Heel pain is a frequent complaint in children due to intensive school and leisure-time sports. Heel pain accompanied by inflammatory signs has to be considered as osteomyelitis until the opposite is proven. From 1980 to 1989, twenty children were treated for acute or subacute osteomyelitis of the calcaneus (OMC) at the Department of Pediatric Surgery of the Children's Hospital of Lucerne. The schema of investigation comprising laboratory work-up, x-rays, scintiscanning and aspiration of the focus makes quick and accurate diagnosis possible. Exogenous osteitis of the newborn and calcaneal apophysitis in children must be differentiated; this is a prime consideration. Treatment includes surgical interventions (curettage, drainage) and long-term antibiotics. The course of the disease can be shortened, complications become avoidable and the rate of recurrence is diminished.

A follow-up study of nearly 600 children who had sustained a brain injury of various degree signifies that the prognosis is not as good as is generally assumed. Whereas the initial neurological and psycho-reactive changes may regress in most cases, neurovegetative and psycho-organic disturbances remain frequently. The most prominent finding, however, is the reduced capacity for school-work leading to frequent changes of class and to a reduced expectancy for later profession. The knowledge of these sequelae underlines the urgent need to reinforce all measures to prevent brain injuries in childhood.

Immobilisation hypercalciuria and hypercalcaemia following limb fractures or paralysis is a frequent occurrence in children. Assessment of calcium metabolism should be performed in such patients, since the formation of kidney stones is possible. The beneficial effect of hydrochlorothiazide (HCT) in the prevention of renal stones is most likely due to a reduction of calcium concentration in urine and a significant decrease of crystalluria. Thus, its administration is recommended for children with hypercalciuria following prolonged immobilisation especially due to fracture treatment or paralysis.

Despite the wide use of the international classification of megaureters, there is a lack of clear concepts especially for congenital malformations. We performed a follow-up study in 132 children with 171 megaureters operated on during the past 13 years. In 24 additional cases reconstructive surgery was not feasible due to advanced damaging of the parenchyma. In 97% of 171 megaureters, resection of the distal stenosis and ureterocystoneostomy was successful. In 20%, additional ureteric tailoring was necessary. Only one patient had recurrent reflux, and reoperation for recurrent stenosis was indicated in less than 2.5%. Urographic studies revealed that postoperatively 38% of calices resumed a normal appearance, whereas 80% of the ureters were of normal caliber and had normal peristaltic activity. From this study it is concluded that ureteric stenosis should be treated operatively in refluxing and obstructive cases. As a rule, correction of bladder or urethral pathology does not obviate the need for ureter surgery.

In 21 children with severe injuries of the lower extremities observed within 10 years, limb saving surgery was attempted. The evaluation of an injury is determined by the severity of the soft tissue damage rather than by the type of a fracture. A new classification is suggested for this purpose. Therapeutic clues are an open treatment of the wound with repeated irrigations and debridements. Bone fractures are stabilised and vascular separations repaired. Definitive care of skin, soft tissues and bones is undertaken only within weeks following the injury and in good circulatory conditions. All extremities with an injury-score 3 could be saved. Among the 9 incomplete or complete amputations limb saving procedures succeeded in 3 cases.