Purpose: During the second half of the 80s, Grammont, Trouilloud and Guichet developed a centromedullary nail for progressive limb lengthening. We analysed retrospectively twenty lengthenings, studying the clinical and radiological results to examine the quality of callus formation.

Material and methods: This study included eighteen patients, thirteen men and five women, who underwent lengthening procedures between 1991 and 2000. The patient’s clinical files were analysed in addition to the results of a physical examination. A standardised x-ray protocol was used to analyse bone regeneration.

Results: Mean follow-up was 4.55 years (1.5–10.5). Mean lengthening was 46 mm (30–80) achieved at a mean rate of 1.28 mm/d. The Bastiani index was 26 j/cm. Complications were: one progressive external popliteal sciatic palsy, one persistent knee flexion, one premature callus consolidation, and two callus fractures after nail removal. All patients maintained their activity level. The quality of regenerated bone was better in the dorsal and medial segments exposed to more stress. The callus was cortical and remodelled after removal of the nail.

Discussion: Like all lengthening techniques, the Albizzia nail requires careful preoperative planning, particularly to determine the level of the endomedullary osteotomy. The clinical results in this series were globally satisfactory. The callus was similar to cortical bone and quite different from the callus obtained with external lengthening methods, but our study demonstrated the excellent quality of the regenerated bone. The Albizzia nail can also be left in place until a solid reliable callus has formed, an advantage compared with external fixation which is less well tolerated.

Purpose: Patellar instability raises serious clinical and therapeutic problems in children. We present our results with the “soft baguette” technique used since 1974.

Material and methods: Sixty-four patients (50 girls and 14 boys) (85 knees) treated between 1974 and 2000 were reviewed. Mean follow-up was 140 months (14–234). For eight knees, section of the lateral wing of the patella was associated. The five types of patellar instability, from permanent dislocation to potential instability, were represented.

Results: At last follow-up, 84% of our patients were satisfied with significant improvement in pain, instability and patellar track. We had minor complications in 23.5% of the knees (haematoma, effusions) and eleven recurrences (9.5%) at mid- or long-term which were considered failures. There were no cases of epiphysiodesis. A neoTTA developed in eight cases, proving the efficacy of realignment of the medialised patellar ligament. Following changes in the mechanical axis of these knees revealed a clear trend towards increased valgus.

Discussion: The soft baguette technique has fulfilled expectations: stabilisation of the extensor system without injuring the growth cartilage, and trochlear remodelling for the younger patients. The trend towards increased valgus raises a problem. Because of this risk, if the initial valgum is greater than 5° we emphasise the theoretical importance of temporary medial epiphysiodesis associated with the soft baguette to control this potential source of recurrence and therapeutic failure.

Purpose: The purpose of this study was to analyse the results and morbidity of video-assisted minimally invasive thoracoctomy for anterior arthrodesis of thoracolumbar fractures treated with a two-stage procedure and to evaluate mid-term outcome.

Material and methods: This retrospective series included 6 patients with an unstable thoracolumbar fracture who underwent surgery between November 1997 and June 2002. A two-stage procedure was used: posterior reduction osteosynthesis and anterior arthrodesis with a tricortico-cancellous graft via video-assisted minimally invasive thoracotomy. The cohort included six women and eighteen men, mean age 34.5 years. Fractures were located at: L1 (n=4), T12 (n=10), T11 (n=2). At initial assessment the Franckel classification was: A (n=3), B (n=1), C (n=1), D (n=3), 3 (n=18). Time between the posterior procedure and the anterior thoracotomy was 30.2 days (range 6–86). Postoperative results as well as the time to fusion were recorded. Mean follow-up was 21 months (range 6–45) for functional and radiological assessment. No patient was lost to follow-up.

Results: Mean operative time was 188 min (range 80–240). Mean blood loss was 235 ml (range150–1000) with no intraoperative event requiring conversion to open thoracotomy. Mean duration of morphine administered postoperatively was 2.2 days, the same as for thoracic drainage. Residual pleural effusion was observed in one patient and residual pneumothorax in two; all resolved spontaneously. Mean hospital stay was 12 days (range 6–27). Twenty-five patients had achieved fusion at four months. One patient developed a radiological non-union which was asymptomatic at one year. At last follow-up, the Oswestry function score was 22.6% for the entire series, 18% for Franckel D or E patients (n=21) and 42% for Franckel A, B and C patients (n=5). Loss of angular correction of the spinal kyphosis and regional traumatic angulation between the postoperative films and the last follow-up films was 2 (mean).

Discussion: This series of complementary anterior arthrodesis by video-assisted minimally invasive thoracotomy confirmed the minimally invasive nature of this approach in comparison with thoracophrenolaparotomy and its complications. At mid term, this technique has provided satisfactory functional and radiographic results. Applied for thoracolumbar fractures, this combined surgical option can limit intraoperative morbidity and assure good mid-term results.

Purpose: The purpose of this study was to analyse results of the inverted shoulder prosthesis (Grammont Delta III prosthesis) for surgical treatment of malignant tumours of the upper portion of the humerus in twelve patients.

Material and methods: Twelve patients were treated in two centres (six patients each). There were five women and seven men, mean age 51 years (34–69). Seven had a primary tumour and five had a unique secondary tumour. All tumours were implanted after Malawer I resection (IA four case and IB two cases), with an autologous bone graft using resected irradiated bone. All resections were wide as needed for healthy margins. Resection extended to the lower fourth of the humerus in four cases, to between the lower fourth and third in six cases and to the upper third or less in two cases. Ten patients were reviewed at a mean follow-up of 22 months (7–60) to assess clinical function (Constant score) and radiographic results. Two patients with a unique secondary tumour died within the six months following surgery due to progression of the primary tumour.

Results: The mean Constant score was 58.75 (30–81.1). Weighted for age and gender, the result was 70.3% (32.6–82). Five sedentary patients were able to resume their former activities (1/2). Radiographically, there were two resorptions of the autograft, two glenoid lucent lines that did not progress, four notches in the column, and three Sneppen 1 calcifications. Mechanically, there were no prosthesis dislocations in patients whose resection extended to the lower fourth of the humerus, four dislocations in the one-fourth one-third group (2/6) and two dislocation in the upper group (2/2).

Discussion, conclusion: Functional and radiographic outcome after anatomic prosthesis implantation for surgical treatment of malignant tumours of the upper portion of the humerus was directly related to the status of the rotator cuff. The Grammont Delta III inverted prosthesis provided satisfactory functional and radiographic results in this indication after Malawer I resection, irrespective of the rotator cuff sacrifice. The risk of prosthesis instability appeared to be related to the extent of the humeral resection required for cancerological cure. For patients who undergo resection of one third or more of the humerus, muscle plasty should be associated.