INTRODUCTION:The osteosynthesis of supracondylar fractures (SC) using pins buried under the skin (PB) or externalized (PE) is a subject of debate. The aim of this study was to compare two treatment protocols, one using PB and the other using PE, in terms of clinical and radiographic outcomes, complication rates. HYPOTHESIS:The hypothesis of the study was that both protocols are equivalent in terms of clinical, radiological outcomes, and complication rates. MATERIALS AND METHODS:This was a retrospective bicentric comparative study analyzing 296 boys and 267 girls (mean age 6.2 ± 2.7 years) who underwent SC fracture surgery between 1/1/2010 and 31/12/2020 using two therapeutic protocols. The first protocol (group A; n = 210) involved osteosynthesis with PB, immobilization (6-7 weeks), and pin removal in the operating room under general anesthesia. The second protocol (group B; n = 353) was characterized by osteosynthesis with PE, immobilization (4-6 weeks), and pin removal in an outpatient setting. Functional outcomes were assessed using the QuickDASH questionnaire, radiographic outcomes [Baumann angle, lateral capitulum-humeral angle (LCHA), rotational disorders according to the Von Laer quotient], and postoperative complication rates (infection, recurrent fracture, stiffness, vasculo-nerve complications). RESULTS:No patients were lost to follow-up (n = 563) and the mean follow-up was 6.6 ± 7.3 months (3-70). The mean immobilization duration was longer in group A (45.8 ± 7.4 vs 39.7 ± 12.0 days; p < 0.001). Clinical and functional outcomes were similar (p = 0.316), and the pre- and postoperative complication rates were comparable between the two groups (A-B = 8 %/8.6 %-6 %/7.1 %; p = 0.733 and p = 0.512), while the postoperative Baumann angle, LCHA, number of rotational disorders, and Von Laer quotient were significantly different [A-B = 71.5°-74° (p < 0.001); A-B = 32.8°-35.6° (p < 0.001); A-B = 32-10 (p < 0.001); A-B = 0.2-0.1 (p = 0.020)]. DISCUSSION:This retrospective study compared two surgical protocols for pediatric supracondylar (SC) fractures in 563 children. Functional and clinical outcomes were similar between groups, with no significant difference in complication rates. Group B had better radiographic results and a lower rate of postoperative rotational deformities. Pin buried (Group A) increased costs and required a second general anesthesia for removal. Group B's protocol allowed outpatient pin removal under nitrous oxide, reducing risks and costs. Infection rates were no significant different between both groups. Whereas the decrease of number of rotational disorsders, the increase of Baumann angle and decrease of LCHA in this patient show that decrease of rotational disorders is more likely related to osteolysis of rotational spur than bone remodeling. Despite limitations, this is the largest French series comparing these two protocols, showing equivalent functional outcomes but greater efficiency and safety in Group B. CONCLUSION:Both therapeutic protocols have comparable clinical outcomes and complication rates. Leaving pins exposed does not increase the risk of infection. LEVEL OF EVIDENCE:III comparative retrospective study.

Few data are available in the literature in Europe on the possible impact of social health inequalities on the therapeutic management of idiopathic scoliosis. This study aimed to determine whether the adolescent’s care pathway in the French health system, affected by idiopathic scoliosis, from the stage of diagnosis to the postoperative stage, could be influenced by socio-economic deprivation. This retrospective, multicenter study analyzed 883 patients with surgery for adolescent idiopathic scoliosis between 2009 and 2019. The main clinical outcomes were the Cobb angle at first specialist consultation, brace compliance, the Cobb angle at surgery indication, the time to surgery, postoperative correction, and complications. A multiple linear regression model and multiple logistic regression model were performed to analyze the main outcomes according to the European Deprivation Index (EDI) and Scale Index. With the exception of Cobb’s angle at the first consultation (OR = 1.03 [1.01–1.04]) and on postoperative correction (OR = 0.997 [0.995–0.999]) socio-economic deprivation did not significantly influence the course of care of the adolescent operated on with idiopathic scoliosis. This study suggested the restricted influence of social deprivation on the management of surgical adolescent idiopathic scoliosis in the French health system. It seems that deprivation occurs only before special therapeutic management, strengthening the importance of systematic screening. Further studies are needed to assess the impact of different socioeconomic factors on this pathology.

Background: Treatment of scaphoid waist fractures is generally conservative in children but surgical in adults, given the relatively high risk of nonunion in adults. In adolescents, the required therapeutic strategy is less well defined. The objective of this study was to compare the radiographic and clinical parameters, and the rate of complications, between non-surgical orthopedic treatment (OT) and surgical treatment (ST) by percutaneous screw fixation of these fractures in adolescents approaching skeletal maturity. Hypothesis: ST of non-displaced scaphoid waist fractures in adolescents allows radiographic union, a functional result and a complication rate comparable to that of ST. Methods: This single-center retrospective study included patients who presented with a non-displaced scaphoid waist fracture, with a chronological age (CA) and a bone age (BA) between 14 and 18 years. Clinical and radiographic parameters and complications were analyzed during the trauma and at one year, including functional scores, between two groups of patients; OT and ST. Results: Thirty-seven patients had OT (63.8%) and 21 had ST (36.2%). The median CA was 16 years [14.25-16]. The median BA was 16 years [15;17] according to the Greulich and Pyle method and corresponded to R9 [R7-R10] and U7 [U7;U8] according to the Distal Radius and Ulnar (DRU) classification system. All nonunions were found in the OT group (23.4% vs 0%, p=0.019). The duration of immobilization (8 weeks) and the number of consultations were higher after OT than ST. Functional scores were lower in patients with nonunion after OT (p≤0.002) Conclusion: OT of scaphoid waist fractures in adolescents results in a higher rate of nonunion than ST, similar to the rate found in adults. Findings from this study recommend a surgical approach by percutaneous screw fixation. Level of evidence: III; comparative retrospective study.

Le traitement des fractures du corps du scaphoïde est généralement orthopédique chez l’enfant et chirurgical chez l’adulte, compte tenu du risque relativement élevé de pseudarthrose. La stratégie thérapeutique est moins codifiée chez les adolescents. L’objectif de cette étude était de comparer les paramètres radiographiques, cliniques et le taux de complications entre traitement orthopédique (TO) et chirurgical (TC) par vissage percutané de ces fractures chez les adolescents en fin de croissance. Le TO des fractures non déplacée du corps du scaphoïde chez l’adolescent permet une consolidation radiographique, un résultat fonctionnel et un taux de complication comparables à celui du TC. Une étude rétrospective monocentrique a été menée, incluant les patients ayant présenté une fracture non déplacée du corps du scaphoïde, avec un âge civil (AC) et un âge osseux (AO) entre 14 et 18 ans. Les paramètres cliniques, radiographiques et les complications ont été analysés lors du traumatisme et à un an, incluant des scores fonctionnels, entre deux groupes de patients, TO et TC. Trente-sept patients ont eu un TO (63,8 %) et 21 un TC (36,2 %). L’AC médian était de 16 ans [14,25–16]. L’AO médian était de 16 ans [15–17] selon Greulich et Pyle et correspondait à R9 [R7–R10] et U7 [U7–U8] selon le système radio-ulnaire-distal. Toutes les pseudarthroses ont été retrouvées dans le groupe TO (23,4 % vs 0 %, p = 0,019). La durée d’immobilisation (8 semaines) et le nombre de consultations étaient plus élevés après TO que TC. Les scores fonctionnels étaient inférieurs chez les patients ayant présenté une pseudarthrose après TO (p ≤ 0,002). Le TO des fractures du corps du scaphoïde chez l’adolescent entraîne un taux de pseudarthrose plus important que le TC, similaire au taux retrouvé chez les adultes. Une approche chirurgicale par vissage percutané est suggérée par ce travail. III ; étude rétrospective comparative.

Background: Several Medial Patellofemoral Ligament (MPFL) reconstruction techniques have been developed, and those with soft tissue fixation are often preferred in children because they allow the growth cartilage to be preserved. Nevertheless, the recurrence rate of patellar dislocation varies widely from one series to another, with no clear superiority of one technique in the pediatric setting. The objectives of this study were to compare the results of two tendon graft fixation techniques (tendon-tendon fixation and anchor-screw fixation) by analyzing: 1) the rate of patellar dislocation recurrence, 2) clinical outcomes, 3) tourniquet time and 4) complication rate. Hypothesis: The two tendon graft fixation techniques used in MPFL reconstruction are equivalent in terms of the patellar dislocation recurrence rate.Patients and methods: This is a retrospective comparative study including 57 patients with a median age of 14 years (12-15 years) who underwent MPFL reconstruction between 2016 and 2020. The tendon graft was fixed upon itself, after passing through a patellar tunnel (Group A: tendon-tendon fixation; n = 29) or by two anchors and an interference screw (Group B: anchor-screw fixation; n = 28). The preoperative radiographic data were comparable in the two groups: patellar height [A: 1.3 (interquartile range (IQR): 1.2-1.4) / B: 1.2 (IQR: 1-1.4) (p = 0.21)], tibial tuberosity to trochlear groove (TTTG) distance [A: 16 (IQR: 13-19) / B: 13.5 (IQR: 11.5-18.8) (p = 0.12)], patellar tilt [A: 25 (IQR: 20-35) / B: 24.5 (IQR: 21-32) (p = 0.93)]. For each technique, the rate of patellar dislocation recurrence, clinical and functional results (Kujala score, Marx activity score, Lille patellofemoral score), complications (pain, stiffness, revision) were analyzed. In addition to MPFL repair, 13 patients (2 in Group A, 11 in Group B) underwent additional orthopedic procedures to enhance patellar stability.Results: no patients were lost to follow-up and the median follow-up was 30 months (IQR: 20-38). The dislocation recurrence rate was higher in Group A, 6.9% (2/29) compared to none in Group B. The clinical results were comparable for the two groups with a Kujala score [A: 94 (IQR: 89-100) / B: 92 (IQR: 87.5-94.5) (p = 0.12)]; Marx score [A: 10 (IQR: 7-11) / B: 9.5 (IQR: 7.5-12) (p = 0.89)] and Lille patellofemoral score [A: 97 (IQR: 91-100) / B: 94 (IQR: 90-98) (p = 0.21)]. The tourniquet time was shorter in Group A than in Group B, 61 minutes (IQR: 52-71) versus 85 minutes (IQR: 55-115) (p = 0.024) excluding additional orthopedic procedures. The complication rate was 17.2% (5/29) in Group A (dislocation n = 2, stiffness n = 2, ATT (anterior tibial tuberosity) revision with screw removal n = 1) and 10.7% (3/28) in B (pain n = 1, ATT revision with screw removal n = 2) (p = 0.35).Conclusion: Clinically, anchor-screw fixation appears to reduce the risk of patellar dislocation recurrence but this could not be statistically tested. On the other hand, the two techniques are comparable in terms of the functional results. Level of evidence: III; retrospective case-control study.(c) 2022 Elsevier Masson SAS. All rights reserved.

The aim of this study was to evaluate the effects of definitive arthrodesis on frontal and sagittal spine balance in EOS patients treated with MCGR, as well as the complications associated with this procedure and the outcome at last follow-up. This was a multicentre study in 10 French centres. All patients who underwent posterior spinal arthrodesis after completion of MCGR treatment, regardless of age, etiology of scoliosis between 2011 and 2022, were included. A total of 66 patients who had a final fusion after the lengthening programme were included in the study. The mean follow-up time was 5.5 ± 1.7 years (range: 2.1–9). The mean follow-up time after arthrodesis was 24 ± 18 months (range: 3–68) and the mean age at arthrodesis was 13.5 ± 1.5 years (range: 9.5–17). The main and secondary curves were significantly (p < 0.005 and p = 0.03) improved by arthrodesis (16.4° and 9° respectively) and stabilised at the last follow-up. The T1-T12 and T1-S1 distances increased by 8.4 mm and 14 mm with spinal fusion, with no significant difference (p = 0.096 and p = 0.068). There was no significant improvement in the rest of the parameters with arthrodesis, nor was there any significant deterioration at last follow-up. After final fusion, there were a total of 24 complications in 18 patients (27.3 Final fusion after MCGR provides satisfactory additional correction of the main and secondary curves and a moderate increase in the T1-T12 distance but has no impact on sagittal balance and other radiological parameters. The post-operative complication rate is particularly high in patients at risk of complications. Level 4.

De nombreuses techniques de reconstruction du Ligament Fémoro-Patellaire Médial (LFPM) ont été mises au point et celles avec fixation aux parties molles sont souvent préférées chez l’enfant car permettant de préserver le cartilage de croissance. Néanmoins, le taux de récidive de luxation de la patella varie largement d’une série à une autre, sans supériorité claire d’une technique dans le cadre pédiatrique. Les objectifs de cette étude étaient de comparer les résultats de deux techniques de fixation du greffon tendineux (fixation tendon-tendon et fixation ancres-vis) en analysant : 1) le taux de récidive de luxation de la patella, 2) les résultats cliniques, 3) le temps de garrot, 4) le taux complications. Les deux techniques de fixation du greffon tendineux dans le cadre d’une reconstruction du LFPM sont équivalentes en termes de taux de récidive de luxation de patella. Il s’agit d’une étude comparative rétrospective incluant 57 patients avec une médiane d’âge de 14 ans (12–15 ans) opérés d’une reconstruction du LFPM entre 2016 et 2020. Le greffon tendineux a été fixé sur lui-même, après passage dans un tunnel rotulien (Groupe A : fixation tendon-tendon ; n = 29) ou par deux ancres et une vis d’interférence (Groupe B : fixation ancres-vis ; n = 28). Les données radiographiques préopératoires étaient comparables dans les deux groupes : hauteur patellaire [A : 1,3 (écart interquartile (EI) :1,2–1,4)/B : 1,2 (EI :1–1,4) (p = 0,21)], distance gorge trochléenne tubérosité tibiale (TAGT) [A : 16 (EI :13–19)/B : 13,5 (EI :11,5-18,8) (p = 0,12)], bascule patellaire [A : 25 (EI :20-35)/B : 24,5 (EI :21–32) (p = 0,93)]. Pour chaque technique le taux de récidive de luxation de patella, les résultats cliniques et fonctionnels (score Kujala, score d’activité de Marx, score fémoropatellaire lillois), les complications (douleur, raideur, révision) ont été analysés. Outre la réparation du LFPM, 13 patients (2 dans le Groupe A, 11 dans le B) ont bénéficié de gestes osseux complémentaires. Aucun patient n’a été perdu du vue et le suivi médian était de 30 mois (EI :20–38). Le taux de récidive de luxation était plus élevé dans le Groupe A, 6,9 % (2/29) contre aucune dans le groupe B. Les résultats cliniques étaient comparables pour les deux groupes avec un score Kujala [A : 94 (EI :89-100)/B : 92 (EI :87,5–94,5) (p = 0,12)] ; Marx [A : 10 (EI :7–11)/B : 9,5 (EI :7,5–12) (p = 0,89)] et le score fémoropatellaire Lillois [A : 97 (EI :91–100)/B : 94 (EI :90–98) (p = 0,21)]. Le temps de garrot était plus court dans le Groupe A que dans le Groupe B, 61 minutes (EI :52-71) versus 85 minutes (EI :55–115) (p = 0,024) en excluant les gestes osseux complémentaires. Le taux de complications était de 17,2 % (5/29) dans le Groupe A (luxation n = 2, raideur n = 2, révision ablation vis TTA n = 1) et de 10,7 % (3/28) dans le B (douleur n = 1, révision ablation vis TTA n = 2) (p = 0,35). Cliniquement, la fixation ancre-vis semble réduire le risque de récidive de luxation de patella mais cela n’a pas pu être testé statistiquement. En revanche, les deux techniques sont comparables sur les résultats fonctionnels. III étude cas témoin rétrospective.

Purpose To assess the risk of developing thoracogenic scoliosis (THS) in paediatric patients, depending on the side of lateral thoracotomy (LT) and of spine deviation in the coronal plane by means of logistic regression and scoliosis-free survival analyses. Methods A total of 307 consecutive patients undergoing LT were retrospectively reviewed; 32 patients met the inclusion criteria: 1) underwent LT and developed THS; 2) age < 15 years at LT; 3) clinical and radiographic follow-up ≥ 5 years. Patients were divided into ipsilateral group (convexity ipsilateral to LT) and contralateral group (convexity contralateral to LT). Results The mean follow-up was 10 ± 4.7 in the ipsilateral group ( n = 13) and 12 ± 4.8 years in the contralateral group ( n = 19). The contralateral group underwent LT at a younger age (4.4 vs 6.4 years, p = 0.55), developed more severe coronal deformity (27.8° vs 18.9°, p = 0.15), had higher rate of THS > 20° (47.5% vs 38.4%; p = 0.34) and > 45° (21.1% vs 0%; p = 0.99). The mean time from LT to THS diagnosis was 4.2 ± 2.9 in ipsilateral group and 5.5 ± 4.2 years in contralateral group. Left-side LT ( p = 0.03) and age > 5 years ( p = 0.01) showed a lower risk of THS diagnosis. The group variable had a statistically significant effect on the risk of developing THS > 45° ( p = 0.03). Conclusion In this series, children that developed THS with a convexity contralateral to the side of LT had more severe and progressive coronal spine deformity. Level of evidence: III

L’algorithme thérapeutique de l’épiphysiolyse fémorale supérieure (EFS) instable à grand déplacement est peu consensuel, et l’ostéotomie sous-capitale est une des options chirurgicales. L’ostéotomie est réalisée par voie antérieure (ostéotomie cunéiforme antérieure, OC) ou latérale avec trochantérotomie (opération de Dunn, OD). L’OC est plus facile techniquement et diminue le temps opératoire, de plus dans notre service l’OD était classiquement employée avant que l’OC ne la remplace nous permettant d’avoir une série consécutive de patients. Il s’agit à notre connaissance de la première étude comparative entre ces deux interventions. L’objectif de cette étude rétrospective était de comparer pour les EFS instables à grand déplacement traitées par OC versus OD : (1) les complications postopératoires et notamment la survenue d’une ostéonécrose avasculaire, (2) la fonction, (3) les résultats radiologiques. L’OC est moins ou autant pourvoyeuse d’ostéonécrose épiphysaire et permet d’obtenir les mêmes résultats clinico-radiographiques que l’OD. Quarante et un patients (24 filles soit 58,5 %) ont été inclus entre 2005 et 2018 : 23 dans le groupe OC et 18 dans le groupe OD. L’âge médian était de 12,9 ans (extrêmes, 11,5 à 14,9), le déplacement médian de 70° (extrêmes, 62,5° à 80°) avec un suivi médian de 3 ans (extrêmes, 2 à 4). Des paramètres clinico-radiographiques (angles de Southwick et de Nötzli, offset cervicocéphalique postérieur) préopératoires, peropératoires et à distance ont été analysés ; toutes les complications ont été répertoriées. Deux cas d’ostéonécrose ont été recensés dans le groupe OC (8,7 %) et 6 (33,3 %) dans le groupe OD (p = 0,11) avec un pourcentage d’ostéonécrose global sur la série de 19,5 % (8/41). Cinq patients sur 41 (12,2 %) ont bénéficié d’une arthroplastie totale de hanche : 1/23 dans le groupe OC (4,3 %) et 4/18 dans le groupe OD (22,2 %) (p = 0,16). Avant éventuelle arthroplastie, deux patients (9,5 %) dans le groupe OC et 7 (38,9 %) dans le groupe OD ont développé une boiterie postopératoire (p = 0,055). L’angle de Nötzli au recul (54° ± 6,1 vs 59,1° ± 7,2 [p = 0,027]), le score d’Oxford-12 au recul (17/60 [extrêmes, 14 à 20] vs 23,5 [extrêmes, 19 à 27]) (p = 0,021), le temps opératoire (132 min. [extrêmes, 103 à 166] vs 199,5 min. [extrêmes, 142 à 215]) (p = 0,011) et le saignement (250 mL [extrêmes, 100 à 350] vs 300 mL [extrêmes, 197 à 450]) (p = 0,088) étaient plus favorables dans le groupe OC que dans le groupe OD. L’OC présente des résultats comparables à l’OD dans la chirurgie des EFS instables à grand déplacement. III ; étude rétrospective comparative.

To determine the midterm outcome of lateral thoracotomy (LT) in skeletally immature patients concerning thoracogenic scoliosis development and lung parenchyma resection (LPR) extent. In total, 129 children met the inclusion criteria: (1) LT during the study period; (2) skeletally immature at the time of LT; (3) clinical and radiographic follow-up of at least 3 years; and (4) no spinal or thoracic deformity on radiographs before LT. Patients were grouped according to their underlying disease, age at LT, and LPR extent. Radiographic parameters were assessed. Kaplan–Meier survival curves and univariate and multivariate analysis were performed. Of 129, 108 patients underwent pneumonectomy (9; 9.1%), lobectomy (79; 61.2%), segmentectomy (20; 15.5%) and 21 patients LT without LPR. The mean age at LT and at last radiological follow-up was 5.5 years (birth-17.8) and 15.2 years (3.4–33.2). The mean follow-up was 10 years (3–28.1). Scoliosis developed on average 5.3 years after LT. The mean Cobb angle was 22.1° (11–90°); > 10° in 37/129 patients (28.7%), of whom 5/129 (3.9%) had > 45°. The average vertebral rotation was 16.2° (2–43°; grade 0–II). RVAD was 26.5° (8°-33°) and 15.3° (2–43°) in patients with Cobb > 45° and ≤ 45°. Gender, age at surgery, and extent of LPR were not risk factors for post-thoracotomy scoliosis (p > 0.05), although younger patients developed a more severe deformity. Although post-thoracotomy scoliosis is not associated with significant rotation, the risk of curve progression > 45° is relatively high. Regular follow-up is required as scoliosis may develop several years after LT with or without LPR.

Ewing's sarcoma is the second most frequent primary malignant bone tumor in adolescents and young adults. Locations on the thoracic wall represent up to 20% of primary and secondary locations. We present the case of a 13-year-old patient treated with the use of a radiolucency porous bioceramic prosthesis as a sternal replacement for a wide tumor resection in an oncologic context. Focal radiation therapy was not possible due to the high risk of severe myocardial injuries caused by the sternal location of the tumor. The sternum CERAMIL® (I.CERAM, Limoges, France), in porous alumina (Al2O3) has already been implanted into adults in sternal replacement during its invasion by a tumor or its infectious destruction. There were no complication concerning the surgery. The last follow-up at 2 years postoperatively reveals a satisfactory clinical situation with any functional thoracic complaint and nor any functional respiratory symptoms. The porous alumina sternal prosthesis offers a reliable alternative for sternal replacement indications for children in an oncologic context.

INTRODUCTION:The too-long anterior process (TLAP) increases mechanical stress on the hindfoot and could lead to osteochondral lesions of the talus (OLT) by localized hyper-pressure. The purpose of this study is to investigate an association between TLAP and OLT in children. METHODS:This is a retrospective, multicenter, case-control study conducted between 2010 and 2020. The OLT group was compared to a control group (CoG). TLAP is characterized by a distance between the anteromedial process of the calcaneus and the navicular bone (CN) of< 5 mm. RESULTS:Forty-three feets were included in the OLT group and 92 in the CoG. The OLT group had a lower CN distance on CT than the CoG, a median of 2.8 mm versus 3.75 mm (p = 0.002); 86% of patients (37 feet/43) in the OLT group had a CN distance of< 5 mm (OR=3.0 [1.1; 9.5], p = 0.023) compared to 67% in the CoG. DISCUSSION:The OLT group had an increased risk of developing TLAP compared to the CoG. LEVEL OF EVIDENCE:III.

Background and objectives: The epidemiology and distribution of pediatric fractures change over time and are influenced by a multitude of factors including geography, climate, and population characteristics. The aims of our work were to study the distribution of traumatic pediatric orthopedic injuries admitted to the Lille University Hospital (LUH) Pediatric Emergency Department in 1999 and in 2019 and to analyze the epidemiological differences 20 years apart. Materials and methods: This was a retrospective, comparative, monocentric, and epidemiological study involving all children between 0 and 15 years and 3 months of age who consulted the pediatric emergencies of LUH from 1 January 1999 to 31 December 1999 and from 1 January 2019 to 31 December 2019. On admission, the following data were collected: sex, age at the time of injury, month and time of the day the trauma occurred (4:00 a.m to 11:59 a.m, 12:00 p.m. to 19:59 p.m, and 20:00 p.m to 3:59 a.m.), mechanism of injury, laterality (right or left), anatomical location, type of injury, and whether the fracture was closed or open. The type of treatment (orthopedic or surgical) was collected from the medical records. Results: A total of 939 children were included in 1999 compared with 781 in 2019 (21% decrease); the average age of children with fractures was significantly higher in 1999 (8.81 years) than in 2019 (7.19 years). This difference was explained by the majority involvement of older children (10–15 years) in 1999 (43% of fractures in 1999 versus 25% of fractures in 2019). Conversely, small children (1–5 years) had significantly more fractures in 2019 (36%) than in 1999 (24%). Conclusions: Overall, the types and sites of fractures did not change over the studied time despite a change in the population and mechanism of injury. This suggested that the reflexes of breaking a fall still tended to implicate and damage the same bone segments. Finally, the proportion of fractures managed surgically versus orthopedically has not evolved since 1999. Exploring this is a possible area of further research that would complement our study.

In pectus excavatum, minimally invasive endoscopic repair is the current gold standard in adolescents. The main postoperative pitfall is bar displacement, making fixation a major issue. We report an original transcostal technique using absorbable USP-2 suture in 36 patients. There was a single case of bar displacement (2.78%; 95% CI: 0.07-14.53). Bar stability was comparable to literature reports; but the present technique avoided the complications potentially incurred by use of metal wire, pericostal fixation points and stabilizers.

Le pectus excavatum est une pathologie dont la chirurgie mini-invasive sous contrôle endoscopique est actuellement le traitement de référence chez l’adolescent. Le principal écueil post-opératoire de cette chirurgie est le déplacement de la barre et donc sa fixation. Une technique originale de fixation transcostale au fil résorbable (décimale 5) a été utilisée chez 36 patients. Un seul cas de déplacement de la barre a été observé soit 2,78 % de la population (intervalle de confiance à 95 % IC=0,07–14,53). Les résultats sur la stabilité de la barre étaient comparables à ceux retrouvés dans la littérature mais cette technique permet d’éviter l’utilisation d’un fil métallique, d’un point péricostal ou d’un stabilisateur potentiellement sources de complications.

Colistin pharmacokinetics (PK) has been recently extensively revisited [1Nation R.L. Li J. Cars O. Couet W. Dudley M.N. Kaye K.S. et al.Framework for optimisation of the clinical use of colistin and polymyxin B: the Prato polymyxin consensus.Lancet Infect Dis. 2015; 15: 225-234Abstract Full Text Full Text PDF PubMed Scopus (240) Google Scholar, 2Grégoire N. Aranzana-Climent V. Magréault S. Marchand S. Couet W. Clinical pharmacokinetics and pharmacodynamics of colistin.Clin Pharmacokinet. 2017; 56: 1441-1460Crossref PubMed Scopus (93) Google Scholar], but limited and sometimes conflicting information is available for paediatric patients [[3]Nation R.L. Dose suggestions for intravenous colistin in pediatric patients: caution required.Clin Infect Dis. 2018; 66: 810-811Crossref PubMed Scopus (8) Google Scholar]. Further, the dosing regimen currently recommended for children by the European Medicines Agency (EMA) for the colistin methanesulfonate (CMS) prodrug (75 000 to 150 000 IU/kg per day) seems likely to result in suboptimal colistin plasma concentrations [[3]Nation R.L. Dose suggestions for intravenous colistin in pediatric patients: caution required.Clin Infect Dis. 2018; 66: 810-811Crossref PubMed Scopus (8) Google Scholar]. We report the case of a 8-year-old boy weighing 25 kg, 1.35 m in height and a plasma creatinine of 35 μmol/L, corresponding to a creatinine clearance (CLCR) estimated at 103 mL/min according to the Schwartz estimate. The boy had an open fracture of the right femur resulting from a bicycle accident. Bacteriologic samples during the surgical procedure revealed the presence of a Pseudomonas aeruginosa metallo-carbapenemase sensitive to colistin. The patient received CMS as Colimycin at a dose of 3 MIU, approximately 90 mg colistin-based activity, every 8 hours (360 000 IU/kg per day, corresponding to 10.80 mg colistin-based activity/kg per day), infused intravenously over 60 minutes. Four blood samples were collected after the tenth infusion on day 4 for determinations of total colistin and CMS concentration in plasma [[4]Couet W. Grégoire N. Gobin P. Saulnier P.J. Frasca D. Marchand S. et al.Pharmacokinetics of colistin and colistimethate sodium after a single 80-mg intravenous dose of CMS in young healthy volunteers.Clin Pharmacol Ther. 2011; 89: 875-879Crossref PubMed Scopus (110) Google Scholar], followed by their simultaneous PK analysis by Monolix Suite 2016R1 software (Lixoft, Orsay, France). Differences in molecular weight between CMS (1632 g/mol) and colistin (1167 g/mol) were considered for PK calculations. Satisfactory data fitting was obtained with a one-compartment model for both compounds (Fig. 1). Although the CMS daily dose (360 000 IU/kg per day) was more than twice the higher recommended dose (150 000 IU/kg per day) and equivalent to the adult daily dose (9 MIU per day) for a patient with preserved renal function, measured colistin plasma concentrations were relatively low, fluctuating between 0.5 and 1.5 μg/mL. The average concentration at steady state (Css), corresponding to the ratio of the area under the concentration–time curve at steady state and during 24 hours to 24 (AUC0–24/24), was equal to 1.0 μg/mL, which is twice as low as the recommended target [[1]Nation R.L. Li J. Cars O. Couet W. Dudley M.N. Kaye K.S. et al.Framework for optimisation of the clinical use of colistin and polymyxin B: the Prato polymyxin consensus.Lancet Infect Dis. 2015; 15: 225-234Abstract Full Text Full Text PDF PubMed Scopus (240) Google Scholar]. Compared to an adult, this 8-year-old child had a low weight (25 kg) but had adult renal function, with CrCl estimated at 103 mL/min. To our knowledge, this is the first PK study of colistin in a paediatric patient with determination of CMS concentrations. At early time points, CMS concentrations should be substantially higher than those of colistin, and uncontrolled postsampling hydrolysis of CMS may lead to greatly overestimated colistin concentrations. CMS volume of distribution (Vd) and therefore peak concentration (Cmax) are related to body weight [[2]Grégoire N. Aranzana-Climent V. Magréault S. Marchand S. Couet W. Clinical pharmacokinetics and pharmacodynamics of colistin.Clin Pharmacokinet. 2017; 56: 1441-1460Crossref PubMed Scopus (93) Google Scholar]. In this 25 kg child, the estimated Vd (10.1 L) was about two thirds of the typical values reported in adults [[2]Grégoire N. Aranzana-Climent V. Magréault S. Marchand S. Couet W. Clinical pharmacokinetics and pharmacodynamics of colistin.Clin Pharmacokinet. 2017; 56: 1441-1460Crossref PubMed Scopus (93) Google Scholar] and was consistent with measured plasma concentration at the end of infusion (Cmax at 12.9 μg/mL). Because CMS is mostly excreted unchanged in urine [1Nation R.L. Li J. Cars O. Couet W. Dudley M.N. Kaye K.S. et al.Framework for optimisation of the clinical use of colistin and polymyxin B: the Prato polymyxin consensus.Lancet Infect Dis. 2015; 15: 225-234Abstract Full Text Full Text PDF PubMed Scopus (240) Google Scholar, 2Grégoire N. Aranzana-Climent V. Magréault S. Marchand S. Couet W. Clinical pharmacokinetics and pharmacodynamics of colistin.Clin Pharmacokinet. 2017; 56: 1441-1460Crossref PubMed Scopus (93) Google Scholar], its total clearance is related to CrCl. CMS clearance was estimated at 205 mL/min, consistent with typical values reported in healthy volunteers (148 mL/min) [[4]Couet W. Grégoire N. Gobin P. Saulnier P.J. Frasca D. Marchand S. et al.Pharmacokinetics of colistin and colistimethate sodium after a single 80-mg intravenous dose of CMS in young healthy volunteers.Clin Pharmacol Ther. 2011; 89: 875-879Crossref PubMed Scopus (110) Google Scholar]. However, because the fraction of the CMS dose eventually converted into colistin is unknown, only apparent PK parameters values can be estimated for this active moiety. Therefore, the effects of body weight and CrCl on colistin PK are difficult to assess. Colistin systemic exposure after multiple dosing at steady state is only governed by its apparent clearance (CLcoli/fm) according to AUC0–24 = [daily dose/(CLcoli/fm)] [[2]Grégoire N. Aranzana-Climent V. Magréault S. Marchand S. Couet W. Clinical pharmacokinetics and pharmacodynamics of colistin.Clin Pharmacokinet. 2017; 56: 1441-1460Crossref PubMed Scopus (93) Google Scholar], where CLcoli corresponds to colistin clearance and fm to the fraction of the CMS dose converted into colistin. In this child CLcoli/fm was estimated at 332 mL/min, twice as high as in healthy volunteers [[4]Couet W. Grégoire N. Gobin P. Saulnier P.J. Frasca D. Marchand S. et al.Pharmacokinetics of colistin and colistimethate sodium after a single 80-mg intravenous dose of CMS in young healthy volunteers.Clin Pharmacol Ther. 2011; 89: 875-879Crossref PubMed Scopus (110) Google Scholar] (160 mL/min), which is responsible for the relatively low colistin concentrations (Fig. 1) and Css estimate (1.0 μg/mL) despite the 9 MIU daily dose. The relatively high CLcoli/fm value estimated in this child is difficult to interpret. CLcoli is hard to assess because the mechanism of colistin elimination is unknown and the fraction of CMS converted into colistin (fm) depends on the fraction of the CMS dose excreted unchanged in urine (fe), which is correlated to CrCl. Because the CrCl value in this child (103 mL/min) compared favorably with that of healthy volunteers, fm should not be markedly altered. This relatively high CrCl is actually not surprising considering that glomerular filtration rate reaches adult values at prepubertal age [[5]Rodieux F. Wilbaux M. van den Anker J.N. Pfister M. Effect of kidney function on drug kinetics and dosing in neonates, infants, and children.Clin Pharmacokinet. 2015; 54: 1183-1204Crossref PubMed Scopus (74) Google Scholar]. Therefore, the reason for this relatively high CLcoli/fm remains unknown, and although difficult to assess, an altered protein binding could also contribute to this high CLcoli/fm value. However, this parameter, which determines colistin Css for a given daily dose, is not decreased together with body weight, at least in this child, a finding that is in agreement with our recent understanding of colistin PK [1Nation R.L. Li J. Cars O. Couet W. Dudley M.N. Kaye K.S. et al.Framework for optimisation of the clinical use of colistin and polymyxin B: the Prato polymyxin consensus.Lancet Infect Dis. 2015; 15: 225-234Abstract Full Text Full Text PDF PubMed Scopus (240) Google Scholar, 2Grégoire N. Aranzana-Climent V. Magréault S. Marchand S. Couet W. Clinical pharmacokinetics and pharmacodynamics of colistin.Clin Pharmacokinet. 2017; 56: 1441-1460Crossref PubMed Scopus (93) Google Scholar]. Although more data would be needed to confirm this observation, it appears that there is no clear justification for reducing CMS daily dose in children because of their low body weight, as far as their glomerular filtration rate reaches adults values. The dosing regimen currently recommended by EMA in children may not be optimal, and we would recommend higher doses with close monitoring of concentrations, in particular to avoid nephrotoxicity. All authors report no conflicts of interest relevant to this article.

To evaluate in children microdose protocol compared with low dose for lower limb alignment (LLA) measurements on biplanar radiography.

SMC, which was first described in 1958, is an autosomal recessive skeletal dysplasia. The disease bears similarity to Dyggve-Melchior-Clausen (DMC) syndrome except that patients with SMC have normal intelligence function, whereas patients with DMC have moderate to severe intellectual disabilities. The DMC gene is mapped to the 18q12-12.1 chromosomal region. SMC (OMIM: 607326) also mapped to this same region and as it turns out both conditions have mutations in the DYM gene. DMC results from mutations in the gene that results in loss of function, whereas in SMC, the mutation is a missense mutation resulting in residual DYM activity, thus a less severe phenotype. The gene codes for a novel protein known as Dymeclin, which is involved in Golgi organisation and intracellular trafficking. Recently, another gene, RAB33B, which decreases the level of another Golgi protein that is involved in retrograde transport of Golgi vesicles, has been implicated in the pathogenesis of SMC.

Poster: ECR 2017 / B-1028 / Pertinence of the micro-dose biplanar radiographs in children's pangonometry by: C. Tillaux , H. Lerisson, E. Amzallag-Bellenger, A. Cebulski-Delebarre, L. Deruyter, E. Nectoux, F. E. Avni, B. Herbaux, N. Boutry; Lille/FR