Outcome of Perthes' disease in unselected patients after femoral varus osteotomy and splintage.

We evaluated 56 hips (48 patients) with Perthes' disease to compare the radiographic results of two unselected groups: one treated with femoral varus osteotomy (22 hips) and another with Thomas splint (34 hips). The patients with less than 50% femoral head involvement (Salter Group A hips) seemed to have no advantage from the operation. The angle of the femoral neck was 10 degrees less in the operative group than in the nonoperative group. In hips with more than 50% head involvement (Salter Group B), the operative method resulted in slightly better coverage and sphericity of the femoral head than the conservative method. On average, the acetabular direction was similar in both groups. The authors conclude that femoral varus osteotomy may lead to residual coxa vara and does not necessarily improve the radiographic results in limited epiphyseal involvement. Neither does the operation have an effect on the acetabular direction in severe Perthes' disease.

MRI in late sequelae of Perthes' disease: imaging findings and symptomatology in ten hips.

Five painful (group A) and five symptomless (group B) hips in nine patients with late sequelae of Perthes' disease were studied with plain radiography and magnetic resonance imaging (MRI) in order to correlate MRI findings with symptomatology. The unaffected hips were also studied. In group A hips, poor congruence of the articular cartilage surfaces was present in three of five cases, whereas good congruence was found in all group B hips. In one spherical but painful hip (group A), MRI revealed a protuberance in the anterolateral cartilage of the femoral head. The joint cartilage in group A and B hips was, on average, 0.5 and 1.5 mm thicker, respectively, than the cartilage in the unaffected hips. The lateral joint capsule was, on average, 3.0 mm thicker in group A hips than in the unaffected hips (P < 0.05), which possibly reflects reactive changes due to chronic irritation in the painful hips. The mean joint capsule thickness differed by only 0.5 mm between the unaffected and group B hips. Mean anterior acetabular coverage by MRI was 97 % in group A and 98 % in group B, while in the unaffected hips mean anterior coverage was 102 %. In an aspherical painful hip, MRI revealed a juxta-articular cyst not visible by radiography. A symptomless intra-articular fragment, due to osteochondritis dissecans, was well visualized with MRI. MRI is recommended for evaluation of pain in hips with late sequelae of Perthes' disease. It may show abnormalities in bony structures, as well as in joint capsule and cartilage.

Free fat transplant prevents osseous reunion of skull defects. A new approach in the treatment of craniosynostosis.

Free fat tissue transplant to correct premature epiphyseal fusion of long bones has been successfully used to prevent re-ossification after bone bridge resection. In the present study we have applied this principle in the prevention of osseous reunion of the bone defect in the calvaria of the rabbit. In two-week-old animals standard bone defects were made on both sides of the sagittal suture to the temporal bone. The dura was left intact. On the right side a free autogenous fat transplant was placed to fill the bone defect. On the left side the control defect was left without fat interposition. The skull defects were examined postoperatively at three weeks, three months, and eight months. The control defects reossified within three weeks. The bone defects with fat tissue transplant were found to be open and of original size at eight months postoperatively. On the transplanted side histological examination revealed living fat cells filling the gap. Osteogenesis was inhibited and reunion of the bone edges was prevented. All the control bone defects were filled by lamellar bone. The use of free fat tissue transplant can be a useful alternative, serving as a biological interposition material in the surgical treatment of craniosynostosis.