Paul Grammont

Lower limb-length discrepancy. An epidemiologic study.

Two retrospective epidemiologic studies have examined the incidence and prevalence of significant lower limb-length discrepancy and the number of surgical corrections by lengthening in 1987 in France. The incidence of apparatus prescriptions for asymmetry correction filled was 2.16 per 100,000 population. The prevalence of people using a corrective apparatus was one per 1000 population. The male-to-female ratio was 1.95:1. Because of biases in the study population, the actual incidence and prevalence of significant limb-length discrepancies is likely to be considerably higher. A questionnaire administered to surgeons of the French Orthopedic Society revealed that the majority of surgical lengthenings were performed by large orthopedic teams. In the 418 procedures reported, the tibia was lengthened more often than the femur (ratio 1.1:1). Gradual distraction techniques were used in 89.4% of cases, with the Ilizarov apparatus used in 57.4%, the Wagner apparatus in 20.6%, and the Orthofix fixator in 11.2%. Immediate distraction techniques were used in 7.9% of cases, 85% of which were done on the femur. Average total lengthening was 51 mm for tibia and femur. Average lengthening was greater for methods of gradual distraction (53.5 mm) than for immediate distraction (31.4 mm).

The Classic: Delta Shoulder Prosthesis for Rotator Cuff Rupture

We provide a link to the original description of the “delta” reverse shoulder arthroplasty published in 1993 by Paul Grammont and Emmanuel Baulot. While many surgeons view “anatomic reconstruction” as essential for virtually all operations, Grammont recognized that not all reconstructions needed to be anatomic and in fact some problems with so-called anatomic reconstructions could be solved by developing nonanatomic approaches. Through careful reasoning and intuition, Grammont and Baulot suggested placing the ball of the shoulder on the glenoid and the concave matching surface on the humerus in patients with an absent rotator cuff (essentially rendering any anatomic reconstruction “nonanatomic” when the cuff function could not be normally restored). They argued the deltoid muscle could compensate for an absent rotator cuff if four conditions were present: (1) a lever arm effective from the start of movement; (2) a fixed center of rotation; (3) inherent stability; (4) maintenance of adequate external rotation. The result of their reasoning was the Delta Shoulder Prosthesis, the prototype of all other modern reverse shoulder arthroplasty designs. They briefly reported 14 patients with 2-year followup, finding acceptably restored function in 13. (Editor’s Note: The original article had no Abstract; this Abstract was therefore written to provide readers a summary.) The Classic article is