Georges-François Penneçot

Paris Diderot University, AP-HP · PEDIATRIC ORTHOPAEDIC SURGERY ROBERT DEBRÉ HOSPITAL

In diplegic patients, the orientation of foot progression depends on multiple factors. We investigated the relationship between foot progression alignment, hip and pelvic rotations during gait, femoral anteversion, and tibial torsion. Kinematic and clinical parameters were evaluated for 114 children who walked independently and had not undergone pr...

Résumé Introduction Chez l’enfant diplégique spastique, l’insuffisance d’extension de hanche en fin de phase d’appui liée à la rétraction du psoas diminue la propulsion et la longueur du pas controlatéral. L’intérêt de réaliser un allongement intramusculaire du psoas (AIMP) reste controversé. Le but de cette étude était de déterminer l’impact de l...

Background: In children with spastic diplegia, hip extension in terminal stance is limited by retraction of the psoas muscle, which decreases stride propulsion and step length on the contralateral side. Whether intramuscular psoas lengthening (IMPL) is effective remains controversial. The objective of this study was to assess the impact of IMPL as...

Résumé La consultation multidisciplinaire de spasticité (CMD) pédiatrique permet une approche croisée du neurochirurgien, de l’orthopédiste, du médecin de médecine physique et de réadaptation, ainsi que de rééducateurs, pour proposer un traitement de la spasticité non contrôlée chez des enfants atteints de pathologies neurologiques centrales, surto...

Gait disorders in children with cerebral palsy result from muscular spasticity, impaired balance and lack of selective motor control. These primary problems are the consequence of the upper motor neuron lesion. With growth, the spastic muscle is permanently under stretch and tends to develop contracture. Because of the increased tone, the bone segm...

Lower limb rotational anomalies in spastic diplegic children with cerebral palsy (CP) are common and difficult to identify through physical examination alone. The identification and treatment of the overall rotational disorders must be considered in order to restore physiological lever-arms lengths and lever-arms orientation. The aims of the study...

Hip subluxation is common in children with cerebral palsy (CP). Surgery is indicated in case of pain or progressive increase of Reimers index on radiographs. Peri-iliac osteotomy combined with femoral osteotomy is one of the numerous operative techniques available, but results at skeletal maturity remain unclear. The purpose of this radiological st...

Determining patellar orientation in the transverse plane during observational gait analysis is a fundamental aspect of physical examinations. Many physicians consider that an abnormal position of the patella in the transverse planes is only explained by a rotational abnormality of the proximal femur. A total of 188 spastic diplegic children with ce...

Lack of normalization of foot progression angle after correction of lower limb torsional troubles raised the question about the influence of pelvis transverse plan kinematics on lower limb alignment during gait.

Hematogenous osteoarticular infections of the hand and the wrist in children with sickle cell anemia are rare and no specific studies for this location have been published. This retrospective and comparative study reviewed 34 children who carry the diagnosis of osteoarticular infections of the wrist and the hand at our institution during a 10-year...

: Many commissural reconstruction techniques have been described for the treatment of syndactyly. This study is the first to compare long-term results of 2 commissural dorsal flap procedures (T-flap and omega-flap). : Fifty-nine web-spaces in 39 patients, operated on between 1991 and 2008, were retrospectively analyzed. Thirty-six T-flap and 23 ome...

Segmental defects of the tibia are challenging therapeutic problems for both the physician and the patient. These defects may be caused by severe trauma, infection, tumors and congenital processes. Several different techniques have been described for treatment of these defects including the Papineau technique, allograft reconstruction, bone transpo...

C: Huntington procedure: Cassab did 11 cases of ipsilateral fibular transposition in patients aged between 16 and 61 years for tibial defects from 4 to 22 cm caused by severe trauma, osteomyelitis or tumor resection. They recommended arteriography for assessment of lower limb vasculature and to select the best surgical approach. They used a postero...

: Thirty to 60% of hereditary multiple exostoses patients have forearm deformities. There is no consensus regarding optimal therapy. This long-term retrospective study is the first to compare radiologic and clinical data with patient assessments, to define more precise surgical indications. : All children presenting with hereditary multiple exostos...

Résultats.– La différence moyenne entre les mesures en CT-Scan et EOS était entre 1,978 et 2,468 (non significatif). Les deux séries de mesures présentaient une excellente corrélation (r = 0,92). Les reproductibilités intra et inter-observateur pour la mesure EOS étaient excellentes (ICC = 0,98, SEM = 6,728 et ICC = 0,98, SEM = 6,888, respectivemen...

The Universal Clamp (UC) is a novel vertebral anchor consisting of a sublaminar polyester band connected to fusion rods by a titanium jaw locked with a screw. The authors prospectively studied patients treated for thoracic or lumbar burst fractures with short pedicle screw constructs reinforced with UCs to prevent screw pullout. Eleven patients bel...

Percutaneous epiphysiodesis using transphyseal screws (PETS) has been developed for the treatment of lower limb discrepancies with the aim of replacing traditional open procedures. The goal of this study was to evaluate its efficacy and safety at skeletal maturity. A total of 45 consecutive patients with a mean skeletal age of 12.7 years (8.5 to 15...

La maîtrise de l’équilibre au cours de la marche découle d’un processus qui se poursuit jusqu’à des âges avancés de l’enfance. Sutherland (1980) a montré que la marche serait largement mature à 3 ans, bien que les paramètres spatiotemporels (PST) continuent de changer jusque 7 ans. Les modifications postérieures seraient dues à la croissance. Or, l...

Lack of normalization of foot progression angle after correction of lower limb torsional troubles raised the question about the influence of pelvis transverse plan kinematics on lower limb alignment during gait. The goal of this study was to explore the influence of pelvis kinematics on foot progression angle deviations.

The purpose of this study is to describe the kinematic changes in children with cerebral palsy (CP) after treatments performed on the forearm, wrist or thumb, with specific attention to the changes around the trunk, shoulder and elbow kinematics. With the use of a specific kinematic protocol, we first described the upper limb kinematics in a group...

Le traitement des infections ostéo-articulaires de l’enfant comprend une antibiothérapie précoce ciblant Staphylococcus aureus et Kingella kingae associée au drainage chirurgical des collections purulentes associées (arthrite, abcès sous-périosté). En 2007, le Groupe de pathologie infectieuse pédiatrique de la Société française de pédiatrie a propo...

Management of bone and joint infections in children associates early appropriate antibiotic therapy against Staphylococcus aureus and Kingella kingae and, if necessary, surgical drainage of abscess or septic arthritis. In 2007, the Paediatric Infectious Diseases Group of the French Society of Paediatrics (GPIP) proposed guidelines for antibiotherap...

Children with spastic diplegia frequently show excessive knee extension (stiff-knee gait) throughout swing phase, which may interfere with foot clearance. Abnormal rectus femoris activity is commonly associated with a stiff-knee gait. Rectus femoris transfer has been recommended to enhance knee flexion during swing. However, recent studies suggest...

Le Functional ambulation performance score (FAPS) est utilisé pour mesurer la qualité des para- mètres spatiotemporels (PST) chez l’adulte. Les auteurs ont cherché à mettre en évidence l’adé- quation de ce score avec une population d’enfants asymptomatiques. Les PST ont été enregistrés chez 32 enfants répar- tis par groupes d’âge, via la piste de m...

We conducted a retrospective study comparing the presenting clinical and biologic features of 64 children who had septic arthritis caused by Kingella kingae with 26 children who had septic arthritis caused by Staphylococcus aureus. Children with K. kingae septic arthritis were significantly younger than those with S. aureus septic arthritis. Otherw...

Introduction La maladie de Blount peut s’accompagner dans les formes sévères d’une dépression du plateau tibial médial. Le traitement doit alors prendre en compte la congruence articulaire, la laxité, l’axe du membre, les troubles de torsion, l’inégalité de longueur des membres inférieurs (ILMI) et la survenue de récidives. Matériel et méthodes Hu...

Avulsion of a digit has not always been an indication for replantation because of extensive injuries. The advent of microsurgery changed this, permitting avulsed digit replantations with varying rates of success. The aim of this study was to analyze surgical management of finger avulsion injuries of an exclusively pediatric series. A retrospective...

Thoracoscopy is now considered a safe and feasible method for surgical management of spinal disorders in both adults and children. Nevertheless, a weight less than 20 kg has been reported as a relative contraindication because of the small volume of the thoracic cage and the anticipated difficulties of single-lung ventilation. The aim of this study...

Gait characteristics of a healthy adult population have been used to develop the Functional Ambulation Profile (FAP) score to evaluate gait in patients with neuromuscular or musculoskeletal involvement (A. J. Nelson, 197414. Moreno-Hernandez , A. , Rodriguez-Reyes , G. , Quinones-Uriostegui , G. , Nunez-Carrera , L. and Perez-SanPablo , A. I....

Severe forms of Blount's disease may be associated with medial tibial plateau (MTP) depression. Management should then take account of joint congruence, laxity, limb axis, torsional abnomality, leg length discrepancy (LLD) and eventual recurrence history. Eight knees (six patients) were managed in a single step comprising MTP elevation osteotomy, l...

Les paramètres spatiotemporels (PST) renseignent sur la façon dont le patient organise sa marche et met en évidence la nature du contrôle moteur mis en oeuvre pour la réaliser. Le Functional Ambulation Performance Score (FAPS), récemment validé chez l’enfant de plus de 12 ans [1], quantifie par un seul nombre l’écart à la norme de ces PST. Un nouve...

Les paramètres spatiotemporels (PST) sont les paramètres quantifiables les plus utilisés pour évaluer la marche et estimer le risque de chute. Deux aspects de l’équilibre - que nous nommerons en nous inspirant de la sémantique utilisée en posturologie pour étudier l’équilibre statique [1] - doivent être pris en compte : « steadiness » et « stabilit...

Disposer d’un outil permettant d’évaluer rapidement la marche d’un sujet se révèle fortement utile dans la pratique clinique quotidienne. Ainsi, tenter de résumer un ensemble de paramètres de la marche en un seul score ou index a toujours été un champ de recherche prolifique. Concernant les paramètres spatiotemporels de la marche, Nelson a introdui...

La epifisiólisis femoral superior (EFS) es un deslizamiento de la cabeza femoral respecto al cartílago de crecimiento cervicocefálico. En la literatura anglosajona se denomina slipped capital femoral epiphysis. El tratamiento consiste en impedir que continúe el deslizamiento progresivo y en prevenir que se produzca de forma súbita un deslizamiento...

Introduction La production de travaux de recherche est de plus en plus encouragée dans notre pays. Cependant, publier dans les journaux à facteur d’impact élevé anglophones reste difficile pour les auteurs français. Les Anglo-Saxons organisent depuis longtemps des séances de bibliographie, dans le but de mettre à jour leur pratique et de stimuler l...

Retrospective study of prospectively collected data. Compare Universal Clamps (UCs) and hooks for the thoracic correction of adolescent idiopathic scoliosis (AIS). In scoliosis surgery, sagittal correction is as important as frontal correction due to the risk of junctional kyphosis. Compared to all-screw constructs, hybrid constructs with lumbar pe...

Disposer d’un outil pour évaluer rapidement la marche se révèle utile dans la pratique clinique quotidienne. En ce qui concerne les paramètres spatiaux et temporels de la marche, Nelson a introduit un score, le Functional Ambulation Profile. Méthode papier crayon à l’origine (Nelson, 1974), le FAP a évolué avec les technologies d’analyse de la marc...

Objectif L’analyse cinématique au membre supérieur est de plus en plus utilisée en pratique courante comme le montrent plusieurs études récentes. Nous avons décrit un protocole d’analyse cinématique au membre supérieur que nous avons appliqué à un groupe d’enfants sains afin de disposer de données normatives, puis à un enfant présentant une paralys...

Lumbosacral fusion is often needed in cases of pediatric neuromuscular spinal deformities. Despite the numerous fixation techniques described, the procedure remains challenging. Jackson has described a method of intrasacral fixation providing immediate 3-dimensional stability and promising clinical results. The purpose of this study was to report o...

The development of claw toe deformity following fracture of the tibia in children has not been described in our review of the literature. We report on the management of the acquired claw toe deformity after tibia fracture in five children. We report on five patients, between 5 and 15 years of age, who developed clawing of the hallux following a fra...

Shoulder external rotation posturing in patients with cerebral palsy can severely impair bimanual activities and lead to painful shoulder instability. We performed an anatomical study to describe the surgical approach to the shoulder external rotators nerves. Using this technique, we performed a selective neurotomy in five shoulders with external r...

Several recent studies demonstrate that upper extremities kinematics analysis is in increasing use to assist clinical practice. We describe an upper limb kinematics analysis protocol that was first applied to a group of healthy children (to obtain normative data), and subsequently, to a child presenting with obstetrical brachial plexus palsy (OBPP)...

There are two types of congenital enlargement of the finger. In one type, the finger is enlarged as part of a syndrome or because of a tumor or a malformation. In the other, the finger is enlarged as an isolated anomaly called "true macrodactyly", with an abundance of fat mainly on the palmar side of the finger. This condition is a rare congenital...

Introduction et objectifs Nous relatons l’épidémiologie bactérienne des IOA communautaires survenues à l’hôpital R. Debré entre 2000 et 2008 chez les enfants de moins de 15 ans. Matériels et méthodes Ces infections ont été documentées par culture des prélèvements, par PCR universelle à partir de 2005 et PCR spécifique vis-à-vis de Kingella kingae...

Inoculation of blood culture vials with joint fluid samples has revealed the important pathogenic role of Kingella kingae in pediatric arthritis. However, recent studies based on broad-range 16S ribosomal DNA PCR and real-time PCR without a probe suggest that conventional methods remain suboptimal. We developed a new real-time PCR method with a pro...

Que ce soit chez l’enfant IMC ou la personne âgée, il est courant d’observer une instabilité pendant la marche pouvant accroître le risque de chute. De nombreux auteurs ont cherché à identifier des paramètres déterminant la stabilité, principalement chez les sujets âgés chuteurs [2, 3], moins chez l’enfant [1] ; pourtant il n’existe actuellement au...

La incidencia de las malformaciones congénitas del miembro superior es de 6,5/10.000 nacimientos. La ecografía prenatal permite hacer una detección cada vez más precoz. Cuando se descubre una gran malformación en período prenatal, la atención médica se efectúa en un centro especializado con el fin de practicar una valoración morfológica precisa y b...

Correction of adolescent idiopathic scoliosis (AIS) has been reported with various systems. All-screw constructs are currently the most popular, but they have been associated with a significant decrease in thoracic kyphosis, with a potential risk of junctional kyphosis, not observed with hybrid constructs in the literature. In addition, it is impor...

Determining the level of fusion remains a highly debated topic in adolescent isiopathic scoliosis. The King and Lenke classifications are used, but have their limitations, particularly the weak interobserver reproducibility. We describe the method we use which is independent of the anatomic classification, based on the predictable reduction of the...

The selection of fusion levels continues to be controversial in adolescent idiopathic scoliosis (AIS). The classifications of King and Lenke remain the most widely used, but recent studies have demonstrated their shortcomings, including poor interobserver reproducibility. We propose a method of preoperative planning that is independent of anatomica...

Purpose of the study Determining the level of fusion remains a highly debated topic in adolescent isiopathic scoliosis. The King and Lenke classifications are used, but have their limitations, particularly the weak interobserver reproducibility. We describe the method we use which is independent of the anatomic classification, based on the predicta...

Iliac crest autograft is currently the gold standard material for spinal fusion. However, its use is limited by additional operative time, increased blood loss, and morbidity. Recently, a synthetic osteoconductive bone graft material composed of bioactive glass has been described, with high effectiveness in animal models. Its ability to achieve spi...