Biomedical subjects
Publications and source records attributed to H Bensahel.
The authors have studied anatomical specimens and findings at time of surgery to determine the functional anatomy of clubfoot. The importance of the midtarsal joints (especially of the talonavicular joint) is emphasized as well as the importance of the tibialis posterior. The findings of the authors concerning the function of these elements have allowed them to develop a new approach to the treatment of clubfoot.
After intravenous injection of 99mTc methyldiphosphonate, 190 hip bone scans were performed on 103 children. In 64 children with Perthes disease, 61 of 71 hips (86%) showed abnormal scintigraphy. There were no false positives. In other hip disorders, the scan was never considered to simulate Perthes disease. There were 36 children with acute synovitis and three with Meyer's dysplasia. The sensitivity was 97%, suggesting that this test should be used more frequently in the early assessment of hip pain in the young child, before the appearance of characteristic radiographic abnormalities. This test is also valuable for follow-up of the disease because of its prognostic value--the bone scan becomes normal far earlier than the radiograph. The progressive normalization of the scan may help determine when the child can begin weight-bearing.
Most tibial lengthenings are undertaken at the level of the diaphysis but in some cases this cannot be done and the lengthening can be made at upper epiphyseal level. The technique involves the application of pins in the upper epiphysis and diaphysis fixed by a Hoffman external fixator adapted for progressive distraction. The technique was used in a child of 13 years with 9 cm of shortening and an expected shortening of 13 cm at the end growth. The method has obtained the progressive lengthening of 11 cm and bony union without grafting.
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Basing themselves on eight cases treated over the past six years, the authors recount their experience of the operative elimination of partial closure of the epiphyseal plate. The closures were due to various causes and involved the lower extremities of the femur or tibia. Operative elimination alone was carried out in three cases, and associated with bone realignment in the remaining five. The results confirm the best prognosis for comparatively recent, localized peripheral epiphyseal plate closures.
One hundred and thirty three children were studied (a total of 218 scintigrams) after IV injection of 100 microCi/kg 99Tc-MDP. Of 64 pathological hips (6 being bilateral), 52 were judged typically abnormal, 8 without initial radiological evidence. Of the rest, 8 were considered doubtful and 4 normal. No scan was considered typical of Perthes' disease in other hip disorders. The resulting figure of the sensitivity was 94%, for specificity 97%, for positive predictive value 97%, and for negative predictive value 95%. It is more difficult to assess the value of bone scintigraphy in the follow up of these patients. The disappearance of uptake defect in the femoral head may be a good index and occurs earlier than the normalization of the radiographs. On the other hand, the significance of the neighbouring region of increased uptake is difficult to assess although related to revascularization and reconstruction. The evolution of the disease does not seem to be correlated with the localization and the intensity of these regions in a straightforward manner.
The authors has observed a case of recurrent dislocation of the elbow in a child of 11. The lesion has been studied by arthrography and a good result has been obtained by surgical reconstitution of the capsule on the lateral aspect of the joint. Experiments have been made on cadavers which confirm the importance of the role of the lateral ligaments in this condition.
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Solitary bone cyst is characterized by its tenacity and the risk of recurrence. This fact led the authors to use a surgical procedure very different of the classic ways of treatment as they excluded any bone graft to the benefit of a muscle graft with wide resection. 35 cases have been operated on at several steps of childhood. The recurrence's rate decreased plainly and is no more than 9%. They concern only the wide humeral cysts which were active and close to the fertile plate of the humeral head. These recurrences have been very well tolerated and have not predisposed the child to some pathological fractures. Residual pseudo-cysts were seen in 20% of the cases; they related for us, to some gaps of rehabilitation. This procedure ay be considered as the complement of cortisone's local infection when this one is not able to heal the solitary bone cyst.
Ten cases of femoral neck retroversions are reported in order to eliminate functional retroversions more frequent. True retroversions were confirmed by X-rays or by body scan which gives the exact degree of the retroversion. The authors emphasize the late onset, over eight, the first sign is lateral rotation of the gait and often a genu valgum. The imbalance between lateral and medial rotation is very important, the latter being very restricted. These retroversions are divided unanatomical forms which are mild and geometrical forms which are severe. These ones require surgical treatment which is derotation osteotomy of the femur.
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The use of a new apparatus has enabled the authors to study the distribution to the ground of the plantar pressures by the way of ciphering each support area. This procedure is valuable and very precise as 500 pressure pick-up are used which give reliable, numerous and regularly distributed informations. The normal footprint has first been evaluated. Then, a comparison was possible with pathologic foot, so it was possible to estimate the result of a functional or surgical treatment on the morphology of the foot.
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