Publications (11)11.66 Total impact

  • Revue de Chirurgie Orthopédique et Traumatologique 11/2012; 98(7):S297. DOI:10.1016/j.rcot.2012.08.059
  • Resuscitation 11/2011; 97(7). DOI:10.1016/j.rcot.2011.08.186 · 3.96 Impact Factor
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    ABSTRACT: La indicación de una resección-reconstrucción ósea en niños, se plantea esencialmente ante tumores malignos. Las pruebas de imagen iniciales incluyen la resonancia magnética (RM), la cual es esencial y permite delimitar mejor las zonas de resección. La afectación sobre el crecimiento se debe de tener en cuenta en la medida de lo posible, ya que a menudo los tumores se hallan próximos a las placas de crecimiento. Los procedimientos de reconstrucción pueden ser biológicos o protésicos. Los procedimientos biológicos se basan en autoinjertos vascularizados diafisarios o epifisarios o bien pueden consistir en la técnica de membrana inducida o aloinjertos. La reconstrucción mediante prótesis requiere a menudo prótesis de crecimiento que permitan limitar los problemas derivados de la desigualdad de los miembros. En algunos casos la asociación de procedimientos biológicos y prótesis puede ser útil. Los procedimientos de reconstrucción deben tener en cuenta el resultado funcional a corto y a largo plazo.
    12/2010; 2(2):1–15. DOI:10.1016/S2211-033X(10)70085-2
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    ABSTRACT: Introduction Dans la classification de Wassel le type IV correspond à une duplication au niveau de l’articulation métacarpophalangienne (MCP) du pouce et représente plus de la moitié des cas. Il est subdivisé en quatre types dont le type IV-D ou divergent (9 %) représente la forme la plus complexe puisque les deux hémipouces sont hypoplasiques avec une divergence au niveau de la MCP et une convergence au niveau de l’interphalangienne. Dans le traitement des types IV-D, la méthode de reconstruction d’un des deux hémipouces expose à des déviations et à l’instabilité alors que le procédé de Bilhaut-Cloquet pose souvent un problème de dystrophie unguéale. Afin d’éviter ces complications, nous proposons une procédure de Bilhaut-Cloquet modifiée et nous rapportons les résultats préliminaires de quatre cas. Patient et méthode Quatre garçons présentant une duplication du pouce de type IV-D ont eu une reconstruction du pouce selon une procédure de Bilhaut-Cloquet modifiée. L’âge moyen lors de l’intervention était de 11 mois (dix à 12 mois). Technique chirurgicale On trace préalablement les futures incisions avec une résection cutanée centrale emportant la totalité de l’ongle du pouce le plus hypoplasique (le radial le plus souvent). Au niveau osseux, on réalise une ostéotomie longitudinale des phalanges proximales sur toute leur longueur en réséquant la partie centrale. Au niveau de la base de la phalange distale de l’hémipouce ulnaire (le moins hypoplasique), on réalise une ostéotomie oblique avec résection du coin radial. Au niveau de la base de la phalange distale de l’hémipouce radial, le même type d’ostéotomie est réalisé mais avec conservation du coin basal radial. Une ostéosuture est réalisée au niveau des hémiphalanges proximales et au niveau de la moitié des bases des phalanges distales. Ainsi, on obtient une réaxation et une stabilisation de l’interphalangienne sans avoir recours à un geste unguéal. Résultats Les quatre enfants ont été revus avec un recul moyen de 24 mois (12 à 36 mois). Les résultats selon le score de Horii ont été jugés bons dans tous les cas. Discussion et conclusion Cette technique associe une résection centrale des phalanges proximales et une résection partielle au niveau de la base des phalanges distales. Elle permet la réaxation-stabilisation de l’articulation interphalangienne tout en évitant le problème des dystrophies unguéales puisqu’un seul ongle sera conservé. Les résultats préliminaires sont encourageants puisque aucune déviation ou instabilité n’a été notée et qu’il n’y a pas de dystrophie unguéale. Cependant ces résultats devront être confirmés par une étude à long terme. Niveau de preuve IV rétrospectif.
    Resuscitation 09/2010; 96(5):594-598. DOI:10.1016/j.rcot.2010.05.012 · 3.96 Impact Factor
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    ABSTRACT: In the Wassel type IV classification category, the thumb is duplicated from the metacarpophalangeal joint; this abnormality accounts for approximately 50% of the cases of thumb duplication. Type IV is divided into four subtypes in which the IV-D type, or convergent (9% of cases), is the most complex form because both thumbs are hypoplastic with a divergent metacarpophalangeal joint and a convergent interphalangeal joint. Reconstruction is prone to axis deformity and ligament laxity, whereas the Bilhaut-Cloquet technique's main pitfall is nail dystrophy. We propose a modified Bilhaut-Cloquet procedure to avoid these complications. Four males (mean age: 11 months; range: 10-12 months) with IV-D thumb duplication were operated on using a modified Bilhaut-Cloquet procedure. The skin is preliminarily marked, taking into account the excision of the central skin and the more hypoplastic nail of the two (most often the radial nail). Both proximal phalanges are split longitudinally and the central halves discarded. An oblique osteotomy is performed at the base of the distal phalanx of the ulnar thumb duplicate (the less hypoplastic) and the radial wedge is excised. The same osteotomy is applied to the distal phalanx of the radial thumb duplicate, but the radial wedge is preserved. The proximal phalanx and the bases of the distal phalanx are joined by bone suture. Axis correction and ligament stability are thus achieved without nail surgery. The patients were examined with a mean 24 months of follow-up (range: 12-36 months). The result was good in all four cases according to the Horii score. This procedure combines an excision of the central part of the proximal phalanx and partial excision of the base of the distal phalanx. It provides axis correction and stabilization of the interphalangeal joint while avoiding subsequent nail dystrophy because a single nail is preserved. Preliminary results are encouraging: no axis deformity, instability or nail dystrophy has been noted. Nonetheless, the long-term results need to be evaluated. IV retrospective study.
    Orthopaedics & Traumatology Surgery & Research 09/2010; 96(5):521-4. DOI:10.1016/j.otsr.2010.01.013 · 1.17 Impact Factor
  • 01/2009; 4(4):1-16. DOI:10.1016/S0246-0467(09)48879-2
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    ABSTRACT: Retraction of the shoulder in internal rotation is observed in 25% of children with brachial plexus birth palsy (C5, C6 +/- C7). Early bone and joint deformities affecting the glenohumeral joint are the consequences. The stiff internal rotation requires surgical release which can involve the capsule and ligaments, muscles, or both. Internal release can be combined with muscle transfer to improve active external rotation. We report the results obtained with arthroscopic anterior capsular release combined with latissimus dorsi transfer. From 1999 through 2006, fourteen children with a stiff shoulder in internal rotation secondary to brachial plexus birth palsy were managed in our unit. All had recovered biceps function six months after surgery. The glenohumeral dysplasia was analyzed on the preoperative magnetic resonance imaging. Pre- and postoperative passive external rotation (RE) were measured with the arm along the body and at 90 degrees elbow flexion. Internal rotation was measured using the Mallet score (hand-back test). Combined active abduction antepulsion was measured when the child was playing. Mean age at surgery was three years six months. Arthroscopic internal release was performed for eight children. All had an associated latissimus dorsi transfer. Among the 14 children managed in the unit, arthrolysis was not be performed in six, either because of the lack of an adequate electrode (two patients) or because the child presented posterior glenohumeral dislocation making it impossible to introduce the optic channel (four patients). Arthroscopic anterior release was performed for the eight other patients. These eight patients were reviewed at a mean three-year follow-up. Passive external rotation was improved, with a mean gain of 60 degrees with no recovery of passive internal rotation. The abduction antepulsion movement was also improved, mean gain 90 degrees . A stiff shoulder in internal rotation can develop during the first two years of life. Several techniques have been proposed for internal release. The origin of the progressive limitation of passive external rotation remains a subject of debate. Is it due to retraction of the internal rotators, or to capsule-ligament retraction, or both? In 1992, Harryman et al. demonstrated the role of the capsule and the coracohumeral ligament in limiting external rotation. Consequently, we have opted for early release (less than two years of age) using an arthroscopic method limited to the capsule and ligaments. Our results for passive external rotation are comparable to those reported by others. However, this technique enables preserved mobility for internal rotation. Arthroscopic anterior release limited to the capsule and the ligaments is an effective, minimally invasive technique. Leaving the internal rotator muscles intact preserves internal rotation of the shoulder and reduces the risk of anterior instability.
    Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 12/2008; 94(7):643-8. · 0.55 Impact Factor
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    ABSTRACT: Purpose of the studyRetraction of the shoulder in internal rotation is observed in 25% of children with brachial plexus birth palsy (C5, C6 ± C7). Early bone and joint deformities affecting the glenohumeral joint are the consequences. The stiff internal rotation requires surgical release which can involve the capsule and ligaments, muscles, or both. Internal release can be combined with muscle transfer to improve active external rotation. We report the results obtained with arthroscopic anterior capsular release combined with latissimus dorsi transfer.Material and methodsFrom 1999 through 2006, fourteen children with a stiff shoulder in internal rotation secondary to brachial plexus birth palsy were managed in our unit. All had recovered biceps function six months after surgery. The glenohumeral dysplasia was analyzed on the preoperative magnetic resonance imaging. Pre- and postoperative passive external rotation (RE) were measured with the arm along the body and at 90° elbow flexion. Internal rotation was measured using the Mallet score (hand-back test). Combined active abduction antepulsion was measured when the child was playing. Mean age at surgery was three years six months. Arthroscopic internal release was performed for eight children. All had an associated latissimus dorsi transfer.ResultsAmong the 14 children managed in the unit, arthrolysis was not be performed in six, either because of the lack of an adequate electrode (two patients) or because the child presented posterior glenohumeral dislocation making it impossible to introduce the optic channel (four patients). Arthroscopic anterior release was performed for the eight other patients. These eight patients were reviewed at a mean three-year follow-up. Passive external rotation was improved, with a mean gain of 60° with no recovery of passive internal rotation. The abduction antepulsion movement was also improved, mean gain 90°.DiscussionA stiff shoulder in internal rotation can develop during the first two years of life. Several techniques have been proposed for internal release. The origin of the progressive limitation of passive external rotation remains a subject of debate. Is it due to retraction of the internal rotators, or to capsule–ligament retraction, or both? In 1992, Harryman et al. demonstrated the role of the capsule and the coracohumeral ligament in limiting external rotation. Consequently, we have opted for early release (less than two years of age) using an arthroscopic method limited to the capsule and ligaments. Our results for passive external rotation are comparable to those reported by others. However, this technique enables preserved mobility for internal rotation.Conclusion Arthroscopic anterior release limited to the capsule and the ligaments is an effective, minimally invasive technique. Leaving the internal rotator muscles intact preserves internal rotation of the shoulder and reduces the risk of anterior instability.
    Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 11/2008; 94(7):643-648. DOI:10.1016/j.rco.2008.01.003 · 0.55 Impact Factor
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    Archives de Pédiatrie 07/2006; 13(6):766-9. · 0.41 Impact Factor
  • Archives de Pédiatrie 06/2006; 13(6):766-769. DOI:10.1016/j.arcped.2006.03.137 · 0.41 Impact Factor
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    ABSTRACT: The effects of percutaneous Ethibloc (Ethicon/Johnson & Johnson, St-Stevens-Woluwe, Belgium) injection into primary aneurysmal bone cysts were analysed. Two patients with a venous drainage after injection of a medium contrast were excluded. Twelve patients underwent at least one percutaneous injection of Ethibloc. The average follow-up period was 5.1 years. At final follow-up, six patients had complete healing of the cyst, three had partial healing and three, who had no response, were treated by curettage and bone grafting. Complete healing was observed for all the aggressive lesions. No major complications were noted. Ethibloc injection may be performed as a primary treatment of aneurysmal bone cysts if the technique is followed with precision.
    Journal of Pediatric Orthopaedics B 09/2005; 14(5):367-70. DOI:10.1097/01202412-200509000-00010 · 0.66 Impact Factor