[Salter's innominate osteotomy in the treatment of congenital dislocation of the hip. Apropos of 129 cases]. / L'ostéotomie innominée de Salter dans le traitement de la luxation congénitale de la hanche. A propos de 129 cas.

The authors studied a series of 129 innominate osteotomies performed for the treatment of a congenital dislocation of the hip (C.D.H.) in 109 children. This procedure was performed at an average 26 months age and its result reviewed after 6 years and 2 months in average. The innominate osteotomy was most of the time performed after the conservative treatment of the dislocation and an articular procedure was only necessary 19 times out of the 129 hips. In 14 cases, an external derotation of the femur was associated to the pelvic osteotomy. The analysis of the results showed an excellent correction of the acetabular dysplasia as much by the improvement of the femoral head as by the decrease of the obliquity angle of the acetabular roof. At the maximum follow-up, 90.3 per cent excellent and good were counted and the results in 9.7 per cent of the cases were poor. Among these 12 poor results, 9 were caused by a technical surgical fault. The femoral antetorsion decreased in a large majority of the cases. The study of the 28 cases with an over 12 years follow-up showed that good results were time proof. The authors discuss about the criteria that may indicate surgery before 3 years. Those may only be determined on the basis of some abnormalities which remain after the conservative treatment: acetabular morphology, concentricity of the articular surfaces, femoral antetorsion and social problems.

[Surgical treatment of scoliosis of 100 degrees and greater in children and adolescents (neurological and myopathic scoliosis excluded). Apropos of a series of 66 cases]. / Traitement chirurgical des scolioses de 100 degr'es et plus chez l'enfant et l'adolescent (à l'exclusion des scolioses neurologiques et myopathiques). A propos d'une série de 66 cas.

In a retrospective study the authors had compared the results obtained in two series of identical scoliosis. All were examined after a two year minimal follow-up. Group A. There were 31 children operated on between 1966 and 1972. The average initial curve measured 111 degrees, and the average follow-up was eight years. In this group there was no preoperative preparation, and a Harrington rod was accompanied by cancellous grafting. The average correction was 34 degrees. Four paraplegias were seen, three of which recovered. Group B. There were 45 children operated on between 1973 and 1980. The average initial curve was 170 degrees and the average follow-up was 4.5 years. In this group, there was pre-operative use of a Halo cast routinely. In 14 children, Harrington rodding was supplemented by anterior fusion to correct associated kyphosis. The posterior Harrington rodding was completed by tibial grafting. The average correction was 47 degrees, without any neurological complications. It was noted that after one year, pulmonary function was not impaired to a greater extent after an anterior fusion than after a purely posterior fusion. Two-thirds of the cases gained considerable cosmetic benefit.

[Tibial lengthening using Judet's method. Apropos of 108 cases in children]. / Allongement de tibia selon la méthode de Judet. A propos de 108 cas chez l'enfant.

One hundred and eight tibial lengthenings were performed in 106 children using the technique and apparatus of R. and J. Judet. The average lengthening obtained was 43,7 mm with a maximum of 60 mm. In some cases, repeated lengthening obtained 98 mm. Bone union was sound after an average of 4 months. It took 5 months in 13 cases, and a secondary graft was necessary in only 5 cases. Only one non-union occurred, due to infection. It seems that the results obtained with this technique were better than those obtained after internal fixation following removal of the distractor. In 5 instances vascular impairment was seen with recovery in 3 cases, but necrosis of a toe and of the tibialis posterior muscle in 2 cases. In 17 instances neurological impairment was seen with 2 showing persistent anaesthesia and one a paralysis of the extensor hallucis longus. However mild neurological impairment was more frequent than was initially expected. In some cases, preexisting knee deformities were aggravated by the leg lengthening. Some deformities at the site of the lengthening were related to an incorrect position of the distractor or to a contracture of soft tissues. It may also be made worse by non-union of the fibula. These deformities may react on the ankle or the foot and may continue to worsen after the completion of lengthening due to subsequent disturbance of growth in 15 p. 100 of cases.

[Correction of scoliosis using plates. Results of 99 cases seen at a later time]. / Redressement par plaque des scolioses. Résultats de 99 cas vus avec recul.

The authors have reviewed 99 scolioses with an average follow up of 4.5 years which had been corrected by plating. The complications were not infrequent, but were rarely severe. The best early mechanical results were obtained in low curves when the plating was sufficiently extensive. After one year follow up some secondary displacements of the device were seen, mainly in the thoracic region. The long term results were satisfactory both in terms of the angulation and the cosmetic and functional result, except in high thoracic curves. The causes of failure were analysed. It is concluded that this type of operation is worthwhile in idiopathic reducible low curves without rigid secondary curves. It may be applied to paralytic curves provided there is not severe lordosis.

[Fungal osteoarthritis of the knee with joint destruction treated with ketoconazole]. / Ostéoarthrite mycosique du genou avec destruction articulaire traitée par kétoconazole.

The authors report a case of acute fungal arthritis following traumatic inoculation (bramble prick) in a 9 year-old boy. The implicated fungus was an highly pathogenic atypical strain of Scedosporium (monosporium) apiospermum. Two surgical operations (synovectomy and arthrodesis) and antifungal treatment with ketoconazole led to recovery. The pathogenic role of this fungus and especially the importance of toxic phenomena are discussed. This case is compared with other in the literature. The part of ketoconazole in the recovery of this patient is emphasized.

[Prognosis of extensive vertebral arthrodesis for scoliosis using Harrington's rods. Initial evaluation]. / L'avenir des grandes arthrodèses vertébrales pour scoliose réalisées avec le matériel de Harrington. Une première évaluation.

The authors have studied the technical results and the social status of patients operated on for scoliosis with Harrington rods. Only 137 of the first 330 patients, now adults, could be located and questioned. The scoliosis was idiopathic in nearly all cases. Correction of angulation was comparable to that found in the international literature. The aesthetic results were fair. Most of the patients are still young, and lead active lives without any noticeable loss of function or discomfort, except for low back pain whose frequency is discussed. Scoliosis, therefore, is thought to influence the social and professional future of these patients very little. Their problems have been analysed by the use of a questionnaire. The follow-up period for this early assessment is still short and needs to be completed by a further review in 10 to 15 years. It is likely that these results will not then be applicable to scoliosis of the future whose management will be likely to have altered.

[Cranio-vertebral junction and Morquio disease. Apropos of 6 cases]. / Charnière cranio-rachidienne et maladie de Morquio. A propos de 6 observations.

The authors study the anomalies of the cranio-vertebral junction in the Morquio disease. The first 6 cases reported, in addition to the usual vertebral anomalies, suffered from a junctionnal malformations that were operated by posterior decompression and occipito-vertebral arthrodesis. In these cases, they especially study: --the neurological repercussion in 5 cases that could only be evidenced by a very careful examination after a stress test; --the simple roentgenographic examination, in forced position, and gaseous myelography proved on one band, that the instability, which is supposed to be responsible for the neurological symptoms, is actually inconstant (2 case out of 6). But on the other hand a narrow canal was present in every cases; --the surgical procedure performed in the 6 cases consisted of a removal of the posterior arch of the Atlas, of a widening of the occipital foramen if necessary (4 cases) and of an occipito-vertebral arthrodesis. There has been no aggravation compared to the previous state. Three indisputable improvements in the cases with a pyramidal syndrome. The authors compared their cases to those published in the literature and on which most of the time only a simple stabilisation was performed. For the authors this stabilisation can only be considered as a complementary procedure to the decompression which remains the main part of the treatment. The indications are discussed: they are based on the neurological examination and the myelography.

[Spine deformity in Marfan's syndrome in childhood (author's transl)]. / Les déviations rachidiennes de la maladie de Marfan chez l'enfant. Etude de 20 cas.

The authors have studied twenty cases of spine deformity in children suffering from Marfan's syndrome. They describe the main features of the disease and point out the difficulty of accurate diagnosis in children with minor involvement. The deformities are those of a dysplastic scoliosis as shown by the frequency of vertebral inversion on the lateral view: dorso-lumbar kyphosis, decreased lumbar lordosis. The treatment should be surgical because of the danger of a fatal outcome without treatment. The incidence of non-union is high and the authors recommend systematic revision of the fusion double curve scolioses with a moderate kyphosis. In cases of severe kyphosis, the addition of anterior grafting is recommended.

[The incidence of progressive scoliosis and kyphosis after fractures and dislocations of the spine in children (author's transl)]. / Le risque de déviation rachidienne évolutive dans les fractures et luxations du rachis chez l'enfant.

The authors have observed forty-two cases of fractures and dislocations of the spine in children. In twenty-eight cases there was a complete spinal cord lesion and in four cases a partial cord lesion with some recovery. Ten children had no neurological lesion. Fifteen progressive kyphoses and twenty-two progressive scolioses were noted and analysed. The kyphotic deformities were more severe at cervical levels and seem to be aggravated by laminectomies. They were stabilised at the time of bone maturity. To prevent this deformity, the authors recommend long-term plaster cast immobilisation associated with posterior fusion. In scoliotic deformities, the authors distinguish those due to neurological involvement and those arising at the level of the fracture due to disturbance of vertebral growth. Indications for treatment are discussed in relation to the age of the patient and the level of the fracture.

[Orthopedic problems in fibrous dysplasia in infant's bones. A report on 23 cases (author's transl)]. / Les problèmes orthopédiques de la dysplasie fibreuse des os chez l'enfant.

The authors report on 23 cases of fibrons in infants who had been treated surgically, and review the therapeutic problem which arise from this particular type of bone fragility. When located in the diaphysis they had been treated by screw fixation, isolated grafts being constantly unsuccessful. Various procedures had been used in 9 cases with localization in the proximal end of the femur, and they are reviewed critically.

[Scoliosis and congenital cardiopathies]. / Scolioses et cardiopathies congénitales

The authors have followed up 26 children suffering from severe scoliosis associated with congenital heart disease up to the end of puberty. The curve was usually a very severe idiopathic scoliosis developing early and requring surgical treatment. Two types may be distinguished: I. Scoliosis without excessive surgical risk, in patients in whom the heart disease is not associated with cyanosis or where the heart condition has already been treated surgically and in which there are no clinical, radiological or electrical signs of cardiac failure. 2. Scoliosis with considerable surgical risk because of heart disease with cyanosis not treated surgically, or with signs of heart failure or pulmonary hypertension. In such cases, the surgical treatment of the scoliosis is likely to endanger life.