Analysis of kinematic and postural data of adolescent idiopathic scoliosis (AIS) patients seems relevant for a better understanding of biomechanical aspects involved in AIS and its etiopathogenesis. The present project aimed at investigating kinematic differences and asymmetries in early AIS in a static task and in uniplanar trunk movements (rotations, lateral bending, and forward bending). Trunk kinematics and posture were assessed using a 3D motion analysis system and a force plate. A total of fifteen healthy girls, fifteen AIS girls with a left lumbar main curve, and seventeen AIS girls with a right thoracic main curve were compared. Statistical analyses were performed to investigate presumed differences between the three groups. This study showed kinematic and postural differences between mild AIS patients and controls such as static imbalance, a reduced range of motion in the frontal plane, and a different kinematic strategy in lateral bending. These differences mainly occurred in the same direction, whatever the type of scoliosis, and suggested that AIS patients behave similarly from a dynamic point of view.

INTRODUCTION:Proximal physeal fracture of the medial clavicular physis is a rare specific injury occurring in the immature skeletal. Several studies describe unilateral cases with posterior or anterior displacement and the following complications (vascular and mediastinal compression). An immediate diagnosis and management are necessary to avoid complications. The clinical diagnostic might be obvious or difficult, pain and swelling in the sternoclavicular joint area, sometimes a deformity and focal tenderness. A chest X-Ray may help and a three-dimensional reconstructed computed tomography scan has to be done to evaluate the lesions before surgery. The imaging is useful to confirm and specify the diagnostic and the displacement. PRESENTATION OF CASE:This case report presents 4 cases of proximal physeal fracture of the medial clavicular physis in 2 male-teenagers with bilateral displacement, one posterior and the other asymmetric. DISCUSSION:After reviewing the literature of the unilateral clavicular physeal fracture, we can conclude that the ideal management of these injuries has not been well described. An open reduction associated an osteosuture with non-resorbable suture was performed. One-year follow-up, both of them had full recovery without any functional impact or any complains. This management of the proximal physeal fracture of the medial clavicle on children shows an excellent result according our cases and the literature. CONCLUSION:The purpose of this study is to evaluate the functional impact of osteosuture in medial bilateral clavicular physeal fracture in teenagers after 1-year follow-up.

Analysis of kinematic and postural data of adolescent idiopathic scoliosis (AIS) patients seems relevant for a better understanding of biomechanical aspects involved in AIS and its etiopathogenesis. The present project aimed at investigating kinematic differences and asymmetries in early AIS in a static task and in uniplanar trunk movements (rotations, lateral bending and forward bending). Trunk kinematics and posture were assessed using a 3D motion analysis system and a force plate. Fifteen healthy girls, fifteen AIS girls with left lumbar main curve and seventeen AIS girls with right thoracic main curve were compared. Statistical analyses were performed to investigate presumed differences between the three groups. This study showed kinematic and postural differences between mild AIS patients and controls such as static imbalance, a reduced range of motion in the frontal plane and a different kinematic strategy in lateral bending. These differences mainly occurred in the same direction whatever the type of scoliosis, and suggested that AIS patients behave similarly from a dynamic point of view.

Arthrogryposis multiplex congenita (AMC) consists of congenital joint contractures that affect at least two joints. There are two types: in the first, arthrogryposis is an additional sign in the context of various pathologies (neuromuscular diseases); in the second, it is the main and constant symptom. In the first type, the progression of the causal underlying disease must be considered. In the second type, there are two specific forms: Amyoplasia corresponds to a significant congenital absence of muscles (epigenetic disease or vascular origin) while distal arthrogryposis has a genetic component and is transmissible. The orthopedic surgeon's purpose, which is usually to enhance movement, is not appropriate for an arthrogryposis patient. One must keep in mind that without muscle, movement is impossible. The goal differs between the upper and lower limbs: for the upper limb, it is to allow grasping, and, if possible, to bring the hand to the mouth; for the lower limb, it is to ensure ambulation with plantigrade support, and the knees extended, which is the only stable position possible with little to no muscles. The rehabilitation, orthoses and/or surgical techniques are chosen to achieve this singular aim. While it may appear modest, it is crucial for patients. The goal is to achieve useful mobility, not maximum mobility. This multidisciplinary treatment, which evolves over time, must be explained to the family to get its adherence.

Les arthrogryposes multiples congénitales s'expriment par une raideur congénitale d'au moins deux articulations. Il existe deux grands cadres : pour le premier, l'arthrogrypose est un signe d'accompagnement dans un contexte de pathologies diverses (maladies neuro-musculaires), pour le second, elle constitue le symptôme principal et constant. Dans le premier, il faudra prendre en compte l'évolutivité de la maladie causale sous-jacente. Dans le second, deux formes sont à préciser : l'Amyoplasie, qui correspond à une absence congénitale plus ou moins importante de muscles, maladie épigénétique ou d'origine vasculaire, et les arthrogryposes distales qui ont un support génétique et sont transmissibles. Pour le traitement, il faut se débarrasser de nos convictions profondes qui sont de favoriser le mouvement : sans muscle, pas de mouvement actif possible. Le but qu'il faut poursuivre est différent aux membres supérieurs et aux membres inférieurs. Pour les membres supérieurs, le but est de permettre une préhension et, si possible, de porter la main à la bouche. Pour les membres inférieurs, il est d'assurer une déambulation par un appui plantigrade, genoux en extension, seule position de stabilité possible sans ou avec peu de muscles. Il faut adapter et choisir les techniques de rééducation, d'appareillage et/ou de chirurgie, pour permettre ce seul but. Il peut paraître modeste, mais il est essentiel pour les patients. Il faut rechercher la mobilité utile et non la mobilité maximale. Cette prise en charge, pluridisciplinaire, évolue dans le temps, doit être expliquée à la famille afin d'obtenir son adhésion en accordant les objectifs familiaux et thérapeutiques.

Osteochondroma is one of the most common benign bone tumors; however, as it rarely affects any bones in feet, it may easily escape detection without rigorous examination. We present an exceptionally rare case of tarsal navicular dorsal osteochondroma diagnosed in an 11-year-old female child affected by chronic foot pain. Radiographs, MRI, and computed tomography scan revealed bony excrescences extending outward from the navicular bone. After conservative treatment failed, the navicular dorsal exostosis was excised in open surgery with complete resolution of symptoms. Navicular-cuneiform impingement was diagnosed by instrumental and intraoperative techniques. Histological analysis confirmed the diagnosis of navicular dorsal osteochondroma. This case report illustrates the necessity of particularly rigorous evaluation of the substrates of pediatric chronic foot pain.

Visual feedback is used in different research areas, including clinical science and neuroscience. In this study, we investigated the influence of the visualization of a real-time personalized avatar on gait parameters, focusing on knee flexion during the swing phase. We also studied the impact of the modification of avatar's knee amplitude on kinematic of the knee of healthy subjects. For this purpose, we used an immersive reality treadmill equipment and developed a 3D avatar, with instantly modifiable parameters for knee flexion and extension (acceleration or deceleration). Fourteen healthy young adults, equipped with motion capture markers, were asked to walk at a self-selected pace on the treadmill. A real-time 3D image of their lower limbs was modelized and projected on the screen ahead of them, as if in a walking motion from left to right. The subjects were instructed to continue walking. When we initiated an increase in the knee flexion of the avatar, we observed a similar increase in the subjects' knee flexion. No significant results were observed when the modification involved a decrease in knee flexion. The results and their significance are discussed using theories encompassing empathy, sympathy and sensory re-calibration. The prospect of using this type of modified avatar for stroke rehabilitation is discussed.

Unicameral bone cyst (UBC) is a common lesion in skeletally immature patients. Multiple treatments are proposed as curettage and autologous bone graft, percutaneous local corticoids injections, decompression with internal fixation, and injection of bioresorbable cement. Decompression, curettage, and percutaneous bioresorbable cement injection showed interesting results, but until now, no long-term follow-up was reported in pediatric patients with UBC.

El diagnóstico de una desigualdad de longitud de los miembros inferiores, es decir, una diferencia de longitud real de los segmentos óseos, es fácil. La descripción es indisociable de la de los ejes, así como de la valoración de la movilidad y la estabilidad de las articulaciones vecinas. La etiología es un elemento fundamental para establecer el pronóstico y determinar el tratamiento. Existen anomalías congénitas o constitucionales y anomalías adquiridas (traumáticas, infecciosas, vasculares, neurológicas y secuelares de enfermedades de la cadera). El diagnóstico clínico, con una exploración en posición de pie y en decúbito supino, permite precisar las anomalías axiales, así como las movilidades y la estabilidad articulares. Las mediciones radiológicas son posibles en una radiografía panorámica anteroposterior (AP) de los miembros inferiores, teniendo en cuenta la magnificación de la imagen, si el paciente no presenta una actitud viciosa y es capaz de colocar las rótulas bien de frente. La medición radiológica de los ejes hace más precisa la descripción. La desigualdad es evolutiva y previsible en las malformaciones congénitas de porcentaje constante. En caso de aceleraciones temporales de crecimiento postraumáticas o postinfecciosas, la desigualdad no será evolutiva. En caso de destrucción completa del cartílago de conjugación, el aumento de la anisomelia corresponde al crecimiento residual de la fisis contralateral. La determinación de la edad ósea es un criterio significativo para situar esta desigualdad en el crecimiento. El tratamiento inicial es ortopédico con compensaciones. Después se elige entre una ortesis o una prótesis en las desigualdades congénitas graves, un acortamiento progresivo (epifisiodesis) o, de forma excepcional, extemporáneo o, la mayoría de las veces, el alargamiento progresivo mediante un fijador externo o, mejor, con un clavo intramedular motorizado. Las complicaciones son frecuentes, a veces sin consecuencias, pero también temibles y con secuelas en función de la etiología, de la técnica y de la experiencia del equipo. El alargamiento de las extremidades es una intervención difícil que hay que planificar con cuidado y debe ser realizada por un equipo con experiencia.

Adolescent idiopathic scoliosis is a 3D spine deformity that worsens during the whole growth. New methods for spinal growth modulation with flexible spinal implants have been described to avoid progression of the deformity during growth spurt. The main limitations are that no specific ancillaries and devices are available, which makes the surgery technically demanding.

L’objectif de cette étude était d’évaluer, à maturité squelettique, l’efficacité du traitement orthopédique par corset nocturne seul en prévention de la progression des scolioses idiopathiques évolutives inférieures à 25°. Le port d’un corset nocturne seul est efficace pour prévenir la progression des scolioses idiopathiques de faible courbure (Cobb < 25°). Il s’agit d’une étude rétrospective monocentrique sur 142 patients traités par corset nocturne pour des scolioses idiopathiques évolutives d’angle de Cobb inférieur à 25° ayant atteint leur maturité osseuse. L’angle de Cobb moyen au début du traitement était de 15,5° (10–25°). Les valeurs moyennes de l’angle de Cobb et les paramètres sagittaux ont été comparés avant traitement et à maturité osseuse par un test t de Student. La variabilité de l’angle de Cobb dans le temps a également été analysée. L’angle de Cobb moyen à maturité osseuse (16,3°) a significativement augmenté (p = 0,04) par rapport à la valeur de départ (15,5°), mais les différences observées sont inférieures à l’incertitude de mesure de cet angle (±6°). Dans le sous-groupe à Risser 0 ou 1 au début de traitement, l’évolution de l’angle de Cobb moyen à maturité osseuse (16,2°) n’était pas significative (p = 0,1). L’angle de Cobb avait diminué dans 26 cas (18 %), augmenté dans 24 cas (17 %) et était resté inchangé dans 92 cas (65 %). Cette étude confirme l’efficacité du traitement orthopédique par corset nocturne dans les scolioses idiopathiques progressives de faible courbure (inférieures à 25°) dans la très grande majorité des cas. Le port nocturne du corset semble donc être une option efficace pour le traitement des scolioses idiopathiques de l’adolescent permettant de rester dans la zone de sécurité des 20°. Étude rétrospective de niveau IV.

INTRODUCTION:Osteochondrosis is characterized by a disturbance of enchondral ossification in skeletally immature patients and should be investigated in children having a history of persistent foot and ankle pain. Involvement of the medial malleolar epiphysis is rarely reported. PRESENTATION OF CASE:We describe the case of a sporty 12-year-old male with osteochondrosis of the left medial malleolar epiphysis treated with a conservative management. DISCUSSION:Calcanear, navicular and metatarsal apophysis are the most common locations for osteochondrosis in ankle and foot. Anyway other osteochondrosis should be excluded. Medial malleolar osteochondrosis is occasionally described. We performed a review of the relevant literature and we summarized clinical aspects, radiological characteristics and reported management of this painful and probably underestimated condition. CONCLUSION:Medial malleolar osteochondrosis is a rare but well recognized condition. Only seven cases are described in literature.

OBJECTIVES:The transient breath holding sign (TBHS) is a clinical sign often associated with magnetic resonance imaging (MRI) spine traumatic lesions. The aims of this study were to prospectively evaluate the TBHS in the detection of thoracolumbar lesions in a large cohort of children and to establish a comprehensive strategy on the use of MRI in spine traumas in children.STUDY DESIGN:All conscious 5- to 16-year-old patients admitted for a spine trauma in our institution were prospectively included in the study. All patients were asked for the TBHS and underwent a full spine MRI. Sensitivity and specificity of the TBHS were derived from the confusion matrix. All MRI lesions were analyzed and classified.RESULTS:One hundred ninety-eight patients were included. The sensitivity of the TBHS was 92%, the specificity was 83%, the positive predictive value was 83%, and the negative predictive value was 91%. The x-rays missed 67% of the vertebrae injured in the MRI. The MRI lesions consisted in an upper end plate injury, in the sagittal plane only, in 90% of the cases. The vertebral canal and the spinal cord were never injured.CONCLUSIONS:This study confirms that the TBHS is a relevant clinical tool that should be added in the routine questionnaire after any trauma at admission. Magnetic resonance imaging should be restricted to patients with a TBHS positive at admission. A single T2 Short T1 Inversion Recovery (STIR) sagittal sequence seems sufficient to make the diagnosis and could replace the use of standard x-rays in pediatric spine traumas.

Levetiracetam is a relatively novel antiepileptic drug used for the treatment of partial and generalized seizures in adult and children. Several animal studies describe a possible drug adverse effect on skeletal growth and metabolism. We present a case report of a 10-year-old female child who underwent a prolonged 7-year treatment with levetiracetam for sporadic secondary convulsions secondary to enterovirus encephalitis at the age of 15 months. This patient developed an osteochondritis dissecans lesion (OCD) of the talar head well treated conservatively. Only a few cases have been described of this rare type of OCD. We hypothesize a possible association between levetiracetam therapy and OCD development, suggesting the importance of long-term control of bone growth in levetiracetam-treated pediatric populations.

INTRODUCTION:The objective of the present study was to assess, at skeletal maturity, the efficacy of non-operative treatment by isolated nighttime brace in the prevention of progression of progressive idiopathic scoliosis of less than 25°. HYPOTHESIS:Isolated nighttime brace treatment is effective in the prevention of progression of mild progressive idiopathic scoliosis (Cobb<25°). MATERIAL AND METHODS:A single-center retrospective study included 142 patients managed by nighttime brace for progressive idiopathic scoliosis with Cobb angle<25°, with assessment at skeletal maturity. Mean Cobb angle at start of treatment was 15.5° (range, 10-25°). Mean values for Cobb angle and sagittal parameters before treatment and at skeletal maturity were compared on Student t-test. Change in Cobb angle over time was also analyzed. RESULTS:Mean Cobb angle at skeletal maturity was 16.3°, showing significant increase over baseline (15.5°; P=0.04), although the difference was less than the uncertainty of measurement (±6°). In baseline Risser 0 or 1, mean change in Cobb angle at skeletal maturity (16.2°) was not significant (P=0.1). Cobb angle diminished in 26 cases (18%), increased in 24 (17%) and was unchanged in 92 (65%). CONCLUSION:The present study confirmed the efficacy of non-operative treatment by nighttime brace in mild progressive idiopathic scoliosis (<25°) in a large majority of cases. A nighttime brace thus seems to be an effective option for the treatment of adolescent scoliosis, ensuring a safe curve of around 20°. LEVEL OF EVIDENCE:Level IV, retrospective study.

The Child and Family Hospital of Grenoble is one of the rare university hospitals in France to benefit from the presence of a physician specializing in rehabilitation medicine. This hospital includes both inpatient and outpatient units. During the temporary closure of one department, certain members of the rehabilitation unit were reassigned to the acute care wards of the pediatric department, including physical therapists, occupational therapists, and speech therapists. Over the course of one year, these therapists completed more than 150 interventions in this department, more than half of which were in the hematology and oncology ward. The most common requests were for speech therapy interventions to maintain and improve swallowing and feeding in the prolonged presence of a nasogastric tube as well as the prevention and follow-up for swallowing difficulties in brain tumor patients. The second most common request was for the assistance of an occupational therapist with wheelchair use, both to allow patients to sit upright early in good conditions and to analyze the conditions necessary for a patient to return home. The teamwork between the speech and occupational therapists is invaluable for patients learning to use voice synthesis software. Finally, care from a physical therapist allows for the maintenance of motor skills during oncological as well as orthopedic care. The data we report calls for the creation and systematic use of a rehabilitation medicine team in the pediatric oncology ward. Requests increased over the course of the year, showing that pediatricians became more and more aware of the benefits offered by these therapists. We observe that improvement is present regardless of the prognosis, from the beginning of treatment to the sometimes prolonged rehabilitation process, including situations of palliative care. The integration within the Child and Family Hospital allows for quick coordination that improves the quality of care. Improvement in quality of life is always observed by reducing patients' hospital stays and allowing them to return home more quickly as well as expediting the process of choosing the most suitable form of rehabilitation.

Malgré de nombreuses pistes et hypothèses, la pathogénie de la scoliose idiopathique reste mystérieuse et il est généralement difficile de différencier causes et conséquences. La biomécanique ainsi que le contrôle proprioceptif et postural semblent être un des aspects des mécanismes intrinsèques liés à la scoliose idiopathique. Cela n’a été que très peu étudié mais certains auteurs ont mis en évidence des déficits posturaux et des différences cinématiques présents chez les patients scoliotiques. Néanmoins, à notre connaissance, aucune étude n’a porté d’intérêt à l’analyse spécifique des mouvements du tronc et de la colonne vertébrale lors de tâches standardisées simples afin de quantifier précisément ces différences cinématiques dans les différents plans de l’espace. C’est le principal objectif de cette étude. Il s’agit de déterminer s’il est possible d’observer des comportements asymétriques ou des stratégies biomécaniques différentes chez les patients présentant une scoliose faible (Cobb < 25°) en fonction du type de scoliose. Nous avons observé la cinématique du tronc chez 45 adolescentes entre 9 et 16 ans divisées en 3 groupes : 15 patientes présentant une scoliose lombaire gauche, 15 patientes présentant une scoliose thoracique droite et 15 volontaires saines. Pour cela, un système optoélectronique de suivi du mouvement (Codamotion® avec 4 caméras) a été utilisé pour mesurer les déplacements du tronc des sujets dans différentes tâches simples mono-planaires (inclinaisons du sujet dans le plan frontal, rotations dans le plan transverse, flexion antérieure dans le plan sagittal) en comparaison avec une tâche de posture statique de référence. Toutes les tâches ont été effectuées sur une plate-forme de force (AMTI®) afin d’évaluer l’équilibre des sujets au cours de ces mouvements. L’analyse de la tâche statique de référence a montré que les patientes scoliotiques ont en moyenne le tronc en torsion vers la gauche et en inclinaison vers la droite. Nous avons de plus observé une instabilité posturale accrue chez les patientes scoliotiques. Alors que la tâche de flexion antérieure n’a révélé aucune différence statistique, les tâches de rotations du tronc et d’inclinaisons latérales ont montré des amplitudes de mouvement du pelvis réduites et ont révélé des asymétries internes permettant aux patientes scoliotiques d’effectuer des mouvements d’amplitudes symétriques. Les tâches d’inclinaisons latérales ont également permis d’identifier une stratégie d’inclinaison différente chez les patientes scoliotiques. En effet, ces dernières présentent une translation du bassin dans la direction opposée à la flexion et ainsi une amplitude latérale de déplacement moins important. La tâche statique a révélé des différences segmentaires qui ne seraient pas liée au sens de la scoliose mais un sens de déformation du tronc unique qui indiquerait que la scoliose se met en place dans la même direction quelle que soit sa typologie. De plus, une instabilité posturale est déjà présente pour les scolioses faibles. La stratégie d’inclinaison développée par les sujets scoliotiques permet certainement de compenser cette instabilité. Contrairement à nos hypothèses initiales, les patientes scoliotiques présentent un cône de mouvement global symétrique. Cependant, leur déformation initiale induit des asymétries locales que ce soit en inclinaison ou en flexion. L’absence de différence lors de la tâche de flexion antérieure peut être expliquée du fait que le plan sagittal n’est que très peu affecté dans les scolioses faibles. Cette étude révèle que les déséquilibres posturaux et anomalies biomécaniques du patient scoliotique sont bien présents et indépendants du sens de la scoliose, mais aussi que leurs mouvements restent symétriques malgré une mobilité réduite.

Delivery room emergencies due to birth injuries are serious, usually unexpected, and can be distressing situations that necessitate immediate action to reduce neonatal morbidity and prevent neonatal mortality. Birth injuries requiring immediate, urgent care in the delivery room are uncommon, hence knowledge of obstetric risk factors and prenatal conditions linked to birth injury is an important first step in the management of affected neonates. Furthermore, immediate recognition of injury and quick action upon delivery is essential in order to achieve the best possible outcomes. This chapter briefly reviews the known risk factors associated with birth injury, and then discusses the identification and management of specific injuries that may require immediate treatment in the delivery room, or hasty management within hours after birth.