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Biomedical subjects

Franck Launay

Publications and source records attributed to Franck Launay.

18 recordsLinked to original sources
PubMed2007

Classification of chance fracture in children using magnetic resonance imaging.

STUDY DESIGN: MRI study of pediatric Chance fracture. OBJECTIVE: To evaluate bone and soft tissue lesions in pediatric Chance fracture. SUMMARY OF BACKGROUND DATA: Several descriptions and classifications have been already developed for Chance fracture, but mainly for adult. Furthermore, they are all based only on radiographic studies. METHODS: MRI and radiographs of 18 children with Chance fracture were analyzed before treatment. RESULTS: On MRI, in all cases, no abnormal signs were noted on the intervertebral disc. Six patients had a bone fracture going through the pedicle and the vertebral body. Twelve patients had a physeal injury located on the superior or on the inferior vertebral endplate. Three types of lesions could be identified according to the location of the lesion in relation to the pedicle. CONCLUSION: MRI is useful in the diagnosis of pediatric Chance fracture. It allows physeal injury to be clearly identified from disc injury.

Adolescent↗
PubMed2007

Assessment of acute ankle sprain with os subfibularein children.

Children commonly present with acute inversion injuries of the ankle. Radiographs occasionally show small fragments under the tip of the lateral malleolus. The purpose of our study was to clarify their origin. A prospective standardized clinical examination and a magnetic resonance imaging were carried out. Among the 116 included patients, seven of them showed an os subfibulare. They presented more pains on the lateral ankle area than the other children. We found also more injuries on the anterior talofibular ligament. The os subfibulare could be secondary to an accessory ossification but the lateral area of the ankle would be likely to be injured.

Ankle Injuries↗
PubMed2006

Thoracolumbar hemivertebrae resection by double approach in a single procedure: long-term follow-up.

STUDY DESIGN: Retrospective review of patients records with clinical and radiographic assessment. OBJECTIVE: To evaluate the long-term result of thoracolumbar hemivertebrae resection using a double approach in a single procedure. SUMMARY OF BACKGROUND DATA: Thoracolumbar hemivertebrae resection by a combined posterior and anterior approach has been previously described, but this is the largest series of hemivertebrae reported. METHODS: From 1987 to 2003, a consecutive series of 34 congenital scoliosis or kyphoscoliosis due to thoracolumbar hemivertebrae were managed by hemivertebra resection using a combined posterior and anterior approach and short anterior and posterior convex fusion in the same day/same anesthesia. RESULTS: The mean age at surgery was 3.5 years. The mean follow-up period was 6.0 years. There was a mean improvement of 69.3% in the segmental curve from a mean angle of 34.8 degrees before surgery to 10.7 degrees at the latest follow-up assessment. The global scoliosis curve improved of 33.4% from 40.4 degrees to 26.9 degrees, respectively. Trunk shift was significantly improved. The mean final kyphosis was within normal values. CONCLUSIONS: This procedure is safe and offers a persistent correction with a short segment fusion. Surgery should be performed as early as possible to avert severe local deformities and prevent secondary structural deformities in order to avoid extensive fusions.

Adolescent↗
PubMed2006

Lumbosacral hemivertebrae resection by combined approach: medium- and long-term follow-up.

STUDY DESIGN: Retrospective review of patients records with clinical and radiographic assessment. OBJECTIVES: To evaluate the long-term result of lumbosacral hemivertebrae resection using a combined approach. SUMMARY OF BACKGROUND DATA: Lumbosacral hemivertebrae resection by a combined posterior and anterior approach have been previously described, but only one study is concerning such a large series of hemivertebrae. METHODS: From 1980 to 2001, a consecutive series of 17 congenital scolioses due to lumbosacral hemivertebrae were managed by hemivertebrae resection using a combined approach and short anterior and posterior convex fusion. RESULTS: The mean age at surgery was 4.9 years. The mean follow-up period was 7.6 years. One postoperative complication was encountered: a patient had motor deficit and recovery was incomplete. The mean segmental scoliosis curve was 27.5 degrees before surgery, 10.7 degrees after surgery, and 8.9 degrees at the latest follow-up assessment. This represents a mean improvement of 61.1% after surgery and of 67.6% at the latest follow-up. The total main scoliosis curve improved from 28.4 degrees to 12.7 degrees and 11.4 degrees , respectively. It represents a mean improvement of 55.3% and 59.9%, respectively. The mean final lordosis was within normal values. CONCLUSIONS: This procedure offers a persistent correction with a short-segment fusion. The early surgery is able to avert severe local deformities and prevent secondary structural deformities in order to avoid extensive fusions.

Child↗
PubMed2006

[Scoliosis in children].

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.

Arthrodesis↗
PubMed2006

Polyarthritis and familial pulmonary fibrosis in a child.

A 7-year-old girl presented with seropositive polyarthritis, autoimmune thyroiditis, and pulmonary fibrosis. Several family members had complex autoimmune disorders and pulmonary fibrosis, and the pedigree was consistent with autosomal dominant inheritance. The possible links between polyarthritis and familial pulmonary fibrosis are discussed, as well as the therapeutic challenges raised by this extraordinarily rare combination.

Anti-Inflammatory Agents↗
PubMed2006

Infection after fingertip injury in children.

We describe two cases of severe infectious complications after trauma to the finger phalanges in children: osteoarticular infection of the thumb and phlegmon of the thumb's long flexor sheath. These complications are rare after such injuries, which are common and for which the appropriate treatment is often an issue.

Antibiotic Prophylaxis↗
PubMed2006

Lipoblastoma and lipoblastomatosis.

We report two cases of lipoblastoma of the buttock in a 10-month-old boy and a 20-month-old girl, the first with rearrangement of chromosome 8 and the second without cytogenetic abnormality, and one case of lipoblastomatosis of a leg in a 6-month-old boy with a normal karyotype but with a rearrangement of the PLAG1 gene. Lipoblastoma and lipoblastomatosis are two different presentation of the same rare benign soft tissue mesenchymal tumour arising from fetal white fat and occurring almost exclusively in young children under 3 years. These neoplasms have no malignant potential but may recur in cases of incomplete resection. Histological diagnosis sometimes used to be difficult because of the close resemblance of the lesion with myxoïd liposarcoma. Nowadays, cytogenetic analysis may contribute to the diagnosis by showing abnormalities of the long arm of chromosome 8, leading to rearrangement of the PLAG1 gene. Actual advances in cytogenetic molecular analysis may aid in accurate diagnosis.

Buttocks↗
PubMed2006

Lumbar hemivertebra resection.

BACKGROUND: A single lumbar hemivertebra can be expected to cause progressive scoliosis. The aim of this study was to evaluate the results of a lumbar hemivertebra resection and short-segment fusion through a combined posterior and anterior approach. METHODS: From 1987 to 2002, a consecutive series of twenty-one patients with congenital scoliosis or kyphoscoliosis due to a lumbar hemivertebra were managed by resection of the hemivertebra through a combined posterior and anterior approach and with the use of a short anterior and posterior convex-side fusion. RESULTS: The mean age at the time of surgery was 3.3 years (range, twelve months to 10.2 years). The mean followup period was 8.6 years. There was a mean improvement of 71.4% in the segmental scoliosis curve from a mean angle of 32.9 degrees before surgery to 9.4 degrees at the time of the latest follow-up assessment, and a mean improvement of 63.9% in the global scoliosis curve from 34.1 degrees to 12.3 degrees. The mean final lordosis was within normal values. CONCLUSIONS: Excision of a lumbar hemivertebra is safe and provides stable correction when combined with a short-segment fusion. Surgery should be performed as early as possible to avert the development of severe local deformities and prevent secondary structural deformities that would require a more extensive fusion later.

Child↗
PubMed2005

Pediatric spinal cord injury without radiographic abnormality: a meta-analysis.

UNLABELLED: Using a meta-analysis, we identified 392 published cases of patients recently diagnosed with spinal cord injuries without radiographic abnormalities (SCIWORA) and studied the epidemiologic, pathophysiologic, clinical, and radiologic data. To describe those at risk for this uncommon syndrome, mainly pediatric patients (90% of the cases) who sustain serious trauma in car accidents, serious falls, sports injuries, or child abuse, we analyzed the reported information in the literature. Magnetic resonance imaging scans may indicate neural (hemorrhages, edema, or both) or extraneural (disc protrusions, extradural hematomas) injuries, and the location and type of the injury. Every patient having magnetic resonance imaging scans had either intraneural or extraneural injury. However, followup magnetic resonance imaging scans are necessary because evidence of the injury might not appear immediately. Late and recurrent spinal cord injuries without radiographic abnormalities are reported. External immobilization for 12 weeks helps patients who are moderately injured and helps prevent recurrence of these types of injuries. Approximately 44% of the patients in our study did not recover whereas complete recovery occurred in 39% of the population. The prognosis can be improved if the syndrome is diagnosed early, so we recommend considering spinal cord injuries without radiographic abnormalities as a possible diagnosis for any child who has a mechanism of injury that suggests trauma to the spine. LEVEL OF EVIDENCE: Therapeutic study, Level III-3 (case-control study). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2005

First cuneiform osteotomy alters hindfoot architecture.

UNLABELLED: Three-dimensional concepts underlie various congenital foot deformities in the midfoot. We wondered whether the first cuneiform osteotomy, usually indicated for forefoot correction, had an effect on the hindfoot. We retrospectively studied 18 patients (31 feet) with metatarsus adductus and varus who had a biplane first cuneiform osteotomy between 1994 and 2001. No patients had associated malformations or neuromuscular disease. All had persistent pain and functional complaints for at least 2 years before surgery, and all had a minimum followup of 2 years. Group A (13 feet) with forefoot adduction without hindfoot valgus had an isolated first cuneiform osteotomy. Group B (18 feet) with slight forefoot adduction, hindfoot valgus, and supination after hindfoot valgus correction had first cuneiform osteotomy and a subtalar arthrodesis. At 5 years mean followup we evaluated multiple measurements on preoperative and followup weightbearing radiographs. Complementary demographic information and clinical patient information were collected. First cuneiform osteotomy was associated with architectural changes in hindfoot bone angles. This finding suggests new surgical approaches. LEVEL OF EVIDENCE: Therapeutic Study. Level IV (Case series). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMedDate not supplied

Growth plate behavior after desepiphysiodesis: experimental study in rabbits.

The aim of this work was to study the potential healing of the growth plate in the case of a central desepiphysiodesis. A central defect was made in the distal femoral growth plate of thirty 3-week-old rabbits. In group A the growth plate defect was left empty as control. The defects of group B were implanted with a polymeric cylinder fixed in the metaphysis with a pin. In group C the cylinder was fixed in the epiphysis. Two months after implantation, clinical, radiologic, and histologic analyses were carried out. In group A, the mean shortening was 12.63%; it was 4.9% in group B and 1.54% in group C. Histologic analysis showed constant appearance of an epiphysiodesis after migration of the implant in the metaphysis. No regeneration of the growth plate was observed. Prevention of migration of the interpositional material is recommended to avoid recurrence of an epiphysiodesis.

Animals↗
PubMedDate not supplied

Femoral head resection for painful hip subluxation in cerebral palsy: Is valgus osteotomy in conjunction with femoral head resection preferable to proximal femoral head resection and traction?

Patients with severe cerebral palsy who underwent either a femoral head resection with traction or a McHale procedure (femoral head resection and valgus osteotomy) were studied retrospectively and then contacted by telephone to assess whether removing the femoral head or proximal femur as a salvage procedure improved sitting tolerance, relieved pain, or improved hygiene. Twenty-seven patients (36 involved hips) were available for a retrospective chart and x-ray review, and over half (56%) of these patients or caretakers were able to complete a telephone questionnaire. Of the study cohort, 16 patients underwent femoral head resection with traction and 11 patients had a McHale procedure. The average age at surgery was 19 years and average follow-up was 3.4 years. For those in the McHale group, the length of stay in the hospital was shorter, the postoperative superior migration of the femoral head was less pronounced, and the surgical and medical complications were lower. The telephone survey showed that both groups had increased sitting tolerance and decreased pain, and both showed overall satisfaction with the surgical outcome.

Adolescent↗
PubMedDate not supplied

Hip flexion contracture and lumbar spine lordosis in myelomeningocele.

The objective of this study was to assess the correlation between hip flexion contracture (HFC) and the sagittal alignment of the lumbar spine in ambulatory children with myelomeningocele. Ambulatory patients with myelomeningocele are generally free of scoliosis or kyphosis. Among them, some develop increased lumbar lordosis. It is postulated that HFC and increased lumbar lordosis may be correlated. Thirty-eight patients, with a mean age of 12.7 years, were evaluated. Standing lateral spine films were obtained and the lumbar lordosis was measured using the Cobb method. HFC was measured using the Thomas test. A statistically significant correlation was found between the lumbar curve and HFC. High values of lumbar Cobb angle (hyperlordosis) were correlated with high values of HFC. These results show a correlation between HFC and increased lumbar lordosis in ambulatory myelomeningocele patients.

Adolescent↗
PubMedDate not supplied

Fractures in children with cerebral palsy.

INTRODUCTION: We studied the fracture history in a large population of patients with cerebral palsy to determine which children were at the highest risk for fracture. METHODS: The International Classification of Diseases (Ninth Revision) coding identified 763 children with cerebral palsy. Patients and caregivers were contacted for information about fracture history and risk factors for low bone density. Of the 763 children identified, 418 children (54.8%) were available for this study; 243 (58%) had quadriplegia, 120 (29%) diplegia, and 55 (13%) hemiplegia. Three hundred sixty-six children were spastic, 23 mixed tone, 13 athetoid, and 16 classified as others. We identified 50 children (12%) who fractured; 15 of these same children had, over time, multiple fractures. RESULTS: The number of fractures showed a normal distribution by age, with a mean of 8.6 (SD, 4.0). Children with cerebral palsy with mixed tone had a higher rate of fracture (chi = 14.7, P < 0.01); chi analysis indicated that the children who fractured were, as a group, more likely to use a feeding tube, have a seizure disorder, take valproic acid (VPA), and use standing equipment in therapy. Multiple regression analysis demonstrated older age and VPA use as predictive of fracture and gave the following equation: fracture = -0.01 + (VPA x 0.17) + (age x 0.15). The subgroup that sustained multiple fractures were older at the time of first fracture than the children who had only one reported fracture (t = -2.3, P < 0.05). CONCLUSIONS: The main finding of our article is that older age at first fracture and use of VPA are predictive of fractures and define a group of children with cerebral palsy who may benefit from treatment interventions to increase bone density.

Adolescent↗
PubMedDate not supplied

Progressive forearm lengthening with an intramedullary guidewire in children: report of 10 cases.

Indications for forearm lengthening are rare. Between 1994 and 1999, 10 forearm lengthenings were performed in seven children for functional reasons and/or esthetic discomfort. Only one of the two forearm bones was involved in the procedure in all cases. The technique consisted of a transverse osteotomy and progressive distraction after intramedullary nailing. When a bone axis correction was needed, it was performed with a substraction osteotomy in the initial osteotomy site. The distraction device was removed when bone healing was achieved. The authors noted the various complications and assessed the amount of elongation, bone healing, and potential bone axis deviation. Mean follow-up was 4.5 years. Mean elongation was 30.8 mm. Four bone grafts were needed for delayed union. No bone axis deviation was noted. An initial axial correction osteotomy allows an easier lengthening procedure. Use of an intramedullary wire avoids axis deviation. This technique can be helpful in malformative pathologies.

Adolescent↗
PubMedDate not supplied

Lateral humeral condyle fractures in children: a comparison of two approaches to treatment.

The treatment of lateral condyle fractures in children remains controversial. This study investigates whether minimally displaced lateral condyle fractures should be treated surgically and compares different techniques of operative management. The authors retrospectively reviewed medical charts and radiographs of 97 children from two international centers whose therapeutic modalities differed, noting demographic data, fracture features, treatment modalities, complications, and clinical and radiographic results. Long-arm immobilization alone resulted in additional fracture displacement and a higher number of nonunions than did surgical management. The authors conclude that displaced fractures should be fixed surgically with two smooth or threaded Kirschner wires; they can pass through the ossific nucleus of the capitellum if necessary, but they must engage the far cortex. If patients are likely to be noncompliant with treatment, the wires should be buried under the skin to avoid the risk of infection, but this procedure necessitates a second surgery for removal of fixation.

Bone Wires↗