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Publications (16)6.89 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The development of reconstructive surgery of the lower limbs aimed at multilevel correction demands a precise knowledge of the physiological variations in general radiological parameters of the lower limbs in children of various age groups. It is crucial in systemic skeletal diseases, when deformities affect limbs and the surgeon does not have an intact limb as a reference. The aim of this retrospective study was to establish the normal radiological values of lower limb parameters used in the surgical correction of deformities in children of various age groups.
    Skeletal Radiology 07/2014; · 1.74 Impact Factor
  • 88e Réunion annuelle de la SOFCOT; 11/2013
  • European Orthopaedics and Traumatology 09/2013; 5(2):175-179.
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    ABSTRACT: Introduction The issue of prognosis in limb length discrepancy in children affected by congenital abnormality remains a subject of concern. Therapeutic strategy must take length prediction into account, to adapt equalization techniques and the timing of treatment. Initial prognosis, however, may need revising after completion of one or several surgical interventions on the pathologic limb. The aim of this study was to determine the different types of growth response that a bone segment can present after progressive lengthening in case of congenital limb length discrepancy. Materials and methods A series of 114 bone lengthenings with external fixator, performed in 36 girls and 50 boys with congenital lower limb length discrepancy, was retrospectively analyzed. Bone segment growth rates were measured before lengthening, during the first year after frame removal and finally over long-term follow-up, calculating the ratios of radiological bone length to the number of months between two measurements. Mean follow-up was 4.54 ± 0.2 years. Results Changes in short- and long-term growth rate distinguished five patterns of bone behavior after lengthening, ranging from growth acceleration to total inhibition. Discussion These five residual growth patterns depended on certain factors causing acceleration or, on the contrary, slowing down of growth: age at the lengthening operation, percentage lengthening, and minimal period between two lengthenings. These criteria help optimize conditions for resumed growth after progressive segmental lengthening, avoiding conditions liable to induce slowing down or inhibition, and providing a planning aid in multi-step lengthening programs. Level of evidence Level IV. Retrospective study.
    Orthopaedics & Traumatology Surgery & Research 10/2012; 98(6):621–628. · 1.06 Impact Factor
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    ABSTRACT: Introduction L’établissement du pronostic d’inégalité de longueur chez les enfants atteints d’anomalie congénitale reste toujours un sujet de préoccupation. La stratégie thérapeutique doit tenir compte du pronostic en longueur, afin d’adapter à la fois les techniques d’égalisation et la chronologie des traitements. Cependant, il apparaît que le pronostic initialement calculé peut être faussé, dès lors qu’une ou plusieurs interventions chirurgicales ont été effectuées sur le membre pathologique. Objectif Le but de cette étude est de définir les différents types de réponse de croissance que peut présenter un segment osseux après un allongement progressif, dans le cadre des inégalités de longueur d’origine congénitale. Patients et méthodes Nous avons analysé de manière rétrospective une série de 114 allongements progressifs par fixateur externe, réalisés chez 36 filles et 50 garçons, ayant tous une inégalité de longueur des membres inférieurs d’origine congénitale. Nous avons mesuré les vitesses de croissance des segments osseux avant l’allongement, puis durant la première année suivant l’ablation du fixateur et enfin à long terme, en calculant les longueurs radiologiques osseuses rapportées au nombre de mois entre deux mesures de longueur. Le recul moyen est de 4,54 ± 0,2 ans. Résultats Les modifications des vitesses de croissance à court et long terme ont permis de mettre en évidence cinq types différents de comportement osseux après un allongement progressif, allant de l’accélération de la croissance jusqu’à l’arrêt définitif de celle-ci. Discussion Ces cinq types de croissance osseuse résiduelle sont sous la dépendance de certains facteurs qui conditionnent l’accélération ou au contraire le ralentissement de la croissance. Il s’agit de l’âge au moment de l’allongement, du pourcentage d’allongement et du délai minimal entre deux allongements. La connaissance de ces critères permet d’optimiser les conditions de reprise de croissance après un allongement segmentaire progressif, tout en évitant celles qui risquent d’entraîner un ralentissement ou un arrêt de la croissance du segment allongé. Il s’agit d’une aide à la planification d’un programme d’allongement, lorsque celui-ci est itératif. Niveau de preuve Niveau IV étude rétrospective.
    Revue de Chirurgie Orthopédique et Traumatologique 10/2012; 98(6):551–559.
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    ABSTRACT: But La plupart des techniques d’allongement de l’avant-bras impliquent l’utilisation d’un fixateur externe pour permettre un montage stable et imposer la distraction souhaitée. Nous proposons l’association d’un tuteur intramédullaire par embrochage centromédullaire élastique stable (ECMES) à un fixateur externe circulaire dans cette indication à l’avant-bras. Le but de cette étude était de comparer l’allongement classique mené à l’aide d’un fixateur externe circulaire et cette technique combinée. Méthode Cinquante-sept patients, traités pour des inégalités de longueur ou des déformations antébrachiales congénitales et acquises, ont été suivis de façon prospective. Les patients étaient divisés en deux groupes : 35 avec fixation externe seule, et 22 avec association ECMES – fixation externe. Les patients ont été suivis cliniquement et radiologiquement, jusqu’à un recul moyen de 21 mois après retrait du fixateur. Résultats L’allongement moyen était de 45 mm pour les deux groupes. L’index de consolidation moyen (IC) était de 22,2 j/cm avec la technique combinée et de 32,0 j/cm avec la fixation externe seule, soit une réduction de 30 %. La technique combinée était par ailleurs associée à un taux de complications plus faible. Discussion et conclusion Bien que l’allongement progressif de l’avant-bras reste toujours une procédure longue pour nos patients, l’association de l’ECMES au fixateur externe permet de diminuer le temps de fixation externe associé. Aucune complication surajoutée due à l’ECMES n’a été enregistrée, et les complications osseuses de l’allongement semblent réduites par l’usage de cette technique. Nous recommandons cette technique désormais appliquée à la plupart de nos patients justifiant d’un allongement à l’avant-bras. Niveau de preuve IV.
    Revue de Chirurgie Orthopédique et Traumatologique 06/2012; 98(4):335–341.
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    ABSTRACT: Most of the techniques for forearm lengthening involve external fixation to achieve stability and provide progressive distraction. We introduce the use of elastic stable intramedullar nailing (ESIN) in combination with external circular assembly for the procedure. The purpose of this prospective study was to compare Ilizarov's classical technique with this combined technique. Fifty-seven patients, with forearm length discrepancies or deformities either congenital or acquired, were prospectively followed-up. Patients were divided in two groups: 35 had only external fixation, and 22 had external fixation-ESIN combined techniques. Patients were assessed for clinical and radiographic outcome with a mean follow-up of 21 months after external device removal. Overall lengthening was 45.0mm. Healing index (HI) was 22.2d/cm with the combined technique, and 32.0 d/cm with external fixation. HI was 30% better when ESIN was used, for congenital and for overall cases. Combined technique has a lower complication rate. Although forearm lengthening still remains a time-consuming procedure, ESIN can shorten external fixator wearing time. No additional complication occurred and bony complications seem to be limited by the nails. We recommend this technique, which we now use for most of our patients undergoing limb lengthening. Level IV.
    Orthopaedics & Traumatology Surgery & Research 05/2012; 98(4):376-82. · 1.06 Impact Factor
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    ABSTRACT: The aim of this study is to evaluate the influence of the external fixation associated with flexible intramedullary nailing (FIN) on the healing index (HI) in limb lengthening. We compared the healing index between 2 groups of children undergone the lengthening of upper and lower limbs carried out with the Ilizarov external fixator alone (group I, 194 cases of lengthening) or with the combination of the Ilizarov external fixator and intramedullary nailing (group II, 92 cases). Two nails of the diameter from 1.5 to 2.0 mm with the ray of curvature about 40 degrees to 50 degrees were used for the intramedullary nailing. The HI was less in every subgroup of Group II compared with Group I. A significant difference was noted in congenital pathologies: monofocal monosegmental lengthening at the level of femur and forearm, bifocal lengthening of the tibia, polysegmental lengthening; and in acquired discrepancy: monofocal tibial lengthening, bifocal femoral lengthening, and the forearm lengthening. The reduction of HI was between 60% and 85% in congenital pathologies: monosegmental femur and forearm, bifocal femur and tibia lengthening; and in acquired discrepancy: femur, tibia, humerus and forearm monosegmental lengthening, humerus and tibia bifocal lengthening, and polysegmental in upper and lower limbs. This difference varies from 1.9 days/cm to 19.1 days/cm. That means that the duration of the external fixator was decreased of 20% to 33% of the number of days between the Group I and the Group II. Maximum diminution of HI was noted for monofocal acquired forearm cases (51.3%) and bifocal acquired femoral lengthening cases which (59.9%). The flexible intramedullary nailing allows adding multiple advantages to the method of limb lengthening with the external fixator. Correctly applied the FIN indeed respects the bone biology that is essential during the limb lengthening. The major effect of application of the combination of Ilizarov frame fixation with FIN is a significant decrease of duration of the external osteosynthesis. II.
    Journal of pediatric orthopedics 12/2010; 30(8):910-8. · 1.23 Impact Factor
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    ABSTRACT: During progressive lower limb lengthening in the management of Ollier's disease, the mean bone-healing index usually reported in the literature stands around 35 days/cm. One of the therapeutic objectives is to reduce the duration of the external fixation. The use of an elastic stable intramedullary nailing system (ESIN) combined with a circular external fixator significantly reduces the healing index. Two groups of patients were compared. In group I, seven patients were operated on for progressive limb lengthening using a circular external fixator associated with an ESIN system: four monosegmental femoral lengthenings, one monosegmental tibial lengthening and two polysegmental femorotibial lengthenings. Nailing was performed via two intramedullary nails already used in traumatology. The date of external fixator removal coincided with that of radiographic healing. The nails were left in place. Group II included 37 patients who underwent limb lengthening by means of an external fixator only. The healing index was calculated and complications were analysed in both groups. The mean healing index (HI) values were: in group I: 23.3 days/cm for the femur, 22.4 days/cm for the tibia and 11.6 days/cm for polysegmental lengthenings ; in group II: 31.6 days/cm for the femur, 35.7 days/cm for the tibia and 19.9 days/cm for polysegmental lengthenings. Group I demonstrated a statistically significant decrease in the HI for monosegmental femoral lengthenings. A substantially reduced duration of external fixation, limited postoperative complications and prevention of later pathologic fractures are the reported advantages of the associated use of a circular external fixator with an ESIN system in the management of Ollier's disease. Level III, comparative retrospective study.
    Orthopaedics & Traumatology Surgery & Research 06/2010; 96(4):348-53. · 1.06 Impact Factor
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    ABSTRACT: Introduction Lors de l’allongement progressif des membres inférieurs dans la maladie d’Ollier, l’index de consolidation (healing index [HI]) généralement décrit dans la littérature se situe aux alentours de 35 jours/cm. Un des objectifs thérapeutiques est de diminuer la durée du port du fixateur externe. Hypothèse L’utilisation d’un embrochage centromédullaire élastique stable (ECMES) associé au fixateur externe circulaire diminue de façon significative l’HI. Patients et méthodes Deux groupes de patients ont été comparés. Dans le groupe I, sept patients ont été opérés d’un allongement progressif par fixateur externe circulaire associé à un ECMES : quatre allongements monosegmentaires du fémur, un allongement monosegmentaire du tibia et deux allongements polysegmentaires fémorotibiaux. L’embrochage consistait en l’utilisation de deux clous intramédullaires déjà utilisés en traumatologie. La date d’ablation du fixateur externe coïncidait avec la date de la consolidation radiologique. Les clous étaient laissés en place. Le groupe II comprenait 37 patients qui ont eu un allongement osseux par le seul fixateur externe. Pour les deux groupes, l’HI a été calculé et les complications ont été étudiées. Résultats Les valeurs moyennes de l’HI étaient : dans le groupe I : 23,3 jours/cm pour le fémur, 22,4 jours/cm pour le tibia et 11,6 jours/cm pour les cas polysegmentaires. Dans le groupe II : 31,6 jours/cm pour le fémur, 35,7 jours/cm pour le tibia et 19,9 jours/cm pour les cas polysegmentaires. La diminution de HI dans les cas du groupe I était statistiquement significative pour les allongements fémoraux monosegmentaires. Conclusion Les avantages de l’association du fixateur externe circulaire avec un ECMES dans la maladie d’Ollier sont la diminution réelle de la durée du fixateur externe, la diminution des complications postopératoires et la prévention de fractures pathologiques ultérieures. Niveau de preuve Niveau III, étude rétrospective comparative.
    Revue de Chirurgie Orthopédique et Traumatologique. 06/2010; 96(4).
  • Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 11/2007; 93(7):107-107. · 0.37 Impact Factor
  • Revue De Chirurgie Orthopedique Et Reparatrice De L Appareil Moteur - REV CHIR ORTHOP REPARAT APP. 01/2007; 93(7):107-108.
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    Revue De Chirurgie Orthopedique Et Reparatrice De L Appareil Moteur - REV CHIR ORTHOP REPARAT APP. 01/2004; 90(6):69-69.
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    ABSTRACT: We assessed an adaptation of the Ilizarov method aimed at a considerable reduction in the period of treatment for leg lengthening in order to limit complications related to the duration of the external fixation. This technique associates multiple segment lengthening, automatic high-frequency lengthening, and stimulation of bone regeneration by extemporaneous compression at the end of traction. We analyzed 78 cases of automatic fémur lengthening in 40 patients and simultaneous fémur and tibia lengthening in 38 patients. There were 51 men and 27 women, mean age 13.2 years (6 - 43 years). Mean length deficiency was 4.3 cm for the fémur and 3.5 cm for the tibia. Femoral and/or tibial deformations were observed in 32 patients. Minimal follow-up was 1.5 years. The automatic traction device was composed of the conventional Ilizarov fixator and complementary elements. Different assemblies were used depending on the associated deformations allowing their progressive correction. For 17 patients, radioimmunoassay of thyrocalcitonin and parathormone was performed to compare the time courses. Mean femoral lengthening achieved was 49 mm (8.5 to 20%). Mean tibial lengthening was 42 mm (7.2 to 18.8%). The consolidation index was 18.1 to 21.3 days/cm for single-segment lengthenings and 11.5 days/cm (mean) for two-segment lengthenings (taking into account both the femoral and tibial gain in length). The ideal moment of compression was 5.6 N/cm(2). Acceleration of the bone repairing process was evidenced by activation of the osteotrop hormone system. According to the SOFCOT classification of complications (1990), 60 patients (76.9%) were in category I, 15 (19.3%) in category II, and 3 (3.8%) in category III. Improvement of lengthening procedures with external fixators remains an important issue. Treatment periods are often long with consolidation indices for the femur ranging from 39.6 d/cm to 45 d/cm, which can lead to many types of complications. Use of a high-frequency progressive lengthening procedure based on the Ilizarov method considerably reduces the rate of complications compared with progressive lengthening methods and has allowed achieving more satisfactory results in a shorter treatment period. Multiple-segment lengthening using an automatic lengthening procedure set at 1 mm per day in four times provides an important reduction in the treatment delays since distraction is performed more rapidly and fewer steps are needed. Automatic high-frequency lengthening with the Ilizarov method provides optimal conditions for tissue regeneration: Treatment periods are shorter and anatomic and functional outcome is very satisfactory. Stimulation by extemporaneous compression of the regeneration zone allows a significant reduction in the duration of consolidation. Shorter delays to consolidation help avoid device-related complications.
    Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 06/2001; 87(3):248-56. · 0.37 Impact Factor
  • Dmitry Popkov, Pierre Journeau, Arnold Popkov
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    ABSTRACT: Purpose Multilevel surgeries with hip reconstruction in children with cerebral palsy require low morbid surgical interventions. The aim of our study is to compare results of application of two locking plates in hip reconstructive surgeries in children with cerebral palsy (CP) from the point of view of efficiency and morbidity of the intervention. Methods We performed a prospective study on the results of 25 consecutive children with CP operated for hip reconstruction. The patients were divided into two groups according to the type of applied plate chosen at random. Group 1 (Synthes, LCP Pediatric Hip Plate) included 12 patients (22 hips) of an average age 6.2 years. Group 2 (Surfix, PSFE or PPSFE) included 13 patients (23 hips) of an average age 6.1 years. Thirteen acetabuloplasties were performed in group 1 and 15 acetabuloplasties in group 2. Duration of the procedure, amount of intraoperative blood loss, and hematogram indices before and in 24 h after surgery were compared. The following radiographic parameters were compared preoperatively and in 5–6 months of follow-up: acetabular index, projected neck shaft angle, Reimers index, and Wiberg angle. Results A statistically longer duration of surgery and more significant intraoperative blood loss were noted in group 1. Evaluation of radiograms did not reveal difference between the groups. Conclusions Results of hip reconstruction in children with severe forms of CP are satisfactory and reproducible in our series. Application of Surfix locking plates is associated with smaller volume of blood loss, and operation time is shorter.
    European Orthopaedics and Traumatology.
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    ABSTRACT: Background The aim of this study was to evaluate the influence of the external fixation associated with intramedullary nailing on the healing index in limb lengthening. Methods We compared the healing index (HI) between two groups of children undergoing limb lengthening by the external fixator alone (group I, 194 cases of lengthening) or with the combination of an external circular fixator and intramedullary nailing (group II, 100 cases). Results The HI was less in every subgroup of group II compared with group I. The decrease of HI between groups I and II varied from 2.4 days/cm in the monosegmental congenital tibia to 13.1 days/cm in the monosegmental acquired forearm, reaching 7.5 days/cm on average. The reduction of HI was between 65% and 80% in congenital pathologies—monosegmental femur and forearm, bifocal tibia lengthening—and acquired discrepancy—femur, tibia, humerus, and forearm monosegmental lengthening, humerus bifocal lengthening, as well as polysegmental in lower limbs. This difference varies from 1.9 to 19.1 days/cm. The maximum gain of HI concerned the acquired femur with a reduction of 59.9%. Conclusion The flexible intramedullary nailing allows adding multiple advantages to the method of limb lengthening. Correctly applied, the flexible intramedullary nails (FIN) indeed respect the bone biology, which is essential during limb lengthening. The major effect of the application of the combination of external circular fixation with FIN is a significant decrease of external osteosynthesis duration.
    European Orthopaedics and Traumatology. 3(1).