The purpose of this study was to investigate the effectiveness of lateral column lengthening in the treatment of flexible, planovalgus foot deformity of ambulatory children with spastic cerebral palsy (CP). Fifteen ambulatory children (23 feet) with spastic CP and flexible planovalgus foot deformities received lateral column lengthenings through the calcaneus or calcaneocuboid joint. At an average of 4.1 years of follow-up (minimum, 2.3 years), 17 (74%) feet had good, two (9%) had fair, and four (17%) had poor outcomes. Poor outcomes resulted from recurrence of deformity. Improvements in preoperative, postoperative, and follow-up radiographic measurements were found. However, these improvements are not related to the clinical outcomes. Calcaneal lengthening is a successful treatment for flexible planovalgus foot deformity in ambulatory children with spastic CP. The high failure rate is a significant limitation to the procedure. Further investigation of the objective measurement of planovalgus foot deformity is needed.

Since Virchow first described the unicameral bone cyst (UBC) in 1876, several methods for management were proposed. Currently performed surgical procedures include curettage combined with bone grafting, allografting with freeze-dried crushed cortical bone, use of homologous cancellous bone chips, the application of high-porosity hydroxyapatite, and cryosurgery. Decompression with multiple drill holes and intralesional injections of either steroids or bone marrow have also been used to treat UBC, with variable success rates. Elastic stable intramedullary nailing for the treatment of UBC in long bones has been rapidly gaining popularity. Elastic stable intramedullary nailing for the treatment of a UBC was performed in 56 patients between 1994 and 2003. The follow-up is between 2.1 and 11 years. Nine children were excluded because of short period of follow-up or were lost. The study population consisted of 47 children. The cyst was located in the humerus in 36 patients, in the femur in 11. The mean age of the patients at the time of surgery was 8.9 years. Results were evaluated on plain radiographs according to the classification system of Capanna et al. In our study population of 47 UBCs, 31 (65.9 %) were classified as completely healed, and 16 (34.1%) were healed with residual radiolucency. No recurrence or no response was observed. Each lesion responded to treatment after the nailing. This method can solve in time the pathology, and we feel that, with skilled hands, this method is the best one for UBC treatment in the long bones of the children.

This study aims to assess the functional outcome of children treated with elastic stable intramedullary nailing (ESIN) for displaced proximal humerus fractures using the short version of the disabilities of the arm, shoulder, and hand outcome questionnaire (Quick DASH). Fifty-eight consecutive children with displaced proximal humerus fractures were treated with ESIN. Fifty-two children (89.7%) were available for follow-up and responded to the questionnaire after hardware removal. Average age at time of injury was 11.1±2.8 years (range, 4–15.9). Among the 52 patients available for evaluation, 37 had a Quick DASH score of 0 (71.1%), seven a score of 2.3 (13.5%), four a score of 4.5 (7.7%), and four a score of 6.5 (7.7%). Shoulder and elbow ranges of motion were comparable with the noninjured side. No skin irritation or local infections were observed. There was no radiographic evidence of delayed union, refracture, hardware migration, or secondary displacement. Mean follow-up was 18.3±8.3 months (range, 6–39.5). Our study reports good functional outcomes in children with closed isolated fractures, both physeal and metaphyseal, of the proximal humerus treated with ESIN. The use of a standardized rating scale is recommended to homogeneously compare functional outcome and may facilitate the comparison of clinical outcome in different patient populations.

Background: The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced tibial shaft fractures with intact fibula in children after nonoperative management and operative treatment by elastic stable intramedullary nailing.Methods: A study was performed on 80 consecutive children, 56 males, 24 females from 2 Institutions, with displaced and closed tibial shaft fracture with intact fibula. All patients underwent regular clinical and radiographic follow-up visits for at least 2 years after injury.Results: In total, 26 patients (group A-Institution I) were treated surgically by elastic stable intramedullary nailing and 54 patients (18 patients from group B-Institution I and 36 patients from group C-Institution II) were treated nonoperatively with closed reduction and casting. groups A, B, and C did not significantly differ on sex (P=0.37), side (P=0.54), and fracture site (P=0.14).Valgus deformity was significantly controlled in group A patients only (P=0.001); during follow-up in group B patients (P=0.017), and showed no significant change between pretreatment images and last follow-up in group C patients (P=0.71). Procurvatum deformity was significantly controlled in group A patients only (P=0.001); it showed no significant improvement after conservative treatment in group B (P=0.73) and C patients (P=0.8). Recurvatum was significantly improved in group A (P<0.001) and C patients (P<0.001) but remained unchanged in group B patients (P=0.15). Varus deformity improved significantly in all patient groups.Immobilization time was significantly shorter in group A compared with group B and C patients (P<0.001).However, numerical differences, although statistically significant, were not clinically relevant for all variables but immobilization time.Conclusions: This study showed good functional and radiologic outcomes in the pediatric population who had sustained closed, traumatic, displaced fracture of tibial diaphysis without associated fibula fracture.On the basis of the findings reported here, it is not contraindicated to operate skeletally immature patients with displaced fracture of tibial diaphysis without associated fibula fracture. However, results were essentially the same and either method is a satisfactory choice for pediatric tibia shaft fractures with an intact fibula. In particular, we found that conservative treatment was as efficacious as surgical treatment apart from the length of time for immobilization.Level of Evidence: Level III.

Objectives: Our study analyzes 40 years’ experience with pediatric Langerhans cell histiocytosis patients. Materials and Methods: Between June 1968 and December 2009, 121 patients (79 males, 42 females; median age 4.13 y) were diagnosed at our center (74% monosystemic disease; 26% multisystemic), treated according to current protocols. We evaluated the response, the survival, and the neuroendocrinological sequelae. Results: Overall survival (OS) for all patients was 93% at 10 years from diagnosis, event-free survival (EFS) 77%. OS for patients younger than 2 years and older than or equal to 2 years was 82% and 97% (P=0.003); EFS 48% and 87% (P=0.001). OS for patients diagnosed before and after April 1, 1991 was 84% and 98% (P=0.007), EFS 66% and 85% (P=0.03). OS for monosystemic and multisystemic disease was 100% and 71% (P<0.001); EFS 88% and 45% (P<0.001). OS for “risk” patients (involvement of bone marrow, spleen, liver, lungs) and “low-risk” patients was 50% and 94% (P=0.007), EFS 37% and 54% (P=0.06). Fourteen patients developed diabetes insipidus, 7 patients growth hormone deficiency, 2 hypothyroidism, and 1 neurodegeneration. Conclusions: Our study confirms improvement of pathogenetic knowledge and treatment over the last 20 years. Age at diagnosis older than or equal to 2 years and standardized treatment are associated with improved prognoses. Multisystemic involvement, especially with “risk” organs seem to be correlated to a worse outcome.