Anatomic reconstruction of the MPFL that respects the distal femoral physis in skeletally immature patients is a safe and effective technique for the treatment of patellofemoral instability and allows patients to return to sports without redislocation of the patella.

The case of a 9-month-old girl with glutaric aciduria type 1 (GA 1) is reported. On initial presentation at 6 months of age, the patient demonstrated bilateral subdural hemorrhages and widening of the basal cisterns. After neurosurgical intervention the subdural effusions regressed; their etiology remained unclear. At the age of 9 months the patient presented again because of progressive loss of psychomotor abilities and a dystonic movement disorder. Cerebral MRI revealed regressive subdural hematoma, but marked frontotemporal atrophy as well. Because of a suspected metabolic disorder, urinary analysis of organic acids was performed. This repeatedly showed marked excretion of glutaric acid, 3-hydroxyglutaric acid and glutaconic acid, indicating a diagnosis of GA 1. Considering our patient's history, we recommend the inclusion of GA 1 in the differential diagnosis of patients with unexplained subdural hematoma and neurological deficits.

IV.

Prophylactic contralateral fixation in unilateral slipped capital femoral epiphysis (SCFE) remains a controversial issue. In this study, 66 patients treated for unilateral SCFE (July 1997-April 2009) were screened for complications with need for surgical reintervention in the asymptomatic contralateral hip. Except for one patient, prophylactic fixation was performed in all cases. Major complications such as avascular necrosis were not seen; minor complications such as wound revision occurred in 4.6% (three of 65). In 16.9% (11/65) secondary loss of fixation with need for second fixation occurred. As the need for second fixation arose mostly bilaterally (10.7%, 7/65), only four patients (6.2%) required an additional surgical procedure for second fixation. Children who needed second fixation were significantly younger (11.8 years) than those who did not (13.1 years, P=0.013). In conclusion, this retrospective analysis shows that prophylactic contralateral fixation in SCFE is a safe procedure with no major complications and an acceptable rate of minor complications. When Kirschner wires are used for prophylactic pinning, there is a possibility of secondary loss of fixation due to length growth at the level of the physis. To avoid the need for secondary fixation, screw epiphysiodesis might be considered.

Level IV, retrospective case series.