BACKGROUND: Children with osteogenesis imperfecta frequently present with coxa vara. Skeletal fragility, severe deformity and limited fixation options make this a challenging condition to correct surgically. Our study aimed to determine the efficacy of the Fassier technique to correct coxa vara and determine the complication rateMETHODS: We retrospectively reviewed the records of a cohort of eight children (four females, 12 hips) with osteogenesis imperfecta (6/8 Sillence type III, 2/8 type IV) who had surgical treatment with the Fassier technique for proximal femoral deformity between 2014 and 2020RESULTS: The mean age at operation was 5.8 years (range 2-10). The mean neck-shaft angle (NSA) was corrected from 96.8° preoperatively to 137° postoperatively. At a mean follow-up of 38.6 months, the mean NSA was maintained at 133°, and 83% (10/12) of hips had an NSA that remained greater than 120°. There was a 42% (5/12) complication rate: three Fassier-Duval rods failed to expand after distal epiphyseal fixation was lost during growth; one Rush rod migrated through the lateral proximal femur cortex with recurrent coxa vara; and one Rush rod migrated proximally and required rod revisionCONCLUSION: The Fassier technique effectively corrected coxa vara in children with moderate and progressively deforming osteogenesis imperfecta. The deformity correction was maintained in the short term. The complication rate was high, but mainly related to the failed expansion of the Fassier-Duval rods. Further studies are required to determine the long-term outcome of this techniqueLevel of evidence: Level 4

SUMMARY Falsely elevated estradiol is rare, may result from heterophile antibody interference, and can result in unnecessary investigation and intervention. We present the case of a 56-year-old female with falsely elevated estradiol levels inconsistent with her overall clinical picture, which ultimately led to an unnecessary surgical procedure. With the use of alternative analytical platforms and a heterophile antibody blocking agent, we determined the false elevation was due to heterophile antibody interference. Clinicians must suspect and investigate for laboratory error when the clinical picture contradicts laboratory results.

BACKGROUND: Children with osteogenesis imperfecta suffer from frequent fractures and deformities due to skeletal fragility. Stabilisation of fractures, correction of deformity and intramedullary rodding result in decreased pain and improved function. Modern expandable intramedullary rods aim to provide lasting stability during growth, without an increase in complications. The aim of our study was to determine and compare the outcome of static Rush rods and expandable Fassier-Duval rods in terms of complications and reoperation rate. METHODS: We reviewed the records of a cohort of 17 children (seven female) with osteogenesis imperfecta (11 Sillence type III, six Sillence type IV) who were treated with intramedullary rods in the lower limb between 2011 and 2017. They had 64 rodding (38 femoral and 26 tibial) procedures (26 Rush rods and 38 Fassier-Duval rods). These were a primary procedure in 46, and a revision procedure after previous Rush rodding in 18 cases. RESULTS: The overall complication rate was 66% (n=42). There was a higher complication rate in the Rush rod group (81%, n=21) when compared to the Fassier-Duval group (55%, n=21)(p=0.035). The most frequent complication in the Rush rod group was distal deformity as the rod is outgrown (69%, n=18). The most frequent complication in the Fassier-Duval rod group was intramedullary migration due to a failure to expand (45%, n=17). Factors that were associated with increased risk of complications included younger age (p=0.031), type of rod (p=0.035), and deformity as an indication for surgery (77% complications, p=0.033). At a mean follow-up of 3.1 years, the reoperation rate in the Rush rod group was 58% (n=15). Comparatively, at a mean of 3.7 years follow-up, there were no reoperations in the Fassier-Duval group. CONCLUSIONS: Despite the numerous innovations, the surgical management of lower limb deformities and fractures in children with osteogenesis imperfecta remains challenging with a relatively high complication rate. The use of Fassier-Duval rods may result in a lower reoperation rate when compared to Rush rods, in the short term. Level of evidence: Level 4

BACKGROUND: The management of end-stage hip disease in children and adolescents is a challenging clinical problem. While total hip replacement (THR) offers the benefit of improved mobility, this is offset by the risk of multiple revisions. Hip arthrodesis remains a salvage option to relieve pain and restore function at the cost of hip movement. This study aimed to determine the short- to medium-term outcome of hip arthrodesis in paediatric and adolescent patients in a developing world setting. METHODS: All children and adolescents under the age of 18 years who underwent hip arthrodesis between 2010 and 2014 were included in the study. Measurements included diagnosis, preoperative deformity, fusion position, fusion rate and functional outcomes. Our surgery involved transarticular compression screw fixation and subtrochanteric osteotomy. Postoperative skeletal traction maintained optimal limb position for two weeks, after which spica cast immobilisation was used. RESULTS: Nineteen patients (11 female) had hip fusions at a mean age of 12 years (range 5-18). The mean follow-up period was 5 years (range 1-8). Most cases were due to end-stage TB arthritis (12/19; 63%). Other causes were septic arthritis (3/19; 16%); neglected slipped capital femoral epiphysis (1/19; 5%); post-traumatic avascular necrosis (1/19; 5%); and idiopathic chondrolysis (2/19; 11%). Primary fusion was achieved in 68% (13/19) of cases. Six patients developed complications. Complications included adduction drift (3/19), failed fusion (3/19), screw malpositioning (1/19) and screw breakage (1/19). Eight reoperations were required in six patients. In two of these patients, one additional surgery had to be performed to achieve fusion or correct limb position. The mean fusion position was 31° (range 20 to 50) flexion, 2° (range 10 to -10) abduction, and 1° (range 10 to -10) external rotation. Mean leg length discrepancy was 1.8 cm (range 0 to 4.5) of shortening. All except one patient reported relief of hip pain and satisfaction with the procedure. CONCLUSION: While hip arthrodesis is a technically challenging procedure, high fusion rates and reliable pain relief may be expected in these patients. However, complications should be anticipated, and reoperation may be required to achieve fusion and an optimal limb position Level of evidence: Level 4

BACKGROUND: This study aimed to determine whether the addition of a lateral proximal tibial tension band plate, combined with proximal tibial dome realignment osteotomy, would decrease the recurrence rate in a group of children younger than 7 years with infantile Blount's disease (IBD) and high recurrence risk, defined as a medial physeal slope >60°METHODS: We reviewed the records of 14 children (22 limbs) under the age of 7 years with IBD and a medial physeal slope >60° that were treated with a combination of tibial osteotomy and tension band plates (group 2) to determine the recurrence rate and time to reoperation. These results were compared with a matched group of eight children (12 limbs) with IBD and a medial physeal slope >60° that were treated previously with tibial osteotomy alone (group 1RESULTS: The two groups were matched in terms of age, sex, obesity, Langenskiöld stage, tibio-femoral angle and medial physeal slope. The recurrence rate was 92% (11/12) in group 1 and 77% (17/22) in group 2 (odds ratio 0.31; 95% CI 0.03-3.01, p=0.312). The mean time to reoperation was 2.4 years in group 1 and 1.9 years in group 2 (p=0.319). There were two implant-related complications: one broken screw and one case of epiphyseal fixation failure in the tension band plate group, both in cases of recurrenceCONCLUSION: The addition of a lateral tension band plate to a proximal tibial realignment osteotomy may be an option to consider in children younger than 7 years with IBD and a high risk of recurrence. Further research is required to determine recurrence risk in IBD and to develop and evaluate surgical strategies to mitigate this risk with well-designed, multicentre controlled trialsLevel of evidence: Level 4

BACKGROUND: Significant advances have been made in the global effort to eradicate polio. Vaccine-associated poliovirus, or other enteroviruses, may still affect the anterior horn cell and cause acute flaccid paralysis. Following the acute disease, residual paralysis results in lower motor neuron weakness, altered growth and deformity. Our study aims to describe the clinical manifestations of a group of children that mimic that of classic paralytic poliomyelitisMETHODS: We identified six children from our paediatric orthopaedic database that presented with polio-like deformities. Their clinical and imaging records were reviewed and described, together with the clinical manifestations of paralytic poliomyelitisRESULTS: Limb hypoplasia, pathological gait patterns and foot deformities were consistent features. The median leg length discrepancy was 2.5 cm (range 2-4 cm). The gait patterns observed included a Trendelenburg gait in 33% (n=2), a short limb gait in 50% (n=3), and one case with a combination of Trendelenburg, short limb and steppage gait. Tensor fascia lata contracture was present in 50% (n=3) of our patients. Foot deformities ranged from calcaneo-cavo-valgus to equino-cavo-varus deformitiesCONCLUSION: Despite significant advances made in the global fight to eradicate polio, we still see children with clinical manifestations reminiscent of the disease. Orthopaedic surgeons should remain familiar with the assessment and diagnosis of the sequelae of paralytic poliomyelitisLevel of evidence: Level 5

Se evaluó el impacto de cultivos intercalados con algodonero (Gossypium hirsutum) en la densidad de insectos hemípteros depredadores. Además, se pretendió encontrar evidencias de interdepredación. Los cultivos intercalados con algodonero fueron canola (Brassica napus), alfalfa (Medicago sativa), veza (Vicia villosa) y esparceta (Onobrychis viciifolia). La densidad fue presentada como promedio de individuos en 30m lineales (i/30m). Se establecieron también parcelas de algodonero, sin cultivos intercalados, bajo tratamientos con productos para control de gusano rosado (Pectinophora gossypiella) y un testigo sin ningún tipo de control. Los cultivos intercalados al algodonero promovieron densidades altas de depredadores, existiendo migración significativa de éstos al algodonero intercalado al final de la temporada. Geocoris spp. mostró su mayor densidad en veza, con un aumento gradual hasta el muestreo final en sus estados de ninfa y adulto. Nabis spp. también fue más abundante en veza, como ninfa al principio y como adulto a la mitad de la temporada, y disminuyó posteriormente su densidad en todos los cultivos, siendo en la segunda mitad del ciclo superior en alfalfa y esparceta. Orius spp. mantuvo su mayor densidad en alfalfa, excepto en el último muestreo, cuando fue mayor en el algodonero intercalado. Una significativa reducción de Orius spp. en proporción al incremento de Geocoris spp., así como otros resultados, proporcionaron indicios de interdepredación de Geocoris spp. hacia Orius spp. e incluso hacia Nabis spp. El tratamiento con insecticida químico presentó los valores más bajos para todas las especies evaluadas.

The impact of interplanting crops with cotton (Gossypium hirsutum) on the density of predator hemipterans was evaluated. In addition, this work pretended to reach evidences of intraguild predation among the predators. The interplanting crops were canola (Brassica napus), alfalfa (Medicago sativa), hairy vetch (Vicia villosa) and sanfoin (Onobrychis viciifolia). Density values were given as average number of individuals in 30 linear meters (i/30m). Density was also evaluated in cotton plots under different treatments to control pink bollworm (Pectinophora gossypiela), which were applied in plots without interplanting crops. The interplanted crops promoted high densities of predators and a significant migration toward the intercropped cotton. Geocoris spp. showed its highest density in hairy vetch, with a gradual increment towards the final sampling date on both nymph and adult stages. Nabis spp. also showed its highest abundance in hairy vetch, as nymph at the beginning of the season, and as adult in the middle of the season, decreasing its density subsequently in all crops, but its density in the second half of the season was statistically higher in alfalfa and sanfoin. Orius spp. had its highest density in alfalfa during the whole season, except in the last sampling date, when it was higher in the intercropped cotton. A significant reduction of Orius spp. in relation to an increment of Geocoris spp., and other results, provide signs of intraguild predation from Geocoris spp. to Orius spp. and probably to Nabis spp. The treatment including chemical insecticide in cotton showed the lowest averages.

Avaliou-se o impacto de cultivos intercalados com algodoeiros (Gossypium hirsutum) na densidade de insetos hemípteros depredadores. Além disso, se pretendeu encontrar evidências de interdepredação. Os cultivos intercalados com algodoeiro foram canola (Brassica napus), alfafa (Medicago sativa), ervilha (Vicia villosa) e esparceta (Onobrychis viciifolia). A densidade foi apresentada como média de indivíduos em 30 m lineares (i/30 m). Estabeleceram-se também parcelas de algodoeiro, sem cultivos intercalados, sob tratamentos com produtos para controle de minhoca rosa (Pectinophora gossypiella) e uma testemunha sem nenhum tipo de controle. Os cultivos intercalados ao algodoeiro promoveram densidades altas de depredadores, existindo migração significativa de estes ao algodoeiro intercalado ao final da temporada. Geocoris spp. mostrou sua maior densidade em ervilha, com um aumento gradual até a amostragem final em seus estados de ninfa e adulto. Nabis spp. também foi mais abundante em ervilha, como ninfa ao princípio e como adulto na metade da temporada, e diminuiu posteriormente sua densidade em todos os cultivos, sendo na segunda metade do ciclo superior em alfafa e esparceta. Orius spp. manteve sua maior densidade em alfafa, exceto na última amostragem, quando foi maior no algodoeiro intercalado. Uma significativa redução de Orius spp. em proporção ao incremento de Geocoris spp., assim como outros resultados, proporcionaram indícios de interdepredação de Geocoris spp. para Orius spp. e incluso para Nabis spp. O tratamento com inseticida químico apresentou os valores menores para todas as espécies avaliadas.