Seckel's syndrome: presentation of one case associated with Legg-Calvé-Perthes disease.

The authors present the case of one patient affected with Seckel's syndrome which came to their observation as a result of pain in the hip with limping, diagnosed after Legg-Calvé-Perthes disease. There seems to be an accidental relationship between the two diseases, although Legg-Calvé-Perthes disease is frequently described in all cases of endocrinous dwarfism.

[Apophysis detachment in adolescents]. / I distacchi apofisari dell'adolescente.

The authors present a review of 37 patients (mean age 15 years), treated in our Institute from 1974 to 1984 for an apophysis detachment. The lesions were mainly due to indirect trauma. The results verify that a complete functional activity may be achieved also by an incomplete reduction of bone fragments and that conservative treatment is sufficient for almost all patients.

The effect of autoclaving on the mechanical properties of bank bovine bone.

Xenologous bone grafts are frequently used in modern orthopaedic surgery. There is a risk of infection associated with the transmission of diseases among different species for these types of grafts. As for bovine bone grafts in recent times attention has been paid to the diffusion in various countries of the European Economic Community of "bovine spongiform encephalopathy"; this pertains to the same group of encephalopathies as Creutzfeldt-Jakob disease which strikes humans and has a lethal outcome. Thus, in the absence of clinical evidence, there is a potential source of risk of infection associated with specimens of bovine origin in relation to which a document of the European community suggests proceeding by sterilization by autoclaving at 132 degrees C. for at least 1 hour. It is the purpose of this study to verify the effect of this treatment on the mechanical properties of bone graft. The results show how this procedure reduces the graft's resistance to compression by approximately 70%. Thus, it is not acceptable for all bone grafts for which good mechanical resistance is required. In cases such as these, bovine bone grafts may be used only when the immunity of the farm of origin has been certified; then sterilization may be conducted using methods that are less destructive for the mechanical integrity of the bone tissue.

Küntscher nailing in the treatment of femoral fractures in children. Is it completely contraindicated?

Seventeen children between the ages of 6 and 12 years with fractured femoral shafts were treated by Küntscher nailing. They were followed up clinically and radiographically to ascertain if nailing had any long term adverse effects. The following radiographic parameters were considered: --valgus, varus angle; --distance between lesser trochanter and acetabulum; --width of the neck of the femur; --distance between greater trochanter and acetabulum; --intertrochanteric distance. On analysing the results it was found that Küntscher nailing did not give rise to any adverse effects provided it is carried out after 8-9 years of age.

Recurrent aneurysmal bone cysts in children. Discussion on the treatment of three cases.

Three children presented with recurrence of aneurysmal bone cyst. In two of these patients the lesion was localized in the superior metaphyses of the tibia and humerus respectively. Total resection was performed followed by the introduction of autoplastic transplants of cortical and spongy bone. In the third case prosthetic substitution of the upper fourth of the ulna was preferred. Healing was obtained in all cases. The indications, operative technique and the final results are discussed.

Tenomyoplasty of the flexor muscles in the surgical treatment of congenital recurvatum, subluxation and dislocation of the knee.

The writers present eight cases of congenital recurvatum or dislocation of the knee in which tenomyoplasty of the flexor muscles of the knee was performed. The operation was the only one used in cases with flexion greater than 60 degrees, while in cases of more severe loss of flexion, it was supplementary to mobilisation of the quadriceps according to Judet's technique. The technique of tenomyoplasty is described and the results are reported. These are considered to be favourable.

Long term results of centralising intertrochanteric osteotomy in Legg-Calvé-Perthes' disease. (Report on 60 cases).

The writers propose a new classification of Legg-Calvé-Perthes' disease into three degrees of increasing gravity. Grade 1 includes hips with minimal or no flattening of the epiphysis, normal relations between the head of the femur and the acetabulum, and a normally orientated epiphyseal cartilage. Grade 2 comprises hips with slight epiphyseal flattening (one third or less), the epiphyseal growth cartilage is horizontal, the femoral head is partly uncovered due to epiphyseal subluxation, but becomes normal in the abduction test. Grade 3 hips show severe epiphyseal flattening (more than one third), the epiphyseal growth cartilage is horizontal, and the epiphyseal subluxation persists even in the abduction test. In our opinion, the advantage of this classification, which is not dependent on a determination of the extent of the necrosis, is that it is less subjective, and can be applied more easily and immediately, as compared with Catterall's classification. The results in sixty cases of intertrochanteric centralising osteotomy were constantly satisfactory in grades 1 and 2, but unsatisfactory in grade 3. The writers consider that surgical intervention is unnecessary in patients with hips in grade 1, while femoral osteotomy is contra-indicated in grade 3 cases. In the latter event, surgical intervention, if considered necessary, should be a pelvic osteotomy or cheiloplasty of the femoral epiphysis. Centralising osteotomy is the operation of choice in patients of grade 2. The results were better in patients who were less than six years of age at the time of operation.