Raphael is one of the tenors of the Parisian, French and international pediatric csotcina.comedics. Its work devoted to the congenital dislocation of hip and the equine clubfoot considerably cleared up our comprehension of the intimate mechanisms of these pathologies. Its virtuosity is unanimously admired, as well with the as near its violoncello.

Speak to us about your route. How did you become csotcina.comedic surgeon of children?

: I was born in a medical family since many generations on the side from my father. At the beginning of the century, the great-grandfather of my great-great-grandfather was sworn surgeon, graduate of Medical faculty, unlike the surgeons barbers. My father himself was Médecin of the Hospitals of Paris, Departmental manager of Pediatry to the Ill children. It was thus natural that I direct myself towards medicine.

One six-month period at Robert Blackbird-D' in his antenna of with Jean who dealt with paraplegic had given me the taste of neuro-csotcina.comedy, before the term is not created. It was in 1962 and one already tried to make walk the paraplegic ones by using a pacemaker to stimulate the muscle groups likely to propel the patient.
During the Boarding school, I spent one year to Versailles at Michel who taught me all the bases from csotcina.comedy traumatology. I also spent six months to the hospital in Jacques . This last held a great place for two reasons: professional because one six-month period at his place was extremely formative and personal because I met there that which became my wife and the mother of our three daughters, then the grandmother of our 6 small children. She always exerts her trade of child psychiatrist and surely a lighting brought to me on the manner of better understanding the children and the parents.

One year of Boarding school with in Blackbird D' , at the time of the six-month period which preceded its retreat, then at Robert and Michel , enabled me to acquire a solid formation of adult csotcina.comedy. It is in fact the six-month period of boarding school at Pierre Petit who was to decide my final guideline: it was for me a revelation to discover the wealth of pediatric pathology, the immense potentialities for growth. I was also impressed by the team which surrounded Pierre Petit: Pierre , Henri , Jean with which enthralling discussions took place at the time of the and at the time of the famous inspection to the bed of the patients the 8 a.m. saturdays to 2 p.m. One six-month period of Boarding school with St Vincent of Paul and a several years with such a team created an extraordinary emulation to advance.

You belonged to a generation which made anatomy because it was the channel for a hospital surgical career…

: At that time, there existed indeed 2 successive contests of anatomy organized by the Instructor André with the Faculty of St Fathers: the which made it possible to become aid of anatomy then the that I prepared with Jean Yves of and which we must forward in June 1968. But it was cancelled at the last time because of the events of May. This anatomical career nevertheless continued with research tasks on the venous drainage of the pineal glands, the defense of my thesis in anatomy in 1969 and the accession with the functions of Chief of Practical works of anatomy during three years. With A. and of we organized the teaching of the new diploma of anatomy and started to form the future generation of the instructors of anatomy.

I remain convinced that the anatomy with the practice of the dissections on fresh corpses remains a crucial step in the training of the surgeons. That surely predisposed me being studied anatomo-pathological of the birth defects of the members like the clubfoot and the congenital dislocation of hip.

Your name is associated with these two important affections of the pediatric csotcina.comedics. When and how you were interested in the congenital equine?

: It is of 1971 to 1975, during my with and St Vincent of Paul, that I dived myself in a quasi daily way in the study of the . Already, during my last six-month period of boarding school at Small Pierre, I had started with me to interest in it with Jean and Robert by preparing two “Mondays of ”: one on the surgery of the clubfoot become inveterate after 4 years and the other on the initial process of the clubfoot according to the functional method focusing by Paul Masses. Seeing the interest that I carried to the , Pierre Petit had helped me to operate my first case when I was internal then entrusted to me, as from 1972, a weekly consultation and an operational morning entirely devoted to this subject. In parallel, I could dissect neonatal anatomic specimens and I continued a study critical and deepened literature on all the aspects of the clubfoot. I operated a great number of it because Pierre , Henri , Rene and others entrusted their small patients to me. At the end of this “five-year period” dedicated to the , I could start to publish on the pathological anatomy with the princeps description of the postéro-side fibrous node and the antéro-side fibrous node. I also showed the absence of retraction of the soft parties and the ligaments of the hinge under-talienne, where the main surgical releases took place before 1975. A new physiopathological design could be proposed with the concept of false supination, but of strong adduction of the calcanéo-pedal block with specific recommendations for the csotcina.comedic and surgical corrections.

How did you improve the functional method of processing of the ?

: It is thanks to the team of kinesitherapists of St Vincent of Paul that was possible, in particular thanks to the exceptional personality of the framework kinesitherapist, , which could bring adjustments gradually and create a specific training for the kinesitherapists of city. We thus abolished the splints of Refusals, cumbersome and ineffective against the equine one. We replaced them by splints with capture of the knee, only way of controlling the equine one and the adduction under-talienne calcanéo-pedal block. The platelet was amended to avoid a deformation in convex foot and the attachment unit became more strict to avoid the rise of the . With this technique the surgery of release of the soft parties could be avoided in approximately 60% of the cases.

What do you think of the method of which is spread everywhere in the world?

: I do not have direct experience of it but for 10 years I have practiced, when it is necessary towards the nths age, a percutaneous of Achilles what made it possible to decrease the percentage by feet further to be operated by release of the soft parties. At the time of the next congress of the 2007, an extremely interesting controversy must take place on the processing of the clubfoot by the method of and the method of St Vincent of Paul; that will surely make it possible to see there more clearly. 

Why do you systematically lengthen the tendon of tibial former in the surgery of the clubfoot?

: This surgical time that we practice since ade it possible to clearly improve the results of the surgery of the clubfoot and published we it in the in 2002 with Philippe . Indeed, the correction of the defects leads to lengthen the column foot and it appears logical to lengthen its two satellite tendons which are the posterior tibial and the tibial former one. In addition, the lengthening of tibial former improves muscular balance in the coronal plane between the long muscle fibular too weak to correctly lower the 1st metatarsal and the former tibial muscle too powerful person responsible for the “dorsal ” at the end of the growth. It is effective also to improve muscular balance in the sagittal plan between the triceps weakened by surgical lengthening of the Achilles' tendon and tibial former the too powerful one. Lastly, that makes it possible to decrease the frequency and the degree of dorsal subluxation of the navicular bone.

You are also a reference impossible to circumvent on the congenital dislocation of hip. When and how you were interested in this pathology?

: It is the history of a “second five-year period” of 1976 to 1980 during which I invested myself thoroughly on this subject. It should be said that I profited in my hospital complex from the privilege to have three great university maternities: Royal port, and St Vincent of Paul. As I was Senior registrar, I had asked for to the pediatrists maternity of call me immediately as soon as a “projection” was perceived with the birth so that I can personally examine the unstable hips before any processing. Previously, one saw the children only 15 to 20 days after the birth and the hips were already stabilized in abduction.

From 1976, I could make the synthesis of all the clinical observations that I had make in these maternities and consider a new interpretation of the instability of the néo-native hip and physiopathology of the . It is into 1976 that I drew the diagrams become conventional of instability with frank projection, light projection and absence of projection or piston; these diagrams were confirmed 10 years later with the introduction of echography. As for the study of the , I could dissect anatomic specimens of and make a thorough critical study of the literature. Lastly, a prospective work, very rare in France at that time, could be carried out with Bertrand : the systematic csotcina.comedic examination of 1500 new-born babies seen in the first 2 days of life to the maternity of St Vincent of Paul. The hips of 5 or 6 new-born babies could be examined daily, without only one day of lack, for nths consecutive. This “marathon” of 3000 hips was very productive because new observations could be made on the whole of the csotcina.comedic problems of the newborn baby.

The terminology of the evolved/moved because since about fifteen years it is replaced in the literature by “ off tea ” where the congenital adjective was abolished. What do you think about it?

: If the “congenital” adjective were replaced by “” it is because of the medico-legal problems in the USA because the not-reconnaissance of the instability of hip in néo-native period had become the csotcina.comedic cause most frequent of share of medical responsibility against the pediatrists. The other explanation is the persistence of the belief at fault a luxating dysplasia of hip, i.e. primary of the which would involve the displacement of the femoral head secondarily. This pathogenetic design seems to me erroneous because all shows that it is the luxation which is “” and not the dysplasia which is luxating.

In the 30 last years, we saw decreasing the number of hips considerably to be put in abduction because the majority of the only hips cure spontaneously. That explains the recommendations given in 1985, at the time of the national campaign of the tracking which I had organized with the , to discuss only the children for which a diagnosis of luxation or subluxation was certain.

In the current course of a future pH, it is required a “year of mobility”. Had you done it?

: Yes, I spent one year to the Institute Stone-block to in 5977 1667 at Yves to specialize me in the processing of the scoliosis. If I had not been appointed with the Contest of aggregation, I would have taken the continuation of Yves who was obliged to stop prematurely for health reasons. It was the full time of associated with the of which gave already important corrections and a fast osseous merger making it possible to decrease the duration of the postoperative plaster seriously. Institute Stone-block, I have a marvellous memory: the teaching of Y. , staffs with Jean , discussions with Georges on hip dislocation and other problems csotcina.comedic. Yves received each month during 3 or 4 days of the French and foreign visitors for operational meetings, demonstrations of plaster EDF and talks scientific. During this year , I had kept a weekly consultation of pediatric csotcina.comaedics with St Vincent of Paul and I benefitted from my weekend in Paris to occupy me of my small family which increased.

Which are the other outstanding dates of your career?

: In 1975, the departure with the retreat of my Master P. Petit in a teaching hospital context disturbs, marked by the departure of H. to St Louis then on Trousseau, the not-appointment of J. for complex reasons in connection with the premature death of R. and arrival of J. as new department head who had to manage a crisis related to all these changes.

In 1977, my appointment with the infantile aggregation of surgery. By taking my functions with St Vincent of Paul, after my year , it seemed to me that it was fundamental to constitute with Pierre and Jean a team welded after the preceding upheavals. Jean was impassioned rachis and I felt that a competitive situation on this pathology was not the right track to be followed. We thus organized ourselves so that Jean has two fields of predilection, the rachis and the tumors, that me I deal more particularly with néo-native csotcina.comedy and that one works in concert on neuro-csotcina.comedy, by organizing multi-field with the . We thus functioned very well at the same time on a professional level and a friendly and personal level. All the colleagues, interns and senior registrars who passed in the service told us with which point they had appreciated this complementarity.

In 1980, troubles of health obliged me to stop my community activities for nths. I benefitted from it to think of the life which I carried out who was, perhaps, too centered on work. I thought that it was important, beside the scientific work and of the care of the patients to devote a little more time to my own family. It is as that which I decided to go to twice seek my daughters at the school per week, that of which they have an excellent memory whereas they forgot that their mother ensured the other ways. And I also took again the music. I have can be less travelled than my colleagues but I made other things quite as important on the human plan.
In 1990, the departure with the retreat of J. with which I always had very cordial reports. The service was then divided into two: visceral surgery for P. and csotcina.comedic surgery for me. As of the return of the USA of J. in 1987, I had begun steps to make appoint it pH and that spent 5 years to be concretized because, at the time, the course was sown obstacles. The administrative tasks became more and more invading and I continued to interest me in the newborn baby and all that relates to the acquired deformations of the foot of the child of in particular neurological various origin.

In 2000, the serious threat of closing and dismantling of the hospital St Vincent of Paul led me to battle firm to defend the future of the service and our team, heritages of Pierre Petit.

In 2004, afterwards many adventures, a project was born, under the impulse of the senior , the merger with Necker-Child-Patients at the time of the rebuilding of this hospital. To prepare the merger of our two services, provided for in 2010, we very quickly started to work together: the team of Christophe and mine. Common meetings make it possible to swap our experiments and of common work are in project or in progress.

In 2006, the appointment of Philippe as pH which will succeed me in a few years.

You are brought to look after children heavily handicapped. Which are your experiment and your glance on this problem?

: During more than 30 years, I was consulting in a center of unsuited children and children poly-handicapped people. It was necessary to take into account the psychological conditions of the child and concerns of the educational and psychological personnel to discuss the best possible these children who could develop serious scolioses, hip dislocations, deformations of the knees, feet. That was an experiment very enriching in the professional plan and the human plan.

Which contacts with outside did you tie, in particular with the foreign countries?

: Fame of St Vincent of Paul and in particular of
J. attracted many foreign visitors including one great number made nths a long stay even more. We find them with pleasure each year with the congress of the . Much is very faithful in particular those with which we wove links privileged at the time of many exchanges: one can quote Algeria, Tunisia, Lebanon, Syria and much of others.

Let us come in to teaching. Which is the best form of teaching according to you?

: Although the practice is lost, although it is not “politically correct” I remain persuaded that it is teaching with the bed of the patient or the patient in consultation which remains the most effective form of teaching. In pediatric csotcina.comaedics it is always possible, if one explains it to the child and the parents. In the same way the trade-guild remains impossible to circumvent for the training of the operational act.

In addition, the medical knowledge and thus teaching should not remain fixed: it is very often the patient besides himself which brings a version somewhat different to us from what is taught in the scientific books and items. I often repeat with the students and the interns that they are the patients who teach us medicine in the condition that they well are listened to and that one examines them thoroughly. In the same way, the complementary examinations, in particular radiographies, are there only to mislead us… except when they can help us!

You thus have a very critical glance on the books of medicine and yet you did not write yourselves of them several?

: The first work was written with Remi on the primitive of hip and published in 1981 in the collection of the monographs of the . It was a titanic work of critical reading of all the literature with multiple working sessions to precisely make possible synthesis the most objective between the really proven facts and all that concerned sometimes whimsical assumptions. That was an enthralling work which enabled me in addition to create very strong bonds of friendship with Remi .

More recently, with J. and Y. , we published at a book of “illustrated neuro-csotcina.comedic Semiology”: unfortunately, it does not have much success whereas it has surely a great teaching value since it reproduces all the clinical maneuvres to examine and evaluate such or such csotcina.comedic problem of the rachis and the members.
Lastly, with Henri we published at for the general doctors but also for the csotcina.comedic surgeons a book of “csotcina.comedy of the newborn baby to the adolescent” who is a certain success.

The drafting of this work in 2002 pointed out some very good memories to me of the years 5972 5475 before Henri leaves St Vincent of Paul. To work with Henri, it was to benefit from its immense crop, its rigor, its requirement, for him and the others, from its intellectual honesty, and finally from its solid and faithful friendship. In 1976, it wished that I become his aggregate but, unfortunately, the risks of the contests and of the appointments on St Vincent of Paul and Trousseau did not allow it. We knew to preserve our bonds of friendship and I am very grateful to him to have agreed to be the godfather of my last daughter.

You are correspondent with the Review of csotcina.comedic surgery. Of what does consist this work?

: The team of drafting of the directed by Jean-Michel allowed this review to make progress her impact Factor thanks to the quality of the memories published. The work of drafting consists, with the aid of two experts, to make a precise study of the text to decide or not its publication in the review. Amendments are very often requested from the authors to improve quality of the item and the second reading of the manuscript falls to the correspondent. Work with Jean-Michel for the dissemination of the scientific work of value was always a real pleasure and an enrichment.

I am also committee member of Drafting of the “Books of Teaching of the ”, collection directed since his creation in 1967 per Jacques . This collection which has a very broad dissemination contains a party specifically pediatric coordinate by R. “Ortho-pediatry”. They are 4 volumes gathering a republication by topic of the conferences of csotcina.comedy of the 10 last year old child in a very accessible form stitched for our young colleagues in formation.

You are an former chief executive of the French company of Pediatric csotcina.comedics and you will chair in November 2007 the Congress of the ? Which are the relations between this two Society?

: The relations are excellent because our society has a synergy and an important complementarity. Among society girls, the can be regarded as the “oldest daughter”. As of this year, this privileged position is recognized to him because we wished to increase the meetings where the adult csotcina.comedists and pediatrists are likely to verge on themselves for better swapping. This is why, we moved Wednesday to Thursday the day of speciality of the , to allow to the csotcina.comedists “pediatrists” to fully take part Wednesday with their “adult” colleagues in work of other society girls.

Does remain to you time for ?

: Not, enough little but it is necessary to take time and it is what I have done for 25 years for the music: I am likely to play of the violoncello in the symphony orchestra of the Public assistance - Hospital of Paris since his creation in 1994; this brought me after weekly repetitions Monday evening and daily work to the house, with being able to play in orchestra in concerts several times a year. Our currency is: “To make music together, as one looks after together”, because this orchestra gathers all the trades of the hospitals of Paris. In addition, at the time of next congress 2007, the csotcina.comedists will be pleased to discover our orchestra directed by Olivier , on Tuesday, November 6 at the time of the inaugural session.

What do you wish to transmit to young people?

: I have the feeling to have belonged to a generation privileged on the intellectual level because exceptional beings were run alongside. I wish to forward what my Masters Pierre Petit and Pierre taught me the rigor from the clinical review, the precision of the operational gesture, the importance of team work welded in the interest of the patient, the humanity with respect to the patients and of their family, the need for looking further into its knowledge permanently, and especially the respect of the others.

What do you think of the future of the pediatric csotcina.comaedics? Do you encourage the young people to launch out there?

: The pediatric csotcina.comaedics are a speciality with share because of its dual membership: pediatric and csotcina.comedic. For the assumption of responsibility of the children, it can be exerted only in pediatric structures, therefore in contact with the visceral pediatric surgery. On the other hand, for the formation and search, it depends especially on the csotcina.comedic surgery with which privileged links must be developed.

The young people should be encouraged to launch out in this speciality for at least two reasons. First is related to medical demography because of the great starting number to the retreat provided for in the ten next years. A renewal of the generations is thus essential. The second reason relates to the development of the pediatric csotcina.comedics itself: admittedly, of very important progress have taken place for 30 years but others are awaited in fields where one can already speak about on-specialization: rachidian pathology, neuro-csotcina.comedy, the pathology of the foot… It is to the young people to take up the challenge because much of things remain to be made.