Biomedical subjects
Publications and source records attributed to G Filipe.
Avulsions of the anterior inferior and anterior superior iliac spine and the ischial tuberosity are seen most commonly as the result of trauma in the adolescent age group. The lesions are usually by simple rest, but surgical reduction when there is a major displacement or a large bony fragment avulsed, may be required.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The authors report 3 cases of Larsen's syndrome in which the spine was involved. There was one instability between C1 and C2 and another between C2 and C3. These two cases were treated by posterior grafting. All three cases presented with a severe thoraco lumbar kypho-scoliosis which was treated conservatively, but one of the scolioses had to be grafted later. It is concluded that cervical instability may be missed and needs to be looked for. The kypho-scoliosis appeared to be particularly progressive.
Explore the source record for details and available documents.
The authors have performed 18 operative procedures to remove bony bridges across the growth plate in children. The causes of the formation of the bone bridge were many, including 10 after injury and 3 after infection. There were 9 good results and 9 failures. The causes of the failures were the extent of the bone bridge, sepsis as the causative lesion and technical errors during operation. The best results were obtained in cases where the bridge was peripheral, was easily approached and followed injury in young children. Extensive bridges located centrally had a poor prognosis. All the post-infective cases were failures.
Explore the source record for details and available documents.
Osteochondritis dissecans in a few cases may complicate Perthes' disease. A review of the literature shows 27 published cases. The authors have personally observed 6 cases. The age of the patient was older than in most Perthes' disease. All were male. This condition is diagnosed by the presence of a persisting irregularity of the femoral head with abnormal texture. The clinical signs are not obvious except in cases of recurrent locking where there is a loose body. The avascular fragment is visible on standard radiographs and is best recognised by arthrography. Conservative treatment should be given when the disability is moderate. The loose body should be removed surgically when it is mobile, when it bulges into the joint space or when there are signs of early arthrosis.
Explore the source record for details and available documents.
The authors report the case of an infant presenting with a syndrome associating dwarfism, microcephaly, facial dysmorphy and important skeletal abnormalities consisting of radiologic changes concerning the skull, long bones, vertebrae, pelvis, ribs, metacarpus and metatarsus. Severe cerebral atrophy and neurologic involvement were responsible for death in the first year of life. This rare syndrome is likely to have an autosomal recessive transmission.
The Pavlik harness has made an important contribution to the treatment of congenital dislocation of the hip before walking age. Our experience of 74 cases confirms the good results already reported by several authors; however, four instances of moderate avascular necrosis of the femoral head occurred. The precise indications for the harness and the rules governing its use must be clearly understood. It may be used from the neonatal period up to 6 to 8 months of age for dislocation or subluxation with limitation of hip abduction. Selection of suitable candidates is made more accurate by taking into account the child's general tone and that of the adductor muscles, as well as the data from X-ray films taken in the harness position.
Explore the source record for details and available documents.
The authors have observed 5 cases of atlanto-axial instability in children aged from 18 months to 8 years. All the cases were seen after severe trauma and presented with abnormal neurological signs. All patients were first treated conservatively and were operated on secondarily by atlanto-axial fusion using graft and wiring for persistent radiological instability between the atlas and axis. In two cases instability was due to an atlanto-axial subluxation with rupture of the transverse ligament; one of these was reduced by traction. In one case there was an anterior subluxation without fracture. In one case there was a fracture of the odontoid process in which instability persisted in spite of bony union of the fracture. In the last case, the odontoid process was intact shortly after the trauma but its central portion disappeared secondarily. The cause of this disappearance is discussed.
Explore the source record for details and available documents.
The authors report 6 cases of acute osteomyelitis of the leg, presenting with a very severe subcutaneous cellulitis and progressing to sub-periosteal abscess, then pandiaphysitis with major bone destruction at the 15th day, despite antibiotics. However, all these children recovered without sequelae, apart from one case. Early diagnosis was difficult and treatment started after an excessive delay in the majority of cases. If it can be performed on an emergency basis, Technetium bone scan is useful in making the diagnosis. In the absence of the type of examination, any case of severe subcutaneous cellulitis in a child must be considered as a potential osteomyelitis and treated as such.
Repeated fractures are not unusual in the course of forearm fractures in children. 49 cases were reviewed in this work. Some of them result from insufficient duration of the plaster. Other fractures are due to the weakness of the forearm bones after the fractures especially when there is a residual malalignment. The findings of this work emphasize the importance of the reduction even when the displacement is moderate. Open reduction and internal fixation is reserved in only rare cases.
The authors report 13 pyogenic infections of the sacro-iliac joint in children. They emphasize the difficulties of the diagnosis. The disease is sometimes recognised only at a late stage because the sign must be misleading. The radiological appearance of the sacro-iliac joint is usually sufficient to diagnose the condition. The germ was most often a staphylococcus aureus. Healing is always obtained by rest or immobilisation on a plaster and antibiotics active against staphylococcus. Surgery is only indicated in presence of an abcess or in cases of diagnostic uncertainty.
The authors have reviewed 190 feet treated by double arthrodesis for a variety of lesions including post-traumatic deformities, flat foot, paralytic lesions, club foot and other conditions. Follow-up was more than two years in 101 cases, more than five years in 73 cases and more than ten years in 30 cases. The importance of obtaining a good correction of both hindfoot and forefoot is emphasized. The long-term results of feet correctly aligned was good. The fate of the neighbouring joints and the functional adaptability of the foot have been studied. Details of surgical technique are given.