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This study attempted to analyze objectively the longstanding impression that children under 5 years of age, who have Legg-Calvé -Perthes disease, generally do well. Thirty patients, with 36 hips and onset of disease prior to their fifth birthday were reviewed at skeletal maturity. More than 50% of the hips were classified in Catterall group 3 or 4, and Herring group C. The end evaluation by the Stulberg classification showed 44.5% good, 22.2% fair and 33.3% poor results. By the Mose rating the results were respectively 27.8% good, 30.6% fair and 41.6% poor.A meta-analysis of the literature showed a very broad spectrum of results, leading to the conclusion, first, that comparison is difficult and, second, that young age is not a free ticket to a good result. J Pediatr Orthop B 12:222-228

Twin-to-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies. This condition is associated with high mortality if untreated. Treatment consists of either serial reduction of amniotic fluid or selective laser photocoagulation (SLP). In utero limb ischemia is a known complication of TTTS. An interaction between this condition and SLP has never been established. Here, we describe the first of twins born at 34 weeks' gestational age, delivered by emergency cesarean section for fetal distress after a pregnancy complicated by severe TTTS. The first twin, the recipient in the TTTS, showed a necrotic right limb, which was amputated above the knee joint on the 23 rd day of life. Anatomicpathological investigation revealed vascular thrombosis. The foot-length was compatible with a gestational age of 16-18 weeks, the time of limb ischemia, which is well before 26 weeks, when SLP was performed. Therefore, we refute that the fetal limb ischemia was a complication of SLP.

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