The aim of this retrospective study is to isolate the cases of “overuse syndromes” in young athletes in whom the initial diagnosis proved wrong.

During six-year period 2002 – 2007, 28 young athletes (16 boys and 12 girls) aged 9.6 years (ranged from 6.5 to 14 years), suffering an underlying disease that had initially attributed to “overuse syndromes”, were treated in our Department. In all of the cases the history was misleading and the clinical examination was precarious, while the x-ray examination proved to be unclear. The remaining imaging exams led finally to the correct diagnosis that was confirmed in the operating room or via the biopsy.

In 4 cases a slipped capital femoral epiphysis was ascertained. In other cases we verified an osteochondritis dissecans of femoral condyle or talus (4), an osteoid osteoma (4), Perthes disease (3), osteochondromas (3), calcaneonavicular synchondrosis (3), hemangioma (2), discoid meniscus (1), herpes zoster along the sciatic nerve (1), aneurysmal cyst of fibula (1), accessory navicular (1), and osteosarcoma of fibula (1).

Overuse syndromes in young athletes should be treated with skepticism because another more serious disease may be hidden behind the symptoms and clinical signs. The children and adolescents have a skeleton that grows constantly and develops a special pathogenesis and this fact must be always kept in mind of parents, trainers and therapists. The young subjects who expect to be integrated in the athletic family should be previously examined by Pediatrician and Pediatric Orthopedic Surgeon so that a congenital anomaly or an acquired disease will be diagnosed in time.

Aim: This study was carried out in order to clarify the causes that are mainly responsible for the necessity of reoperation after the initial correction of the deformity in congenital talipes equinovarus. The cases, which had been treated surgically with the same method and recurred later, were studied retrospectively in order to be ascertained epidemiological data related to the disease, to be isolated operative findings related to its pathology and to be estimated the surgical results based on clinical and radiological criteria.

Material-Methods: During the 15-year-period from 1990 to 2004, 123 infants (196 feet) with congenital talipes equinovarus have been treated operatively. There were 88 males and 35 females. Seventy three patients (59.3%) had the deformity bilaterally, 20 patients in right foot and 30 in left. Family history was positive in 5 infants. Other congenital anomalies coexisted in 12 infants (9.7%). Preoperative application of successive plasters was started into the first week for 93 infants (75.6%) and its duration was 3 months for 83.7% of cases. All the patients have been operated on with posteromedial approach, extensive ligament division and generous release of soft tissues during the first year of age. Two thirds of cases (67.4%) were treated surgically into the first 6 months of age.

Results: Anatomical variations were revealed during the operation in 14 feet (7.1% of the cases). The clinical results as well as the radiological signs into the first 6 postoperative months were satisfactory, but a reoperation was necessary in 21 feet (in 14 infants) for correction of part of the initial deformity into the following 2–5 years. The clinical criteria were related to the manner of standing and walking, the range of motion of the foot joints and block test. The radiological criteria were related to anteroposterior and lateral talocalcaneal angles and the angle between the longitudinal axis of the talus and that of the first metatarsal in the anteroposterior view as well as the position of the calcaneus in the lateral view. The causes that led to recurrence were related to imperfect correction with the plasters, to incomplete release of soft tissues during the initial operation and to some likely predisposing congenital and environmental factors.

Conclusions: The prevention of recurrence of the initial deformity, in the operative correction of congenital talipes equinovarus, is mainly related to the attentive pre-operative application of plasters, the careful lege artis surgical technique and the early diagnosis and treatment of the predisposing factors.

Pyogenic arthritis of the hip in childhood despite improved antibiotic therapy remains a serious disorder which demands early diagnosis and prompt treatment. The most serious complication of the pyogenic arthritis of the hip in childhood and especialy in newborns and infants is the avascular necrosis of the femoral head which can lead to partial or complete destruction of the capital femoral epiphysis or the growth plate or both. This destruction may lead to hip joint deformity, leg length discrenpancy and dysfunction. The PURPOSE of this study was an effort to determine the factors which affect the outcome of the hip joint in pyogenic arthritis.In the present study included 37 children, 24 boys and 13 girls, with 37 involved hips. Their ages ranged from 10 days to 1 year old in 17 children and from 1y–11 years old in 20 children. All patients were hospitalized and treated in our Orthopaedic Department with proven pyogenic arthritis. All children were suspected to have pyogenic arthritis of the hip from the history, clinical features, laboratory and imaging findings and were confirmed with positive aspiration in 35 patients. In two negative aspirations the pyogenic arthritis was confirmed of the performed surgical interventions. The treatment consisted of I.V. and oral administration of appropriate antibiotics and cast immobilization for about six weeks. In 23 only patients was performed immediate incision and surgical drainage with debridement of the hip joint, wipping the panus of the cartilage. The length of the follow up was 2–9 years. The hips were classified according to radiographic findings into 3 groups. TYPE I (31 Patients, 84%) Normal overgrown femoral head. TYPE II (3 Patients, 8%) Deformed femoral head. TYPE III (3 Patients, 8%) Partial or complete destruction of the proximal femoral epiphysis. The evaluation and analysis of the results revealed primarily that the delayed diagnosis lead in delayed treatment especialy in neonates and infants. Other factors which have unfavorable outcome in the pyogenic hip arthritis are the multiple location, osteomyelitis of the hip region and the causative organism. Of course the rapid diagnosis followed of immediate aspiration with surgical drainage and early administration of apropriate antibiotics lead to good or excellent results.

Introduction: The values of Q angle in a child’s knee cover a wide range. Frequently its extreme values are responsible for complaints or the appearance of some pathological conditions( e.g. chondromalacia, recurrent dislocation of patella etc).

Material and Methods: The Q angle has been measured in both lower limbs of 1955 children aged 7–12 (1017 boys and 938 girls). Cases of children with a history of previous fractures on lower limbs or major orthopedic or neurological disorders have been excluded. Eighty one per cent of children have had the right foot as their prominent one, the 14.8% of children have had the left foot as their prominent one, and the 4.2% of children have had no difference between their limbs.

Results: For the children aged 7–8, the values of Q angle have been measured to range from 11.30±7.4 degrees in left limb to 11.52±7.4 degrees in right limb in boys, while in girls they ranged from 11.05±7.2 to 11.20±6.9 respectively. For the ages 9–10, the values ranged from 11.30±7.8 degrees in left limb to 11.38±7.2 degrees in right limb in boys, while in girls they ranged from 11.02±7.7 to 11.51±7.1 respectively. For the ages 11–12, the values of Q angle ranged from 11.72±8.8 degrees in left limb to 11.56±8.3 degrees in right limb in boys, while in girls they range from 11.87±8.3 to 12.06±8.4 respectively. There has been no difference between the right and left lower limbs in all ages and both sexes. There has been no difference between the boys and girls in both lower limbs in all ages. As girls are growing up the Q angle is increasing in both lower limbs ( P< 0.01), whereas boys have no difference in their limbs while they are growing up. Children with their prominent right limb have performed increased Q angle in both lower limbs( P< 0.05). Regarding boys, the more Bone Mass Index (BMI) has been increased, the more the Q angle has been decreased ( P< 0.001).

Conclusion: We conclude that in children aged 7–12, the Q angle 1) frequently appears increased values, 2) performs no difference between both lower limbs, and 3) has negative correlation with BMI in boys.