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Biomedical subjects

M Jacquemier

Publications and source records attributed to M Jacquemier.

At least 19 recordsLinked to original sources

[Acetabular anteversion in congenital luxation of the hip].

MATERIAL AND METHOD: Acetabular anteversion angle (AAA) and orientation angle of the iliac bone (AOOI) determined by use of a CT scan were studied in CDH. 55 children with CDH were selected on hip arthrography for this study. Subluxated hips were excluded (i.e. opposite hip of a unilateral CDH is normal). 10 boys and 45 girls with a mean of age of 2 years 1 month (extremes from 1 to 4 years 3 months) were studied. CT scan was performed before any orthopaedic treatment in 3 cases of bilateral luxation and 14 cases of unilateral. In the other cases, time between the end of orthopaedic treatment and CT scan varied between 4 and 18 months. A group of 23 normal children, 10 boys and 13 girls, (mean age of 2 years 10 months) served as reference group. On the selected CT slide we measured AAA, AOOI, IAA and IAP (anterior acetabular index and posterior acetabular index as proposed by Guggenheim). RESULTS: We noted that the orientation of the iliac bone was variable in the two groups. This orientation angle could have higher or lower values. AAA: in bilateral luxation, this angle was higher (16 degrees +/- 5 degrees) than in reference group (13 degrees +/- 4 degrees), p < 0.005. In unilateral luxation there was no statistical difference (14 degrees +/- 4 degrees) with reference group, between normal and pathological side and when CT scan was performed before or after orthopaedic reduction. AOOI: there was no significant difference between bilateral, unilateral or reference group. Correlation analysis showed that AAA and AOOI moved in the same direction. IAA: in bilateral luxation this index was higher (p < 0.001); in unilateral luxation only right luxation showed an higher index (p = 0.002). IAP: no significant difference between the different groups. DISCUSSION: This study shows that there is any typical CT scan aspects of morphologic abnormality in CDH. The lesions of the anterior or posterior acetabular wedge are variable. The orientation of the iliac bone is also variable; we concluded that acetabular anteversion must be analysed depending on the morphologic aspects of the anterior and posterior extremities of the acetabulum and iliac bone orientation.

Acetabulum

[Femoral anteversion in upper femoral epiphysiolysis in adolescents. Apropos of 25 cases].

CT-scan examinations have been performed in 25 children with slipped capital femoral epiphysis (SCFE) and in 127 children in an out-patients orthopaedic consultation. A low femoral anteversion (FA) was present in SCFE. This morphological abnormality, in association with other factors, could explain the production of SCFE at the moment of the most important fragility of the upper femoral growth plate, which is puberty. A statistical analysis showed that the risk of SCFE was distinctly greater, even for the contralateral hip when FA was low.

Adolescent

[Acute osteomyelitis of the ilium. A study of 2 cases with review of the literature].

The authors have made a review of the literature about two cases of osteomyelitis of the iliac ala. They insist on rarity of the disease and how often the right diagnosis may be delayed because of misleading clinical symptoms. Any tumefaction of the buttock associated with pelvic pain and with an infectious syndrome necessarily evoke an iliac osteomyelitis. The bone scan may be negative which need not exclude the possibility. The evolution may be the formation of intra or extra or sometimes simultaneous sub-periosteal abscesses which must be drained. This is the reason why the authors advise to verify systematically the other side of the ilium by its surgical trepanning in case of a sub-periosteal abscess.

Abscess

[15 cases of vertebral involvement of histiocytosis X in children. Review of the literature].

Fifteen pediatric cases of vertebral involvement in histiocytosis X are reported. The study of these cases and a review of the literature shows that every patient with histiocytosis X should have a local and systemic staging work-up to differentiate isolated eosinophilic granulomas of the bone, multiple eosinophilic granulomas of the bone, and visceral disseminated disease. Management varies according to the extension of the disease. Systemic chemotherapy may be indicated in patients with extraosseous lesions. Local investigations should be performed to look for instability of the spine, which may require surgery, and above all for spread to the soft parts indicating chemotherapy with or without surgery. Forms which are strictly confined to the bone and cause no instability, such as vertebra plana, require no treatment.

Child

[Intertrochanteric osteotomy of the femur in children under 5 years of age. A new osteosynthesis plate].

Between 1980 and 1988, 70 varus inducing and varus derotation osteotomies of the upper end of femur were carried out in children. The osteotomies were maintained by a plate and screws developed by the author. This plate combines a bend to medialize the inferior fragment and screw perforations for easy positioning; it facilitates the procedure since the degree of varus correction depends completely on the shape of the plate. This firmly maintains the desired correction and reduces the amount of radiation received at subsequent controls.

Child, Preschool

[Role of acetabuloplasty in the treatment of residual cotyloid dysplasia before 4 years of age. Apropos of 14 cases followed over 5 years].

Concerning 14 cases with a follow-up of over 5 years, the authors describe their acetabuloplasty technique which is applied to dysplastic sockets with normal cotyloid cavity anteversion, innominate osteotomy is reserved for cases in which this anteversion is excessive; results have been excellent for 11 cases with adequate lowering of the roof-edge of the cavity and improvement of the C and CE angles as well as satisfactory subsequent bone growth; the result was insufficient in 3 cases in which either the head of the femur was off-centre or deformed by osteochondritis. The age of the patients was between 16 and 37 months. No growth disorder caused by the operation has been observed. Three failures may be related to pre-existing abnormalities in the growing areas of the acetabulum or to ischaemic troubles in the femoral head.

Acetabulum

[The treatment of old dislocations of the radial head in children by osteotomy of the upper end of the ulna. Apropos of 15 cases].

Fifteen old dislocations of the radial head in children were treated by open reduction combined with a high osteotomy of the ulna and a reconstruction of the annular ligament. This method, described by the authors in 1978, was used in nine post-traumatic, three congenital, two paralytic and one dislocation associated with multiple exostoses. Twelve children were reviewed with a follow-up of two to 11 years. Nine radial heads remained stable and well reduced. The three congenital dislocations recurred. Eight elbows showed normal alignment and the other four were only improved. Ten elbows had normal movement or better movement than before the operation. Eleven children used their elbow normally or better than before. In all, 14 children were improved, and only one elbow had unaltered function. The results obtained in congenital dislocations should be able to be improved by a number of technical precautions.

Child

[Surgical treatment of congenital dislocation of the hip in older children; analysis of the results. Apropos of 46 cases].

The results of surgical treatment of 46 congenital dislocations of the hip in children older than 4 years are analysed. Several techniques were used; progressive traction for a short time, stabilisation by plaster cast immobilisation or surgical reduction, pelvic osteotomy with or without combined femoral rotation osteotomy with shortening. Apart from other means of assessment, 3 radiological signs were used to determine the results - sphericity of the femoral head, coverage of the femoral head and centering of the femoral head. A new classification is proposed by the authors. Only 25 p. 100 of the results were excellent or good. The other hips had at least one radiological anomaly and 17.5 p. 100 of the hips had a non-spherical head. Cases with poor coverage of the femoral head did well when this was the only defect because this anomaly was easily corrected. In contrast, excentration of the femoral head was poorly tolerated in the long term. The degree and direction of excentration had to be assessed in the frontal plane.

Acetabulum

[The development of our therapeutic concept in the treatment of ulnar epicondyle fractures].

50 patients with epicondylus ulnaris fractures are analysed. 4 types of fracture are recognised. The results of therapy are often described in literature much more optimistically than in reality. The first critical examination and the selection of therapy, mostly a surgical intervention, had a great influence on mobility of the elbow joint, on strength and subjective perception. The results could only be assessed after three years. Complications of concomitant injuries - nerve lesion and ligament/capsule structures - were discussed with regard to surgical approach.

Arthrography

[Fracture-avulsions of the patella in children. Apropos of 3 cases].

Three cases of sleeve fractures of the patella are reported. These lesions are epiphyseal fractures. Attention is drawn to the fact that the diagnosis may be missed. Surgical treatment is necessary to attaining and maintaining reduction. The authors focus on that avascular necrosis is important in sleeve fractures and the open reduction increases this risk.

Child

[Tomodensitometric aspects of hip luxation in childhood. Apropos of 100 hips].

One hundred hips in children were examined by computer assisted tomography. They were either dysplastic, subluxated or dislocated. The study resulted in more precision as to the degree of femoral anteversion and acetabular anteversion. The indications for femoral or pelvic osteotomy can thus be more accurate. Mechanical effects of some pelvic osteotomies have been analysed.

Acetabulum

[Femoral neck fractures in children. About 14 cases (author's transl)].

The authors study 14 femoral neck fractures in children after a four and half years follow up. They point out the scarcity of these fractures in children. They describe their therapeutic methods and results. They corroborate the bad prognosis of this injury (femoral neck necrosis or further growth trouble) and emphasise the importance of a long term follow up to appreciate precisely the sequellar growth trouble. They discuss the responsibility of the femoral neck's vascularisation pattern in the origin of the sequella. They ask two questions : -- Is it useful to treat these fractures in emergency? -- Is the surgical dogma still valid?

Adolescent

New procedure to remove a centrally located bone bar.

A centrally located bone bar of the lower tibia was removed after epiphyseolysis with an Ilizarov device. The bone bridge attached to the metaphysis was easy to remove, and methylmethacrylate was used as an interpositional material. Varus deformity was corrected at the level of the epiphyseolysis. At the 2-year follow-up, there was evidence of further growth and correction of the varus was maintained.

Child

Bone lesions in histiocytosis X.

Sixty-two patients with histiocytosis X were followed for an average of 5 years. The patients were classified into three groups: general visceral types (14 cases), multiple eosinophilic granulomas (nine cases), and solitary eosinophilic granulomas (39 cases). One hundred bony lesions were noted in 60 of the 62 patients. The bone lesions showed progressive improvement in single and multiple eosinophilic granulomas independent of treatment type. After biopsy, patients received no treatment unless there was a dangerous extension into the soft tissues because of its site, i.e., in the skull. In the general visceral types, chemotherapy was effective in visceral sites and in extensions of the tumor outside the bone but did not alter the natural history of the bony lesion.

Adolescent