[Bone hemangioma of the limbs. A report of two cases in children]. / Les angiomes osseux des membres. A propos de deux cas chez l'enfant.

Hemangiomas of bone are rare lesions corresponding approximately to 1% of all primary bone tumors. Cases of hemangiomas in the vertebral bodies and in the skull occur fairly frequently but are unusual in other bones. The authors reported two cases of unusual and fairly rare aspects of this vascular tumor in children. In both cases, recurrences occurred and leaded to a wide bone resection in case one and to several curettage in case two. In these two case the histological type of hemangioma was the capillary one. In reviewing the literature we found no indication for wide resection of the benign forms in children.

[Impact of angiodysplasia on bones]. / Retentissement osseux des angiodysplasies.

Vascular malformations usually have an impact on bones because of hemodynamic disturbances in the muscular and osteoperiosteal systems. In fact, even when these structures are not involved by arterial or venous malformations, the blood flow is altered in them. The consequences for bones affect the longitudinal growth of the skeleton of the malformed limb. Growth rarely becomes slower. On the contrary, the condition usually results in an acceleration of bone growth, which results in an excess in the length of the limb presenting with the vascular malformation. This overlengthening may be variably great, and the therapeutic indications must be adapted to its extent. When it is slight, compensation is sufficient to balance the pelvis. Conversely, when it is greater, its correction must be surgical. This surgery is aimed at equalizing the lower limbs, either by slowing down epiphyseal growth and shortening the longer side, or by progressively lengthening the other side, as the case may be. The respective indications of these methods must be carefully considered and adapted to each case, in order to obtain the best possible result with the smallest surgical risk.

Final evaluation of clubfoot.

After analyzing the multiple evaluations described in the literature, we propose an evaluation that can be used during growth. The global score is based on 50 points. The normal foot is scored 0. The functional evaluation (passive motion, muscle function, and gait analysis) is based on 28 points. The morphology is based on 12 points. The radiographic analysis is scored on 10 points. The final evaluation score is linked to the initial classification at birth. The gain during the treatment is the difference between the score at birth and the score of the final evaluation. It is noted as a percentage.

The unstable patella in children.

The authors reviewed 102 unstable patellas which had been observed and treated from 1964 to 1990. They were divided according to whether they suffered from traumatic dislocations, recurrent dislocations or malformative instability. The clinical findings were the major stage of the check up. In the field of imaging, standard X-rays had to be performed in all cases. MRI was of interest in the congenital dislocations, in order to thoroughly investigate the soft tissue anomalies. Two types were described: Type 1 was observed in children with joint laxity, but without major X-ray anomalies; Type 2, a major femoropatellar dysplasia could be formed with some bone deformity. The latter was observed in the malformative instability. Four different surgical procedures have been used, from the release of the retinacula of patella to the medial displacement of the patellar tendon or the tibial tuberosity. This study emphasises the concept of a true development dysplasia of patella (DDP) which can gather the different varieties of the instability of patella.

Ultrasonographic approach to the neonatal foot: preliminary study.

We report our preliminary experience with use of ultrasound in clubfoot and describe our protocol and initial results in the use of this technique.

Classification of clubfoot.

Clubfeet must be classified according to severity to obtain reference points, assess the efficacy of orthopaedic treatment, and analyze the operative results objectively. A scale of 0-20 was established on the basis of four essential parameters: equinus in the sagittal plane, varus deviation in the frontal plane and derotation around the talus of the calcaneo-forefoot (CFF) block and adduction of forefoot on hindfoot in the horizontal plane. Four grades of clubfeet can be individualized: (a) Benign feet so-called "soft-soft feet," grade I, similar to postural feet, with a score of 5 to 1 (these mild feet must be excluded from any statistics as they tend to increase good results); (b) moderate feet, so-called "soft > stiff feet," grade II (reducible but partly resistant, with a score of 5-10); (c) severe feet, so-called "stiff > soft feet," grade III (resistant but partly reducible, with a score of 10-15); and (d) very severe, pseudoarthrogryposic feet, so-called "stiff-stiff feet," grade IV (score of 15-20 points). To avoid risks of errors, our method is based on a very complete checklist and on diagrams. Our training material inculdes an audiovisual package.

Slipped capital femoral epiphysis: evaluation of different modes of treatment.

We reviewed 91 hips with slipped capital femoral epiphysis (SCFE) after an average follow-up period of 6 years 6 months. Different treatment methods used, according to types and stages of slipping, are discussed. In situ fixation appears to be the best procedure for SCFE with < 60% displacement. Careful reduction-fixation is indicated in acute and acute-on-chronic SCFE > 60%. Primary rotation osteotomies are associated with a high percentage of complications. Secondary osteotomies should be simple (preferably a subtrochanteric derotation osteotomy) to reduce the risk of necrosis. Preventive contralateral fixation is indicated when the growth cartilage is still open.

Closed flexible intramedullary nailing of the femoral shaft fractures in children.

We treated 34 femoral shaft fractures in 32 children with elastic intramedullary nailing using titanium rods. The 24 boys and 8 girls ranged from 6-17 years. All fractures united. The weight bearing was authorized at an average of 67 days and was complete at an average of 89 days. All children returned to school before the end of the second postoperative month. An an average of 2.5 years, no rotational malalignment was present. Neither anteroposterior nor frontal malalignment of more than 2 degrees was noticed. A leg length discrepancy of more than 10 mm was present in 3 patients (8%). No injury of femoral head vascularization or of the proximal or distal growth plate was noticed. In our experience, this technique seems to be safe for the surgical treatment of the immature femoral shaft fractures. The elastic properties of titanium provide a very good stability of the montage, when the technique is correctly performed.

Solitary bone cyst: controversies and treatment.

The solitary bone cyst (SBC) has not yet revealed all its secrets. The pathogeny of the SBC is thus considered and also its evolutivity. Conservative treatment has been used in attempts to heal this tumor-like bone. In the case of surgery, an original technique is described. The SBC still remains mysterious in many of its aspects. At the time of this writing, nobody can predict the occurrence modalities of this benign bone tumor. In a similar way, the reality of this tumor-like lesion cannot be precisely described. This emphasizes the first controversial point about this lesion. Indeed, must we consider differently the bone cysts that remain close to the growth plate and those which located in the diaphysis? Must we regard the true unicameral bone cysts (UBCs) differently and those that are multilocular? Moreover, are the cysts located in the long bones identical to the those of the short cancellous bones? Alas, SBC was supposed to be a lesion in children that disappeared after growth ended. Is it still true since some cases have been reported more recently in adults? This study represents a long follow-up. It includes the different aspects of the SBC and emphasizes an original technique in case surgery becomes indicated.

[Arthrography in pathology of the hip in older children]. / L'arthrographie dans la pathologie de la hanche du grand enfant.

Arthrography of the hip was performed in outpatients on 25 children aged 5 to 14 years, using a supra-trochanteric latero-external puncture approach. Data obtained supplied anatomical details indispensable for the decision to operate or not, particularly in certain congenital dislocations or in Legg-Perthes-Calvé disease. The examination findings were useful not only for analyzing articular cartilages, limbus and chondro-articular surfaces in abduction and adduction but also for evaluating anteversion of bony and cartilaginous acetabula using an axial projection. The scanner provides comparable data with respect to the latter feature, but access is still more difficult.

[Value of ultrasonic diagnosis in the evaluation of hip dislocation in neonates and infants. Apropos of 340 cases]. / Valeur de l'échographie dans le bilan de la maladie luxante de la hanche du nouveau-né et du nourrisson. A propos de 340 cas.

Ultrasound imaging of hip (UIH) was performed in 170 children (340 hips) with normal (193) and dysplasic (147) hips and findings compared with results of clinical and radiologic examinations. Ultrasound demonstrated 100% sensitivity in cases with abnormal clinical and radiologic finding, and 94% specificity for UIH when clinical and radiologic examinations were negative. Sensitivity and specificity of ultrasound screening (respectively 96 and 81%) were comparatively superior to those of radiography of the pelvis (83 and 78%) in relation to the clinical examinations. These findings predict further development of UIH for screening of congenital dislocation of the hips and for follow up surveillance of treated children.

[Fracture separation of the articular process of the cervical spine in children]. / Fracture séparation du massif articulaire du rachis cervical chez l'enfant.

A case of fracture-separation of the articular process of the sixth cervical vertebra was seen in a five year old child. This type of fracture does not appear to have been described in children. Treatment by plaster cast led to complete healing.

[Lumbar disc herniation in childhood (author's transl)]. / La hernie discale lombaire chez l'enfant.

Two cases of lumbar disc herniation are reported in children. The disease is very rare during growth and the authors describe the clinical aspect and discuss treatment. A new concept of the pathogenesis is proposed.

[Recurrent dislocation of the elbow (author's transl)]. / Un cas de luxation récidivante du coude chez l'enfant. Incidence pathogénique.

The authors has observed a case of recurrent dislocation of the elbow in a child of 11. The lesion has been studied by arthrography and a good result has been obtained by surgical reconstitution of the capsule on the lateral aspect of the joint. Experiments have been made on cadavers which confirm the importance of the role of the lateral ligaments in this condition.

[Transepiphyseal lengthening of the tibia. Apropos of a case]. / L'allongement trans-épiphysaire du tibia. A propos d'un cas.

Most tibial lengthenings are undertaken at the level of the diaphysis but in some cases this cannot be done and the lengthening can be made at upper epiphyseal level. The technique involves the application of pins in the upper epiphysis and diaphysis fixed by a Hoffman external fixator adapted for progressive distraction. The technique was used in a child of 13 years with 9 cm of shortening and an expected shortening of 13 cm at the end growth. The method has obtained the progressive lengthening of 11 cm and bony union without grafting.

[Study of the foot ground pressure pattern in children (author's transl)]. / Etude de l'appui plantaire chez l'enfant par photo-élastométrie.

The use of a new apparatus has enabled the authors to study the distribution to the ground of the plantar pressures by the way of ciphering each support area. This procedure is valuable and very precise as 500 pressure pick-up are used which give reliable, numerous and regularly distributed informations. The normal footprint has first been evaluated. Then, a comparison was possible with pathologic foot, so it was possible to estimate the result of a functional or surgical treatment on the morphology of the foot.

[Expanding intramedullary rods in the treatment of osteogenesis imperfecta (author's transl)]. / L'enclouage centro-médullaire télescopique chez l'enfant atteint d'ostéogenèse imparfaite.

Eleven cases of osteogenesis imperfecta were treated by corrective osteotomies and fixation with expanding intramedullary rods. The authors have used the Bailey-Dubow nail. Despite a short follow-up (average one year) they think that the device will avoid future repeated changes of rods during the growing period. Several technical pitfalls are described. It is thought that the same technique could be applied to congenital pseudarthrosis of the tibia.

[Fractures of the spine in children without permanent neurological injuries]. / Les fractures du rachis de l'enfant sans lésions neurologiques définitives

Three cases of trauma of the spine are reported compared with dislocation of the cervical spine; these mixed lesions are especially rare. They usually produce various spinal disorders which result in irreversible paralysis. The young age of one of these children and the favourable course, shows the interest of emergency repair of the damage. Reduction of the dislocation followed by internal fixation, may lead to a favourable course.

[Evaluation of the treatment of the unicameral bone cyst in children (author's transl)]. / Bilan du traitement du kyste essentiel des os de l'engant.

Solitary bone cyst is characterized by its tenacity and the risk of recurrence. This fact led the authors to use a surgical procedure very different of the classic ways of treatment as they excluded any bone graft to the benefit of a muscle graft with wide resection. 35 cases have been operated on at several steps of childhood. The recurrence's rate decreased plainly and is no more than 9%. They concern only the wide humeral cysts which were active and close to the fertile plate of the humeral head. These recurrences have been very well tolerated and have not predisposed the child to some pathological fractures. Residual pseudo-cysts were seen in 20% of the cases; they related for us, to some gaps of rehabilitation. This procedure ay be considered as the complement of cortisone's local infection when this one is not able to heal the solitary bone cyst.

[Reflexion on thirty eight cases of Monteggia fracture of children (author's transl)]. / Réflexion à propos d'une série de 38 fractures de Monteggia chez l'enfant.

The authors report thirty eight cases of Monteggia fractures, seven of which being old dislocations of the head of the radius. They insist on early diagnosis and treatment of recent fractures, with a successful result if the ulnar hache become rightly alined. In late untreated luxations of the head of the radius, they occasionally use fascia lata transplant to repair the annular ligament, after correction of ulnar hache. However, early diagnosis and immediate full treatment are the best for successful result.