[Knee injury in children]. / Le genou traumatique de l'enfant.

The diagnosis approach after knee injury in children must be carefully taken care of the growth plates but it is necessary to emphasize the frequency of the ligament and intra-articular lesions, and on the other hand to consider their benign reputation. Clinical and conventional radiologic examination give in most of the cases the correct diagnosis. For the others an examination under general anesthesia ++ is necessary to distinguish the ligament and the growth plate lesions. MRI must not replace the arthroscopy which is necessary for an haemarthrosis with a stable knee or a little isolated anterior instability. The non-surgical treatment is indicated for benign sprain and non-displaced or mid-displaced fractures if the reduction is perfect and stable. All the other lesions need a surgical treatment which must be the most conservative as possible, especially for the meniscus, because their integrity is a guarantee for the quality of the long term result.

[Radiographic and histologic observations of autoclaved and non autoclaved allografts in the distal femoral metaphysis in dogs]. / Observations radiographiques et histologiques d'allogreffes autoclavées et non autoclavées dans la métaphyse fémorale inférieure de chien.

PURPOSE OF THE STUDY: A canine experimental work was performed, to study osseointegration of cortico-cancellous bone allografts implanted in the lower femoral metaphysis. Particular attention was focused on observing the effects of autoclaving, used as a sterilizing method, on the osseointegration of bone allografts. MATERIAL AND METHODS: Eighteen dogs were operated on and three groups were formed according to the type of graft: the first group included 4 autoclaved autografts and one animal, in which no graft was implanted. The second group included 11 frozen allografts in which 4 had been autoclaved. The third group included 2 animals, who received autoclaved allografts and were sacrificed at 10 months. In the first two groups, all animals were treated with the same protocol: graft stabilization using a plate, and specimen harvest at 4 months after surgery. In the third group, graft stabilization was obtained by press-fit only, and no plate was used. RESULTS: Overall roentgenographic results were satisfactory, suggesting graft fusion with the host. Histological results were inferior to roentgenographic results, and showed graft resorption, but only some signs of bone formation at the periphery of the graft. DISCUSSION: Roentgenographic results appeared optimistic, when compared to histological results. This suggests that roentgenographic results should not be considered as a reliable criteria for graft osseointegration. Despite favorable experimental conditions (cortico-cancellous graft implanted in the metaphyseal region, in a loaded segment of the skeleton, optimum graft stabilization using lateral plating), histological results were poor. New bone formation was observed at the periphery of the graft, but the major part of the graft remained fibrous. No difference was found between autoclaved and non autoclaved allografts in this small series. CONCLUSION: These preliminary results suggest that autoclaving does not impair osseointegration of frozen bone allografts, which anyway remains incomplete.

[Three rare fractures of the radius associated with an ulnar slipped epiphyses]. / Trois cas rares de fracture basse du radius associée à un décollement épiphysaire du cubitus.

Over a period of 7 years, three adolescent boys had an associated diaphyseal fracture of the distal third of the radius with separation of the distal ulnar epiphysis. The fracture involved towards early epiphysiodesis of the growth plate of the distal ulna leading to a shortened ulna without any severe functional disability. The mechanisms of injury and complication are described. The treatment of this associated lesion is classical emergency, but the radiological follow-up must be extended in time because the growth potential of the forearm bones is important even during adolescence. The onset of a growth disturbance requires rapid surgical epiphysiodesis of the radius to prevent the development of deformity.

Cementless fixation of hip prostheses in dogs.

Fixation of smooth cementless femoral prostheses was studied in 16 dogs which were killed 2, 3 and 4 months after operation. Rotational stability, examined by hand, was good in 9 cases and all stable prostheses could be extracted. Five out of 6 dogs, who did not bear weight after the operation, had a stable prosthesis compared with 4 out of 10 who walked early. Histology showed close bone apposition in 4, tight fibrous encapsulation in 4 and lack of tissue apposition in 8 which were loose. Bone remodelling in radiographs reflected the histological appearances; narrow radiolucent spaces were associated with dense well organised fibrous tissue, and wide radiolucent spaces with loose connective tissue. Prostheses with stems which fill the femoral canal should improve the fixation of smooth cementless prostheses.

Congenital dislocation of the hip in Ehlers-Danlos syndrome.

Nine patients with Ehlers-Danlos syndrome (EDS) were treated for bilateral congenital dislocation of the hip (CDH). CDH was diagnosed at six months of age in two patients and at two to five years of age in the remaining seven patients. The diagnosis of EDS, based on clinical criteria, was established considerably later. One patient with multiple deformities was only observed; the remaining eight patients were initially treated by closed reduction. Due to difficulties encountered in reduction and especially in stabilization, all hips were subsequently treated surgically, with a total of 42 procedures. Avascular necrosis of the femoral head developed in five hips, four of which had been treated with closed reduction with the patients under general anesthesia. At the follow-up evaluation, six patients had reached adulthood. Clinically, satisfactory results were obtained in 12 of 16 hips but roentgenographically in only six hips. Both femoral and innominate osteotomies are necessary to achieve and maintain the reduction in EDS patients with CDH.

Subtalar posterior displacement osteotomy of the calcaneus: a preliminary report of seven cases.

A preliminary report of a new posterior displacement osteotomy of the calcaneus is presented. Seven calcaneocavus feet in six patients ranging in age from 10 to 18 years were operated on with a follow-up of 2-4 years. The osteotomy was performed just below the subtalar joint after a complete plantar release. The posterior shift obtained was limited only by skin tension. The cavus deformity was corrected, and gait improvement was evident. The geometric study of postoperative lateral radiographs showed an expected 30-50% increase in tendo-Achilles strength.

[Epiphyseal fractures-dislocations of the lower extremity of the tibia]. / Les fractures-décollements épiphysaires de l'extrémité inférieure du tibia.

Ninety six distal tibial epiphyseal fractures were identified and treated in our institution from 1976 to 1988. The average age was twelve years and eight months (range two to seventeen years), but seventy-one were between eleven and fourteen years old. Using the Salter-Harris classification we have found twelve type 1 tibial fractures, fourty-two type 2, thirty type 3 and twelve type 4. Four were triplane fractures and seven were Tillaux fractures. Twenty-six had injuries in the medial corner of the ankle mortise (Mac-Farland). Fifty patients were treated non-operatively with closed reduction and plaster cast. Fourty-six fractures were treated surgically. Seventy patients were available for follow-up evaluation. The average follow-up was thirty-two months (range 6 months to eleven years). The tibial distal epiphyseal cartilage was closed in 48 patients. As short-term complications we have seen three post-operative displacements after closed reduction; all of them were treated surgically. Five incomplete closed reduction needed open reduction needed open reduction and bone fixation. Two infections occurred after a surgical approach. Among late complications we have seen eleven premature epiphyseal cartilage closure (rate 15%). Four were responsible of angular deformities. One child has a tibial osteotomy for varus deformity after a medial closure. Two ankle arthritis occurred: one of them was seen after a post-operative infection. In two cases of fracture of the medial mortise corner, a valgus deformity with hypertrophy of the medial malleolus occurred. Ankle arthritis is the most severe complication of the adolescent articular fractures (Tillaux and triplane fractures).(ABSTRACT TRUNCATED AT 250 WORDS)

Tibiofibular torsion from the fetal period until birth.

The anatomic findings of Le Damany and Dupuis are still valuable as a reference. However, their measurement of tibial torsion does not correspond to clinical conditions. In fact, the torsion of the tibiofibular functional unit corresponds to the angle between the transverse axis of the proximal tibial epiphyseal plate and the axis through the middle of both malleoli. A comparative morphologic, radiologic, computerized axial tomographic and anatomic study performed on 50 fetuses with this definition has shown different results. Tibiofibular torsion was in the clear lateral position from the beginning of the fetal period, with a positive gradient at birth.

[Choice of first-line antibiotic therapy in the treatment of bone and joint infections in children]. / Choix de l'antibiothérapie de première intention dans le traitement des infections osseuses et articulaires de l'enfant.

Because of the frequency of Haemophilus influenzae and Staphylococcus aureus in joint and bone sepsis in children, a prospective study of first line antibiotic therapy was performed. In a series of 23 cases, including 8 osteomyelitis and 15 arthritis, Gram stain on joint fluid or antigen detection was helpful in reaching a decision about initial therapy in only 3 cases (Haemophilus influenzae). In 20 of the 23 patients, the first line antibiotic therapy was cefotaxime (100 mg/kg/day) and fosfomycin (100 mg/kg/day) in combination. In 6 of them, the bacteriologic culture was positive (3 Staphylococcus aureus, 1 Haemophilus influenzae and 2 Streptococcus pneumoniae) and the initial antibiotic therapy was changed according to the antibiotic susceptibility testing. In the others 14 cases, from whom no agent was isolated, this combination was continued during about 15 days, then followed by pristinamycin and amoxicillin-clavulanic acid in combination during one month. The C. reactive protein dosage was performed in each patient. All children cured. In view of these first results, cefotaxime and fosfomycin in combination seems to us to be interesting in first line antibiotic treatment without initial orientation.

Lateral humeral condylar fractures in children: a report of 47 cases.

Forty-seven children with fractures of the lateral condyle were reviewed, 4 of whom were treated after a five month delay. The roentgenographic study revealed 4 different types of fractures according to the degree of displacement. Each type corresponded to precise anatomical lesions. In the treatment of recent fractures, we must distinguish between strictly undisplaced fractures, which can be immobilized in a cast, and other fractures, which require open reduction and internal fixation.

[Correction of architectural defects by femoral osteotomy and/or shelf procedure in the treatment of secondary coxarthrosis in adult]. / La correction des vices architecturaux par ostéotomie fémorale et/ou butée dans le traitement des coxarthroses secondaires de l'adulte.

One hundred and forty-nine cases of secondary osteoarthritis of the hip have been analysed. Twenty-eight were treated by a simple shelf operation, 60 by a varus upper femoral osteotomy with or without derotation and 61 by a combination of the two, in an attempt to re-establish the anatomy of the hip to as near normal as possible. The consequences of the operations and their morbidity were analysed for the whole series. Thirty-four patients, only five of whom were operated on both sides were reviewed after a 10 year follow-up or more with 30 good results in 39 hips. The results seem to depend above all on the quality of the articular congruence and the acetabular cover. These procedures are intended, in general, for young adults between 20 and 45 years of age. They can equally be considered up to the age of sixty as an alternative to total hip arthroplasty when the clinical and radiological condition makes it possible.

Fractures of the medial condyle of the humerus in children.

Twenty-seven cases of fractures of the medial condyle of the humerus in children were grouped into one of three types, based on displacement of the medial condyle on initial roentgenograms. Results after an average follow-up of 2.2 years showed that children less than 5 years old tended to have undisplaced fractures giving rise to good results. Older children tended to have more severely displaced fractures. Good results were obtained in patients who were seen early after injury and who had adequate reduction of their fractures. In cases seen late, proper reduction and immobilization are necessary to achieve satisfactory results.

[Idiopathic severe valgus deformity of the knee in children. Apropos of 2 cases]. / Genu valgum unilatéral sévère idiopathique chez l'enfant. A propos de deux cas.

The authors have reviewed two cases of important and idiopathic deformity in children coming from Africa. In the third year of life, a valgus deformity of a knee occurs spontaneously and increases rapidly in a previously healthy child. Varus deformity of the other knee follows but seems to be just a mechanical consequence of the valgus deformity. The pathological lesions observed radiologically concern mainly the metaphyseses. General skeletal or metabolic disease, malnutrition or sickle-cell disease are not found.