J P Cahuzac

Clinique de L'UNION, Saint-Jean, Midi-Pyrénées, France

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Publications (81)53.1 Total impact

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    ABSTRACT: Percutaneous techniques for the correction of foot deformities are gaining popularity in the adult population, but remain poorly explored in children. Of the several surgical techniques described to treat persistent severe metatarsus adductus (MA) deformity in children, neither was percutaneous. The purpose of the study was to describe a percutaneous technique for MA correction in children, to report the outcomes, and to discuss the advantages it offers. We designed a prospective study on 34 consecutive feet with MA deformity from 26 children undergoing percutaneous correction. All operated feet had severe, rigid MA deformities, most of which were components of residual/recurrent clubfoot deformities. The mean age at surgery was 5.7 years and the mean follow-up was 55.2 months. For clinical evaluation, we used the bisector method; the first cuneometatarsal angle and metatarsal-metaphyseal angle measured in weight-bearing radiographs and AOFASf score were determined preoperatively and postoperatively. In unilateral cases, we used the contralateral foot measurements as control. The operating time and the hospitalization time were also recorded. The surgical technique consisted of performing the Cahuzac procedure for MA correction with a percutaneous approach. At the final follow-up all feet presented a normal heel bisector line. Radiologic parameters were normalized when compared with control feet. The mean surgical and hospitalization time was 14 minutes and 6 hours, respectively. Mean AOFAS score improved from 78 to 98. A minimally invasive percutaneous technique allowed a successful correction of MA deformity in children and resulted in a substantive decrease in both surgical and hospitalization time and better cosmetic results. Level II.
    Journal of pediatric orthopedics 11/2013; · 1.23 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate a minimally invasive subscapularis-preserving arthroscopic release of capsule in the treatment of internal rotation contracture of the shoulder due to Erb's palsy. We performed our procedure (subscapularis-preserving arthroscopic release of capsule) in 10 paediatric shoulders with an average age of 20.2 months and followed them for an average period of 41.5 months. All the patients were assessed clinically and radiologically preoperatively and postoperatively at regular intervals. The Mallet scoring system was used for analysing the results. The average gain in passive external rotation was 50°. The active internal rotation was preserved in all the cases. With the mid-term follow-up, there was no loss of the gained external rotation or the recurrence of internal rotation contracture of the shoulder. Our hypothesis has achieved its goal in preserving subscapularis, active internal rotation and treatment of internal rotation contracture of the shoulder. The success of this procedure lies in the early identification of starting of internal rotation contracture and early surgical intervention to prevent progressive permanent glenohumeral osseocartilaginous deformity.
    Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America 05/2012; 21(5):469-73. · 0.66 Impact Factor
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    ABSTRACT: Internal rotation contracture of the shoulder in brachial plexus birth palsy frequently leads to shoulder dysplasia. Six children underwent anterior arthroscopic release sparing the subscapularis. Clinical examination and MRI were performed preoperatively and repeated at the 5-year follow-up. MRI was carried out for assessment of glenohumeral dysplasia. Passive external rotation was improved by 63.3° without any limitation of active internal rotation. Active antepulsion/abduction was improved by 90°. Remodeling of the glenoid and improved coverage of the humeral head were observed in all cases. Shoulder arthroscopic release sparing the subscapularis seems to be an efficient procedure to restore external rotation without affecting active internal rotation.
    Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America 04/2012; 21(4):305-9. · 0.66 Impact Factor
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    ABSTRACT: La synostose calcanéo-naviculaire est une cause fréquente de douleurs avec un pied plus ou moins plat et raide chez l’enfant. Le traitement classique consiste à réséquer le pont par un abord dorsolatéral. La qualité de la résection et l’interposition s’associent à l’absence de récidive. Les complications les plus fréquentes sont l’hématome, l’infection et le névrome. L’arthroscopie représente une alternative mini-invasive de traitement. Cependant, les voies d’abord restent imprécises. Nous décrivons la technique opératoire avec des abords basés sur la proéminence antérolatérale du calcanéus et appliquée sur trois cas avec un an de recul. La résection arthroscopique présente des avantages. La récupération est plus rapide, et le résultat esthétique meilleur. L’abord instrumental requiert une incision cutanée superficielle suivie d’une discision du tissu sous-cutané afin d’éviter de léser le nerf fibulaire superficiel. En attente d’un plus grand recul, l’arthroscopie s’avère comme une technique mini-invasive séduisante pour ce type de pathologie.
    Resuscitation 01/2011; 97(5):551-555. · 4.10 Impact Factor
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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 01/2010; 96(5):594-598. · 4.10 Impact Factor
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    ABSTRACT: PurposeCongenital scoliosis resulting from hemivertebrae can be treated surgically through resection or convex epiphysiodesis. Our purpose was to assess the results obtained in a series of children operated using both methods.
    Revista Española de Cirugía Ortopédica y Traumatología. 01/2009; 53(1).
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    ABSTRACT: PurposeCongenital scoliosis resulting from hemivertebrae can be treated surgically through resection or convex epiphysiodesis. Our purpose was to assess the results obtained in a series of children operated using both methods.
    Aquatic Botany - AQUAT BOT. 01/2009; 53(1):38-44.
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    ABSTRACT: Purpose Metatarsus adductus is an adduction deformity of the forefoot. Our purpose is to uphold the claim that the main anomaly is to be found on the cuneiform side of the cuneo-metatarsal joint and that the growth of the medial cuneiform is fundamental for correction further to capsulotomy. Materials and methods This is a radiological study of 23 children with idiopathic or clubfoot-related metatarsus adductus subjected between 1982 and 2000 to a release of the cuneiform metatarsal joint. X-rays were taken of the 30 operated feet and of 12 contralateral feet used as controls. The following measurements were made: cuneiform-metatarsal angle, distal inclination angle of the medial cuneiform bone, angle formed between the latter surface and the first metatarsal and the proximal articular angle of the first metatarsal. The mean pre-op, immediate post-op and post-op final values of these angles were compared using the relevant statistical tests. Results As regards idiopathic metatarsus adductus, the cuneiform metatarsal angle went from a preop value of 150.4° to 170.2° at the end of follow-up; the distal inclination angle of the medial cuneiform went from 62° to 81.1°; and the angle formed between the latter surface and the first metatarsal and the proximal articular angle of the first metatarsal went from 88.4° to 89.1°. With respect to clubfoot-related metatarsus adductus, the cuneiform metatarsal angle went from a preop value of 155.3° to 169.7°, the distal inclination angle of the medial cuneiform went from 61.9° to 79.7°, and the angle formed between the latter surface and the first metatarsal and the proximal articular angle of the first metatarsal went from 88.3° to 90°. On the healthy side, the angle values showed virtually no changes. Conclusions The obliqueness of the medial cuneiform-metatarsal joint is closely related to metatarsus adductus. Postsurgical correction also takes place at the expense of this bone, which tends to fill the space created by the capsulotomy.
    Revista Española de Cirugía Ortopédica y Traumatología. 04/2008; 52(2).
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    ABSTRACT: Ulnar styloid fractures are frequently ignored in the treatment of wrist fractures in children. Forty-six untreated ulnar styloid fractures (40 tip and six base fractures) associated with radial injuries (45 patients) were retrospectively analysed. At the removal of the cast, we recorded that 80% had a nonunion of the styloid fracture. Thirty-five patients were reviewed at an average of 19 months after treatment. Thirty tip fractures and five base avulsions were found. We recorded 28 patients with a good clinical result despite 21 cases of nonunion, whereas seven patients (all nonunions) had a fair result. All the fair results suffered from intermittent pain during sports and movement, radioulnar joint instability and tears of the triangular fibrocartilage complex. It can be concluded that both distal radius and ulnar styloid fractures should be taken into account in the initial treatment and pain associated with a nonunion of the ulnar styloid in a child may be due to a tear of the triangular fibrocartilage complex.
    Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America 02/2008; 17(1):15-9. · 0.66 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. 01/2008; 94(7):643-648.
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    ABSTRACT: Objetivo El metatarso adducto (MTA) es una deformación en adducción del antepié. Nuestro objetivo es apoyar la hipótesis por la cual la principal anomalía se encuentra en el lado cuneiforme de la articulación cuneo-metatarsiana, y que el crecimiento de la primera cuña es fundamental en la corrección tras la capsulotomía. Material y método Se trata de un estudio radiológico realizado con 23 niños con MTA idiopático o secundario a pie zambo, operados entre los años 1982 y 2000, con liberación de la articulación cuneo-metatarsiana. Se realizaron radiografías de los 30 pies operados, y de 12 pies contralaterales utilizados como controles, con las siguientes mediciones: ángulo cuneo-metatarsiano (FMCA), ángulo de inclinación distal de la primera cuña (DCAA), ángulo entre esta superficie y la del primer metatarsiano (PENTE) y ángulo proximal articular del primer metatarsiano (PMAA). Se compararon las medias de estos ángulos tomadas en pre, post-operatorio inmediato y final del seguimiento, mediante los pertinentes tests estadísticos. Resultados Respecto al MTA idiopático, el FMCA aumentó de 150,4° en el preoperatorio a 170,2° al final, el DCAA pasó de 62° a 81,1°, y el PMAA de 88,4° a 89,1°. Respecto al MTA secundario a pie zambo, el FMCA aumentó de 155,3° a 169,7°, el DCAA pasó de 61,9° a 79,7°, y el PMAA de 88,3° a 90°. En el lado sano los ángulos apenas se modificaron. Conclusiones La oblicuidad de la articulación cuneo-metatarsiana medial está estrechamente relacionada con el metatarso adducto. La corrección post-quirúrgica se hace también a expensas de este hueso, que tiende a rellenar el espacio creado por la capsulotomía.
    Aquatic Botany - AQUAT BOT. 01/2008; 52(2):84-93.
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    ABSTRACT: The goal of this study was to evaluate the results of meniscal repair in children and adolescents by a retrospective case series. Twelve arthroscopic-assisted meniscal repairs were performed on 12 patients younger than 17 years of age (8-16 years, mean 13 years). The anterior cruciate ligament was torn in three cases. Eight lesions involved the lateral meniscus and four involved the medial meniscus; there were no discoid menisci. All patients were seen at an average of 3 years 1 month follow-up (range, 2-4 years 10 months). Three patients required subsequent surgery for partial meniscectomy. We evaluated the remaining nine patients by clinical examination, International Knee Documentation Committee clinical score, Lyshölm score, Tegner's activity, and by computed tomography arthrogram or magnetic resonance imaging. Seven patients were asymptomatic at follow-up, two reported occasional pain, and none had experienced symptoms of locking. Their average Lyshölm score and Tegner's activity were 96.3 and 6.6, respectively. Eight patients were International Knee Documentation Committee A and one was International Knee Documentation Committee B. Healing status was assessed at follow-up in eight patients by computed tomography arthrogram or magnetic resonance imaging: the tear was considered as completely healed in three patients. The apparent failure rate was 66%. Indications for meniscal repair in children are not actually established. The pejorative outcome of meniscectomy at a young age has led us to consider symptomatic meniscal tears for repair. Objective results of meniscal healing are poor. The method to assess healing of the repaired menisci objectively is still a matter of debate.
    Journal of Pediatric Orthopaedics B 02/2007; 16(1):56-60. · 0.53 Impact Factor
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    ABSTRACT: AimEpidemiological analysis in a universitary paediatric emergency unit of children admitted after accidental injuries resulting from fingers crushed in a door.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2007; 14(8):958-963.
  • Revue De Chirurgie Orthopedique Et Reparatrice De L Appareil Moteur - REV CHIR ORTHOP REPARAT APP. 01/2007; 93(4):403-403.
  • Revue De Chirurgie Orthopedique Et Reparatrice De L Appareil Moteur - REV CHIR ORTHOP REPARAT APP. 01/2007; 93(4):410-410.
  • Revue De Chirurgie Orthopedique Et Reparatrice De L Appareil Moteur - REV CHIR ORTHOP REPARAT APP. 01/2007; 93(4):396-396.
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    ABSTRACT: Retrospective analysis of a prospectively accrued series of 191 consecutive patients who underwent intraoperative neurophysiologic monitoring during scoliosis corrective surgery. To compare the monitoring outcome of idiopathic and neuromuscular scoliosis. To demonstrate the usefulness of the epidural electrode. To report sensitivity and specificity of the monitoring method employed at a single institution. Reports in the literature emphasized the difficulty to obtain data in neuromuscular patients. Multimodality spinal cord monitoring has been recommended. Despite their still debated composition, neurogenic motor-evoked potentials have proven their validity in clinical practice. Somatosensory and neurogenic evoked potentials were attempted in all patients presenting for scoliosis correction between 1999 and 2005. Study patients were divided into 3 groups: group 1, idiopathic; group 2, neuromuscular; and group 3, miscellaneous origins. The use of the epidural electrode demonstrated significant usefulness in the ability of monitoring otherwise nonmonitored patients, especially in group 2. Inability to obtain any evoked potentials occurred in 4 cases (2.1%). Five cases were found to be true positives. An adapted and rapid intervention permitted to avoid new postoperative deficit in all cases. There was no instance of false-negative data. The overall method sensitivity was 100%, and specificity was 52.69%. The use of a single epidural electrode allowing somatosensory evoked potentials recording and spinal cord stimulation alternately is a safe and valid method of intraoperative monitoring.
    Spine 11/2006; 31(22):2614-23. · 2.16 Impact Factor
  • C. Dao, F. Accabled, X. Cassard, J.-P. Cahuzac
    Revue De Chirurgie Orthopedique Et Reparatrice De L Appareil Moteur - REV CHIR ORTHOP REPARAT APP. 01/2006; 92(8):56-56.
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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. · 0.53 Impact Factor
  • Journal de Radiologie 01/2005; 85(12 Pt 1):2043-6. · 0.35 Impact Factor

Publication Stats

325 Citations
123 Downloads
53.10 Total Impact Points

Institutions

  • 2012
    • Clinique de L'UNION
      Saint-Jean, Midi-Pyrénées, France
  • 2004–2006
    • Muséum de Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 1995–2004
    • Centre Hospitalier Universitaire de Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2002
    • University of Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France