Questions/purposes Adolescent idiopathic scoliosis is a 3D spine deformity that worsens during th... more Questions/purposes Adolescent idiopathic scoliosis is a 3D spine deformity that worsens during the whole growth. New methods for spinal growth modulation with flexible spinal implants have been described to avoid progression of the deformity during growth spurt. The main limitations are that no specific ancillaries and devices are available, which makes the surgery technically demanding. Methods We have developed a new method of spinal growth tethering using minimal invasive videothoracoscopic approach. Fixation is performed with staples and synthetic ligament on the lateral aspect of vertebral bodies on main curvature convexity. Patients with progressive thoracic idiopathic scoliosis despite the brace treatment were included. The clinical and radiological examinations were compared before and 2 years after surgery. Results Six patients with flexible thoracic curves with a mean age 11.2 ± 1.2 years and a mean Cobb angle 45°± 10°(35-60) were operated. All were skeletally immature. At last follow-up, the Cobb angle was stable. None of the patient underwent fusion. Conclusions The procedure allowed a stabilization of the deformity during growth spurt. Validated devices and further studies with longer term follow-up are needed to confirm the efficiency of this technique. This small cohort of patients is a source of reflection for further medical devices developments. Level of Evidence Level 4 case series comparing to not randomized studies.
Disponible sur Internet le 17 octobre 2016 Résumé Les traumatismes du coude de l'enfant sont très... more Disponible sur Internet le 17 octobre 2016 Résumé Les traumatismes du coude de l'enfant sont très fréquents mais le diagnostic radiologique des lésions osseuses est parfois difficile. Or certaines fractures ne souffrent pas de délais à une prise en charge adaptée. Quelques règles simples de lecture des radiographies peuvent aider le clinicien à éviter les pièges diagnostics. La connaissance de la chronologie d'apparition des noyaux d'ossification ainsi que les constructions géométriques simples sur les radiographies peuvent éliminer les pièges les plus importants et aider au dépistage de l'immense majorité des fractures occultes du coude de l'enfant.
Journal de Radiologie Diagnostique et Interventionnelle, 2014
Matéo, 2 ans, sans antécédent particulier, s'était présenté aux urgences pour une fracture de l'e... more Matéo, 2 ans, sans antécédent particulier, s'était présenté aux urgences pour une fracture de l'extrémité inférieure du quart distal des deux os de l'avant-bras droit suite à une chute de sa hauteur (Fig. 1). L'évolution avait été favorable suite à une immobilisation par plâtre brachio-antebrachio-palmaire d'une durée de 45 jours. Toutefois, une radiographie contrôle avait été demandée à 3 mois après la fracture initiale. La radiographie montrait alors des lésions ostéolytiques corticales, à l'emporte-pièce, millimétriques, l'une au niveau de la métaphyse distale du radius et trois autres médio-diaphysaires, sur le même os (Fig. 2). Le patient était asymptomatique et l'examen de l'avant-bras était sans particularité. Une tomodensitométrie de l'avant-bras avait alors été réalisée (Fig. 3).
Background The conventional approach for MRI procedures in very young children is to use general ... more Background The conventional approach for MRI procedures in very young children is to use general anesthesia which comes with inherent risks. Non-pharmacological strategies to reduce anxiety in children have also been described, but they all require patient cooperation. The purpose of the study was to evaluate the ability to complete diagnosis using temporary spica cast immobilization (TSCI) in children less than 3 years old undergoing MRI procedures for lower limb disorders. Materials and methods A retrospective review identified 14 children under 3 years old that had required an MRI for a lower limb disorder, using TSCI. The MRI procedure was performed for evaluation of hip dysplasia, bone infections, limping, evaluation of soft tissue tumor and femoral head osteonecrosis. A spica cast was fitted by the pediatric orthopedic team. The MRI procedure was subsequently performed. Results Diagnosis was achieved in all cases. The radiologist identified movement artifacts (14 %) that did not impair the image quality enough to prevent interpretation. Conclusion TSCI is a safe, effective and costless procedure avoiding general anesthesia for young patients under 3 years old who require MRI for pelvis or lower limb disorders. Level of evidence IV.
Questions/purposes Adolescent idiopathic scoliosis is a 3D spine deformity that worsens during th... more Questions/purposes Adolescent idiopathic scoliosis is a 3D spine deformity that worsens during the whole growth. New methods for spinal growth modulation with flexible spinal implants have been described to avoid progression of the deformity during growth spurt. The main limitations are that no specific ancillaries and devices are available, which makes the surgery technically demanding. Methods We have developed a new method of spinal growth tethering using minimal invasive videothoracoscopic approach. Fixation is performed with staples and synthetic ligament on the lateral aspect of vertebral bodies on main curvature convexity. Patients with progressive thoracic idiopathic scoliosis despite the brace treatment were included. The clinical and radiological examinations were compared before and 2 years after surgery. Results Six patients with flexible thoracic curves with a mean age 11.2 ± 1.2 years and a mean Cobb angle 45°± 10°(35-60) were operated. All were skeletally immature. At last follow-up, the Cobb angle was stable. None of the patient underwent fusion. Conclusions The procedure allowed a stabilization of the deformity during growth spurt. Validated devices and further studies with longer term follow-up are needed to confirm the efficiency of this technique. This small cohort of patients is a source of reflection for further medical devices developments. Level of Evidence Level 4 case series comparing to not randomized studies.
Disponible sur Internet le 17 octobre 2016 Résumé Les traumatismes du coude de l'enfant sont très... more Disponible sur Internet le 17 octobre 2016 Résumé Les traumatismes du coude de l'enfant sont très fréquents mais le diagnostic radiologique des lésions osseuses est parfois difficile. Or certaines fractures ne souffrent pas de délais à une prise en charge adaptée. Quelques règles simples de lecture des radiographies peuvent aider le clinicien à éviter les pièges diagnostics. La connaissance de la chronologie d'apparition des noyaux d'ossification ainsi que les constructions géométriques simples sur les radiographies peuvent éliminer les pièges les plus importants et aider au dépistage de l'immense majorité des fractures occultes du coude de l'enfant.
Journal de Radiologie Diagnostique et Interventionnelle, 2014
Matéo, 2 ans, sans antécédent particulier, s'était présenté aux urgences pour une fracture de l'e... more Matéo, 2 ans, sans antécédent particulier, s'était présenté aux urgences pour une fracture de l'extrémité inférieure du quart distal des deux os de l'avant-bras droit suite à une chute de sa hauteur (Fig. 1). L'évolution avait été favorable suite à une immobilisation par plâtre brachio-antebrachio-palmaire d'une durée de 45 jours. Toutefois, une radiographie contrôle avait été demandée à 3 mois après la fracture initiale. La radiographie montrait alors des lésions ostéolytiques corticales, à l'emporte-pièce, millimétriques, l'une au niveau de la métaphyse distale du radius et trois autres médio-diaphysaires, sur le même os (Fig. 2). Le patient était asymptomatique et l'examen de l'avant-bras était sans particularité. Une tomodensitométrie de l'avant-bras avait alors été réalisée (Fig. 3).
Background The conventional approach for MRI procedures in very young children is to use general ... more Background The conventional approach for MRI procedures in very young children is to use general anesthesia which comes with inherent risks. Non-pharmacological strategies to reduce anxiety in children have also been described, but they all require patient cooperation. The purpose of the study was to evaluate the ability to complete diagnosis using temporary spica cast immobilization (TSCI) in children less than 3 years old undergoing MRI procedures for lower limb disorders. Materials and methods A retrospective review identified 14 children under 3 years old that had required an MRI for a lower limb disorder, using TSCI. The MRI procedure was performed for evaluation of hip dysplasia, bone infections, limping, evaluation of soft tissue tumor and femoral head osteonecrosis. A spica cast was fitted by the pediatric orthopedic team. The MRI procedure was subsequently performed. Results Diagnosis was achieved in all cases. The radiologist identified movement artifacts (14 %) that did not impair the image quality enough to prevent interpretation. Conclusion TSCI is a safe, effective and costless procedure avoiding general anesthesia for young patients under 3 years old who require MRI for pelvis or lower limb disorders. Level of evidence IV.
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Papers by E. Bourgeois