La deformation de Madelung est une entite pathologique rare se definissant comme une fermeture pa... more La deformation de Madelung est une entite pathologique rare se definissant comme une fermeture partielle et prematuree du cartilage de croissance distal du radius, au cours de la croissance. Elle peut etre isolee, ou au contraire s'integrer dans des dysostoses generalisees comme la maladie de Leri et Weil. La consequence anatomique de cette epiphysiodese est la creation d'une dysharmonie complexe du poignet : l'orientation de la glene radiale est exageree en avant et en dedans, avec un carpe de forme triangulaire et une distorsion de l'articulation radio-ulnaire distale du fait de la bascule anterieure du radius et de sa brievete relative par rapport a l'ulna ( figure 20.1a et b ) . Les consequences cliniques de cette anomalie anatomique sont marquees par une tete ulnaire anormalement proeminente en region dorsale ( figure 20.1c ) et, sur le plan fonctionnel, une impotence qui peut etre tres variable en fonction des sujets et de la severite de la deformation anatomique. Souvent, les amplitudes articulaires sont limitees, essentiellement en prono-supination, mais aussi en flexion-extension et en abduction-adduction. Cependant, les patients se plaignent tout d'abord de l'aspect inesthetique de leur poignet. La plainte fonctionnelle est au second plan. Rarement, et de maniere tardive, certains patients peuvent presenter une arthrose sur ce poignet deforme. Dans cette affection, il faut differencier la forme severe et la forme moderee. Dans la forme severe, on observe une rotation du radius distal, et la surface articulaire radiale de l'articulation radio-ulnaire distale regarde vers l'arriere. Dans les formes moderees, on n'observe pas cette rotation du radius distal, et la surface articulaire radiale de l'articulation radio-ulnaire distale ne regarde pas vers l'arriere, mais vers le cote ulnaire, comme c'est le cas dans un poignet normal. Dans ces formes moderees, le radius est simplement « courbe » en avant, c'est-a-dire avec un exces majeur d'anteversion de la glene radiale.
Marfan syndrome (MFS) is a genetic disease often marked with the presence of scoliosis, which is ... more Marfan syndrome (MFS) is a genetic disease often marked with the presence of scoliosis, which is poorly described in the literature. No three-dimensional analysis of the deformity in the literature is observed. Thirty patients diagnosed with MFS were prospectively included in our series. Each patient was proposed to undergo a stereoradiographic examination of the spine. Personalized three-dimensional reconstruction from T1 to L5 of the spine were made. The Cobb angle of each curve and the axial rotation of each vertebra were assessed. Our aim was to assess whether there is a correlation between the Cobb angle and the axial vertebral rotation at the apex of the curves associated with MFS. Fourteen females and 16 males were included. The mean age was 25.9 years, ranging from 4 to 65 years. Eleven patients were under 16 years. Nineteen patients were defined as scoliotic (Cobb angle over 10 degrees ), and 11 were defined as nonscoliotic (Cobb angle under 10 degrees ). A strong correlation (Pearson) between the Cobb angle and the axial vertebral rotation at the apex of the curves associated with MFS was observed. This is the first step of a three-dimensional analysis of the scoliosis associated with MFS. This study pointed out that the vertebral axial rotation in scoliosis associated with MFS compared with that observed in adolescent idiopathic scoliosis and in scoliosis associated with cerebral palsy patients. II (Diagnostic Study).
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur
We report the case of a 15-year-old girl who suffered an indirect knee trauma. The standard X-ray... more We report the case of a 15-year-old girl who suffered an indirect knee trauma. The standard X-rays revealed a tract of ivory-like bone partially obstructing the medullary canal of the femur and the tibia. Magnetic resonance imaging produced a hypointense signal on the T1 and T2 sequences. The radiographic diagnosis was melorheostosis which was confirmed on the biopsy specimen which ruled out other diagnoses. The MRI also revealed a tear of the anterior cruciate ligament, treated conservatively. Clinical and radiological surveillance were proposed for the melorheostosis.
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2007
We report the case of an 8-year-old boy who presented an osteoid osteoma of L5 associated with bi... more We report the case of an 8-year-old boy who presented an osteoid osteoma of L5 associated with bilateral spondylolysis involving the same vertebra. Diagnostic bone scintigraphy is highly contributive in children presenting back pain. For us, it is the first intention exploration in patients with isthmic lysis seen on the plain x-ray. Symptomatic spondylolysis is the most frequent cause of back pain in children and is much more frequent than vertebral osteoid osteoma. The presence of isthmic lysis associated with focal uptake on the bone scintigraphy is highly suggestive of symptomatic spondylolysis. In this context, magnetic resonance imaging should be performed for both diagnostic purposes and prognostic assessment. The degree of bone and soft tissue edema in the present case was unusual for symptomatic spondylolysis. Complementary computed tomography finally established the diagnosis of osteoid osteoma of the posterior vertebral arch. To our knowledge, the association of osteoid o...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2005
The aim of this work was to validate the pertinence of a radiological index (P/A) used as a predi... more The aim of this work was to validate the pertinence of a radiological index (P/A) used as a predictive factor for risk of kyphosis in children with spina bifida. P/A is defined as the ratio between P, the distance between the posterior vertebral wall and the remnant of the posterior arch, over A, the distance between the anterior wall and the posterior vertebral wall, measured on the lateral view of the spine in the most dysplastic vertebra before one year of age. The files of 163 children were reviewed. The value of the P/A ratio was measured on lateral views of the spine obtained before the age of one year. The bone level on the anteroposterior film was also noted. The presence or absence of kyphosis was determined from the lateral views obtained at ten years of age. Paired variable analysis was used to compare the mean differences in P/A at one year and at ten years in 31 patients with a bone level of L1 or higher. The exact Fisher test was used to determine the difference in the...
The authors performed a biometric analysis of the femoral patellar groove in fetus and compared t... more The authors performed a biometric analysis of the femoral patellar groove in fetus and compared their findings with those observed in adults. Forty-four formalin-preserved fetuses were studied (13-38 weeks). Digitalized images were used to obtain measurements (alpha angle of the groove, trochlear slopes thetaL and thetaM). A comparison of means of independent samples between our series and adults was performed. For each angle of the distal epiphysis (alpha, thetaL, thetaM) there was no significant difference between this fetal series and adults. This is the first biometry of the fetal patellar groove. The morphology of the lower femur appears to be the same in fetus and adults. The results of this study suggest that the anatomic characteristics of the patellar groove could have been integrated into the genome during the course of evolution. This would be in favor of a genetic origin of patellar groove dysplasia.
The diagnosis of scoliosis is based on the association of kyphosis, vertebral rotation, and later... more The diagnosis of scoliosis is based on the association of kyphosis, vertebral rotation, and lateral deviation of the spine. The clinical examination has to be rigorous in order to rule out a potential etiology for this tridimensional deformity. The assessment of the growth, and of the progressive nature of the scoliosis, is essential before any treatment. For minor deformities, a simple clinical monitoring will be necessary. On the other hand, for moderate deformities, a non-surgical treatment with brace will be recommended. Finally, for severe deformities, the treatment will be a surgical treatment. Surgery will consist of a spinal arthrodesis.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2008
quatre patients sur 16 ont présenté des déformations angulaires frontales supérieures à 5 • et ci... more quatre patients sur 16 ont présenté des déformations angulaires frontales supérieures à 5 • et cinq sur 16 des inégalités de longueur des membres inférieurs supérieures à 2 cm. Aucun des cinq patients traités par lame-plaque n'a présenté de déformation angulaire, ni d'inégalité de longueur supérieure à 2 cm.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2008
We report the case of a 15-year-old girl who suffered an indirect knee trauma. The standard X-ray... more We report the case of a 15-year-old girl who suffered an indirect knee trauma. The standard X-rays revealed a tract of ivory-like bone partially obstructing the medullary canal of the femur and the tibia. Magnetic resonance imaging produced a hypointense signal on the T1 and T2 sequences. The radiographic diagnosis was melorheostosis which was confirmed on the biopsy specimen which ruled out other diagnoses. The MRI also revealed a tear of the anterior cruciate ligament, treated conservatively. Clinical and radiological surveillance were proposed for the melorheostosis.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
We report the case of a 48-year-old woman who underwent a revision procedure to insert a costocho... more We report the case of a 48-year-old woman who underwent a revision procedure to insert a costochondral autograft after failed trapeziectomy-ligamentoplasty. Clinical outcome was assessed at 3, 6, 12, and 24 months and compared with the preoperative situation. Pain (VAS), force (key pinch and grasp), writing capacity, use of an ignition key, and range of motion of the trapeziometacarpal joint
Grafts available in revision anterio cruciate ligament reconstruction: analysis of the literature... more Grafts available in revision anterio cruciate ligament reconstruction: analysis of the literature This work is an exhaustive analysis of the literature focussing on revision anterior cruciate ligament reconstruction. The aim was to determine if there is a specific graft among all available that is correlated with better results. The Pub Med search engine was filled in with the words "revision" and "cruciate". All of the original articles considered as apt were retrieved and matched with inclusion criteria. The aim was to gather groups of patients (according to the graft used) and to compare the results of each group (KT 1000, IKDC score, Lysholm score, Tegner score). 264 items were found out. 52 articles were considered as pertinent, and 14 articles had a result section with clearly expressed outcomes. Only 5 articles met the inclusion criteria. The comparison of the results from the different groups pointed out: KT 1000: no significant difference. IKDC and Lysholm score: the group "iterative patellar tendon group" demonstrated lower results than the other groups. Tegner score: no significant difference. Only one conclusion can be drawn from our analysis: iterative patellar tendon harvesting must be avoided for revision ligamentoplasty of the anterior cruciate ligament.
Orthopaedics & Traumatology: Surgery & Research, 2010
We report the case of a 7-year-old girl presenting with giant cell tumor (GCT) of the index finge... more We report the case of a 7-year-old girl presenting with giant cell tumor (GCT) of the index finger, complicated by lung metastases. Index disarticulation, pulmonary metastasectomy and chemotherapy failed to produce a cure, and the child died at the age of 8 years after 1 year's evolution. The pulmonary metastases were discovered following hypoxia during initial biopsy. A review of the literature shows this observation to be original, in terms of the patient's age and of the location, onset and fatal outcome of metastasis. The hypoxic episode complicating biopsy raises the issue of early screening for lung metastases in GCT. Pulmonary dissemination of GCT is of severe prognosis.
Orthopaedics & Traumatology: Surgery & Research, 2009
Limb deformities in children can be corrected using different techniques, notably external fixati... more Limb deformities in children can be corrected using different techniques, notably external fixation following the Ilizarov principles. However, correction can be difficult in cases of multiple deformities. In 1994, Charles Taylor developed a new computer-assisted hexapodal external fixator system to treat these pathologies, the Taylor Spatial Frame TM. The objective of this study was to evaluate the results obtained with this technique in treating lower-limb deformities in children. Thirty-six patients were included in this prospective study, with a mean age of 11.1 years. The etiologies were distributed into six groups: congenital pathologies in 17 cases, fractures in five cases, post-traumatic pathologies in two cases, postinfectious sequelae in three cases, achondroplasia in three cases, and other causes in the last six cases. A total of 67 deformities in the three spatial planes were found in the entire group of patients. The procedure consisted of lengthening, correcting the axis, or both simultaneously. All the patients were managed with the same protocol: placement of an external fixator, AP and lateral X-rays, and planning of the correction using dedicated software. In this group of 36 patients, the fixator was worn for a mean 183 days; when lengthening was performed, a mean 4.3 cm was gained with a healing index of 38.2 days/cm. Of the 67 initial deformities, 91% were corrected. The most frequently encountered complications were a superficial infection in 22.2% of the cases; one deep infection was also noted as well as three bone regenerate fractures. Use of this computer-assisted fixation system seems effective in treating complex deformities of the limbs in children, and allows treating several deformities simultaneously.
Revue de Chirurgie Orthopédique et Traumatologique, 2011
S280 86 e réunion annuelle de la Société française de chirurgie orthopédique et traumatologique m... more S280 86 e réunion annuelle de la Société française de chirurgie orthopédique et traumatologique ment libéré en zone portante doit idéalement être réalisé dans les 10 jours mais est encore possible à 2 mois ; il donne régulièrement une consolidation et de bons résultats.
Revue de Chirurgie Orthopédique et Traumatologique, 2011
ABSTRACT Objectif Description d’une nouvelle procédure chirurgicale permettant la réalisation d’u... more ABSTRACT Objectif Description d’une nouvelle procédure chirurgicale permettant la réalisation d’une arthrodèse circonférentielle et une fixation trans-sacrolombaire par l’intermédiaire d’une vis sur mesure. Patients et méthodes Sept patients âgés de 13 à 18 ans ont été opérés selon cette technique (âge moyen 15 ans). L’ensemble des patients était porteur d’un spondylolisthésis de haut grade (stade III et IV de Meyerding). Il y avait cinq filles et deux garçons. À chaque fois, l’approche fut uniquement postérieure. L’arc postérieur de L5 était entièrement enlevé, puis une laminectomie sacrée jusqu’en S2 était réalisée. Les racines S2 et S3 étaient prudemment disséquées et relevées. Une broche était ensuite placée médialement au travers des vertèbres du bord postérieur de S2 jusqu’au coin antérosupérieur de L5. Un contrôle scopique peropératoire permettait d’assurer la bonne position de la broche. La vis sur mesure, d’un diamètre de 10 mm était ensuite introduite en utilisant la broche comme guide. La fixation de la vis se faisait ensuite par la mise en place d’un bouchon spécifique de diamètre plus important permettant de réaliser une compression de l’ensemble. Une fois la fixation effectuée, le dôme sacré était retirée et une fusion intersomatique était réalisée (greffe tricorticospongieuse de chaque côté de la vis). Il était ensuite effectué une fusion postérolatérale bilatérale additionnelle. En postopératoire, un corset hémiculotte était prescrit pendant trois mois, suivi du port d’un lombostat pendant trois mois. Résultats Une complication neurologique a été notée. Une brèche durale fut réalisée durant la dissection et a nécessité une simple réparation. Tous les patients ont été levés au cinquième jour postopératoire avec reprise de la marche. Un corset hémiculotte postopératoire a été porté pendant quatre mois pour quatre patients et pendant deux mois pour les trois derniers. Au dernier recul, aucun des patients ne présentait de symptômes douloureux résiduels. Discussion Chez les enfants porteurs d’un spondylolisthésis de haut grade, le rachis lombaire s’adapte aux nouvelles conditions mécaniques. Le principal but du traitement est donc d’obtenir une fusion solide. Notre philosophie de traitement repose sur le concept de la double instabilité. Pour nous, il existe une instabilité générale responsable de la survenue du spondylolisthésis qu’il faut respecter en ne cherchant pas à corriger le glissement au-delà de ce qui peut être obtenu sur table opératoire en relâchement musculaire complet et une autre instabilité, locorégionale, qu’il faut neutraliser, le temps d’obtenir une fusion circonférentielle. Cette vis sur mesure, de calibre 10 mm, a démontré son efficacité dans la neutralisation des contraintes mécaniques pendant le délai nécessaire à l’obtention de cette arthrodèse circonférentielle, par une approche postérieure unique, évitant ainsi les risques inhérents à un abord antérieur. Les résultats à distance mettent en évidence que la posture préopératoire n’a pas un déterminisme purement mécanique chez l’enfant et chez l’adolescent mais que cette posture répond en grande partie à une recherche d’antalgie. Niveau de preuve IV étude rétrospective.
La deformation de Madelung est une entite pathologique rare se definissant comme une fermeture pa... more La deformation de Madelung est une entite pathologique rare se definissant comme une fermeture partielle et prematuree du cartilage de croissance distal du radius, au cours de la croissance. Elle peut etre isolee, ou au contraire s'integrer dans des dysostoses generalisees comme la maladie de Leri et Weil. La consequence anatomique de cette epiphysiodese est la creation d'une dysharmonie complexe du poignet : l'orientation de la glene radiale est exageree en avant et en dedans, avec un carpe de forme triangulaire et une distorsion de l'articulation radio-ulnaire distale du fait de la bascule anterieure du radius et de sa brievete relative par rapport a l'ulna ( figure 20.1a et b ) . Les consequences cliniques de cette anomalie anatomique sont marquees par une tete ulnaire anormalement proeminente en region dorsale ( figure 20.1c ) et, sur le plan fonctionnel, une impotence qui peut etre tres variable en fonction des sujets et de la severite de la deformation anatomique. Souvent, les amplitudes articulaires sont limitees, essentiellement en prono-supination, mais aussi en flexion-extension et en abduction-adduction. Cependant, les patients se plaignent tout d'abord de l'aspect inesthetique de leur poignet. La plainte fonctionnelle est au second plan. Rarement, et de maniere tardive, certains patients peuvent presenter une arthrose sur ce poignet deforme. Dans cette affection, il faut differencier la forme severe et la forme moderee. Dans la forme severe, on observe une rotation du radius distal, et la surface articulaire radiale de l'articulation radio-ulnaire distale regarde vers l'arriere. Dans les formes moderees, on n'observe pas cette rotation du radius distal, et la surface articulaire radiale de l'articulation radio-ulnaire distale ne regarde pas vers l'arriere, mais vers le cote ulnaire, comme c'est le cas dans un poignet normal. Dans ces formes moderees, le radius est simplement « courbe » en avant, c'est-a-dire avec un exces majeur d'anteversion de la glene radiale.
Marfan syndrome (MFS) is a genetic disease often marked with the presence of scoliosis, which is ... more Marfan syndrome (MFS) is a genetic disease often marked with the presence of scoliosis, which is poorly described in the literature. No three-dimensional analysis of the deformity in the literature is observed. Thirty patients diagnosed with MFS were prospectively included in our series. Each patient was proposed to undergo a stereoradiographic examination of the spine. Personalized three-dimensional reconstruction from T1 to L5 of the spine were made. The Cobb angle of each curve and the axial rotation of each vertebra were assessed. Our aim was to assess whether there is a correlation between the Cobb angle and the axial vertebral rotation at the apex of the curves associated with MFS. Fourteen females and 16 males were included. The mean age was 25.9 years, ranging from 4 to 65 years. Eleven patients were under 16 years. Nineteen patients were defined as scoliotic (Cobb angle over 10 degrees ), and 11 were defined as nonscoliotic (Cobb angle under 10 degrees ). A strong correlation (Pearson) between the Cobb angle and the axial vertebral rotation at the apex of the curves associated with MFS was observed. This is the first step of a three-dimensional analysis of the scoliosis associated with MFS. This study pointed out that the vertebral axial rotation in scoliosis associated with MFS compared with that observed in adolescent idiopathic scoliosis and in scoliosis associated with cerebral palsy patients. II (Diagnostic Study).
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur
We report the case of a 15-year-old girl who suffered an indirect knee trauma. The standard X-ray... more We report the case of a 15-year-old girl who suffered an indirect knee trauma. The standard X-rays revealed a tract of ivory-like bone partially obstructing the medullary canal of the femur and the tibia. Magnetic resonance imaging produced a hypointense signal on the T1 and T2 sequences. The radiographic diagnosis was melorheostosis which was confirmed on the biopsy specimen which ruled out other diagnoses. The MRI also revealed a tear of the anterior cruciate ligament, treated conservatively. Clinical and radiological surveillance were proposed for the melorheostosis.
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2007
We report the case of an 8-year-old boy who presented an osteoid osteoma of L5 associated with bi... more We report the case of an 8-year-old boy who presented an osteoid osteoma of L5 associated with bilateral spondylolysis involving the same vertebra. Diagnostic bone scintigraphy is highly contributive in children presenting back pain. For us, it is the first intention exploration in patients with isthmic lysis seen on the plain x-ray. Symptomatic spondylolysis is the most frequent cause of back pain in children and is much more frequent than vertebral osteoid osteoma. The presence of isthmic lysis associated with focal uptake on the bone scintigraphy is highly suggestive of symptomatic spondylolysis. In this context, magnetic resonance imaging should be performed for both diagnostic purposes and prognostic assessment. The degree of bone and soft tissue edema in the present case was unusual for symptomatic spondylolysis. Complementary computed tomography finally established the diagnosis of osteoid osteoma of the posterior vertebral arch. To our knowledge, the association of osteoid o...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2005
The aim of this work was to validate the pertinence of a radiological index (P/A) used as a predi... more The aim of this work was to validate the pertinence of a radiological index (P/A) used as a predictive factor for risk of kyphosis in children with spina bifida. P/A is defined as the ratio between P, the distance between the posterior vertebral wall and the remnant of the posterior arch, over A, the distance between the anterior wall and the posterior vertebral wall, measured on the lateral view of the spine in the most dysplastic vertebra before one year of age. The files of 163 children were reviewed. The value of the P/A ratio was measured on lateral views of the spine obtained before the age of one year. The bone level on the anteroposterior film was also noted. The presence or absence of kyphosis was determined from the lateral views obtained at ten years of age. Paired variable analysis was used to compare the mean differences in P/A at one year and at ten years in 31 patients with a bone level of L1 or higher. The exact Fisher test was used to determine the difference in the...
The authors performed a biometric analysis of the femoral patellar groove in fetus and compared t... more The authors performed a biometric analysis of the femoral patellar groove in fetus and compared their findings with those observed in adults. Forty-four formalin-preserved fetuses were studied (13-38 weeks). Digitalized images were used to obtain measurements (alpha angle of the groove, trochlear slopes thetaL and thetaM). A comparison of means of independent samples between our series and adults was performed. For each angle of the distal epiphysis (alpha, thetaL, thetaM) there was no significant difference between this fetal series and adults. This is the first biometry of the fetal patellar groove. The morphology of the lower femur appears to be the same in fetus and adults. The results of this study suggest that the anatomic characteristics of the patellar groove could have been integrated into the genome during the course of evolution. This would be in favor of a genetic origin of patellar groove dysplasia.
The diagnosis of scoliosis is based on the association of kyphosis, vertebral rotation, and later... more The diagnosis of scoliosis is based on the association of kyphosis, vertebral rotation, and lateral deviation of the spine. The clinical examination has to be rigorous in order to rule out a potential etiology for this tridimensional deformity. The assessment of the growth, and of the progressive nature of the scoliosis, is essential before any treatment. For minor deformities, a simple clinical monitoring will be necessary. On the other hand, for moderate deformities, a non-surgical treatment with brace will be recommended. Finally, for severe deformities, the treatment will be a surgical treatment. Surgery will consist of a spinal arthrodesis.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2008
quatre patients sur 16 ont présenté des déformations angulaires frontales supérieures à 5 • et ci... more quatre patients sur 16 ont présenté des déformations angulaires frontales supérieures à 5 • et cinq sur 16 des inégalités de longueur des membres inférieurs supérieures à 2 cm. Aucun des cinq patients traités par lame-plaque n'a présenté de déformation angulaire, ni d'inégalité de longueur supérieure à 2 cm.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2008
We report the case of a 15-year-old girl who suffered an indirect knee trauma. The standard X-ray... more We report the case of a 15-year-old girl who suffered an indirect knee trauma. The standard X-rays revealed a tract of ivory-like bone partially obstructing the medullary canal of the femur and the tibia. Magnetic resonance imaging produced a hypointense signal on the T1 and T2 sequences. The radiographic diagnosis was melorheostosis which was confirmed on the biopsy specimen which ruled out other diagnoses. The MRI also revealed a tear of the anterior cruciate ligament, treated conservatively. Clinical and radiological surveillance were proposed for the melorheostosis.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
We report the case of a 48-year-old woman who underwent a revision procedure to insert a costocho... more We report the case of a 48-year-old woman who underwent a revision procedure to insert a costochondral autograft after failed trapeziectomy-ligamentoplasty. Clinical outcome was assessed at 3, 6, 12, and 24 months and compared with the preoperative situation. Pain (VAS), force (key pinch and grasp), writing capacity, use of an ignition key, and range of motion of the trapeziometacarpal joint
Grafts available in revision anterio cruciate ligament reconstruction: analysis of the literature... more Grafts available in revision anterio cruciate ligament reconstruction: analysis of the literature This work is an exhaustive analysis of the literature focussing on revision anterior cruciate ligament reconstruction. The aim was to determine if there is a specific graft among all available that is correlated with better results. The Pub Med search engine was filled in with the words "revision" and "cruciate". All of the original articles considered as apt were retrieved and matched with inclusion criteria. The aim was to gather groups of patients (according to the graft used) and to compare the results of each group (KT 1000, IKDC score, Lysholm score, Tegner score). 264 items were found out. 52 articles were considered as pertinent, and 14 articles had a result section with clearly expressed outcomes. Only 5 articles met the inclusion criteria. The comparison of the results from the different groups pointed out: KT 1000: no significant difference. IKDC and Lysholm score: the group "iterative patellar tendon group" demonstrated lower results than the other groups. Tegner score: no significant difference. Only one conclusion can be drawn from our analysis: iterative patellar tendon harvesting must be avoided for revision ligamentoplasty of the anterior cruciate ligament.
Orthopaedics & Traumatology: Surgery & Research, 2010
We report the case of a 7-year-old girl presenting with giant cell tumor (GCT) of the index finge... more We report the case of a 7-year-old girl presenting with giant cell tumor (GCT) of the index finger, complicated by lung metastases. Index disarticulation, pulmonary metastasectomy and chemotherapy failed to produce a cure, and the child died at the age of 8 years after 1 year's evolution. The pulmonary metastases were discovered following hypoxia during initial biopsy. A review of the literature shows this observation to be original, in terms of the patient's age and of the location, onset and fatal outcome of metastasis. The hypoxic episode complicating biopsy raises the issue of early screening for lung metastases in GCT. Pulmonary dissemination of GCT is of severe prognosis.
Orthopaedics & Traumatology: Surgery & Research, 2009
Limb deformities in children can be corrected using different techniques, notably external fixati... more Limb deformities in children can be corrected using different techniques, notably external fixation following the Ilizarov principles. However, correction can be difficult in cases of multiple deformities. In 1994, Charles Taylor developed a new computer-assisted hexapodal external fixator system to treat these pathologies, the Taylor Spatial Frame TM. The objective of this study was to evaluate the results obtained with this technique in treating lower-limb deformities in children. Thirty-six patients were included in this prospective study, with a mean age of 11.1 years. The etiologies were distributed into six groups: congenital pathologies in 17 cases, fractures in five cases, post-traumatic pathologies in two cases, postinfectious sequelae in three cases, achondroplasia in three cases, and other causes in the last six cases. A total of 67 deformities in the three spatial planes were found in the entire group of patients. The procedure consisted of lengthening, correcting the axis, or both simultaneously. All the patients were managed with the same protocol: placement of an external fixator, AP and lateral X-rays, and planning of the correction using dedicated software. In this group of 36 patients, the fixator was worn for a mean 183 days; when lengthening was performed, a mean 4.3 cm was gained with a healing index of 38.2 days/cm. Of the 67 initial deformities, 91% were corrected. The most frequently encountered complications were a superficial infection in 22.2% of the cases; one deep infection was also noted as well as three bone regenerate fractures. Use of this computer-assisted fixation system seems effective in treating complex deformities of the limbs in children, and allows treating several deformities simultaneously.
Revue de Chirurgie Orthopédique et Traumatologique, 2011
S280 86 e réunion annuelle de la Société française de chirurgie orthopédique et traumatologique m... more S280 86 e réunion annuelle de la Société française de chirurgie orthopédique et traumatologique ment libéré en zone portante doit idéalement être réalisé dans les 10 jours mais est encore possible à 2 mois ; il donne régulièrement une consolidation et de bons résultats.
Revue de Chirurgie Orthopédique et Traumatologique, 2011
ABSTRACT Objectif Description d’une nouvelle procédure chirurgicale permettant la réalisation d’u... more ABSTRACT Objectif Description d’une nouvelle procédure chirurgicale permettant la réalisation d’une arthrodèse circonférentielle et une fixation trans-sacrolombaire par l’intermédiaire d’une vis sur mesure. Patients et méthodes Sept patients âgés de 13 à 18 ans ont été opérés selon cette technique (âge moyen 15 ans). L’ensemble des patients était porteur d’un spondylolisthésis de haut grade (stade III et IV de Meyerding). Il y avait cinq filles et deux garçons. À chaque fois, l’approche fut uniquement postérieure. L’arc postérieur de L5 était entièrement enlevé, puis une laminectomie sacrée jusqu’en S2 était réalisée. Les racines S2 et S3 étaient prudemment disséquées et relevées. Une broche était ensuite placée médialement au travers des vertèbres du bord postérieur de S2 jusqu’au coin antérosupérieur de L5. Un contrôle scopique peropératoire permettait d’assurer la bonne position de la broche. La vis sur mesure, d’un diamètre de 10 mm était ensuite introduite en utilisant la broche comme guide. La fixation de la vis se faisait ensuite par la mise en place d’un bouchon spécifique de diamètre plus important permettant de réaliser une compression de l’ensemble. Une fois la fixation effectuée, le dôme sacré était retirée et une fusion intersomatique était réalisée (greffe tricorticospongieuse de chaque côté de la vis). Il était ensuite effectué une fusion postérolatérale bilatérale additionnelle. En postopératoire, un corset hémiculotte était prescrit pendant trois mois, suivi du port d’un lombostat pendant trois mois. Résultats Une complication neurologique a été notée. Une brèche durale fut réalisée durant la dissection et a nécessité une simple réparation. Tous les patients ont été levés au cinquième jour postopératoire avec reprise de la marche. Un corset hémiculotte postopératoire a été porté pendant quatre mois pour quatre patients et pendant deux mois pour les trois derniers. Au dernier recul, aucun des patients ne présentait de symptômes douloureux résiduels. Discussion Chez les enfants porteurs d’un spondylolisthésis de haut grade, le rachis lombaire s’adapte aux nouvelles conditions mécaniques. Le principal but du traitement est donc d’obtenir une fusion solide. Notre philosophie de traitement repose sur le concept de la double instabilité. Pour nous, il existe une instabilité générale responsable de la survenue du spondylolisthésis qu’il faut respecter en ne cherchant pas à corriger le glissement au-delà de ce qui peut être obtenu sur table opératoire en relâchement musculaire complet et une autre instabilité, locorégionale, qu’il faut neutraliser, le temps d’obtenir une fusion circonférentielle. Cette vis sur mesure, de calibre 10 mm, a démontré son efficacité dans la neutralisation des contraintes mécaniques pendant le délai nécessaire à l’obtention de cette arthrodèse circonférentielle, par une approche postérieure unique, évitant ainsi les risques inhérents à un abord antérieur. Les résultats à distance mettent en évidence que la posture préopératoire n’a pas un déterminisme purement mécanique chez l’enfant et chez l’adolescent mais que cette posture répond en grande partie à une recherche d’antalgie. Niveau de preuve IV étude rétrospective.
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