Lateral tibial plateau fractures are articular fractures that can have a severe prognosis involving a joint biomechanically and functionally very important.

Osteosynthesis is very often required as the articular surface must be accurately restored.

In many cases rigid devices were implanted, often sacrificing lateral meniscus and leading to osteoarthritic changes in the following years.

In the recent years new diagnostic tools as TC and MRI and the growing role of arthroscopy have allowed a more precise diagnosis and the possible use of less invasive devices.

Considering all fractures classified as B3 according AO (or type 2 by Schatzker), we considered 10 cases treated with Barr screw and 8 cases treated with K-wires positioned as a shelf after reduction and bone grafting.

All patients underwent an accelerated rehabilitation protocol with immediate mobilization and full weight bearing within 10 weeks.

At the follow-up at 24 months, both the groups showed very good and comparable clinical, radiographical and functional results.

We can conclude that after an accurate preoperative planning also the use of less invasive devices allow a quick recovery of range of motion without compromising the stability of osteosynthesis and the morphology of knee joint.

Introduction: In temperate places pyomyositis is very uncommon in children and adolescents. West European and North American Literature about is relatively poor (104 articles from 1998 to nowadays and most of these papers are case-rep orts). S. Aureus is the etiologic agent in 90% of cases. Muscle of the thighs and hips are the most frequent localisation and severe complications are observed in 10% of cases.

Material and Methods: We reviewed all patients affected by primary pyomyositis and admitted in our Department from 1995 to nowadays. Age, sex, history and clinical findings, general and local risk factors were reported. X-rays, Ultrasonography, MRI, Scintigraphy, Haematological investigation and culture were considered in order to state the imaging and laboratory findings of the disease.

Result: Pyomyositis was diagnosed in three males, aged 11, 13 and 16. There was no evidence of medical or familiar risk factors. Soleus, Otturatorius and Psoas muscles were respectively involved. In all cases fever, local signs of inflammation and pain, neutrophylic leukocytosis, increased ESR and CRP levels were present. Blood culture was positive in one case. Standard X-Rays were normal in all cases. Ultrasound scan, RMI and Scintigraphy were positive but non-specific in all cases. 2 cases underwent to surgical drainage and a 3 weeks antibiotic therapy; 1 case resolved performing only medical treatment (5 weeks of antibiotic). All patients showed complete clinical, haematological, and RMI recovered without reliquates.

Conclusions: Pyomyositis is uncommon in temperate climate and it may be easy misdiagnosed at the onset. In our patients the mean time from onset of symptoms to diagnosis was 10 days. History and clinical examination might be evocative, but there are no pathognomonic haematological or radiological findings so that diagnosis is often the result of extensive and wide considerations. Pyomyositis should be suspected in any unclear septic condition of the musculoskeletal apparatus. High index of suspicion, prompt diagnosis, and early treatment can prevent complications and allow the recovery of this potentially life-threatening disease.

Renal failure in children is associated with a wide range of musculoskeletal disorders such as osteonecrosis, stress fractures, brown tumours, epiphysiolysis, joint infections and angular deformities. In this paper the authors report their experience concerning the surgical treatment of the angular deformities of the lower limbs in renal osteodystrophy (RO).

Between 1995 to 2003, 10 children (five girls and five boys) with RO underwent surgical correction of angular deformities of the lower limbs. Of these, seven had femoral osteotomies because of knee deformities (three genu valgum, four genu varum) and three had osteotomies because of tibial angular deformity. The average age at surgery was 5 years (min. 2 years, max. 12 years). Different types of osteosynthesis were used (staples and cast, Ortho-fix and Ilizarov frames) according to the age of the child and the degree and the site of the angular deformities.

All osteotomies healed without complications and the surgical correction was considered appropriate at the end of treatment. At an average follow-up of 4.5 years there was no significant relapse and no need for second surgery.

Simple osteosynthesis (staples and cast) was most appropriate in the youngest children and in mildest deformities (particularly at the distal tibial metaphysis). External devices were more suitable in the oldest children and for genu valgum/varum deformities. To optimise the time of consolidation close collaboration with the paediatricians is required in order to perform surgery under the best metabolic conditions (elevation of the serum alkaline phosphatase concentration above 500/l is a good marker of bone metabolic healthy).

Aims: The purpose of our review is to evaluate results of surgical treatment in bone metastases and to relate the surgical indications to these results. Methods: 297 patients operated between 1980 and 1998 were reviewed. Main age of the patients was 60.9 (18–86). The involved bones were femur (169cases), humerus (77), spine (33), tibia (8), pelvis (4), cubitus (2)others (4). The primary tumours (of 215 reviewed diagnosis) were breast (80cases), lung (31), myeloma (21), kidney (18), intestine (8), thyroid (7), prostate (6), uterus (6), pharynx (4), sarcoma (4), bladder (2), liver (2), others (4), well differentiated unknown origin (14), undifferentiated (8). The operations performed were nailing (86cases), interlocked-nailing (59), prosthesis (58), spinal osteosynthesis (34), plating+cement (25) nailing+cement (17), resection (10), resection+cement (6), amputation (2). Minimal conditions for surgery were life expectancy of at least 60 days, possibility of a solid implant and acceptable blood parameters (wbc> 2,000, plt> 30,000). Most of the patients underwent postoperative radiotherapy. Results: The Karnofsky index at sixty days showed a mean improvement of 30pts% using nails and prosthesis, and 10pts% with plating+cement (performed in patients in better general conditions). After surgery, all of the patients reached a score over 70pts% and in every case pain was sensibly reduced. There were 3 perioperative deaths (1%) and 10 major complications (3.4%). Conclusions: An operation performed after an accurate planning leads to an improvement in the quality of life and self-sufþciency of these patients, thereby reducing the cost of care. The choice of technique must allow to obtain a quick result (no bone grafting) and a fast functional improvement, considering the limited life expectancy of the patients.

Purpose: To elucidate the pathomorphology of the unossified clubfoot and to monitor the progressive correction of the deformity during treatment, the authors introduce a standardized sonographic assessment of the foot at birth and at the end of both conservative and surgical corrective procedures.

Methods: 42 congenital clubfeet and 42 normal newborns were documented by ultrasound using a 7,5/10 MHz linear arrays probe with direct contact. Clubfeet were documented in the position of spontaneous alignment and during passive manual correction at the admission and at the end of both conservative and surgical treatment. Five standard ultrasound planes were used: sagittal posterior, sagittal anterior, coronal lateral, transversal and coronal medial plane.

Results: On the sagittal posterior plane the progressive gain of the dorsiflexion during the different steps of the treatment was documented measuring the distance between the distal tibial metaphysis and the calcaneal apophysis. In clubfeet, looking at the ossification centre of the talus, both its forfeit of domicile in the ankle mortise and its right positioning after treatment can be showed. On the sagittal anterior plane and on the transversal plane the medial displacement of the navicular is documented. The normalisation of the anatomic alignment of the navicular is well documented by these planes after appropriate treatment. On coronal lateral plane the relationships between the os calcis and cuboid can be estimated using the calcaneal-cuboid angle. The coronal medial plane exhibited a very low reproducibility in the neonatal clubfoot and it is not reccomended

Conclusions: Ultrasonography it is a very promising technique in the monitoring of clubfoot deformity during treatment. On the sagittal posterior and on the coronal lateral planes strictly quantitative information can be easily deduced while prevalently qualitative information are deduced on the sagittal anterior and on the transversal planes. Ultrasound gives exact and reproducible information concerning the pathomorphology of the not ossified

Paediatric acute leukemia may present with various clinical mifestations that mimic different orthopaedic conditions and can produce diagnostic confusion. In a retrospective study we reviewed the cases of 129 children (average age 6.2 years) affected by acute leukemia who had been seen between 1984 and 1999 at the Paediatric Haemato-Oncology Department of the University of Padova and had complete clinical and radiographic data. Almost all the patients (93.7%) had a variety of general signs and symptoms at presentation: weakness (44.3%); anorexia (32.7%); lethargy (7.8%); fever (64.2%); pallor (79.6%); bleeding (25.3%); lymphoadenopathy (58.8%); hepatosplenomeg-aly (75.6%). Thirty-seven patients (28.6%) had complaints related to the muscoloskeletal system when they were first seen including: pain (92.7%), swelling (29,7%), joint limitation (47.8%), limping (18.8%). Skeletal surveys were made for ninety-two (71.3%) of the patients when the diagnosis of leukemia was made, while the other thirty-seven (28.6%) had radiograms of the symptomatic areas. Seventy-five patients (58.1%) presented normal radiograms and fifty-four (41.9%) showed one or more abnormalities. Osteopenia was diagnosed in eight patients; lytic lesions were see in fourteen; metaphyseal bands in ten; periosteal reactions in four; osteosclerosis in two; mixed osteoscle-rosis and osteolysis in two; permetive pattern in eight; vertebral collapse in three children. During the course of the disease two patients developed avascular necrosis of the femoral head; one reported a pathologic femoral neck fracture; three presented collapse of one or more vertebral bodies. All these findings are not pathognomonic but the clinician should always include acute leukemia in the differential diagnosis of any child with unexplained radio-grafic changes and/or persistent skeletal pain.