Management of sports-related and recreational knee Injuries in children: surgical aspects

Sports -related knee injuries are common in children and the management of these injuries continues to evolve. Sports injuries in children affect both growing bone and soft tissues and can result in damage of growth mechanisms with subsequent lifelong, growth disturbance. With an increasing number of paediatric and adolescent athletes presenting with knee injuries. due to sports, a greater demand is put on clinicians and radiologists to assess the specific type of knee injury. Traumatic forces applied to the immature skeleton cause a different type of injury than those seen in adults due to the differences in vulnerability of the musculoskeletal system, especially at the site of the growth cartilage. An overview of several sport-related knee injuries of young athletes are presented, based on anatomical location and their management. The training programmes should be considered an important training tool that growing athletes can adjust to the changes in their bodies and could prevent knee injuries. Keywords: Sports-Related, paediatric, Children, Knee Injuries, Adolescent Sports Players, immature skeleton, growth cartilage.

A Juvenile Skeleton from a Classical Athenian Grave (No 48, 470–50 BC) Displaying Dental Developmental Abnormalities (Hypodontia)

We studied an immature skeleton, recovered from a Classical Athenian Grave. We employed standard anthropological methodology for skeletal age-estimation. Additionally, odontognathic components were subjected to X-ray imaging analysis. We concluded that the skeletal finds under study represent a juvenile with a biological age ranging between 10 and 13 years with multiple disturbances involving practically the entire dentition. Evidence of craniofacial/dentofacial developmental abnormalities may represent isolated conditions or may constitute part of a more complex phenotype, i.e. may represent syndromic traits. These changes may have carried an aesthetic, functional and psychosocial burden for the young patient and his or her family.

The role of orthopaedic surgery in haemophilia: current rationale, indications and results

The musculoskeletal problems of haemophilic patients begin in infancy when minor injuries lead to haemarthroses and haematomas. Early continuous haematological primary prophylaxis by means of the intravenous infusion of the deficient coagulation factor (ideally from cradle to grave) is of paramount importance because the immature skeleton is very sensitive to the complications of haemophilia: severe structural deficiencies may develop quickly. If primary haematological prophylaxis is not feasible due to expense or lack of venous access, joint bleeding will occur. Then, the orthopaedic surgeon must aggressively treat haemarthrosis (joint aspiration under factor coverage) to prevent progression to synovitis (that will require early radiosynovectomy or arthroscopic synovectomy), recurrent joint bleeds, and ultimately end-stage osteoarthritis (haemophilic arthropathy). Between the second and fourth decades, many haemophilic patients develop articular destruction. At this stage the main possible treatments include arthroscopic joint debridement (knee, ankle), articular fusion (ankle) and total joint arthroplasty (knee, hip, ankle, elbow).Cite this article: EFORT Open Rev 2019;4:165-173. DOI: 10.1302/2058-5241.4.180090

Asymptomatic Dysplasia Epiphysealis Hemimelica of the Shoulder in a Skeletally Mature Patient with Normal Function

Dysplasia epiphysealis hemimelica is a rare osteocartilaginous overgrowth syndrome of bone epiphysis, mostly encountered in the lower limbs of immature skeleton patients. We report a case of proximal humerus presentation in an adult male, with neither articular involvement nor clinical dysfunction. This case highlights the importance of stratification into intra- and extra-articular lesions, as this distinction ultimately influences both symptoms and treatment outcome. In addition, the case highlights the importance of specific imaging modalities, such as CT and MR images, which provide excellent anatomic location of the lesion, adequate extension of cartilaginous components, exact status of articular cartilage, and accurate assessment of neighboring structures, such as vessels, nerves, ligaments, tendons, and muscles. The imaging features are described, the relevant literature is reviewed, and salient features are discussed.

Percutaneous transolecranon pinning and lateral pinning Vs lateral pinning in displaced supracondylar fractures of humerus in children: an observative study

Background: Supracondylar fracture (humerus) is type of extra-articular fracture occurring in the distal metaphyseal site of humerus. It is almost exclusively a fracture of the immature skeleton, seen in children and young teenagers. Fractures around the elbow are a great challenge to orthopaedic surgeons. Clinical diagnosis may be difficult due to noncooperative patient and massive swelling around the elbow. Displaced type of supracondylar fractures poses problem not only in reduction but also in maintenance of reduced fracture and rapid inclusion of nerves and vessels.Methods: The present study was conducted on 30 cases of displaced supracondylar fracture humerus in children, aged 2-14 years, who were treated by CRPP with either lateral entry of k-wires or a lateral wire and a vertical wire through olecranon (transolecranon).Results: Both the Groups achieved 90% satisfactory results, but 10% unsatisfactory results recorded in Group A only rather than in Group B.Conclusions: Although the transolecranon wire has the disadvantage of limiting the flexion and extension of the elbow, this does not influence the final-outcome much as the elbow is fixed in a POP splint for minimum 3 weeks-in all patients in both groups.

Giant Cell Tumor Arising from Fibular Head in Immature Skeleton Treated with Marginal Excision

ABSTRACTGiant Cell tumor (GCT) is the benign tumor commonly found in second to fourth decade of life. Proximal fibula is very rare site and its occurrence in immature skeleton is still rare with very limited case report. We present a case of painful bony lesion arising from proximal fibula diagnosed as GCT in 15 year boy which was managed successfully with marginal excision and lateral collateral ligament anchorage in proximal tibia. There is no evidence of local recurrence, lung metastasis, knee pain and instability till 24 months of follow up. Keywords: giant cell tumor; proximal fibula; marginal excision .