Anatomical basis of a new naso-labial island flap.

We describe a nasolabial island flap with a proximal base. This anatomical study confirms the interest of a proximal base especially with regard to venous return. As opposed to classical naso-labial flaps with subcutaneous pedicle, it has a vascularization of musculo-cutaneous type which allows a greater degree of mobility and reliability. This flap is an effective therapeutic option in surgery for skin defects of the face.

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.

Vascular disorders of the proximal femur following treatment of congenital hip dislocation.

Early diagnosis of congenital dislocation of the hip entails treating patients in a very young age-group. These patients present a high risk of vascular disorder in the femoral capital epiphysis in the course of either surgical or nonsurgical treatment. Thirty-five cases of anomalies in the proximal femur of vascular origin were observed, corresponding to 3% of hips treated for congenital dislocation. Roentgenographic diagnostic elements are included in an evolutive classification. In recent cases, radionuclide bone scans were used to obtain supplementary information. Based on bone scans, two distinct groups of patients can be identified: in the first group, vascular disorders of the proximal femur (VDPF) are iatrogenic in origin; in the second, VDPF are due either to the precariousness of prereductional blood flow to the epiphysis or to the summation of risk factors.

Surgery in residual clubfoot: one-stage medioposterior release "à la carte".

A series of 142 clubfeet in 113 children were treated by a one-stage medioposterior release for deformity persisting after vigorous physical therapy. The talonavicular joint and hindfoot are released to achieve correct alignment. Long-term good results were seen in 73% of the entire series and in 87% of the idiopathic subgroup.

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.

Atypical bone angiomas in children.

Bone angiomas can present in a variety of clinical, radiological and histological forms. The two cases reported illustrate unusual and fairly rare aspects of this vascular tumor.

[Therapeutic remarks on the congenital elevation of the scapula. Apropos of 16 cases]. / Réflexions thérapeutiques sur la surélévation congénitale de l'omoplate. A propos de 16 cas.

The authors review a series of 16 cases of congenital high scapula including 4 bilateral cases. The pathological aspects are detailed including investigations for scapular hypoplasia (3 cases), omovertebral bone (7 cases), loco-regional muscular anomalies (5 cases), and various deformities of the cervical spine (present in all cases). The entire spine and the thoracic cage was examined in all cases. The Woodward procedure was performed with some modifications described in the text. The operative results in 3 cases were judged to be failure based on cosmetic and functional criteria. The age of the patients at operation and the presence of an omovertebral bone did not influence the results, however, the presence of important deformities of the cervical spine had a poor prognosis. The authors insist on the loco-regional character of the deformity and on the importance of the reorientation of the scapulo-humeral joint. Results were judged on cosmetic and functional criteria with 79% excellent or fair results.

Bone scintigraphy in Perthes disease.

After intravenous injection of 99mTc methyldiphosphonate, 190 hip bone scans were performed on 103 children. In 64 children with Perthes disease, 61 of 71 hips (86%) showed abnormal scintigraphy. There were no false positives. In other hip disorders, the scan was never considered to simulate Perthes disease. There were 36 children with acute synovitis and three with Meyer's dysplasia. The sensitivity was 97%, suggesting that this test should be used more frequently in the early assessment of hip pain in the young child, before the appearance of characteristic radiographic abnormalities. This test is also valuable for follow-up of the disease because of its prognostic value--the bone scan becomes normal far earlier than the radiograph. The progressive normalization of the scan may help determine when the child can begin weight-bearing.