[Surgical treatment of scoliosis using Harrington instrumentation and arthrodesis. A comparison of 2 series with and without sublaminar segmental wiring]. / Traitement chirurgical de la scoliose par instrumentation de Harrington et arthrodèse. Une comparaison de deux séries sans et avec cerclages segmentaires sous-lamaires.

The use of sublaminar segmental wires to enhance the stability of Harrington instrumentation was assessed in a review of our experience in the treatment of scoliosis over the last 6 years. Thirty patients were treated by spinal fusion, Harrington instrumentation and a prolonged postoperative period of immobilisation, initially in a plaster cast and then in a brace (Group 1). A further 29 patients have been treated by augmenting the Harrington instrumentation with sublaminar segmental wires (Group 2). Post-operatively, this group was left free of any brace or cast and early mobilisation was allowed. We observed no neurological complication in either group. The blood loss and the duration of the operation were greater in Group 2, but the period of hospitalisation and time to return to school has been markedly reduced. There has been no significant difference in the degree of correction of the scoliosis between the groups, but the improvement in kyphosis was greater with the use of sublaminar wires. There were no pseudoarthroses in either group during a minimum follow up of 18 months.

[Respiratory function in idiopathic scoliosis in adolescents treated by Harrington instrumentation with or without sublaminar segmental wiring]. / La fonction respiratoire dans les scolioses idiopathiques de l'adolescent, traitée par instrumentation de Harrington, associée ou non à un cerclage sous lamaire segmentaire.

The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) of 40 adolescents with idiopathic scoliosis were studied before and after surgery. The values obtained are expressed as percentages of the predicted normal. Twenty-one patients underwent surgical correction of the curve with Harrington rods followed by cast and brace immobilisation for one and a half years (Group A). In the other 19 patients the Harrington rod was contoured in the sagittal plane and supplemented with segmented sublaminar wires to allow rapid post-operative mobilisation free of any orthosis (Group B). A negative correlation was found pre-operatively between the magnitude of the curve and the FEV1 and FVC. The post-operative pulmonary function showed no statistically significant improvement. Contouring the Harrington rod to improve kyphosis in Group B did not affect the outcome.

Assessment of vascularity of head of femur by bone scan and histopathology.

A prospective study of 17 patients with fracture neck of femur was undertaken to study the vascularity of the femoral head by bone scan using Technetium-99m MDP, as well as to study the viability of the femoral head by histopathology, and therefore determine correlation, if any, between these two methods. Treatment was by primary endoprosthetic replacement (Moore's Arthroplasty). In 16 of the 17 patients the bone scan showed decreased vascularity of the head, but histopathological examination could not confirm non-viability of the head. It is likely that, since the majority of the patients were operated on within 4 days, there was insufficient time for histopathological evidence of ischemia to develop, prior to removal of the femoral heads.

Spirometric pulmonary function tests before and after surgical correction of idiopathic scoliosis in adolescents.

Severe scoliosis causes a deterioration in cardiopulmonary function. The effect of surgical correction on this is variable. We studied the forced vital capacity [FVC) and forced expiratory volume in one second (FEV1) before and after surgical correction in 30 adolescents with idiopathic scoliosis and the results are expressed as a percentage of the predicted normal values using 101 children as controls. A negative correlation was noted preoperatively between the magnitude of the curve and FVC and FEV1. Surgical correction of the curve was done with a Harrington rod in 17 patients followed by cast and brace immobilisation for one and a half years. In the remaining 13 patients the Harrington rod was supplemented with sublaminar wires (SSI) to eliminate the use of an orthoses. All patients had a posterior spinal fusion. Our study showed that there was an improvement in the spirometric values post-operatively but this was not statistically significant. This improvement was similar in both groups of patients. Further studies, for a longer period and of other indices of pulmonary function are required.

Tumoral calcinosis--a case report.

Tumoral Calcinosis is a well established but rare clinical entity. It was first described in 1899, and since then, scattered reports have occurred in the literature from many parts of the world. The main controversy lies in the aetiology of the condition. One such case is presented in this paper, along with a review of the literature.

Idiopathic scoliosis. Prevalence and ethnic distribution in Singapore schoolchildren.

Routine examination for spinal deformity as part of a school health screening programme was introduced in Singapore in 1981. The three different ethnic groups included in the study provided figures for the prevalence of idiopathic scoliosis in an Asian population. A three-tier system of examination was used and a total of 110744 children in three age groups were studied. In those aged 6 to 7 years the prevalence was 0.12%. The prevalence in those aged 11 to 12 years was 1.7% for girls and 0.4% for boys, a ratio of 3.2 to 1. In girls aged 16 to 17 years the prevalence was 3.1%. In the latter two age groups there was a significantly higher prevalence in Chinese girls as compared with Malay and Indian girls. The optimal age for school screening seemed to be 11 to 12 years, but repeated examinations may be worthwhile.

Moiré topography in scoliosis. Its accuracy in detecting the site and size of the curve.

Moiré topography was added to school scoliosis screening in Singapore in 1982. The results from 1342 topographs, assessed in isolation, were used to study the accuracy of the method in predicting the radiographic location and magnitude of scoliotic curves. Accuracy in identifying the site of the curve was 68% in the thoracic spine, 54% in the thoracolumbar spine, and 15% in the lumbar region. There were 12.7% false-positive results and 4.3% false negatives. Of patients with a deviation of one moiré fringe, 76.5% had a curve of 15 degrees or less; of those with a deviation of four moiré fringes, 69% had a curve greater than 26 degrees. The prediction of the Cobb angle was less accurate when there was a deviation of two or three fringes. It is suggested that moiré topography as a screening device should be reserved for use in the second tier of screening, since the forward-bending test is an effective and cheap method for the first tier of a mass school-screening programme.

Vascular pedicle graft of the ipsilateral fibula for non-union of the tibia with a large defect. An experimental and clinical study.

Failure of union of the tibia with a large defect is difficult to treat, especially in the presence of sepsis and adherent scars. Conventional methods of fixation and bone grafting are not easily applicable. Experiments on Macaca monkeys showed that a vascularised pedicle graft of the shaft of the ipsilateral fibula could be fixed across a defect in the tibia and remain viable, even if it was isolated from surrounding soft tissues. Transfer of part of the shaft of the ipsilateral fibula on a vascular and muscle pedicle was carried out in 11 patients with large tibial defects and sepsis. There was one failure because of severe infection, but the other 10 patients gained sound union in about four months. The tibia was then protected by a caliper for the 18 months of full reconstitution. The bone infection healed and there was no evidence of avascular necrosis. Although the salvaged limbs were scarred, stiff and ugly, none of the patients suffered from pain, recurrent oedema or persistent infection.

Replantation of digits using microvascular technique.

This paper reports our experience of replantation of 31 digits. The operative technique and sequence of replantation is described. We have attempted to classify the functional results into three groups: near normal, useful and useless digits.

A study of radioulnar movements following fractures of the forearm in children.

The range of radioulnar movements, following fractures of the forearm bones treated conservatively in 53 children under the age of 15 years, was measured by a goniometer. The most common age group was 6-10 years. All fractures united within 8 weeks and the average follow-up was 3 years. Although subjective assessment of the result was good in all cases, 52.8% had some limitation of rotational movements. The factors which limited rotation were angulatory deformity of the bones, rotational malalignment or injury to the inferior radioulnar joint. An angulatory deformity of more than 10 degrees in a child above the age of 10 years failed to remodel adequately with growth particularly if the fracture was in the proximal half of the forearm. Rotational malalignment also did not correct with growth.