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ABSTRACT: We asked whether locally applied recombinant-bone morphogenic protein-2 (rh-BMP-2) with a type I collagen carrier could enhance the consolidation phase in distraction osteogenesis and whether a dose effect could be reported. We performed unilateral transverse osteotomy of the tibia in 15 immature male rabbits. In Group I (five rabbits), 750 microg of rh-BMP-2 on the type I collagen sponge (Inductos, Medtronic) was locally applied on the day of osteotomy; the Group II animals (five rabbits) received 375 microg of the drug and the Group III (control group, five rabbits) had no local application. After 7 days, 3 weeks of distraction was begun at a rate of 0.5 mm/12 h. Starting week 2 of distraction, we assessed radiographic, ultrasonographic, and densitometric parameters once per week. Animals were sacrificed after a 3-week consolidation period. Radiographic evaluation revealed increased regenerate ossification in the rh-BMP-2 groups compared with the control group. The bone mineral content was significantly higher in the rh-BMP-2 treated groups at each time point. A dose effect is shown as densitometric parameters were significantly higher between Groups I and II. 3/5 of the Group I treated animals developed a premature bony union in the regenerate resulting in premature fusion and incomplete distraction.
Injury 10/2009; 41(7):680-6. · 1.98 Impact Factor
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ABSTRACT: Chondroblastoma is a rare benign bone lesion that occurs in young patients and has a high rate of recurrence. The purpose of the present study was to report on eighty-seven cases of chondroblastoma in children and to identify the possible factors that increase the risk of recurrence.
We retrospectively reviewed eighty-seven cases of chondroblastoma in patients with open physes at the time of diagnosis and treatment. Historical data, complete imaging data, histological findings, and surgical charts were analyzed. Multiple logistic regression was used to identify predictors of recurrence.
The series included fifty-three boys and thirty-four girls with a mean age of 12.5 years. Lesions were located in the epiphysis in 68% of the patients, especially in the proximal part of the tibia (twenty-four patients) and the proximal part of the femur (twenty-three patients). Pain was the presenting symptom in 84% of the patients. The treatment consisted of intralesional curettage with autogenous bone-grafting in 63% of the patients. The functional outcome at an average of 62.5 months of follow-up was good for 68.5% of the patients. At a minimum of twenty-four months of follow-up, 32% of the lesions had recurred. Sex, radiographic aggressiveness, an aneurysmal bone-cyst component on histological analysis, and the method of surgical treatment had no significant influence on recurrence. Epiphyseal chondroblastomas were associated with a higher risk of recurrence when compared with metaphyseal, apophyseal, and epiphyseal-metaphyseal lesions (p = 0.004).
Chondroblastoma in growing children is most frequently located in the proximal part of the tibia and the proximal femoral epiphysis. The recurrence rate is high, particularly for strictly epiphyseal lesions. Proximal femoral lesions and tarsal lesions are associated with a poorer outcome.
The Journal of Bone and Joint Surgery 10/2009; 91(9):2159-68. · 3.27 Impact Factor
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ABSTRACT: The authors report four cases of Jeffery type 2 lesions in children. Despite the probable mechanism of such lesions, none of the cases reported here displayed a dislocation of the elbow. In the first observation the diagnosis was suspected only 15 days after injury. Two other cases were initially treated by closed external manipulations, one with percutaneous Kirschner wire leverage and the other with closed intramedullary pinning, but both cases displayed a 180 degree reversal of the radial head, suspected only secondarily. The first exhaustive review of the literature on the subject, shows that this complication is classical in Jeffery type 2 fractures. In fact none of the 22 cases described in the literature had successfully been reduced by external manipulations. Interposition of the lateral condyle, pathognomonic of the Jeffery type 2 fracture, hampers reduction. Attempts at reduction by external manipulation in nine cases therefore led to two non-reduction and seven reversal of the radial head. Knowledge of this particular fracture will allow an early diagnosis and an immediate surgical treatment.
Journal of Pediatric Orthopaedics B 08/2004; 13(4):268-74. · 0.47 Impact Factor
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ABSTRACT: Nonoperative treatment avoids the complications after extensive surgery for idiopathic clubfeet. The purpose of this study was to compare retrospectively French physiotherapy and Ponseti method used to treat idiopathic clubfoot in 2 institutions.
Two hundred nineteen idiopathic clubfeet (146 patients) managed during a 3-year period (2000 to 2003) were included in this study: 116 clubfeet in group FM were treated according to modified French physiotherapy (with percutaneous heel-cord tenotomy in 17%) and 103 clubfeet in group PM were treated according to the Ponseti method. The use of further surgery was considered as failure of the nonoperative management: complete posteromedial release were noted poor, limited posterior release were noted fair, and nonrelease surgery or nonoperated feet were scored with the modified Ghanem score.
After a mean follow-up of 5.5 years (range, 2.5 to 7.4 y), similar rate of surgery was performed in both groups (21% in group FM and 16% in group PM) but complete posteromedial release was mainly done in group FM (19% of feet), and limited surgery was done in group PM. Results were noted excellent, good, fair, and poor in respectively 55%, 20%, 6%, and 19% of patients in group FM and 79%, 15%, 4%, and 2% of patients in group PM. Results for Dimeglio grade II clubfeet were not different, but results for grade III and grade IV clubfeet were better in PM group.
Ponseti method enables reduction of extensive surgery compared with French physiotherapy mainly for severe deformities.
Journal of pediatric orthopedics 31(3):320-5. · 1.23 Impact Factor
