[Coral substituted for bone grafting in posterior vertebral arthrodesis in children. Initial results]. / Le corail substitué à l'apport osseux dans l'arthrodèse vertébrale postérieure chez l'enfant. Premiers résultats.

The authors used natural coral as a substitutive element to bone supply in children in need of posterior vertebral graft. The use of natural coral was part of a protocol aiming at diminishing peroperative bleeding, and as far as possible, at doing away with resorting to homotransfusion. After reviewing the biological, experimental and clinical bases, the authors studied 49 cases of posterior vertebral fusion instrumented with the Cotrel-Dubousset device and with natural coral grafts. Results were appraised with X-ray in all cases, 5 times with scintigraphies and 7 times with biopsies and were encouraging: coral behaves quite similarly to the usual bone graft. From their experience the authors describe how coral is to be used and consider that the use of this substitutive element should spread in the future under various forms.

[Femur lengthening in children and adolescents. Comparative study of a series of 82 cases]. / Allongement de fémur chez l'enfant et l'adolescent. Etude comparative d'une série de 82 cas.

The authors reviewed 82 cases of femur lengthenings performed in 71 children and adolescents during a period of 15 years. They successively used 6 technics, the one-stage lengthening 14 times, the Judet technic 20 times, the Wagner technic 13 times, a personal technic combining the transversal osteotomy and a grafting 11 times, the llizarov technic 4 times, the callotasis technic 20 times. They study the complications faced, according to the technic, the etiology, the importance of the shortening, the age, and the repetition of the procedure. If the previous lengthenings were always achieved, complications frequently occurred with the ancient technics. In the authors' experience, the callotasis technic is the best, since they had no serious complications out of 20 cases, and 85 p. 100 of the patients had none apart from the inevitable infection of the pins in progressive lengthenings. They provide explanations to this important improvement and recall the details of the technics.

[Old post-traumatic dislocation of the radial head in children]. / Luxations anciennes post-traumatiques de la tête radiale chez l'enfant.

27 cases of neglected post-traumatic dislocations of the radius head were followed up for 30 years. 23 of the cases were neglected Monteggia fractures. The treatment varied over the years from no therapy to the presently used technique of cubital osteotomy associated with surgical repositioning to the radius dislocation. The follow-up results were analysed to determine: 1) whether surgical intervention was justified, as the function of the upper limb of these children was often perfectly good, 2) the type of surgery to use, 3) when such surgery should be done. The results form this study, and the review of 66 previously published cases indicate that surgery may be done on patients of any age, but preferably as early as possible, using precise surgical procedure, as these alone seem to guarantee a first class functional outcome, likely to improve on the pre-operative status of the patients.

[Autotransfusion and hemodilution in orthopedic surgery in children]. / Auto-transfusion et hémodilution en chirurgie orthopédique pédiatrique.

The risk of transmitting viral diseases is a constant worry for those who perform blood transfusions. In the last three years several techniques were used to avoid homologous blood transfusions. Four series of patients were evaluated: 1st series: Only homologous blood transfusions (27 cases); 2nd series: Acute normovolaemic haemodilution during surgery (20 cases); 3rd series: Autologous blood storage prior to surgery and haemodilution during surgery (20 cases); 4th series: Blood storage prior to surgery + haemodilution + Trinitine perfusion during surgery (44 cases). 111 patients having undergone vertebral arthrodesis and 13 children having undergone orthopaedic or repair surgical procedures are reported. In the first series, 98 per cent of blood loss was replaced by homologous transfusions, in the second series, 46 per cent, in the third series, 19 per cent, in the fourth series, less than 5 per cent. This study provides confirmation that in cases of major pediatric orthopaedic surgery, it is possible to use the various techniques demonstrated to avoid homologous transfusions.

[The peroperative isotopic location of osteoid osteomas and other lesions exhibiting increased uptake on scintigraphy]. / Le repérage isotopique per-opératoire des ostéomes ostéoïdes et autres lésions hyperfixantes à la scintigraphie.

The technique, advantages and pitfalls of the isotopic localization and control during operation in orthopaedic surgery were evaluated throughout 28 interventions on lesions, which exhibited an increased uptake of a radioactive bone-seeker: the dimethyl-aminodiphosphonate, provisionally designated SF44 (Laboratoires Solabco, Coutras, France). For bone scanning, following the injection of this radiopharmaceutical that increased by 25% the lesion to normal bone ratio compared to the data for the diphosphonates in current use, the localization of lesions at surgical sites was carried out with the use of a sterilisable small radiation probe of a circular cross section 2 mm in diameter (Quartz et Silice, Paris, France). The probe was connected to a portable electronic device that converted the rates of radioactive disintegration into an acoustic signal, which increased with increasing radioactivity (Novelec, Meylan, France). The method was atraumatic and has proved to be useful at various times of the operation. More often, it was used to locate the lesion on the exposed bone. It enabled monitoring the progress of excisions and allowed to shorten their dimensions. The method was of great value at the end of the intervention for ensuring a complete excision as indicated by the lack of any residual focus of increased uptake detectable on the periphery of the operative site. Isotopic control during an operation is fully efficient to locate osteoid osteomas and other circumscribed lesions of the skeleton that give rise to an increased uptake of radioactivity.

[Spastic knee flexion deformity. Results of surgical treatment]. / Le genu flexum spastique. Résultat du traitement chirurgical.

The records of 36 children who had been treated surgically for spastic knee flexion deformity were studied. The procedures were either a modified Eggers' operation, a lowering of the patella or a combination of both. Thirty-three children were reviewed at a distance and a comparison made between their initial and final function. The results were also assessed in relation to the state of the muscles and the length of follow-up. Many patients were improved but this improvement could not reasonably be expected except in those who could walk or in whom walking had been abandoned for a short time. The indications for the type of procedure should follow systematic examination by a medical and surgical team, taking account of the strength of the gluteus maximus and the quadriceps and the response to novocaine infiltration of the sciatic nerve.

[Tibial lengthening using Judet's method. Apropos of 108 cases in children]. / Allongement de tibia selon la méthode de Judet. A propos de 108 cas chez l'enfant.

One hundred and eight tibial lengthenings were performed in 106 children using the technique and apparatus of R. and J. Judet. The average lengthening obtained was 43,7 mm with a maximum of 60 mm. In some cases, repeated lengthening obtained 98 mm. Bone union was sound after an average of 4 months. It took 5 months in 13 cases, and a secondary graft was necessary in only 5 cases. Only one non-union occurred, due to infection. It seems that the results obtained with this technique were better than those obtained after internal fixation following removal of the distractor. In 5 instances vascular impairment was seen with recovery in 3 cases, but necrosis of a toe and of the tibialis posterior muscle in 2 cases. In 17 instances neurological impairment was seen with 2 showing persistent anaesthesia and one a paralysis of the extensor hallucis longus. However mild neurological impairment was more frequent than was initially expected. In some cases, preexisting knee deformities were aggravated by the leg lengthening. Some deformities at the site of the lengthening were related to an incorrect position of the distractor or to a contracture of soft tissues. It may also be made worse by non-union of the fibula. These deformities may react on the ankle or the foot and may continue to worsen after the completion of lengthening due to subsequent disturbance of growth in 15 p. 100 of cases.