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SUMMARY The observation of growth landmarks in the evolution of scoliosis during childhood and adolescence is useful in determining when treatment with a spinal orthosis may be reduced and when treatment may be stopped. However, because there are marked variations in growth and development, treatment should always be considered on an individual basis. The most reliable indicator of spinal growth is the total height of the patient: measured serially throughout the period of observation, the rapid increase in height parallels spinal growth velocity. Tanner stages of puberty are a helpful–though not absolute– guide to the onset and cessation of puberty. Iliac apophyseal ossification (Risser's sign) remains a reliable method of determining maturation of the spine and of spinal growth velocity. RESUME Reperc de croissance et evolution de la scoliose: revue des etudes pertinentes sur leur utilite clinique L'observation des reperes de croissance au cours de l'evolution d'une scoliose durant l'enfance est un guide utile pour determiner quand le traitement d'orthese de la colonne doit etre attenue et quand il peut etre arrete. En raison de variations marquees de croissance et de developpement, le traitement doit etre individuellement adapte. L'indicateur le plus fidele de la croissance de la colonne est la taille totale du sujet: mesuree regulierement durant la periode d'observation, 'augmentation rapide de taille est parallele a la vitesse de croissance de la colonne. Les stades de puberte de Tanner constituent un guide pour marquer le debut et la fin de la puberte mais n'ont pas de valeur absolue. L'ossification apophysaire illiaque (signe de Risser) demeure une methode fidele pour determiner la maturite de la colonne et sa vitesse de croissance. ZUSAMMENFASSUNG Wachstumsstadien und die Entwicklung der Skoliose: eine zusammenfassende Uberprufung einschlagiger Untersuchungen aufihre klinische Relevanz Die Beachtung der Wachstumsstadien bei der Entstehung der Skoliose im Kindesalter ist ein niitzlicher Anhaltspunkt fur die Entscheidung, wann die Behandlung mit einer spinalen Orthose reduziert und wann sie beendet werden kann. Aufgrund erheblicher Schwankungen beim Wachstum und in der Entwicklung sollte sich die Behandlung individuellen Gegebenheiten anpassen. Der zuverlassigste Parameter fur das spinale Wachstum ist die Grose des Patienten: sie wurde wahrend der Beobachtungsperiode serienmasig gemessen und es fand sich, das der rasche Anstieg der Grose zur Wachstumsgeschwindigkeit parallel verlauft. Tanners Pubertatsstadien sind ein nutzlicher –wenn auch nicht absoluter– Leitfaden fur den Beginn und den Abschlus der Pubertat. Die Verknocherung der Darmbeinapophyse (Risser' sches Zeichen) ist ein zuverlassiges Zeichen bei der Reifebestimmung des Ruckgrates und der spinalen Wachstumsgeschwindigkeit.

The spontaneous correction of hip dysplasia occurs at every level of growth of the lower limb and it may be inadequate at any of these levels. Every abnormality of correction may induce different troubles at any level of the lower limb. A complete clinical evaluation, X-ray with different special views and CT examination is mandatory. Every deformation in any of the three spatial planes must be detected for a good understanding of the defect. The authors describe the X-ray techniques necessary for a complete evaluation of the patient and propose a CT protocol to precisely calculate the different angles of torsion of the lower limb. The possibilities of surgical treatment at different levels of the lower limb (acetabular, femoral, tibial and ankle or foot level) in DDH are pointed out to address directly the proper procedure at the correct level of the pathology.

Resume Introduction La clinique et l'histologie du carcinome cuniculatum (CC) sont souvent trompeuses. Cas clinique Nous rapportons un cas de CC du pied, pris a tort pendant deux ans pour une osteite, et qui a recidive deux mois apres une exerese complete. Discussion Le CC doit etre evoque devant une osteite chronique en regard d'une plaie torpide. L'anatomopathologiste doit etre sensibilise au diagnostic recherche.

Some metallic prostheses undergo physico-chemical modifications a few years after their implantation. The organism reaction leads to a corrosion process. Consequently, liberation of metallic debris or wear might be observed. The purpose of our analysis was to determine the importance, in surrounding tissues, of the contamination by metallic elements released from joint prosthesis and to localise it. We analysed two types of samples: the first ones were taken during surgical procedure and the other ones were extracted in post-mortem tissues. PIXE technique (Particles Induced X-ray Emission) with a 50 μm proton beam and 3 MeV of energy is an efficient technique to analyse these tissues. We used it to determine qualitatively and quantitatively trace element contamination, and we have developed an analytical method based on the χ 2 distribution to separate the different contributions of the different elements, to detect the possible correlation between these metallic elements.

When a metallic implant is in contact with human tissues, the organism reacts and a corrosion process starts. Consequently, we might observe liberation of metallic debris and wear. Our purpose is to measure the contamination and the migration of these metallic elements in the surrounding tissues of the implant. Two types of samples have been studied. First type is sample taken on post-mortem tissues around prostheses to study contamination gradients. Second type is sample taken on pathologic joints on periprosthetic capsular tissues in surgical conditions. These allow estimating contamination degree. The experiments were made on a Van de Graaff accelerator located at CERI (Centre d'Etude et de Recherche par Irradiation, Orl\'{e}ans, France). We measure elemental concentrations resulting from the contamination of the surface of each sample. Results are analysed in function of the pathology and the type of implants. According to the pathology and the location of the sampling, these measurements show a very heterogeneous contamination by metallic elements under particles and/or ionic species which can migrate through soft tissues by various mechanisms

Metallic prostheses are widely used in orthopaedic surgery. The degradation of these implants can induce metallic element transfers into biological tissues. The aim of this study is to determine concentration of metallic elements and to follow their migration from the prosthesis to the adjacent tissues. In order to quantify this phenomenon, we use PIXE method. Its feasibility is established. The samples were taken during surgical orthopaedic procedures performed on patients who have implants for a long time with or without adverse reactions. Analysed tissues were taken at the contact of the implants. We have used a Van de Graaff accelerator and the analyses have been made at the CENBG (Centre d'Etude Nueleaire de Bordeaux Gradignan). The experiment allows us to study the quantification of the contamination and the migration through tissues. We have scanned and obtained cartographies of the analysed surfaces which can show the correlation, between the location of different kind of elements in these samples. The difference of concentration in metallic elements between a reference sample and tissue at the contact of implant can be observed. The contamination is heterogeneous and depends on the state and type of the prostheses. We must consider the pathology of the patient which can induce some modifications in tissular behaviour and explain the reactivity of these elements in biological environment.

After implantation of a metallic prosthesis in a patient, damage can occur and surrounding tissues may be modified. We relate these effects by characterizing the soft tissue content. However, the variations in element concentrations can be small and it is necessary to evaluate the instrumental contamination, which we measure in muscular and capsular tissues surrounding the hips of selected corpses. From corpses, which never undergo surgical operations, samples have been cut with different surgical tools. From corpses with hip prosthesis, samples have been cut with scalpels to determine the contamination induced by metallic prostheses. Results give the mineral composition of surgical tools and of muscular and capsular tissues.

Prostheses can release some metallic elements to the surrounding tissues, particularly when they are not covered with a biomaterial layer and when an unsealing process happens. We try to measure major and trace elements in these tissues with an experimentally sensitive method. Proton-induced X-ray emission is used to detect about 10 elements in tissue. Tissues are calcinated and deposited in a thin layer before irradiation. Results are obtained in a standard and samples from three patients. We observe contamination by Ti, Cr, Ni, and Zn in the tissues. Correlations are to be studied between these atomic transfers and prosthesis in the patient.

This study is dedicated to the problems met with metal-metal bearing prostheses. We have analysed the results of the reports sent to the AFSSAPS relating incidents described with this interface. Only 11 incidents were reported during the last 4 years by surgeons from different centers in France. At a mean follow-up of 7 years, we collected 2614 total hip arthroplasties with metal-metal bearings and among them only 5 cases of unusual osteolysis and 10 cases of impingement. The bibliographic analysis did not show any severe specific complication due to the release of Cobalt or Chromium ions. The increased levels of Co an Cr in the patients' blood is now a well established notion (with more than 10 years follow up) and no special carcinogenetic effect has been correlated with the metal-metal bearings. Small diameter cemented cups can provide complications with high rates of acetabular loosening and metallosis; the same is true for some cementless cups also with loosening and a high revision rate. Among 143 hip prosthesis with a cemented polyethylene cup, at a mean follow-up of 42 months there were 22% of evolutive radiolucencies around the cups concerning all three De Lee and Charnley zones. Furthermore there was a statistically significant difference between small and large diameter cups (loosening of cups less than 46 mm in diameter). The same problem has been described for some cementless cups with loosening at the metal-bone interface due to a failure of osteointegration at the implant surface. However no failures were observed with an hydroxyapatite coating on the same cup. An other matter of concern is the skirted metal head: this design is responsible for a high rate of impingement and of prosthetic revision (2.3% among 642 THA). In these cases the increase of Cobalt serum levels was well correlated with the failure of the metal-metal interface. Large diameter heads decrease significantly the risks of dislocation. This is correlated with the increase in size. The release of ions in the blood was not affected by the large diameter compared to the regular size. So this overview confirms that if we respect some basic rules for the indications there are no specific complications related to the use of metal-metal bearings. In prospective studies the results of ceramic-ceramic and metal-metal bearings are similar but we must keep on observing prospectively the patients as for the release of Co and Cr.

en The norms elaborated by national and international bodies contain essential information concerning various authorisation processes relevant to the marketing of orthopaedic equipment. Primarily, they guarantee the quality of the use and/or construction of equipment. Concerning authorisation specific to the marketing of hip prostheses (homologation), the AFNOR norms represent the globally validated criteria. Concerning authorisation of products marketed in Europe (EC marking), it is essential for safety purposes that the norms prescribed by the directives be strictly followed, and that equipment conforms to these norms. These norms, at the various stages in which they exist, result from a consensus between the different concerned parties. They have therefore been established a posteriori, and do not apply to innovative equipment. In these cases, the manufacturer must prove the product in a specific fashion. These norms results from open discussions, and the entire industry is in agreement to follow them. Finally, they are open to revision, and it is one of the fundamental roles of equipment vigilance to periodically challenge the accepted rules.

Les auteurs font ressortir les avantages des fixateurs externes dans le traitement des fractures ouvertes de jambe. Le premier est la stabilisation du foyer par un montage stable. Celui ci est obtenu par l’utilisation de broches transfixiantes, la multiplication des plans de montage (l’ideal etant 2 plans de 60 a 90°) et la position des fiches (proches et loin du foyer). Si les broches sont souples la stabilite est obtenue par leur mise en tension, leur nombre et la fixation a des anneaux. Le deuxieme avantage est de permettre une reduction secondaire et de favoriser la consolidation par compression, distraction ou dynamisation (selon Ilizarov). Le troisieme avantage est le respect de la liberte articulaire adjacente, parfois difficile a realiser dans les fractures epiphysaires ou metaphysaires, bien que les nouveaux fixateurs s’y essaient. La conservation de la fonction musculaire est parfois delicate et depend de la position des broches. Le quatrieme avantage est de pouvoir effectuer une couverture cutanee bien que la realisation de lambeaux soit parfois delicate en raison de la position des broches. Ainsi l’ideal dans les fractures ouvertes de jambe serait de fixer le foyer par des broches a distance, d’effectuer le geste de couverture cutanee avant la realisation complete du fixateur mais apres stabilisation du foyer de fracture.

En premiere approche, la demande est simple: ce qui est casse doit etre repare. En realite, ce qui est casse, ce n’est pas un os ou une structure anatomique mais: une fonction.

De nombreuses pathologies chroniques s’accompagnent, a titre principal ou secondaire, de deformations articulaires dont la survenue est attendue; elles sont generalement prises en charge par les rhumatologues, qui peuvent confier ces patients au chirurgien (cf. chapitre « Lesions articulaires multiples »).

The spontaneous correction of hip dysplasia occurs at every level of growth of the lower limb and it may be inadequate at any of these levels. Every abnormality of correction may induce different troubles at any level of the lower limb. A complete clinical evaluation, X-ray with different special views and CT examination is mandatory. Every deformation in any of the three spatial planes must be detected for a good understanding of the defect. The authors describe the X-ray techniques necessary for a complete evaluation of the patient and propose a CT protocol to precisely calculate the different angles of torsion of the lower limb. The possibilities of surgical treatment at different levels of the lower limb (acetabular, femoral, tibial and ankle or foot level) in DDH are pointed out to address directly the proper procedure at the correct level of the pathology.

This study is dedicated to the problems met with metal-metal bearing prostheses. We have analysed the results of the reports sent to the AFSSAPS relating incidents described with this interface. Only 11 incidents were reported during the last 4 years by surgeons from different centers in France. At a mean follow-up of 7 years, we collected 2614 total hip arthroplasties with metal-metal bearings and among them only 5 cases of unusual osteolysis and 10 cases of impingement. The bibliographic analysis did not show any severe specific complication due to the release of Cobalt or Chromium ions. The increased levels of Co an Cr in the patients' blood is now a well established notion (with more than 10 years follow up) and no special carcinogenetic effect has been correlated with the metal-metal bearings. Small diameter cemented cups can provide complications with high rates of acetabular loosening and metallosis; the same is true for some cementless cups also with loosening and a high revision rate. Among 143 hip prosthesis with a cemented polyethylene cup, at a mean follow-up of 42 months there were 22% of evolutive radiolucencies around the cups concerning all three De Lee and Charnley zones. Furthermore there was a statistically significant difference between small and large diameter cups (loosening of cups less than 46 mm in diameter). The same problem has been described for some cementless cups with loosening at the metal-bone interface due to a failure of osteointegration at the implant surface. However no failures were observed with an hydroxyapatite coating on the same cup. An other matter of concern is the skirted metal head: this design is responsible for a high rate of impingement and of prosthetic revision (2.3% among 642 THA). In these cases the increase of Cobalt serum levels was well correlated with the failure of the metal-metal interface. Large diameter heads decrease significantly the risks of dislocation. This is correlated with the increase in size. The release of ions in the blood was not affected by the large diameter compared to the regular size. So this overview confirms that if we respect some basic rules for the indications there are no specific complications related to the use of metal-metal bearings. In prospective studies the results of ceramic-ceramic and metal-metal bearings are similar but we must keep on observing prospectively the patients as for the release of Co and Cr.

The clinical and histological features of cuniculatum carcinoma (CC) are often misleading.We report a case of CC of the foot, which was misdiagnosed as osteomyelitis for a two year period and which relapsed 2 months after complete resection.The CC has to be evoked in patients with chronic osteomyelitis and torpid wound. The anatomopathologist needs to be aware of the suspected diagnosis.

Some metallic prostheses inserted in human hip undergo physico-chemical modification, a few years after their implantation. Tissues surrounding these prostheses are damaged by metallic element transfer. Surgeons in Clermont-Ferrand Hospital (France) recover tissues of abnormal coloration that were in contact with metallic implants. PIXE technique (particles induced X-ray emission) with a 400 μm proton beam and 3 MeV of energy is an efficient technique to analyze these tissues and to detect elements, which are transferred from prosthesis to tissues. PIXE analyses were carried at the CERI-CNRS Laboratory. We have applied this method to determine qualitatively and quantitatively trace elements migration from metallic implants to surrounding tissues and organs, like kidney, spleen, liver, lymphatic gland and lung.

The influence of various modes of carrying a load of 16 kg (15.69 DaN) on the static positioning of the pelvic girdle and the thoracic and lumbar segments of the spine was examined in seven male subjects. The displacement of cutaneous markers attached to easily palpable skeletal landmarks was recorded using 4 CCD cameras; the data acquired were analysed using an optoelectronic technique (SAGA3). The subjects stood upright on an AMTI biomechanical force platform, from which the ground reaction forces enabled displacements of the centre of gravity axis and thus the moment of the mass carried to be determined. The modes of load carriage examined were: 1) in a case in the left hand; 2) in a case in the right hand; 3) equally in two cases; 4) on the head; 5) in a rucksack; and 6) in an anterior bag. The results showed displacements of the pelvic girdle, the caudal and cranial lumbar segments, and the caudal and cranial thoracic segments in the three orthogonal planes (sagittal, frontal and transverse). The influence of the moment created by the load was seen in the statokinesigrams. The use of external markers using an optoelectronic technique, in association with the ground reaction forces, enables the mode of load carriage to be determined. The results show that the influence of the moment exerted by the mode of load carriage on the gravity axis has important ergonomic consequences.

Physiological displacements of the trunk are the addition of these of the pelvic girdle and thoracic and lumbar spine segments. For a long time (3), this conjunction had been noticed but without numbered precisions. The purpose of this communication is to appreciate quantitatively, from a series of 16 subjects, the respective share of each components during lateral bending movements in the frontal plan and movements of rotation in the transverse plan. It results from this work that the pelvic girdle presents as reduced amplitude (4 degrees) in lateral bending on the other hand, displacement predominate to the level of thoracic spine (50 degrees). In rotation pelvic displacements are very important (30 degrees), while the spine so thoracic that lumbar has a weak participation (inferior to 5 degrees). Moderated abduction of hips increases by significant manner the motility of the pelvic girdle.

The overall movement of the trunk is made up of two components, namely the movements of the pelvic girdle and the vertebrae. In the frontal plane, the amplitude of the pelvic movements appears to be relatively limited compared to the vertebral column whereas the pelvis makes the major contribution to the total rotational movement in the axial plane.

Coral and hydroxyapatite may be used as substitution biomaterials for bone grafts. In this work, we extracted the implants from the femora to study the kinetics of elementary mineral transformation of the osseous substitutes. The use of physical analysis methods such as PIXE (particle-induced X-ray emission) shows that coral and hydroxyapatite, after their implantation in vivo, reach a mineral composition comparable with that of bone. For the first time we have measured the concentration of mineral elements, at different time intervals after implantation, along a cross-section. The distribution according to mineral elements (Ca, P, Sr, Zn, Fe) in the implant, in the receiver site and also at the interface, showed that the kinetics of coral resorption was faster than that of hydroxyapatite; in the same way, the osseous attack was not global but, rather, centripetal.

Coral and hydroxyapatite may be used as substitution biomaterials for bone grafts. In this work, we extracted the implants from the femora to study the kinetics of elementary mineral transformation of the osseous substitutes. The use of physical analysis methods such as PIXE (particle-induced X-ray emission) shows that coral and hydroxyapatite, after their implantation in vivo, reach a mineral composition comparable with that of bone. For the first time we have measured the concentration of mineral elements, at different time intervals after implantation, along a cross-section. The distribution according to mineral elements (Ca, P, Sr, Zn, Fe) in the implant, in the receiver site and also at the interface, showed that the kinetics of coral resorption was faster than that of hydroxyapatite; in the same way, the osseous attack was not global but, rather, centripetal.

The authors will highlight the advantages of external fixation in the treatment of open fractures of the leg.The first is stabilisation of the fracture site. It is obtained by using transfixion pins in multiple planes (the ideal being 2 planes between 60 and 90°). With flexible pins, stability is obtained by using multiple pins and fixing them to rings under tension.The second advantage is to allow secondary reduction and encourage consolidation by compression, distraction or dynamisation (according to Ilizarov).The third advantage is to leave the adjacent joint free which is sometimes difficult with epiphyseal and metaphyseal fractures even with the newer fixators. Preserving muscle function is sometimes difficult and depends on pin position.The fourth advantage is to be able to obtain skin cover although the use of flaps may be compromised by the pin tracks.The ideal therefore in open fractures of the leg is to fix the fracture site by pins at a distance from the fracture, to obtain skin cover after the fracture has been stabilised and then complete the assembly of the fixator.

The authors present a technique of palliative treatment of trapezius paralysis after injury to the spinal accessory nerve. The transfer of the levator scapulae associated, or not, with the rhomboid minor allows regression of functional signs and a return to normal function of the shoulder. Five cases are exposed, with results ranging from 3 months to 15 years.

The multitude of total hip replacement systems cannot mask the fact that it is after all a matter of friction between two surfaces. The wear and distorsion resulting from this friction are still to be precisely evaluated for each marketed hip system. These two parameters have indeed to be evaluated when new devices are used. The "in vivo" behavior of a hip system is best approached when studied on a model reproducing the hip movements and the cyclic loads endured by the hip throughout walking. Data obtained using this type of model allow us to approach the behavior of metal-polyethylene interfaces: there is always a grinding period whose duration varies from 300,000 to 2,000,000 cycles. The friction factors during this initial grinding period may be two to three times greater than the final ones. Data obtained upon wear over 5 millions cycles correspond to clinical findings. Concerning the high density polyethylene-metal interface, variations of molecular size or supply of supplementary molecules may increase the friction factors up to three times the initial values. But wear may vary much more.

The authors report a series of 9 cases over the period 1981-1992.Debridement was achieved in a single procedure in 44.5% of the cases, in 2 procedures in 33.3%, in more than 2 procedures in 22.2%. The closure of the wound was achieved by secondary sature in 77.8% of the cases and by a muscule flap in 22.2%. The fixation of the fracture was performed by an external fixator in all cases.Primary consolidation was obtained in 44.4% of the cases. A tibiofibular graft was needed in 4 cases.The mean time to consolidation was 23 months.

Les cals vicieux en rotation externe, l'un des inconvenients majeurs de l'enclouage fascicule selon Ender des fractures pertrochanteriennes du col du femur, sont induits par la methode: introduction d'un clou plan dans le femur, sans tenir compte de l'anteversion du col, et surtout de la courbure diaphysaire a concavite posterieure. Afin de chiffrer de maniere precise la frequence et l'importance de ces cals vicieux rotatoires, nous avons compare, dans trois groupes de malades, l'anteversion radiologique du col femoral fracture et encloue, par rapport au cote oppose. Dans le groupe I, l'enclouage a ete realise avec un clou de Ender plan, la retroversion du col est constante, et sa valeur moyenne de 12° par rapport au cote oppose. Dans le groupe II, les clous ont beneficie d'un bequillage anterieur de l'extremite superieure, la retroversion reste constante et sa valeur moyenne de 14°. Dans le groupe III, nous avons modele les clous de maniere a retablir la courbure sagittale diaphysaire a concavite posterieure et l'anteversion du col. La valeur de la retroversion moyenne n'est plus que de 1°; nous avons donc reconstitue une anteversion normale. Nous concluons que pour eviter les cals vicieux en rotation externe, il faut adapter la forme du clou a la structure anatomique du femur: reconstituer la courbure diaphysaire a concavite posterieure et l'anteversion du col.

Sixteen cases of spontaneous dislocation of the atlanto-axial joint have been reviewed, fifteen in rheumatoid arthritis and one in ankylosing spondylitis. On four occasions there was some neurological impairment, but in eleven there was only pain and stiffness. The only case of ankylosing spondylitis was operated on after failure of conservative treatment. Three patients died between one and eight months after operation, two of them having had severe neurological impairment before operation. In the thirteen other cases, the average follow up was four years. All had satisfactory fusion after grafting from the skull to axis. Six had only a partial reduction of the displacement and united with some displacement of about 5 mm. The results were satisfactory with absence of pain and regression of neurological signs.

Eighty three cases of intertrochanteric flexion osteotomy of the hip for severe osteoarthritis are reported with a five year follow up. Osteotomy is performed in the sagittal plane with flexion of the proximal fragment. The anatomical, biomechanical and operative criteria for this procedure are discussed. The indications are based on a precise radiographic survey of hip congruity in flexion. The majority of the patients had severe osteoarthritis of the hip. Radiographs in abduction or adduction showed no improvement in congruity indicating that there would have been no benefit from a Pauwels type of frontal osteotomy. Results after five years are presented. Seventy-five per cent are good, 10% fair, and 15% are failures. Forty-five patients have a long term follow up of more than ten years which allows analysis of the evolution of this osteotomy.

This report is based on the study of 63 intertrochanteric flexion osteotomies of the hip with a ten-year follow-up. Every patient had severe osteoarthritis of the hip where abduction or adduction osteotomies could not possibly have recentered the femoral head in the acetabulum. The only alternative would have been a total hip arthroplasty. The reappearance of a congruent joint space on the anteroposterior roentgenogram of the proximal femoral epiphysis in flexion was the criterion for intertrochanteric flexion osteotomy. At ten-year follow-up, 65% had a good result, 10% fair, and 25% poor. This per cent of poor results is comparable to some statistics of late complications following total hip arthroplasties. After osteotomy, infection seldom occurs. Moreover, intertrochanteric osteotomy does not complicate the results of total hip arthroplasty.

Twenty patients with osteoarticular infections, fourteen post-arthroplasty and six with osteitis, were treated with ofloxacin, usually in combination. Sixteen staphylococcus strains including eight aureus and eight coagulase negative (modal MIC and MBC: 0.5 micrograms/ml), three Escherichia coli (modal MIC and MBC: 0.06 micrograms/ml) and one Peptococcus (MIC: 0.25, MBC: 0.5) were isolated. Treatment was given at a mean dose of 9.81 +/- 2.46 mg/kg for a mean duration of 100 days. The serum concentration of ofloxacin was measured at 3.73 +/- 2.13 micrograms/ml for a dosage of 8.23 +/- 0.94 mg/kg (25 assays) and 7.42 +/- 4 micrograms/ml for 11.46 +/- 1.3 mg/kg (23 assays). Bacteriological control was carried out nineteen times; in one case of staphylococcal osteitis, a relapse occurred on the 43rd day of treatment when the strain isolated was resistant to ofloxacin. Three patients presented adverse effects: two cases of bone and muscle pain and one cutaneous allergic reaction: treatment was withdrawn after two restarts. The antibacterial action, the good tolerance and the easy administration of ofloxacin make it a useful antibiotic in the treatment of osteoarticular infections, where a dosage of 8 mg/kg appears to be necessary, particularly in infections due to staphylococci.

Valid clinical correlations with biomechanical data require three-dimensional visualization of a joint, in order to determine the true spatial configuration of the various segments of the part studied. The CAT scan has opened a new pathway in this direction, as it supplies precise mathematical information on the segments explored. An original analytical programme was employed in humans to establish the true spatial orientation of the acetabular cavity. The validity of the method was confirmed by comparing results in 31 subjects with the rare cases where such measurements were made, reported in the published literature. The method could be extended to other body regions.

The shape of the standard Ender nail may result in malunion in external rotation in intertrochanteric fractures treated with this device. The nail is curved in one plane, and is usually introduced into the femur without making allowance for the bowing of the diaphysis and the anteversion present in the neck. We have measured radiographically the anteversion of the femoral neck in three groups of patients after operation using Ender nails, and also assessed the anteversion of the unoperated hip for comparison. In Group I normal Ender nails were used. The operated hip showed an average of 12 degrees of retroversion compared with the opposite side. In Group II the nails were bent anteriorly at their upper end, but an average retroversion of 14 degrees was produced compared with the other hip. In Group III the nails were bent to produce anterior bowing as well as proximal anteversion. The group showed retroversion of only 1 degree compared with the normal side. We therefore recommend that Ender nails be bent in this manner in order to reduce rotatory malunion when used for intertrochanteric fractures of the neck of the femur.