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G Filipe

Publications and source records attributed to G Filipe.

At least 19 recordsLinked to original sources
PubMed2003

[Intraspinal rib penetration in four patients in neurofibromatosis vertebral deformities].

We describe the clinical and radiological features observed in four patients with neurofibromatosis-related scoliosis or kyphoscoliosis who developed rib penetration into the intervertebral foraminae. Rib penetration should be searched for on standard and elective x-rays in patients with moderate curvatures. The diagnosis can be confirmed by computed tomography or magnetic resonance imaging of the spine. In case of major deviation, x-rays must be carefully examined, with an accurate search for spinal cord compression to avoid missing the diagnosis. Surgical treatment must consist in ablation of the posterior ends of the dislocated ribs associated with anterior and posterior fusion. It should be performed early to avoid the development of spinal cord compression.

Adolescent↗
PubMed2003

[Voluntary bilateral dislocation of the hip in children: a case report and review of the literature].

Voluntary bilateral dislocation of the hip was discovered in a three-year-old girl. Dislocation was documented by arthrography and computed tomography. After failure of a capsuloraphy, successful treatment was achieved with bilateral femoral varus oseotomy. Stability has been good after six years follow-up. Clinical and radiological signs as well as the underlying causes and treatment are discussed in light of this case and fifteen others reported in the literature.

Child↗
PubMed2003

[Femoral shaft fracture in children: treatment with early spica cast].

PURPOSE OF THE STUDY: Fractures of the femoral shaft are frequent in children and prognosis is good. For children aged less than 7 years, most authors propose orthopedic treatment using prolonged traction then cast immobilization, or orthopedic reduction under general anesthesia and early cast immobilization. The purpose of the present work was to analyze results of orthopedic treatment using a spica early for children aged less than 7 years in comparison with other published series with similar age or management. MATERIAL AND METHOD: Forty-seven unselected children aged less than 7 years with a closed fracture of the femoral shaft were treated by orthopedic reduction under general anesthesia and immobilization with a spica cast after a short period (<48 hr) of traction in the plane of the bed. Hip immobilization was set in flexion and minimal abduction, knee in flexion. The children were discharged the day the cast was installed or the next day. Follow-up examinations (tolerance) with x-rays cast in place were scheduled for day 8 and day 15. Clinical and radiological assessment was also recorded at removal of the cast, at 3 months, at 1 year, and at maximum follow-up. RESULTS: Mean age was 37 months (range 2-83 months). Boys predominated (n=34, 73%). Mean duration of traction was 1.13 days (range 0-5 days). Mean duration of cast immobilization was 45.4 days (range 28-78 days). Mean hospital stay was 2.8 days (range 1-10 days). Four patients (8%) were rehospitalized for secondary displacement under the cast. Weight bearing was effective at day 49 (range 33-78). Mean follow-up was 12.1 months (range 3 months-6 years). Five children (10.5%) developed leg length discrepancy greater than 10 mm. The anatomic axis of the femur in the saggital and frontal planes exhibited deviation in 7 children measuring less than 8 degrees in all cases. DISCUSSION: The localization and type of fracture observed in this series of children was similar to that reported in epidemiological studies. There were no treatment-related complications. In respect to healing time, deviation, and residual leg length discrepancy, results in this series were equivalent to those reported by others, irrespective of the treatment method employed. The major advantage of early spica is a short hospital stay allowing cost containment and rapid return to the child's everyday environment.

Casts, Surgical↗
PubMed1997

[Treatment of congenital hip dislocation using Pavlik's harness. Long term results].

PURPOSE OF THE STUDY: After many years using Pavlik harness for treatment of congenital hips dislocation, it is important to evaluate long-term results, failure causes and factors responsible for avascular necrosis. MATERIAL: One hundred and forty one children were treated by this mean (159 dislocated hips, 30 acetabular dysplasia). The follow up was 74 months (12-175). METHODS: In this study, the severity of the dislocation was evaluated by antero-posterior radiographs of the pelvis. The importance of proximal dislocation was measured by the distance from the top of the proximal femoral metaphysis to the Y line and the lateralization by the distance from the medial border of the proximal femoral metaphysis to the ischium. Results were appreciated using Severin classification modified by Kasser and Mose's circles. Several factors as age at the beginning of treatment, sex, previous treatment, passive abduction of the hip, amount of dislocation were statistically evaluated (chi 2 and P test). RESULTS: Of 159 dislocated hips, 10 (6.3 per cent) were not reduced by the harness. Temporary growth modifications and avascular necrosis were observed in 24 (16.1 per cent) of 149 reduced hips. We shall add to these, 3 avascular necrosis in 10 hips which were not reduced in the pavlik harness and 2 avascular necrosis which occurred in normal hips. This complication was not encountered in dysplasic hips without dislocation. Using Severin classification, there was 61 excellent, 33 good and 5 fair results in the group of 99 hips followed for more than 72 months. Of all growth anomalies and avascular necrosis, only half of them keep sequelae at the last follow-up. DISCUSSION: Some factors as age, sex, previous treatment have no incidence in the number of failures and avascular necrosis. On the contrary, passive abduction of the hip, severity of the dislocation were responsible for most of these complications. Pavlik harness must be used with circonspection. It can be used only where passive abduction is superior to 30 degrees and distance H superior to 4 mm. In other cases, it is preferable to use progressive traction. CONCLUSION: Pavlik harness is widely used for treatment of congenital hip dislocation. Reduction can be obtained as stabilisation and correction of acetabular dysplasia. The risk for avascular remains relatively high. The use of the harness needs a rigourous choice of indications.

Age Factors↗
PubMed1997

[Sciatica caused by avulsion of the vertebral limbus in children].

PURPOSE OF THE STUDY: Sciatica is very rare in children. We report a particular from due to traumatic avulsion of the posterior vertebral limbus. The purpose of this study was to give the principal clinical and radiological aspects of this entity and to discuss the treatment which should be different from that of common adult disk herniation. MATERIALS: From 1980 to 1992, 10 children were examined for a sciatica (7 boys and 3 girls aged from 10 years 1 month to 15 years 2 months). Sciatica appeared in all cases during sport activities and sometimes after a sport accident. Lumbar spine stiffness was encountered in all cases. Radiculalgia was unilateral in 7 cases, bilateral in 3 cases, in L5 territory in 3 and S1 in 7 cases. 4 children had deficitary neurological signs: 3 abolitions of achilles reflex, 1 weakness of foot dorsi-flexors. Standard x-rays showed in 4 cases the avulsed fragment in the vertebral canal. Spondylosis was encountered in 3 cases and spondylolisthesis in one case. Diagnosis was possible in all cases with CT Scan, M.R.I., when done showed a normal disk signal. Three children were managed by a conservative treatment by rest or brace. Seven had a surgical treatment: resection of the avulsed fragment in 6 and total diskectomy in one. The mean follow-up was five years (2 to 8 years). RESULTS: There was no complication. At last follow-up all children had a good result without sciatica recurrence. DISCUSSION: Many factors allow us to think that avulsion of the vertebral rim in children is of traumatic origin. CT Scan is the best exploration for this particular lesion. It enabled evaluation of fragment volume and location. Magnetic resonance imaging showed uninjured disks. Removal of the avulsed fragment without diskectomy seems possible in children.

Adolescent↗
PubMed1995

Blount's disease: magnetic resonance imaging.

To evaluate the information obtained by magnetic resonance (MR) imaging, the radiographic and MR investigations of nine patients treated for idiopathic tibia vara were reviewed in retrospect. There were six unilateral and three bilateral cases (12 tibiae). Initial radiographs of each patient were assigned a stage according to Catonné's classification. MR imaging was performed with a 0.5- or 1.5-T apparatus. Bony epiphyses were poorly developed in all cases. The cartilaginous component of the epiphyses compensated partially (6/12 cases) or completely (6/12 cases) for the collapse of the physes. In two cases an abnormal area was found between the medial meniscus and the cartilaginous portion of the epiphysis. An abnormally large medial meniscus was noted in four cases; an abnormal signal in the medial meniscus was seen in two cases. MR imaging has several advantages over plain film: it uses no ionizing radiation, it shows the shape of the ossified and cartilaginous epiphysis, and it demonstrates meniscal and physeal abnormalities. MR imaging may influence the choice of treatment.

Bone Diseases, Developmental↗
PubMed1995

[Congenital convex talus. Methods and results of a single-stage surgical correction].

PURPOSE OF THE STUDY: The aim of this study was to emphasize the anatomical particularities of congenital vertical talus. We propose a one stage operative procedure adapted to the deformities. MATERIALS AND METHODS: A retrospective study of 24 children with congenital vertical talus was conducted. An etiology was observed in 58 per cent of cases and 42 per cent were considered as idiopathic. From a radiological analysis of 39 feet, we precise the anatomical particularities. We used anteroposterior and lateral X-ray and lateral stress views with maximal plantar and dorsal flexion. Most of the lesions were localized in the midtarsal joint. The irreducibility of the talonavicular dislocation is the predominant lesion. It is usually associated with a disorientation of the cubocalcaneal joint. The articular surfaces are disorganized with a dorsal orientation. There is a variable amount of equinus deformity in the hindfoot. However the talocalcaneal divergence angle is nearly normal. The forefoot is most of the times in eversion but sometimes in inversion. PROCEDURE: All children were treated initially by physiotherapy. We recommend operative treatment for them between one to two years old. After a soft tissue release, the talonavicular dislocation and the hind foot equinus deformity is reduced simultaneously. The subtalar joint is respected and not opened. Retracted tendons may be an obstacle to the reduction. They must be lengthened if necessary especially the Achilles tendon, the peronei, the extensors and the tibialis anterior. Reduction is maintained by a K wire transfixing the midtarsal joint. RESULTS: Clinical results were difficult to evaluate. Out of 24 operated feet, a satisfactory outcome had been achieved in 15 feet. All were plantigrad and 18 had a good cosmetically aspect. The only bad result concerned an old case which was not operated by this technique. DISCUSSION AND CONCLUSION: Conservative treatment is usually unsuccessful in congenital vertical talus. Numerous procedures have been advocated for the surgical correction of this deformity. Some authors advised excision of the navicular, full open peritalar release or extraarticular talocalcaneal arthrodesis. These are often extensive procedures and most are performed in two stages. Recently, one stage operative procedure was proposed. It allows a good correction with the respect of the subtalar joint and a lower risk of talus avascular necrosis. Furthermore it is more adapted to the deformity with a less extensive scar and a better respect of the anatomy.

Arthrodesis↗
PubMed1994

Legg-Perthes-Calvé disease: staging by MRI using gadolinium.

Twenty-one patients (26 hips) with typical signs of Legg-Perthes-Calvé (LPC) disease on plain radiographs were explored by MRI. Patients were imaged with a 0.5 T MR unit. Gadolinium-enhanced spin-echo MR images were obtained after nonenhanced T1-weighted (spin-echo) and T2*-weighted (gradient-echo) images. Four different areas were identified in the femoral epiphysis (necrosis, regenerative, cartilaginous and normal fatty bone tissue). The histological evolution of LPC is well described by Catterall and others. Comparing their descriptions with our MR findings, we suggest classification of LPC into five phases: necrosis: regeneration, reconstruction, reossification and sequelae.

Child↗
PubMed1993

[Pes cavus in children].

There are several forms of pes cavus with specific anatomical features and different outcomes. Medial pes cavus is often due to a neurological disorder and causes severe symptoms. The causal disease is responsible for gradual deepening of the arch and deformities of the toes and hindfoot. Surgery is warranted in severe deformities with functional impairment. Procedures performed in younger patients involve the soft tissues; an example is plantar release with or without osteotomy of the calcaneus. In older children, osteotomy or fusion is required.

Adolescent↗
PubMed1992

[Spinal deformities in Marfan disease].

Spinal deformities are frequent in Marfan's disease. 37 patients were examined at the average age of 11 years. 32 showed a spinal deformity. The treatment of the spinal deformity was a brace in 15 cases, surgery in 16 cases (including 5 cases after brace-failure). 7 cases were just followed-up without treatment. Bracing was efficient only for mild curves, this treatment was satisfying 4 times out of 11 with adequate follow-up. The surgical treatment in 16 cases was a posterior fusion twice associated with anterior fusion. We used the same technique as for idiopathic scoliosis with Harrington instrumentation 5 times, Harrington with sublaminar wires 4 times and Cotrel-Dubousset instrumentation 7 times. The correction of scoliosis was achieved in 48.2 per cent. The use of segmental instrumentation compared with the use of the Harrington instrumentation can explain the small number of non unions and the improvement of the lateral spinal balance. We did not note any cardiovascular complication during or early after the operation. Aortic lesions were responsible of one death in the long term, three patients went through a surgical replacement of aortic valves or the aorta.

Adolescent↗
PubMed1991

[Growth of the hip].

The hip grows by a complex process involving several growth cartilages, each one playing a specific role. Dysfunction of any of these cartilages, whatever its cause, may result in architectural defects of the hip. These defects must be perfectly known in order to foresee the consequences of some hip diseases in children and sometimes to prevent these diseases by orthopaedic measures. The copious blood supply of the acetabulum protects it against all traumas, in contrast with the poor blood supply of the upper end of the femur which exposes to the risk of femoral head necrosis.

Adolescent↗
PubMed1990

[Arthrography of the hip. Role of the acetabular rim].

The authors describe the technique of arthrography of the hip and the aspect of the limbus in the normal hip as well as in subluxation and different types of dislocation. Arthrography may establish whether a dislocated hip may be reduced by conservative means. This radiological technique is reliable when reduction, or stabilization are unsatisfactory or after previous treatment failure.

Acetabulum↗
PubMed1989

[Triple osteotomy of the pelvis in children].

The innominate osteotomy described by Salter was used to redirect the acetabulum in the course of the treatment of a number of hip diseases in children. This resulted in an immediate improvement of coverage of the femoral head. One can also expect a more congruent growth of the two constituents of the hip joint in the forthcoming years. In older children in whom rigidity of the pubic symphysis did not permit a sufficient amount of acetabular tilt the acetabulum had to be isolated from the rest of the pelvis by a triple osteotomy which consisted of, in addition to the osteotomy of the ilium, osteotomies of the superior pubic ramus and the ischium or the inferior pubic ramus.

Acetabulum↗
PubMed1988

[Fractures of the pelvis in children excluding isolated fractures of the acetabulum and sacrum. Apropos of 267 cases. Anatomic study, contribution of modern radiologic studies, therapeutic management].

This work studies the combined experience of several orthopedic services of 267 pelvic fractures (excluding isolated iliac and sacral fractures) in childhood. The mechanism of these fractures was studied, the majority were the result of road traffic accidents. Among the complications lesions of the urinary tract were most common. Hypotensive states secondary to retroperitoneal bleeding were common but their exact incidence was difficult to estimate accurately. In association with these pelvic lesions it is necessary to emphasize the high incidence of associated cranial, abdominal and skeletal injuries. Computed tomography represents a considerable advance in the assessment of these fractures, demonstrating fractures not visible on standard radiographs and permitting a more precise analysis of displacement. The same type of fractures were in infants as has been reported in adults. However in addition in childhood fractures involving the cartilaginous growth plate are also seen. These include true separation of the growth plate at the triradiate cartilage, the iliac crest and the pubic symphysis. Surgical treatment is only considered for fractures interrupting the pelvic ring and particularly in the context of anterior and posterior column fractures. However, these displaced fractures may leave, contrary to popular opinion sequelae such as leg length discrepancies, ankylosis of the sacro iliac joint, malunited fractures and pain. Therefore it is necessary to adopt a more rigorous attitude in the management of pelvic fractures in the child to avoid these sequelae and to aid in the treatment of associated injuries.

Adolescent↗