Selecting the lowest instrumented vertebra in adolescent idiopathic scoliosis: Comparison of the Lenke, Suk, and Dubousset criteria.

BACKGROUND: Selection of the lowest instrumented vertebra (LIV) in patients undergoing selective fusion for Lenke type 1 or 2 adolescent idiopathic scoliosis (AIS) varies widely across centres around the world. HYPOTHESIS: Lenke, Suk, and Dubousset criteria show moderate agreement for LIV selection. METHODS: Sixty-eight patients with Lenke type 1 or 2 AIS managed by selective posterior fusion and followed-up for at least 2 years were included in a retrospective observational study. Agreement among Lenke, Suk, and Dubousset criteria for LIV selection was assessed. For surgery, the LIV was selected based on Dubousset criteria. Retrospectively, in each patient, the LIV selected by the Lenke and Suk criteria sets was identified on the preoperative images. The patients were then divided into two groups based on whether the Dubousset LIV was identical versus more distal than the LIV identified retrospectively by the Lenke or Suk criteria. The primary evaluation criterion was coronal balance. RESULTS: The LIVs selected by the Lenke, Suk, and Dubousset criteria were identical in 57% of cases. The LIV selected by the Dubousset criteria were identical to that selected by the Lenke or Suk criteria in 70% of patients. No significant between-group differences were found for any of the evaluation criteria assessed preoperatively, postoperatively, or at last follow-up. DISCUSSION: Agreement among the Lenke, Suk, and Dubousset criteria was moderate, confirming the working hypothesis. No coronal malalignment developed in the patients whose actual LIV was distal to the LIV selected by the Lenke or Suk criteria, supporting the validity of Dubousset criteria for LIV selection. When selecting the LIV, all three criteria sets should be assessed. The LIV is the vertebra selected by all three if they agree or by the Dubousset criteria if they do not. LEVEL OF EVIDENCE: IV, retrospective cohort study.

Fusionless surgery in early-onset scoliosis.

BACKGROUND: Surgical treatment of early-onset scoliosis has greatly developed in recent years. Early-onset scoliosis covers a variety of etiologies (idiopathic, neurologic, dystrophic, malformative, etc.) with onset before the age of 5 years. Progression and severity threaten respiratory development and may result in respiratory failure in adulthood. Many surgical techniques have been developed in recent years, aiming to protect spinal and thoracic development. MATERIAL AND METHODS: Present techniques are based on one of two main principles. The first consists in posterior distraction of the spine in its concavity (single growing rod, or vertical expandable prosthetic titanium rib [VEPTR]), or on either side (dual rod); this requires iterative surgery, for lengthening, unless motorized using energy provided by a magnetic system. The second option is to use spinal growth force to lengthen the assembly; these techniques (Luque Trolley, Shilla), using a sliding assembly, are known as growth guidance. RESULTS: These techniques are effective in controlling early scoliotic deformity, and to some extent restore spinal growth. However, they show a high rate of complications: infection, rod breakage, spinal fixation pull out and, above all, progressive spinal stiffness, reducing long-term efficacy. Respiratory gain is harder to assess, as thoracic expansion does not systematically improve respiratory function, particularly due to impaired compliance of the thoracic cage.

[Computer-assisted surgery in total knee replacement. Preliminary results: report of 60 cases]. / Prothèse totale du genou assistée par ordinateur Résultats préliminaires: à propos de 60 cas.

PURPOSE OF THE STUDY: Conventional techniques proposed for total knee arthroplasty (TKA), necessarily require an acceptable alignment of the lower limb. Computer-assisted surgery is becoming increasingly popular in order to improve the precision of the component alignment, an essential element for good long-term results. The purpose of this prospective study was to present our preliminary results with computer-assisted implantation of TKA. MATERIAL AND METHODS: This was a prospective study of 55 patients (60 knees) included at random for computer-assisted TKA between April 2004 and September 2005. Mean age was 70.5 years. The preoperative assessment noted genu varum in 56 knees and genu valgum in four knees. Three knees with unilateral degenerative disease presented a post traumatic tibia malunion. The same surgeon performed all of the operations using the same prosthesis and navigation system (P.F.C. Sigma). Lower limb alignment and orientation of the prosthetic implants were assessed with standard pre- and postoperative gonometry. Sagittal alignment was measured on the standard X-rays (lateral and anteroposterior view). RESULTS: Knee alignment improved from 8.1+/-4.5 degrees varus (10 degrees valgus to 18 degrees varus) preoperatively, to 0.4+/-0.6 degrees varus (1 degrees valgus to 2 degrees varus) postoperatively. In the frontal plane, the mean angle of the femoral component on the anteroposterior (ap) view was 89.7+/-0.7 degrees (88-91 degrees). The mean angle of the tibial component on the ap view was 89.9+/-0.7 degrees (88.5-91 degrees). The femorotibial mechanical axis was within +/-2 degrees for all prostheses. In the sagittal plane, the mean angle of the femoral component on the lateral view was 4.8 degrees (3-6.5 degrees). The mean tibial slope was 2.7 degrees (1-4 degrees) for the prostheses with a fixed tibial plateau and 0.2 degrees (-1 degrees to +1 degrees) for those with a rotating plateau. The mean operative time was 135 min (110-180 min) and was inversely proportional to experience. There was one conversion to conventional surgery due to software dysfunction. There were no complications related to the operative technique. DISCUSSION: The best outcome, particularly in terms of aseptic loosening, is reported for knees with a valgus or varus angle within 3 degrees . The improved accuracy of computer-assisted implantation has enabled better orientation of the components in the frontal, sagittal and horizontal planes with implantations well within this range.

[Adolescent bicipitoradial bursitis: a rare disease that can simulate a malignant tumor]. / Bursite bicipitoradiale de l'adolescent: une entité rare pouvant simuler une tumeur maligne.

Bicipitoradial bursitis is a rare condition: we found 36 cases reported in the literature, none in children. The main manifestation is a painful tumefaction. We report a case observed in an adolescent whose magnetic resonance imaging findings were compatible with a malignant tumor. Surgical biopsy enabled the correct diagnosis of inflammatory synovium without signs of malignancy compatible with bicipitoradial bursitis. Complete cure was achieved without resection.

[Mirror hand deformity: a new phenotype with literature review]. / Main en miroir: une nouvelle forme avec revue de la littérature.

We report the case of a child who presented polydactyly with eight triphalangeal fingers, no thumb or radius and ulnar dimelia. Hand, wrist, forearm and elbow function was compromised, particularly due to wrist stiffness in flexion, the absence of forearm pronation supination and severe limitation of elbow motion. In addition, the child underwent surgery for pyloric hypertrophy and also presented a multicystic kidney. We present the clinical, anatomic, electromyographic, genetic and therapeutic aspects of this rare deformity and discuss data presented in the literature.

[Fibrodysplasia ossificans progressiva: orthopedic pitfalls and controversies]. / Fibrodysplasie ossifiante progressive: écueils orthopédiques et controverses.

Fibrodysplasia ossificans progressiva (FOP) is a rare disorder of the connective tissue associating malformation of the great toes and progressive heterotopic ossifications. Diagnosis is mostly clinical and currently no treatment is available. We report on the case of an 8 year old boy having an unusual form of FOP. We discuss clinical aspects of the disease and insist on the importance of early diagnosis, avoiding harmful events and therapeutic pitfalls.

[Patient perception of functional and cosmetic outcome of orthognathic surgery. Retrospective analysis of 45 patients]. / L'opinion des patients sur les conséquences fonctionnelles et esthétiques après chirurgie orthognathique. Etude rétrospective de 45 cas.

INTRODUCTION: Orthognathic surgery is generally indicated for the treatment of maxillo-mandibular deformities. Surgery is performed to repair functional abnormalities, but also has a cosmetic impact. MATERIAL AND METHODS: We conducted a retrospective study of 60 patients who underwent orthognathic surgery in 1996 and 1997 in order to assess patient perception of functional and cosmetic outcome. A questionnaire was sent to all patients one year after their surgery; 45 responded. RESULTS: We noted cosmetic, functional, and psychological changes. Patients considered that the changes were for the better. For functional abnormalities, 88.9% considered their occlusion had improved and 80% their chewing; 73.4% reported psychological improvement stating they had more self-confidence; 97.8% considered their cosmetic aspect had improved. DISCUSSION: This study enabled us to assess patients' perception of surgical outcome. It must be recalled that the patient basically decides to undertake surgery for cosmetic reasons while the surgeon proposes surgery to improve function. The psychological consequences of orthognathic surgery must be taken into account because the impact is considerable.

[Linear scleroderma and foot deformity in children]. / Sclérodermie linéaire et déformation du pied chez l'enfant.

Linear scleroderma is a subtype of localized scleroderma generally observed in children, and may produce secondary bone and joint deformities. Its localization at the foot or ankle is rarely reported. A complete review of the literature reveals 21 cases of foot or ankle deformity due to linear scleroderma to which we add one case. The clinical and radiological aspects of the deformity, its pathogenesis, histological findings as well as orthopaedic management are presented and discussed.

[Percutaneous computed tomography-guided thermal ablation of osteoid osteoma]. / Thermocoagulation percutanée scannoguidée de l'ostéome ostéoïde.

PURPOSE OF THE STUDY: Progress in medical imaging has improved recognition and management of osteoid osteoma. The purpose of this study was to assess the efficacy of computed tomography (CT)-guided percutaneous thermal ablation and discuss the advantages and disadvantages. MATERIAL AND METHODS: We reviewed retrospectively 33 consecutive patients with osteoid osteoma who had undergone CT-guided radiofrequency ablation. The diagnosis was established on the basis of the clinical presentation and pathognomonic radiographic findings (CT and bone scintigram) without histological proof. We recorded patient age and gender, tumor location, clinical signs and duration, imaging findings, duration of the ablation procedure, type of anesthesia, hospital stay, and complications. We evaluated their effect on final outcome. RESULTS: Weight-bearing was possible in all patients with a lesion of the lower limb a few hours after surgery. Patients resumed their normal activities in 24-48 hours. Pain resolved immediately after radiofrequency ablation in 26 patients and limping, when present, disappeared within 24 hours. At mean follow-up of 34 months (minimum 12 months) there was one case of recurrent pain. Clinical cure was confirmed by CT and bone scintigraphy in twelve patients. DISCUSSION AND CONCLUSION: This precise and minimally invasive method is an effective and safe way to reduce healthcare expenditures. It can be recommended as the primary treatment for osteoid osteoma.

[Bernese periacetabular osteotomy for the treatment of the degenerative dysplasic hip]. / L'ostéotomie péri-acétabulaire bernoise dans le traitement des coxarthroses sur dysplasie de hanche.

PURPOSE OF THE STUDY: Appropriate management of degenerative joint disease in patients with dysplasic hips is a controversial issue. Non-surgical treatment is generally insufficient to achieve good long-term results and, in young patients, indications for total hip replacement, arthrodesis, or salvage procedures (Chiari, bone block) are limited. The most physiological option is to re-orient the acetabulum to cover the femoral head with a sufficient amount of joint cartilage. Several types of redirection osteotomy have been described. In the present work, we assess the clinical and radiological outcome after Ganz periacetabular osteotomy in patients with dysplastic hips who developed degenerative joints. We searched for factors influencing outcome. MATERIAL AND METHODS: This retrospective analysis was conducted in 57 patients with hip dysplasia who had undergone 64 peri-acetabular osteotomies for joint degeneration. Mean age at surgery was 31 years. The preoperative diagnosis was primary osteochondritis of the hip in 9 patients. The Merle d'Aubigné scores and VCE, VCA, HTE angles on standard x-rays were obtained before surgery and at last follow-up. The Tönnis grade for the severity of the joint degeneration was determined. In 19 patients, inter-trochanteric femoral osteotomy was performed to improve joint congruency in addition to peri-acetabular osteotomy. Clinical and radiological results were assessed at a mean follow-up of 3.5 years (range 2-6 years). The effects of age, cause of dysplasia, surgical history of the hip, severity of joint degeneration, association with femoral osteotomy, and learning curve were studied. Complications were recorded. RESULTS: On the average, the Merle d'Aubigné score improved from 13 points preoperatively to 16.5 points at last follow-up. Limping was observed for a longer period after surgery in patients who had an associated inter-trochanteric osteotomy. At last follow-up, the overall score was lower in grade 3 hips than in grade 1 and 2 hips. Serious complications were observed in the first 15 patients. There was no statistical relationship between age at surgery or surgical history of the hip and final outcome. Comparing the preoperative x-rays with those obtained at last follow-up demonstrated an improvement in the mean value for VCE (2 degrees preoperatively to 25 degrees at last follow-up), VCA (- 6 degrees to 39.5 degrees ), and HTE (25 degrees to 15 degrees ). Radiologically, the severity of joints degeneration was improved or remained unchanged in 83% of the hips (especially for grade 1 and 2 hips). DISCUSSION: In our hands, peri-acetabular osteotomy has provided good results, especially in terms of improved function and control of joint degeneration. Although this procedure is basically indicated for young patients with hip dysplasia free of joint degeneration, it would also be a useful alternative for those who have developed only moderately extensive joint degeneration (Tönnis grades 1 and 2) and a moderately excentric femoral head. Success in these patients depends on surgical experience, correct indications, and careful attention to technical details. Nevertheless, complications are not exceptional and the learning curve may be long. In our series, the main factor predictive of outcome was the Tönnis grade of joint degeneration.

[Otomycosis due to Scopulariopsis brevicaulis]. / Otomycose à Scopulariopsis brevicaulis.

We report a case of otomycosis due to Scopulariopsis brevicaulis in a patient with left cholesteatomatous chronic otitis media who presented with otorrhea associated with left otalgia. Scopulariopsis brevicaulis is a fungus which is rarely described as causing otomycosis although it is a saprophyte and widespread in the environment. In this case the contamination could be due to intensive gardening with poor hygiene. Its mycologic diagnosis is relatively easy and nystatin remains the most effective treatment in this region.

Four sibs with dislocated elbows, bowed tibiae, scoliosis, deafness, cataract, microcephaly, and mental retardation: a new MCA/MR syndrome.

We report four sibs with an MCA/MR syndrome whose parents were first cousins. The sibs had mental retardation, microcephaly, hearing problems, cataract, and multiple osseous malformations, such as dislocated elbows, bowed tibiae, and scoliosis. Review of published reports and the use of the London Dysmorphology Database suggest that this family presents a new syndrome.

[Synovial chondromatosis of the hip]. / Chondromatose synoviale de la hanche.

The authors report a case of synovial chondromatosis of the hip in physically active male adult operated on three years ago and apparently cured. Review of the literature shows that the diagnosis, essentially based on X-ray examination, bone-scan and arthrography, needs to be confirmed by histological examination. Treatment must be surgical and must be carried out as soon as possible to prevent arthrosis. Surgery should include thorough excision of the synovial membrane and a curettage of the acetabular fossa to avoid recurrence. Under these conditions, prognosis appears to be excellent.

[Synovial chondromatosis of the hip]. / Chondromatose synoviale de la hanche.

The authors report a case of synovial chondromatosis of the hip in physically active male adult operated on three years ago and apparently cured. Review of the literature shows that the diagnosis, essentially based on X-ray examination, bonescan and arthrography, needs to be confirmed by histological examination. Treatment must be surgical and must be carried out as soon as possible to prevent arthrosis. Surgery should include thorough excision of the synovial membrane and a curettage of the acetabular fossa to avoid recurrence. Under these conditions, prognosis appears to be excellent.

[Tumor calcinosis. Review of the literature: apropos of a case]. / Calcinose tumorale. Revue de la littérature: à propos d'un cas.

Tumoral calcinosis is an uncommon disease of unknown etiology characterized by the presence of single or multiple lobulated, para-articular, cystic soft tissue productions. Hyperphosphatemia is the only biological abnormality which can be detected. The honeycomb roentgenographic pattern is characteristic. CT scan and ultrasound are useful in showing the extra-articular location of the mass. The treatment is surgical and the prognosis is good.

Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children.

In selected patients a method of rod insertion without fusion combined with use of a full-time external orthotic support, e.g., the Milwaukee brace, is effective. The orthopedic surgeon confronted with young children who have curves that do not respond to conservative treatment alone or in which bracing is contraindicated should find this procedure particularly suitable. The method allows for the expression of full growth potential while maintaining curve correction.

[Congenital dysplasia and dislocation of the hip. Pathological anatomy in the newborn and infant (author's transl)]. / Dysplasie et luxation congénitale de la hanche. Anatomie pathologique chez le nouveau-né et le nourrisson.

The authors have had the opportunity of making a complete and precise dissection of newborns with congenital dislocation of the hip. They have also made a dynamic study of the hip joints in the specimens. The findings have been compared with other studies published in the literature. It is concluded that the dislocation is posterior or postero-superior and that acetabular dysplasia is consistent in unstable hips in the newborn. The acetabular plasia is secondary to the dislocation and lies postero-superiorly. It cannot be detected radiologically. The existence of primary acetabular dysplasia is doubtful. The main responsibility for congenital dislocation of the hip is a faulty position of the foetus in utero. The disease therefore cannot be prevented. It is of importance to diagnose the disease as soon as possible.

[Degenerative lumbar stenosis (author's transl)]. / Sténoses lombaires dégénératives. Revue de 78 cas opérés.

Sixty eight patients with degenerative lumbar stenosis have been operated on: 42 presented a degenerative spondylolisthesis (S.D) with predominantly central stenosis; while in 36 with arthrosic sciatica (S.A.), stenosis was rather lateral. In most cases clinical symptoms are different from those of disc herniation. Myelography with "amipaque" appears necessary to allow a really planified operation, with liberation of all the roots involved by bony compression. In these conditions, a high percentage of good results is obtained. Consequently, after failure of conservative treatment, open release of the compression is advisable, even in elderly patients. In some cases postero-lateral fusion should be performed in addition.