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ABSTRACT: Isolated congenital elbow contracture is a rare upper-extremity disorder and there are few data about management of this condition. Authors report their experience after aggressive management of children with isolated congenital elbow contracture in flexion. Because of total absence of range of motion (ROM) improvement despites physical therapy (ROM 90-120°) and bone deformity, an anterior surgical release of the elbow was performed through an extensive lateral approach, at sixteen months of age. After surgery, this child was treated by three casts at maximal gained extension followed by sequential Turnbuckles splints. After five years of follow-up, the result was excellent with ROM 5-135°, normal function and absence of growth disturbance. The limiting factor of this protocol was excessive traction in elbow extension on the neurovascular structures, especially the radial nerve. This treatment represents an aggressive management with multiple general anaesthesia, but was found to be a valid option.
Orthopaedics & Traumatology Surgery & Research 05/2012; 98(4):465-9. · 0.94 Impact Factor
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ABSTRACT: Segmental long-bone defect due to tumor resection remains a challenge to treat. The induced membrane technique is a new alternative for biological reconstruction. During the first stage, a cement spacer is inserted after bone resection and stabilisation. The cement spacer is removed during a second stage procedure performed after chemotherapy, and cortico-cancellous bone autograft was placed in the biological induced chamber. The aim of this study was to assess preliminary results in eight children.
This prospective study included six girls and two boys, with a mean age of 12.1 years (range 9.5 to 18) and treated for a mean 15 cm defect (range 10 to 22 cms) due to resection of osteosarcoma (n=4), Ewing sarcoma (n=3) and low grade sarcoma. All patients except one, were given pre- and postoperative chemotherapy. Surgery was performed for three patients with a distal femur tumor, two patients with a proximal tibial tumor and three patients who had proximal humerus, shaft of humerus and fibular tumors. Fixation was mainly performed with locking compression plate (n=4) and locked nail (n=2). The mean operating times for first and second step procedures were 4.8 and 4h respectively. The healing process was radiologically assessed.
After a mean follow-up of 21.6 months (15 to 30), all patients were free of disease and seven had bony union. For the lower limb reconstructions, full weight bearing was possible after a mean of 116 days (range 90 to 150) following the second stage. Mean time to bone union was 4.8 months (1.5 to 10). The early Musculoskeletal Tumor Society (MSTS) score was 25.2/30 (range 20-30). Complications were: non-union (n=1), paradoxical graft resorption (n=1) requiring graft revision.
This two stage procedure reduces the operating time during the first stage and it also reduces early complications. Rapid bone union is objectively obtained despite major bone resection and the patients receiving chemotherapy.
The induced membrane technique could be an excellent alternative for biological reconstruction after tumor resection in children.
Orthopaedics & Traumatology Surgery & Research 04/2012; 98(3):301-8. · 0.94 Impact Factor
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ABSTRACT: Legg-Perthes-Calvé disease (LPC), or primitive hip osteochondritis, is a frequent pathology but in which recurrence is extremely rare. WE REPORT: The case of a girl diagnosed with bilateral LPC at the age of 4.5 years. Containment in a Scottish-Rite (Atlanta) brace was prescribed. X-ray follow-up found complete right-hip healing at 1.5 years' evolution (Catterall group 2). The patient was seen again at the age of 8 years, for limp and functional disorder associated with recurrence of right-hip LPC (Catterall group 3). Evolution was satisfactory: the girl was assessed at the time of bone maturity, with good clinical and radiological findings.
Children contracting LPC are commonly thought to be thereby "vaccinated" against it. This is wrong, and a literature search found 10 cases similar to the present one, making 11 children in all (two girls, nine boys) presenting with recurrent LPC. Mean age at initial onset was 4 years (range, 2.5-6 yrs). Five of the 11 had initially been presented with bilateral LPC. Mean age at recurrence was 9.4 years (range, 6-12 yrs). The recurrences were more severe than the initial episodes, but final prognosis after recurrence would not seem to be worse than normal.
This exceptional case of recurrent LPC was well documented up to bone maturity. It does not support the notion of Meyer's disease at the initial episode, as suggested by certain authors, but rather that of true recurrence of the primitive LPC.
Orthopaedics & Traumatology Surgery & Research 06/2010; 96(4):480-4. · 0.94 Impact Factor
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Archives de Pédiatrie 07/2005; 12(6):797-801. · 0.30 Impact Factor
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12/2004: pages 297-316;
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ABSTRACT: Avulsion fractures of the greater trochanter are very rare in children. We report two such cases which led to femoral head necrosis. Based on these two cases and an extensive review of the literature, we discuss the pathophysiology of this complication and propose a new classification system. Three types of lesions can be identified as a function of the mechanism causing fracture. Type 1 lesions are avulsion fractures of the greater trochanter secondary to acute contraction of the gluteus muscles. This contraction produces a vertical displacement of the greater trochanter. Femoral head necrosis has never been reported as a complication after this type of fracture mechanism. Type 2 avulsion fractures are associated with fracture of the femoral neck with a subsequent risk of femoral head necrosis. Type 3 associates hip dislocation with apophyseal avulsion with, according to the literature, an inevitable progression to head necrosis. The two cases reported look identical with those described by Linhart and Kawenblum illustrate type 3 avulsion fractures of the greater trochanter.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 06/2004; 90(3):274-9. · 0.37 Impact Factor
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ABSTRACT: The choice of first-line treatment for congenital varus equine clubfoot remains a controversial issue largely dependent on experience. In France, functional treatment predominates. In 1948, Ponseti proposed reducing the deformity with successive casts. Although cast treatment is a very old method, Ponseti's method is original because it is based on strict rules established from anatomic evidence. The goal is not to correct the apparent deformation, but on the contrary to impose a simultaneous supination and abduction of the foot. Once the calcaneopedal block has been derotated, percutaneous tenotomy of the Achilles tendon is performed. We relate our experience with this method and recall the precise technique used to make the casts. After the cast, derotation braces are worn at night but rehabilitation exercises are not required. We emphasize the quality of the clinical reduction achieved as well as the smaller number of patients who require surgery at walking age.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 12/2002; 88(7):710-7. · 0.37 Impact Factor
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ABSTRACT: Children with cerebral palsy who cannot walk have an oblique pelvis and scoliosis. There is a certain degree of controversy in the literature on the best way to manage this difficult situation. We present a descriptive analysis of a population of non-ambulatory adults with cerebral palsy in order to formulate hypotheses concerning the factors determining scoliosis.
This descriptive cross-sectional study was conducted in 234 patients aged over 15 years who had cerebral palsy and could not walk. Physical examination and an x-ray of the pelvis and spine in the reclining position were obtained for all patients. The following variables were recorded: luxation and subluxation of the hip, spontaneous deviation attitude, ability or not to turn over in bed, pelvic obliquity, history of bone surgery, defective hip abduction. The statistical analysis accounted for laterality and pelvis obliquity to the scoliosis convexity and the laterality of the hip excentration.
Scoliosis was observed in 66.2% of the patients; it was more than 60 degrees in 34.5%. Two basic groups were distinguished: thoracolumbar scoliosis (41.6%) and lumbar scoliosis (41.6%). The prevalence of oblique pelvi was 59.9% with important difference by side: 31.6% right oblique and 68.4% left oblique pelvi. We were unable to find any relationship between the side of the pelvic obliquity and the side of the scoliosis convexity, the side of the hip excentration, or the deviation attitude, but the deviation attitude appeared to be a risk factor for pelvic obliquity, which itself was a risk factor for excentration, which was a risk factor for scoliosis.
Scoliosis is an important problem in this population. Hip luxation is a direct risk factor for scoliosis, but the deviation attitude and pelvic obliquity are intermediary stages. The prevalence of oblique pelvi was greater on the left than the right. This finding should be confirmed in other series before hypotheses can be formulated concerning this difference.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 07/2002; 88(4):337-41. · 0.37 Impact Factor
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ABSTRACT: To propose a simple method of analysis of whole body DXA scan results, for the bone mineral content of the entire skeleton (BMCt) and the arms and legs (BMCa and BMCl), as well as the analysis of the body composition in lean (Lt, La and Ll) and fat (Ft, Fa and Fl) in children and adolescents with normal growth. Materials and methods. A whole body DXA scan (Norland XR36(TM) DXA system) was performed in 90 control females and 76 control males aged from 2.3 y to 21.0 y, and from 2.3 y to 20.1 y, respectively. BMC values, as well as L and F values were correlated with the body weight (BW) of the measured subjects. BMCt, Lt and Ft values corrected for the body surface area (BS), and the ratio BMCl/BMCa, were also calculated.
High linear correlations (r>0.9) were found between BMCt, Lt or Ft values and BW, as well as between BMC (a & l) and BMCt, L (a & l) and Lt, F (a & l) and Ft. The ratios BMCt/BS(1.5), Lt/BS(1.5), and Ft/BS(1.5) had constant values of 1.2+/-0.1, 17.5+/-1.9, and 8.7+/-2.0, respectively, in females, and 1.2+/-0.1, 18.9+/-1.3, and 7.3+/-1.4, in males. The ratio BMCl/BMCa had a constant value of 2.8+/-0.4 in both sexes.
The reference values obtained by DXA for the bone mineral content, lean and fat masses of the entire body and limbs are of interest, in our experience, to follow-up the growth in patients with long-term treatments, and to quantify orthopedic disorders and treatments.
Journal de Radiologie 05/2002; 83(5):627-33. · 0.42 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the sensitivity and predictive value of early postoperative bone scan for detection of avascular necrosis (AVN) of the femoral head after surgical treatment of slipped capital femoral epiphysis. We reviewed records of 49 patients (64 hips) operated on between 1980 and 1997 with a mean follow-up of 3 years. Sixty-one out of 64 hips went through an early postoperative bone scan. The three hips that developed AVN showed significant loss of radionuclide uptake. There were neither false-positive or false-negative cases in this series. Early postoperative bone scan has an excellent sensitivity and predictive value for detection of AVN after surgical treatment of slipped capital femoral epiphysis.
Journal of Pediatric Orthopaedics B 02/2001; 10(1):51-5. · 0.47 Impact Factor
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ABSTRACT: To assess the efficacy of percutaneous embolization with an alcoholic solution of zein in the treatment of aneurysmal bone cysts.
Eighteen patients with aneurysmal bone cysts were treated percutaneously with alcoholic zein. The cysts were in the lower limb (n = 7), upper limb (n = 5), pelvis (n = 3), cervical spine (n = 2), and mandible (n = 1). All patients were symptomatic, three had previously undergone surgery. Percutaneous embolization was performed with fluoroscopic or computed tomographic guidance with the patient under general anesthesia. Clinical and imaging follow-up lasted 18 months to 4 years.
Percutaneous embolization was performed in 16 cases. In two cases, cystograms showed marked venous drainage and thus embolization was not attempted. Six patients underwent repeat embolization. Complications consisted of a local transitory inflammatory reaction (n = 5), aseptic osteitis (n = 1), and a small pulmonary infarct without sequelae (n = 1). Relief of symptoms was achieved in all patients except one, who underwent surgery. At imaging, improvement was total in 13 cases (87%) and partial in two cases (13%). No recurrence was noted during follow-up.
Percutaneous embolization of aneurysmal bone cysts with alcoholic zein should be considered a reliable alternative to surgery, especially in cases with a difficult surgical approach or cases of postsurgical recurrence.
Radiology 09/1998; 208(2):369-73. · 5.73 Impact Factor
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ABSTRACT: Percutaneous epiphysiodesis is the actual treatment for mild leg length discrepancy. The authors discuss complications and efficiency of this technique and its accuracy for the prevision of leg length discrepancy.
We reviewed 60 skeletally mature patients (35 boys, 25 girls). Limb length was defined by clinical and teleradiographic evaluation. Bone age was recorded using Sempé's and Pavia's atlas, using the hand, and Sauvegrain's method, using the elbow. Anticipated discrepancies and timing of epiphysiodesis were calculated using Héchard and Carlioz's graph. The percutaneous curetage was employed in all cases.
The treatment was successful for all cases. Complications occurred postoperatively in 2 children who developed an hematoma. 10 children required a surgical revision: 2 cases had an inverted discrepancy, 4 patients were found to have limb deviation, and in four children this treatment was not adequate. The outcome was excellent in 48.3 per cent of cases, satisfactory in 31.7 per cent, acceptable in 6.7 per cent and bad for 13.3 per cent of cases.
Percutaneous epiphysiodesis is well tolerated in childhood with similar results to other techniques (stapling and Phemister's technique). Our experience suggest that:--complications are rare--this treatment is a satisfactory surgical solution--effective previsions for the best time for surgery have not yet been defined.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 05/1998; 84(2):172-9. · 0.37 Impact Factor
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ABSTRACT: Effects of selective dorsal rhizotomy (SDR) were studied in children with spastic cerebral palsy in orthopaedic and functional fields.
In a prospective study, we compared the same population before SDR and 1 year after SDR. This population included children with spastic cerebral palsy, when spasticity was responsible for a halt in the motor skill acquisitions or for orthopaedic complications. All the children had intensive physiotherapy for 6 months postoperatively. We observed spasticity by a 4-point scale, isolation of movement by a 3-point scale, and orthopaedic status by the measure of range of motion, hip migration on the radiography, and function by Gross Motor Function Measure (GMFM) and Abbott scale. All the assessments were done by the same physiotherapist. We compared the results with a Wilcoxon statistic test.
18 quadriplegic children had spastic cerebral palsy; their mean age was 9 years (5.5-16.5 years). We observed a decrease in spasticity in all the muscular groups; increase in range of motion only on abduction and extension of the hips; no evolution of hip migration; an increase of 3.2% in the total GMFM score; 1 child was classified IV before SDR and V after SDR on the Abbott scale; 3 children had planned orthopaedic surgery in the year after SDR; 16 children and their families were highly satisfied with the result of the surgery.
The decrease in spasticity does not entail prevention of orthopaedic problems in children with quadriplegic spastic cerebral palsy. However, we observed an improvement in qualitative function that is outside the scope of current assessment scales.
Stereotactic and Functional Neurosurgery 02/1997; 69(1-4 Pt 2):259-67. · 1.85 Impact Factor
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ABSTRACT: High-resolution real-time sonography (US) has been used for many years in departments of pediatric radiology to image soft tissues and joints in children. The purpose of this study was to review the main indications and results of US in assessing the hip (except for congenital dislocation and subluxation) and the soft tissues of the thigh and groin in children. The technical and anatomical factors relative to the optimal imaging of the hip joint and thigh muscles are also discussed and a variety of conditions considered, ranging from painful hips to soft tissue masses. In conclusion, high-resolution US emerges as a particularly useful tool in the study of children with acute hip pain (hip joint effusion), suspected osteomyelitis (fluid collection around the femoral saft) and various soft tissue of the thigh.
La radiologia medica 06/1993; 85(5 Suppl 1):247-51. · 1.44 Impact Factor
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ABSTRACT: The aim of this study was to precisely analyse the physio-pathogenic mechanisms, bring to light the risk factors, and find a more practical way of proceeding in spinal surgery. Out of 667 spinal instrumentation surgical operations carried out between 1980-1989, we found 33 (4.8 per cent) neurological complications and have divided them into 2 groups: 7 peripheral complications, 26 cord and central complications. After further analysis, especially of the cord complications (2.5 per cent), we were able to pick out the factors which influence the rate of neurological complications and their evolution: secondary aetiology and the kyphotic composition of spinal deformation, and above all the notion of cord at risk. The delay of cord complications and especially the relation between the severity of the neurological syndrome and its evolution is extremely important. Somesthesic evoked potential monitoring confirmed that per operative diagnosis of a cord injury is possible. The steps to take when confronted with neurological complications, depend on the results of many examinations: pre and post-operative neurological evaluations electrophysiological exploration of the cord and neuro radiological explorations (myelography, scanner and IRM). This helps to complete aetiology and eliminate mechanical causes, which are the only positive indications of iterative surgery. The problems of instrumentation removal in emergency and the legal-medical aspect brought on by this type of complication are discussed.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 02/1992; 78(2):90-100. · 0.37 Impact Factor
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ABSTRACT: Three observations of skeletal angiomatosis are reported: one diffuse and two focal forms (Gorham's disease). The analysis of these cases and a review of the literature enhance the clinical and radiological presentation of this uncommon disease. The authors point out the interest of indirect lymphoscintigraphy and dwell on the gravity of its course, in spite of therapeutic attempts.
Pédiatrie 01/1986; 40(8):613-22.
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ABSTRACT: The Armstrong procedure combines the use of a conventional Harrington rod in the concavity of a curve, together with a distracting force on the convex side, this force being applied one vertebra lower. Workers have used this procedure in 35 cases. It is concluded that there are three advantages: A better horizontal disposition of the lower vertebra. Greatly diminished stress on the two rods shown by a biomechanical study. Derotation is more easily obtained and the spine is better balanced as a whole, as shown by a three-dimensional study comparing this method and conventional Harrington rodding.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 02/1985; 71(2):111-8. · 0.37 Impact Factor
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ABSTRACT: A long-term follow-up study has been made of 276 patients with thoracic or double major idiopathic curves treated by Harrington rodding between 1963 and 1971. 82 patients were able to be followed up to the present date, including 24 double major idiopathic curves and 58 thoracic or thoracolumbar curves. The average follow-up was 15 years with a maximum of 20 years. There were 71 female and 11 male patients. It was concluded that the lumbar curve associated with a thoracic or thoraco-lumbar curve lost about 9.9 degrees when the lower point of insertion of the rod was higher than L3. When it was at L3 or L4 loss of correction was only 3.6 degrees. During the same period the loss of correction of the main grafted curve was 13.6 degrees. In double major curves, the best results were obtained when the lumbar curve was completely or almost completely fused, with an average correction of 17.2 degrees. The results were good when the fixation extended to the apex of the lumbar curve, with an average correction of 11.6 degrees and was moderate when it extended to a higher level with an average correction of 10.9 degrees. It is concluded that in almost all cases, instrumentation needs to be extended to a low level at L3 or L4 to provide greater stability. A study on all 276 cases showed that the morphological adaptation beneath the grafts was satisfactory and long lasting. When the instrumentation stopped at the level of T12, L1 or L2 there was a danger of the development of secondary lumbar kyphosis. Low back pain was not made worse in any cases of low lumbar fixation.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 02/1985; 71(3):187-93. · 0.37 Impact Factor
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Pédiatrie 35(5):425-30.
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Journal of musculoskeletal & neuronal interactions 8(1):32. · 2.00 Impact Factor
