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Article ; Online: The spastic hip in children and adolescents.

Dohin, Bruno

Orthopaedics & traumatology, surgery & research : OTSR

2018 Volume 105, Issue 1S, Page(s) S133–S141

Abstract: The hip is the joint most exposed to orthopaedic complications in cerebral palsy (CP), which is the main cause of spasticity in paediatric patients. The initial immaturity of the hip allows the forces applied by the spastic and retracted muscles to ... ...

Abstract	The hip is the joint most exposed to orthopaedic complications in cerebral palsy (CP), which is the main cause of spasticity in paediatric patients. The initial immaturity of the hip allows the forces applied by the spastic and retracted muscles to displace the femoral head, eventually causing it to dislocate. The risk of hip dislocation increases with the severity and extent of CP, exceeding 70% in the most severe cases. Hip dislocation causes pain in up to 30% of cases, carries a risk of orthopaedic and cutaneous complications and hinders patient installation and nursing care. These adverse outcomes warrant routine screening, which has been proven effective in lessening the frequency and severity of hip displacement. Preventive techniques including physical therapy, orthoses and treatments to alleviate spasticity are strongly recommended in every case. The beneficial effects of treating spasticity, if needed via neurosurgical procedures, have been convincingly established. Orthopaedic surgery is required when prevention fails. Soft-tissue release is designed to correct the asymmetry in the forces applied by the muscles. Femoral osteotomy creates the possibility for spontaneous correction of secondary acetabular dysplasia. Progress has been made in standardising the use of multilevel surgery involving the soft tissues, femur and pelvis, which is often effective in correcting the morphological abnormalities and stabilising the joint. When hip pain or alterations are severe, hip resection or total hip arthroplasty are highly effective in alleviating the pain and improving patient comfort. The spastic hip is a complex condition in which currently available screening protocols and treatment strategies have been proven effective in benefitting patient outcomes.
MeSH term(s)	Adolescent ; Arthrodesis ; Cerebral Palsy/complications ; Child ; Conservative Treatment ; Femur/surgery ; Hip Dislocation/diagnosis ; Hip Dislocation/etiology ; Hip Dislocation/therapy ; Hip Joint/diagnostic imaging ; Hip Joint/surgery ; Humans ; Muscle Spasticity/complications ; Neurosurgical Procedures ; Osteotomy ; Pain/etiology ; Physical Examination ; Quality of Life ; Radiography
Language	English
Publishing date	2018-07-26
Publishing country	France
Document type	Journal Article ; Review
ISSN	1877-0568
ISSN (online)	1877-0568
DOI	10.1016/j.otsr.2018.03.018
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Article ; Online: Hip internal rotation in cerebral palsy: does femoral derotation osteotomy influence abductor insufficiency?

Dohin, Bruno

Developmental medicine and child neurology

2017 Volume 59, Issue 9, Page(s) 884

Language	English
Publishing date	2017-09
Publishing country	England
Document type	Journal Article
ZDB-ID	80369-8
ISSN	1469-8749 ; 0012-1622
ISSN (online)	1469-8749
ISSN	0012-1622
DOI	10.1111/dmcn.13527
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Article ; Online: Diagnosis and treatment of cervical spine injuries in children.

Haddad, Elie / Al Khoury Salem, Hassan / Dohin, Bruno

Orthopaedics & traumatology, surgery & research : OTSR

2023 Volume 110, Issue 1S, Page(s) 103762

Abstract: Cervical spine injuries in children are a common reason for emergency room visits, while bone, ligament or spinal cord cervical lesions are relatively rare (1-1.5% of severe trauma in children) and mainly involve the upper cervical spine. The main causes ...

Abstract	Cervical spine injuries in children are a common reason for emergency room visits, while bone, ligament or spinal cord cervical lesions are relatively rare (1-1.5% of severe trauma in children) and mainly involve the upper cervical spine. The main causes are sports injuries, accidents at home and traffic accidents. Clinical triage is needed to avoid unnecessary radiation exposure from imaging. We propose a protocol to optimize the diagnosis and treatment. In children, conservative treatment using rigid immobilization (cervical collar or halo-vest) is the preferred option in stable and/or minimally displaced injuries. Frequent clinical and radiological monitoring is required to ensure the patient's condition does not deteriorate due to inappropriate or poorly tolerated treatment. In these cases, surgical treatment can be proposed as second-line treatment. Internal fixation is indicated as the first-line treatment if the injury is unstable or a neurological deficit is present. The fixation methods must be adapted to the pediatric population by taking into account the vertebral volume and residual growth potential. Intraoperative CT scans or neuronavigation can make the surgical procedure safer and easier. Clinical, radiographic and CT scan monitoring should continue until the end of growth in a child who underwent surgical treatment to quickly detect any mechanical complications or sagittal imbalance due to poor craniocervical or cervicothoracic alignment. LEVEL OF EVIDENCE: IV.
MeSH term(s)	Humans ; Child ; Spinal Fractures/diagnostic imaging ; Spinal Fractures/surgery ; Cervical Vertebrae/diagnostic imaging ; Cervical Vertebrae/surgery ; Cervical Vertebrae/injuries ; Radiography ; Tomography, X-Ray Computed ; Fracture Fixation, Internal/methods ; Spinal Injuries/diagnostic imaging ; Spinal Injuries/surgery
Language	English
Publishing date	2023-11-20
Publishing country	France
Document type	Journal Article ; Review
ISSN	1877-0568
ISSN (online)	1877-0568
DOI	10.1016/j.otsr.2023.103762
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Article ; Online: Impact of spinal fusion on severity health status in scoliotic adolescents with polyhandicap.

Bessaguet, Hugo / Rousseau, Marie-Christine / Gautheron, Vincent / Ojardias, Etienne / Dohin, Bruno

PloS one

2024 Volume 19, Issue 3, Page(s) e0300065

Abstract: Background: Scoliosis constitutes a prevalent comorbidity in adolescents with polyhandicap and frequently leads to other severe impairments, impacting abilities and requiring complex caregiving strategies. Therefore, spinal fusion surgeries are commonly ...

Abstract	Background: Scoliosis constitutes a prevalent comorbidity in adolescents with polyhandicap and frequently leads to other severe impairments, impacting abilities and requiring complex caregiving strategies. Therefore, spinal fusion surgeries are commonly performed to alleviate pain and provide more comfort. However, spine stabilization has not previously been proven to improve the severity health status of adolescents with polyhandicap according to specific clinical scales. Objective: This study describes and compares the severity health status of adolescents with polyhandicap before and after they underwent spinal fusion. Methods: A monocentric retrospective observational study was conducted in the university hospital centre of Saint-Etienne, France. We included between 2009 to 2020, 30 scoliotic adolescents with polyhandicap who underwent spinal fusion performed with the same surgical technique and the same surgeon. The main outcome was the variation in the Polyhandicap Severity Scale (PSS) score after surgery. Secondary outcomes were variations in PSS subscores, quality of life scores, fronto-sagittal X-ray parameters, and measures of surgical complication rates and lengths of stay. Results: Among 30 adolescents, 27 PSS analyses were performed. We found a significant improvement between pre- and postoperative PSS scores, mainly for pain and respiratory, digestive, and skin disabilities. These improvements were accompanied by significant reductions in pelvic obliquity, in frontal and sagittal curves. The mean hospital length of stay was 45 days. During postoperative period, patients received a personalized postoperative rehabilitation procedure with spasticity and pain treatments, physiotherapy, and verticalization (wheelchair sitting and positioning devices such as contoured seat intended to increase postural stability). The mortality rate was estimated at 7%. At least 1 complication per patient occurred. Conclusions: We show that spinal fusion surgeries confer a significant improvement in the severity health status in scoliotic adolescents with polyhandicap.
MeSH term(s)	Humans ; Adolescent ; Spinal Fusion/methods ; Treatment Outcome ; Quality of Life ; Scoliosis/complications ; Retrospective Studies ; Pain/etiology
Language	English
Publishing date	2024-03-07
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0300065
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Article ; Online: Outcomes of isolated soft tissue surgery for in-toeing gait in patients with ambulatory cerebral palsy.

Dohin, Bruno / Haddad, Elie / Zagorda-Pallandre, Bérénice / Zemour, Marion

Orthopaedics & traumatology, surgery & research : OTSR

2020 Volume 106, Issue 7, Page(s) 1367–1371

Abstract: Background: Soft tissue surgery to address in-toeing gait in young cerebral palsy (CP) patients may be an alternative in some cases to femoral derotation osteotomy (FDO), which is the currently accepted treatment. The relative contribution of muscular ... ...

Abstract	Background: Soft tissue surgery to address in-toeing gait in young cerebral palsy (CP) patients may be an alternative in some cases to femoral derotation osteotomy (FDO), which is the currently accepted treatment. The relative contribution of muscular contracture, spasticity and bone deformity is still controversial. In this study, we determined the outcomes of soft tissue surgery on hip internal rotation (HIR) when femoral anteversion was less than 45° and the soft tissues were identified as being the cause. Methods: This prospective study included select adolescent patients who were operated in the context of single-event multilevel surgery. The soft tissues' contribution to the HIR was identified beforehand. The surgical procedures focused on the hamstrings, adductor magnus and gluteus minimus muscles. Results: Over a 6-year period, 21 patients (mean age 14 years) and 25 lower limbs were treated. The HIR improved by an average of 17.4°±4.8° (95% CI). The gait deviation index and gait profile score also improved significantly. At a mean follow-up of 36 months, no loss of correction had occurred. Discussion: In-toeing gait in CP patents is due to the action of retracted and/or spastic muscles and the presence of excessive bone torsion. When femoral anteversion<45°, confirming soft tissue involvement allows us to do a surgical procedure on the soft tissues only to correct the dynamic aspect of HIR. Our findings suggest that, under the right conditions, soft tissue surgery can improve in-toeing gain in the long term. This technique has its place alongside FDO in certain CP patients who do not have severe femoral anteversion.
MeSH term(s)	Adolescent ; Cerebral Palsy/complications ; Cerebral Palsy/surgery ; Femur/surgery ; Gait ; Humans ; Metatarsus Varus ; Prospective Studies ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2020-09-29
Publishing country	France
Document type	Journal Article
ISSN	1877-0568
ISSN (online)	1877-0568
DOI	10.1016/j.otsr.2020.06.008
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Article ; Online: L-pinning for fifth metacarpal neck fracture in adolescents.

Haddad, Elie / Zemour, Marion / Belkacemi, Yacine / Al Khoury Salem, Hassan / Dohin, Bruno

Orthopaedics & traumatology, surgery & research : OTSR

2021 Volume 108, Issue 1, Page(s) 102992

Abstract: Introduction: Fifth metacarpal neck fracture is the most frequent type of hand fracture in adolescents between 13 and 16 years of age. It mainly affects males and the dominant hand. The L-pinning technique combines intramedullary anterograde pinning and ...

Abstract	Introduction: Fifth metacarpal neck fracture is the most frequent type of hand fracture in adolescents between 13 and 16 years of age. It mainly affects males and the dominant hand. The L-pinning technique combines intramedullary anterograde pinning and transverse pinning between the 4 Materials and methods: Data for patients aged between 13 and 16 years, operated on for closed 5 Results: Eighteen patients, all male, with a mean age of 14 years, were included. All had bone age≥14 years. Mean palmar tilt was 52°±6.8° versus 6°±2.4° postoperatively, for a mean correction of 45°±4.3°. Mean operating time was 15min, and X-ray exposure 0.36minutes for a mean radiation dose of 2.89 cGy/cm Conclusion: L-pinning seemed reliable in terms of feasibility and stability of reduction in 5 Level of evidence: IV.
MeSH term(s)	Adolescent ; Fracture Fixation, Intramedullary/methods ; Fractures, Bone/diagnostic imaging ; Fractures, Bone/surgery ; Hand Injuries/surgery ; Humans ; Male ; Metacarpal Bones/diagnostic imaging ; Metacarpal Bones/injuries ; Metacarpal Bones/surgery ; Retrospective Studies ; Spinal Fractures ; Treatment Outcome
Language	English
Publishing date	2021-06-27
Publishing country	France
Document type	Journal Article
ISSN	1877-0568
ISSN (online)	1877-0568
DOI	10.1016/j.otsr.2021.102992
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Article ; Online: Intra-medullary osteosclerosis of the tibia in children.

Barbier, Dominique / Journeau, Pierre / Lascombes, Pierre / Dohin, Bruno / Cottalorda, Jérôme / Sales de Gauzy, Jérôme

Orthopaedics & traumatology, surgery & research : OTSR

2019 Volume 105, Issue 3, Page(s) 551–556

Abstract: Background: Intra-medullary osteosclerosis of the tibia is a rare condition characterised by chronic pain due to diaphyseal hyperostosis with no detectable triggering factor. The main differential diagnoses are stress fracture and osteoid osteoma. Of ... ...

Abstract	Background: Intra-medullary osteosclerosis of the tibia is a rare condition characterised by chronic pain due to diaphyseal hyperostosis with no detectable triggering factor. The main differential diagnoses are stress fracture and osteoid osteoma. Of the few cases reported to date, most were in adults. The objective of this study was to assess paediatric patients with intra-medullary osteosclerosis to determine whether the first visit provides sufficient information to establish the diagnosis and rule out both osteoid osteoma and stress fracture, whether a biopsy is required, and which treatment is optimal. Hypothesis: The diagnosis of intra-medullary osteosclerosis of the tibia can be made at the first visit. Patients and methods: Seven paediatric patients, 4 males and 3 females, with a mean age of 11 years, were included in this retrospective study. We evaluated the clinical features, findings from imaging studies (standard radiographs, computed tomography, magnetic resonance imaging, and bone scintigraphy), and treatment outcomes. Results: At the first visit, all patients had a painful swelling at the middle of the shin and imaging study evidence of antero-lateral tibial cortical thickening extending into the medullary cavity; in 5 patients, a linear lucency was visible. No other bone abnormalities were seen. Treatments included non-operative measures, pinning, and nailing. None of these treatments provided permanent bone healing or pain relief, although transitory freedom from pain with or without radiological bone healing was achieved. Discussion: Intra-medullary osteosclerosis of the tibia is rarely reported and therefore probably underdiagnosed. Distinctive characteristics of the cortical and endosteal thickening include location at the antero-lateral mid-diaphysis and, in some cases, the concomitant presence of a linear lucency that can provide the early diagnosis. The distinctive radiological features allow differentiation from a stress fracture. The management is challenging. Level of evidence: IV, retrospective observational study.
MeSH term(s)	Adolescent ; Biopsy ; Bone Neoplasms/diagnosis ; Bone Neoplasms/surgery ; Child ; Child, Preschool ; Diagnosis, Differential ; Diaphyses/diagnostic imaging ; Diaphyses/pathology ; Edema/etiology ; Female ; Fractures, Stress/diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Male ; Musculoskeletal Pain/etiology ; Osteoma, Osteoid/diagnostic imaging ; Osteosclerosis/complications ; Osteosclerosis/diagnosis ; Osteosclerosis/therapy ; Retrospective Studies ; Tibia/diagnostic imaging ; Tibia/pathology ; Tomography, X-Ray Computed ; Treatment Outcome
Language	English
Publishing date	2019-04-08
Publishing country	France
Document type	Journal Article
ISSN	1877-0568
ISSN (online)	1877-0568
DOI	10.1016/j.otsr.2018.10.026
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Article: Masquelet's procedure and bone morphogenetic protein in congenital pseudarthrosis of the tibia in children: a case series and meta-analysis.

Dohin, Bruno / Kohler, Remi

Journal of children's orthopaedics

2012 Volume 6, Issue 4, Page(s) 297–306

Abstract: Purpose: A type 2 recombinant human bone morphogenetic protein (rhBMP2) and Masquelet's procedure were used in three children presenting with congenital pseudarthrosis of the tibia (CPT). Recent studies on CPT suggested the presence in situ of ... ...

Abstract	Purpose: A type 2 recombinant human bone morphogenetic protein (rhBMP2) and Masquelet's procedure were used in three children presenting with congenital pseudarthrosis of the tibia (CPT). Recent studies on CPT suggested the presence in situ of pathologic tissues promoting pseudarthrosis. The authors hypothesized that large segmental resection of pseudarthrosis could improve prognosis of the CPT. Masquelet's procedure and rhBMP2 have been advocated for the treatment of long bone defect. Method: The authors report three cases of CPT in children treated with Masquelet's procedure and application of rhBMP2. They analyzed all published cases of CPT similarly treated. Results: In the present study, Masquelet's procedure did not improve the results in the treatment of CPT, but segmental bone reconstruction was possible. Bone healing was obtained in three out of the five applications of rhBMP2. In one case, the patient's parents asked for leg amputation. Analysis of the 33 published cases with the application of BMP in CPT points to a 62 % healing rate in this pathology. Conclusion: The authors confirmed that segmental bone reconstruction is possible in CPT using Masquelet's procedure. In the literature, the success rate of the application of rhBMP in CPT appears to be lower than the healing rate usually reported without BMP. Nevertheless, the strict selection of patients, limited number of cases, and their heterogeneity make interpreting the results difficult. However, the theoretical risk which the children are exposed to during the use of BMP makes rigorous selection of the indications necessary. Finally, the interest of rhBMP2 application in Masquelet's procedure remained to be proven.
Language	English
Publishing date	2012-07-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2279410-4
ISSN	1863-2548 ; 1863-2521
ISSN (online)	1863-2548
ISSN	1863-2521
DOI	10.1007/s11832-012-0421-3
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Article ; Online: Clinical practices in intrathecal baclofen pump implantation in children with cerebral palsy in France.

Mietton, Claire / Nuti, Christophe / Dohin, Bruno / Bayle, Beatrice / Fernandez, Bruno / Poirot, Isabelle / Gautheron, Vincent / Vuillerot, Carole

Annals of physical and rehabilitation medicine

2016 Volume 59, Issue 4, Page(s) 282–284

MeSH term(s)	Baclofen/therapeutic use ; Cerebral Palsy/complications ; Cerebral Palsy/drug therapy ; Cerebral Palsy/surgery ; Child ; Child, Preschool ; France ; Humans ; Infusion Pumps, Implantable/utilization ; Infusions, Spinal/utilization ; Muscle Relaxants, Central/therapeutic use ; Muscle Spasticity/drug therapy ; Muscle Spasticity/etiology ; Muscle Spasticity/surgery ; Physical and Rehabilitation Medicine/statistics & numerical data ; Practice Patterns, Physicians' ; Surveys and Questionnaires
Chemical Substances	Muscle Relaxants, Central ; Baclofen (H789N3FKE8)
Language	English
Publishing date	2016-09
Publishing country	Netherlands
Document type	Evaluation Studies ; Letter ; Review
ZDB-ID	2480363-7
ISSN	1877-0665 ; 1877-0657
ISSN (online)	1877-0665
ISSN	1877-0657
DOI	10.1016/j.rehab.2016.02.009
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Article ; Online: Biomechanical maturation of joint dynamics during early childhood: updated conclusions.

Samson, William / Van Hamme, Angèle / Desroches, Guillaume / Dohin, Bruno / Dumas, Raphaël / Chèze, Laurence

Journal of biomechanics

2013 Volume 46, Issue 13, Page(s) 2258–2263

Abstract: Dynamic parameters have been commonly explored to characterize the biomechanical maturation of children's gaits, i.e., age-revealing joint moment and power patterns similar to adult patterns. However, the literature revealed a large disparity of ... ...

Abstract	Dynamic parameters have been commonly explored to characterize the biomechanical maturation of children's gaits, i.e., age-revealing joint moment and power patterns similar to adult patterns. However, the literature revealed a large disparity of conclusions about maturation depending on the study, which was most likely due to an inappropriate scaling strategy and uncontrolled walking speed. With the first years of independent walking, a large growth in height and a large variability of dimensionless walking speed are observed. Moreover, the dynamic parameters were not well studied during early childhood. In the present study, seventy-five healthy children between 1 and 6 years of age were assessed during gait trials at a self-selected speed. Four hundred and sixty-two gait trials constituting five age groups with comparable dimensionless walking speeds were selected. 3D joint moments and the power of the lower limbs were computed and expressed using a dimensionless scaling strategy (according to body weight, leg length and the acceleration of gravity). Statistical analysis was performed to examine inter-group differences. Based on the current results, we concluded the biomechanical maturation of joint dynamics occurred around an age of 4 years for the ankle and between 6 and 7 years for the knee and the hip. Moreover, age group comparisons seemed more appropriate in young children using both the dimensionless strategy and a similar walking speed. Future investigations will be conducted on an older population (i.e., adding children older than 6 years) to clearly define the status of knee and hip biomechanical maturation.
MeSH term(s)	Ankle Joint/physiology ; Biomechanical Phenomena ; Child ; Child, Preschool ; Gait/physiology ; Hip Joint/physiology ; Humans ; Infant ; Knee Joint/physiology ; Walking/physiology
Language	English
Publishing date	2013-09-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	218076-5
ISSN	1873-2380 ; 0021-9290
ISSN (online)	1873-2380
ISSN	0021-9290
DOI	10.1016/j.jbiomech.2013.06.017
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