Introduction

Sternoclavicular dislocations are well-known adult injuries. The same traumatism causes growth-plate fracture of the medial clavicle in children and young adults. At this location, the emergence of the secondary ossification center and its bony fusion are late. We report the results of 20 cases hospitalized in the Toulouse University Hospital Center that were treated surgically.

Purpose of the study: Increasing the number of times the operating room doors open increases the number of airborne bacteria and consequently the rate of postoperative infections with sometimes disastrous results, particularly for prosthesis surgery.

Material and methods: An observer counted the number of times the door to the operating room were opened during orthopaedic operations. The study was conducted in a teaching hospital (hospital A) during scoliosis surgery then repeated for a similar operation after posting dissuasive signs and delivery of information to the personnel concerning the risk of contaminating the patient. A study was then conducted for total hip arthroplasty (THA) in another teaching hospital (hospital B) and in a private clinic (hospital C). The same protocol as used in South Australia was applied for these studies.

Results: The mean rate of door opening in hospital A was 0.52/min. This rate was 0.45/min (13.5% less) in the same hospital A after posting dissuasive signs on the doors and providing information to the personnel. In hospital B, the rate was 0.67/min. In hospital C, the rate was 0.42/min (i.e. 37% less). In Australia, the mean rate was 1/min in hospital A before sign posting and information delivery and 0.65 (−35%) after. In hospital B, the rate was 0.87/min and in hospital C 0.47/min (i.e. 46% less).

Discussion: Nearly 50 years ago Sir John Charnley demonstrated that airborne contamination must be controlled in prosthetic orthopaedic surgery. In France airborne contamination is regulated by a series of standards (NF EN ISO 14644 established in 1999) and partially controlled during the design phase of operating rooms with the installation of laminar flow ventilation. Door opening, and particularly swinging doors, causes turbulent airflow increasing bacterial contamination.

Conclusion: Circulation in the operating room should be limited to necessary organisation (prior transport of instruments and consumables, fluoroscope, nursing staff turnover, etc.) and by information and education of all participants. The presence of observers is inevitable in the operating rooms of teaching hospitals. Their entrance and exit should however be limited and their movement within the room controlled. It is also recommended to use cell phones.

Purpose of the study: Duplication of the thumb is the most common congenital anomaly of the first ray. The characteristic feature of type IV is the diversity of the clinical forms and the presence of certain complex forms particularly difficult to treat (Hung IVD). We propose a new procedure for reconstruction of IVD type thumb duplication.

Material and method: This new procedure was used for thumb reconstruction in two boys with type IVD thumb duplication. Mean age at surgery was 10 months. Surgical technique. The future incisions were traced with a central skin resection removing the most hypoplastic nail entirely (generally the radial nail). At the bone level, a longitudinal osteotomy of the proximal phalanges was made over the entire length to remove the central part and obtain a width for the first phalanx comparable to that of the contralateral thumb. An oblique osteotomy was cut in the base of the distal phalanx of the ulnar hemithumb with resection of a radial corner. The same type of osteotomy was performed at the base of the distal phalanx of the radial hemithumb, but with preservation of the radial corner and resection of the rest of the radial thumb. The proximal hemiphalanges were sutured as were the bases of the distal phalanges. This produced automatic realignment and stabilisation of the interphalangeal joint without an ungueal intervention.

Results: The three children were reviewed at 24, 18 and 12 months. The Horii score was good in all cases.

Discussion: Type IVD duplications of the thumb are difficult to treat and may leave serious sequelae. Our technique is based on the principle of a central resection of the proximal phalanges associated with partial resection of the base of the distal phalanges. This enables realignment and stabilisation of the interphalangeal joint while avoiding the problem of ungueal dystrophy since only one nail is preserved. Our preliminary results are encouraging but must be confirmed with a longer term study.

Purpose of the study: For symptomatic discoid meniscus, the treatment of choice in children is arthroscopic meniscoplasty. The treatment of associated meniscal lesions remains a subject of debate. The purpose of our work was to evaluate our results with arthroscopic meniscoplasty associated with meniscal repair as needed and the findings of the systematic postoperative MRI.

Material and methods: This was a retrospective series of patients treated by one operator. There were 23 discoid menisci (21 patients) treated from 2004 to 2007 with arthroscopic meniscoplasty followed by a complementary procedure depending on the residual meniscus: abstention if there was no associated lesion, suture or reinsertion for reparable lesions, partial meniscectomy for non-reparable lesions. The Lysholm and Tegner scores, plain x-rays, and MRI were obtained systematically.

Results: Mean age at surgery was 9.8 years. The Watanabe classification was I:9, II:9, III:5. Arthroscopy revealed 15 lesions, including 11 longitudinal tears. Meniscoplasty was performed in 9 cases alone, associated with partial meniscectomy in 6 and with repair in 8 (5 cases of disinsertion and 3 tears). Mean follow-up was 37.1 months. The mean postoperative Lysholm was 87.9, the Tegner 5.9. Outcome was considered satisfactory or very satisfactory by 90% of patients. MRI failed to reveal any signs of chondral degeneration or meniscal tear. There were however four cases of high intensity intra-meniscal signals and one meniscal cyst. Mean measurements of the residual meniscus were: anterior segment 8.6 mm thickness and 2.6 mm height; middle segment 5.5 and 2.3 mm; posterior segment 5.8 and 3.0 mm. One case of osteochondritis of the lateral condyle was noted postoperatively.

Discussion: To our knowledge, there is no other study evaluating the outcome of discoid meniscus surgery with postoperative MRI. There have been few reports concerning meniscoplasty then repair. This approach spares meniscal tissue, essential for children. We obtained good clinical results and patient satisfaction. At the MRI, the residual meniscus had a morphology close to normal. There were no signs of tears. The high intensity signals occurred in patients with good outcome.

Conclusion: Arthroscopic meniscoplasty associated with repair or partial meniscectomy as needed appears to be a good therapeutic solution for discoid meniscus in children.

In 12 infants aged under 16 months with unilateral club foot we used MRI in association with multiplanar reconstruction to calculate the volume and principal axes of inertia of the bone and cartilaginous structures of the hindfoot.

The volume of these structures in the club foot is about 20% smaller than that in the normal foot. The reduction in volume of the ossification centre of the talus (40%) is greater than that of the calcaneus (20%). The long axes of both the ossification centre and the cartilaginous anlage of the calcaneus are identical in normal and club feet. The long axis of the osseous nucleus of the talus of normal and club feet is medially rotated relative to the cartilaginous anlage, but the angle is greater in club feet (10° v 14°). The cartilaginous structure of the calcaneus is significantly medially rotated in club feet (15°) relative to the bimalleolar axis. The cartilaginous anlage of the talus is medially rotated in both normal and club feet, but with a smaller angle for club feet (28° v 38°). This objective technique of measurement of the deformity may be of value preoperatively.