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Biomedical subjects

J P Damsin

Publications and source records attributed to J P Damsin.

At least 19 recordsLinked to original sources
PubMed2000

Upper limb lengthening.

Congenital deficiencies and developmental deformities of the upper extremity often result in complex deformities that include, to variable degrees, shortening and angulation. Because of the nonweight-bearing status of the upper extremity, these deformities are better tolerated and often of less functional significance than their counterparts in the lower extremity. The need for lengthening therefore is less common in the upper extremity than in the lower extremity. When planning a lengthening procedure to the upper limb, the surgeon must be aware of some specific indications, goals, and complications. In the final analysis, one must weigh the risk of upper limb lengthening against the benefits. In fact, there are many pitfalls, and it is not a surgery to be undertaken lightly. In the hands of experienced specialists, it can achieve excellent results. The potential complication rate is high initially, but tends to diminish with increasing experience. The authors believe that the functional, cosmetic, and psychological benefits of upper limb lengthening outweigh the risk of permanent sequelae and functional impairment in selected patients.

Bone Lengthening↗
PubMed1997

Scoliosis and fused ribs. A case report.

STUDY DESIGN: This case report illustrates a scoliotic patient with congenital fusion of several ribs associated with a thoracic curvature. OBJECTIVES: To report the procedure used to correct scoliosis in association with congenitally fused ribs. SUMMARY OF BACKGROUND DATA: All cases of congenitally fused ribs reported in the literature are associated with malformed vertebrae. For this reason, the only proposed treatment for patients with progressive scoliosis is a spinal fusion. This report presents the first case of progressive scoliosis associated with fused ribs, but without vertebral malformation, that was managed by resection of these ribs. METHODS: When worsening of the thoracic scoliosis was observed from 30 degrees at 13 months to 44 degrees at 4 years, the three fused ribs were resected en bloc. No spinal fusion was performed. The spine was held in correction by a localizer cast for 3 months. RESULTS: Fourteen years after treatment, the spine is almost normal; thoracic and lumbar curves are 10 degrees. CONCLUSIONS: When malformed fused ribs are on the concave side of a progressive scoliosis with no vertebral malformation at the same level, resection of these ribs is probably an efficient and sufficient method of treatment.

Humans↗
PubMed1997

Evolution of the angle of obliquity of the femoral diaphysis during growth--correlations.

Numerous studies of the bicondylar angle of the adult femur have been carried out in human anatomy, paleoanthropology and primatology. The aim of this paper is to study the evolution of this angle in relation to age and acquisition of walking in young children. Seventy-seven radiographs of children, ranging from 5 months to 17 years postnatally, and of four dead newborn were analysed. The measurements concern the bicondylar angle (A.O.F.), the collo-diaphyseal angle (A.C.D.), the length of the femoral neck (L.N.) and of the femur (L.F.) and the interacetabular distance (D.I.A.). Some children were x-rayed at different ages, which permits a longitudinal as well cross-sectional study. The results show that there is no sexual dimorphism and that the increase in the angle is closely related to the age of the child. The bicondylar angle starts at 0 degree at birth and then increases progressively with growth to reach adult values of at least 6 degrees-8 degrees between 4 and 8 years postnatally. In adults, the mean values are between 8 degrees and 11 degrees and the maximum range is between 6 degrees and 14 degrees. The obliquity angle corresponds to an angular remodeling of the femoral diaphysis, which is independent of the growth and shape of the distal femoral epiphysis. The tibio-femoral angle measures the evolution of a physiologic phenomenon, from the load "in varus" to the load "in valgus" of the lower limb. It is linked with the bicondylar angle but is different from it.

Adolescent↗
PubMed1996

[Contralateral preventive screwing in proximal femoral epiphysiolysis].

PURPOSE: The incidence of bilaterality in slipped capital femoral epiphysis (SCFE) ranges, in the literature, from 19 per cent to 80 per cent. The role of contralateral pinning is to prevent late slipping of the femoral epiphysis and its complications. The purpose of this study is to assess the usefulness of routine preventive contralateral pinning in SCFE, and to evaluate its complications. MATERIAL AND METHODS: We reviewed retrospectively 74 consecutive patients treated for unilateral SCFE by associated routine preventive contralateral pinning. The age at surgery ranged from 10 years and 6 months to 16 years and 10 months. The osteosynthesis was achieved by a single cannulated holothreaded screw with a cross grooved head, with or without the use of washers. RESULTS: An accidental pin penetration was noted in 4 cases. The epiphyseal position of the screw was satisfactory in 56 cases. The patient was allowed to walk the second or third day after surgery with the use of crutches. All our patients were reviewed after the end of squeletal growth. The follow-up ranged from 2 to 12 years and 8 months. The age at which the patient was last seen ranged from 15 years and 7 months to 27 years. Two major complications were noted: a femoral fracture at the level of the screw penetration in one case, and secondary slipping of the epiphysis after premature removal of the screw in two cases. The removal of the screw was considered to be very difficult in 10 cases. A relative overgrowth of the greater trochanter was noted in 8 cases, and was of no clinical significance. No infection was noted. At last follow-up, the shape of the femoral head and the function of the hip were normal in all cases except for one hip where severe coxa vara developed because of a secondary slip after premature removal of the screw. DISCUSSION: There is a lot of controversy about the real necessity of routine preventive contralateral osteosynthesis in SCFE. In our experience this surgery succeeded in reducing the incidence of secondary contralateral slipping. The two cases in our series could have been prevented by an accurate timing of screw removal. The complications of this procedure are rare, and it could be done during the same operative time as the SCFE side's. The only case of femoral fracture was secondary to a violent car accident. CONCLUSION: The routine prophylactic controlateral osteosyntheis in SCFE, using a single screw is a safe procedure and allows to reduce the incidence of bilaterality.

Adolescent↗
PubMed1996

[Contribution of Ilizarov's equipment in the treatment of congenital pseudarthrosis of the lower limb].

INTRODUCTION: Risks and benefits of using Ilizarov apparatus in the treatment of congenital tibial or fibular pseudarthrosis (CTFP) are presented in this retrospective study. MATERIALS AND METHODS: We reviewed with an average follow-up of 3 years and 4 months, the outcome of twenty consecutive patients treated between 1985 and 1993, for a CTFP using the Ilizarov apparatus. Sixteen patients were treated for non union of both tibia and fibula, 1 patient for an isolated non union of the fibula, and 3 patients for correction of a previously treated, malunited pseudarthrosis. The apparatus was used in four different ways: Realignement, end to end compression, and leg lengthening in 14 cases, Simple external fixation in association with another method of treatment in 2 cases, Progressive correction of malunion in 3 cases, Progressive diaphyseal reconstruction in 1 case (fibula). RESULTS: The mean fixation duration was 7.3 months. Union was achieved with the initial treatment in 11 out of 20 cases (including the 3 cases of malunion correction). Bone grafting was used in 7 out of the 9 remaining cases, and led to bone healing in 3 of them. Five complications were encountered: deep infection in 1 case, repeated stress fracture in 1 case, repeated fracture of the pins in 1 case, malunion in 6 cases, and less than 3 cm leg length discrepancy in 4 cases. DISCUSSION: Ilizarov external fixator is an efficient solution for many cases of CTFP, in which healing did not occur with other methods of treatment. The best indication for its use are the normotrophic and the hypertrophic types of non union (Apoil II), after the age of 4 or 5. Secondary massive bone grafting is to be considered in some cases, since it can either achieve bone union or strengthen it. The major disadvantage of this method is the lack of excision of the dystrophic tissue at the non union site. So, even after the non union is healed, the bone remains dystrophic and fragile, and necessitates a permanente protective orthosis, until the end of bone growth.

Adolescent↗
PubMed1996

Treatment of severe flexion deformity of the knee in children and adolescents using the Ilizarov technique.

We have used the Ilizarov technique for severe flexion deformity of the knee in 11 patients (13 knees) between 1986 and 1994 and have followed them up for an average of 4.1 years. The age of the patients at operation ranged from 1.7 to 18.8 years. The femoral and tibial components were connected by two anterior hinges, medial and lateral, and two posterior distraction rods. The deformity was corrected to a femorotibial lateral shaft angle of less than 20 degrees. A permanent orthosis was applied after removal of the fixator. Fractures occurred in four patients and paralysis of the common peroneal nerve in another. There was a recurrence of the deformity in four patients. At the last review all patients were able to walk on their operated leg with or without an orthosis. We have found the Ilizarov method to be helpful in correcting severe fixed flexion deformity of the knee, with relatively few complications, but the basic principles of the method must be carefully followed.

Adolescent↗
PubMed1995

Study of the arterial vascularisation of the medial tibial condyle in the fetus.

Varus deformity of the knee is common in young children who have suffered from fulminating purpura. This study was directed at the anatomic features of the vascularisation of the upper end of the tibia that might account for such deformation. It was based on the dissection of 28 anatomic specimens prepared by injection of Indian ink into the vascular trunk. 16 specimens were diaphanised for better analysis of the intracartilaginous distribution of the vessels. The study showed that the vascularisation of the medial condyle of the tibia is poor and of terminal nature, which may explain the occurrence of ischemic growth disorders following fulminating purpura.

Femoral Artery↗
PubMed1994

[Treatment of limb deformities by the Ilizarov method].

INTRODUCTION: The numerous possibilities for adapting the Ilizarov apparatus allows the progressive correction of complex angular deviations, for which flat apparatus are sometimes difficult to adapt and this report describes our experience using the Ilizarov apparatus to treat axial limb deformities. MATERIAL AND METHODS: A total of 48 patients (22 girls and 26 boys aged between 2 and 18 years-old) suffering from 58 angular deformities were treated with an Ilizarov device. 40 of the deformities involved bones: 22 tibias, 13 femurs and 6 radius. The remaining 18 deformities involved joints, (17 knees and 1 elbow), 12 were total ankylosis and 6 were flexion contractures. 31 of the cases involved an isolated deformity (16 bones and 16 joints) and 27 were associated with other orthopedic problems. The cause of the deformities were either malformation or infection in most cases. In 39 cases the angular deformities were deviations in a single plane: 13 in two planes and 6 déformities were complex, involving deviation in all three planes. Correction was progressive in 49 cases and immediate in 9 cases. Unequal limb length was treated in 21 cases: 19 of these were caused by bone deformity. The apparatus should cover the entire bone segment to be corrected, from metaphysis to metaphysis. When the deformity is close to a joint, the joint should be bridged so as to stabilize the brace. The fastening of the sides of the deformity involves a maximum of three pins in two different planes. The apparatus must be absolutely rigid so as to avoid any lateral slipping or any movement of the rings relative to the segments of the limbs. The two parts of the apparatus fixed on either side of the deformity should be linked by two groups of three threaded rods with articulations at the ends. When the correction is in a single plane, it is effected around the axis formed by two threaded rods at the point of the deformity. When the deformity is major, 90 degrees or more, the rings tend to shift under the strain, and this leads to a loss of correction and cutaneous problems on the concave face. This may be avoided by fixing threaded rods to the ring, perpendicular to the plane of the deformity. For knee flexion contractures, the rods should be connected to the ring where it crosses the frontal plane passing through the femoral diaphysis. RESULTS: 48 angular deviations were completely corrected. In 10 cases the deformity persisted, but was less than 20 degrees. The deformity reoccurred in 6 of the children: in 3 cases due to the persistence of muscular imbalance, in two cases by assymetric growth, in the other case by plastic deformation on the insufficiently mineralized regenerated bone tissue formed during lengthening. In one case, the common, motor and sensor peroneal nerve was paralyzed, complicating the correction of an anterior dislocation of the knee. The paralysis occurred at the end of the correction and recovery began after 6 months. One 10 year old child, suffering from nail patela syndrome, was left with a completely immobilized elbow after treatment of a webbed, 100 degrees flexion contracture. A total of 9 epiphyseal separations (Salter I type) occurred during the correction of severe deformities, with little or no displacement, all occurred around the knee. These epiphyseal separations did not interfere with the treatment of the angular deviations in three cases, however, advantage was taken of these events to effect the intended lengthening of the bone. DISCUSSION: The Ilizarov method for correcting joint ankylosis is difficult to perform, and depends on a detailed knowledge of the apparatus and braceing system, and requires rigourous installation of the pins, ring, joints and rods. Whatever the position of the two rings in relation to each other, it is always possible to link them by a system which can be adjusted. This is not possible with other external braces which have only a single plane.

Adolescent↗
PubMed1993

Lumbosacral agenesis. Three cases of reconstruction using Cotrel-Dubousset or L-rod instrumentation.

Three patients with lumbosacral agenesis underwent surgery to lock the lumbopelvic instability. All three patients had an unstable sitting position and a kyphotic bearing that impaired intestinal transit or hampered further colostomy or ureterostomy. Luque instrumentation with iliac fixation performed according to Galveston was used in one patient. Cotrel-Dubousset instrumentation was used for the two other patients. Autografts plus allografts provided sufficient bone for fusion without requiring lower leg amputations. Increased hip flexion was obtained after pelvic stabilization, but knee flexion contracture remained the same. All patients showed improved intestinal transit or decreased urinary infections, and two patients attained a stable sitting position without aid.

Adolescent↗
PubMed1992

Arterial supply of the acetabulum in the fetus: application to periacetabular surgery in childhood.

The need to perform triple osteotomies of the pelvis passing very close to the articular surface leads to the isolation of bony fragments whose vascularisation may be precarious. To assess the risks of such surgery, we undertook an anatomic study of the vascularisation of the acetabulum in the fetus. 53 specimens were injected to study the vessels to the acetabulum and their distribution within the osteocartilaginous specimen. The acetabular a., a branch of the obturator a., gives a central pedicle distributed to the acetabular fossa, the triradiate cartilage and ending in the three primary bony components. The superior gluteal, inferior gluteal, internal pudendal and obturator aa. form a periacetabular vascular circle. The abundant vascularity of the acetabulum makes massive necrosis improbable in the child. However, there is a zone of precarious anastomosis at the anterior portion of the acetabulum.

Acetabulum↗
PubMed1992

[Spinal deformities in Marfan disease].

Spinal deformities are frequent in Marfan's disease. 37 patients were examined at the average age of 11 years. 32 showed a spinal deformity. The treatment of the spinal deformity was a brace in 15 cases, surgery in 16 cases (including 5 cases after brace-failure). 7 cases were just followed-up without treatment. Bracing was efficient only for mild curves, this treatment was satisfying 4 times out of 11 with adequate follow-up. The surgical treatment in 16 cases was a posterior fusion twice associated with anterior fusion. We used the same technique as for idiopathic scoliosis with Harrington instrumentation 5 times, Harrington with sublaminar wires 4 times and Cotrel-Dubousset instrumentation 7 times. The correction of scoliosis was achieved in 48.2 per cent. The use of segmental instrumentation compared with the use of the Harrington instrumentation can explain the small number of non unions and the improvement of the lateral spinal balance. We did not note any cardiovascular complication during or early after the operation. Aortic lesions were responsible of one death in the long term, three patients went through a surgical replacement of aortic valves or the aorta.

Adolescent↗
PubMed1991

[Hip pain in children].

When lameness is discovered in a child minutious investigations must be started in search of its cause. The first step in these investigations is to determine the exact location of the pain and to exclude all causes of lameness unrelated to the hip. In difficult cases, radioisotope scanning locates the pathological area. These points being acquired, the second step is to find whether the lesion is infectious, dystrophic, inflammatory, tumoral or traumatic. Usually, the investigations rapidly give a clue: transient discomfort, negative radiological results and clinical normalization indicate "growth pain". Transient acute synovitis is the most frequent of true lesions of the hip, followed by infectious arthritis and primary osteochondritis.

Child↗
PubMed1991

[Current surgical therapy of congenital clubfoot].

The operative treatment of congenital club foot deformity in childhood consists of a release of soft tissues which are retracted in fibrous "knots" at the hindfoot and midtarsus. This release is more or less extensive, depending on the importance of the contracture and allows reduction of the triple deformity i.e. varus and equinus of the hindfoot and adduction at the midtarsus. Surgery is performed preferably before walking commences in order to take advantage of the functional self-treatment by bearing weight after removal of the cast. During the last several years, the different operative procedures employed for release have gained in precision and efficiency by addressing the deformity at their precise location. The difficult aim of the surgical procedure is to avoid insufficient release causing pseudo-recurrencies or overcorrection.

Clubfoot↗
PubMed1991

[A technical modification of the use of Dwyer's equipment].

Dwyer's technique for correction and anterior fusion of the spine was improved by using lockers at the level of each screw. So, like with the Zielke's technic this procedure allowed a global progressive and controllable correction and a real derotation of the spine.

Humans↗