Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
-
Rev Chir Orthop Reparatrice Appar Mot · Nov 2007
Comparative Study[Botulinum toxin for postoperative care after limb surgery in cerebral palsy children].
Spasticity can be the cause of pain in cerebral palsy (CP) children who may suffer increased postoperative pain after orthopedic surgery. Moreover, symptoms can be worsened by abnormal movements, cast immobilization or anxiety. Spasticity must therefore be treated after surgery in CP children. A randomized study has demonstrated that when these children undergo surgical tenotomy, preoperative injections of botulinum toxin have a beneficial effect in terms of pain relief. The aim of this study was to assess the benefit regarding pain and comfort provided by preoperative use of botulinum toxin in total-body CP children undergoing bone surgery. ⋯ We cannot confirm that botulinum toxin before bone surgery induces lesser consumption of analgesic drugs. Our results do however support the hypothesis that treatment of spasticity using preoperative injections of botulinum toxin decreases the duration of postoperative pain and improves the children's comfort. Moreover, postoperative under-cast skin lesions can be prevented. This work suggests that improved patient comfort and pain relief could be achieved by using multisite botulinum toxin injections before orthopedic surgery in spastic total-body CP children.
-
Rev Chir Orthop Reparatrice Appar Mot · Nov 2007
[Treatment of mallet finger with dorsal nail glued splint: retrospective analysis of 270 cases].
Management of mallet finger is both difficult and controversial. Sequelae are not uncommon, particularly after surgical treatment. Many authors advocate orthopedic treatment which is less invasive but requires greater patient participation to implement. Despite the large number of orthopedic methods proposed, none has proven superiority. We report here our experience with a dorsal adhesive splint which preserves digital pulp function and improves observance. ⋯ In conclusion, our series demonstrates that the adhesive dorsal splint is an effective treatment for all types of mallet finger, reducing the number of indications for surgery. Compared with other techniques, the advantages are: free digital pulp, better patient observance, lesser extension deficit.
-
Rev Chir Orthop Reparatrice Appar Mot · Nov 2007
Review Case Reports[Traumatic lumbosacral fracture dislocation: a case report and review of the literature].
Lumbosacral dislocation is uncommon. We report a case of traumatic lumbosacral dislocation which occurred in a 33-year-old pedestrian traffic accident victim. The posterior impact produced lumbar injury with diffuse pain exacerbated at the lumbosacral junction. ⋯ After L5 laminectomy and extraction of the voluminous herniation of the L5-S1 disc, a short L5-S1 posteriolateral fusion was achieved using pedicular screws and two rods on either side as well as a posterolateral iliac autograft. The clinical course was satisfactory with nearly complete neurological recovery (persistent levator ani paresis). This clinical case and a review of the literature illustrate the pathogenic, clinical, radiological and therapeutic aspects of lumbosacral fracture dislocation.
-
Rev Chir Orthop Reparatrice Appar Mot · Nov 2007
Case Reports[Osteoid osteoma of the inferior articular process of L5 associated with a bilateral spondylosis: a case report].
We report the case of an 8-year-old boy who presented an osteoid osteoma of L5 associated with bilateral spondylolysis involving the same vertebra. Diagnostic bone scintigraphy is highly contributive in children presenting back pain. For us, it is the first intention exploration in patients with isthmic lysis seen on the plain x-ray. ⋯ To our knowledge, the association of osteoid osteoma with bilateral spondylolysis on the same vertebra has not been described elsewhere. In children, the diagnosis of symptomatic spondylolysis can only be established after ruling out other causes of back pain. The diagnosis of osteoid osteoma must be kept in mind.