. : Can you tell us how and within which framework you conceived this method, and which are the principles?

M: The first case, I remember it perfectly well, it acted of a girl called , she forwarded vitamino-resistant rickets with large skeletal deformations. After having corrected his tibia by multiple osteotomies, I could not put of plate because the cortical ones were too weak. The too narrow medullary canal did not let pass a nail, I had thus decided to use an axial pin associated with a plaster. I had the idea, I cannot say how, to bend my pin, simply to avoid introducing it through the hinge. This curved pin printed a deformation with the skeleton, I thus introduced a second, symmetrical of it and I had the surprise to have a perfectly rectilinear and stable assembly, that I nevertheless plastered. This a little unexpected result then encouraged me to use this technique on . I intervened then after the neurosurgeons and the surgeons under conditions of asepsis which were not optimal and where the essential access and osteosynthesis exposed at the certain risk; percutaneous osteosynthesis made it possible to solve the problem of the fracture without opening and raising the infectious risk. After several successes without complications, one extended within the framework of the pediatric surgery in the Instructor Prévot, this treatment some particular cases of adolescents at the end of the growth for which an csotcina.comedic processing by pelvi-pedal appeared a little limiting. Then, the experiment was prolonged by operating more and more patients while measuring the indications. In front of the quality of the results obtained and the very reduced rate of complications, the method was extended to the two bones of the front armlever, with some fractures of the tibia, the surgical necks of the very moved humeri which posed problems of application.

In 1977, the principles of the method were a little with against current; osteosynthesis in the child was highly disadvised, and in the adult, the principles of strict immobilization preached by the appeared undeniable. However, we noticed all that a child in traction moved enormously in his bed forwarding his fracture to ceaseless movements of great amplitudes, in spite of that the cal appeared as of the fifteenth day and in three weeks, the fracture was sufficiently limed to be foundation of concrete. Under plaster the immobilization is never strict either, in spite of this mobility and an always imperfect reduction the consolidation occurred in all the cases and times definitely shorter than after an osteotomy. However in this case the cut clear, was well faced and strictly immobilized. As of this time, some such , - little listened stressed the significant role of the hematoma , and a certain mobility in the chamber of fracture definitely favorable to the cal periosteum. The aforementioned is essential with the consolidation of the bone in the child. The fills the as regards pediatric osteosynthesis perfectly: closed chamber, minimal infectious risk, safeguarding of the hematoma, respect of the periosteum, mobility and elasticity in the chamber, development of one cal optimal periosteum. Osteosynthesis in place does not offer an anatomical reduction, but avoids important displacements. It is in fact an internal csotcina.comedic processing.

. : How the fractures of the child were discussed before the time of the ?

M: One can estimate that 95% of the fractures were discussed in an csotcina.comedic way, at the prices sometimes of long fixed assets constraining and very uncomfortable. Imagine an adolescent or a 13 years in traction three or four week old adolescent, then out of pelvi-pedal plaster for six weeks. When the csotcina.comedic processing was really not possible (severe head injury, neurological child, , osseous brittleness,…) an osteosynthesis was carried out with hardware and principles of adult surgery. Most of the time these techniques gave good performances, but the few complications were severe and often worse than one cal vicious. The main issues encountered after adult standard osteosynthesis were hypertrophy, the pseudarthroses exceptional after an csotcina.comedic processing, the not very frequent but extremely serious infections in the child, and the iterative fractures.

. : Won't the family and school requirements push the pediatrists to operate all the fractures systematically?

: It is certain, but it belongs to us to guide them to avoid this drift. The gave me the reputation to spit all the fractures, and I am often solicited by parents who would wish to give up the immobilization foundation of concrete, with the profit of a more comfortable method; most of the time I refuse, I accept only if the reduction is really not sufficient. In “first hand”, if I can obtain an acceptable csotcina.comedic good performance, I avoid the surgery.

. : Can you specify your current indications?

: For the fractures of the femur the indication is quasi systematic after 6 years. Front, it forwards little interest. Replanning is sufficiently effective to tolerate important vicious cal. The csotcina.comedic processing relatively short and is well tolerated. Moreover the child who has two pins on the level of the knee generally the functioning begins again only after the ablation of the hardware. The thus does not bring of time-saver, nor of comfort and does not have great interest. Beyond that, the csotcina.comedic processing becomes constraining, long and uncomfortable. The vicious cal in particular in valgus-varus are reorganized incompletely. After 6 or 7 years, the fractures of the femur are thus spit.

On the level of the front armlever, the situation is a little similar for other reasons. The csotcina.comedic processing does not have anything painful but the reduction must be perfect and the risks of displacement under plaster are high. Before 6 years, replanning is sufficient and the is not essential. Beyond, I always test an csotcina.comedic reduction, then I carry out a in the event of failure or of instability.

The fractures of the lower end of the radius are not, with my direction, an indication; if they are sometimes difficult to reduce, they are generally stable and a secondary rocker is easy to begin again by replanning of the soft cal.

The fractures of the neck of the humerus are very accessible to the csotcina.comedic processing, but they are often very unstable. The brings a definitely higher comfort and especially it abolishes the initial painful long period.

The supra-condylar fractures are spit when the method of is not possible.

Finally the fractures of the tibia are operated only when it is not possible to obtain an correct alignment by plaster, or in specific circumstances (., neurology…).

. : For do the fractures of the femur you have a higher age limit for the ?

: On this point, the limit is not very defined. The welding of the cartilage of the great trochanter could constitute a good reference mark, because it is then possible to put a locked nail which is not very large gauge and which gives a good immobilization, on the other hand the risk of femoral head necrosis persists and some prefer to preserve the beyond the welding of the cartilage as long as the patient is discussed in a department of pediatric csotcina.comaedics.

. : Where is the dissemination of the method on the national plan, European and international?

: I do not know the exact calculation of the number of realized, but the conversations with our foreign fellow-members show that the is now used in a usual way in Switzerland, Belgium, Spain, Germany; it is also well-known in the Maghreb countries, in Israel, and in Lebanon; it starts to be employed in England. On a more international level, some teams have used it for approximately ten years and start to publish their results in the USA, in Australia and South America.

. : Do you think that it is necessary to be a surgeon pediatrist to discuss the fractures of children correctly?

: On the geographical level, there are not sufficient departments of pediatric csotcina.comaedics so that all the children traumatized there are transported within an acceptable time, he is thus necessary that the surgeons of general surgery or the csotcina.comedists of adults can deal with the fractures of the child. On the technical plan, any surgeon, csotcina.comedist or general practitioner, Officials sufficient gestures and techniques to be able to discuss the majority of the fractures of the child, this obviously on the condition of knowing the characteristics of pediatric traumatology, in particular the operation of the periosteum of the child and cartilage of conjugation.

. : You in Lorraine, do you come exert from this area?

: I am a Lorrain old man of adoption. All my family is resulting from Turns even, the name as for him is Vendean. My father came to work in Lorraine when which I had 7 years, and since I carried out all my schooling like my secondary studies in Nancy, then I settled in Metz in 1984.

. : How were you attracted by medicine, then towards the pediatric surgery?

: I was always attracted by sciences, physics and work asking for a certain manual skill, in addition, I had relatively little provisions for the literary disciplines. When I was child and adolescent, the surgeons fascinated me because they were able to repair the extraordinary mechanics of the human body. But my family did not understand any doctor, and this completely unknown world appeared inaccessible to me.

After the vat, an university, preferably in mechanics, would have enabled me to remain in the family rail, but the surgery had the attraction of the unknown, and this channel filled my interest for sciences, physics, and manual work. A posteriori, I do not regret this choice, and I wonder even sometimes if I could have made another thing.

. : During were your formation which your Masters?

: I would like to quote in first the instructor Jacques , Neurochirurgien, unfortunately too quickly missing. My first training courses of intern did not encourage me to continue the surgery, I had rather had the impression to be only the agent with the stapler with skin, which was to be always present, with which one did not owe anything, and especially not of explanations. Jacques , it, stopped everywhere, constantly to explain a file, an indication, an attitude; as an operating-room, he commented on each one of his gestures. At 2 o'clock in the morning, after an urgency, it could still spend an hour to be taught. He wanted especially that its interns understand; he was against the automatically repeated dogmas. It arrived to him for example, to frequently ask an examination (radio, biological or different) useless, it invented imaginary syndromes or interventions to then reprimand the intern who carried out his command or repeated his remarks without reflecting. He taught me two main things: never not to accept information without understanding it or it to check, and seek another channel if the solutions suggested do not appear satisfactory.

The pr. R , was a vascular surgeon of a fabulous control and an address, but who never put himself ahead. He insisted to render comprehensible that in surgery nothing was to be randomly left, that the intervention belongs to a whole since the consultation until the cure, and that one should not neglect any the stages, in particular the technical realization, often considered as secondary after the indication.

J. Provost finally drew my attention to the interest of the pediatric surgery at one time when I intended myself rather, with the neurosurgery. Then, they are the founders of the , mainly H. , . and P. at which I accomplished several short stays which taught me the bases from the pediatric csotcina.comedics, and gave me what one could describe as spirit .

. : How did you arrive at Metz?

: I would have liked to remain in the bosom of the , and I remained a long time assistant, then pH. When I understood that no place would be available before an unlimited time, I sought a place where I could exert in in an exclusive way. The private practice did not try me; Luxembourg had proposed to create a post of teaching, but the administrative problems did not seem to find of fast solution. In Metz, I found the conditions ideal, in a not-for-profit hospital. I have a department of pediatric csotcina.comaedics in time to with it that paid surgeon full-time, or almost, because my consultation takes place in deprived. I have in addition a vacation in the center of rehabilitation of where I keep a monthly consultation, and a vacation in the department of pediatric csotcina.comaedics of Pierre with which we organize common meetings of work.

. : Do you take part in the assumption of responsibility of pediatric traumatology urgently?

: In theory not, because I am alone and that it is not possible to ensure all the urgencies. But when those are forwarded in the course of the day and that it is possible to insert them in the operational board or after the consultation, I accept them readily. That represents nevertheless a great number of urgencies, because the major section of the accidents implying of the children takes place before 19 or 20 hours, except in summer.

. : Do you regret having left the university and the function of teaching?

: I could tell yes and not. First of all yes, because I liked much teaching; to make exchange rate, to explain to external and the interns, interested me much. The structure of search that the university offers was very important, for me which am very attracted by the new channels.

But in Metz, I found an work environment very favorable, a hospital equipped very well, a team of high level surgeons, very welded in whom it is very pleasant to work so much on the technical plan, which relational. In addition, even if that is difficult, I kept many links with the of which I was the treasurer, then the secretary, and maintaining the chairman. The various work days of the make it possible to preserve part of the research activity and publication which one is supposed to have in academic world.

. : How do you imagine the future of the profession of csotcina.comedic surgeon pediatrist within sight of the family requirements and of sedentary obsession and indemnitee?

: The occupation of csotcina.comedic surgeon pediatrist is now well delimited as well in term of activity as on the geographical level. The interns seem very interested by this very innovative speciality in the very varied interventions, but little intend themselves there, and the posts of head of private clinic are difficult to provide. If the possibilities of installation currently appear rare, in the near future, the vacancies are likely to be numerous.

The relationship between surgeon and families becomes certainly complicated a little, but that is not specific to our discipline. Sometimes the litigious spirit which develops in the public is likely to encourage us to decide not only for the good of the patient on purely scientific concepts, but also to avoid the nuisances of possible legal continuations. It is a drift which is very dangerous because one will direct oneself towards bastard attitudes, which probably will not undoubtedly protect the surgeon, but who on the statistical level will certainly not offer to the patient the best chances of success.

. : You are currently the organizer of a seminar of teaching of the which is held in close to Metz, which are the topics and which audience you targeted for this meeting?

: The area Is France has a long vocation of traumatology. There is 12 years the seminar of Strasbourg organized by Jean Michel was already devoted to the processing of the fractures in the child.

The seminar counts on the presence of the interns and senior registrars intending itself for the pediatric csotcina.comaedics. They represent the hard core of the assistance present each year. But according to the tackled subject, of many other specialities can be interested. In , the topic was gravitational for many doctors A&E doctor, general surgeons, pediatrists, or csotcina.comedists of adult. They represented a third party of the assistance, and if I believe of them the discussions of corridors, they appreciated the message, but also the way of which it was disseminated, and large family the side of the .

. : In which form teaching it is practiced in this seminar?

: We try not to be conventional, and without escaping some masterly conferences, we privilege more alive means of communication and as much as possible implying the audience; match between two speakers defending two different techniques, video, presentation and discussion of files by young people.

. : The csotcina.comedists pediatrists initiated the formulas of teaching per seminar with topic, thereafter appraisals by the surgeons of adult; when did take place the first seminar of the ?

: The first Seminar organized in this spirit did not have label yet. It had been organized by and A. with in 1977, with “the cartilage of growth” for topic. This meeting was used as springboard for the constitution of the , founded in 1982, then the organization of the following seminars. It is amusing to note that the majority of the speakers present here at were listeners on the test rigs of at that time.

. : This formula knows a priori a great success since the number of registered voters does not cease increasing.

: The assistance generally turns around 200 participants. According to the topic chosen, other specialities like the pediatrists, neuro-pediatrists, doctors of physical therapy, radiologists, rheumatologists, take part in the meeting. The very specialized subjects seem to attract a less important audience, because only the csotcina.comedists are present. Pediatric traumatology remains always a wide field which interests in addition much of csotcina.comedists of adults and general surgeons. This explains the increase in registered voters in this specific topic.

. : The preceding seminar devoted to traumatology took place there is a dozen years: does this time represent for you the cycle of renewal of knowledge on the subject?

: Not inevitably: in the field of traumatology in particular, there no was novel method; however, those which were rather recent at the time now reached their maturity. Their advantages, their complications difficulties and disadvantages are better known. Their indications were refined by it, and it was important to take stock.

But it should not be forgotten that the Seminar is intended for teaching and, even if in a specific field, knowledge do not seem much to have evolved/moved on a 10 years cycle, audience, him, is constantly renewed.

. : How is the seminar compared to traditional teaching with faculty and the continuing education organized by the learned societies, according to you?

: With faculty teaching is a lecturing, intended for not differentiated students. It is thus not also precise and excavated that the being can teaching only one exempts with the seminar. In the departments of pediatric csotcina.comaedics the interns profit from a more pointed teaching but also more directed. The experiment of the service or the school which developed the techniques used locally generally refer.

The purpose of the seminar is especially to take stock at one given moment on a preset topic which will be explored thoroughly, since the fundamental matters, until the therapeutic one while passing by the history, investigations etc the participants must set out again while knowing exactly which is the state of our knowledge at the time of the meeting. He is requested from the lecturers, to avoid forwarding too specific or personal designs and to forward all the manners of seeing and of solving a problem. A vast space is reserved for the discussion of files with young people.

With the difference of the learned societies it is not provided for meetings of specific communications. In fact the seminar approaches rather to a very complete teaching and especially interactive with an important participation the audience.

. : You the chairman of the , can you are this year forward the group to us and be defined his mission?

: The was founded 20 years ago, by an small group of csotcina.comedists pediatrists. It succeeded the of P. , H. , H. , Mr. , . , to which joined. , R. , B. , JP. , Mr. , H. , J. … all conscious of the inexistence of nationwide teaching in this discipline. The speciality was rather badly delimited at the time. Few surgeons exerted exclusively in pediatric csotcina.comaedics (OP), the majority shared this activity with a practice in visceral infantile surgery, or adult csotcina.comedy. The services of COp were generally a small department within a unity of pediatric surgery or general csotcina.comedy.

The first mission of the was and remains the teaching of the pediatric csotcina.comedics. But beside that it is the loving one which ensures cohesion between the csotcina.comedists pediatrists. It developed an identity of .

The group is now well structured understanding more than embers to which all the COp belong of which it in addition ensured the formation. Currently, very few surgeons not belonging to our group exert this discipline.

. : Which is the role of the chairman of the ?

: The group chief executive has a role of representation near other society and apart from France. The members of the office are elected for 4 years, and are renewed per half, which ensures the continuity of the share of the . Each chairman brings his personal touch there while developing according to his sensitivity and his poles of interest, a specific sector; search, the bibliography, the relationship with a foreign company…

. : How does one become member of the ?

: It is initially necessary to exert exclusively into csotcina.comedic pediatric. To be a senior registrar or hospital practitioner in a department of pediatric csotcina.comaedics. Then, it is necessary to be made sponsor by two current regular members. There exist also honorary members, corresponding associated members and members who are not surgeon but whose activity brings them closer to our speciality like the , doctors of pediatric rehabilitation, the pediatrists rheumatologists, certain neurosurgeons of children and certain fundamentalist doctors in biology, pathological anatomy, etc….

. : Is your son currently house surgeon, he intends himself for the pediatric csotcina.comedics?

: Yes, but I do not think that it is with the purpose of following the same channel as his/her father. Initially, it appeared to turn towards the neurosurgery, but following its training course in pediatric csotcina.comedics it chose our speciality which interested it much by the variety of pathologies met and the remaining number of fields to explore.

. : Are we referred to the seminars of teaching, which the other scientific activities organized by the ?

: Because of its Bi-membership, the organizes 2 regular official annual meetings, one within the framework of the congress of the in September, the other Monday preceding that by the lasting which one half-day is reserved for the pediatric csotcina.comedics.
Other less regular meetings are generally organized with a foreign group, this year, J-pH organized an excellent meeting with our British fellow-members in Toulouse.
The in addition created a price of thesis given each year to best work in pediatric csotcina.comaedics. Lastly, it organizes studies, and proposes purses of voyage.

. : Which are the links with European society of pediatric surgery?

: The was the first society of pediatric csotcina.comedics structured in Europe. When the was created, little of members of the were admitted there and now, we represent the most important quota there.
We maintain the very tight links with practically all European society with which we organize common day's works regularly. Many bonds of friendship were created between the members of the and a certain number of fellow-members outside the hexagon and much among us are regularly invited abroad to intervene in an exchange rate, a congress, or a meeting…

. : Work and the publications of the have for you a consensual value of good practice of the profession?

: It is difficult to define this concept of “good practice” because at the same moment several solutions can be regarded as good.
The is a group of search, it needs to explore various channels, and to let express opinions very varied to progress. At our meetings great diversity of the designs and exposed solutions reflects the dynamism of our members. In almost all the fields (clubfoot, congenital dislocation of hip, traumatology, scolioses for example) much of attitudes currently allowed and considered as conventional are the prolongation of work forwarded to the .
The seminar, has a didactic aim to him, it must thus make known all the existing solutions, those which are recognized bad by majority, those which are allowed by the majority even by those which do not use them, finally those which are used only by some, and badly known by the others, generally because they are new methods.
We thus try to guide our younger colleagues towards than one can regard indeed at this time as “the good practice of the profession” to take again your term.

. : One often forwards to you like a brilliant bubbling inventor of new ideas. Can you give us some examples of them?

: I believe that many surgeons are inventors, and like much, when a technical epic appears difficult to me, or not very satisfactory; when a problem seems unsolved, I seek a solution, preferably simple. Often, the ideas come to me during another intervention, even apart from the framework of the surgery, because a gesture, an instrument could bring a beginning of solution to the problem that I was posed the day before. It then sometimes happens to me to spend a few hours with a paper in a pencil to refine the solution. I avoid the bibliography which directs too the reflection and it is only after having found that I seek if my solution were already proposed, which is often the case. Sometimes, the idea appears new, or at least not published, if you want some examples here:
I had drawn a goniometer with two hinged jibs, allowing me to directly read the angle of a scoliosis without carrying out geometrical constructions on the radiograph.
At the request of I defined the characteristics of an aircraft for the processing of the clubfeet.
The “” builds with a pointer with , a bottle of serum and a pipe of perfusion made it possible to monitor and avoid the obstruction of the digestive probes used in the of the esophagus.
The by percutaneous screwing.
I had asked for the Faculty of Science of Metz to study a technique to study the hip; several radiographs were carried out, while turning each time the hip of 20° around the axis of the neck, then a computer software made it possible to rebuild in 3D the epiphysis. We obtained very realistic images, and a scientific thesis had been carried out on this subject. Since, to scan it developed, and this idea lost its interest.
A small astuteness in last example - because often my ideas are technical astutenesss to facilitate the life to me consists, during an osteotomy of , to tilt by means of a pin used like lever, rather than to take a grip with field which tears off the antéro-lower spine regularly. A large thread spindle of external fixer is screwed under the feature of the osteotomy, in the antéro-lower spine to the sciatic notch, in the thickness of the hip bone. One can use this pin as lever, which makes it possible to reorientate in a more precise way the with only one hand, the other remains free to position the graft.  

. : One also tells you musician at your lost hours?

: It is exact, I am impassioned by the music in all the forms. I buy many discs (I have approximately 1500 CD) in all the kinds and I attend with the same pleasure the conventional concerts, as with those of jazz and even of rock'n'roll or varieties. But, if I like to listen, I prefer by far to play, it is almost a drug. I had a first price of academy of Piano, and, since my beginnings with the 8 years age, I believe that I never ceased playing. I try to work regularly, but it is difficult to find the 6 to 7 a.m. in the week, minimum essential to maintain its technique and to learn the pieces which interest me. My formation is unfortunately only conventional, and I am with my great despair unable to play of the jazz or the variety, kinds user-friendly and festive that the conventional one which offers a more solitary pleasure.

. : Do you have other passions?

: In fact much of things interest me, and I have much evil to devote myself to an activity without me to invest thoroughly there, which is not at all easy with a trade as demanding as the surgery.
I always practiced at least a sport regularly, the physical exercise relieves of the daily stress and decreases the state of mental voltage which we maintain. I do not have now any more the drive nor a physical shape sufficient for the constraining sports, and like much, I put myself at the Golf. Besides this activity has a philosophy rather close to that of the surgery; it imposes a different comprehensive strategy on each hole, the choice of the good instrument for each gesture, much of address, drive, and the experiment. The technical epic is carried out by that which conceived it as in our trade

. : Summers you an optimistic surgeon?

M: In my trade I have tendency, as in the life in general, with being rather optimistic, and besides I deplore a little the fact that this frame of mind, in our medium, is often compared to a certain unconcern, or an over-estimate of its capacities. I fear, like each one among us, these complications which do not save any surgeon. It is essential to keep in mind them to be able to avoid the majority of it. But the statistics plead in favor of the surgery, and I imagine badly that one can operate a patient if it is not thought reasonably that one will improve it. Which funambulist would go up on his yarn which mountaineer would climb a wall if he thought that he will fall from there?
However, I am anxious for the future of our profession especially with regard to his conditions of exercise. The legal and administrative contingencies are increasingly present; they reduce our effective time of care and take a place which they should not have in the therapeutic indication. It should not be forgotten that the technical component of our activity conditions most of the result, and that like any practical activity, the quality of the gesture depends on the address of each one, of its experiment, but also of its daily drive. I doubt that the reduction of the time spent as an operating-room and the number of acts carried out, induced by time spent to fill a growing number of papers, improves patient safety.