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Biomedical subjects

P Rigault

Publications and source records attributed to P Rigault.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Pavlik's harness in congenital hip dislocation before the first birthday].

Three hundred cases of congenital dislocation of the hip have been treated with the Pavlik harness since 1979. The reduction is obtained by progressive flexion of the thighs. The femoral head penetrates the acetabulum from bottom to top. Placing the harness and managing the treatment must be very carefully done. The explanation given to the family is essential to success. Complications are rare. Arthrography followed by reduction in traction should be considered in case of failure. The Pavlik harness is indicated under the age of 9 months.

Braces↗
PubMed1990

[Are there still indications for femoral osteotomy?].

Derotation osteotomy is indicated after reduction and stabilization of a dislocation, if there is still an augmented anteversion with a risk of reluxation: osteotomy is also indicated for prevention of leg deformities. Varization and derotation-varization osteotomies are occasionally indicated for secondary reconstruction of a more or less normal hip with severe residual dysplasia.

Femur↗
PubMed1990

[Are there still indications for Colonna's capsular arthroplasty?].

The Colonna arthroplasty was used in previous years in the treatment of severe CDH in children or even in the treatment of severe incongruities or subluxations. For most of these indications, other techniques are currently used, owing to both the current rarity of severe dislocation and delayed diagnosis and to improved pelvic osteotomies, in some cases associated with open reduction. Despite its complications, the Colonna arthroplasty still gives very good results if it is performed with a perfect technique. Presently the only indications are subluxation in the older child, which is very rare in developed countries, and failures or sequellae of the initial treatment when the articular space is severely damaged. The Colonna operation has now become a salvation procedure.

Arthroplasty↗
PubMed1989

[Thromboembolic complications in pediatric orthopedics. Multicentric collection of 33 case reports].

We report 33 cases of venous thrombosis of the limb, in children aged 15 years or less (average age is 10 years old): 22 acute thrombophlebitis have been treated, 11 children shown post-phlebitic disease. The thrombus was found, most of the time, in the iliac and/or femoral vein. Acute complications were seen in 30% of our cases, and 25% treated children reviewed, had post-phlebitic sequelae. Congenital disease of hemostasis (deficiency of antithrombin III, protein C or S) must be detect before anticoagulant start, because such deficiency influence the treatment and the prognosis. There is non indication for preventive treatment, because of the rarity of spontaneous thrombophlebitis by children. Nevertheless, we can draw an "high risk" population: antecedent of phlebitis, antecedent of congenital disease of hemostasis, antecedent of thrombophlebitis by parents below 40 years old, thrombogenic disease (homocystinuria), vertebral arthrodesis.

Adolescent↗
PubMed1989

[Old post-traumatic dislocation of the radial head in children].

27 cases of neglected post-traumatic dislocations of the radius head were followed up for 30 years. 23 of the cases were neglected Monteggia fractures. The treatment varied over the years from no therapy to the presently used technique of cubital osteotomy associated with surgical repositioning to the radius dislocation. The follow-up results were analysed to determine: 1) whether surgical intervention was justified, as the function of the upper limb of these children was often perfectly good, 2) the type of surgery to use, 3) when such surgery should be done. The results form this study, and the review of 66 previously published cases indicate that surgery may be done on patients of any age, but preferably as early as possible, using precise surgical procedure, as these alone seem to guarantee a first class functional outcome, likely to improve on the pre-operative status of the patients.

Child↗
PubMed1989

[Intervertebral disk calcification in children].

Thirty one intervertebral space calcifications (I.S.C.) were studied in 21 children (12 boys, 9 girls), with mean age of 7 years; 25 calcifications had been followed for an average of 71.5 months. The main symptom was pain (Crisis) which relieved in a delay of 1 month in 70 per cent of cases. "Crisis" and radiographic fragmentation of the calcification are both criteria of going out of 18 calcifications, in a delay ranged from 28 days to 6 months. The calcification appears as a sign which disclose a general disease of spine, interesting vertebral body, growth plate, and disc; therefore we have observed 15 lesions due to growth disorders in 16 cervical I.S.C., at dorsal level we have described 4 cases of intrasomatic cavitation containing calcified material, opened in the intervertebral space. This growth disturbance has been noted either on first radiograph, or has appeared later, after disappearance of the I.S.C.; we found more over absence of listel and lesion of multiple plates distant from the calcification. This disease is identified to vertebral osteochondrosis where residual deformities are more worrying than the benign calcification; they have concluded management of I.S.C. as early as possible to avoid great deformities of vertebral bodies.

Adolescent↗
PubMed1989

[Operations for lengthening the upper limbs in children and adolescents].

We report 16 cases of lengthening of the upper limb: 4 humerus, 12 ulna from 1976 to 1987. Humerus lengthening are progressive with Wagner apparatus. They gave lengthening from 7.5 to 12 cm. There were no important complication. Ulna lengthening were done in patients with multiple hereditary osteochondromes and hereditary multiple exostoses, to correct the deformities of the forearm, and prevent dislocation of the proximal radial head. Actually progressive lengthenings replace immediate ones with radial osteotomy.

Adolescent↗
PubMed1989

[Cartilaginous tumors in children].

For the last 15 years, 44 cartilaginous bone tumors had been treated in children aging from 2 to 15 years. 80% were chondromas, either isolated (27), or multiples in enchondromata (9). Treatment varied from simple biopsy to extensive excision with cancellous bone graft. Two of these patients experienced postoperative recurrence but have been cured by another surgical excision. One chondromyxoid fibroma of the big toe and 2 chondroblastomas of the femur had been treated by excision with no recurrence. Three young boys (mean age 5 years) who had a metachondromatosis with chondromas of the extremities had been treated with one recurrence. Two children had a chondrosarcoma and both of them died from lung metastasis. Surgical treatment is indicated for all these tumors and is discussed with our results for each of them.

Adolescent↗
PubMed1989

[Long-term results of surgical treatment of congenital elevation of the scapula].

This study reviews the cases of 21 children with 24 Sprengel's disease, operated from 1961 to 1981. They were classified according to the classification of P. Rigault and J.C. Pouliquen (5 grade I, 12 grade II, 4 grade III). Multiple deformities were associated. The average operative age was 8 years old. The surgical procedure was in 3 cases a partial scapular resection; in 15 a unilateral Woodward and in 3 a bilateral Woodward. The authors have observed 7 post-operative complications, including 2 brachial plexus palsies. The average follow-up is 12 years. Cosmetic results are good in 57.2 per cent, fair in 33.3 per cent and poor in 9.5 per cent. The study of function shows 18 normal shoulders with an average improvement of 51 degrees. Partial resection results seem to be good on mobility and fair on the cosmetic stand point. On the other hand, the results of Woodward procedure are distinctly better. Good results appear to be grade I, operated with Woodward technique and a resection of the most prominent part of the scapula. The authors propose their indications, knowing that Woodward procedure does not solve every problem, and that the existence of associated deformities may go against any surgical correction.

Abnormalities, Multiple↗
PubMed1988

[Extemporaneous lengthening of the femur in children and adolescents. Study of 25 cases].

Twenty-five one-stage lengthenings of the femur have been made using a specific technique: an oblique osteotomy in the frontal plane with a mean length of 12 cm, with routine tenotomies and fascial divisions. The average lengthening was 37 mm, that is 9.4 per cent of the femoral length. Complications were uncommon: one infection, three non-unions and one fracture, none of which resulted in any loss of length or deleterious late effects. One-stage lengthening is ideally indicated in adolescents at the end of growth for inequalities of limb length of 40 to 50 mm mainly affecting the femur, whatever the cause.

Adolescent↗
PubMed1987

[Van Nes rotation osteoplasty in congenital dysplasias and aplasias of the proximal femur in young children. A study of 6 cases].

Six rotation-plasties, as described by Van Nes, have been carried out in children between 5 and 11 years of age, 5 of whom had congenital defects of the proximal femur, and the other femoral hypoplasia. The operation involved arthrodesis of the knee, accurate shortening of the leg so that the ankle would be at the same level as the opposite knee at the end of growth, and clockwise derotation of the leg through 180 degrees. The only complications encountered were 3 transient palsies of the peroneal nerve. Rerotation was only required if the operation was performed in early childhood, or if it had been carried out counterclockwise. The ideal age for operation seems to be between 8 and 10 years of age. The results are satisfactory. Function and gait are improved. The prosthesis may need to be long because of the pelvi-femoral instability associated with the basic deformity. The operation is indicated in some children with congenital abnormalities of the femur who would otherwise require a rigid brace or an amputation to accommodate a prosthesis.

Arthrodesis↗
PubMed1987

[Congenital pseudarthrosis of the tibia and fibula in children. Results of the treatment of 18 cases with nails and bone grafts].

Eighteen cases of congenital pseudarthrosis of the leg in 17 children were treated by nailing and tibio-fibular graft with a mean follow-up of six years (from one to twelve years). Six patients had reached the end of growth. Primary union was obtained in 17 cases in a mean time of 6.5 months (from 3.5 to 18 months), but one case developed a new pseudarthrosis at the level of an associated upper tibial osteotomy. Only one case required a supplementary graft. Walking was usually achieved without any apparatus after five-and-a-half months, the tibia being protected by a nail which was left in place until the end of growth. In two cases, a fracture produced by trauma occurred in the limb long after consolidation. These two fractures healed in the normal time. Inequality of limb length was present in all the cases, but its progress varied. On three occasions it was treated by femoral lengthening. Stiffness of the ankle and subtaloid joints resulted from nailing of the hindfoot in nine cases and improved very little after freeing of the joints. The use of telescopic rods avoids the need for further operations to change the rod during growth. We consider that this is a reliable method but that, in certain cases, the effects on growth and on the foot can be diminished by appropriate modifications of technique.

Bone Transplantation↗
PubMed1987

[Syringomyelia and scoliosis in children and adolescents. Apropos of 14 cases].

The authors report their experience of 14 cases of scoliosis in children or young adults in association with syringomyelia. The neurological lesion was discovered at a variable time during the development of the scoliosis which may appear to be idiopathic for several years. There were 11 cases of syringomyelia or hydromyelia and three intramedullary tumours with cyst formation. The neurological lesion must be treated first and sufficiently early to avoid the development of muscle weakness and scoliosis. The scoliosis can be treated by normal without risk of additional complications.

Adolescent↗
PubMed1987

[Aneurysmal bone cysts in children. Study of 28 cases].

Twenty-eight aneurysmal bone cysts in children aged between 3 and 16 years, with a mean follow-up of five years, have been reviewed. The diagnosis in these uncommon lesions was straightforward in 22 cases, based on the clinical, radiological and macroscopic features. The histological characteristics confirmed the diagnosis. Apart from these typical lesions, there were some cases in which the diagnosis remained doubtful in spite of a review of the sections and a re-assessment of the radiological and clinical findings. For the surgeon, the diagnosis is primarily from a unicameral bone cyst, whose treatment is very different. For the pathologist, the diagnostic problem is not so much from benign dystrophies, which are often difficult to distinguish from them, but from rare lesions in children, such as telangiectatic sarcoma, which have a more serious prognosis. The high recurrence rate, in four cases out of eleven, after curettage led to a preference for more radical treatment whenever possible, such as excision or resection, which was performed in 14 cases and which limited the liability to recurrence. Aneurysmal bone cyst is a benign tumour whose severity depends on its site, especially in the spine, where there is a risk of neurological complications, on its size, which may render surgical removal difficult and on its proximity to the growth plate, which may result in disturbance to growth which not infrequently occurs.

Adolescent↗
PubMed1986

[Braces for congenital leg length inequality in children].

Despite recent advances in techniques of limb equalisation, some congenital anomalies cannot be corrected and shortening at the end of growth is severe. These children then need to be braced permanently. The role of the surgeon is then limited to satisfactory adaptation of the prosthesis which must be light, cosmetic and functional. The authors described different types of bracing according to the type of anomaly, its level, its permanent state and the existence of unilateral or bilateral involvement. Indications are given for surgery to obtain satisfactory fitting of the patient to the brace. In congenital femoral aplasia were realised either bracing similar to that of above the knee amputation after knee arthrodesis, or bracing after Van Nes procedure, the foot being rotated 180 degrees to allow the motion of the braces. The authors have observed 20 such cases.

Adolescent↗