Coxa antetorta describes an abnormal torsion of the femur. It is commonly considered a cosmetic problem and is treated surgically only in severe cases and the presence of physical complaints. The purpose of this study was to identify deviations in gait kinematics and kinetics in pediatric patients caused by coxa antetorta and to categorize these deviations into primary and secondary deviations. We conducted a retrospective, cross-sectional three-dimensional (3D) gait analysis study to detect gait deviations in adolescents (n ¼ 18; age range 10.5-17.5 years) with coxa antetorta compared to age-matched healthy control subjects (n ¼ 17). Principal component (PC) analysis was used for data reduction. Linear mixed models applied to PC-scores were used to estimate the main effects within retained PCs followed by a post-hoc subgroup analysis. Patients walked with smaller external foot progression angle, greater knee adduction, more internally rotated and flexed hips and greater anterior pelvic tilt. Subgroup analysis revealed that-depending on knee alignment-patients had higher knee and hip adduction moments. These deviations in joint kinematics and kinetics may be associated with physical complaints and accelerated development of osteoarthritis. Assessment of gait deviations related to coxa antetorta using 3D gait analysis may be an additional tool in individual clinical decision-making. ß

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Osteochondritis dissecans (O.d.) of the knee is a common disease, but the aetiological factors are still controversial. With a follow-up examination of 97 surgically treated patients (109 lesions) we looked for the influence of preoperative sports activities as a possible aetiological factor. Most of the patients complained first symptoms at puberty age between 10 and 15 years, girls with a mean age of 12.4 years and boys with a mean age of 15 years. Because of that, humoral factors are supposed to have influence on the onset of this lesion. Also patients with O.d. of the knee demonstrated a high rate of sports activities and/or trauma prior to the onset of symptoms. There was also a good correlation between lesions at the medial condyle with varus malalignment. Additionally, in most of the patients a high grade of general ligament laxity could be observed at the follow-up examination. It seems that biomechanical factors have an important aetiological influence on the initiation of O.d. at the knee. At the date of follow-up examination all patients reported on a minor sports activity in comparison to sports activities prior to the onset of symptoms. The amount of postoperative sports activities depends on the level of the resulting Lysholm score and on the grade of osteoarthritis.

We retrospectively reviewed the safety and efficacy of operative treatment of torsional malalignment of the tibia in 44 children, on whom we performed 71 derotational osteotomies of the distal tibia to treat tibial torsion. We placed four pins using an alignment jig, performed a percutaneous osteotomy, and applied an external fixator after derotation. Postoperative radiographs showed accurate tibial derotation and pin placement in all patients. Nine patients developed superficial pin-tract infections that resolved with antibiotic treatment. Two developed fractures after removal of the external fixator, which healed in a plaster cast. Operative treatment of these cases with an external fixator is safe, effective, and well tolerated.