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The primary goal of curve correction in neuromuscular patients is to restore coronal and sagittal trunk balance, including the pelvis, to maximize sitting balance. For several years, it has been a common practice to inject polymeric cement into osteoporotic bone through specially designed, perforated pedicle screws in an effort to enhance screw stability. Therefore, we started using the association of a spinopelvic fixation with S1 pedicle screw augmentation, using bisphenol-a-glycidyl dimethacrylate composite resin in neuromuscular patients with pelvic obliquity, technique in neuromuscular patients to improve pedicle screw stability of our pelvic construct. Ten patients undergoing spinopelvic fixation for a neuromuscular spinal deformity were enrolled in the study. Clinical and radiographic data were analyzed and presented. Minimal follow-up took place at 6 months to assess early complications. Five patients were diagnosed with spastic quadriplegia secondary to cerebral palsy, four had Duchenne’s muscular dystrophy, and one had a T5-level traumatic flaccid paraplegia. Preoperative PO ranged from 8° to 34° (mean 19.16°). Postoperative PO ranged from 0° to 6.3° (mean 1.6°). After surgery, all patients returned to a full-time sitting position between days 5 and 12 without the need for additional bracing. No mechanical failure of the construct was noted during follow-up. We used sacral pedicle screw augmentation as a reliable tool to strengthen spinopelvic fixation in neuromuscular scoliosis without increasing the intraoperative morbidity. In our practice, sacral screw augmentation can definitely enhance PO correction obtained by a posterior procedure.

Background Tissue engineering strategies include both cell-based and cell homing therapies. Ligamentous tissues are highly specialized and constitute vital components of the musculoskeletal system. Their damage causes significant morbidity and loss in function. Hypothesis The aim of this study is to analyze tendinous graft integration, cell repopulation and ligamentization by using GFP+/– allografts in GFP+/– transgenic New Zealand white (NZW) rabbits. Material and methods Graft implantation was designed to closely mimic anterior cruciate ligament (ACL) repair surgery. Allografts were implanted in 8 NZW rabbits and assessed at 5 days, 3 weeks and 6 weeks through: (1) arthroCT imaging, (2) morphological analysis of the transplanted allograft, (3) histological analysis, (4) collagen type I immunochemistry, and (5) GFP cell tracking. Collagen remodeling was appreciated at 3 and 6 weeks. Results Graft repopulation with host cells, chondrocyte-like cells at the tendon-bone interface and graft corticalization in the bone tunnels were noticed at 3 weeks. By contrast we noticed a central necrosis aspect in the allografts intra-articularly at 6 weeks with a cell migration towards the graft edge near the synovium. Discussion Our study has served to gain a better understanding of tendinous allograft bone integration, ligamentization and allograft repopulation. We believe that both cell-based therapies and cell homing therapies are beneficial in ligament tissue engineering. Future studies may elucidate whether cell repopulation occurs with pre-differentiated or progenitor cells. We believe that both cell-based therapies and cell homing therapies are beneficial in ligament tissue engineering. Level of evidence Level V (animal study).

Multidisciplinary care, modern care management, and medical progress have brought significant gains in modern survival rates for children and adolescents with tumors of the musculoskeletal system.The surgical approach must rest on the consideration of the long-term orthopedic sequelae likely to be caused by the elected treatment (limb amputation versus limb conservation - reconstruction choices), as well as by adjuvant therapies, such as chemotherapy or radiotherapy. Complications due to allograft reconstructions (infections, fractures, pseudoarthritis) occur within the range of 0 to 36 months. After 36 months, allograft longevity is fair, but 10 years later, 60% of grafts are likely to have failed and been removed. Joint prostheses have overall survival rates of 75% over 10 years, and 52% over 20 years. As for allografts, infectious complications occur within the first few years, while later prosthetic replacements are mostly due to mechanical causes. Assessing the long-term evolution of biological reconstructions proves a lot more challenging, due to the lack of hindsight and available information, except for vascularized fibula grafts, which show good long-term results. Numerous medical reviews have been published that address the quality of life of children treated for malignant tumors of the musculoskeletal system. They mostly consist in comparative studies between limb conservation and limb amputation, and point to similar results overall. Such data must be taken into account when deciding on a treatment for a child or an adolescent: quality of life, the function of the affected limb, the probable need for re-operation all encourage to favor reconstructions whenever they are possible, as they come closest to normal anatomy.Too frequently, medical knowledge remains fragmented among multiple disciplines, because of the difficulty of organizing follow-up over the very long-term. Progress can only be achieved by setting-up multidisciplinary care pathways between pediatric surgeons and surgeons treating adult patients.

OBJECT Spinopelvic alignment is crucial in assessing an energy-efficient posture in both normal and disease states, such as high-displacement developmental spondylolisthesis (HDDS). The overall effect in patients with HDDS who have undergone local surgical correction of lumbosacral imbalance for the global correction of spinal balance remains unclear. This paper reports the progressive spontaneous improvement of global sagittal balance following surgical correction of lumbosacral imbalance in patients with HDDS. METHODS The records of 15 patients with HDDS who underwent surgery between 2005 and 2010 were reviewed. The treatment consisted of L4–sacrum reduction and fusion via a posterior approach, resulting in complete correction of lumbosacral kyphosis. Preoperative, 6-month postoperative, and final follow-up postoperative angular measurements were taken from full-spine lateral radiographs obtained with the patient in a standard standing position. Radiographic measurements included pelvic incidence, sacral slope, lumbar lordosis, and thoracic kyphosis. The degree of lumbosacral kyphosis was evaluated by the lumbosacral angle. Because of the small number of patients, nonparametric tests were considered for data analysis. RESULTS Preoperative lumbosacral kyphosis and L-5 anterior slip were corrected by instrumentation. Transient neurological complications were noted in 5 patients. Statistical analysis showed a significant increase of thoracic kyphosis on 6-month postoperative and final follow-up radiographs (p < 0.001). A statistically significant decrease of lumbar lordosis was noted between preoperative and 6-month control radiographs (p < 0.001) and between preoperative and final follow-up radiographs (p < 0.001). CONCLUSIONS Based on the authors' observations, this technique resulted in an effective reduction of L-5 anterior slip and significant reduction of lumbosacral kyphosis (from 69.8° to 105.13°). Due to complete reduction of lumbosacral kyphosis and anterior trunk displacement associated with L-5 anterior slipping, lumbar lordosis progressively decreased and thoracic kyphosis progressively increased postoperatively. Adjusting the sagittal trunk balance produced not only pelvic anteversion, but also reciprocal adjustment of lumbar lordosis and thoracic kyphosis, creating a satisfactory level of compensated global sagittal balance.

BACKGROUND: Multiple distraction strategies have been proposed to reduce the incidence of anxiety and pain in children. Animal-assisted therapy is acknowledged and used in children as an adjunctive treatment with cognitive, physical, psychosocial and spiritual benefits.OBJECTIVE: To determine the effect of fish aquarium animal-assisted therapy (FA-AAT) on pain perception in a cohort of healthy volunteers.METHODS: Sixty-nine healthy subjects (mean age 27.3 years) were exposed to >20 different species of soft or hard corals and >25 fish in a 1000 L saltwater aquarium. Pain perception was assessed using an electrical stimulation device, the Pain Matcher (Cefar Medical AB, Sweden), after 5 min, 10 min, 20 min and 30 min of continuous aquarium viewing. The measurements were repeated 10 min after stopping aquarium viewing.RESULTS: A statistically significant pain perception threshold augmentation was observed after a 5 min aquarium viewing. This threshold augmentation was also increased after 10 min, 20 min and 30 min of FA-AAT. A remnant effect was noted up to 10 min after exposure. This short post-viewing time period could be useful in clinical practice to perform certain painful procedures in children, such as those involving needles, under improved conditions immediately after aquarium exposure.CONCLUSIONS: In the authors’ department, FA-AAT is now used as a nonpharmacological antinociceptive technique in association with a protocol of inhalated oxygen/nitrous oxide mixtures for needle-related procedures. Children and parents are invited to watch the aquarium during the 10 min to 20 min before venous punctures.

Osteoid osteoma is a solitary, benign lesion of bone causing significant nocturnal pain. Magnetic resonance imaging (MRI), computed tomography (CT), and bone scan are commonly used in this diagnosis. A case of osteoid osteoma of the distal femur mimicking chronic osteomyelitis with Brodie's abscess is reported and discussed. Initial radiographs and MRI showed a lesion of the distal femur consistent with subacute osteomyelitis with a Brodie's abscess. Because primary malignant tumor could not be eliminated, surgical biopsy was carried out. Histological examination showed a typical nidus consistent with the diagnosis of osteoid osteoma. Subacute osteomyelitis (Brodie's abscess) may be difficult to distinguish from other malignant or benign bone lesions as osteoid osteoma. CT usually is recommended as the best imaging procedure to identify the nidus and confirm the diagnosis. MRI also can be used for this purpose. Surgical biopsy remains mandatory for unclear lesions before deciding on appropriate treatment.

Objectives Both bone forearm fractures are efficiently treated by elastic stable intramedullary nail (ESIN). According to the original technique, the tip of the nail must be bent at 90° and buried under the skin. However, skin irritation is commonly reported and may lead to early surgery to shorten the tip or remove the hardware. The purpose of this study was to investigate the influence of the bending of the tip of the nail in this procedure. Methods We retrospectively reviewed 72 children operated on using this technique with the tip bent either at 90° or at 180°. In both groups we recorded complication rates after the procedure and at the removal. Results Time until removal and duration of the removal were similar in both groups. Three complications (6.7%) that required additional surgery were recorded when the tip was bent at 90° whereas no complications were found with the tip bent at 180°. Conclusion We advocate bending the tip of the nail at 180° before burying it in order to avoid skin irritation and additional procedures. Level of evidence Level III—retrospective comparative study.

EOS imaging (EOS System; EOS imaging, Paris, France) enables fast 2-D/3-D imaging of children in standing load-bearing position. Non-ambulatory children with neuromuscular scoliosis need evaluation of their spinal balance while in a normal daily position. We designed a customized chair fitting the EOS patient-area dimensions to obtain images in natural sitting postures. The chair is a 360° rotating orthopaedic chair made of fully radiolucent polyethylene and equipped with an adjustable headrest and three-point belts. Out of 41 consecutive patients, 36 (88%, 95% confidence interval 74–96%) had successful imaging. In most patients with severe neuromuscular trunk deformities, the EOS system combined with our chair was useful for assessing preoperative trunk collapse, pelvic obliquity and postoperative corrections in all planes. This specific device changed our daily practice for the assessment of spinal deformities in non-ambulatory patients.

Pedicle screw fixation is considered biomechanically advantageous in adolescent idiopathic scoliosis (AIS) correction, because it uses as an anchor the pedicle, which is the hardest part of the vertebral body. The ability of the rod to correct and hold the correction is a key factor in the selection of rod material. The goal of this study was to compare the results obtained by stainless steel (SS) and cobalt–chromium (CoCr) rods materials for the treatment of AIS curves. Ninety patients were retrospectively included. Sixty-four patients (group 1) were operated on using CoCr rods. Twenty-six patients (group 2) were operated on using SS rods. All the patients were treated by the same surgeon using all-pedicle screw constructs. In group 1, the correction was respectively 41.03° and 35.78° for main and secondary curves. In group 2, the correction was respectively 30.98° and 24.42° for main and secondary curves. Statistical analysis showed improved correction rates in patients operated with CoCr rods for main (P

Background The purpose of this study was to determine whether a preoperative radiologic assessment of the coracoid process is predictive of the amount of bone available for coracoid transfer by the Latarjet procedure. Material Thirty-five patients with anterior instability undergoing a Latarjet procedure were included. A preoperative radiologic assessment was performed with the Bernageau and true anteroposterior (true AP) views. Methods The length of the coracoid process was measured on both radiographic views and the values were compared with the length of the bone block during surgery. Statistical analysis was carried out by ANOVA and Wilcoxon tests (P Results On radiologic examination, the mean coracoid process length was 29 ± 4 and 33 ± 4 mm on the Bernageau and true AP views, respectively. The mean bone block length during surgery was 21.6 ± 2.7 mm. A significant correlation was found (P = .032) between the coracoid process length on the true AP view and the intraoperative bone block length. Discussion Preoperative planning for the Latarjet procedure, including graft orientation and screw placement, requires knowledge of the length of coracoid bone available for transfer. This can be facilitated with the use of preoperative standard radiographs, thus avoiding computed tomography. This planning allows the detection of coracoid process anatomic variations or the analysis of the remaining part of the coracoid process after failure of a first Latarjet procedure to avoid an iliac bone graft. Conclusion Radiologic preoperative coracoid process measurement is an easy, reliable method to aid preoperative planning of the Latarjet procedure in primary surgery and reoperations.

STUDY DESIGN Prospective randomized trial. OBJECTIVE To explore the use of a microbial sealant applied before the surgical incision to reduce surgical site infection in patients with scoliosis. SUMMARY OF BACKGROUND DATA The incidence of superficial or deep infections is reported in 2 groups of patients treated for neuromuscular or adolescent idiopathic scoliosis. Statistical analysis aimed to compare the effect of the use of a cyanoacrylate microbial sealant on infection rate. METHODS From June 2010 to June 2011, 56 patients were prospectively enrolled in the study. Using a random number table, patients were assigned either to receive or not a sterile, film-forming cyanoacrylate liquid application (Integuseal). Epidemiological data and infection occurrence were compared in both groups. RESULTS Statistical analysis comparing patients with neuromuscular scoliosis and adolescent idiopathic scoliosis showed that patients with neuromuscular scoliosis had more fused levels, increased intraoperative bleeding, and longer intraoperative time. Six patients had early postoperative infections of the posterior approach, which included 3 deep and 3 superficial infections. Five infections occurred in patients treated with Integuseal. Outcome was favorable in 6 cases after local wound debridement and antibiotics. Nonparametric statistical tests (Fisher exact test) showed no significant correlation (P = 0.096) between early postoperative infection occurrence and the use of Integuseal. CONCLUSION Although microbial sealant may be a useful addition to a multimodal approach to minimize surgical site infection, there is currently insufficient evidence as to whether the use of microbial sealants reduces the risk of surgical site infection in patients undergoing scoliosis surgery.

Many techniques are reported to decrease blood loss in children and adolescents undergoing extensive spinal surgeries. The reduction of blood loss and subsequent reduction of allogenic blood transfusion is a desired outcome in such surgical programs. In patients with severe neuromuscular scoliosis, this becomes a greater concern due to a variety of factors such as the need for extensive surgical exposure and the longer intraoperative time [18]. A lot of pharmacological, anesthetic, and surgical techniques including preoperative autologous blood donation [1], human recombinant erythropoietin [17, 27], intraoperative blood salvage techniques, and topical and systemic hemostatic agents [8, 20] are employed to reduce intraoperative and postoperative bleeding. The extensive use of monopolar electrocautery has been proposed as a safe and rapid technique to perform posterior exposure of the spine [18]. No significant differences with operative times, intraoperative blood loss, and postoperative hemoglobin levels have been demonstrated in orthopedic patients using bipolar sealer devices for intraoperative haemostasis [3, 11, 13]. In some patients with implanted pacemaker of brain stimulator, electrocautery has a potential risk of serious implanted hardware dysfunction [2, 6, 19, 24, 25]. In these patients, the use of harmonic scalpel, using high-frequency mechanical vibrations to cut and coagulate at the same time, could be an alternative technique to the use of monopolar electrocautery [14, 16]. We report the case of a 14-year-old girl previously treated for a severe acquired dystonia by pallidal bilateral stimulation. The presence of brain stimulators contraindicated the use of monopolar electrocautery for a requested extensive scoliosis surgery. In this case, the successful use of harmonic scalpel is reported and discussed.

Infection after spinal fusion for scoliosis is a commonly reported complication. Although techniques in paediatric spinal fusion have improved with regard to infection prophylaxis, postoperative infection rates range from 0.4% to 8.7%.The rate of infection in surgery for adolescent idiopathic scoliosis (AIS) has ranged from 0.9% to 3%. The rate of infection in spinal surgery for deformity related to myelomeningocele has been reported to be from 8% to 24%. The rate of infection in spinal surgery for deformity related to cerebral palsy has been reported to be from 6.1% to 8.7%. Infection after spinal fusion for scoliosis related to a muscular dystrophy is generally less frequent. Despite a large number of cases and studies, the literature did not provide documentation of several factors that may be related to the occurrence of wound infection. The rate of wound infection after spine surgery is dependent on many factors, including the complexity of the procedure, health status of the patient, and potentially the experience and technique of the operating surgeon.The general algorithm for treatment depends on a variety of factors, including the delay from the index procedure, the infecting organism, the location and extent of the infection, the gross appearance of the fusion mass, and the surgical strategy used to correct the initial deformity. For infections that develop within the first 90 days after the index procedure all attempts to retain the instrumentation should be made. In late infections, the fusion mass must be carefully inspected before instrumentation removal is considered. Although fusion may appear to be solid both radiographically and intra-operatively, there still may be the possibility of loss of correction at last follow-up.Deep wound infection after instrumented fusion of the spine remains a difficult and challenging clinical problem and entails substantial morbidity, cost, and recovery time for the patient. An aggressive approach to deep wound infection emphasising early irrigation and debridement allowed preservation of instrumentation and successful fusion in most cases. At the conclusion of treatment, patients can expect a medium-term clinical outcome similar to patients in whom infectious complication did not occur.

Osteoid osteoma is a solitary, benign lesion of bone causing significant nocturnal pain. Magnetic resonance imaging (MRI), computed tomography (CT), and bone scan are commonly used in this diagnosis. A case of osteoid osteoma of the distal femur mimicking chronic osteomyelitis with Brodie's abscess is reported and discussed. Initial radiographs and MRI showed a lesion of the distal femur consistent with subacute osteomyelitis with a Brodie's abscess. Because primary malignant tumor could not be eliminated, surgical biopsy was carried out. Histological examination showed a typical nidus consistent with the diagnosis of osteoid osteoma. Subacute osteomyelitis (Brodie's abscess) may be difficult to distinguish from other malignant or benign bone lesions as osteoid osteoma. CT usually is recommended as the best imaging procedure to identify the nidus and confirm the diagnosis. MRI also can be used for this purpose. Surgical biopsy remains mandatory for unclear lesions before deciding on appropriate treatment.

Introduction La rupture du ligament croise anterieur (LCA) chez l’enfant et l’adolescent est une incidence croissante posant un reel probleme therapeutique. L’attitude de differer le traitement chirurgical en fin de croissance pour s’affranchir du risque d’epiphysiodese fait prendre le risque de voir apparaitre des lesions meniscales. L’instabilite est ainsi un facteur determinant pour poser l’indication chirurgicale. Chez l’adolescent, et surtout chez l’enfant, cette instabilite est difficile a mettre en evidence. L’objectif de cette etude est d’evaluer l’interet d’un test diagnostique clinique pour objectiver l’instabilite du genou chez l’enfant. Materiel et methode Cette etude prospective monocentrique a etudie 20 patients repartis en deux groupes. Neuf patients presentaient une rupture isolee du LCA confirmee a l’IRM et 11 patients representaient le groupe temoin. Les patients devaient realiser successivement trois sauts monopodaux sur chacun des deux membres inferieurs. La longueur de ces sauts etait recueillie a partir d’un marquage au sol. Un test non parametrique de Wilcoxon sur echantillons apparies a ete utilise. Resultats Onze filles et 9 garcons ont ete inclus. L’âge moyen etait de 13 ans (10–16 ans). L’analyse statistique montrait une bonne reproductibilite des mesures chez un meme patient. Il existait une difference significative ( p = 0,048) du saut monopodal chez les patients presentant une rupture du LCA entre membre atteint et membre sain controlateral. Dans le groupe temoin, il n’y avait pas de difference significative entre les valeurs des deux membres inferieurs ( p = 0,306). La comparaison des valeurs obtenues sur le cote sain des patients du groupe LCA et chez les patients temoins montrait des valeurs statistiquement equivalentes. Discussion Le test clinique du « saut monopodal » vise a demasquer une instabilite qui serait frustre chez l’enfant et l’adolescent et permet de donner des elements objectifs pour proposer un traitement chirurgical. Sa realisation peut etre discutee en raison du risque d’instabilite qu’il genere et du risque « theorique » de lesion meniscale. Les sujets et les parents ont ete informes du risque d’une telle lesion et n’ont pas realise le test si leur sensation subjective d’instabilite etait trop forte. Aucune lesion meniscale surajoutee n’a ete a deplorer lors de l’etude. Conclusion Le test du « saut monopodal » est un test sensible pour confirmer une instabilite objective du genou qui peut etre difficile a mettre en evidence par l’interrogatoire et l’examen clinique chez l’enfant. Sa realisation doit etre correctement encadree. Sa specificite reste a etudier et peut etre augmentee par l’interrogatoire et l’examen clinique.

La pollicisation consiste en une redistribution digitale permettant de restaurer une pince pollici-digitale en cas d’aplasie hypoplasie severe du pouce. La technique operatoire est desormais bien codifiee, mais la litterature reste marquee par la difficulte d’analyse et de standardisation des resultats, ainsi que la controverse liee aux traces des incisions cutanees. Cette etude tente d’apprecier le resultat fonctionnel et esthetique des pollicisations chez l’enfant en comparant deux techniques - technique de Malek vesus technique de Flatt. Les resultats postoperatoires ont ete evalues a l’aide d’une methode d’analyse fonctionnelle et esthetique s’inspirant des scores de Percival et Dash 36. Nous avons adresse un questionnaire aux patients, puis ils ont ete convoques pour une evaluation clinique fonctionnelle et esthetique par un chirurgien et un ergotherapeute. De 1987 a 2015, 55 pollicisations ont ete realisees selon la technique de Malek, 9 selon la technique de Flatt. Trente-quatre questionnaires ont ete recuperes, et 16 patients revus avec un recul moyen de 110 mois ± 74 (3–274). Les reponses a l’auto-questionnaire comprenait 93 % de patients tres satisfaits pour le groupe Malek (M), et 98 % pour le groupe Flatt (F). L’aspect esthetique etait tres satisfaisant a 80 % pour le groupe M, et 94 % pour le groupe F. Tous les patients recommanderaient l’intervention. Cliniquement, l’apparence globale semblait meilleure dans le groupe Flat (3,9/5 vs 3,4/5), de meme l’aspect de la premiere commissure (4,7/5 vs 3,6/5). En revanche, le pouce etait plus long (110 % vs 98 %). Pour le groupe M, l’abduction moyenne etait de 51° (40–80°), et de 76°(55–90°) pour le groupe F. La rotation moyenne etait de 80° (20–110°) pour le groupe M, et de 74° (60–90°) pour le groupe F. Concernant la force musculaire, donnee exploitable pour 6 des 16 patients, le deficit moyen est de l’ordre de 75 %. Notre etude reste marquee par le manque de donnees objectives chez les tout-petits. Cependant, il semblerait que le trace des incisions cutanees n’entraine pas de differences fonctionnelles et esthetiques significatives. Le principal probleme influencant la qualite des resultats semble etre en rapport avec la force d’opposition du pouce. Il se pourrait qu’un renfort d’opposition par transfert tendineux primaire ou secondaire puisse ameliorer la fonction et l’usage du neo-pouce de ces patients.

Resume Contexte L’evaluation du resultat fonctionnel au moyen d’auto-questionnaires permet d’apprecier la qualite du resultat apres le traitement chirurgical des scolioses idiopathiques a l’adolescence. Methode Quarante-cinq patients operes de scoliose idiopathique a l’adolescence ont eu une evaluation au moyen de la version francaise de l’auto-questionnaire SRS-22 de la Scoliosis Research Society portant sur les resultats en termes de douleur, d’activites de la vie quotidienne et de satisfaction globale. Le recul minimum lors de l’evaluation etait de plus de deux ans apres la chirurgie. Resultats Les valeurs moyennes du questionnaire SRS-22 etaient de 3,66 pour le score douleur, de 3,85 pour le score evaluant l’auto-perception en termes d’image de soi, de 4,32 pour le score evaluant le resultat fonctionnel, de 3,52 pour le score evaluant le retentissement psychologique et de 4,12 pour le score evaluant la satisfaction globale du patient concernant la prise en charge chirurgicale. La valeur moyenne du score SRS-22 global etait de 3,88. Aucune difference statistique n’etait mise en evidence entre les patients pour la part du score SRS-22 evaluant le resultat fonctionnel en fonction du type de courbure traitee (selon la classification de Lenke). Une difference significative etait notee entre les patients concernant les scores d’auto-perception en termes d’image de soi et le score evaluant le resultat fonctionnel pour les patients ayant eu une meilleure correction de l’angle de Cobb. Il existait une relation significative entre le score evaluant la satisfaction globale du patient concernant sa prise en charge chirurgicale et l’importance de l’angle de Cobb preoperatoire. Conclusion Bien que les scores evaluant la fonction et l’auto-perception en termes d’image de soi soient proches entre les patients operes et les valeurs publiees chez des patients temoins, traduisant les bons resultats a court et moyen termes de ces interventions chirurgicales, nous avons constate que les scores evaluant la douleur et le retentissement psychologique etaient statistiquement diminues chez les patients operes par rapport aux sujets temoins. Des etudes multicentriques a long terme portant sur l’auto-evaluation des patients operes au moyen de cet auto-questionnaire nous semblent necessaires pour mieux comprendre et evaluer le resultat fonctionnel et psychologique global de ces traitements chirurgicaux. Niveau de preuve Niveau IV etude retrospective.

Introduction Le but essentiel de la correction d’une deformation du rachis d’origine neuro-musculaire est de permettre la restauration d’un equilibre global du tronc dans le plan frontal et dans le plan sagittal. Cette correction globale doit tenir compte de la position du bassin dans l’espace et corriger toute obliquite du pelvis pouvant perturber l’equilibre du patient en position assise. Depuis 2008, nous utilisons une technique originale de fixation du bassin au moyen de quatre vis pelviennes et d’une extension au montage rachidien au moyen de connecteurs permettant une correction selective de l’obliquite du bassin. Nous avons souhaite ameliorer la fixation primaire des deux vis sacrees par l’injection d’une resine bi-phasique de type BIS-GMA (Bisphenol-a-glycidyl dimethacrylate) dans le corps vertebral de S1 au travers de vis specifiquement canulees et perforees pour cet usage. Les resultats preliminaires de l’utilisation de cette technique sont evalues au recul minimal d’un an. Materiel et methode Les dix premiers patients ayant beneficie de cette technique constituaient le materiel d’etude. Les donnees cliniques et radiologiques, preoperatoires et postoperatoires ont ete revues et analysees. Le recul minimal etait de une annee. Resultats Cinq patients avaient une tetraplegie spastique dans le cadre d’une paralysie cerebrale. Quatre patients etaient porteurs d’une dystrophie musculaire de Duchenne. Un patient avait une paraplegie flasque post-traumatique de niveau lesionnel T5. Aucune complication peroperatoire liee a l’utilisation des vis cannulees et de la resine bi-phasique n’ont ete notees durant le geste chirurgical. L’obliquite pelvienne preoperatoire etait comprise entre 8° et 34° (en moyenne 19,16°). L’obliquite pelvienne postoperatoire etait comprise entre 0° et 6,3° (en moyenne 1,6°). Tous les patients ont repris une position assise stable et confortable entre le 5e et le 12e jour postoperatoire. Aucun maintien postoperatoire par corset orthopedique n’a ete necessaire. Aucune faillite mecanique de l’osteosynthese n’a ete notee durant la periode de suivi comprise entre 12 et 18 mois. Une infection tardive (7 mois) a Propionibacterium acnes a necessite une reprise chirurgicale et l’ablation du materiel. Aucune difficulte n’a ete notee lors de l’ablation des vis sacrees chez ce patient. L’evolution a ete favorable par la suite avec une guerison de l’infection et le maintien d’une position stable et confortable du tronc. Conclusions L’utilisation de vis sacrees cimentees est possible chez le patient porteur d’une deformation du tronc d’origine neuromusculaire. Cette technique est fiable, reproductible et permet d’augmenter la stabilite primaire de la fixation sacree. Dans notre experience, elle augment encore la rigidite et les possibilites de correction par voie posterieure de l’obliquite pelvienne chez ces patients.

Summary Purpose Assessing functional outcome from patient-based outcomes questionnaires are essential to the evaluation of adolescent idiopathic scoliosis surgical treatment Methods At the minimum follow-up of 2 years, 45 operated on adolescent idiopathic scoliosis patients were mailed the French version of the Scoliosis Research Society Outcome Instrument (SRS-22) questionnaires containing items on pain, activities of daily living, and satisfaction. Results Mean values of the SRS-22 domains were 3,66 for the Pain domain, 3,85 for the Self-perceived image domain, 4,32 for the Function domain, 3,52 for the Mental health domain and 4,12 for the Global satisfaction with management domain. Mean value of the global SRS-22 score was 3,88. We showed no differences in functional SRS-22 health status in patients according to the type of curve (Lenke classification). We showed statistically significant correlations between the gain of Cobb angle and Patients self-image and function domain scores. There was a statistically significant correlation between preoperative Cobb angle and patient satisfaction with management. Conclusions Even if Function and Self-image scores in our patients are close to control group values, indicating good short to mid-term outcome of surgical treatment, scores for pain and mental health status were significantly lower in patients than controls. Long-term follow-up studies conducted by multiple surgeons over successive generations are mandatory to assess clinical significance of these differences. Level of evidence Level IV. Retrospective study

Background Various methods regarding allograft knee replacements have been described. The animal models, which are generally used for this purpose include sheep, dogs, goats, and pigs, and accrue significant costs for study protocols. The authors herein describe an efficient and cost-effective model to study either native or tissue-engineered allografts for anterior cruciate ligament (ACL) replacement in a New Zealand rabbit model with the potential for transgenic and cell migration studies. Methods ACL reconstructions were performed in rabbits under general anesthesia. For fresh allograft implantations, two animals were operated in parallel. Each right extensor digitorum longus tendon was harvested and prepared for implantation. After excision of the ACL, tibial and femoral bone tunnels were created to implant each graft in the native ACL position. Results During a 2-year period, the authors have successfully undertaken this surgery in 61 rabbits and have not noticed any major complications attributed to this surgical technique. In addition, the authors have observed fast recovery in the animals postoperatively. Conclusion The authors recommend this surgical procedure as an excellent model for the study of knee surgery.