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J P Padovani

Publications and source records attributed to J P Padovani.

At least 19 recordsLinked to original sources
PubMed2005

[Avulsion fracture of the tibial tubercle in adolescents: 22 cases and review of the literature].

PURPOSE OF THE STUDY: Fracture of the anterior tibial tubercle is exceptional in adolescents. The purpose of this work was to better understand the circumstances of such fractures, identify potential complications, and assess outcome of different therapeutic options. MATERIAL AND METHOD: This was a retrospective analysis of a consecutive series of 22 children with avulsion fracture of the anterior tibial tubercle. The circumstances of the fracture were noted. The Ogden classification was used to establish the radiological type. Associated lesions were also noted as were any complications. Two types of treatment were given: orthopedic or surgical (several types). The functional outcome was assessed at last follow-up. RESULTS: Mean age at fracture of the anterior tibial tubercle was 13 years (range 12-16) in 14 boys and 7 girls. It occurred after a jump or reception after a jump in 22 of the children. Five patients presented symptomatic homo- or contralateral anterior tibial apophysitis before the accident. The fracture was not displaced (type IA) in ten patients and was treated orthopedically. In twelve patients, the fracture was displaced (type IB, II, or III) and required osteosynthesis. Immobilization was maintained for four weeks on average (range 3-7). Associated lesions were observed in half of the twelve displaced fractures, with five cases of patellar ligament avulsion and three cases of meniscal injury. There were no complications with type IA fractures. For the twelve displaced fractures, complications were observed in seven children: hematoma (n = 2), infrapatellar hypoesthesia (n = 2), complete rupture of the patellar ligament 38 months after surgery (n = 1), recurvatum with leg length discrepancy (n = 1), and stiff knee (n = 1). Mean follow-up was two years (range 9 months-8 years). The functional outcome was excellent in all patients with a non-displaced fracture and in seven of the twelve patients who underwent surgical treatment. DISCUSSION: Non-displaced fracture of the anterior tibial tubercle I children (type IA) should be considered as a separate entity responding very well to orthopedic treatment. The other cases of displaced fracture generally require surgery which enables an assessment of often associated lesions. The prognosis of displaced fractures of the anterior tibial tubercle is more sever due to the associated lesions and potential complications. We describe the second case of recurvatum and leg length discrepancy following fracture of the anterior tibial tubercle. CONCLUSION: Displaced fracture of the anterior tibial tubercle in adolescents is often associated with soft tissue injury (patellar ligament, menisci). Surgery is indispensable and provides good functional results.

Adolescent↗
PubMed2004

[Posterior spinal fusion for kypho-scoliosis associated with osteogenesis imperfecta: long-term results].

PURPOSE OF THE STUDY: A survey was conducted at the Necker-Enfants-Malades Hospital in Paris and the Roscoff Helio-Marin Center in Roscoff, France to document results of posterior spinal fusion for scoliosis associated with osteogenesis imperfecta. MATERIAL AND METHODS: The cases of 27 patients who underwent posterior spinal fusion and Harrington (n = 2) or CD (n = 23) instrumentation performed by one senior orthopedic surgeon were reviewed. Two patients had posterior arthrodesis without instrumentation and were left in halo-traction together with a plaster cast until bone healing was achieved. RESULTS: The series included eleven males and sixteen females. Mean age at fusion was 13 y 4 m. The average curvature before surgery was 77 degrees and the average correction was 37 degrees. Mean follow-up was six years. Minor complications due to halo pin infection or migration were observed in two patients and loss of correction with rod fracture in four. DISCUSSION: Because of the risk of physical and respiratory incapacity, we believe that spinal surgery and arthrodesis for spinal deformity should be considered after a preparation period by halo-traction with exceptional precautions to correct major curves and prevent complications that could occur in patients with osteogenesis imperfecta. Correction and stabilization of the scoliotic spine in osteogenesis imperecta has yet to be definitively described since we have noticed that the site of deformation is transferred to the sacroiliac region once spinal fusion is achieved.

Adolescent↗
PubMed2001

Obstetric dislocation of the thoracic spine: case report and review of the literature.

A fracture dislocation of the upper thoracic spine with spinal cord injury is reported in a neonate. This rare injury is associated with attendant predisposing obstetric circumstances (breech transverse presentations, large baby size) that can alert clinicians of potential problems and aid in the diagnosis of neonatal hypotonia and paralysis.

Birth Injuries↗
PubMed2001

Evolution of scoliosis in six children treated with growth hormone.

During a period of 6 years to 11 years, the authors have been following six girls with scoliosis and treated with growth hormone (GH) for a growth insufficiency. The treatment with GH started after the discovery of the scoliosis for five patients. Three curve progressions have been observed, but always in the puberty period. Only one progression was noticed at the beginning of the GH treatment, but it was relieved with bracing. The results of this study do not permit one to conclude that a relation exists between GH treatment and scoliotic progression. This treatment is nevertheless not devoid of side effects, and a rigorous supervision is necessary.

Adolescent↗
PubMed2000

[Congenital pseudarthrosis of the clavicle: 25 childhood cases].

PURPOSE OF THE STUDY: Congenital pseudarthrosis of the clavicle is rare, only 200 cases having been reported. Based on 25 personal cases and an overview of the literature, we try to explain the etiology of this condition and the different kinds of treatment. MATERIAL AND METHODS: A retrospective analysis was performed on twenty-five children (16 females, 9 males, mean age at the end of the follow up - 11.5 yrs) from three different centers. We assessed the outcome of surgical and nonsurgical procedures, based on pain, functional ability, cosmetic results, and x-ray examination. RESULTS: A family background was noted in three children. The lesion always involved the right side. Twenty patients presented a bump over the middle third of the clavicle, thirteen a foreshortened shoulder girdle, three complained of discomfort. In two cases, palpation of the clavicular area was painful. No neurovascular compressive syndrome was reported. None of the patients complained of a decrease in the range of motion or in the strength of the upper limb. X-rays showed a middle third defect. In five cases we found abnormal first ribs. Seventeen patients underwent surgery, at a mean age of 6 years and 4 months. The procedure always included excision of the pseudarthrosis at both ends and internal fixation with a wire or a plate. In only eight cases a bone graft was used. Healing was achieved in fourteen patients. Three patients needed a second surgical procedure. In these 3 cases we had not used bone grafting. All patients had a normal range of shoulder motion, except a twelve year old girl who complained of discomfort of the right upper limb. The cosmetic result was good in eleven cases, one surgical wound was noted as hypertrophic, and one developed a keloid. An asymmetry of the trunk was still noted in seven cases. The x-rays showed symmetric clavicles in ten cases. Eight patients were treated conservatively. All of them had a normal range of motion of the shoulder, six had a good cosmetic result and two cases a poor one. DISCUSSION: According to Alldred, the anomaly results from the failed coalescence of the two primary ossification centers of the clavicle. The overview of the literature and our findings (in one case) confirm that the cartilage which covers both ends of the bone is made of growth cartilage. However, the true mechanism of the nonunion is still unknown. The three familial cases of our work suggest a possible genetic transmission of the disease. The diagnosis is based on the following criteria: right side lesion, found in infancy, without previous fracture, increasing size with growth, without major functional consequences, without neurofibromatosis or cleidocranial dysostosis symptom. X-rays or histologic examination will confirm the diagnosis showing the usual findings described above. Complications of the pseudarthrosis of the clavicle are rare and late. Conservative management appears to give good results as seen with our eight patients. However surgical treatment ensures symmetrical shoulder girdles and good function with few complications. Therefore, we recommend performing an excision of the cartilaginous caps, followed by an iliac bone graft and an internal fixation with wire. Surgical management will be preferred in symptomatic patients, in the case of major or increasing deformity, or on parental request.

Arm↗
PubMed1999

[Pott's disease paraplegia in children. Mechanics and therapeutic strategies. Six cases].

PURPOSE: We report a series of 6 Pott's disease paraplegias treated between 1982 and 1996. MATERIALS AND METHOD: Out of 15 children suffering from Pott's disease, 6 had paraplegia. Treatment consisted of anterior medullar decompression and anterior spine fusion with bone grafting. Two or three weeks later, posterior spine fusion was achieved systematically using a CD fixation device in 3 cases. RESULTS: Neurological signs completely disappeared in 5 children. Vertebral fusion was correct in all patients and kyphosis was less than 50 degrees. DISCUSSION: The posterior approach to the spine must be proscribed as a first step, except for spine dislocation. The anterior approach allowed us to drain the abscess, to correct the kyphosis, and to perform an anterior spine fusion. The posterior spine fusion was performed a few weeks later in order to avoid kyphosis aggravation. CONCLUSION: Prognosis of Pott's disease is good but at the present time, paraplegia remains too frequent. Adapted treatment must be performed without delay.

Age Factors↗
PubMed1996

[Solitary infantile myofibromatosis of bone].

We report one case of Solitary infantile Myofibromatosis of Bone in a 14-year old girl. Radiologic features of the tibial lesion were consistent with the diagnosis of a benign bone tumor. The final diagnosis was made on a total resection of the tumor. Histologically, the tumor consisted of nodules, hyalinized or cellular, with spindle-shaped cells resembling fibroblasts or smooth-muscle cells. There were numerous vascular spaces in close contact with these nodules. The tumor cells were immunoreactive with anti-alpha-smooth muscle actin antibodies. These data were consistent with the diagnosis of Myofibromatosis. The histologic features were similar to those of Infantile Myofibromatosis of other sites such as skin and soft tissue. The case reported is rare and not yet published, due to the age and sex of the patient, and the location of the tumor.

Adolescent↗
PubMed1995

Sternal cleft: case report and review of a series of nine patients.

Cleft sternum is a rare malformation due to partial or total failure of sternal fusion at an early stage of embryonic development. Sternal clefts can be classified as superior, inferior, or complete. Here we report on a 2-year-old boy with inferior sternal cleft and complex cardiac malformation. We review a series of 9 children with sternal clefts, referred to us over a 10-year period. Hypothetical mechanisms for this developmental anomaly are discussed.

Abnormalities, Multiple↗
PubMed1995

Upper limb malformations in DiGeorge syndrome.

We report on upper limb anomalies in two children with a complete DiGeorge sequence: conotruncal defects, hypocalcemia, thymic aplasia, and facial anomalies. One child had preaxial polydactyly, and the other had club hands with hypoplastic first metacarpal. In both patients, molecular analysis documented a 22q11 deletion. To our knowledge, limb anomalies have rarely been reported in DiGeorge syndrome, and they illustrate the variable clinical expression of chromosome 22q11 deletions.

Chromosome Deletion↗
PubMed1995

[Essential bone cysts in children. Value of systematic cystography. Apropos of a series of 42 cysts].

INTRODUCTION: The treatment of children's essential bone cysts, is controversial. Intra focal injection of a corticoid, the Methylprednisolone, described by Scaglietti in 1974, given in most of the case serials, a rate of healing of more than 30 per cent. MATERIAL AND METHODS: The case serial we present include 42 essential bone cysts treated between 1975 and 1992 in the orthopaedic department of Necker Enfants Malades hospital. These children have been reviewed with a mean follow up of 4 years. A healing rate over 35 per cent has been noticed. However, some failures stayed completely an understanding even if nothing at the beginning let suppose a slower evolution. RESULTS: Attempting to explain those phenomenes, the authors realised in 70 per cent cases, an opaque cystography, before the Methylprednisolone injection. This simple radiological technique permitted to reveal abnormal aspect in 75 per cent cases. Most of the time, it shows massive-veinous licks in an abnormal veinous system or one or plurial separations of the cystic area. This type of picture could perfectly explain the defect of the corticoids action by a lick of the solution or by a partial unefficacity of the solution because of the separation in the cyst area. The hypothetic idea has been completed by the calcul of the duration of the evolution. Effectively, the cysts showing an abnormal cystography had a longer healing delay compared to the cyst whose cystography was normal. CONCLUSION: The opaque cystography is for us a necessary element in the treatment of essential bones cysts, once the diagnostic is certain and the indication of intra focal corticoid injection has been retained. The radiographic study of the cyst area permits to precise the treatment; for example multiplying the injections in the areas of the cysts when there is separations and overseing the evolution.

Adolescent↗
PubMed1995

[Value of pelvic osteotomy in the management of the hip in children with cerebral palsy].

PURPOSE OF THE STUDY: The authors analyzed the effectiveness of pelvic osteotomy for the treatment of hip dislocation or subluxation in CP children. MATERIAL: Fifteen pelvic osteotomies were performed on 11 children aged 30 months to 12 years (mean age 6 years). Seven children suffered from Little's disease. Follow-up averaged 10 years (from 2 to 16). Six children were reviewed at the end of growth (9 cases). METHODS: A Salter or triple osteotomy with adductor release was performed. Four cases had also a proximal femoral osteotomy. RESULTS: Following surgery, the mean Reimers' percentage decreased from 55 to 0 per cent. Correction was perfect in 11 cases, incomplete in 4 but excentration remained under 20 per cent. At the end of growth, 6 out of 9 hips remained stable without any further surgery, 2 hips developed slight excentration (less than 20 per cent) and one recurrent subluxation was treated by proximal femoral osteotomy. Six hips remained stable but their growth was not ended at last review. DISCUSSION: This surgical procedure is compared to others described in literature. Pelvic osteotomy with tenotomy improves acetabular cover and corrects muscle imbalance. Its risks seem overestimated in the literature. Both pelvic and femoral osteotomies are useful in specific cases. CONCLUSION: Triple or Salter osteotomy with adducter release seems to be a useful procedure to restore good hip morphology at the end of growth. No posterior dislocations following this osteotomy were seen in spite of the important correction. Proximal femoral osteotomy is not always necessary.

Cerebral Palsy↗
PubMed1994

[Foot deformities in longitudinal ectromelia of the lower limbs].

We have studied 204 feet in 181 children with congenital limb shortening. There were 17 short femurs in 11 children in whom it was impossible to lengthen the leg. Thirteen feet were abnormal. It was necessary to adapt the foot to fit the chosen prosthesis. In 34 children it was possible to correct the length of the short femur. In 21 the feet were normal. 13 had abnormal feet associated with fibular aplasia and deformities included equinovalgus, hind foot synostosis, and deficient rays. In 72 children with congenital hypoplasia or aplasia of the fibula, 76 feet were affected. The function of the foot depends on attaining a stable position beneath the tibia. In 34 children (35 feet), the feet were in a stable position. There were 22 ball and socket ankle joints. Before carrying out leg lengthening, operation was necessary on 9 feet, and a further 13 required operation after lengthening had been carried out. In 34 children (41 feet) there was fibular aplasia. The feet lay in equinovalgus and were often narrow. Only 5 did not have a degree of synostosis. Twenty-three feet in twenty two children were operated on with early soft tissue release, tendon transfer and tibiotalar arthrodesis. This is our treatment of choice. Twenty-seven children had tibial dysplasia which affected 37 feet. The feet lay in equinovarus and in 5 there was partial diplopodia. In the absence of a tibia (19 feet) disarticulation of the knee was carried out. In 12 there was proximal shortening of the tibia which in 9 cases was treated by tibiofibular union. It was possible to retain only 2 feet in a proper position in a lengthened leg. In 30 children (33 feet) both fibular and tibial hypoplasia was present. The feet functioned well. There were 22 ball and socket ankles, 28 narrow feet and numerous synostoses. In limbs with atypical dysplasia 7 abnormal feet were noted. If it is possible to preserve or lengthen the limb it is vital that the foot is retained in a stable position beneath the tibia in order that satisfactory function be obtained. If limb lengthening is impossible, the foot must be adapted to match the prosthesis.

Adolescent↗
PubMed1994

Desepiphysiodesis--elimination of partial premature epiphyseal closure. Experience of 17 cases.

Between 1975 and 1990, 17 growth plates have been operated on by epiphyseal bridge resection. The children were from 4 years and 10 months to 13 years and 10 months old. The etiology of partial closure was traumatic (10 times), caused by therapeutic mistakes (3 times), septic osteomyelitis (1 case), purpura fulminans (1 case), unknown (2 cases). There was always length discrepancy or deformity of bone. The regions that have been subjected to treatment were distal femur, proximal tibia, distal tibia, distal radius. Evaluation of the bone bridge was made by tomoscintigraphies and recently by MR imaging and computed tomoscintigraphy. The bone bridge size was from 2.5% to 60% of the growth plate surface; surgical technique consists of resection of bone bridge connecting epiphysis and metaphysis which is replaced by methyl metacrylate. In 16 cases simultaneous corrective osteotomy was performed. Results are poor, there were only two good results and 8 failures; seven results were medium. The failures can all be explained by mistakes in technique or indication, except one. Indications are post-traumatic narrow bridges in young children. It would be useful to know the vitality of the residual growth plate.

Adolescent↗
PubMed1993

Osteochondritis dissecans of the humeral capitellum in children.

We studied 13 cases of osteochondritis dissecans of capitellum humeri in 12 children, 11 boys and 1 girl, aged between 10 and 15 years. We distinguished this affection from Panner's disease which affects young children and resembles Legg-Perthes-Calvé disease of the hip. Operative treatment was performed in 7 out of 13 elbows for removal of loose bodies or excision of osteochondritis in situ with cartilage damage. In other cases, functional treatment was carried out. At long-term follow-up, ranging from 2 to 13 years, clinical examination demonstrated satisfactory results in 9 cases; in 3 cases limitation of movement was related to fracture of the radial head or to delay in operative treatment for too long. Roentgenographically, changes related to growth disturbance were constantly observed; they involved the radial head, the olecranon, the trochlea and the proximal end of the ulna.

Adolescent↗
PubMed1993

[Acute infectious arthritis of the knee in children. Prognosis and therapeutic discussion apropos of 51 cases with an average follow-up of 5 years].

The purpose of this paper was to evaluate the results after acute septic arthritis of the knee in children and to discuss the method of treatment. 51 cases records of septic arthritis of the knee in children were studied with an average follow-up of 5 years. The etiology was hematogenous in 42 cases, penetrating wounds in 7 cases and osteomyelitis in 2 cases. Treatment was chiefly joint washing by arthrotomy 36 times, arthroscopy 4 times, with a needle 8 times; 3 synovectomies were necessary. Patients underwent systematic joint immobilization and parenteral antibiotics. The results were excellent in 35 cases, good in 10 cases, fair in 6 cases. Prognosis was good for hemategenous arthritis, but much less so for arthritis secondary to penetrating wounds and osteomyelitis. The essential factor for a good result was an early diagnosis and treatment. Apart from 2 arthrodeses, functional results were good. One of the noteworthy facts of our series was the great number of negative cultures (68 per cent). Treatment is discussed according to literature. Joint washing by arthroscopy has the double advantage of being simple and innoculous, and enables synovial biopsy. Immobilization at first seems necessary but its duration can be shortened to encourage articular cartilage nutrition. Antibiotics must be given parenterally at first, to be continued by oral administration as soon as their efficiency is proven. To evaluate this, CRP seems to be an efficient test.

Adolescent↗
PubMed1993

[Osteogenesis imperfecta with hypertrophic callus. Apropos of 2 cases with early onset].

BACKGROUND: The callus that forms at the site of recent fractures in patients with osteogenesis imperfecta is usually normal, but hyperplastic callus may develop. CASE REPORTS: Case 1. A hyperplastic callus with local inflammation developed at the site of a fracture of the left thigh of a boy, aged 11 months suffering from osteogenesis imperfecta. This disease was characterized by the progressive development of broad limbs, bone islands on skull x-rays and blue sclerae. He had also had fractures at the ages of 4 and 7 months. Follow-up showed that this boy, now aged 15 years, had several fractures with the development of similar hyperplastic calluses. These limitated joint motility, causing him to remain confined to his bed. Case 2. This girl of consanguineous parents had a fracture of the femora at the age of 1 month; she had blue sclerae and developed a hyperplastic callus. The roentgenographic studies showed generalized osteopenia and deformities indicating osteogenesis imperfecta. CONCLUSION: Hyperplastic callus may develop in osteogenesis imperfecta. Its diagnosis may be difficult with neoplasms of bone, such as osteosarcoma, and its treatment is difficult.

Bony Callus↗
PubMed1992

[Instability and misdiagnosed or neglected dislocations of the upper cervical spine in children. Apropos of 20 cases].

Neglected instabilities or luxations of the upper cervical spine in children are rare if one discards conditions such as chondrodysplasia, Down Syndrome or others, were the spine is known to be at high risk of instability. We have studied twenty cases of neglected luxations and the delay in diagnosis is explained either by the asymptomatic character of some of these lesions, or by the difficulty in diagnosis. At the occipito-atlantal level we have reviewed: an instability in translation which required an occipito-axial fusion; two compensatory counter occipito-atlantal luxation of an atlanto-axial rotatory fixation. The diagnosis was best made with computed tomography scan and the treatment was not much different from the isolated atlanto-axial rotatory luxation. An instability in flexion extension, which was merely followed at regular intervals. At the atlanto-axial level 9 cases of sagittal instabilities in kyphosis and translation with a distance between atlas and axis of more than 5 mm were observed. These instabilities were most often associated with a malformation of the cranio-cervical junction; their treatment was usually surgical by means of an atlanto-axial or occipito-axial arthrodesis depending on the case. 9 other cases of atlanto-axial rotatory luxations were either isolated (7 cases) or associated with a counter occipito-atlantal rotatory subluxation (2 cases). Their diagnosis was made on routine X-rays, but the complete or incomplete aspect of the luxation, as well as its fixed aspect, was best appreciated with dynamic CT scan. Their treatment was always started with collar neck or halo traction in order to obtain, reduction of the dislocation, or at least the disparition of the torticollis and the head straight up on shoulders. The stability of the spine was achieved with a minerva cast jacket, halo cast or spine fusion depending on the case.

Adolescent↗