RESUMEN
PURPOSE: Evaluation of effectiveness of internal rigid fixation for occipito-cervical fusion with occipital hooks and cervical screws and/or hooks to improve fusion in young or small children with various bone dysplasia or congenital abnormality. METHODS: Fourteen children with mean age of 8.4 years and height and weight below 140 cm and 35 kg, respectively, who underwent occipito-cervical fusion for miscellaneous pathologies reading to stenosis and/or instability were reviewed. The posterior instrumentation consisted of a precontoured titanium plate rod with an occipital fixation by hooks and a vertebral fixation by screws and/or hooks. Eight patients had cervical fixation with C2 pedicle screws. The mean follow-up was 48 months (27-81 months). RESULTS: Thirteen patients (92.8 %) had a complete fusion and no failure of the fixation was observed. We had two deep wound infections not related to implants. CONCLUSION: Instrumentation was technically feasible even in a very young child. Rigid internal fixation in the little children did not increase surgical complications and significantly increased the union rate of occipito-cervical arthrodesis.
Asunto(s)
Articulación Atlantooccipital/cirugía , Vértebras Cervicales/cirugía , Fusión Vertebral/instrumentación , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Oseointegración , Estudios RetrospectivosRESUMEN
Two patients with Kabuki make-up syndrome with bilateral recurrent dislocation of the patella are presented. They had generalized ligamentous laxity and patellofemoral dysplasia. Both developed patellar dislocation in adolescence and required surgery, with medial transfer of the tibial tuberosity associated with vastus medialis plasty (Insall technique). One postoperative complication occurred in one case: a nondisplaced tibia fracture at the sixth postoperative week that healed with conservative means. Final results were good in both cases. Good surgical results can be achieved in patellar dislocation in patients with Kabuki syndrome.
RESUMEN
Focal fibrocartilaginous dysplasia of the tibia (FFCD) is a rare and benign condition associated with unilateral tibia vara in childhood. The first description was done by Bell in 1985. Since then more than sixty cases have been reported. The aetiology remains unknown. Five new cases are retrospectively reported. Four of them with tibia vara less than 30 degrees showed a spontaneous correction. One patient had a severe varus deformity (> 30 degrees) leading to physeal impairment and underwent a tibial valgus osteotomy. Biopsy is not necessary as radiographs are typical. The infantile growth plate is able to correct a tibia vara due to FFCD if less than 30 degrees. In case of spontaneous resolution, a long-term follow-up remains necessary because of a possible progressive leg length discrepancy.