Cotrel-Dubousset instrumentation for the treatment of severe scoliosis.

In a multicentric study, 36 cases (40 curves) of severe scoliosis were analysed; 19 were idiopathic and 17 neurological, Cobb angles ranged from 70 degrees to 145 degrees, all had undergone three-rod Cotrel-Dubousset (CD) instrumentation. The correction on the frontal plane achieved more than 50% of the preoperative angle (53.9% for idiopathic curves and 55.6% for neurological ones). On the sagittal plane the pathological shape of the spine was reduced and distinctly ameliorated. In ten patients, the authors successfully applied a technique, alternative to the original one, which was based on the use of two or three screws in the lumbar area, one supplementary pedicle transverse claw on the cranial area and two rods connected by a domino, instead of a single rod (the longer one applied on the concave side). The main complications were: one case of infection, three of vascular compression of the duodenum, one of crank-shaft phenomenon and one laminar hook displacement. The excellent result achieved in both, idiopathic and neurological severe and stiff scoliosis shows the efficacy, reliability and versatility of CD three-rod instrumentation.

Trichorhinophalangeal syndrome type I in monozygotic twins discordant for hip pathology. Report on the morphological evolution of cone-shaped epiphyses and the unusual pattern of skeletal maturation.

A pair of monozygotic twin girls with trichorhinophalangeal syndrome type I (TRPS I), followed from 8.3 to 16.1 years of age, is described. Both showed typical dysmorphic features and severe short stature, but only one had Perthes-like changes in the right capital femoral epiphysis. The radiographic findings and evolutionary changes of phalangeal cone-shaped epiphyses (PCSE) of the hands are illustrated in this report. The unusual bone maturation and growth of the twins are also described. Both presented poor growth and delayed bone age until about 13 years, followed by marked acceleration of bone age and stunted pubertal height spurt.

[Adolescents with scoliosis: psychological and psychopathological aspects]. / Adolescenti con scoliosi: aspetti psicologici e psicopatologici.

BACKGROUND: The present study focuses on psychological and psychopathological aspects in children and adolescents with scoliosis. METHODS: The case series included 28 subjects with scoliosis (7 males, 21 females; range 9-25 years; mean age 15.8 years) admitted to the Dept. of Orthopaedics of Gaslini Institute and referred to our observation. Psychological approach included semi-structured interviews focused on the evolution of scoliosis and based on questions about consciousness of illness, family and patient emotional reactions during treatment; familial, social and school adaptation; body image; onset of psychopathological disorders. Family relational and educational attitudes were also considered. The following psychological tests were also performed: Raven Progressive Matrices; "Draw-a-Person" test; Sacks' battery of incomplete sentences to evaluate cognitive aspects, body image, familial and social relationships, interactive aspects. RESULTS: During adolescence consciousness of illness appeared concomitantly with the beginning of treatment. Most subjects presented intellectual-relational compensation strategies, but in a reasonable number of cases they showed insecurity and inferiority feelings. On a conscious level, body image appeared normal in most cases, but unconsciously (in 45% of cases) there were anguish aspects related to feelings of body deterioration. During long-term treatments anxious reactions, sometimes temporary, (in 36% of cases) and depressive aspects (in 9% of cases) were observed. CONCLUSIONS: The results obtained stress the importance of the family and the medical staff in providing a reassuring and firm support, in order to face difficulties related to the patient's illness.

Study of foetal hip: intrauterine positions and sonographic aspects.

The authors present their initial experience in the US Study of the foetal hip. Focusing on difficulties found and the possible advantages. The US foetal hip study shows that it is most likely to obtain qualitative morphologic data rather than quantitative that are interesting in case of occasional identification remark during US.

Mechanical process and growth cartilages. Essential factors in the progression of scoliosis.

This study showed that the worsening of scoliosis was the result of a mechanical phenomenon. The key feature in this mechanical process was the finding that cuneal deformation affects only part of the vertebral body. The onset of scoliotic curvature occurred as a result of intervertebral motions. However, the worsening was essentially caused by deformation of the vertebral bodies. After the onset of scoliosis, the orientations of the vertebrae were modified in all three planes, and as a result, the spine became mechanically unstable. As a result of this mechanical instability, intervertebral pressures no longer were distributed equally but were concentrated at the junction of the growth cartilages of the vertebral body, near the pedicle on the concave side. Osseous growth was perturbed in this area, the vertebra became deformed, and the vertebral body became wedge shaped. These cuneal deformations resulted in a relative change of position between adjacent vertebral bodies and led to a worsening of the scoliotic curve without involving any articular motion. This phenomenon occurred mostly in the apical region because of the geometric shape of the curvature.

Stress analysis of the growing femur: effects of frontal axial deviation.

Both the pathogenesis and the evolution of lower limb deformity secondary to primitive axial deviation during the growth period are affected by biomechanical factors which direct the remaining skeletal growth along abnormal lines. This study, limited to the femur, aims to analyze these factors from a practical as well as abstract standpoint, with references to prevention and surgical treatment. For this biomechanical study the authors applied finite element analysis to 16 models of the femur with various deformities in the frontal plane--proximal, distal, valgus, and varus. Analysis of the results shows significant variations in the physiologic status of stress on the femur associated with axial deviation in the frontal plane. These variations have special characteristics according to the type and level of the deviation. Furthermore, the stress imbalances seem to be concentrated in the distal metaphyseal region, even in cases of proximal deformity.

Langerhans' cell histiocytosis: a case report.

The authors describe the morphologic features of Langerhans' cell histiocytosis and discuss the main prognostic factors which divide patients into two groups requiring different treatment. They then describe a case of multifocal Langerhans' cell histiocytosis due to pelvic osteolysis and early diabetes insipidus, emphasizing the effectiveness of the combination of surgery and chemotherapy and the rapid reparative new bone formation.

[Scoliosis and lateral gaze paralysis. Description of a case and review of the literature]. / Scoliosi e paralisi laterale dello sguardo. Descrizione di un caso e revisione della letteratura.

The paper reports the case of a girl affected by progressive scoliosis and paralysis of the horizontal gaze, and reviews previously published cases. This is a rare and little known neurological entity transmitted by recessive autosomal inheritance. To all effects, this appears to be the first report of an Italian case. A correct early diagnosis is of considerable importance in view of appropriate genetic counselling.

Ellis-Van Creveld syndrome: description of four cases. Orthopaedic aspects.

Four cases of Ellis-Van Creveld syndrome are reported in which three were in the same family. The clinical and radiological findings were characteristic of the traditional features of the disease. The authors discuss the role of the orthopaedic surgeon in correcting the skeletal deformities.

Maguelone plaster braces for the reduction of scoliotic curves: methods and results.

The authors discuss the basic principles in the reduction of scoliotic curves using the Maguelone method devised by Perdriolle and Vidal. The mechanical concepts of this method derive from corrective forces characteristic of the E.D.F. method but are used differently in terms of direction and quantitative relationships, namely derotation-de-flexion-kyphotisation replaces the elongation-de-flexion-derotation which characterizes the E.D.F. method. This modification is based on the assumption that in the pathogenesis of scoliosis the stages involve rotation, flexion and lordosis in that order. The method is discussed in detail as are the principles on which it is based. Finally, a group of cases are presented demonstrating the percentage gain after reduction, expressed in Cobb angles and degrees of torsion. The results appear to provide significant support for the effectiveness of the method.