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Biomedical subjects

H Bensahel

Publications and source records attributed to H Bensahel.

At least 19 recordsLinked to original sources
PubMed2000

The unstable patella in children.

The authors reviewed 102 unstable patellas which had been observed and treated from 1964 to 1990. They were divided according to whether they suffered from traumatic dislocations, recurrent dislocations or malformative instability. The clinical findings were the major stage of the check up. In the field of imaging, standard X-rays had to be performed in all cases. MRI was of interest in the congenital dislocations, in order to thoroughly investigate the soft tissue anomalies. Two types were described: Type 1 was observed in children with joint laxity, but without major X-ray anomalies; Type 2, a major femoropatellar dysplasia could be formed with some bone deformity. The latter was observed in the malformative instability. Four different surgical procedures have been used, from the release of the retinacula of patella to the medial displacement of the patellar tendon or the tibial tuberosity. This study emphasises the concept of a true development dysplasia of patella (DDP) which can gather the different varieties of the instability of patella.

Adolescent↗
PubMed1998

Solitary bone cyst: controversies and treatment.

The solitary bone cyst (SBC) has not yet revealed all its secrets. The pathogeny of the SBC is thus considered and also its evolutivity. Conservative treatment has been used in attempts to heal this tumor-like bone. In the case of surgery, an original technique is described. The SBC still remains mysterious in many of its aspects. At the time of this writing, nobody can predict the occurrence modalities of this benign bone tumor. In a similar way, the reality of this tumor-like lesion cannot be precisely described. This emphasizes the first controversial point about this lesion. Indeed, must we consider differently the bone cysts that remain close to the growth plate and those which located in the diaphysis? Must we regard the true unicameral bone cysts (UBCs) differently and those that are multilocular? Moreover, are the cysts located in the long bones identical to the those of the short cancellous bones? Alas, SBC was supposed to be a lesion in children that disappeared after growth ended. Is it still true since some cases have been reported more recently in adults? This study represents a long follow-up. It includes the different aspects of the SBC and emphasizes an original technique in case surgery becomes indicated.

Adolescent↗
PubMed1997

Dynamic gadolinium-enhanced subtraction MR imaging--a simple technique for the early diagnosis of Legg-Calvé-Perthes disease: preliminary results.

PURPOSE: To determine whether the simple technique of dynamic gadolinium-enhanced subtraction MR imaging, which is available on standard MR units, can detect ischemia of the femoral head in children with early Legg-Calvé-Perthes disease (LCP). MATERIALS AND METHODS: Bone perfusion of eight hips in four patients (mean age 7.5 years) was studied using dynamic gadolinium-enhanced subtraction MR imaging at the onset of proven LCP (with initial negative plain films). Enhancement of subtracted images was compared with that on standard MR images and with bone scintigraphy findings. RESULTS: Subtraction MR imaging depicted ischemia as a widespread absence of enhancement and was in good agreement with bone scintigraphy. The subtraction technique improved the sensitivity and the specificity of MR imaging in two children. Furthermore, subtraction MR imaging allowed recognition of the pattern of early reperfusion. CONCLUSION: Our preliminary results indicate that dynamic gadolinium-enhanced subtraction MRI is a simple and promising means of early recognition of ischemia in LCP.

Child↗
PubMed1997

Closed flexible intramedullary nailing of the femoral shaft fractures in children.

We treated 34 femoral shaft fractures in 32 children with elastic intramedullary nailing using titanium rods. The 24 boys and 8 girls ranged from 6-17 years. All fractures united. The weight bearing was authorized at an average of 67 days and was complete at an average of 89 days. All children returned to school before the end of the second postoperative month. An an average of 2.5 years, no rotational malalignment was present. Neither anteroposterior nor frontal malalignment of more than 2 degrees was noticed. A leg length discrepancy of more than 10 mm was present in 3 patients (8%). No injury of femoral head vascularization or of the proximal or distal growth plate was noticed. In our experience, this technique seems to be safe for the surgical treatment of the immature femoral shaft fractures. The elastic properties of titanium provide a very good stability of the montage, when the technique is correctly performed.

Adolescent↗
PubMed1996

Slipped capital femoral epiphysis: evaluation of different modes of treatment.

We reviewed 91 hips with slipped capital femoral epiphysis (SCFE) after an average follow-up period of 6 years 6 months. Different treatment methods used, according to types and stages of slipping, are discussed. In situ fixation appears to be the best procedure for SCFE with < 60% displacement. Careful reduction-fixation is indicated in acute and acute-on-chronic SCFE > 60%. Primary rotation osteotomies are associated with a high percentage of complications. Secondary osteotomies should be simple (preferably a subtrochanteric derotation osteotomy) to reduce the risk of necrosis. Preventive contralateral fixation is indicated when the growth cartilage is still open.

Adolescent↗
PubMed1995

Classification of clubfoot.

Clubfeet must be classified according to severity to obtain reference points, assess the efficacy of orthopaedic treatment, and analyze the operative results objectively. A scale of 0-20 was established on the basis of four essential parameters: equinus in the sagittal plane, varus deviation in the frontal plane and derotation around the talus of the calcaneo-forefoot (CFF) block and adduction of forefoot on hindfoot in the horizontal plane. Four grades of clubfeet can be individualized: (a) Benign feet so-called "soft-soft feet," grade I, similar to postural feet, with a score of 5 to 1 (these mild feet must be excluded from any statistics as they tend to increase good results); (b) moderate feet, so-called "soft > stiff feet," grade II (reducible but partly resistant, with a score of 5-10); (c) severe feet, so-called "stiff > soft feet," grade III (resistant but partly reducible, with a score of 10-15); and (d) very severe, pseudoarthrogryposic feet, so-called "stiff-stiff feet," grade IV (score of 15-20 points). To avoid risks of errors, our method is based on a very complete checklist and on diagrams. Our training material inculdes an audiovisual package.

Clubfoot↗
PubMed1995

Final evaluation of clubfoot.

After analyzing the multiple evaluations described in the literature, we propose an evaluation that can be used during growth. The global score is based on 50 points. The normal foot is scored 0. The functional evaluation (passive motion, muscle function, and gait analysis) is based on 28 points. The morphology is based on 12 points. The radiographic analysis is scored on 10 points. The final evaluation score is linked to the initial classification at birth. The gain during the treatment is the difference between the score at birth and the score of the final evaluation. It is noted as a percentage.

Adolescent↗
PubMed1993

Dominant carpotarsal osteochondromatosis.

Dominant carpotarsal osteochondromatosis is a particular disorder of the wrist and tibiotalar joints with abnormal bone proliferation and osteochondromas. Two patients, a mother and son, are described here; a similar condition has previously been described in seven affected members of a family. The upper and the lower limbs are affected in the same patient and the lesion can be bilateral. Autosomal dominant inheritance is a further criterion allowing the diagnosis of dysplasia epiphysealis hemimelica.

Adolescent↗
PubMed1992

[Three rare fractures of the radius associated with an ulnar slipped epiphyses].

Over a period of 7 years, three adolescent boys had an associated diaphyseal fracture of the distal third of the radius with separation of the distal ulnar epiphysis. The fracture involved towards early epiphysiodesis of the growth plate of the distal ulna leading to a shortened ulna without any severe functional disability. The mechanisms of injury and complication are described. The treatment of this associated lesion is classical emergency, but the radiological follow-up must be extended in time because the growth potential of the forearm bones is important even during adolescence. The onset of a growth disturbance requires rapid surgical epiphysiodesis of the radius to prevent the development of deformity.

Adolescent↗
PubMed1992

[Bone hemangioma of the limbs. A report of two cases in children].

Hemangiomas of bone are rare lesions corresponding approximately to 1% of all primary bone tumors. Cases of hemangiomas in the vertebral bodies and in the skull occur fairly frequently but are unusual in other bones. The authors reported two cases of unusual and fairly rare aspects of this vascular tumor in children. In both cases, recurrences occurred and leaded to a wide bone resection in case one and to several curettage in case two. In these two case the histological type of hemangioma was the capillary one. In reviewing the literature we found no indication for wide resection of the benign forms in children.

Adolescent↗
PubMed1992

[Impact of angiodysplasia on bones].

Vascular malformations usually have an impact on bones because of hemodynamic disturbances in the muscular and osteoperiosteal systems. In fact, even when these structures are not involved by arterial or venous malformations, the blood flow is altered in them. The consequences for bones affect the longitudinal growth of the skeleton of the malformed limb. Growth rarely becomes slower. On the contrary, the condition usually results in an acceleration of bone growth, which results in an excess in the length of the limb presenting with the vascular malformation. This overlengthening may be variably great, and the therapeutic indications must be adapted to its extent. When it is slight, compensation is sufficient to balance the pelvis. Conversely, when it is greater, its correction must be surgical. This surgery is aimed at equalizing the lower limbs, either by slowing down epiphyseal growth and shortening the longer side, or by progressively lengthening the other side, as the case may be. The respective indications of these methods must be carefully considered and adapted to each case, in order to obtain the best possible result with the smallest surgical risk.

Arteriovenous Malformations↗
PubMed1990

[Epiphyseal fractures-dislocations of the lower extremity of the tibia].

Ninety six distal tibial epiphyseal fractures were identified and treated in our institution from 1976 to 1988. The average age was twelve years and eight months (range two to seventeen years), but seventy-one were between eleven and fourteen years old. Using the Salter-Harris classification we have found twelve type 1 tibial fractures, fourty-two type 2, thirty type 3 and twelve type 4. Four were triplane fractures and seven were Tillaux fractures. Twenty-six had injuries in the medial corner of the ankle mortise (Mac-Farland). Fifty patients were treated non-operatively with closed reduction and plaster cast. Fourty-six fractures were treated surgically. Seventy patients were available for follow-up evaluation. The average follow-up was thirty-two months (range 6 months to eleven years). The tibial distal epiphyseal cartilage was closed in 48 patients. As short-term complications we have seen three post-operative displacements after closed reduction; all of them were treated surgically. Five incomplete closed reduction needed open reduction needed open reduction and bone fixation. Two infections occurred after a surgical approach. Among late complications we have seen eleven premature epiphyseal cartilage closure (rate 15%). Four were responsible of angular deformities. One child has a tibial osteotomy for varus deformity after a medial closure. Two ankle arthritis occurred: one of them was seen after a post-operative infection. In two cases of fracture of the medial mortise corner, a valgus deformity with hypertrophy of the medial malleolus occurred. Ankle arthritis is the most severe complication of the adolescent articular fractures (Tillaux and triplane fractures).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Congenital dislocation of the hip in Ehlers-Danlos syndrome.

Nine patients with Ehlers-Danlos syndrome (EDS) were treated for bilateral congenital dislocation of the hip (CDH). CDH was diagnosed at six months of age in two patients and at two to five years of age in the remaining seven patients. The diagnosis of EDS, based on clinical criteria, was established considerably later. One patient with multiple deformities was only observed; the remaining eight patients were initially treated by closed reduction. Due to difficulties encountered in reduction and especially in stabilization, all hips were subsequently treated surgically, with a total of 42 procedures. Avascular necrosis of the femoral head developed in five hips, four of which had been treated with closed reduction with the patients under general anesthesia. At the follow-up evaluation, six patients had reached adulthood. Clinically, satisfactory results were obtained in 12 of 16 hips but roentgenographically in only six hips. Both femoral and innominate osteotomies are necessary to achieve and maintain the reduction in EDS patients with CDH.

Child↗
PubMed1988

Vascular disorders of the proximal femur following treatment of congenital hip dislocation.

Early diagnosis of congenital dislocation of the hip entails treating patients in a very young age-group. These patients present a high risk of vascular disorder in the femoral capital epiphysis in the course of either surgical or nonsurgical treatment. Thirty-five cases of anomalies in the proximal femur of vascular origin were observed, corresponding to 3% of hips treated for congenital dislocation. Roentgenographic diagnostic elements are included in an evolutive classification. In recent cases, radionuclide bone scans were used to obtain supplementary information. Based on bone scans, two distinct groups of patients can be identified: in the first group, vascular disorders of the proximal femur (VDPF) are iatrogenic in origin; in the second, VDPF are due either to the precariousness of prereductional blood flow to the epiphysis or to the summation of risk factors.

Epiphyses↗
PubMed1988

[Choice of first-line antibiotic therapy in the treatment of bone and joint infections in children].

Because of the frequency of Haemophilus influenzae and Staphylococcus aureus in joint and bone sepsis in children, a prospective study of first line antibiotic therapy was performed. In a series of 23 cases, including 8 osteomyelitis and 15 arthritis, Gram stain on joint fluid or antigen detection was helpful in reaching a decision about initial therapy in only 3 cases (Haemophilus influenzae). In 20 of the 23 patients, the first line antibiotic therapy was cefotaxime (100 mg/kg/day) and fosfomycin (100 mg/kg/day) in combination. In 6 of them, the bacteriologic culture was positive (3 Staphylococcus aureus, 1 Haemophilus influenzae and 2 Streptococcus pneumoniae) and the initial antibiotic therapy was changed according to the antibiotic susceptibility testing. In the others 14 cases, from whom no agent was isolated, this combination was continued during about 15 days, then followed by pristinamycin and amoxicillin-clavulanic acid in combination during one month. The C. reactive protein dosage was performed in each patient. All children cured. In view of these first results, cefotaxime and fosfomycin in combination seems to us to be interesting in first line antibiotic treatment without initial orientation.

Adolescent↗