[The importance of age in patients for the subsequent state of the growth cartilage lengthened by distraction epiphysiolysis]. / Dulezitost veku pacienta pro dalsí stav rustové chrupavky prodlouzené metodou distrakcní epifyzeolýzy.

The authors evaluated the state and behaviour of 18 growth cartilages in 16 patients lengthened by the method of distraction epiphysiolysis in 1974 to 1991 at the Clinic of Child Orthopaedics in Brno. Lengthening was performed in 8 boys and 8 girls in the area of the distal femur and/or proximal or distal tibia. The follow-up period of these patients was 2 to 8 years. The authors revealed that the bone age of the patient had a decisive effect on the state and behaviour of the lengthened epiphyseal growth plate. The mode and rate of release of the growth zone was the same, similarly as the rate of lengthening; despite this the patients could be divided into three defined groups: 1. The growth cartilage remained open, remained active and closed when the cartilages on the non-lengthened side closed. The bone age was on average 8 years. 2. The growth cartilage was apparent for a certain period (2 or more years) but closed sooner than on the non-lengthened side. The mean bone age was 10.35 years. 3. The growth cartilage disappeared already during distraction epiphysiolysis. The mean bone age was 14.3 years. The authors conclude that assessment of the bone age in patients where lengthening of bones by distraction epiphysiolysis is planned is very useful as it makes it possible to predict with a high probability further behaviour of the epiphyseal cartilage after its lengthening and thus the need of possible revision.

[Application of Bone Grafts in the Materials of the Clinic of Children's Orthopaedics in Brno in the Recent 10 Years.]. / Pouzití kostních transplantátu v materiálech kliniky detské ortopedie v Brne v posledních 10 letech.

Out of the total number of operations performed at the Clinic of Children's Orthopaedics in Brno bone grafts were used in 51.9 cases (9.37%). The authors have divided bone grafts according to their character into autografts, frozen aloimplants and AAA bone, and they also used their combinations. The authors deal with various types of grafts and their role in certain operations. In principle they differentiate 4 basic groups of the clinical application of bone grafts aimed at: 1.fixing the placement of fragments in osteoto mies (276 times) 2.filling in the defects after excochleation of foci of benign tumours and tumour-like lesions (152 times) 3.biological stimulation of osteogenesis (61 times) 4.their application as osteosynthetic material (29 times). The authors point out that it is necessary more often in children than in adults to replace biologically most suitable autografts with other forms of bone grafts. Key words: bone grafts, autografts, frozen aloimplants, AAA bone.

[Bone Reconstruction of Autolyzed Antigen-free Allogenic /AAA/ Bone in Children and Adolescents with Benign Bone Tumours.]. / Kostní prestavba autolyzované antigenuprosté alogenní /AAA/ kosti u detí a dospívajících s benigními kostními tumory.

The authors describe in detail the preparation of six batches of human AAA/autolyzed antigen-free allogenic bone/ prepared in 1985 to 1988. This bone was administered to a total of 48 children and adolescents aged 6 to 19 years. It was used to fill cavities after metaphyseal connective tissue bone defects /31 x/, solitary bone cysts /10 x/, enchondromas /5 x/ and fibrous dysplasia /2 x/. The observation period was 2 years and 2 months to 5 years and 9 months. The mean volume of the cavities was 21 ml. In all patients the X-ray pictures were evaluated in a chronological sequence and changes on the host s bones in the cavity and the inserted AAA bones were described, and finally also changes of the entire bone complex with incorporated AAA implants. The results were arranged in tables. On the host's bones a periosteal reaction was observed in the area surrounding the focus, the entire cavity was covered with a soft shadow, there was sclerosis of the margins and bottom of the bone bed and gradual diminution of the bone defect from the sides and bottom of the bed. On the AAA bones the following observations were of interest: the connection of AAA bone with the surrounding newly formed bone, less clearly defined outlines of the AAA bone, loss of identity of the AAA bone. Sclerosis or elimination of the AAA bone were not observed. In three patients with batch 5 a "halo" effect was observed. On the entire complex with incorporated AAA bones the following were investigated: sclerosis of the entire portion of the bone, then regression and diminution of sclerosis, differentiation of the corticalis and medullary cavity and formation of a normal bone structure without signs of previous treatment. Preparation of six different batches of AA bone revealed that: 1.The spongious parts are more readily and more rapidly incorporated than the cortical part which is only partly demineralized. 2.Gelatinization with LiCI had a favourable effect on the incorporation of thus prepared implants. X-ray investigation revealed that the course of incorporation and reconstruction of these bones has the following specific features: 1.Reconstruction begins as a rule by the periosteal reaction of the host and its shift above the gap has a favourable effect on healing of the defect. 2.Two months after operation the cavity is covered by a soft shadow when the newly formed vessels and mesenchymal cells of the host infiltrate into the focus. 3.Activation of the bed is manifested by its greater density, sclerotization and by gradual diminution of the volume of the cavity. The greater density is not necessarily associated with diminution of the size of the cavity. 4.Bone implants are connected to the newly formed bone without passing through the stage of densi fication and sclerotization. The newly formed bone infiltrates them, absorbs and replaces the bone proper without signs of the previous stage of scle rosis, as observed in patients with frozen allogenic bones. 5.After incorporation of AAA implants further bone reconstruction takes place, as known from the healing of fractures or bone gaps. Key words: demineralized bone, AAA bone, benign bone tumors, reconstruction of bone transplant.

[Neonatal osteomyelitis is still a reality]. / Novorozenecké osteomyelitidy jsou stále aktuální.

The authors draw attention to the fact that it is essential to consider osteomyelitis of children under 1 year as a separate nosological unit with regard to the anatomical features of the vascular supply of epimetaphyses. The authors discuss the diagnostic difficulties. In addition to the basic examination they emphasize also the importance of whole-body scintigraphy and examination by ultrasound. They indicate surgery where clinical symptoms do not recede within 24-48 hours after the onset of antibiotic treatment and where on probatory puncture pus is revealed and if during establishment of the diagnosis the X-ray finding is already positive. As to antibiotics they use Oxacillin first. The authors evaluate the results of treatment of 25 neonates after a 2-10-year interval following the onset of the disease. The process was found most frequently in the proximal and distal metaphysis of the femur (56%) and in the proximal metaphysis of the tibia (24%). They operated 18 patients in the acute stage (72%). Staphylococcus aureus was cultivated in 60% from pus and in 50% from haemocultures. The authors found a satisfactory state in 17 patients (68%) and an unsatisfactory one in 8 patients (32%).

Short humerus: results of 11 prolongations in 10 children and adolescents.

The author evaluates the results of extension of 11 humeri in 10 children and adolescents with an average age of 12.5 years. The most frequent cause of the abbreviation was neonatal osteomyelitis. A Wagner apparatus was used with success and is considered highly suitable for this purpose. The maximum extension was 95 mm; one bone was extended twice with an interval of 2 years in between. The most serious complication was temporary paralysis of the nerves of the forearm and hand. Correction of the length of the upper extremities has a positive effect on the patient's psyche and on the aesthetic appearance and the functioning of the limb.

[Clinical and ultrasonic diagnosis of congenital hip dislocation (dynamics of changes in early therapy)]. / Klinická a ultrasonografická diagnostika vrozeného vykloubení kycelních kloubu (dynamika zmen pri vcasné terapii).

The authors present part of their prospective epidemiological study of congenital dysplasia of hip joints within which newborns were examined by ultrasonogram prior to the beginning of the therapy. Apart from the standard examination in the frontal plane after Graf they examined on principle also the ultrasonographic stability by the dynamic test after Schuler as well as by the application of the probe anteriorly with the simultaneous provocation according to Palmén. The authors have processed pathological ultrasonographic findings in 53 newborns (64 hip joints). The technique of the examination by ultrasound from the anterior approach is explained in detail. The comparison of both dynamic tests has shown that the examination from the anterior approach is considerably more sensitive than Schuler's dynamic test and also fully correlates with the clinical finding. It is a fact that the shift of the head in the flexion dorsally represents the most important component of the movement in unstable hip joint during provocation, it is far more noticeable than the lateralization of the head or the shift in the cranial direction. After achieving ultrasonographic stability the classical Graf method is sufficient for the registration of residual changes on the acetabular rim. The follow-up of patients until their complete healing has shown a surprisingly rapid remodellation of hip joints. The whole complex of clinically unstable hip joints has been divided into subgroups according to Graf classification. In type IIc or IId on the basis of ultrasonographic examination from the anterior approach the stable joints from the ultrasonographic viewpoint have been distinguished from unstable ones. The follow-up carried out in short intervals has shown that of longest duration is the remodellation of total dislocation and, on the contrary, of shortest duration is the healing of joints in the IIc or IId type. An absolute majority of affected hip joints have become normal until 3rd month of the age. The complex does not include two patients with teratological dislocation, the incidence of which has been determined in our study by the ratio of 2 cases in 35,550 of timely examined newborns. The role of the factor of spontaneous stabilization cannot be in this part of the study completely discounted. However, herewith we present part of an accomplished epidemiological study where the number of timely diagnosed patients including late diagnoses corresponds to the number of dislocations and subluxations determined within the conventional late diagnosis.

[Analysis of the results of femoral lengthening in 34 children and adolescents]. / Rozbor výsledku prodluzování femuru u 34 detí a dospívajících.

The authors have evaluated a complex of 34 femurs prolongated in the period 1978-1988 by means of Wagner (26), Ilizarov (5) or bisegmental external fixation device of their own design (3). The whole group comprised 13 boys and 21 girls in the age group ranging from 6.5 to 17.25 years of age. In 13 cases the shortening of the extremity was congenital, in 21 cases it was of secondary nature. All usual data were observed and the quality of healing in the distraction gap was assessed by means of x-ray check up. The average shortening in the above mentioned group of patients ranged from 40 to 50 mm, the average prolongation of the bone was 40 mm. Subsequent osteosynthesis by means of a plate was carried out and bone grafts were applied in one third of the children. The healing of the bone gap was more rapid in children up to 12 years of age. The differentiation of medullary canal and corticalis occurred on average 15 months after operation and the normal shape of the bone was restored 22 months after operation. Full body weight bearing was allowed in case of the Wagner device on average after 11 months, in case of the Ilizarov's device after 14.5 months, but in case of the bisegmental device as early as 6 months after the accomplishment of the prolongation phases. The complications during the prolongation comprised angulation of the bone (3), dislocation of patella (2), reduction of the range of motion of the knee (4). The complications after the removal of the device included traumatic fracture (4), fatigue fracture (3), angulation of femur (1). On the basis of the analysis of the material the authors recommend in case of these patients to concentrate attention in the following direction: 1. In cases where the shortening is evident the operation should not be delayed and the femur should be prolonged as early as until 12th year of age of the patient. 2. The prolongation should be performed only by means of a stable external fixation device. Ilizarov's device is not in this case desirable. Where the size of the femur is suitable it is recommended to apply the bisegmental device. 3. Osteotomy should be longer and oblique and the contact of bone fragments should be maintained. 4. The prolongation should start no sooner than 7-10 days after operation to enable the bone callus to be prolongated to get organized.(ABSTRACT TRUNCATED AT 400 WORDS)

[The development of early diagnosis and treatment of congenital hip dislocation in Czechoslovakia]. / Vývoj casné diagnostiky a lécení vrozeného vykloubení kyclí v Ceskoslovensku.

The author gives an account of the early diagnosis and treatment of congenital dislocation of the hip joint in Czechoslovakia since 1918. He pays more detailed attention to the period before the Second World War and the period immediately after the war when aids now used on a world-wide scale were introduced into practice such as Hanausek's apparatus, Frejka's cushion and Pavlik's stirrups. At the same time screening of neonates in some areas was started. The author mentions also methods of preventive examinations of the entire population introduced in the fifties. He also pays attention to efforts to reduce the radiation load in X-ray screening of the population.

[Evaluation of the immunologic response in various types of bone grafts using lymphocytic nucleoli activity]. / Hodnocení imunologické odpovedi ruzných typu kostních transplantátu pomocí aktivity jadérek lymfocytu.

Assessment of the activity of nucleoli in lymphocytes is considered an important sign for assessment of the degree of activation of the immune system after transplantation. The authors evaluated the activity of nucleoli in lymphocytes of patients with transplantations of different types of bony tissues (autografts, frozen alloimplants, autolyzed antigen-free allogenic bone, control group) before operation, two weeks, 70 days and longer after operation. Differences were revealed during the period between two weeks and 70 days after operation. While in autografts and autolyzed antigen-free allogenic bone at that time a slight decline of inactivated forms of lymphocytes occurred, in frozen alloimplants a rise was recorded. The number of active forms of lymphocytes increased in autolyzed antigen-free allogenic bone and declined in frozen alloimplants. In autografts a mild decline was recorded in active as well as inactive forms of lymphocytes at the expense of an increased number of annular nucleoli. In the conclusion the authors present different interpretations.

Autolyzed antigen-extracted allogeneic bone for bridging segmented diaphyseal bone defects in rabbits.

The autolyzed antigen-extracted allogeneic (AAA) bone implant was placed into a 17-mm long diaphyseal periosteum-free defect in the radius in 27 rabbits. The animals were observed physically and roentgenologically every week. The continuity of the radius was evaluated macroscopically and histologically. Maximum length of the follow-up period was 114 days. The AAA implants were progressively resorbed and replaced by the recipient's bone growing from fragments of radius, restoring the continuity of diaphysis. Osteoinductive activity of the implant was transferred across a tube of a polyamide vascular prosthesis. There were no appreciable histologic signs or immune of foreign-body reaction.