[Enlargement plasty of the acetabulum by vascularized iliac crest cartilage transfer in children]. / Plastie d'agrandissement du cotyle par transfert vascularisé de cartilage de la crête iliaque chez l'enfant.

INTRODUCTION: Following an experimental study with rabbits published in 1983, the authors report the results of a surgical technique for the enlargement plasty of the acetabulum in children. This study was preceded by an anatomical study of the vascularization of foetal iliac crest epiphysis. MATERIAL: 10 children were operated on at an average of 8 years old. The indications were 5 dysplastic hips (short acetabulum), and 5 Perthes diseases. The results were evaluated by the acetabular index of the weight-bearing zone, Wilberg center-edge angle and joint congruence. The comparison with the non operated side estimated the growth due to the graft. METHODS: An iliac crest cartilaginous fragment 4 to 5 cm long is harvested from the endopelvic side. This graft is pediculized on the deep circonflex iliac vessels. The hip joint is opened and the labrum is partially resected. The graft is correctly oriented, placed at the periphery of the acetabulum in an intra-articular position and fastened with two trans osseous stitches. The length of the vascular pedicle allows to place the graft without any microanastomosis. RESULTS: At maximum follow-up (range 3.3 to 8 years), in average values, the coverage Wilberg angle increased of 4 degrees on the non operated side and of 23 degrees on the operated side (increase of 19 degrees due to the graf). The acetabular index decreased of 2 degrees on the non operated side and of 10 degrees on the operated side (decrease of 8 degrees due to the graft). The joint congruence showed that the graft molds itself on the femoral head and ensured harmonius coverage. It seemed that it favoured growth remolding of the femoral head. DISCUSSION: The results showed the growth pursuit of an iliac crest cartilage vascularized graft placed intra-articularly. This graft increases the acetabulum size by adjusting itself to the femoral head. The hyalin cartilage cells of the graft which are in contact with the femoral head, are likely to transform themselves into articular cartilage cells. This surgical technique seems to have its place with the enlargement techniques of the acetabulum as long as remolding of the head and acetabulum is required.

[Topographic and developmental study of primary osteochondritis of the hip by x-ray computed tomography]. / Etude topographique et évolutive de l'ostéochondrite primitive de la hanche par la tomodensitométrie.

The authors have studied 40 normal hips and 69 hips affected by Perthes' disease by computerised axial tomography. A classification proposed into three groups according to the extent of epiphyseal involvement. Type A comprises peripheral and limited abnormalities. Type B is concerned with more or less extensive central necrosis with an unaffected posterior area. Type C comprises involvement of the whole epiphysis. This classification allows a prognosis to be made. Type C patients were sub-divided into two groups--before and after 5 years of age. It was only in the latter group that excentration was observed. The authors note the considerable advantage of computerised axial tomography in the assessment of the degree of excentration.

[Acetabular protrusion in Marfan's disease]. / La protrusion acétabulaire dans la maladie de Marfan.

The etiologic assessment that had been made on the person of a young girl revealed a protrusio acetabuli which was painful and stiff and the evolution of which was quick, was allowed us to reveal a Marfan's syndrome. On this occasion, we have studied the links between the Marfan's syndrome and the protrusio acetabuli. After having resumed the history of this illness, the author remind us of its main characteristics while insisting upon the orthopedic abnormalities. They define the three steps of a protrusio acetabuli according to the Ruelle and Dubois criteria. For the child, the protrusio acetabuli is said to be primary without any well determined etiology. On the contrary, numerous studies deal with the idiopathic chondrolysis of the hips and describe surprising associations such as scoliosis, kyphosis, deformations of the hands and hereditary characteristics. Twelve observations of the Marfan's syndrome are presented, eleven of which concerning children and one concerning an adult. Among these twenty-four hips, the authors find nineteen protrude hips (80%) which belong to one of the three steps described by Ruelle and Dubois. There is an absence of clinical symptoms in nine cases among the twelve observed and the protrusion is systematically found. In three cases, there existed a functional symptomatology which in two cases, has led us to reveal a Marfan's syndrome. There were great pains of the mechanical type, linked to a limitation of the articular mobility; the radiography revealed an idiopathic chondrolysis of the hips. Moreover, the authors underline the primary importance of the skin-biopsy and of the metacarpal index measure in order to confirm the diagnostic of the Marfan's syndrome. Thus, the protrusio acetabuli appear to be a quasiconstant sign of Marfan's syndrome and has to be included in the long check of the orthopedic abnormalities of such a syndrome. The verification of a deep hip needs to research of the Marfan's syndrome. The primary protrusio acetabuli has to be closely studied, since we have just showed that the Marfan's syndrome was one its rare etiologies known up to now.

[Experimental study of a growing acetabulum shelf (vascularized graft)]. / Etude expérimentale d'une butée cotyloïdienne en croissance (greffon vascularisé).

The author has operated on 50 immature rabbits to perform a vascularised transplantation of the growing iliac crest to replace the rim of the acetabulum. Vascularity was preserved through the vascular pedicle and there was no need for vascular anastomosis. The results were assessed radiologically and by histological studies. The subsequent growth of the transplanted epiphysis could be illustrated in 15 out of 16 cases. The growing shelf had the advantage of good adaptation to the shape of the femoral head and produced a satisfactory physiological result.

[Continual valgum and varum in children treated by stapling (author's transl)]. / Traitement des déviations frontales du genou par épiphysiodèse temporaire de Blount. Etude expérimentale et clinique.

The authors have conducted stapling experiments in 25 rabbits which have shown that, after four weeks, growth was stopped because of lesions of the germinal layer of the growth plate and the formation of bony bridges. They have reviewed the results obtained in 105 children with satisfactory results in 80 p. 100. The cause of some complications have been analysed. The best indication was idiopathic genu valgum of adolescence.

[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.

[Synovial chondromatosis in children (author's transl)]. / La chrondromatose synoviale de l'enfant.

A serie of four patients is reviewed. We conclude that synovitis chondromatosis is very rare in children; the diagnosis, accepting Jaffe definition is not easy. In this serie age and localisation on the hip modify consequently our indication of the treatment, and explain some recurrence.

[The epiphyseal defect in children (author's transl)]. / Les lacunes épiphysaires de l'enfant.

The authors produced four cases which all show at first almost the same radiographical espect: an epiphysal defect of the knee. The first case developed in an inflammatory context and proved to be an osteomyelitis. The second case showed a begnin tumour on X-Ray examination a chondroblastoma. Then an epiphysal tuberculosis was produced which at first led to a rather unsettled diagnosis. The last case was a rare observation of chondrome. The diagnostic problems are frequent and besides possible infections localisations, the diagnosis of chondrablastome seems to be the most likely. Surgical approach of such epiphysal lesions is justified not only to corroborate etiology but also in order to avoid an increase in the volume that could impair the epiphysal plate endanger the growth.

[Partial fractures of the patella (author's transl)]. / Les fractures parcellaires de la rotule.

The authors reviewed the blood supply of the patella necrosis and pseudarthrosis were retained after patella fracture. These complications made the authors better defining the vascular anatomy of the patella region. A poor peripheral blood supply and a special vascular pedicle to the tip are suggested as an factor of these complications.