[Overuse injuries in the young athletes].
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Adolescent↗
Biomedical subjects
P Lascombes
Publications and source records attributed to P Lascombes.
[Surgical management of paediatric malignant bone tumours].
The malignant bone tumours in children are rare, concerning 5% of the all paediatric tumours. Among all paediatric bone tumours, 15% of them are malignant. The main bone tumours in children are the osteosarcoma and the Ewing sarcoma. The diagnosis and treatment need a multidisciplinary medical team. It is essential in front of potential clinical or radiological signs, to perform quickly the specific medical exams and biopsy. The treatment needs a paediatric medical and surgical staff.
Adolescent↗
[Centromedullary nailing for fracture of both forearm bones in children and adolescents].
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Adolescent↗
Why do idiopathic scoliosis patients participate more in gymnastics?
The influence of physical and sporting activities (PSA) on idiopathic scoliosis (IS) is still obscure. The aim of this study was to investigate whether such an influence exists and if so, to determine its characteristics. Two hundred and one teenagers with IS and a control group of 192 adolescents completed an epidemiological questionnaire. Those practising gymnastics were more numerous in the IS group than in the control group. Moreover, the practice of gymnastics was chosen before IS was diagnosed. As gymnastic activities are considered neither as a therapy nor as a precursor of IS, the distribution observed could be linked to a common factor that both increases the likelihood of IS and favors the practice of gymnastics. Joint laxity (JL) may be such a common factor, and was therefore tested (wrist and middle finger) on 42 girls with IS and 21 girls of a control group. IS patients, practising gymnastics or not, showed a higher JL than the control group practising gymnastics or not. Furthermore, the groups practising gymnastic activities did not show higher JL levels than the other groups. Children with a high JL could be drawn toward gymnastics because of their ability to adapt to the constraints of this sport. Girls with a high JL may therefore be prone to developing IS. The fact that most teenagers with IS practise gymnastics could be related to a higher JL.
Adolescent↗
[Elastic stable intramedullary nailing in Ilizarov bone lengthening].
PURPOSE OF THE STUDY: Bone lengthening with the Ilizarov technique gives good results but certain disadvantages are common: possible axial deviation during lengthening, long time to bone union, risk of fracture after removal of the external fixator. Associating the Ilizarov technique with elastic stable intramedullary nailing (ESIN) commonly used in traumatology has to be evaluated. We conducted an experimental study and report results of the first clinical application. MATERIAL AND METHODS: Eleven lengthenings of the tibia were conducted in dogs aged 1 to 4 years using an Ilizarov external fixator associated with ESIN. Lengthening started on day 1 and continued for 28 days. X-rays were obtained every week during lengthening, then at 15 and 30 days during the fixation period and 30 days after removal of the fixator. In two cases, arteriography was performed. In a pilot clinical trial, fourteen patients (8 males, 6 females) were treated with this method (1 humerus, 1 forearm, 7 femurs, 5 tibias). Mean patient age was 14 years. RESULTS: In the experimental study, the x-rays showed rapid ossification of the regenerate which led to increased tibia length in 7 cases from 1.25 to 2 mm/day. Total bone union was observed in four dogs during the lengthening period. At day 15 of the fixation period, all tibia had fused with a good quality cortical bone and healing of the growth part of the regenerate. In three dogs, the external fixator was removed at day 15 of fixation and weight-bearing was total with the ESIN in place. No axial deviation and no skin problems were observed. The medullary artery was seen on the two arteriograms. In the clinical trial, bone union of the regenerate appeared earlier than in the Ilizarov series. The regenerate always displayed good density on the x-rays, proving intense bone activity. In three patients, the lengthening rate was increased to avoid premature bone fusion. The endosteal bone regenerate was obvious. Mean healing index was 18.6 days/cm (SD=6.2). Weight-bearing was allowed at six weeks. The desired correction was achieved in all patients and no complications were related to ESIN. DISCUSSION: Bone lengthening may be obtained with an intramedullary locking nail which avoids the use of an external fixator but also destroys the endomedullary circulation. Our experimental and clinical study shows that use of an ESIN does not inhibit the endosteal regenerate and seems to improve new bone formation. In many patients, the lengthening rate had to be increased to avoid premature bone fusion. When used in optimal conditions, ESIN can stimulate new endosteal and periosteal bone formation. In addition, ESIN increases shaft stability avoiding the risk of axial deviation. ESIN plays an additional role of stabilization after early removal of the external fixation.
Adolescent↗
The effect of inturning of the foot on knee kinematics and kinetics in children with treated idiopathic clubfoot.
OBJECTIVE: To assess the effect of internal foot progression angle (inturning) on knee dynamics in children with treated clubfeet. DESIGN: Prospective study dividing a population of clubfeet according to the factor inturning. BACKGROUND: Excessive internal or external foot progression angle increases knee flexion by a backward shift of the ground reaction force to the knee joint in children with cerebral palsy. Similarly, inturning in clubfeet was hypothesized to shift the ground reaction force backwards with reference to the knee joint, increasing the external knee flexion moment and the maximal knee flexion at stance. METHODS: Three-dimensional gait analysis was performed on 20 children with surgically treated clubfeet (n=28) to assess alterations of knee dynamics related to inturning (>7 degrees ) and on 13 normal children. RESULTS: Inturning occurred in 46% of the clubfeet and was associated during stance, at maximal knee flexion, to an increase in maximal knee flexion (+7 degrees ), external knee flexion moment (+60%) and related lever arm to the knee (+100%) and at minimal knee flexion, to a reduction in external knee extension moment (-62%) and related lever arm (-58%). Inturning was associated with a more frequent prolongation of internal knee extension moment and of rectus femoris activity exceeding 50% of stance. CONCLUSION: Inturning in clubfeet is associated with knee dynamics alteration, which might contribute to the long-term development of knee osteoarthritis. RELEVANCE: The therapeutic correction of inturning in clubfeet would be of importance if the consecutive knee dynamics alteration is shown by further studies to contribute to long-term degenerative knee pathology.
Adolescent↗
[Lameness in the child and adolescent: differential diagnosis].
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Adolescent↗
Osteochondroma after pediatric hematopoietic stem cell transplantation: report of eight cases.
Eight children developed osteochondroma (OS) at a mean of 88 months after hematopoietic stem cell transplantation (HSCT). The mean age at HSCT was 56 months (12-84). This represents a cumulative incidence of 20% among patients less than 18 years of age transplanted from 1981 to 1997. These eight patients underwent allogeneic (n = 2) or autologous (n = 6) transplantation for either acute leukemia (n = 6) or neuroblastoma (n = 2) after a conditioning regimen including TBI (n = 7) or a combination of Bu and CY. OS was multiple in seven patients and solitary in one. Eight lesions were resected and all were benign. Four children received growth hormone before diagnosis of OS, but there was no clinical, radiological or histological difference between those who did not. Univariate analysis showed an increased rate associated only with autologous HSCT, with a 31.7% probability of a new OS at 12 years after HSCT. Osteochondroma should be added to the other adverse effects of HSCT in children.
Actuarial Analysis↗
Influence of different types of progressive idiopathic scoliosis on static and dynamic postural control.
STUDY DESIGN: Balance control assessment of static and dynamic conditions was performed to study the effects of progressive idiopathic scoliosis on postural control in 102 adolescents. OBJECTIVE: To determine how the type and location of idiopathic scoliosis may affect global balance control. SUMMARY OF BACKGROUND DATA: Idiopathic scoliosis may impair postural control components, but the repercussions for global balance are relatively mild. METHODS: The following four different types of idiopathic scoliosis were compared: thoracic (n = 36), thoracolumbar (n = 22), lumbar (n = 23), and double major (n = 21) curves. Center of foot pressure displacements and electromyographic responses were recorded using static and dynamic posturographic tests (single and fast upward tilt, slow sinusoidal oscillations). RESULTS: The major criteria of postural control were better in the double major group for all the tests. In the static test, the patients with high major curves performed better than those with low major curves. In the fast dynamic test, similar latency values were observed in all the groups. In the slow dynamic test, better results were observed for the patients with low major curves. CONCLUSIONS: These data demonstrate that idiopathic scoliosis indeed alters balance control, with different hierarchies, from the best to the worst as follows: double major, thoracic, thoracolumbar, and lumbar curves in the static test and double major, lumbar, thoracolumbar, and thoracic curves in the slow dynamic test. The location of the major curve appeared to be important, with an effect on lateral disequilibrium and vestibular symmetry. The absence of anomaly in the fast dynamic test suggests that the type of scoliosis does not impair proprioception.
Adolescent↗
Pharmacokinetic longitudinal studies of antibiotics administered via a permanent intraosseous device in micropigs.
BACKGROUND: In critically ill children, intraosseous (IO) administration of a medicine provides an alternate vascular access route when IV access is not readily available. We investigated the short and long-term efficacy and safety of a totally intraosseously implantable device. PROCEDURE: This study was undertaken in micropigs (i) to compare serum levels achieved by equal bolus dosages of two antibiotics (amikacin and vancomycin) administered through an intratibial needle, an intraosseous implantable device and central IV routes to determine whether standard parenteral dosing guidelines for antibiotics may be applied without modification for IO injection, and (ii) to show the efficiency of the implantable device over a prolonged period, as a permanent access to intraosseous space. RESULTS: The area under the plasma concentration time curves were similar for IV, intratibial and through the intraosseous implantable device, for intermittent administrations of amikacin and vancomycin, over a period of 6 months. However, vancomycin did not reach therapeutic levels via both IO routes. We did not find any alteration of amikacin and vancomycin pharmacokinetics over a period of 6 months using the implantable device. No complication occurred. CONCLUSIONS: Long-term administration of antibiotics through a totally implantable intraosseous device is feasible and safe in micropigs. Although the procedure seems promising, additional studies of the continuous infusion of chemotherapeutic agents, blood products and antimicrobial solutions are needed prior to use in humans.
Amikacin↗
Transplantation of the proximal fibula based on the anterior tibial artery. Anatomical study and clinical application.
The purpose of this study was to investigate the feasibility of microvascular transplantation, based on the anterior tibial artery, of the epiphysis and the proximal half of the diaphysis of the fibula. India ink injections into the anterior tibial artery were performed in 13 unembalmed adult cadavers, following which transverse frozen sections were taken. Dye was observed in the fibula, both within the intramedullary cavity and at the level of the periosteum, in all specimens. The average distal limit reached by the dye, measured from the tip of the epiphysis, was 10.4 cm in the intramedullary cavity and 11.8 cm in the periosteum. Based on these anatomical findings one case of humeral reconstruction has been performed with a fibular transplant, including both the epiphysis and a segment of diaphysis, vascularized solely by the anterior tibial artery.
Adult↗
Periosteum and bone marrow in bone lengthening: a DEXA quantitative evaluation in rabbits.
We quantitatively studied the role of periosteum and bone marrow-endosteum during lengthening in 18 growing rabbits, comparing four surgical procedures: 1) periosteum and bone marrow preservation, 2) periosteum preservation, bone marrow destruction, 3) periosteum destruction, bone marrow preservation, 4) periosteum and bone marrow destruction. An external fixator was set on one femur, the other serving as a control. Distraction began on day 5 and stopped on day 25 (0.25 mm/12 hours). On day 30, femora were harvested with a layer of muscle. Area, bone mineral content and density were measured by dual-energy x-ray absorptiometry. Procedure 2 showed the highest increase in bone mineral content around the elongated callus (127%) compared to procedures: 1 (81%), 3 (25%) and 4 (-8%, i.e., resorption of bone ends). A statistically significant effect on bone formation was observed when preserving (vs. destroying): 1) periosteum, 2) bone marrow (effect observed only around the distraction gap), 3) periosteum and bone marrow in combination. Periosteum alone forms a larger callus, with more mineral content than bone marrow alone, and destruction of both results in the absence of bone formation around the distraction area. Careful preservation of periosteum is essential to bone healing. Formation of bone with a large mineral content does not require bone marrow preservation, but there is an interaction effect on healing between bone marrow and periosteum.
Absorptiometry, Photon↗
A modified Kapandji procedure for Smith's fracture in children.
Anteriorly displaced fractures of the wrist can be treated by the Kapandji technique of percutaneous intrafocal pinning with pins inserted through an anterior approach to give good reduction and stabilisation of the fracture. We have modified this technique by placing the pins through a posterior approach which decreases the risks of neurovascular damage. We have used this method to treat six children with distal radial fractures showing anterior displacement or instability. Good anterior stabilisation was achieved. The pins were removed at an average of eight weeks and the patients were then able to return to full activity. This simple technique can be used for unstable fractures after the failure of conservative treatment or in bilateral fractures in adolescents.
Adolescent↗
Fractures of the radial head and associated elbow injuries in children.
Fractures of the radial head are frequently associated with elbow injuries in children. Thirty-seven patients with this association treated at the Nancy Children's Hospital were analyzed to ascertain the mechanism and the unfavorable factors of prognosis. The mechanism responsible was a valgus strain on the elbow at the moment of impact, associated with forces of compression and distraction. At an average follow-up of 2 years, 76% excellent and good results were obtained. Conservative treatment was always effective in minimally displaced fractures. With surgical reduction by closed intramedullary pinning (CIMP), there were only three failures in severely displaced fractures. With open reduction, results were always poor; 88% patients with fair and poor results had an associated fracture of the olecranon. The unfavorable prognostic factors were the severity of the initial tilting and displacement, the presence of associated elbow injuries, the inadequacy of reduction, and the open reduction procedure.
Adolescent↗
[Percutaneous resection of osteoid osteoma].
Therapeutic management of osteoid osteomas may vary from conservative medical treatment to more aggressive, though effective, surgery. Based on observations in 4 cases in children, we demonstrate the importance of localizing the lesion on the CT-scan before percutaneous resection of the osteoid osteoma involving small bones since this method is the most conservative surgical procedure.
Adolescent↗
Evaluation of a hydrocolloid dressing.
A hydrocolloid dressing was compared to adhesive skin tapes on children's postoperative wounds. A total of 170 children of varying ages were randomised in two parallel groups, in nine centres of plastic, thoracic, gastrointestinal, urogenital and orthopaedic surgery. Skin closure was satisfactory in both groups, with 76 (89.4%) healthy closures without dehiscence in the hydrocolloid group and 81 (95.3%) in the control group; a relationship was found between partial closures/dehiscence and the type of surgical procedure. No product-related maceration, infection or adverse event was reported during the study and both groups showed very satisfactory cosmetic results.
Adhesives↗
[Villonodular synovitis of the wrist. Apropos of a case in an adolescent].
Pigmented villonodular synovitis of the wrist is an uncommon disease. It is also very rare in childhood and adolescence. The authors report a case with good outcome after surgery and review the literature concerning this.
Adolescent↗
Treatment of Langerhans-cell histiocytosis in children. Experience at the Children's Hospital of Nancy.
Forty children who had Langerhans-cell histiocytosis were followed for an average of six years (range, excluding patients who died of the disease, two to fifteen years). The patients were divided into two diagnostic groups: those who had localized disease (involving one bone or more only) and those who had multifocal disease (an osseous lesion and a soft-tissue mass, a skin rash, diabetes insipidus, or generalized disease). Methods of treatment included curettage, bone-grafting, chemotherapy, local or systemic corticosteroids, and radiotherapy. Nineteen of the thirty patients who had localized disease had a complete response to the therapy, four had a partial response, and seven had no response. Twenty-one of these thirty patients had not had a recurrence by the time of the latest follow-up examination; nine had a local recurrence within four years after the initial therapy but had no additional recurrences after treatment of the local recurrence. No recurrence occurred more than four years after the time that the initial diagnosis had been made. Five of the ten patients who had multifocal disease had a complete response to the therapy, two had a partial response, and three had no response. Six patients had a recurrence; four did not. Two patients died of the disease. As a result of this study, we recommend the avoidance of intensive measures of treatment, if possible, and we advise long-term follow-up of these patients.
Child↗