[Femoro-patellar prosthesis. A retrospective study of 45 consecutive cases with a follow-up of 3-12 years]. / Les prothèses fémoro-patellaires. Etude rétrospective de 45 cas successifs avec un recul de 3 à 12 ans.

Forty-five consecutive patients operated between 1986 and 1995 were evaluated to assess the long term results of patellofemoral arthroplasty. Revision had to be performed in 8 cases for the following reasons: loosening (3), lateral impingement (3), malposition (1) and persistent patella instability (1). Two groups of patients were identified based upon the preoperative assessment: 21 had primary osteoarthritis without anatomic malalignment (group C) and 24 had a history of patellofemoral instability and trochlear dysplasia demonstrated by clinical and radiological evaluation (group D). Only 43% of good results were found in group C whereas in group D, the percentage of good results was close to 83%. The most common cause of poor results in group C was the degenerative involvement of the femorotibial compartments (5 patients had to undergo total knee arthroplasty subsequently). For group D patients, femorotibial osteoarthritis was not a determinant factor as regards the outcome of patellofemoral arthroplasty. To the authors, it appears that the best indication for patellofemoral arthroplasty is femoropatellar osteoarthritis with malalignment in patients having a normal femorotibial axis even in the presence of femorotibial osteoarthritis as long as the latter does not exceed grade II.

Multiple aggressive vertebral haemangiomas in an adolescent: a case report.

We describe a neurologically symptom-free adolescent with aggressive vertebral body haemangiomas at two sites.

[Infected total knee prosthesis. Guidance for therapeutic choice]. / Les prothèses totales de genou infectées. Orientation du choix thérapeutique.

PURPOSE OF THE STUDY: The aim of the study is to assess the functional results and septic evolution in the treatment of infected total knee arthroplasties. MATERIAL AND METHODS: 22 patients were reviewed; 8 were initially treated in our institution and 14 transferred from other hospitals. Articular debridement alone leaving the prosthesis in situ was initiated in 3 of our 8 patients as well as in 6 of the transferred cases. In both groups, this procedure appeared to be a failure. Prosthetic-reimplantation procedure was elected in 10 patients either as a one-stage (5 cases) or a two-stage surgery (5 cases). This has been successfully rated in 7 cases. Femoro-tibial arthrodesis was performed in 15 patients, three of them being a failure of the prosthetic reimplantation. Follow-up ranges from 16 months to 9 years with well documented records. RESULTS: As stated earlier, articular debridement alone has not proven to be a helpful procedure since it did not eradicate the septic complication in any case. Prosthetic reimplantation has been a successful treatment in 7 of the 10 attempted cases. The one-stage procedure is providing the best functional result. Recurrent infection occurred in 3 cases: there were patients with poor host defense (diabetes, arteritis, old age, ...) with resistant bacteria complicating a hinge-knee prosthesis. Femoro-tibial arthrodesis was achieved in 10 of the 15 patients and necessitated all together 23 surgical operations. The highest union rate was observed in cases where sterile conditions were achieved, fixation being performed with an intramedullary nail. Failure of arthrodesis confines the patients in such an uncomfortable situation that 2 of them has asked for an amputation. DISCUSSION AND CONCLUSION: Early surgical debridement may occasionally salve a prosthesis when it is performed shortly after the onset of infection, in an unloosened unconstrained prosthesis infected by a low-virulence organism. In our study, no patient but one met those criteria. For those cases nevertheless, our procedure of choice is now the one-stage reimplantation who seems to be more effective for eradicating the infection and gives rise to a better clinical result. The two-stage reimplantation is the current procedure for handling an infected knee prosthesis. Some patients are still excluded from this procedure because of their poor health condition, bone loss, inadequate viability of skin and extensor mechanism or an uncontrolled sepsis. For such a case, arthrodesis remains the most reliable method of management, especially when it can be stabilized with an intramedullary fixation, which implies to perform a two-stage arthrodesis.

[Revision of arthrodesis of the knee using total prosthesis. Case report]. / Désarthrodèse de genou par prothèse totale. A propos d'un cas.

The authors report the case of a 62-year-old patient whose desire to recover mobility of the knee, arthrodesed 22 years ago, led them to perform a total arthroplasty. The result was satisfactory. The contraindications and implications of such procedures are discussed with reference to 13 other cases reported in the literature.

[Benign osteonecrosis of vertebral body versus neoplastic lesions. Limitations of CT and magnetic resonance imaging]. / Osteonécrose bénigne du corps vertébral versus lésion néoplasique. Limites de l'imagerie en CT-scan et résonance magnétique.

A case of vertebral necrosis of L4 is reported in a young woman without previous steroid therapy. Only the intraoperative histological examination was able to confirm the diagnosis as a benign vertebral collapse, because the CT scan and MR imaging were suggestive of a malignant involvement. The authors report the various criteria proposed to distinguish benign and malignant vertebral collapse with magnetic resonance imaging. These equivocal criteria should be viewed within the context of tissue replacement within the necrotic area during the evolution. Transpedicular biopsy is emphasized. Only the histological examination is specific and allows right planning of the surgical procedure.

Contributing factors for osteogenesis in children's limb lengthening.

A progressive bone lengthening procedure according to the Wagner and Ilizarov technique and our own protocol was performed on 24 children (32 bones). Wagner's (transverse midshaft osteotomy, intraoperative lengthening of 1 cm and postoperative distraction of 1 mm/day) led to a marked reduction in osteogenic capacities. Patients operated on according to the Ilizarov technique had osteogenic reactions in the medullary cavity and on the posterior aspect of bone segments. Our own method, which included bone decortication, 5-7 days of neutral fixation without distraction, led to massive bone production in the medullary canal and around the bone segments. Rigid osseous bridging was present as early as 3 months after surgery. Neither the type of external fixator nor the location or shape of osteotomy had any specific influence on this massive bone reaction. Osteogenesis in limb lengthening is thus closely related to surgical management.

[Fracture-avulsion of the anterior tibial tuberosity in adolescents]. / Fracture-avulsion de la tubérosité tibiale antérieure chez l'adolescent.

A rare case of a 14-year-old girl with an avulsion-fracture of the tibial tuberosity is reported (type III-A). This lesion is described mainly in boys. The authors explain the classification of the different types of avulsion fracture according to the epiphyseal development of the upper end of the tibia and the stage of maturation at the time of trauma.

[Congenital pseudarthrosis of the clavicle. Apropos of a case report and literature review]. / La pseudarthrose congénitale de la clavicule. A propos d'une observation et revue de la littérature.

A new case of congenital nonunion of the clavicle is reported with a histological description. Medullar drilling and bone grafting "in loco" was performed during the surgical procedure. The etiologic hypotheses are discussed. The authors compare congenital nonunions between the pathologies associated with the necessity of medullar drilling for consolidation.

Proposal for a plan of treatment of congenital dislocation of the hip (Belgian Association of Pediatric Orthopaedics).

After several round table discussions between the members of the Belgian Association of Pediatric Orthopedics (BAPO) a plan of treatment of congenital dislocation of the hip was adopted. The purpose of this publication, is to propose this plan as a basis for a general approach to the problem of congenital dislocation of the hip (CDH).

[Y-shaped cartilage in the development of the normal pelvis and in congenital hip dislocation]. / Le cartilage en Y dans la croissance du bassin normal et dans la luxation congénitale de la hanche.

The authors use a radiographic approach to demonstrate the primary role of the triradiate cartilage in hip development in the normal child and in congenital dislocation of the hip. The orientation of this cartilage with respect to the dysplasia gives an indication as to the prognosis of the CDH. The acetabular angle is of lesser interest with respect to the orientation of the triradiate cartilage on the pelvic radiographic examination.

[Limb lengthening in children and osteogenesis using the technics of Wagner and Ilizarov and their modifications]. / L'allongement des membres chez l'enfant et l'ostéogenèse dans les techniques de Wagner et Ilizarov et leur modification.

Different methods of lower limb lengthening are reviewed, related to delays in strengthening and type of callus: Wagner's technique (5 cases), decortication 3 weeks before osteotomy (1 case), and Ilizarov's technique (10 cases on 8 tibiae and 6 femurs). In 5 cases, decortication with osteotomy-closure and waiting 2 weeks before beginning lengthening, was performed. This was carried out at 1 mm/day. The type of fixator is unimportant. This technique allows a restitution of the tubular bone structure in 3 or 4 months in a periosteo-cortico-medullary callus.

[Extraction of a foreign body from the elbow using arthroscopy]. / L'extraction de corps étrangers du coude par arthroscopie.

Arthroscopy of the elbow is now a good diagnostic and therapeutic method, particularly for the removal of loose bodies which are frequently found in the elbow, whatever their etiology. The authors have investigated the advantages and disadvantages of different sites of entry and the technique of removal of loose bodies in five cases. The technical ease of the procedure and the simplicity of the after-care makes it the method of choice in this condition.

Is APD a promising drug in the treatment of severe osteogenesis imperfecta?

The efficacy of (3-amino-1-hydroxypropylidene)-1,1-biphosphonate (APD) is reported in a severe case of osteogenesis imperfecta (OI). An increased density at the metaphysis level is demonstrated on wrist radiograph. Similar findings have been observed in two other children with OI at various metaphyseal levels (e.g., tibia, femur). To our knowledge, this is the first time the effect of APD in children with severe OI has been reported.