Open synovectomy for the prevention of recurrent hemarthrosis of the ankle in patients with hemophilia. A report of five cases with magnetic resonance imaging documentation.

Hemophilic arthropathy is an incapacitating complication of severe hemophilia resulting from recurrent bleeding in the same joint. Open synovectomy has been used since 1969 to prevent recurrent hemarthrosis of target joints. Between 1988 and 1993 we performed open synovectomy of the ankle in five hemophiliacs aged 6 to 9 years with early-stage hemophilic arthropathy. Magnetic resonance imaging proved very useful for evaluating the severity of joint damage, usually underestimated on plain radiographs; for determining the degree of synovial membrane hypertrophy, which is a critical factor in the decision to perform synovectomy; for planning the surgical procedure and for explaining treatment failures. A decrease in the frequency of hemarthrosis episodes occurred in all five ankles. A repeat synovectomy was needed in one case and in another patient the frequency of hemarthrosis episodes increased somewhat after the fourth year. There was no loss of range of motion. Our data suggest that open synovectomy is effective and safe for reducing the frequency of hemarthrosis and that magnetic resonance imaging should be routinely performed before the procedure.

MR imaging in hemophilic arthropathy.

20 children with hemophilia were examined with Magnetic Resonance Imaging (MRI) to determine if MRI could be used to assess hemophilic arthropathy, especially in the early stages. 28 joints of the appendicular skeleton were imaged, including 17 knees, 10 ankles and 1 elbow. The results were compared to clinical and plain radiographic assessments and to the surgical findings when synovectomy was performed. MRI is able to evaluate the components of hemophilic arthropathy such as fluid effussion, synovial hypertrophy, the status of the articular cartilage, and bony lesions. These lesions can be discovered at an early stage when plain radiographs are still normal. MRI seems to be useful for the selection of patients needing early treatment of hemophilic arthropathy and in monitoring response to therapy.

[Long-term results of the Harrington operation. Apropos of a series of 200 cases (1964-1986)]. / Résultats à long terme de l'opération de Harrington. A propos d'une série de 200 cas (1964-1986).

The authors present a series of 200 patients who underwent vertebral arthrodesis with Harrington's distraction rods for idiopathic scoliosis reviewed after a mean follow-up of 7.5 years (maximum: 24 years). The surgical procedure consisted of either simple distraction or distraction associated with convex compression or a transverse traction device or insertion of double rods according to Armstrong's technique. The operative gain was 44%, the angular loss was 12% and the definitive gain was 32%. The results were better in girls and in juvenile scoliosis type III and adolescent scoliosis. The best long-term correction was obtained in cases of lumbar scoliosis. The best operative reduction was obtained in thoracic and thoracolumbar scoliosis and the greatest angular loss was observed with major double scolioses. The most favourable results were obtained in cases of scoliosis were severe angulation. The best system was Armstrong's followed by Dollar's and the least effective was simple distraction. Heavy pre- and intra-operative vertebral traction improved the angular score. Rupture of the rod, when it occurred late, was not equivalent to pseudarthrosis. Angular deterioration over time was essentially observed over the first 10 years but led to disappointing results.

[Subtotal avulsion of the lower limb after traumatic section in a 2 and a half-year-old child]. / Arrachement subtotal d'un membre inférieur après section traumatique sur un enfant de deux ans et demi.

Reimplantation after subtotal section of the right lower limb under the Scarpa triangle was been attempted and was successful. Section and contusion of the femoral artery and vein required 2 end-to-end saphenous bypass grafts. The use of the lower limb is correct, after to a follow up of 4 years. The risks, inherent to all proximal section, with important muscular masses, in a small child, are described. Functional prognosis depends on three aspects: bone, vessels, and nerves. A tibial pseudarthrosis had to be operated secondarily with significant lengthening. A partial stenosis of the graft was demonstrated arteriographically. Pes equinus, a result of paralysis, has been fitted with an orthesis. This observation is almost an experimental one: what can be the future of a reimplanted lower limb in the child.

[Subacute or initially chronic osteomyelitis in children. A series of 17 cases]. / L'ostéomyélite subaiguë ou chronique d'emblée chez l'enfant. Une série de 17 cas.

17 cases of subacute or at once chronic osteomyelitis are shown. At this occasion, an analysis of epidemiological, topographical, clinical and bacteriological data is given. An immunological study has been made in 5 cases: diagnosis is difficult at all stages. A reflexion is proposed concerning the treatment to be performed.

[Experimental study of injuries to growth cartilage (Salter type V)]. / Etude expérimentale des traumatismes du cartilage de croissance (type V de Salter).

The Salter and Harris classification concerning the epiphyseal cartilage traumas is gradually showing its limits. The type V according to Salter, the prognosis of which being severe, should be due to the traumatic compression of the growth cartilage. But no experimental research could up to this time demonstrate this fact. Among 24 rabbits seen during growth, we tried to create a type V on the distal end of the femur. But, even when the impacts had been very strong, we never could create a single V-type injury. During discussion, and in order to give an explanation of late epiphysiodesis, one could call up the role of the periosteum, of the pre-cartilaginous collar, of the metaphyseal lack of blood vessels. This role should be important in forming a so-called "V-type".

[Multiple wounds in children. Apropos of 76 cases]. / Les enfants polytraumatisés. A propos de 76 observations.

Polytraumatisms in the child are relatively unfrequent, less severe, and get a lower rate of deaths compared with polytraumatisms in the adult. The indirect traumatism, being most frequent, is explained by projection and ejection. Direct traumatism is scacre. A classification in 4 types is proposed: type I: visceral polytraumatised child, type II: multiple fractured one, type III: mixed visceral and multiple fractured one, type IV: the crippled one. Cranial trauma has to be noticed as being a constant one. The relative unfrequency of spine, belly and thoracic injuries; the most frequent happening of peripheral traumatisms; the severeness of mutilations are emphasised. Multiple fractured children are healed with very remaining mutilations; the social and economic load is heavy; the pophylactics hypothetical.

[Sports injuries in children. Epidemiologic study]. / Les traumatismes sportifs de l'enfant. Etude épidémiologique.

Among 49 000 cases of infantile emergencies which were received in the BUCI (Bloc d'urgence chirurgical infantile: surgical infantile emergency unit), 5 546 were sport traumas. At an early age, they were caused by outdoor plays; during adolescence, the main cases were caused by team sports. Males are predominant. The number of cases has been regularly progressing, particularly since 1976. The fashion in sports is influenced by médias (i.e. skate board), and can be opposed to the continuous practice of popular sports (swimming, ball games, bycicle. There are winter, summer, school timed sports (the latter being influenced by the sportive scholar associations). The most frequent sports are cycling, football playing, swimming and horse riding, athleticism skating, Other are occasionnal. Changes in sport fashions, female increasing participation, such as horse riding and skating, democratisation (skiing, riding), the worsening of traumas; the pathology concerning bystanders, are described. Cranial and peripheric pathology are dominant. Trunk traumas are scarce but severe. Each sport has an elective pathologic localisation. Injury mechanisms are found, such as stirrup, saddle, ski baton pathology. There is traumatologic similarities; skate board and roller skating; judo and atheleticism; cycling and horse riding. Sport in children is not a replica of the one among adults. Riding a bike is not cycling. Some sports are dangerous: cycling, horse riding, rugby. A traumatological outline is revealed. Preventive measures should be taken. The socio-economical cost is heavy.

[Traumatic pulmonary evisceration in a child. Apropos of 2 cases]. / L'éviscération pulmonaire traumatique chez l'enfant. A propos de 2 cas.

Two cases of pulmonary traumatic evisceration are reported. The question is about exceptional lesions very spectacular and good tolerated.

[Perthes' disease treated by Chiari pelvic osteotomy (author's transl)]. / L'ostéotomie de Chiari dans l'ostéochondrite primitive de la hanche. A propos de 17 cas.

The author has studied the results of 17 pelvic osteotomies performed during the course of Perthes' disease in cases in which the femoral head was poorly covered by the acetabular roof. They found improved cover anteriorly and superiorly after operation. Bone remodelling as seen on radiographs and by arthrography was favourably influenced by the better cover. The technical details for the production of a satisfactory osteotomy are given.