[Surgical treatment of dislocations and subdislocations of the hip in patients with cerebral palsy by femoral and pelvic osteotomy]. / Le traitement chirurgical des luxations et subluxations de hanche chez l'IMC par ostétomie fémorale et pelvienne.

Fifty-one skeletally immature cerebral palsied (C.P.) children with 70 subluxated or dislocated hips were treated by conservative methods: femoral osteotomy (65 hips), pelvic osteotomy (52 hips) and arthrotomy when necessary (19 cases). 31 children were less than 10 years of age when operated on (mean 6 years, 6 months), 20 children were more than 10 years of age (mean 13 years, 13 months); mean follow-up was 4 years. Reduction and coverage were achieved and maintained in all patients, except for 6 redislocations: a pelvic obliquity was neglected in 3 cases; femoral shortening was not performed in 2 cases. Post-operative course was difficult in eldest patients with pain and stiffness but functional result was acceptable at follow-up in all cases except redislocations. Open reduction was related to a higher rate of postoperative rehabilitation problems. Modeling of previously deformed femoral heads and improvement of hip mobility were consistently seen at last follow-up, except for 3 redislocations. It is concluded that conservative methods are quite advisable in CP children and adolescents. Hip reduction should be preferred to femoral resection even in adolescent.

[Surgical treatment of scoliosis in bed-ridden patients with cerebral palsy]. / Le traitement chirurgical des scolioses de l'IMC grabataire.

Thirty-two scoliosis in total body involved children with cerebral palsy (CP) were reviewed. Mean preoperative angle was 13. Average follow-up was four years. Surgery included a single posterior (11 cases) or anterior (3 cases) approach and a double stage anterior and posterior procedure in 18 cases. Fusion was extended to the sacrum in 15 cases. Complications were numerous: 3 deaths, 15 postoperative complications in 10 patients. Most of them were septic and cutaneous. Cobb angle was 78 degrees before surgery, 28 degrees after surgery and 32 degrees at follow-up. Functional status was improved in most of cases. Pain disappeared in 2/3 of cases. Sitting position was acquired in all cases at follow-up; motor possibilities were improved in 1/4 of cases; associated medical pathologies (mainly respiratory) were reduced in 2/3 of cases.

Prevention of hip dislocation in cerebral palsy by early psoas and adductors tenotomies.

The effectiveness of psoas and adductor tenotomies for the prevention of hip dislocation was investigated in 40 hips of 24 total-body-involved children. Age at operation ranged from 1.6 to 10 years. Results were evaluated by the Reimers migration percentage (MP). Average follow-up was 3 years. An overall good result was observed in 67% of cases. Results were correlated with age and MP at operation. Successful results were obtained in 90% of patients under age 4 who had an MP less than 33%. Preventive surgery should be performed at 2 or 3 years of age, before the onset of hip dysplasia.

Chiari pelvic osteotomy in Perthes disease.

A retrospective study of 17 Chiari osteotomies performed on patients with Perthes disease who were followed until the end of growth is presented. The average age at operation was 8 years 9 months. Catterall grading was mainly group IV. Chiari osteotomy provided satisfactory femoral head coverage with a decreased acetabular index and a 19.6 degrees improvement of the Wiberg angle. Good femoral coverage was related to age at operation and the site of the osteotomy on the upper rim of the acetabulum. The postoperative result was less successful on younger patients or when the osteotomy was performed higher. At follow-up, the results of femoral head sphericity studied by Mose measurements were favorable under Catterall grading.

[Anterior vertebral reconstruction of the thoracic and lumbar spine using Hall-Dwyer instrumentation with distraction]. / Reconstruction vertébrale antérieure du rachis thoracique et lombaire avec instrumentation de Hall-Dwyer en détraction.

The Hall-Dwyer instrumentation was used in 64 patients presenting with anterior lesions of the spine. The system was applied on the vertebral bodies; it included Dwyer screws and staples and the Hall rigid rod. Manual distraction on the rod returned normal intervertebral spaces. Results are presented according to the aetiology. In fractures (15 cases) the mean kyphosis was reduced from 24 degrees to 6 degrees. When posterior ligaments were damaged, a complementary posterior osteosynthesis was necessary to provide stability. In kyphosis (5 cases) the kyphosis was reduced from 52 degrees to 21 degrees. At 24 months follow-up, the angular loss was 1 degree. In tumors (36 cases) a corporectomy was performed in 33 cases and a total vertebrectomy in 3 using methylmethacrylate or bone graft for reconstruction. A good postoperative stability was observed in all patients. In discopathies (5 cases) bony fusion was observed in all cases. Distraction improved the intervertebral height and the lumbar lordosis. Lastly the instrumentation was used in 3 patients with Pott's disease. One injury of the aorta was observed at removal of the instrumentation 18 months later. Mechanical complications occurred: rupture of the head of the screw (1 case), sliding of the rod in the eyelet with loss of correction (2 cases), fractures of the rod (1 case) or screws (5 cases). These complications suggest the magnitude of load applied on the material.

[Treatment of lumbar and dorso-lumbar scoliosis using the Boston orthosis and the 3-valve orthosis. Comparative study of the results in the frontal and horizontal planes]. / Traitement des scolioses lombaires et dorso-lombaires par l'orthèse de Boston et l'orthèse 3 valves. Etude comparée des résultats dans les plans frontal et horizontal.

A study was made of 30 patients presenting with lumbar and thoracolumbar scoliosis; 15 patients had been treated with a 3-valve orthosis and 15 with a Boston brace. The mean age at the commencement of treatment was 14 years for the 3-valve orthosis and 14 years 4 months for the Boston brace. The total duration of treatment was 11.1 months for the 3-valve orthosis and 11.8 months for the Boston brace. The patients with the 3-valve orthoses presented with an initial mean curve of 30 degrees and with the Boston braces a curve of 24 degrees. The mean follow-up after removal of the brace was 17 months for the 3-valve orthosis and 12 months for the Boston braces. The efficacy of the two orthoses was studied in the frontal and horizontal planes, taking into account the overall rotation of the curve and the segmental rotation of each vertebra in the curve. The Boston brace and the 3-valve orthosis were identical in the correction of the curve. The overall derotation was better with the 3-valve orthosis. Segmentally, the 3-valve orthosis was more effective at the apex of the curve whilst the Boston brace was more effective at the extremities of the curve. The ilio-lumbar angle and the trunk instability were corrected better by the Boston brace. The specific indication for the 3-valve orthosis seems, therefore, to be scolioses in which there is a predominance of rotation at the apex of the curve. The Boston brace has its main indication in cases where rotation is considerably close to or at the ends of the curve.

[Treatment of spinal deformities with the Hartshill frame]. / Le traitement des déformations rachidiennes par le cadre de Hartshill.

The Hartshill rectangle, a metal frame fixed to the laminae by sublaminar wires, has been used in 50 cases. Twenty idiopathic adolescent scolioses have been corrected from 49.3 degrees to 24.7 degrees with excellent stability of the curve at six and twelve months follow-up. Twelve paralytic scolioses were corrected from 71 degrees to 34.7 degrees but, in nine cases, the associated pelvic obliquity was not appreciably altered. Eleven adult scolioses, with an age range between 20 and 68 years, were corrected from 66.3 degrees to 38.7 degrees by a two-stage procedure of anterior release followed by posterior fixation with a Hartshill frame. In six patients with spinal metastases the Hartshill frame was used to provide spinal stability. The segmental fixation gave immediate post-operative comfort and allowed the patient to mobilise early without bracing. There were transient neurological complications--three cases of cutaneous hyperaesthesiae and one of monoparesis of a lower limb. Failure of the apparatus was encountered in cases of severe deformity with bending of the metal of the rectangle in two cases, breakage of distal wires in three cases and slipping of wires on the frame in two cases. The Hartshill frame provides stable fixation of the spine. It produces a three-dimensional correction of the scoliosis with preservation of reformation of the normal physiological kyphosis and lordosis. It is indicated for the correction of sagittal deformities, particularly in older patients and adults with thoracolumbar or lumbar curves and for spinal instability, especially in cases of destruction of posterior bony and ligamentous elements of the spine.

[Unusual forms of upper femur epiphysiolysis]. / Formes inhabituelles de l'épiphysiolyse fémorale supérieure.

Among 56 slipped capital femoral epiphysis (SCFE) treated over 12 years, the authors report 10 particular cases: 3 hypopituitarisms, 1 adrenal hyperplasia, 1 case after radiotherapy, 2 osteochondrodysplasia, 2 cases with major defect of the posterior wall of femoral neck and 1 coxa valga slip. Literature is analysed with special reference to etiological forms representing a predisposition to slippage. Awareness of these conditions under which SCFE can occur is an important factor. Surgical stabilization is classical, but two points are discussed: stabilization may need to be augmented by autologous bone grafting or to be fixed with pins leading to normal growth without dysplasia of the hip.

[Peroperative isotope labeling in surgery for osteoid osteoma. Apropos of 2 case reports]. / Repérage isotopique per-opératoire dans la chirurgie de l'ostéome ostéoïde. A propos de 2 observations.

The precise localisation of an osteoid osteoma was revealed during operation after an injection of technetium 99m in children. The technique, using a Pitman 235N counter is described.

[Vertebral osteoid osteoma. Diagnostic problems apropos of 3 cases]. / L'ostéome ostéoïde vertébral. Problèmes diagnostiques à propos de trois cas.

One osteoblastoma and two osteoid osteomata were seen in cervical, dorsal and lumbar spines. In the three cases, the diagnosis was made by scintigraphy. In one case, a tomodensitometric (C.A.T.) scan was negative. In two cases the patients had been previously referred to Psychiatrists and in one case there was a painful scoliosis. A review of the literature was made. The value of scintigraphy is considerable and tomodensitometry allows a better localisation of the lesion. Complete excision has led to a complete cure in all cases. In one case, resection of the isthmus led to hypertrophy of the opposite isthmus.