Treatment of congenital pseudarthrosis of the tibia by the Ilizarov method.

Three cases of congenital pseudarthrosis were treated by the Ilizarov method. Consolidation was obtained by 3.5 months in three patients who had undergone several previous surgical procedures. Although the length of follow-up was short (maximum 3.5 years), consolidation occurred more quickly than by traditional methods. This technique also permitted both simultaneous correction of axial malalignment and leg lengthening. We think that this method has a place as a salvage procedure except where the distal fragment is very thin or dystrophic.

[Value of Illizarov's method in the treatment of long bone pseudarthrosis. Apropos of a A.S.A.M.I.F series of 87 cases]. / Intérêt de la méthode d'Ilizarov dans le traitement des pseudarthroses des os longs. A propos d'une série de 87 cas de l'A.S.A.M.I.F.

This study is the outcome of multicenter endeavour compiling 87 cases of pseudoarthrosis managed according to principles set forth by G.A. Ilizarov. All clinical forms are described: simple pseudoarthrosis (non-infected and without loss of substance); septic pseudoarthrosis; pseudoarthrosis with loss of bone substance, both septic and aseptic. This method is used in the majority of cases. This method is used in the majority of cases after several consecutive unavailing attempts with conventional therapeutical procedures. Considering all situations, the lesions heal in over 90% of cases and the infection subsides with an equal rate of success. Such results are achieved within a period of 5 months. Sequelae or complications imputable to the method are few. Indications are specified, which depend upon the clinical form of the treated pseudoarthrosis, as well as upon the surgeon's personal skill.

[Osteosynthesis of thalamic fractures of the calcaneus using triangulation-fixed 1/4-tube plates. Preliminary results of 32 osteosyntheses]. / L'ostéosynthèse des fractures thalamiques du calcanéum par plaques "1/4 de tube" montées en triangulation. Résultats préliminaires de 32 ostéosynthèses.

The authors present a new type of osteosynthesis fixture used in calcaneal thalamus fracture repair. This consists in triangulation fixation, the upper- and retromost part of the thalamus being the apex of the triangle. This is performed using 2 or 3 1/4-tube A.O. instrumentation plates, with adaptable positioning according to the type of fracture. This system presents two advantages compared to currently used fixation components: it is less bulky and is associated with a reduced risk of skin-related complications. Calcaneal reconstruction is much more stable because the plates are in alignment with talocalcaneal stress lines, on the one hand, and because they form a truss that counteracts secondary displacement of the reconstructed thalamus. 32 calcaneal syntheses were thus performed during the period between July 1983 and July 1988. These included 8 stage III DUPARC fracture cases (25%), 21 stage IV cases (65.6%), and 3 stage V cases (9.4%). Nine 2-plate fixtures were assembled in an circumflex-like manner and 23 operations involved setting up the fixation components in a "closed triangle". Cuboid anchorage was necessary in 11 cases. Uncomplicated cutaneous necrosis occurred only once in this series (i.e., 3.2%). The stability of this operative procedure was assessed by measurements of Boehler's angle in the immediate postoperative period and after consolidation. The fixation was perfectly stable in 94% of cases (angle loss less than or equal to 5 degrees). Secondary angle loss occurred in 6% of cases (i.e., 2 cases, 8 degrees and 12 degrees respectively), one of which was caused by untimely weight-bearing. Moreover, no case of plate disruption was reported in this series.

[Axial correction of the legs of children using the Ilizarov method. Apropos fo 22 cases]. / Corrections axiales des membres inférieurs de l'enfant par la méthode d'Ilizarov. A propos de 22 cas.

22 axial corrections of limbs in children were performed using the Ilizarov technique between 1984 and 1986. This prospective study has been performed under the auspices of the Association pour l'Etude Systémique et l'Application de la Méthode d'Ilizarov en France (ASAMIF). Total correction of deformity was achieved in 20 cases. A minimal angulation (less than 5 degrees) was observed in two cases. In 9 cases tibia or femoral lengthening was performed simultaneously. After corticotomy and placement of the stimulant effect of limb distraction. The mean lengthenings achieved was 30 mm. Serious complications were are: there was one case of fracture of the regenerating bone. We deplore only two superficial pin track infections, two cases of rarefaction of bone. The bone consolidation was obtained on an average of two months. If inequality was associated (more than 40 mm) technique of double corticotomy was performed. The best and more results were certainly performed in great deformities. On the other hand the Ilizarov method addresses all inequalities of leg length, whatever the aetiology, who are associated with common deformity.

[Congenital pseudarthrosis of the legs and the Ilizarov method. Apropos of 4 cases]. / Pseudarthrose congénitale de jambe et méthode d'Ilizarov. A propos de 4 observations.

Four cases of congenital pseudarthrosis were treated by the Ilizarov method and consolidation obtained by 3.5 months in three patients who had all undergone several previous surgical procedures. Although the length of follow up is short (maximum 3.5 years) consolidation occurred quicker than by traditional methods. This technique also permitted both simultaneous correction of axial malalignment and leg lengthening. We think that this method has a place as a salvage procedure except where the distal fragment is very thin or dystrophic.

[Meniscal lesions in so-called "isolated" ruptures of the anterior cruciate ligament. Apropos of 59 cases]. / Les lésions méniscales dans les ruptures fraîches soit disant "isolées" du ligament croisé antérieur. A propos de 59 observations.

Between December 1984 and March 1987, i.e. a period of 27 months, the authors operated on 59 "isolated" fresh ruptures of the ACL with routine evaluation of the posterior horns of the medial and lateral menisci. Lesions were investigated either by arthroscopy (23 cases) or by anterior arthrotomy with routine medial and lateral retro-ligamentous counter-incision (36 cases). This revealed 21 lesions of the medial meniscus (i.e. 35.5%) and 38 lesions of the lateral meniscus (i.e. 64.5%). Lesions of both menisci were present in 16 knees (27%) and only 16 knees (27%) were found to be free of any meniscal lesion. The majority of meniscal lesions were viable and could be sutured in 86% of cases for the medial meniscus and 87% of cases for the lateral meniscus. From the standpoint of operative technique, posterior lesions are relatively poorly visualized by arthroscopy (notably concerning the posterior horn of the medial meniscus though it is easier to assess the stability of the meniscus by this technique using the palpating hook. Lesions are well visualized by medial and lateral retroligamentous counter-incisions, but it is difficult to assess meniscus stability. Finally it should be noted that all of these ruptures of the ACL were dealt with by reconstruction of the central pivot either by suture and a strengthening procedure (semitendinous) or by ligament plasty from the outset.