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J M Gennari

Publications and source records attributed to J M Gennari.

12 recordsLinked to original sources
PubMed2002

[Biphosphonates in children: present and future].

Biphosphonates are synthetic analogs of the natural pyrophosphate molecule, introduced primarily for the treatment of Paget disease of bone. Their main mechanism of action consisting in an inhibition of osteoclastic activity is critical for treatment of disorders including an increased bone resorption. In childhood osteoporosis (especially osteogenesis imperfecta), hypercalcemia and heterotopic calcifications are the three main situations in which they have been successfully used, with however few follow-up and no controlled studies. The evolution of these compounds generating more potent products, given orally, with limited effect on bone mineralization should allow an extension of their use in pediatric patients. Multicentric studies are now necessary to specify their efficacy and guidelines for use in children.

Administration, Oral↗
PubMed2000

Treatment of a case of congenital pseudarthrosis of the tibia-fibular osteosynthesis.

We report the results of a case of congenital pseudarthrosis of the tibia treated by tibiofibular synthesis. A 1-year old girl was first treated by intramedullary fixation followed by an intertibiofibular bone graft. This method failed. She then underwent a new operation that was associated two simultaneous approaches, correction of the axis, tibiofibular synthesis and a new intertibiofibular bone graft. Union was achieved four months later. The child has now been followed up for 20 years. During this time, she has led a normal life as we have observed a "tibialisation" of the fibula. Intramedullary fixation has a success rate of 75% but requires repetitive insertion of intramedullary or telescopic rods. Transplantar intramedullary rods are responsible for significant ankle stiffness. Tibiofibular synthesis associated with an intertibiofibular bone graft after correction of the axis is the equivalent of vascularised graft of the fibula but with neither the difficulties of microsurgery nor valgus deformities of the ankle.

Bone Nails↗
PubMed1998

Anterior approach versus posterior approach to surgical treatment of children's supracondylar fractures: comparative study of thirty cases in each series.

The purpose of this study was to consider the surgical treatment of severe supracondylar fractures of the elbow in children, and to compare the anterior approach with the posterior approach used in two homogeneous groups of 30 cases each by two experienced surgeons. Control procedures were maintained with the children of both groups when the plaster was removed, during the fourth month after surgery, and throughout the follow-up that continued for more than 1 year. A posterior approach to surgery is simpler than an anterior approach, but it creates supplementary anatomic damage that can cause circulatory disorders in the external condyle and a higher percentage of limitation in articulation mobility. Thus, although the anterior approach is more technically demanding, it gives better functional results. Because this approach concerns a zone already damaged by the trauma, it eliminates hematoma in the anterior brachial muscle and again places the fragments in the untouched shell of the periosteum.

Adolescent↗
PubMed1997

Indications for surgery in so-called "regular" thoracic and thoracolumbar kyphosis.

Idiopathic thoracic, thoracolumbar, and Scheuermann's kyphosis do not figure in the same global entity. We propose a classification for so-called "regular" kyphosis. This classification is based on the location of the most rigid curvature segment. Segmental kyphosis may be short, in which case we can distinguish between four types: high kyphosis (type I), middle kyphosis (type II), low or thoracolumbar kyphosis (type III), and segmental kyphosis, which can extend along the entire thoracic spine (type IV). The symptomatology and therapeutic indications are different for each type. We report a series of 15 patients (6 female, 9 male), aged between 18 and 33 years (average age 24 years). The mean kyphosis angle (Cobb angle) in type I patients (n = 3) was 75 degrees in type II patients (n = 3) it was 82 degrees, and in type III patients (n = 9) it was 78 degrees. The pain was greater in type III patients. All patients were operated on using a double approach. As the first step, we performed an anterior approach, disc excision, and bone graft. Ten days later, a posterior approach with CD instrumentation was carried out on ten levels. The mean follow-up is 4 years (range 9 months in 7 years). We noticed no neurological complications and one case of late sepsis. Mean angular loss of correction was 6 degrees. The correction obtained depended on the type of kyphosis. We obtained a mean postoperative Cobb angle of 63 degrees in type I curves, 55 degrees in type II, and 45 degrees in type III. The new classification allows a better understanding of regular kyphosis and helps to define clinical and therapeutic approaches. An analysis of the resulting surgical correction can also be made by comparing homogeneous groups of patients.

Adolescent↗
PubMed1997

The treatment of idiopathic scoliosis in adolescents: rotation or in situ bending?

Rotation alone is not fully efficient in order to correct all types of scoliotic curvatures. We report a series of 30 cases instrumented with the EUROS spine system and analyse reductions obtained with in situ rotation or bending alone or with combined maneuvres. The average age of surgery is 17 years for this series composed of 24 female and 6 male patients. The average follow-up is 2.3 years. The curve patterns are displayed with 6 major thoracic, 5 genuine double major, 4 double major thoracic predominant, 6 double major lumbar predominant and 9 double thoracic curves. Combination of both reduction techniques is advisable and is to be made according to the type of curvature and its reducibility in situ bending is made easier with this system without lockers and by reduced diameter of the rod.

Adolescent↗
PubMed1996

The choice of treatment for simple bone cysts of the upper third of the femur in children.

A retrospective study of a series is presented of 19 simple cysts of the upper third of the femur in children of a mean age of 7 years. The patients included 4 adolescents and 15 children under the age of 10. Mean recurrence was 6 years. Different treatment methods were utilized: - surgical treatment: curettage-bone grafting with or without osteosynthesis, - intra-cystic corticoid injection, - orthopedic treatment. Cysts may be small with a low lytic potential, in this case intra-cystic corticoid injections are very effective; or bigger in size with a risk of fracture or have already caused a fracture, the treatment is then surgical but should always be combined with osteosynthesis.

Anti-Inflammatory Agents↗
PubMed1996

X-ray transparency interpositions after reduction of traumatic dislocations of the hip in children.

Traumatic dislocations of the hip are much less frequent in children than in adults. If some complications are well known (avascular necrosis of the femoral head, recurrent dislocation), the lateralization of the head by x-ray transparency interposition is less appreciated. We report 4 cases of x-ray transparency interposition in 15 reductions of incomplete traumatic dislocation of the hip. These 4 dislocations were posterior in non-pathological hips, three on the left side and one on the right. Our reductions have been easy and the hips remained stable. However, the post-reduction roentgenogram shows the same unusual enlarged joint space corresponding to the lateralization of the femoral head. Four arthrotomies were performed, tracing a cartilaginous fragment free or fixed to the articular capsule into the femoral joint. We have found a concentric reduction of the hip in 4 cases and enlargement from 1 to 3 mm of the joint space of the hip. After several years, articular function of the four hips is normal, nevertheless, they have shown a coxa valga with a femoral elongation to 10 mm, a coxa magna with an articular space wider than 1 mm, 2 very good concentric reductions of the hip. The lateralization of the head after reduction had to be detected as soon as the first radiographic control because it can cause immediate instability or arthrosis of the hip. Because of the cartilaginous or capsular composition and the size of the interposition, an arthrotomy is performed in front of a radiological enlarging of the space joint, or a loss of parallelism of osteochondral acetabulum bone. Computerized tomography and MRI can reveal the nature, the place of the included fragment, as well as the surgical approach. An arthrogram is not absolutely indispensible. Surgical exploration should avoid degenerative arthrosis after a lateralisation left untreated.

Adolescent↗
PubMed1995

[Surgical treatment of the rupture of the inferior tendon of the biceps. Apropos of 6 cases].

INTRODUCTION: The purpose of this study is to compare the results of direct reinsertion of the distal bicipital tendon to the bicipital tuberosity, with other methods described in the literature. MATERIAL AND METHOD: This study is based on six athletic patients, all male, ranging in age from 42 to 62 years old. The rupture of the biceps occurred during an unusually violent effort in flexion and forced supination of the arm at a 90 degree of flexion. The surgical procedure which took place between a week and a month after the accident, consisted in a direct reattachment of the detached tendon. RESULTS: No paralysis in the area of the radial nerve occurred. All patients regained normal range of motion of the joints with maintained strength. DISCUSSION: Faced with a recent lesion in a young patient, a reinsertion on the bicipital tuberosity is desirable in order to maximize the strength and movement of the biceps. This simple technique uses a single approach. It does not weaken the bicipital tuberosity nor the muscular function of the biceps.

Adult↗
PubMed1995

[Tenotomy of the psoas muscle in slow reduction of congenital hip dislocations].

PURPOSE OF THE STUDY: The aim of this study was to relate the efficacy of cutting the psoas tendon in case of high congenital hip dislocation treated by slow reduction according to Somerville-Petit. MATERIAL: Twenty psoas tenotomies were realised between 1982 and 1992. The average age was 11 months 15 days old, they were 15 girls and 5 boys. Among them, only 9 patients had never been treated. METHOD: By a short surgical approach close to the lateral lip of Scarpa's triangle, we cut the psoas tendon at the musculotendinous junction doing this suppresses the obstacle that interferes with the femoral head coming down. RESULTS: Results have been evaluated on clinically and especially radiologically. All hips remain stable except one case. A graduated subluxation of the hip occured after removal of the plaster. 18 hips have been revised between the third and fifth year. Clinical results were excellent, on radiological controls 5 hips were considered flawless, 11 satisfying, and 2 were imperfect. Only 2 children have been seen ten years later with excellent clinical and radiological results. DISCUSSION: The hypertrophic psoas tendon interposes between the femoral head and the acetabulum creasing the capsule and the limbus. Cutting tendon of the psoas will decrease the numerous unexplained failures that occured during slow reduction according to Sommerville-Petit method. The use of these surgical techniques may make more outstanding the tenotomies time. CONCLUSION: Tenotomy of the psoas tendon realized by a short surgical approach without any articular effraction, allowed us to obtain complete reduction of the hips dislocation in these 20 patients.

Casts, Surgical↗
PubMedDate not supplied

Is the Cotrel-Dubousset really universal in the surgical treatment of idiopathic scoliosis?

We reviewed the results of 22 cases of Cotrel-Dubousset (C-D) instrumentation, 16 cases of anterior approach, and 200 cases of posterior approach by Harrington instrumentation and modifications of Harrington procedure. Posterior spinal fusion and instrumentation by C-D gives better correction and stabilization in thoracic and balanced double major curves. We no longer use the Harrington procedure and its modification. In lumbar and short thoracolumbar curves, VDS is still preferred. In some double major curves combined procedures, VDS and C-D are used to obtain more correction with a shorter fusion area.

Child↗