Biomedical subjects
Publications and source records attributed to P Lascombes.
A case of a 6-year-old boy with a painful dorsal scoliosis secondary to an osteoid osteoma in a rib is described. Surgical excision was performed and the scoliosis decreased. Such cases are very rare.
A rare case of metaphyseal cupping of the distal femur resulting from infantile scury in a child is reported. The radiological and surgical aspects of this case are of particular interest. MRI demonstrated central epiphysiodesis of the right knee, surgery achieved rupture of the epiphyseal plate and resulted in femoral lengthening. The child's limp disappeared as a result.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Two unusual cases of non-ossifying fibromas in boys of 4 years with partial cystic degeneration are presented. The osseous cavities did not respond to corticosteroids.
Histiocytosis X is still of unknown origin. Its clinical patterns are various and it is above all a bone disease of children, mostly boys. It is a tumoral condition basically benign but with a strong tendency toward dissemination and destruction. Its natural history is unpredictable. The authors have reviewed 37 cases after a 44 months mean follow-up for bringing up a better understanding of the role of orthopedic surgery. The diagnosis was always based on biopsies looking for at least two basic signs out of four possible ones. Scintigraphy was used to detect other locations. MRI was used to evaluate the effect of treatment. In single eosinophilic granuloma, curettage was associated with biopsy. Local injections of corticoids may help in spinal locations. In disseminated forms, surgical treatment should be little aggressive, limited to a biopsy of the most superficial lesion. These forms should be treated by radiotherapy corticotherapy and chemotherapy, as well as the aggressive lesions, the extensive ones, the threatening ones and those which are not accessible.
Four pediatric cases of peptic esophagitis in patients with severe dorsolumbar scoliosis including three with a history of neurological disease provide the opportunity to point out that curvature of the spine fairly often causes development of gastroesophageal reflux. By displacing the anchoring points of the stomach and stretching the lower esophageal sphincter, scoliosis can be responsible for malposition of the cardia and fundus and for gastroesophageal reflux. Furthermore, plaster corsets increase intraabdominal pressure and may therefore promote gastroesophageal reflux.
The rib is frequently used as a bone graft in the surgery of the anterior spine. The advantage of the rib is that it is easily used as a pediculated vascularized graft when it is transferred to the anterior vertebrae. The average length of the pedicle is over 5 cm for the ribs number 3 to 10. Their useful length of bone is 12 cm. With this technique fusion of 4 to 6 lumbar or thoracic vertebrae is possible.
Recent progress is chemotherapy for treatment of malignant tumors of the skeleton permit conservative treatment in many cases by resection-reconstruction rather than amputation. The problem remains acute and divided in young children because of considerable intramedullary tumoral extension and other requirements due to growth. The authors comment their experience of femoral osteosarcoma in 3 different methods of conservative treatment: 1 Creation of a progressive regenerate by Ilizarov's lift technique previously experienced on animal. 2 Total replacement of the femur with hip and knee arthroplasty using Dr Delepine massive growth prothesis. 3 Subtotal femoral replacement, sparing the superior and inferior growth plates, by a massive homograft fixed by a locked nail. The authors discuss the advantages and difficulties of each method with regards to literature and with their own experience.
Eleven biopsies of bone regenerate during bone lengthening following the Ilizarov technique were studied. They concerned 10 patients with a mean age of 13.5 years. The length of the biopsied regenerate was between 14 and 90 mm, and the delay after the initial procedure was 23 to 502 days. The aim of this study was to get informations on the histology of the regenerate, to quantify osseous data and to propose a surgical strategy. These data were obtained by analyze of non decalcified bone, biopsies were included in a methylmetacrylate block. Measure of the mineralisation speed was determined after a double intake of tetracycline. The bony trabeculations were formed very early, as soon as the third week. They were placed like a thread, that means in an anastomotic system which can quickly become resistant. But is was necessary to keep a lengthening speed under 1 mm per day 0.7 to 0.8 mm per day seems to be the best speed in adolescents. The ossification was of membranous type, without cartilaginous stage. Osteoblastic and osteoclastic activities were extremely rich, even after one year or after the bone healing. The main point was the maturity of the regenerate acquired as soon as the 4th month.
The Ilizarov method is an original technique of surgical lengthening of long bones. The constraints in compression and distraction obtained with this method favor the bony healing. The straining of extension induces stimulating consequences on the bone. The healing process is different from that of the fractures because the bony regeneration is accomplished by a membranous bony mechanism without intermediate fibrous or cartilaginous medium. The maturation occurs when the lamellated bone is present, at the end of the 4th month.
Neuromuscular hamartoma is a pseudotumour characterized by the presence of striated muscle fibers in a nerve trunk. The reported case was located in the left sciatic nerve in a 4-year-old girl with equinism and spasticity. A first surgical procedure, with muscle biopsy, did not permit diagnosis of hamartoma. It was followed by the occurrence of a firm mass at the same location. Partial excision was performed; the mass revealed to be fibrous. Further aggravation of functional symptoms lead to leg amputation and correct diagnosis. Discussion is focused on the unique features of this rare disorder, for which therapeutic attempts might be avoided, whereas diagnosis proved to be sometimes difficult.
Explore the source record for details and available documents.
Surgical treatment of supracondylar fractures of the humerus in children concerns a limited number of these fractures. That is fractures with great displacement and periosteal rupture, which are reported in our experience of 96 cases treated by an original method. It consists of external reduction stabilized by 2 nails introduced in the middle third of the shaft and diverging in the lower humeral epiphysis. We insist on the use of two X-ray amplifliers in the operative technique. Ninety-four fractures were controlled after 3 months, during nail removal and 81 patients had a follow-up more than one year. Morphological and functional results were appreciated as 75 excellent 15 good and 4 bad. Among the complications encountered we noticed that cubitus varus was very rare. Only 6 controls showed an angle of less than 10 degrees. As compared to the other surgical techniques this method is very encouraging and comforts our indications in unstable third degree fractures, unsuitable for Blount's method, and the great majority of forth degree fractures.
The principle of osteogenesis under stretch elaborated by Pr. G.A. Ilizarov around 1970 comfort our decision for limb lengthening for it does not need in most cases hemorrhagic operations nor use of bone grafts. Pathological shortening of the humerus may be due to various causes: monomelic dystrophy due to epiphysiodesis of humeral superior growing plate with or without humerus varus, sequelae of neonatal septic osteoarthritis of the shoulder joint are the more frequent etiologies. On the other hand, the fibrous dysplasia, osteochondromatosis (Ollier's disease), sequelae to trauma or iatrogenic etiologies are infrequent. Resulting length discrepancy are very important from 11 to 15 cm and more when growth is achieved. Functional disorders are delayed as compared to the lower limb for each upper limb acts independently to each other. However above 6 cm discrepancy coordinated movements become more difficult or impossible especially above 8 cm discrepancy. The authors reported 4 cases of arm lengthening concerning teenagers by Ilizarov's technique with a discrepancy between 10 to 14 cm. One of the humerus was previously treated by Wagner's technique which allow us to make a comparative analysis of both methods. Technical instructions, incidents and accidents occurring during lengthening, healing delays and functional and esthetic results are discussed in recent publications on this subject.
The authors report a series of 55 fractures of the upper extremity of the humerus in children and adolescents surgically treated by elastic intramedullary nailing. The place of this surgical technique is evaluated in the general treatment of these fractures, which have the prognostic always favorable. The results, with a 1 year follow-up, are all excellent or good on the functional and anatomical plan. The cases of mal union have been rare and the correction is obtained with growth. This way be explained by the capacity of remodeling of the upper humerus. The treatment of fractures of the upper extremity of the humerus is first orthopaedic in children and adolescents, but the osteosynthesis by elastic intramedullary nailing can represent a surgical method of choice in the fractures which are displaced, unstable or which need a thoraco-branchial plaster.
Pelvic growth in bladder exstrophy was studied in 10 patients. Growth of their pelves in length as well as in width was similar to that found by Tanner. Meanwhile, the speed at which the diastasis of the pubic symphysis increases is variable. Before 5 years of age and during the end of growth it is fast, whereas it is slow between 5 and 10 years of age. There are no radiological abnormalities of hip joint orientation, and the acetabular angles are normal.