[Dysplasia epiphysealis hemimelica]. / Displasia epifisaria emimelica.

The Authors present 9 patients affected by Dysplasia Epiphysealis Hemimelica with a mean follow-up of 11 years (range 5 years-21 years). The Authors confirm the benignity of the disease and report the variability of the clinical evolution of this rare type of osteochondrodysplasia. Besides cases with spontaneous evolution characterized by no clinical evidence of the disease, there are cases that require surgical removal of the osteochondromas and, sometimes, corrective interventions because of axial deviations and/or limb discrepancy.

[Surgical limb lengthening in patients of short stature. Indications, complications and results]. / Allongement chirurgical chez les patients de petite taille. Indications, complications et résultats.

PURPOSE OF THE STUDY: The authors report their experience in limb lengthening in 55 patients with short stature. MATERIALS AND METHODS: Surgical treatment must begin at the age of 13-15 years to obtain better collaboration from the patient which is necessary to obtain a good result. The general indication for surgery includes short stature between 110 and 150 cm. The major indication is disproportionate short stature. The authors have operated on some cases of short stature in which there was a disproportion between thighs and legs and other short stature without disproportion. In these patients they have tried to obtain the greatest lengthening compatible with good appearance. RESULTS: Examining the complications, the authors have noted that the rate of bone infections is clearly decreased, whereas non union, a frequent complication of the original Wagner method, has completely disappeared. The use of a circular device has not caused an increase of neurological complications, which on the contrary have diminished. DISCUSSION: Surgical lengthening of the lower limbs in disproportionate dwarfism can lead to cosmetic, functional and psychological benefits. The treatment is long and demanding, for the surgeon and especially for the patient. For this reason it is necessary to carefully evaluate the motivations of the patient, who must be well aware of the achievable results as well as of the possible complications. CONCLUSION: Such a treatment must be undertaken in specialized centers, not only owing to surgical difficulties, but especially because it requires a continuous clinical check and a strong post-operative physiotherapy.

Hip deformity and dislocation in spina bifida.

A group of 118 patients with spina bifida treated between 1960 and 1988 was reviewed with a focus on the problem of hip deformity and dislocation. Deformity can be avoided by physical therapy and correct posture. Hip dislocation often occurs in cases of high or mid-lumbar lesions; at lower levels subluxation is more common. In choosing appropriate treatment, the most important consideration is the patient's true functional potential. If the patient is either not ambulatory or severely impaired, his or her condition will not be exacerbated by a dislocated hip.

Surgical treatment of Legg-Calve-Perthes disease.

Thirty-two patients (out of 52 undergoing surgery) with Legg-Calvé-Perthes disease (LCP) were examined retrospectively to assess the efficacy of surgical treatment on epiphyseal morphology at the primary healing. The analysis of the clinical results of the 33 hips considered indicated that it is necessary to operate above all on 3rd grade hips. For these the most frequent operation indicated is osteotomy of the pelvis. Femoral osteotomy must be limited to cases with only a slightly deformed femoral epiphysis in patients below the age of 7-8 years.

The modified Wagner method for surgical lengthening of the limbs.

The method proposed by Wagner in 1971 for surgical lengthening of the limbs was widely used by the authors for the treatment of dysmetria and (since 1976, for the first time in Italy) for disharmonic hypometria. The limitations of this method were revealed, however, by increasing knowledge in this field and the advent of new biological concepts of bone regeneration. The authors report 51 lengthenings carried out between 1982 and 1987 according to their own modification of the Wagner method. They conclude that the Wagner external fixator associated with corticotomy achieves excellent results, decreasing the number of surgical stages as well as the risk of infection and delay in consolidation.

[Scoliosis (author's transl)]. / La scoliosi.

The distinction between the scoliotic posture (transitory and without pathological significance) and the structural scoliosis (for the more progressive and characterized of spinal and costal bones) is fundamental. Facing every deviation it is of great importance, through an accurate clinical and radiographic examination, to establish the characteristic functions of the aetiology, of the evolution and of the therapeutic possibilities. These last consider bloodless treatment (orthopaedic corsets integrated with gymnastics, and physio-kinesi-therapy) and the surgical cure (arthrodesis, frontal and rear). The necessity of a precoce diagnosis and an exact assessment of the evolution for each spinal deviation is stressed out, with the aim of applying the most suitable therapy.