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Jeantet RE, Violas P, Maximen J, Labarre C, Gauzy JSD, Accabled F, Lascombe P, Lefevre Y, Gouron R, Billy BD, Docquier PL, Laquièvre A, Courvoisier A, Corsier R, Fron D, Haumont T, Launay F, Cottalorda J, Hamel A, Journeau P, Mascard E, Ilharreborde B, Aslan M, Odent T, Gaumetou E. Surgical management of proximal femoral unicameral bone cyst in children. Bone Joint J 2024; 106-B:508-514. [PMID: 38688504 DOI: 10.1302/0301-620x.106b5.bjj-2023-0577.r4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims The aim of this study is to evaluate the surgical treatment with the best healing rate for patients with proximal femoral unicameral bone cysts (UBCs) after initial surgery, and to determine which procedure has the lowest adverse event burden during follow-up. Methods This multicentre retrospective study was conducted in 20 tertiary paediatric hospitals in France, Belgium, and Switzerland, and included patients aged < 16 years admitted for UBC treatment in the proximal femur from January 1995 to December 2017. UBCs were divided into seven groups based on the index treatment, which included elastic stable intramedullary nail (ESIN) insertion with or without percutaneous injection or grafting, percutaneous injection alone, curettage and grafting alone, and insertion of other orthopaedic hardware with or without curettage. Results A total of 201 patients were included in the study. The mean age at diagnosis was 8.7 years (SD 3.9); 77% (n = 156) were male. The mean follow-up was 9.4 years (SD 3.9). ESIN insertion without complementary procedure had a 67% UBC healing rate after the first operation (vs 30% with percutaneous injection alone (p = 0.027), 43% with curettage and grafting (p = 0.064), and 21% with insertion of other hardware combined with curettage (p < 0.001) or 36% alone (p = 0.014)). ESIN insertion with percutaneous injection presented a 79% healing rate, higher than percutaneous injection alone (p = 0.017), curettage and grafting (p = 0.028), and insertion of other hardware combined with curettage (p < 0.001) or alone (p = 0.014). Patients who underwent ESIN insertion with curettage had a 53% healing rate, higher than insertion of other hardware combined with curettage (p = 0.009). The overall rate of postoperative complications was 25% and did not differ between groups (p = 0.228). A total of 32 limb length discrepancies were identified. Conclusion ESIN insertion, either alone or combined with percutaneous injection or curettage and grafting, may offer higher healing rates than other operative procedures. Limb length discrepancy remains a major concern, and might be partly explained by the cyst's location and the consequence of surgery. Therefore, providing information about this risk is crucial.
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Affiliation(s)
| | - Philippe Violas
- Department of Pediatric Orthopedic Surgery, Rennes University Hospital, Rennes, France
| | - Julien Maximen
- Department of Pediatric Orthopedic Surgery, Rennes University Hospital, Rennes, France
| | | | | | | | | | - Yan Lefevre
- Hôpital des enfants, CHU Bordeaux, Bordeaux, France
| | - Richard Gouron
- CHU Amiens Picardie, Site SUD, CHU Amiens-Picardie, Amiens, France
| | | | | | | | | | | | | | | | - Franck Launay
- CHU MARSEILLE, Hôpital Timone Enfants, Marseille, France
| | | | - Antoine Hamel
- CHU NANTES, Hôpital mère-enfant pédiatrie, Nantes, France
| | - Pierre Journeau
- CHRU Nancy, Hôpitaux de Brabois, Vandoeuvre-les-Nancy, France
| | | | | | - Madeleine Aslan
- CHU ST ETIENNE - Hôpital Nord, Chirurgie pédiatrique, St Etienne, France
| | | | - Elodie Gaumetou
- CH Villeneuve Saint Georges, Villeneuve-Saint-Georges, France
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Gaumetou E, Mihluedo-Agbolan KA, Souchet AS, Maupain O. Low-Back Pain Revealing an Abdominal Aortic Aneurysm in a 15-Year-Old Girl: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00022. [PMID: 33599466 DOI: 10.2106/jbjs.cc.20.00240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
CASE An abdominal aortic aneurysm is rarely seen in children. We report the case of a 15-year-old girl who presented with lower back pain in a subfebrile setting with moderate biological inflammatory syndrome. Imaging assessment, including a spinal magnetic resonance imaging, had shown no evidence of spondylodiscitis or other spinal or renal pathology. Ten days later, she presented in hemorrhagic shock and was found to have a ruptured infected aneurysm of the abdominal aorta. CONCLUSIONS This case reminds us to include an aneurysm in the differential diagnosis of lower back pain, even in children.
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Affiliation(s)
- Elodie Gaumetou
- Service de Chirurgie pédiatrique du CHI Villeneuve Saint-Georges, Villeneuve-Saint-Georges, France
| | | | - Anne S Souchet
- Service de Chirurgie orthopédique des Cliniques universitaires Saint Luc, Bruxelles, Belgique
| | - Olivier Maupain
- Anesthésiste réanimateur, Hôpital Privé Claude Galien, Quincy sous Sénart, France
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Rampal V, Rohan PY, Assi A, Ghanem I, Rosello O, Simon AL, Gaumetou E, Merzoug V, Skalli W, Wicart P. Lower-limb lengths and angles in children older than six years: Reliability and reference values by EOS ® stereoradiography. Orthop Traumatol Surg Res 2018; 104:389-395. [PMID: 29122688 DOI: 10.1016/j.otsr.2017.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 09/20/2017] [Accepted: 10/09/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lower-limb alignment in children is classically assessed clinically or based on conventional radiography, which is associated with projection bias. Low-dose biplanar radiography was described recently as an alternative to conventional imaging. The primary objective of this study was to assess the reliability of length and angle values inferred from 3D reconstructions in children seen in everyday practice. The secondary objective was to obtain reference values for goniometry parameters in children. HYPOTHESIS 3D reconstructions can be used to assess the lower limbs in children. MATERIAL AND METHODS The paediatric reliability study was done in 18 volunteers who were divided into three groups based on whether they were typically developing (TD) children, had skeletal development abnormalities, or had cerebral palsy. The reference data were obtained in 129 TD children. Each study participant underwent biplanar radiography with 3D reconstruction performed by experts and radiology technicians. Goniometry parameters were computed automatically. Reproducibility was assessed based on the intra-class coefficient (ICC) and the ISO 5725 standard (standard deviation of reproducibility, SDR). RESULTS For length parameters, the ICCs ranged from 0.94 to 1.00 and the SDR from 2.1 to 3.5mm. For angle parameters, the ICC and SDR ranges were 0.60-0.95 and 0.9°-4.6°, respectively. No significant differences were found across experts or radiology technicians. Age-specific reference data are reported. DISCUSSION These findings confirm the reliability of low-dose biplanar radiography for assessing lower-limb parameters in children seen in clinical practice. In addition, the study provides reference data for commonly measured parameters. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- V Rampal
- Institut de biomécanique humaine Georges-Charpak, arts et métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France; Service d'orthopédie pédiatrique, hôpitaux pédiatriques de Nice, CHU Lenval, 57, avenue de la Californie, 06000 Nice, France.
| | - P-Y Rohan
- Institut de biomécanique humaine Georges-Charpak, arts et métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - A Assi
- Laboratoire de biomécanique, faculté de médecine, université de Saint-Joseph, Beyrouth, Lebanon
| | - I Ghanem
- Laboratoire de biomécanique, faculté de médecine, université de Saint-Joseph, Beyrouth, Lebanon
| | - O Rosello
- Service d'orthopédie pédiatrique, hôpitaux pédiatriques de Nice, CHU Lenval, 57, avenue de la Californie, 06000 Nice, France
| | - A-L Simon
- Service d'orthopédie pédiatrique, hôpital Robert-Debré, 48, boulevard Serurier, 75019 Paris, France
| | - E Gaumetou
- Service d'orthopédie pédiatrique, hôpital Robert-Debré, 48, boulevard Serurier, 75019 Paris, France
| | - V Merzoug
- Service de radiologie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Hôpital Bicètre, 78, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France
| | - W Skalli
- Institut de biomécanique humaine Georges-Charpak, arts et métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - P Wicart
- Service d'orthopédie pédiatrique, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
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Bauer T, Gaumetou E, Klouche S, Hardy P, Maffulli N. Metatarsalgia and Morton's Disease: Comparison of Outcomes Between Open Procedure and Neurectomy Versus Percutaneous Metatarsal Osteotomies and Ligament Release With a Minimum of 2 Years of Follow-Up. J Foot Ankle Surg 2014; 54:373-7. [PMID: 25481724 DOI: 10.1053/j.jfas.2014.08.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Indexed: 02/03/2023]
Abstract
The present study compared the clinical results of open neurectomy versus a percutaneous procedure for Morton's disease. This was a retrospective study comparing the functional results after 2 surgical procedures: open neurectomy and a percutaneous procedure (with deep transverse metatarsal ligament release and distal metatarsal osteotomies). The present study included 52 patients (26 in each group), and the mean follow-up period was 4 (range 2 to 7) years. The patient evaluation criteria included the presence of painful symptoms of Morton's disease, American Orthopaedic Foot and Ankle Society (AOFAS) functional scale score, patient satisfaction, and delay for recovery. Percutaneous treatment of Morton's disease and open neurectomy produced complete relief of pain in 25 of 26 patients in each group. At the latest follow-up visit, the mean AOFAS score had significantly improved from 36 ± 11 preoperatively to a mean of 89 ± 18 (p < .001). After 2 years, the functional improvement obtained with the percutaneous procedure persisted, with a stable AOFAS score (96 ± 10). Persistent metatarsalgia was reported by patients who had undergone open neurectomy, with a significantly decreased AOFAS score (81 ± 21, p = .009). The percutaneous procedure for Morton's disease provided excellent functional outcomes (AOFAS score >90) significantly more often with a shorter delay than after open neurectomy (p = .03). At the latest follow-up visit, metatarsalgia due to plantar hyperpressure or bursitis and requiring plantar orthotics was present in 11 of 26 patients (44%) after open neurectomy and in 1 of 26 patients (4%) after the percutaneous procedure (p = .002). Percutaneous treatment of Morton's disease is a reliable procedure providing results as good as those after open neurectomy, with significantly better outcomes in the longer term and a lower rate of late metatarsalgia.
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Affiliation(s)
- Thomas Bauer
- Department of Orthopaedic Surgery, Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, Boulogne-Billancourt, France.
| | - Elodie Gaumetou
- Department of Orthopaedic Surgery, Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, Boulogne-Billancourt, France
| | - Shahnaz Klouche
- Department of Orthopaedic Surgery, Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, Boulogne-Billancourt, France
| | - Philippe Hardy
- Department of Orthopaedic Surgery, Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, Boulogne-Billancourt, France; Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, London, UK
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Lorrot M, Doit C, Vitoux C, Koehl B, Gaumetou E, Alison M, Sebag G, Faye A, Mazda K, Bonacorsi S, Ilharreborde B. Antibiothérapie des infections ostéo-articulaires de l’enfant. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Desprairies C, Benkerrou M, Imbard A, Pichard S, Lorrot M, Gaumetou E, Melki I, Pharaon I, Sauvé Martin H, Holvoet L, Ithier G, Missud F, Benoist J, Schiff M. SFP CO-07 - Trop de MEOPA : pas si hilarant. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71920-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ilharreborde B, Gaumetou E, Souchet P, Fitoussi F, Presedo A, Penneçot GF, Mazda K. Efficacy and late complications of percutaneous epiphysiodesis with transphyseal screws. ACTA ACUST UNITED AC 2012; 94:270-5. [DOI: 10.1302/0301-620x.94b2.27470] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Percutaneous epiphysiodesis using transphyseal screws (PETS) has been developed for the treatment of lower limb discrepancies with the aim of replacing traditional open procedures. The goal of this study was to evaluate its efficacy and safety at skeletal maturity. A total of 45 consecutive patients with a mean skeletal age of 12.7 years (8.5 to 15) were included and followed until maturity. The mean efficacy of the femoral epiphysiodesis was 35% (14% to 87%) at six months and 66% (21% to 100%) at maturity. The mean efficacy of the tibial epiphysiodesis was 46% (18% to 73%) at six months and 66% (25% to 100%) at maturity. In both groups of patients the under-correction was significantly reduced between six months post-operatively and skeletal maturity. The overall rate of revision was 18% (eight patients), and seven of these revisions (87.5%) involved the tibia. This series showed that use of the PETS technique in the femur was safe, but that its use in the tibia was associated with a significant rate of complications, including a valgus deformity in nine patients (20%), leading us to abandon it in the tibia. The arrest of growth was delayed and the final loss of growth at maturity was only 66% of that predicted pre-operatively. This should be taken into account in the pre-operative planning.
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Affiliation(s)
- B. Ilharreborde
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
| | - E. Gaumetou
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
| | - P. Souchet
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
| | - F. Fitoussi
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
| | - A. Presedo
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
| | - G. F. Penneçot
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
| | - K. Mazda
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
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Gaumetou E, Zilber S, Hernigou P. Non-simultaneous bilateral hip fracture: epidemiologic study of 241 hip fractures. Orthop Traumatol Surg Res 2011; 97:22-7. [PMID: 21239241 DOI: 10.1016/j.otsr.2010.07.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 07/07/2010] [Accepted: 07/21/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hip fractures are an important public health problem given their growing incidence as well as their functional and vital repercussions. With longer survival, patients with a contralateral fracture are increasingly numerous. The objective of this study was to investigate the bilateralization of hip fractures in terms of anatomic location and time to the second fracture. HYPOTHESIS Contralateral fractures are of the same anatomical type as the primary fractures. PATIENTS AND METHODS This was a retrospective epidemiological study on all patients managed for hip fractures between January 2007 and May 2008. Each case of bilateralization was studied. RESULTS We included 241 patients in the study. The mean age at occurrence of the primary fracture was 83.3 years (range, 60-99 years). The distribution showed 45.6% true femoral neck fractures and 54.4% trochanteric fractures. Twenty-six of the 241 patients had already suffered from a hip fracture (10.8%). This fracture was the same type as the recent fracture in 80.8% of the cases. The mean time between the two fractures was 5.6 years (range, 1-277 months). DISCUSSION The contralateral fractures were the same anatomical type as the primary fracture in eight out of ten patients and the symmetry remains intact in 64-83% depending on the series. The fracture occurred on average within 5 years of the first hip fracture. In cases of asymmetry, the second fracture was more often a trochanteric fracture. The causes explaining this symmetry are several and are poorly known. The risk factors are numerous and their prevention is essential (acting on the patient's environment to prevent falls, rehabilitation to reestablish autonomy after the first fracture, and preventive treatment of osteoporosis), although these notions are often ignored by surgeons. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- E Gaumetou
- Department of Orthopaedic Surgery and Traumatology, Henri-Mondor Hospital, Créteil School of Medicine, Paris XII University, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Creteil cedex, France
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