Dorsal trans-scaphoid perilunate dislocation in a 9-year-old child.

The authors reported on the surgical management of a trans-scaphoid retrolunate dislocation of the carpus associated with a stable styloid fracture of the radius and a displaced fracture of the triquetrum in a nine-year-old child. An open reduction of the dislocation and fixation using a screw inserted disto-proximally in the scaphoid were quickly carried out using a palmar approach. X-ray showed a good union nine months later. At 29 months the motion of the wrist was normal and pain-free, the strength was graded at 80 % in comparison to the contralateral side and the X-ray examination showed no carpal instability nor growth trouble. The authors discuss the mechanism of production and the therapeutic strategy.

Tissue reaction against a self-setting calcium phosphate cement set in bone or outside the organism.

Calcium phosphate cements are able to set in situ when injected into bone tissue. We evaluated the tissue reaction occurring when a DCPD-based calcium phosphate cement was either set within the bone or implanted when already set. The samples were implanted in rabbit condyles and examined histologically after 8 and 16 weeks. The relative bone surface, the fibrous capsule around the implants and the implant section surface were measured. Solid material seemed to be better tolerated than paste implants. More bone was found at the solid implant contact whatever the implantation time and the solid material degraded much less rapidly. In conclusion, the physico-chemical modification of the biological environment occurring during setting increases the foreign body reaction against the material.

Femoral lengthening using the callotasis method: study of the complications in a series of 70 cases in children and adolescents.

The authors reviewed 70 femoral lengthenings performed for limb-length discrepancy in 66 children and adolescents using gradual incremental distraction. Nine were performed using the Judet lengthener and 61, the Orthofix external fixator. Etiology of the femoral shortening was congenital in 22, posttraumatic in 17, postinfection in 13, neurologic in 12, and miscellaneous in six. There were 83 complications, which were assessed as to their relation to the etiology of shortening, amount of lengthening, and age. The incidence of joint complications did not seem to be less than that previously encountered with rapid distraction methods of lengthening. Bony consolidation was achieved without additional surgery in 88% of cases. Delayed consolidation was most commonly encountered in children younger than 8 years old with congenitally short femora. The authors believe that good results can be obtained by incremental distraction by using uniplanar fixation by aggressive physical therapy, proper fixator application, and appropriate dynamization of the fixator.

[Femoral lengthening by callotasis. A study of a series of 79 cases in children and adolescents]. / Alongement de fémur par callotasis. Etude d'une série de 79 cas chez l'enfant et l'adolescent.

PURPOSE OF THE STUDY: Results of femoral lengthening using callotasis method, with particular attention to the complications are presented. MATERIAL AND METHODS: 79 femoral lengthenings performed for limb length discrepancy in 75 children and adolescents were studied. Etiology of the femoral shortening was congenital in 23 cases, post-traumatic in 20, post-infection in 14, neurologic in 13, and miscellaneous in 9. Nine lengthenings were performed using the Judet lengthener and 70 using the Orthofix external fixator. We used gradual incremental distraction (callotasis). RESULTS: Average lengthening achieved was 52 mm (range: 35 to 85), which represented a 17.7 per cent increase in femoral length (range 7.6 per cent to 64 per cent). There were 87 complications, i.e. 110 per cent. Several complications were often encountered during one lengthening, thus, 23 lengthenings (30 per cent) were performed without any complication and 49 (62 per cent) without additional unpredicted operations or anesthesia. All these complications were studied according to the stage (intraoperative, elongation, consolidation and delayed) in which they occurred and to their severity. They were assessed to establish their relationship to etiology of shortening, amount of lengthening and age. Intraoperative complications were rare (2 cases). In the distraction period, joint complications are the most frequent (33 complications), involving the hip 22 times and the knee 11 times; 28 healed without any problems, 14 needed reoperation and 1 dislocation of the hip led to an avascular necrosis. DISCUSSION: The incidence of joint complications did not seem to be less than that encountered with previous methods of lengthening. The author believes that systematic tenotomies performed in order to avoid such complications in congenital short femurs are abusive and have to be discussed case-by-case. Bony consolidation was achieved without additional surgery in 90 per cent of cases. Eight patients had delayed consolidation but did not require surgery. Complicated consolidation was most commonly encountered in children less than 8 years old with congenitally short femurs. The author compared healing time according to the type of dynamization. A significant improvement was found when using a silastic collar (33.3 days/cm) in place of classical dynamization (46.6 days/cm). CONCLUSION: The author believes that good results can be obtained by incremental distraction using uniplanar fixation. Results could be improved by proper fixator application, aggressive physical therapy and well-thought dynamization of the fixator.

[Upper metaphyseal lengthening of the tibia. Report of 57 cases in children and adolescents]. / Allongement métaphysaire supérieur du tibia. 57 cas effectués par la méthode du callotasis chez l'enfant et l'adolescent.

INTRODUCTION: The authors reviewed 57 upper metaphyseal lengthenings of the tibia. They especially studied complications in order to evaluate this method. MATERIAL AND METHODS: Fifty seven tibial lengthenings in 47 children and adolescents were reviewed. All lengthenings were performed according to the callotasis technique, using Judet's lengthener in the first 15 cases, the, OF-Garches Orthofix in 42 cases. All the callotasis principles were applied: delayed elongation, 1 mm per day distraction, one month neutralization after elongation period, then dynamization before removing the apparatus. Particularities were: a) metaphyseal osteotomy of the upper tibia, b) screw fixation and osteotomy of the fibula, c) classical dynamization according to De Bastiani and Aldegheri in 29 cases, dynamization by a silastic collar (OF-Dyna-Ring) in 28 cases. METHODS: Severity of complications was classified according to Caton: none, benign, serious (needed reoperation or reanesthesia) and severe (sequel). Complications and rate of lengthenings without complication or with benign complications were studied relative to etiology, age, amount of lengthening and the stage of program in which they occurred. A table summarizes data of all the lengthenings. RESULTS: Lengthening was 52.3 mm in average. Healing time (number of days to lengthen and to fuse the bone divided by the number of lengthened centimeter) was 40 in average (range: 20-105): it was 45.6 days per cm when using classical dynamization and only 34.3 with silastic collar dynamization (p = 0.002). Total of complications was 59 out of 57 lengthenings. 21 complications were benign, 37 serious and 1 severe (partial motor palsy of the foot). Thirty two (56 per cent) lengthenings were performed without unforeseen procedure or anesthesia. There were 4 intra-operative complications: 1 vascular lesion, 1 incomplete osteotomy and 2 malpositioned half screws. Complications of elongation period were the most numerous, 4 transient palsies, 6 knee contractures (2 led to a supracondylar fracture), 6 equinism (4 needed an Achilles tendon lengthening), 12 valgus deviations in which 9 were realigned using OF-Garches fixator without reoperation, 1 serious depression occurred in a bilateral lengthening. Consolidation was achieved without complication in 52 cases. Complications were: 1 refracture (fourth lengthening of the same tibia), 1 delayed union, 1 non-union, 2 late deviations. DISCUSSION: Rate of nervous and joint complications is close to that of other series. However, a high osteotomy decreases the consequences on the foot without increasing knee contracture in flexion. The ability to realign during the elongation period appears to be a prevention of valgus deformity compared to Wagner's technique. The authors's distractor is better tolerated than Ilizarov's. Problems with consolidation are rare, less than 9 per cent of the cases. CONCLUSION: A modular distractor improves the results of tibial lengthening; realignment is possible before, during or after the elongation. OF-Orthofix is easy to apply and well-tolerated by the patient, especially in bilateral lengthenings. Performing a high osteotomy, the callus is thick and the consolidation is quickly achieved and safe. A well-thought dynamization using Orthofix Dyna-Ring decreases the treatment time which is 35 days per centimeter in average.