[Screening of congenital dislocation of the hip in the newborn].
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Follow-Up Studies↗
Biomedical subjects
R Kohler
Publications and source records attributed to R Kohler.
[Thirty years of progress in pediatric orthopedics].
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Adolescent↗
[Transverse sacral fracture in children: a case report presenting with neurological injury and review of the literature].
Transverse fractures of the sacrum are exceptional in children. We report a case in a 10-year-old girl. The patient presented an isolated flexion fracture of the sacrum in Denis zone III (transverse "U" fracture) of S1-S2 with neurological signs at the initial examination: sensorial deficit in the perineum and sphincter dysfunction. Treatment consisted in laminectomy and bone resection to relieve compression causing the neurological injury. Orthopedic treatment led to correct bone healing. Outcome was favorable with complete resolution of the neurological deficit and stability at three years. Eight cases of transverse sacral fracture before the age of 18 years have been reported in the literature. The diagnostic elements are similar to those in adults, but can be missed in children who rarely present sacral fracture. The therapeutic approach has varied, both for children and adults. We advocate surgical treatment in the event of neurological complications and orthopedic treatment of stable bone lesions.
Child↗
[Congenital pseudarthrosis of the forearm in a neurofibromatosis patient: case report and review of the literature].
We report a case of congenital pseudarthrosis of the forearm associated with neurofibromatosis type 1 which was treated by free vascularized periosteal flap transplant and repeated bone grafting. The young female patient recovered good hand and forearm function. A review of the literature revealed the rare occurrence of this disease (approximately 100 cases reported to date), which probably explains the wide variety of surgical proposals.
Abnormalities, Multiple↗
[Backpack and spinal disease: myth or reality?].
Back pain has become a real public health concern both for adults and children. In general, patients complain of moderate pain. While the topic was long ignored by the scientific community, the number of publications has increased over the last three Years. We reviewed the literature to separate real evidence from speculations. Recognized risk factors for spinal pain are: female gender, poor general status, family history of back pain, particular psychological patterns, time spent sitting watching television, history of spinal trauma, intense physical activity, practicing competition sports, and age (more frequent in adolescents than children). Several recent papers have drawn attention to the role of the weight of the school backpack in children, particularly when its weight exceeds 20% of the child's body weight. Many children carry heavy backpacks which for some may weigh 30% to 40% of their body weight. Several groups have estimated that the maximum should be 10% of the body weight. It appears that time spent carrying the backpack as well as its weight is an important factor favoring back pain. Backpacks can injury the head or face, as well as the hands, the elbow, the wrist, the shoulder, the foot and the ankle. Back trauma is observed as the sixth most common injury. The 'weak point' is the shoulder and not the back. A poorly positioned backpack can modify posture and gait. Carrying the backpack with two shoulder straps affects posture and gait less than carrying it on one shoulder. The posture of the spine changes when the weight of the backpack increases. This is probably one of the reasons why many parents who consult believe that there is a relationship between the weight of the backpack and scoliosis or kyphosis, observed in many of their children. It is proven that adolescents who suffer from back pain will probably have chronic back pain as adults, but there is not evidence to our knowledge demonstrating a relationship between the development of spinal deviation and the weight of the backpack. Recent studies have been conducted to design backpacks allowing a better weight distribution and comfort. This type of backpack appears to have a limited benefit. Furthermore, the question of mode must not be ignored for children and adolescents. Backpacks with one sack in front and one in back certainly provide better weight distribution but are they acceptable for children and adolescents?
Adolescent↗
[Aggressive aneurysmal bone cyst of the humerus in a child].
A 9-year-old child presented an aggressive aneurysmal bone cyst of the humerus. Despite multiple treatments (intracystic steroid injections, curettage, Ethibloc injection), the lesion continued to progress. Surgical treatment was undertaken at the age of 19 years and enabled total tumor resection associated with reconstruction with a vascularized fibular flap. Five years later, the patient was free of recurrence. The graft was well integrated and shoulder function was normal. We present the diagnostic difficulties encountered in this case and discuss the therapeutic options. Biopsy is indispensable before instituting treatment.
Bone Cysts, Aneurysmal↗
[Screening of congenital dislocation of the hip in the newborn. A systematic and rigorous clinical examination. A restricted use of imaging].
(1) Clinical examination of the hips should be systematically performed in the newborn, in order to detect a possible congenital dislocation. This translates into hip joint instability, which can be evidenced by both Ortolani's and Barlow's signs, the latter being more sensitive. Special attention should be paid for abduction range, as limited abduction is a warning sign. (2) Use of imaging, especially sonography will be restricted to specific cases only. It's prescription, technical realization as well as interpretation have to be carefully done, so that it is actually relevant to uncertain or "at risk" situations. (3) Treatment if needed, should be ideally managed by a paediatric orthopaedic surgeon.
Diagnosis, Differential↗
Detection of biogenic CO production above vascular cell cultures using a near-room-temperature QC-DFB laser.
We report the first application of pulsed, near-room-temperature quantum cascade laser technology to the continuous detection of biogenic CO production rates above viable cultures of vascular smooth muscle cells. A computer-controlled sequence of measurements over a 9-h period was obtained, resulting in a minimum detectable CO production of 20 ppb in a 1-m optical path above a standard cell-culture flask. Data-processing procedures for real-time monitoring of both biogenic and ambient atmospheric CO concentrations are described.
Air Conditioning↗
Laparoscopic treatment of an isolated gallbladder rupture following blunt abdominal trauma in a schoolboy rugby player.
Laparoscopic treatment of an isolated gallbladder rupture in a schoolboy rugby player resulting from blunt abdominal trauma has not previously been reported. A case report of this rare occurrence is presented together with a brief review of the literature.
Abdominal Injuries↗
[Scoliosis and congenital diaphragmatic agenesis].
PURPOSE OF THE STUDY: Diaphragmatic agenesis is the most extreme anatomic form of congenital diaphragmatic defects. Clinically this pathology is not different from posterolateral diaphragmatic hernia described by Bochdalek. We describe our observations of scoliosis in 16 neonates with diaphragmatic agenesis. MATERIAL AND METHODS: Between 1987 and 1996, 69 neonates underwent surgery for a congenital diaphragmatic hernia (CDH) at our institution. Sixteen of these patients had the most extreme form of CDH. Ten of these 16 patients survived. Spinal and/or chest wall deformities were observed in nine patients, including isolated scoliosis in two patients, scoliosis associated with a chest wall deformity in three, and isolated chest wall deformity (pectus excavatum or pectus carnium) in four. These deformities developed between 13 months and three and a half years of age (mean: two years). RESULTS: For two patients the deformity was mild (Cobb angle<15 degrees ) and required only observation. A Milwaukee brace was used in three patients that had severe kyphoscoliosis. Isolated chest wall deformities were treated with observation. No patient required operative treatment for these skeletal deformities. DISCUSSION: The preliminary results of this study indicate that chest wall deformities and scoliosis frequently occur during surgery for diaphragmatic agenesis. Nonoperative treatment is usually sufficient, however, follow-up of these patients until adulthood is recommended.
Abnormalities, Multiple↗
[Pigmented villonodular synovitis. Diffuse and localized forms in children].
UNLABELLED: Pigmented villonodular synovitis (PVS) is characterized by a locally aggressive synovial proliferation that engenders progressive destruction of cartilage and bone. Two cases, a diffuse and a localized form, are reported. CASE REPORT: 1) A 9.9-year-old boy followed up for a popliteal cyst presented with chronic arthritis of the left knee. Aspiration yielded a bloody synovial fluid. MRI showed a heterogeneous synovial process with decreased signal in both T1- and T2-weighted images. The diagnosis of PVS was made on histology of an excisional biopsy. A complete open synovectomy was then performed. 2) A 13.8-year-old boy had a palpable mass on the internal side of the right patellofemoral joint. MRI showed a heterogenous mass with areas of hypointensity on all spin echo sequences corresponding to hemosiderin deposits suggestive of PVS. Surgical excision of a reddish-brown circumscribed lesion was performed. Diagnosis of PVS was made at surgery and confirmed by histologic examination. CONCLUSION: PVS diagnosis is frequently delayed due to nonspecific symptoms. Bloody fluid aspiration and MRI are valuable tools for early diagnosis. Treatment is surgical: extensive synovectomy for the diffuse form, excision of the lesion for the localized form.
Adolescent↗
[Long term results in treatment of residual hip dysplasia by Salter osteotomy (study of 31 cases)].
Thirty-five hips (31 children, operated between 1971 and 1982) were reviewed after skeletal maturity with a mean follow-up of 12 years. The 31 children had been treated initially by closed reduction of the hip using the Somerville-Petit method (mean age: 18 months), and subsequently by innominate osteotomy (mean age: 4 years) to correct a residual dysplasia which was graded upon the VCE angle, and Severin and McFarland's classifications. There were 88% good results; however only 51% of hips were classified Severin Ia and McFarland 1. In this study, the authors tried to assess the long term efficacy of the innominate osteotomy and to determine the optimal time to perform it. They discuss the limits of indications for innominate osteotomy, which could be excessive if spontaneous improvement may be expected to occur. Age and radiological findings are good indicators.
Adolescent↗
Successful treatment of Mycobacterium fortuitum prosthetic valve endocarditis: case report.
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Adult↗
[Surgical treatment of hallux valgus in children and adolescents: 46 cases treated with the Mitchell technique].
PURPOSE OF THE STUDY: The aim of this study is to discuss special features of hallux valgus in children and assess place of a surgical procedure in some patients. MATERIAL AND METHOD: A retrospective study of 40 children (46 feet) operated for hallux valgus was conducted. An etiology was identified in 10 per cent of cases and 90 per cent were considered as idiopathic. From a clinical and radiological analysis of 46 feet, we describe the anatomical particularities and the indications of the surgical treatment. The Mitchell's technique is described in detail. The correction of the metatarsal varus and the metatarsophalangial valgus was obtained without breaking off the growth plate of the first metatarsus. RESULTS: Clinically, results were satisfactory in 84 per cent of the cases. Radiologically, results were excellents in 45 per cent and good in 35 per cent. DISCUSSION AND CONCLUSION: Hallux valgus in the child is often underestimated; operative treatment should be proposed in some patients. Mitchell's technique gives good results with an early and simply correction.
Adolescent↗
[Pseudotumoral subacute osteomyelitis: a series of 41 children].
PURPOSE OF THE STUDY: To confirm that subacute osteomyelitis in children is a real entity, and give the main characteristics of this disease MATERIAL AND METHODS: We reviewed 41 cases as well as the litterature. RESULTS: Pain without fever was the only constant symptom. The erythrocyte sedimentation rate was increased slightly. XRays were the most important investigation, showing a geode in the metaphysis or more rarely in the epiphysis evoking a benign bone tumor in a child. DISCUSSION: The treatment was most often surgical: scraping permits the isolation of the microbe in 50 per cent of cases (staphylococcus most often) and usualy leady to recovery. CONCLUSION: This form of osteomyelitis is relatively frequent and must be discussed in front of a cystic tumoral image of the child's long bone.
Adolescent↗
[Conservative surgical treatment of osteogenic sarcoma of the limb in children and adolescents].
PURPOSE OF THE STUDY: Advances in chemotherapy protocols over the last 20 years have considerably improved the prognosis and functional outcome in patients with osteogenic sarcoma. We report here the results of a cooperative study conducted under the auspices of the French Society of Pediatric Oncology (SFOP). Twenty-nine oncology centers participated in this retrospective national multicentric study. MATERIALS AND METHODS: The study included 153 patients with osteogenic sarcoma of the limb who were treated by the OS87 protocol with conservative surgery between 1987 and 1994. The OS87 protocol consisted in conservative or non-conservative surgery combined with pre- and postoperative chemotherapy. The following inclusion criteria were used: age under 20 years, tumor localization in a limb (pelvis and spine excluded), no metastasis at diagnosis, biopsy proven osteogenic sarcoma. RESULTS: Mean age at diagnosis was 13 years. The knee localization predominated (80 p. 100). 82.5 p. 100 of the patients had grade IIB disease (Enneking classification). For the 187 patients included in the protocol surgery was non-conservative in 20 p. 100 of the cases and conservative in 80 p. 100. The choice of the surgical technique (arthroplasty, allograft, autograft, resection without reconstruction) depended on the patient's age and school situation. Data analyzed here concerned only those patients who had conservative treatment. Mean follow-up was 64 months. The actuarial survival curve plateaued at 71 p. 100 at more than 6 years. Early and late complications were numerous and variable (mechanical, infectious, local recurrence). Secondary amputation was required in 10 p. 100 of the patients. The overall functional outcome of the preserved limbs was nevertheless good with rapid restoration of self-sufficiency despite major surgery and a high number of reoperations (about 65 p. 100 of cases). DISCUSSION: In light of the frequency and the seriousness of the complications, these results are modest. Patients and family should be advised of the risk, particularly the risk of secondary amputation which may be required early due to contaminated excision or at mid term due to major non-cancerological complications. As survival has been improved, functional capacity must be preserved for several years. This orients surgery towards more "biological" reconstruction which can provide greater longevity than arthroplasty.
Adolescent↗
[The limping child. Diagnostic trends].
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Adolescent↗