpain in the adolescent. The purpose of this study is to present our results from the management of these patients.

Grice-Green subtalar arthrodesis was initially reported to correct valgus hindfoot deformities in patients with poliomyelitis. Nowadays, the indications of the Grice-Green arthrodesis have been significally broadened. The aim of this study is to analyse the indications of treatment and evaluate the results of the Grice-Green arthrodesis in children.

During the period 1986–2006, 17 children with valgus hindfoot deformities were treated in our department. In 12 of them the procedure was performed in both feet and in the rest (5 patients) unilaterally. The mean age at operation was 8.8 years. The most common group of patients suffered from cerebral palsy (10 patients), followed by the patients suffering from myelomeningocele (4 patients), 2 patients suffered from overcorrection following treatment of congenital equinovarus and one patient from Charcot Marie Tooth disease. In neine patients the operation was combined with Achilles tendon lengthening, capsulotomies, tendon transfers, tendonotomies, and Evans arthrodesis. In all operations bone graft from the tibia or the fibula was used. Postoperatively a balow knee non weightbearing cast was applied for 8 weeks followed by a weightbearing cast for 4 weeks. The results were avaluated according to Alman and Zimbies criteria. The mean follow up of the patients was 4.2 years. The results in 24 feet were considered excellent and in 5 cases satisfactory. In all cases subtalar arthrodesis was achieved.

Grice-Green arthrodesis is a very useful operative technique for the correction of severe valgus hindfoot deformities in children. The results of the technique are usually good and the operation does not influence the normal growth of the foot. An accurate preoperative planning and a good surgical technique is neccesary for good results.

The cause of Legg-Calve Perthes disease, 97 years after its original description remains undefined. In the present study we examined factors, which were correlated with a favourable or negative impact on the outcome of surgical treatment.

From a total of 98 children, treated during the period 1994–2006, we studied 20 cases (classified as Catterall III and IV), treated surgically. The average age was 7.4 years (4–13 years). We studied in comparison the most common procedures performed: these were the varus femoral osteotomy (12) and the lateral shelf acetabuloplasty (7). The subtrochanteric osteotomy yielded superior radiological results Stuhlberg I–II (I:6, II:6), than the lateral shelf procedure Stuhlberg II–IV (II:3, III:3, IV:1). The clinical results were similar between the two groups according to the Barrett scale, excellent or good.

Regarding the subtrochanteric osteotomy the most important factor was the precise varisation of the femoral neck and secondly the timing of surgical treatment early during the fragmentation stage of the disease, before the femoral head is significantly distorted. The most important positive factor regarding the lateral shelf procedure appears to be the accuracy of the surgical technique, in order that the graft coverage of the femoral head is accurately placed on the hip capsule. Negative factor for the lateral shelf procedure in one case was early weightbearing, which resulted in collapsing of the femoral head. It appears that with extensive necrosis (Caterall IV) the femoral head isn’t biomechanically enough resistant with this procedure to resist loads that result from early ambulation.

Since the commencement of the Neuromuscular-Unit in the Children’s-Hospital “Agia Sofia”, from December 2002 until December 2008, 306 patients were examined suffering from different neuromuscular diseases (ND). In the present study we examined

the frequency of spine deformities,

From the analysis of our material we found that 152 patients were suffering from Duchenne’s-Becker muscular-dystrophy, 59 patients from spinal-muscular-atrophy I-III, 13 patients from fascioscapulohumeral muscular-dystrophy, 15 patients from hereditary motorsensory-neuropathies, 5 patients from Friedreich’s Ataxia and 62 patients from different types of dystrophinopathies–myopathies. The ages of the patients varied between 8 months and 37 years.

From the total, 89% of the patients above 10 years presented with spine deformities. Most of them were managed with wheelchairseating modifications and 33 patients were fitted with braces in an attempt to slow curve progression. Surgically were managed 24 patients with spine arthrodesis, 5 of them abroad (USA-Eng-land-France). The older patients (> 17 years wheelchair-bound) were frequently, because of impaired general health, not suitable candidates for surgery.

Pulmonary function was examined in 84 patients suffering from Duchenne’s muscular dystrophy. The crucial age, were pulmonary function has fallen dramatically (FVC< 40%), was between ages 12–15 years.

In conclusion spine deformities are very common in patients suffering from neuromuscular diseases. Because of the rapid deterioration of the general health of these patients spine arthrodesis should be performed early, in the patients severely affected, between ages 12–15 years

Fracture separation of the distal epiphysis of the tibia constitutes 10% of all epiphyseal fractures occurring in children. We studied 120 cases, which were treated stationary at our Department over the 10 year period between 1990 – 2000. The ratio between boys and girls was 2:1. The average age was 12,5 years (8–15 years). In 96 cases (80%) the injury occurred after a fall on the playground, in 12 cases (10%) after a roadtraffic accident and in 12 cases (10%) after a fall from a height. The average follow up is 7,2 years (2–12 years). According to the Salter-Harris classification 6 cases (5%) were Salter I, 90 cases (80%) were Salter II, 9 cases (9%) were Salter III and 6 cases (5%) were Salter IV. In all cases a closed reduction under general anaesthesia was attempted. If the reduction was succesful a whole leg plaster was applied. If the reduction was unstable a transcutaneous stabilisation or open reduction and internal fixation was performed. If a reduction could not be acchieved open reduction and internal fixation (ORIF) was performed using Kirschner wires or screws. Closed reduction was performed in 94 cases (78,34%), transcutaneous osteosynthesis in 2 cases (1,66%) and ORIF in 24 cases (20%).

We conclude that sports and for instance football is the main cause, where this injury occurs. The treatment is mainly conservative and complications are rare, when anatomical reduction is acchieved. The most common complication is angulation resulting from the injury at the epiphyseal plate, for instance varus angulation, which occurs from supination injuries mainly of Salter-Harris type III and IV.

Fracture of the lateral humeral condyle accounts for approximately 15% of all elbow fractures in children.

We studied 68 fractures of the lateral humeral condyle, which were treated surgically over a period of six years during 1994 to 2000. There were 49 boys and 19 girls. The average age was 6,5 years (2,5 – 13 years). All cases were treated with open reduction and internal fixation with two divergent K-wires for safer stabilisation of the fracture. Subsequently a cast was applied for 4–6 weeks to the radiological union of the fracture, where the K-wires were removed.

The patients were evaluated with clinical and radiological criteria. Sixty-five cases were classified as Milch type II fractures and three were Milch type I fractures. According to the Jacob classification, which records the degree of displacement, 23 cases were type II fractures and 45 cases were type III fractures. The mean follow up was 4 years (2–8 years). Analysis of the postoperative radiographs showed that radiological union was achieved in all cases. The mean time to radiological union of the fracture was 4,5 weeks (3–8 weeks). At latest follow up we observed abnormalities of the shape of the distal humerus due to overgrowth of the lateral humeral condyle in 40% of the cases. In 4 patients we observed pseudocubitus varus due to overgrowth of the lateral humeral condyle and in 3 patients we observed mild cubitus varus (< 5°). Clinically in all cases there was painless free movement of the elbow.

We conclude that satisfactory anatomical reduction of the fracture gives good clinical results. The radiological abnormalities observed seem not to play an important role in the final result.