Percutaneous epiphysiodesis using transphyseal screws (PETS) has been developed for the treatment of lower limb discrepancies with the aim of replacing traditional open procedures. The goal of this study was to evaluate its efficacy and safety at skeletal maturity. A total of 45 consecutive patients with a mean skeletal age of 12.7 years (8.5 to 15) were included and followed until maturity. The mean efficacy of the femoral epiphysiodesis was 35% (14% to 87%) at six months and 66% (21% to 100%) at maturity. The mean efficacy of the tibial epiphysiodesis was 46% (18% to 73%) at six months and 66% (25% to 100%) at maturity. In both groups of patients the under-correction was significantly reduced between six months post-operatively and skeletal maturity. The overall rate of revision was 18% (eight patients), and seven of these revisions (87.5%) involved the tibia. This series showed that use of the PETS technique in the femur was safe, but that its use in the tibia was associated with a significant rate of complications, including a valgus deformity in nine patients (20%), leading us to abandon it in the tibia. The arrest of growth was delayed and the final loss of growth at maturity was only 66% of that predicted pre-operatively. This should be taken into account in the pre-operative planning.

Purpose of the study: Resection of a malignant primary tumour of the proximal humerus implies sacrifice of a large part of the humeral shaft and the periarticular muscles. Reconstruction can be difficult and raises the problem of preserving function. Recent work has demonstrated the pertinence of combining a glenohumeral prosthesis with an allograft. Several complications are nevertheless reported: non-union, allograft resorption, loosening. We report three cases of malignant primary tumours requiring wide resection of the humerus which were treated by reconstruction with a shoulder arthrodesis applying the induced membrane technique.

Material and methods: Three patients (mean age 15 years) presented a malignant primary tumour of the proximal humerus (Ewing sarcoma or osteosarcoma) which was locally extensive but not metastatic. Resection implied resection of 16 cm of the humerus (mean). The same procedure was used for the three patients: first phase: wide resection of the tumour and neighbouring soft tissues which removed the majority of the proximal end of the humerus and the glenohumeral joint, then insertion of a cement spacer; second phase: reconstruction with a shoulder arthrodesis using cancellous grafts positioned inside the induced membrane. Stabilisation was ensured by insertion of a non-vascularised fibula inside the membrane and with a plate fixation on the scapular spine.

Results: Mean follow-up is five years. There has been no local recurrence and no distant spread. The arthrodeses and the reconstructions healed without reoperation within six to eight months. The functional outcomes were not different from those obtained with shoulder arthrodesis with a mean elevation of 90°.

Discussion: There are many advantages of reconstruction with shoulder arthrodesis using the induced membrane technique: possible wide initial resection, more satisfactory carcinological resection, the periarticular muscles are not pertinent after arthrodesis; there is no need for prosthetic elements or an allograft exposing to later complications; the reconstruction time is a simple procedure; elevation remains satisfactory.

Conclusion: This technique should be included in the surgical armamentarium just like vascularised transfers, allografts and massive prostheses. The indication should be reserved for extensive resection.

Objective: To evaluate the effectiveness of distal rectus femoris (RF) release versus transfer to treat gait abnormalities of the knee in ambulatory children with cerebral palsy.

Methods: Ninety-three children were included in this study. Thirty-two patients underwent RF transfer at a mean age of 11.8 years and sixty-one underwent distal RF release at a mean age of 12.5 years. Indications for surgery included RF contractures, abnormal RF activity during swing phase (EMG) and kinematic characteristics of stiff-knee gait. All patients had pre–and postoperative 3D gait analysis and EMG at one year follow up. To evaluate outcomes, patients were grouped by pre-operative knee kinematics (swing-phase peak knee flexion (PKF) < 50º or PKF > 50º occurring later than 77% of the cycle). All data was analyzed statistically.

Results: For the group of patients with PKF< 50º, this value increased significantly after RF transfer (p=.005) and after RF release (p=.03). Children with PKF later than 77% of the cycle also showed significant improvement after both procedures (p=.001; p=.02). All patients experienced a significant decrease of muscle contractures.

Discussion: According to the results of this study, both RF transfer and release brought significant results. We opt for distal RF release, since is technically easier, particularly when one-stage multilevel procedures are being performed.

Introduction: Sprengel deformity is also named High Congenital Scapula (HCS).

It is a rare abnormality in children of which consequences are cosmetic and functional too.

Purpose: It is to assess those anatomic findings which have a prognostic value and to focus on the main stages of the treatment.

Material and Methods: We reviewed a series of 23 cases of HCS in 19 children, 4 of whom having had a bilateral involvement. In all the cases, the elevation of the scapula was accompanied by a rotation and a varus position of the glena.

The age of our patients ranged from 6 months to 13 years old. 50% of them were younger than 9 at the first visit. Functional consequences consisted in a modification of the plan of the movements of shoulder. Besides the omovertebral bone, many important abnormalities – mainly of the spine – have been noticed in our series.

The cases were classified using the degree of elevation of the superomedial angle of scapula. Three grades could be set up.

Concerning the treatment, 2 children have not been operated on. In the other cases, we used a modification of the Woodward procedure.

Results: Two cases were judged to have a poor result. One case had a fair result.

79% were considered as good on both aspects, cosmetically and functionally, with no complication.

The age at which surgery has been performed seems to have no influence on the result. On the opposite, the number and the severity of the anatomic anomalies have to be taken into consideration for the prognostic assessment.

Discussion: As comparing our results with those of the other series, we could notice that our procedure is less aggressive. Indeed, the majority of the surgical procedures mention a resection of a part of the scapula. In such a way, the cosmetic result can be easily improved, even if the scapula has not been really lowered. On the other hand, the anti-varus stage of our procedure improves the plan of movements of the shoulder.

Conclusion: The Sprengel deformity could need surgical correction in the moderate and major deformities. Surgery shall lower the scapula as much as possible, but it shall avoid neurologic or vascular complications. At last, surgery is first indicated for improving the biomechanics of the scapular girdle.