Stéphanie Pannier

Université René Descartes - Paris 5, Lutetia Parisorum, Île-de-France, France

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Publications (56)48.61 Total impact

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  • C. Dana, S. Pannier
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    ABSTRACT: Las fracturas del extremo inferior del húmero en el niño son frecuentes y dejan secuelas si el tratamiento es inadecuado. La osificación progresiva del codo desde el nacimiento hasta los 12 años de edad va modificando el aspecto radiográfico de la paleta humeral y, en algunos casos, dificulta la interpretación de las imágenes radiográficas. Debido al escaso potencial de crecimiento del codo, lo que se busca es la restitución de las relaciones anatómicas, al contrario que en otras fracturas pediátricas en las que los defectos de reducción son aceptables. Las fracturas supracondíleas, extraarticulares, pueden producir complicaciones inmediatas y graves, sobre todo vasculares. Se las debe considerar urgencias terapéuticas, para de este modo evitar el desarrollo de un edema importante que pudiera dificultar la exploración física. En las fracturas articulares, del cóndilo lateral o más raramente medial, el objetivo de la indicación quirúrgica es restaurar el espacio articular, a menos que el estudio por imagen demuestre la ausencia total de desplazamiento. Las fracturas supra e intercondíleas, infrecuentes, son el resultado de un traumatismo de alta energía. En la mayoría de los casos el tratamiento es quirúrgico, aunque la conducta varía en función del grado de maduración esquelética. Las fracturas apofisarias, del epicóndilo medial o lateral, son equivalentes a las avulsiones ligamentosas y a menudo se asocian a una luxación del codo. La incarceración intraarticular de estas apófisis después de la reducción de una luxación del codo es, sin tratamiento, una complicación posible y grave. Tras una breve reseña radioanatómica del codo, en este artículo se detallará la conducta terapéutica ante cada una de estas fracturas en el niño.
    EMC - Técnicas Quirúrgicas - Ortopedia y Traumatología. 01/2014; 6(2):1–13.
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    ABSTRACT: The purpose of this study was to evaluate the two-stage surgical technique combining induced membrane, spongy autograft and intramedullary fixation for the treatment of congenital pseudarthrosis of the tibia (CPT). Three boys and two girls were treated by this technique between 2003 and 2008. All patients had type IV CPT in Crawford's classification. Four of them had a limited dystrophic form, whereas one case presented an extensive tibia bone dystrophy. The average age of patients at the time of surgery was 23 months (range 10-30 months), with an average follow-up of 5.8 years (range 2.4-8.1 years). Satisfactory tibial bony union was achieved in all cases at the last follow-up. Bone healing was obtained in the four limited forms after an average term of 4 months. One patient suffered from a non-displaced fracture that healed by casting in a usual period of time. The patient with an extensive dystrophic bone had to undergo a secondary inter-tibiofibular bone graft to finally achieve bone union. The preliminary results show that this technique is successful in CPT. It may be used even in young children and offers a good alternative to other treatments available, avoiding external fixation and the technical difficulties of microvascular surgery.
    Journal of Children s Orthopaedics 12/2013; 7(6):477-85.
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    ABSTRACT: An arteriovenous malformation (AVM) is a congenital lesion with high vascular flow resulting from direct connections between arteries and veins. Its treatment is often complex, and most authors recommend a multidisciplinary approach combining surgical and endovascular treatments. We report the case of a 6-month-old boy with a voluminous AVM of the left forearm inducing osteolysis of the radius, with bowing of its diaphysis and subsequent radial head dislocation. Surgical excision of the AVM was not possible, but 2 sequential coil embolizations achieved control of the lesion. After 3.5 years, the AVM was undetectable, and notable improvement was noted both in symptoms and radiographic findings. This case underlines how an AVM can have noteworthy influence on surrounding tissues and shows that embolization alone can achieve a satisfying midterm outcome even when surgery is not possible.
    The Journal of hand surgery 08/2013; · 1.33 Impact Factor
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    ABSTRACT: Traumatisms of distal extremities are frequent in children. They can associate fingertip skin, bone and nail complex injuries. Their severity level is very variable, from simple subungual bruise to distal amputation. Initial care needs careful repair of injured structures. Secondary treatment of sequelae is much more difficult.
    Chirurgie de la Main 04/2013; · 0.30 Impact Factor
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    Pediatric Radiology 12/2012; · 1.57 Impact Factor
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    ABSTRACT: Centralization and radialization are the most widely reported surgical treatments for Bayne and Klug Type III and IV radial longitudinal deficiency. Prior soft tissue distraction has been introduced to improve reducibility of the deformity without skeletal resection. Satisfying long-term effects have been reported with centralization but are still unclear with radialization. This is a retrospective study of 8 consecutive children with Bayne and Klug Type III or IV radial longitudinal deficiency treated with preliminary soft tissue distraction followed by radialization between 2003 and 2008. All children underwent the same surgical protocol. End points of the study were clinical appearance, the hand-forearm angle, and mean angular correction at last follow-up. The mean preoperative hand-forearm angle was 61° (26°-91°). The average duration of distraction was 1.9 month (1-3 mo). The initial postoperative angle averaged 12° (-14°-40°). There were 3 postoperative complications: 2 cases of pin loosening and 1 case of fracture of the base of the small finger metacarpal. Mean follow-up duration was 2.6 years (1-4 y). At last follow-up, 7 of the 8 patients had visible recurrence of the deformity, the hand-forearm angle had deteriorated to 44° (20°-69°), and the mean angular correction was 18° (-43°-59°). Preoperative distraction allows a gradual realignment of the hand on the forearm without skeletal resection, but the recurrence rate after radialization is high. Tendon transfers and soft tissue tensioning were unable to maintain hand-forearm alignment following soft tissue distraction. Therapeutic IV.
    The Journal of hand surgery 10/2012; 37(10):2082-7. · 1.33 Impact Factor
  • S. Pannier, E. Mascard, C. Glorion
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    ABSTRACT: Las resecciones segmentarias amplias de los tumores óseos malignos de los miembros en los niños requieren la reconstrucción del segmento extirpado por motivos oncológicos. En la actualidad, se utilizan muchas técnicas protésicas y biológicas. La capacidad infantil de reparación y reconstrucción permite a veces reconstrucciones de calidad sorprendente. Entre los aspectos específicos de las reconstrucciones en los niños, se pueden señalar las transferencias epifisarias, las prótesis de crecimiento y la técnica del injerto en dos tiempos tras la fabricación de una membrana inducida alrededor de un cilindro de metilmetacrilato. En este artículo se describirán e ilustrarán estas técnicas.
    EMC - Aparato Locomotor. 09/2012; 45(3):1–5.
  • Stéphanie Pannier, Christophe Glorion
    La Revue du praticien 04/2012; 62(4):535-6.
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    ABSTRACT: Percutaneous sclerotherapy is an effective treatment for aneurysmal bone cysts (ABCs). The purpose of this study was to demonstrate the safety and efficacy of sclerotherapy with absolute alcohol and to propose a vascular classification of ABCs based on a retrospective review. This was a review of children treated with absolute alcohol sclerotherapy for ABC at a single institution from January 1995 until November 2009. Treatment response was evaluated radiographically and clinically. Cyst fluid was classified as clear, partially bloody, or bloody. Presence of any venous drainage of the cyst was assessed by injection of contrast medium into the cyst cavity. Twenty-nine children with ages ranging from 2 to 16 years were included. Treatment response was good in 17 (59%), partial in 9 (31%), and poor in 3 (10%) children. Venous drainage was absent in six out of seven clear-fluid cysts, which we classified as lymphatic. Drainage was present in all seven bloody-fluid cysts, which we classified as venous. In seven partially bloody-fluid cysts, venous drainage was seen in three. Sclerotherapy with absolute alcohol is a safe and effective treatment of ABC. We propose classifying ABC as lymphatic or venous and suggest considering ABC intraosseous slow-flow vascular malformations.
    Pediatric Radiology 01/2012; 42(5):599-605. · 1.57 Impact Factor
  • Chirurgie de la Main. 12/2011; 30(6):421.
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    S Pannier
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    ABSTRACT: Congenital pseudarthrosis of the tibia (CPT) is an uncommon disease with various clinical presentations ranging from simple anterolateral tibial angulation to complete non-union with extensive bone defects. Classifications of radiographic findings include atrophic or hypertrophic pseudarthosis as well as cystic or dystrophic lesions. Although the relationship between CPT and type 1 neurofibromatosis is well known, the exact pathogenesis still remains unclear. The fibrous soft tissue found in the pseudarthosis and the abnormal periosteum are certainly a key to the pathology, possibly due to decreased osteogenic capacities and impaired local vascularization. Treatment of CPT is still challenging in pediatric orthopedics because of bone union difficulties, persistant angulation, joint stiffness and sometimes severe limb length discrepancy sequellae. Numerous treatments based on biological and/or mechanical concepts, surgical or not, have been reported with variable success rates. Vascularized fibular grafts and the Ilizarov technique have greatly transformed the prognosis of CPT. Despite these steps forward, repeated surgical procedures are often necessary to obtain bone union and the risk of amputation is never entirely eliminated. The effectiveness of new treatments (bone morphogenetic protein, bone marrow stromal cell grafts, pulsed electromagnetic fields, induced membrane technique…) still requires to be confirmed. Combining these new techniques with existing treatments may improve the final prognosis of CPT, which nevertheless remains poor.
    Orthopaedics & Traumatology Surgery & Research 11/2011; 97(7):750-61. · 1.06 Impact Factor
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    ABSTRACT: Ankle valgus deformity is rare in children. It generally leads to difficulties wearing shoes, walking instability and mechanical pain. No medical treatment is effective and the only option is surgical correction of the deformity. Two main options are available: supramalleolar osteotomy and medial malleolar epiphysiodesis. We report our experience with epiphysiodesis using a transphyseal medial malleolar screw. This is a retrospective study of all children followed for ankle valgus and treated by transphyseal medial malleolar screw epiphysiodesis in our department. The study included 10 cases of ankle valgus deformity in seven children (four with multiple extostoses, two type 1 neurofibromatosis, one Larsen's syndrome) who completed skeletal maturity. At surgery, median bone age was 12 years (10 to 13 years and 6 months) and the median tibiotalar angle was 17.5° (10° to 30°). At skeletal maturity, preoperative valgus was corrected in six patients (9/10 ankles). The median tibiotalar angle was 5° (0° to 25°). Valgus was not corrected in one patient (30° to 25°). No postoperative complications occurred. Epiphysiodesis by transphyseal medial malleolar screw is a simple, efficient and safe procedure to correct a significant or symptomatic ankle valgus deformity in children before skeletal maturity. Level IV, retrospective study.
    Orthopaedics & Traumatology Surgery & Research 06/2011; 97(4):406-9. · 1.06 Impact Factor
  • Clinical dysmorphology 04/2011; 20(2):114-6. · 0.47 Impact Factor
  • S. Pannier
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    ABSTRACT: La pseudarthrose congénitale de jambe (PCJ) est une pathologie rare de l’enfant caractérisée par une grande hétérogénéité dans sa présentation, allant de la simple courbure à convexité antérolatérale (ou concavité postéromédiale) de la jambe, peu évolutive à une véritable solution de continuité avec perte de substance osseuse importante. Les radiographies peuvent mettre en évidence un aspect atrophique ou hypertrophique, des lésions kystiques ou dystrophiques à l’origine de plusieurs classifications. Bien que sa relation avec la neurofibromatose de type 1 (NF1) soit connue, la physiopathologie de la PCJ reste encore, aujourd’hui, mal comprise. Le tissu d’interposition fibreux de la zone de pseudarthrose et le périoste pathologique jouent certainement un rôle déterminant dans la pathologie, probablement par l’intermédiaire d’un trouble du remodelage osseux et de la vascularisation locale. Le traitement de la PCJ reste toujours aujourd’hui un problème difficile en orthopédie pédiatrique en raison des difficultés de consolidation, des déformations résiduelles, des raideurs articulaires et de l’inégalité de longueur séquellaire, parfois sévère. De nombreux traitements basés sur un concept biologique et/ou mécanique, chirurgical ou non, ont été décrits avec des taux de succès variables. Le pronostic des PCJ s’est considérablement transformé ces dernières décennies grâce au transfert fibulaire vascularisé et à la méthode d’Ilizarov. Malgré ces progrès, plusieurs interventions sont souvent nécessaires pour obtenir la consolidation de la pseudarthrose et l’amputation n’est jamais entièrement éliminée. L’efficacité des nouveaux traitements qui émergent aujourd’hui (protéines ostéo-inductrices, greffe de cellules de moelle osseuse, champs magnétique pulsé, membrane induite…) reste à évaluer dans le traitement de la PCJ. Leur association aux techniques classiques permettra peut-être d’améliorer le pronostic, toujours sombre, de cette pathologie.
    Resuscitation 01/2011; 97(7):726-738. · 4.10 Impact Factor
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    ABSTRACT: Introduction Le valgus tibiotalien chez l’enfant est une déformation peu fréquente. Ses manifestations sont des difficultés de chaussage puis des douleurs mécaniques. Ses principaux traitements sont l’ostéotomie supramalléolaire de varisation et l’épiphysiodèse de la malléole médiale. Nous rapportons notre expérience de l’épiphysiodèse de la malléole médiale par vissage transphysaire. Patients et méthodes Il s’agit d’une étude rétrospective sur dix cas de valgus de la cheville chez sept enfants (quatre maladies exostosantes, deux neurofibromatoses de type 1, un syndrome de Larsen) traités par épiphysiodèse de la malléole médiale par vissage transphysaire et arrivés à maturité osseuse. Au moment de l’intervention, l’âge osseux médian était de 12 ans (10 à 13 ans/six mois) et l’angle tibiotalien médian était de 17,5̊ (10̊ à 30̊). Résultats À maturité osseuse, six patients (neuf chevilles sur dix) ont eu une correction de leur valgus préopératoire et l’angle tibiotalien médian était de 5̊ (0̊ à 25̊). Un patient a eu un valgus insuffisamment corrigé (30̊ à 25̊). Il n’y a pas eu de complication postopératoire. Discussion L’épiphysiodèse de la malléole médiale par vissage transphysaire est une technique chirurgicale simple et fiable pour traiter les valgus tibiotaliens importants ou symptomatiques chez l’enfant. Niveau de preuve IV, étude rétropective.
    Resuscitation 01/2011; 97(4):406-410. · 4.10 Impact Factor
  • Resuscitation 01/2011; 97(7). · 4.10 Impact Factor
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    ABSTRACT: Achondroplasia (ACH), the most common form of human dwarfism is caused by a mutation in the Fibroblast Growth Factor Receptor 3 (FGFR3) gene, resulting in constitutive activation of the receptor. Typical radiological features include shortening of the tubular bones and macrocephaly, due to disruption of endochondral ossification. Consequently, FGFR3 has been described as a negative regulator of bone growth. Studying a large cohort of ACH patients, a delay in bone age was observed shortly after birth (for boys p=2.6×10(-9) and for girls p=1.2×10(-8)). This delay was no longer apparent during adolescence. In order to gain further insight into bone formation, bone development was studied in a murine model of chondrodysplasia (Fgfr3(Y367C/+)) from birth to 6weeks of age. Delayed bone age was also observed in Fgfr3(Y367C/+) mice at 1week of age followed by an accelerated secondary ossification center formation. A low level of chondrocyte proliferation was observed in the normal growth plate at birth, which increased with bone growth. In the pathological condition, a significantly high level of proliferative cells was present at birth, but exhibited a transient decrease only to rise again subsequently. Histological and in situ analyses suggested the altered endochondral ossification process may result from delayed chondrocyte differentiation, disruption of vascularization and osteoblast invasion of the femur. All these data provide evidence that FGFR3 regulates normal chondrocyte proliferation and differentiation during bone growth and suggest that constitutive activation of the receptor disrupts both processes. Therefore, the consequences of FGFR3 activation on the physiological process of bone development appear to be dependent on spatial and temporal occurrence. In conclusion, these observations support the notion that FGFR3 has a dual effect, as both a negative and a positive regulator of the endochondral ossification process during post-natal bone development.
    Bone 11/2010; 47(5):905-15. · 3.82 Impact Factor
  • Z Péjin, S Pannier, C Glorion
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    ABSTRACT: Toe walking is a frequent situation for a clinic in pediatric orthopedic. It is, in most cases, an idiopathic trouble. Neurologic examination is very important to recognize spastic diplegia or neuromuscular disease. A contracture of the triceps can occur and will require a specific treatment from physiotherapy to surgery. A psychological approach is sometimes necessary.
    Archives de Pédiatrie 09/2010; 17(9):1368-72. · 0.36 Impact Factor
  • Z. Péjin, S. Pannier, C. Glorion
    [Show abstract] [Hide abstract]
    ABSTRACT: Toe walking is a frequent situation for a clinic in pediatric orthopedic. It is, in most cases, an idiopathic trouble. Neurologic examination is very important to recognize spastic diplegia or neuromuscular disease. A contracture of the triceps can occur and will require a specific treatment from physiotherapy to surgery. A psychological approach is sometimes necessary.
    Archives de Pédiatrie. 09/2010; 17(9):1368–1372.