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ObjectiveTo evaluate the clinical and functional results of a surgical treatment of patellar dislocation whose etiology was iatrogenic quadriceps fibrosis in children.Materials and methodsA prospective study was undertaken from February 2004 to December 2009. The study included 54 pediatric patients (56 knees) that had developed dislocation of the patella after repeated intramuscular injections of antibiotic(s) into the quadriceps muscle. There were 11 males (20.4 %) and 43 females (79.6 %). The patients’ mean age at surgery was 7 years, 9 months (range 6 years, 4 months to 12 years, 6 months). A complete history of each patient was recorded. The affected knees were evaluated preoperatively and postoperatively on the basis of the symptoms, signs, and roentgenographic findings. Patellar dislocation was classified according Bensahel’s criteria. All patients had a three-part surgical procedure that combined capsulorrhaphy, quadricepsplasty, and transfer of the vastus medialis oblique to the superior border of the patella.ResultsThere has been no poor postsurgical result or recurrence so far; we have noted an ugly scar in nine knees (16.1 %), limitation of the knee flexion in five knees (8.9 %), and loss of extension of 5 °–20 ° in four knees (7.1 %). Overall, we attained excellent results in 39 knees (69.7 %), good results in 13 knees (23.2 %), and fair results in four knees (7.1 %).ConclusionIn our cases of pediatric dislocation of the patella caused by iatrogenic quadriceps fibrosis, the introduced three-part surgical procedure has shown great success in restoring the realignment mechanism of the patella. The technique is simple, safe, and effective in skeletally immature children.

BACKGROUND: Surgical treatment for osteogenesis imperfecta (OI) remains controversial. The use of nonelongating rods is considered to be the classic method. This older method is still used by surgeons who are concerned about the possibility of trauma or who are working in developing countries with fewer resources. We are among those who prefer the use of Kirschner wire (K-W). This article presents the results of intramedullary fixation using K-W and Bisphosphonate treament in children with OI and the proper timing of wire exchange to prevent further fracture. METHODS: We treated 29 femora in 24 patients with OI by means of stabilization using K-W. The patients divided two Variant: (1) Variant 1: femoral fractures fixed by K-W only (10 patients); (2) Variant 2: femoral fractures fixed by K-W and combined treated with bisphosphonates (14 patients). Sillence classification of OI with 4 Types and the features: Type I: Osseous fragility, Adulthood hearing loss, Blue sclera; Type II: Extremety severe osseous fragility, Perinatally lethal; Type III: Moderate to severe osseous fragility, Normal sclera, Severe deformity of the long bones and spine, Variable clinical and radiographic phenotypes; Type IV: Osseous fragility, General normal sclera, Severe deformity of long bones and spine. Our Surgical treatment for acute fracture and for angular deformity correction if present on patients with OI is based on the classic Sofield-Millar technique, evaluating treatment according to El Sobky. RESULTS: Indications for the primary surgery included: fracture were 4 fracture only, and Fracture and deform were 25. There were 24 Patients, Right/left/Bilateral fracture femur in 12/7/5; Total fracture femur 29. There were 45.8% in Type 1, 33.4% in Type 3, and 20.8% in Type 4. The male to female ratio was 1: 1.7. There were 5 (20.8%) patients with family history. The mean age at the primary procedure for K-W was 27.9 months old (range, 18-43 months old). The mean follow-up period was 75.5 months (range, 62 months to 89 months). In this study, Variant 2 (accepted was 57.1%) better than Variant 1 (accepted was 20%). CONCLUSIONS: Documented that children treated with Bisphosphonate prior to surgery and afterwards do better than children treated with surgery alone. We suggested that a surgical treatment using non-extensible nails is indicated when complications such as fractures and/ or deformities are present, based on the fact that these nails do not follow bone growth, if early implanted, complications will eventually occur, resulting in a larger number of review surgeries.

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Objective: To evaluate the clinical and functional results of two surgical treatments of patellar dislocation in children. Material and Methods: A prospective study was undertaken from January 1995 to December 2009. Pre-postoperatively, the clinical and roentgenographic examinations were performed. Patellar dislocation was classified according to Bensahel's criteria. There were two surgical techniques performed: 1) the iliotibial tract passing through patella (ITT), and 2) transferring vastus medialis oblique muscle to superior border patella (VMO). Lateral retinacula were released to restore the tension of the medial retinacula and quadricepsplasty was used in all patients. The results of the operations were classified according to Kujala's functional knee-scoring systems. Results: 128 patients (132 knees) were operated. There were 20 males and 108 females. 94 knees (71.2%) were Type 1, and 38 knees (28.8%) were Type 2. The ITT was in 74 patients (76 knees), and VM was in 54 patients (56 knees). Clinical signs, imaging finding before and after the operation and operative results of these patients were operated with ITT and VM with no significant difference (p > 0.05). Overall, we attained excellent results in 95 knees (72.0%), good results in 30 knees (22.7%), and fair results in 7 knees (5.3%). There have been no poor results or recurrences so far. Conclusion: These techniques are simple, safe and effective in skeletally immature children. Long-term follow-up of these patients was operated ITT and these patients which were operated VMO were not different, but time for operation was: ITT: 65 minutes, and VMO: 55 minutes.

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