Biomedical subjects

J-M Laville

Publications and source records attributed to J-M Laville.

4 recordsLinked to original sources

PubMed2005

[Physeal distraction for limb length discrepancy and angular deformity].

PURPOSE OF THE STUDY: Physeal distraction or chondrodiastasis uses the growth plate as a zone of least resistance. Application of force thus provokes distraction and opening of the plate (Salter and Harris type I epiphyseal detachment). Progressive lengthening allows room for regenerate bone and enables limb lengthening and correction of angular deformations. MATERIAL AND METHODS: Twenty chondrodiastasis procedures were performed in fifteen patients. Mean age was 14.4 years (10.3-15.7). The underlying causes were trauma (n = 6), constitutional deformation (n = 8), infection (n = 2, distal lateral femoral epiphysiodesis), and malformation (n = 4). The localizations were: proximal tibia (n = 11), distal tibia (n = 4), distal femur (n = 4), distal radius (n = 1). The surgical procedure involved installation of an external fixator on either side of the physis after planification of the desired correction and taking into account the remaining growth potential of the physis. The distraction was performed by the patient at the rate of 1 mm per day. A one-sided external fixator was used for eleven patients (distal femoral correction and proximal tibial hemichondrodiastasis for angular deformation) and a circular fixator (to control 3D correction) in nine. Complications were noted according to the four grades of severity described by Caton. RESULTS: Mean follow-up was 26.1 months. Epiphyseal detachment was achieved in all patients, even in the presence of an epiphysiodesis bridge, in 7.7 days on average (2-15 days). Mean lengthening was 4.75 cm, mean angular correction was 22.2 degrees (mean preoperative angle 20.5 degrees ). For chondrodiastasis (symmetrical physeal distraction), the mean duration of correction was 4.6 months (1-9), mean time to healing was 8.3 months (4-13) and mean healing index was 55.6 days/cm (Verone). For hemichondrodiastasis (asymmetrical physeal distraction), mean duration of correction was 1.3 months (1-3), and mean time to healing was 2.7 months (2-5). The healing index was different and was 3 days per degree. Complications were studied using the Caton classification. There were 17 (85%) benign complications (not requiring revision under anesthesia) and 6 (30%) serious complications (requiring anesthesia and unplanned revision). There were 2 (10%) severe complications (knee flexion, ankle equinus). DISCUSSION: Chondrodiastasis has specific complications, mainly involving the distal femur (stiff knee, risk of septic arthritis). It provides rapid in situ correction resulting from epiphysiodesis bridges. The resection step proposed by Bollini is not necessary, but the growth plate is definitively sterilized. This implies that the procedure be used for preventive lengthening, depending on the predicted limb length discrepancy. This notion limits indications to older children. Besides the fact that several deformations can be corrected simultaneously, this technique does not require osteotomy and respects vascular supply to the regenerative tissue. It involves the physis responsible for the angular deformation or limb length discrepancy. It does not require internal fixation nor bone grafting and can be performed with weight bearing. Finally, the procedure can be adjusted as needed during the correction phase, with the patient in the standing position.

Adolescent↗

PubMed2004

[Elastic sliding central medullary nailing with osteogenesis imperfecta. Fourteen cases at eight years follow-up].

PURPOSE OF THE STUDY: Elastic sliding centromedullary nailing (ESCN) proposed by Métaizeau in 1987 for the prevention and treatment of limb fractures in osteogenesis imperfecta has never been evaluated. A multicentric serie was studied in order to evaluate results of these procedure. MATERIAL AND METHODS: Thirty-six ESCN procedures were performed in fourteen patients. Percutaneous pinning was used for the femur and distal tibia and arthrotomy for the distal femur as needed and in all cases for the proximal tibia. The pins were bent in compliance with the principles of the ESCN system. The ends of the pins were bent back to form a U pushed into the epiphysis. Reaxing osteotomies required minimal incisions. Age at the first procedure, the number of procedures and complications, and time between procedures were recorded. Pin overlap and the angle formed were also recorded. Pin gliding was evaluated. Ability to walk with or without assistance was noted. RESULTS: The medullary canal measured 4 to 10 mm. The first procedure was performed at a mean age of four years (range 15 days to 10 years). Follow-up was eight years (range 1-12). There were 2.5 procedures per patient (range 1-5). Pins had to be changed in 75% of the bone segments. Mean time between two procedures was 3.2 years. There were no cases of defective sliding or infection. There were four cases of secondary fracture with a mean 30% pin overlap, two pin migrations, one nonunion, and one shortening. The majority of the complications occurred after the age of five years. At last follow-up, three patients could not walk, four walked with aids, and eight without aids. DISCUSSION: The advantages of the technique (size of the pins, nailing without reaming, pin sliding in all cases, low cost) must not overshadow the drawbacks (risk of pin deformation and migration, secondary fracture). Secondary fractures might be limited by discrete valgus of the femoral shaft and preventive pin change when the angle formed approaches 30 degrees and when there is only 30% overlap left. Use of telescopic nails before the age of five years increases the risk of complications while most of the complications observed with ESCN occur after the age of five years. Twenty-five percent of the ESCN complications involved only the femur. The percent of secondary fractures was less than with telescopic nailing (3.6% versus 11%) but there were more cases of nail migration. All pins slid, compared with 6% failure of elongation with telescopic nails. Although proof is not available, surgical treatment of osteogenesis imperfecta before the age of five years appears to provide more rapid functional progress. CONCLUSION: Sliding centromedulary nailing is an attractive alternative before the age of five years. In older children and to the end of growth, telescopic nail or pinning should be discussed although pinning may permit more secondary fractures which can be limited by rigorous surveillance of pin position.

Age Factors↗

PubMed2003

[Shelf acetabuloplasty in Legg-Perthes-Calve disease].

PURPOSE OF THE STUDY: The purpose of this study was to demonstrate the contribution of shelf acetobuloplasty for the treatment of Legg-Perthes-Calve disease. MATERIAL: Eighteen children with Legg-Perthes-Calve disease were operated on between 1992 and 2001. Mean age at diagnosis was 7 years 2 months, and mean age at surgery was 8 years 5 months (range 5-13 years). Mean motion was limited -25 degrees in abduction and internal rotation preoperatively. The radiological classification was: 2 Catterall II Herring B with signs of risk for the head, 8 IIB, 1 III C, 2 IV B, 3 IV C, and 2 at the sequelar stage. Mean excentration was 6.5 mm and mean overhang was 10.2 mm. METHOD: The indication for surgery was aggravation of the excentration or advanced revascularization. An iliac graft was embedded in the supralimbic and covered with a rectus femoris tendon which, left continuous, provided elastic support. A bermuda cast was used in 17 cases and immediate weight-bearing in 11. The patients were hospitalized 36 hours. RESULTS: Sixteen patients were reviewed at mean follow-up of 3 years 2 months (2 lost to follow-up). There were no complications. Clinically, the patients were pain free. Three patients had persistent limping 10 moderate limitation of motion, and three had severe stiffness. Radiologically, head covering was good in 15 cases, and joint congruency was achieved in 15 (11 of which were concentric). Shelf acetabuloplasty was considered useful in 12 cases, not useful in 1 after complete lysis of a poorly positioned graft, and of uncertain usefulness in 3 (including 2 cases treated at the sequalar stage). DISCUSSION: Femoral osteotomy for varisation and pelvic osteotomy for reorientation or enlargement of the acetabulum are effective but have certain drawbacks (limitation of abduction, leg length discrepancy, reintervention to remove material). The excellent integration of the shelf graft at mid-term is a good sign of correct head-acetabulum adaptation, with radiological and clinical results similar to other techniques. Joint stiffness and limping are observed in very severe forms where the prognosis depends on the stage of the disease. CONCLUSION: The patients in this series have not yet all reached maturity. Shelf plasty is a rapid, easily-performed, and safe means of enabling weight-bearing in Legg-Perthes-Calve hips undergoing excentration and beginning revascularization.

Acetabulum↗

PubMed2002

[Rotational osteotomy technique for congenital radio-ulnar synostosis with central medullary nailing and external fixation].

PURPOSE OF THE STUDY: Congenital radio-ulnar synostosis is a very uncommon condition. The functional impairment resulting from the complete pronation posture justifies rotational osteotomy. We present a series of six rotational osteotomies using the Hernigou-Goutallier technique. MATERIAL AND METHODS: The Hernigou-Goutallier osteosynthesis procedure is based on a centromedullary nail and two external fixation pins positioned in the ulna at an angle corresponding to the desired rotation. The nail is partially withdrawn to allow subperiosteal osteotomy in the synostosis via a horizontal incision between the two pins. After rotation, the osteotomy is stabilized with clamps holding the external fixation pins in parallel. RESULTS: Bone healing was achieved at two months in all six cases with no loss of correction. DISCUSSION: Among the different treatments proposed for radio-ulnar synostosis, the risk of vessel or nerve injury is high with screw-plate fixation despite shortening osteotomy. Palm-tree osteotomy raises the same risks and is more invasive and difficult to achieve. The rotational osteotomy technique presented here has the advantage of allowing local care more easily than with cast fixation. Another important advantage is that an overcorrection leading to vessel or nerve injury can be reversed without losing the axis, allowing progressive correction if necessary.

Bone Nails↗