Osteochondral graft in the treatment of osteonecrosis of the femoral condyle.

A 65-year-old woman with spontaneous osteonecrosis of the medial femoral condyle of the left knee was treated by a fresh cadaveric osteochondral bone graft. The latest follow-up examination at 2.5 years demonstrated good functional results, as well as radiographic evidence of satisfactory consolidation with no aseptic necrosis or osteoarthritis.

Persistent dislocation of the shoulder in elderly patients.

Four elderly patients with longstanding unrecognized dislocation of the shoulder were treated by physiotherapy only. Good functional results, associated with a greatly increased range of pain-free motion, demonstrate the usefulness of conservative treatment in cases of persistent dislocation of the shoulder in the elderly.

Arthroscopic treatment of osteochondral lesions of the talus.

In a study of twenty-four patients (twenty-four ankles) with a symptomatic osteochondral lesion of the talus, eighteen of the lesions were found to be associated with trauma. The lesions were evaluated both radiographically and by arthroscopy. The method of treatment was determined at arthroscopy by observing the nature of the articular cartilage overlying the lesion. The cartilage was graded from I to III based on its appearance. It was found that a lesion can progress from grade I to grade III while under observation. There was a lack of correlation between the radiographic appearance and the findings at arthroscopy. The results after an average length of follow-up of thirty months (range, twenty to forty-four months) indicated that osteochondral lesions over which the cartilage is intact (grade I) are best treated by simple restriction of sports activities. Lesions in which the overlying cartilage is soft (grade II) can be treated through the arthroscope by drilling and those in which the overlying cartilage is frayed (grade III) can be treated through the arthroscope by curettage, with minimum morbidity and good results.

Distal femoral varus osteotomy for valgus deformity of the knee.

Twenty-four patients who had degenerative arthritis of the lateral compartment of the knee that was associated with a valgus deformity and a superolateral tilt of the joint line were treated by distal femoral varus osteotomy. A surgical technique that was designed to produce a horizontal joint line and a tibiofemoral angle of zero degrees is described. At an average length of follow-up of four years, twenty-two of twenty-four patients had a successful result as judged by our protocol for evaluation. One osteotomy had to be revised for failure of fixation, and one patient had a pulmonary embolism that had a satisfactory outcome after the administration of anticoagulants. One patient required manipulation of the knee at six months. The simple surgical technique that we used was effective in realigning the femoral with the tibial axis in patients who had a valgus deformity of the knee, a superolateral tilt of the joint line, and osteoarthritis of the lateral compartment.

Sequential use of technetium 99m MDP and gallium 67 citrate imaging in the evaluation of painful total hip replacement.

Fourteen patients with 20 total hip joint replacements were studied for 14 painful prosthetic hips. Clinical examination, plain film radiographs and 99Tcm-MDP bone scans failed to differentiate between infection and mechanical loosening of a prosthesis. Sequential use of 99Tcm-MDP and 67Ga-citrate bone scans were performed in an attempt to discover underlying infectious process. Increased focal uptake of both radiopharmaceuticals over the same hip indicated an infectious process responsible for prosthetic loosening. There were no false positive gallium examinations. Sequential use of 99Tcm-phosphate compounds and 67Ga-citrate is recommended for differentiation between mechanical loosening of a prosthesis and loosening of a prosthesis secondary to an infectious process.

Use of surgical laser in the removal of an osteoma of the skull.

The laser beam can be adapted for use as a surgical cutting instrument. It was chosen for this purpose in the extirpation of an osteoma of the skull. Its removal by conventional means was believed to be too dangerous, because of surrounding vascularity. The nature and properties of the beam and its surgical applications are discussed briefly.

[Experimental traumatic epiphysiolysis (author's transl)]. / Décollements épiphysaires traumatiques. Etude expérimentale.

Two experimental series of epiphysiolysis, with and without displacement, were performed on 100 young rabbits in each group. The histological site of the epiphysiolysis was demonstrated, and the healing process studied. The basic healing process is induced by the vascular metaphyseal penetration of the separation line, as shown in the epiphysiolysis without displacement. A compensative mechanism appears in the series of epiphysiolysis with displacement, consisting of an epiphyseal vascular penetration of the epiphyseal plate, performing then the embryonal anatomical pattern. The vascular epiphyseal channels close progressively after they reach the metaphyseal vessel. If they do not join the metaphyseal vessels quickly enough, or in sufficient number, they are invaded by osteoblastic cells and fibrous or bony bridges will be created through the epiphyseal plate. These bridges are responsible for growth retardation, axial deviation and even early closure of the epiphyseal plate.

[Fractures of the lateral malleolus with interposition of the medial collateral ligaments]. / Fracture isolée de la malléole externe avec interposition du ligament latéral interne de la cheville.

The authors have observed 10 cases of isolated fracture of the lateral malleolus associated with rupture and interposition of the medial collateral ligament. It was concluded that this type of lesion should not be treated conservatively. The ligament should be surgically repaired and the malleolus fixed. The results were excellent in 9 cases out of 10.

[Eosinophilic granuloma affecting long bones in children].

Destructive bone lesions in long bones associated with onion like periosteal reaction was found in two girls. Diagnosis of Ewing sarcoma was followed by bone biopsy which indicated eosinophilic granuloma. The radiological appearances of osteomyelitis, tuberculosis, congenital syphilis, Caffey's disease and metastases of neuroblastoma are similar. Bone biopsy is mandatory for correct diagnosis.