The present study evaluates the long-term outcome of elastic stable intramedullary nailing (ESIN) in children with long-bone shaft fractures. 70 patients were examined, the present mean age of patients was 12.7 (± 3.26) years, mean time interval since surgery was 3.1 (± 1.49) years. Following ESIN at the lower extremity (23 femur fractures, 14 tibia fractures), keloid formation was remarkable in one patient, range of motion (ROM) was adequate in all but one boy (extension deficit of the hip of 10°). Overall leg length discrepancy was + 4.1 mm (± 5.2 mm) following ESIN for femur fracture and + 3.2 mm (± 6.4 mm) following tibia fracture. Radiologically, all fractures had healed and no signs of avascular necrosis (AVN) could be detected. Malalignment was documented in one girl following tibia fracture (valgus of 12°). Assessment of the upper extremity (28 forearm fractures, 5 humerus fractures) revealed keloid formation in 5 children. Impaired ROM was found in three children following ESIN for a forearm fracture (limited pro-fsupination). Radiological controls detected one case of retrocurvation of the humerus (12°, polytrauma patient) and one varus deviation of the radius in a 10-year old boy. Questioning the children about their opinion of the treatment, 93 % considered the cosmetic results as good (6% fair), they judged the functional ability as perfect in 91 % (9% fair) and 93 % expressed great overall content (6% fair, 1% poor). In conclusion, ESIN provides good long-term results and can be a beneficial method for children with long-bone fractures.• Key words: Intramedullary nailing -Shaft fractures -Children -Long-term results ResumeL'Hude evalue le devenir along terme de I'enclouage elastique stable chez les enfants presentant des fractures des os longs. Soixante-dix patients ont ete examines. L'age moyen des patients Hait de 12,5 (± 3,26 ans). Le delai moyen depuis la chirurgie etait de 3,1 (± 1,49) ans. Suivant I'enclouage elastique stable a I'extremite inferieure (23 fractures femorales, 14 fracEur J Pediatr Surg 2000; 10: 319 -322 © Georg Thieme Verlag Stuttgart, New York . Masson Editeur Paris ISSN 0939-7248 ture tibiales) une formation chelo"ide etait remarquable chez un patient; la mobilite etait normale chez tous sauf un garc;on (deficit de I'extension de la hanche de 10°). Le raccourcissement du membre etait de 4,1 mm (± 5,2) apres I'enclouage medullaire elastique stable du femur et de 3,2 (± 6,4) apres les fractures du tibia. Radiologiquement, toutes les fractures ont cicatrise et ne presentaient aucun signe de necrose vasculaire. Un mauvais alignement Hait mis en evidence chez une fille apres une fracture du tibia (valgus de 12°). Le bilan au niveau de I'extremite superieure (28 fractures de I'avant-bras et 5 fractures de I'humerus) montrait une formation chelo"ide chez 5 enfants. Un defaut de mobilite etait trouve chez 3 enfants suivant I'enc10uage stable elastique pour une fracture de I'avant-bras (limitation de la prono-supination). Les contröles radiologiques mettaient en evidence 1 cas de retr...

Megacystis is a typical prenatal sonographic finding in cases of lower urinary tract obstruction. Urinary bladder perforation represents a rare complication in this condition. We report on a boy with in utero bladder perforation and urinary ascites secondary to posterior urethral valves. The pre- and postnatal therapy is described and the current literature is reviewed.

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A surgical technique which is a modification of the technique described by Ravitch is presented in detail. We employed it in 441 patients, among them 85% with funnel chest, 11% with pigeon breast and 4% with combined funnel-pigeon breast. The pre- and postoperative measurement of the chest deformity which provides an objective evaluation of the surgical result is described. The postoperative results were in 91% satisfactory and in only 9% unsatisfactory. No postoperative death was observed in the last 420 patients. The overall mortality in the world literature is 0,05%.

114 children with femoral shaft fractures were treated between 1975 and 1981 at the Department of Paediatric Surgery of the University of Munich. Follow-up examination of 80 children with 81 femoral fractures was possible. 57% were treated conservatively by traction, 43% got an operative treatment by plate osteosynthesis or nailing. With regard to leg length discrepancies there was a significant difference between a control group of children without preceding trauma and one with femoral fractures. After conservative treatment we found an average discrepancy of 0.24 cm. Overgrowth could not be reduced by greater overlapping of fragments at the time of union. After osteosynthesis we found an average discrepancy of 1.2 cm. The data obtained showed no connection between the period osteosynthesis material was implanted and the measurements of leg length discrepancy. Equalization of the discrepancies during further growth cannot be expected.