Stable elastic intramedullary nailing for fractures of the femur in children.

Fractures of the femur are the most incapacitating fractures in children. Conservative treatment necessitates a long stay in hospital for traction and subsequent immobilisation in an uncomfortable cast. This treatment is not well tolerated, especially in adolescents. Moreover, near the end of growth, accurate reduction is necessary, as malunion is no longer correctable by growth. Stable elastic intramedullary nailing uses two flexible nails which are introduced percutaneously either through the lower metaphysis or the subtrochanteric area. This technique does not disturb the healing of the fracture. The elasticity of the device allows slight movement at the fracture site which favours union. Reduction and stabilisation are adequate and the operative risk is very low. A cast is not required, functional recovery is rapid and the patient is allowed to walk with crutches after seven to ten days according to the type of fracture. This technique is very efficient in adolescents and can be used after the age of seven years when conservative treatment is unsuccessful.

Percutaneous epiphysiodesis using transphyseal screws (PETS).

We describe a new technique of percutaneous epiphysiodesis using transphyseal screws (PETS) and our experience with it in 32 cases of limb-length inequality and nine angular knee deformities. A subgroup of 18 patients with postfracture limb overgrowth formed a clinical model for study of the real efficacy of PETS. It proved a reliable method with few complications and many advantages such as simplicity of technique, short operating time, rapid postoperative rehabilitation, and reversibility. Bone-length inequality decreased from a preepiphysiodesis average of 2.47 cm (range, 1.5-4.6) to 0.51 cm at skeletal maturity. The tibiofemoral angle reduced from a preoperative average of 7.66 degrees to 0.86 degrees at maturity. The screws began to exert significant growth inhibition within 6 months of insertion, slowing down the distal femoral and upper tibial physes by 68 and 56%, respectively. They achieved maximum growth retardation over the ensuing 12 months, slowing down the distal femoral physis by 89% and the proximal tibial physis by 95%. At skeletal maturity, total femoral growth was 45% and total tibial growth was 52% that of the normal side. Key

Reduction and fixation of displaced radial neck fractures by closed intramedullary pinning.

Radial neck fractures in children are serious injuries with frequent sequelae when the tilt exceeds 60 degrees. Conservative treatment is often inadequate in such cases and open reduction may produce iatrogenic complications. We report our experience with an original technique. An intramedullary wire introduced from below and projected upward allows reduction of the displacement and maintenance of the correction without infringing the joint. The operative technique is described. This method was used in 31 fractures with between 30 degrees and 80 degrees of tilt and in 16 fractures with > 80 degrees of tilt. Excellent and good functional results were obtained in 30 cases in the first group and in 11 cases in the second group.

Cystic degeneration in non-ossifying fibroma.

Two unusual cases of non-ossifying fibromas in boys of 4 years with partial cystic degeneration are presented. The osseous cavities did not respond to corticosteroids.

Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases.

The results of elastic stable intramedullary nailing (ESIN) of 85 forearm fractures in children are reported. A single curved nail was inserted into each forearm bone with closed reduction. Immediate mobilization was allowed postoperatively. In a 3 year 6 month follow-up of 76 patients, 92% had excellent results with a full range of movement. There were neither nonunions nor infections. ESIN is recommended in the treatment of displaced forearm fractures in children older than 10 years of age, and in younger children when conservative treatment fails.

[Supracondylar fractures of the humerus in children: treatment by downward nailing]. / Fractures supra-condyliennes de l'humérus de l'enfant: traitement par embrochage descendant.

Surgical treatment of supracondylar fractures of the humerus in children concerns a limited number of these fractures. That is fractures with great displacement and periosteal rupture, which are reported in our experience of 96 cases treated by an original method. It consists of external reduction stabilized by 2 nails introduced in the middle third of the shaft and diverging in the lower humeral epiphysis. We insist on the use of two X-ray amplifliers in the operative technique. Ninety-four fractures were controlled after 3 months, during nail removal and 81 patients had a follow-up more than one year. Morphological and functional results were appreciated as 75 excellent 15 good and 4 bad. Among the complications encountered we noticed that cubitus varus was very rare. Only 6 controls showed an angle of less than 10 degrees. As compared to the other surgical techniques this method is very encouraging and comforts our indications in unstable third degree fractures, unsuitable for Blount's method, and the great majority of forth degree fractures.

[Use of vascularized bone grafts in surgery of the spine. Apropos of 6 cases]. / Utilisation de greffons osseux vascularisés en chirurgie du rachis. A propos de six cas.

The Authors report six cases in which a pedicle bone graft was placed by an anterior approach to stabilise a spine deformity. In two cases they used a fibula, in four others it was a cortico-cancellous iliac graft. One case was a neurofibromatosis spine deformity, the second was a Cooley disease, the third one was an hydatidosis, the three remaining cases were spondylolitheses. All patients had been initially operated on by a posterior approach. Fusion was obtained in all cases.

Elastic stable intramedullary nailing of femoral shaft fractures in children.

We report the use of elastic stable intramedullary nailing (ESIN) in 123 fractures of the femoral shaft in children. Flexible rods are introduced through the distal metaphyseal area, and the aim is to develop bridging callus. Early weight-bearing is possible and is recommended. There was one case of bone infection and no delayed union. Complications were minimal, the most common being minor skin ulceration caused by the ends of the rods. A surprising feature was the low incidence of growth changes, with a mean lengthening of only 1.2 mm after an average follow-up of 22 months. Compared with conservative treatment, ESIN obviates the need for prolonged bed rest and is thus particularly advantageous for treating children.

[Microvascular transfer of the heel pad to a thigh stump. Functional benefit of the distal support in prosthetic fitting of the amputated thigh]. / Transfert microvasculaire de coque talonnière sous un moignon de cuisse. Bénéfice fonctionnel de l'appui distal dans l'appareillage de l'amputé de cuisse.

The emergency transfer of a composite microvascular graft comprising the calcaneum, heel-pad and plantar skin in a twelve-year-old child allowed the amputation level to be changed from the upper to the lower third of the thigh and full weight-bearing solely on the bottom of the prosthesis was achieved. This method has several functional and trophic advantages which justify its performance when the indications are appropriate.

[A computer-assisted study of the surgical treatment of talipes equinovarus]. / Application de l'informatique à l'étude du traitement chirurgical du pied bot varus équin.

One-hundred-and-eleven club feet were treated surgically and followed up for more than three years. A computer analysis of the results, compared with the information contained in the operative notes, provided a better assessment of the effectiveness of each surgical procedure. Resection of capsular structures did not give better results than simple division. Posterior capsulotomy of the sub-taloid joint did not alter the separation between the talus and the calcaneus in lateral radiographs. Division of the plantar aponeurosis and lengthening of the long toe flexors seemed to diminish the frequency of secondary cavus deformity. Lengthening of the tibialis anterior improved the range of plantar-flexion of the ankle and reduced the occurrence of residual adduction of the forefoot and elevation of the first metatarsal. Finally, to avoid weakening of muscles, it proved to be vital to preserve the tendon sheaths and to avoid longitudinal tendon division followed by suture, which favours adhesions and tethering of tendons. The authors describe the details of the stages of surgical release. It is not a matter of a new approach to the treatment of club foot but a combination of detailed modifications aiming to produce a perfect final result.

[Sliding centro-medullary nailing. Application to the treatment of severe forms of osteogenesis imperfecta]. / L'embrochage centro-médullaire coulissant. Application au traitement des formes graves d'ostéogénèse imparfaite.

In osteogenesis Imperfecta, the bowing of bones concures to increase their fragility. In order to avoid bowing of bones, Sofield, followed by Bailey have proposed centro medullary nailing. The pins used by Sofield do not expand and repeated changes are necessary. The expanding rods used by Bailey are to large and they can't be used in neonates. The author describe a new technique of bipolar centro medullary pinning. Two bowed K. Wires are introduced in the centromedullary canal, the first one through the proximal epiphysis, the second one through the distal epiphysis. During growth, each pin migrates distally and the osteosynthesis expand regularly. The technique can be used in the neonates and protects their bone from progressive bowing.

Elastic stable intramedullary pinning of long bone shaft fractures in children.

Stable intramedullary pinning is an excellent method for treating shaft fractures in children when there is an indication for operative management. It is a new biomechanical concept which aims at developing the bridging external callus. This closed pinning uses flexible rods which are introduced into a metaphysial area. Technique, results and indications are described particularly in regard to shaft fractures of the femur and the forearm. This closed surgical procedure can always be performed; complication rates are slight (no sepsis, no delayed union). Early mobilisation is possible, and use of a cast is unnecessary.

[Lengthening osteotomy of the femoral neck with transposition of the greater trochanter in acquired coxa vara]. / L'ostéotomie d'allongement du col fémoral avec transposition du grand trochanter dans les coxa-vara acquises.

The main problem in acquired coxa vara is related to shortening of the femoral neck and upward displacement of the greater trochanter. Using the Wagner technique, the authors have performed an intertrochanteric osteotomy in five adolescents with transfer of the greater trochanter to lengthen the femoral neck. The technique is described. The early results are encouraging.

[Osteoarthritis in infants. Follow-up and treatment]. / Ostéo-arthrites du nourrisson. Aspects séquellaires et traitements.

For 25 years, 102 hematogenous septic arthritis have been observed in 82 newborns and infants. The hip joint was the most commun site of involvement (63 cases), than the knee (23 cases), the shoulder (7 cases), the elbow (5 cases), the ankle (3 cases) and one wrist. 14 times, two or more joints were involved. When the diagnosis was made early, an aspiration of pus and an irrigation of the joint was done. But in severe and delayed arthritis, an arthrotomy was preferred. In all cases, joints were immobilized in a post-operative cast or with a traction management, and parenteral antibiotics were prescribed. 52 sequellae were noted, two third of these were seen in second hand. Sequellae are detailed joint by joint, and the authors describe different stages from minor dysplasia and abnormal growth of the epiphysis to severe destruction of the bones and persistent dislocation. Treatment of sequellae is proposed: 1. The hip joint. Dysplasia and deformities of the head and/or the neck were corrected with femoral osteotomy. In 2 cases, a pelvic innominate osteotomy was performed. Progressive coxa vara with short neck and greater trochanteric overgrowth were treated with femoral neck lengthening (personal technic). Dislocations needed open reduction of the hip and extensive excision of the acetabular fibro-fatty tissue. In a few cases, a Colonna's procedure was made. In total destructions of the upper femoral extremity, the treatment consisted in trochanteroplasty. In partial epiphysiodesis of a femoral condyle, disepiphysiodesis was obtained with resection of the physeal bone bridge (2 cases) or with free free physeal transplantation with microvascular anastomosis (2 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

[Legg-Perthes-Calvé disease. Plea for an original ambulatory orthosis]. / Maladie de Legg-Perthes-Calvé. Plaidoyer pour une orthèse déambulatoire originale.

Legg-Perthes-Calvé disease is a local disease which should be treated by non-iatrogenic means. The authors have designed a new ambulatory orthosis allowing containment in abduction, flexion and medial rotation, with relief of weight-bearing on the femoral head. It was tested in thirty six hips. In only eight of them a surgical procedure had to be performed during the evolution of the disease (femoral or pelvic osteotomy) because of secondary exenteration of the hip.

[Surgical treatment of fractures of the long bones in children. Interference between osteosynthesis and the physiological processes of consolidation. Therapeutic indications]. / Le traitement chirurgical des fractures des os longs chez l'enfant. Interférences entre l'ostéosynthèse et les processus physiologiques de consolidation. Indications thérapeutiques.

Flexible medullary nailing is an excellent method when operative treatment of fractures in children is indicated. It is a new biomechanical concept using prebent flexible rods introduced in the medullary canal through a metaphyseal area. This method can be used in all types of Femoral, Tibial, Humeral or fore arm fractures. In Each case, the operative technique is described. This closed surgical procedure has a low complication rate (no sepsis, no delayed union, no length discrepancy). Early mobilization is often possible and cast is not necessary.