An extremely rare muscle disorder in the pectoral region is described. It involves a musculotendinous unit which originates from the pectoralis major and inserts onto the medial epicondyle of the humerus. The authors report a case of an 11-year-old boy, affected bilaterally, who underwent surgical treatment to lengthen the chondroepitrochlearis muscle. There was significant cosmetic and functional improvement.

Child↗

PubMedDate not supplied

Recurrent dislocation of the elbow in children: description of a case.

The authors report a case of recurrent dislocation of the elbow in a boy aged 11 years, surgically treated by reconstruction of the lateral capsuloligamentous structures. After a review of the literature, the need for a diagnostic protocol to establish the main cause of recurrent dislocation is emphasized.

Child↗

PubMedDate not supplied

Femoral shaft fractures during childhood.

The treatment of femoral shaft fractures in the child is influenced by the anatomophysiological peculiarities of the bone in childhood. The authors report a personal series of 51 fractures treated surgically (Kuntschner, Rush, Kirshner, external fixator), and they analyze the most significant aspects of fractures of the diaphyseal segments during childhood: post-fracture lengthening and the ability for post-fracture malalignment to self-correct. Also considered are the different methods of treatment, emphasizing advantages and disadvantages (from an economical point of view, as well), to emphasize the authors' therapeutic orientation. Under 6-7 years: trans-skeletal traction for 5-6 days, reduction in narcosis without expecting to achieve anatomical reduction, pelvipodalic plaster. Over 10 years: surgical indications are more frequent, until they are the same as those for adults aged over 13-14 years. Between 7 and 10 years of age is a no man's land, where indications for surgery must be made based on the individual surgeon's experience.

Adolescent↗

PubMedDate not supplied

Intra-articular deformities of the knee in congenital hypoplasias of the lower limb: an arthroscopic study.

A knowledge of the morphology of the cruciate ligaments in congenital hypoplasias of the lower limb, susceptible to treatment to even the length discrepancy, is of practical importance in the prevention of subdislocation and dislocation of the knee during the distraction phase of femoral and/or tibial lengthening. The authors report their experience with 20 arthroscopies diagnosed in 20 children affected with congenital hypoplasia of the lower limb (shoft congenital femur, longitudinal peroneal hemimelia) performed prior to assembling the Ilizarov external fixator for femoral and/or tibial lengthening. None of the patients had congenital dislocation of the knee or knee with recurvation. In the patients in our study, it is possible to demonstrate that the anatomical cause of instability of the knee in congenital hypoplasias of the lower limb may be constituted by aplasia of one or both cruciate ligaments.

Arthroscopy↗

PubMedDate not supplied

Blount's disease.

Out of a total of 40 patients affected with Blount's disease treated at the Pediatric Orthopaedic Division of the Rizzoli Orthopaedic Institute between 1965 and 1996, 29 were affected with the infantile type, and 11 with the adolescent type. In the group affected with infantile Blount's disease, the mean age was 5.5 years, 11 were bilateral, for a total of 40 limbs affected, with a mean TMD angle of 24 degrees. All of the patients were treated by valgus osteotomy obtaining a percentage of poor results (insufficient correction or recurrence) equal to 25% according to Schoenecker's criteria. Mean follow-up was 3.6 years. In the group affected with adolescent Blount's disease, mean age was 12.6 years, the affection was always monolateral, the mean TMD angle was 15 degrees. All of the patients except 1 were treated by valgus osteotomy with elevation, and the results were constantly favorable. Mean follow-up was 2 years. The authors believe that the type of osteotomy used must be modulated based on the anatomopathologic findings of compromise in the proximal tibial metaepiphysis.

Adolescent↗

PubMedDate not supplied

The treatment of congenital hip dislocation between the ages of 1 and 3.

A total of 81 patients (103 hips) with a diagnosis of congenital hip dislocation were reviewed, who had been treated between one and three years of age. All of the patients were initially treated with adhesive band traction prior to non-surgical reduction, which was performed under general anesthesia using gentle reduction maneuvers followed by immobilization in plaster. Non-surgical reduction was performed in 69 hips (67%), surgical in the remaining 34 (33%). A total of 91 associated surgical procedures were performed for the treatment of residual subluxation. Average follow-up was 12 years (minimum 5, maximum 19). The clinical results of the non-surgical reductions were excellent in 75% of the cases. Radiographically, 48% are hips which have a normal aspect, while 42% have a moderate degree of residual dysplasia or deformity of the femoral epiphysis and of the acetabulum. Hips that were initially classified as grade III dislocations show fair results. Hips treated non-surgically included 11 cases of avascular necrosis (16%); recovery was adequate. Hips treated surgically included 14 cases of avascular necrosis (30%), which was more accentuated in those hips that had initially been treated elsewhere, and in those classified as grade III. The clinical and radiographic results obtained for the hips treated surgically demonstrate poor results in 17% of the cases (6 out of 34), as a consequence of types III and IV osteochondrosis. It may be concluded that in this age group congenital hip dislocation is best treated by non-surgical reduction, possibly followed by surgery of the femur and acetabulum. Surgical reduction was only indicated when conservative methods failed.

Acetabulum↗

PubMedDate not supplied

Treatment of the sequelae of septic osteoarthritis of the hip during pediatric age.

A total of 69 cases (73 hips) of the sequelae of septic osteoarthritis of the hip are studied. The sequelae are classified based on whether or not the femoral epiphysis is present, and on stability of the joint according to Hunka (1982). Three of the hips were treated non-surgically. All of the others were submitted to from a minimum of 2 to maximum of 5 operations with the purpose of re-establishing joint relationships. The results were: good: 50 hips (72.5%); fair 12 (17.4%); poor: 11 (16%). The most significant sequelae were hip instability, joint function limitation, and shortening of the limb.

Arthritis, Infectious↗

PubMedDate not supplied

Glomus tumor in children (description of one case).

Glomus tumor is a lesion of the soft tissues which rarely occurs in children. One case of the disease characterized by deep localization and atypical radiographic symptoms and manifestations is described.

Child↗