Saint-Étienne, France
Saint-Étienne, France

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PubMed | CHU Nord Saint Etienne, Lyon Ortho Clinic, Center osteo articulaire des Cedres and Institute Of Traumatologie Et Dorthopedie Du Leman
Type: Review | Journal: Orthopaedics & traumatology, surgery & research : OTSR | Year: 2016

With the development of conservative hip surgery techniques, new entities such as microinstability have been identified. Microinstability is a painful supra-physiological mobility of the hip. It results from the association of architectural and functional abnormalities impairing joint stability. These risk factors concern hip joint bone architecture or peri-articular soft tissues. Bone abnormalities are identified on hip assessment parameters. Soft tissues also play a key role in the static and dynamic stability of the hip: the joint capsule, labrum, ligamentum teres and adjacent myotendinous structures affect joint coaptation; any abnormality or iatrogenic lesion concerning these structures may constitute a risk factor for microinstability. Diagnosis is based on interview, clinical examination and imaging. Findings of labral lesions or femoro-acetabular impingement do not rule out microinstability; they may be associated. Treatment is based first on physiotherapy for muscle reinforcement to improve joint coaptation. In case of failure, arthroscopic surgery is indicated for femoro-acetabular impingement and capsular plicature which is being evaluated. Periacetabular osteotomy or shelf acetabuloplasty may be indicated, according to the severity of joint bone architecture abnormality. Microinstability is a multifactorial entity. Lesions induced by microinstability may in turn become risk factors for aggravation. Diagnosis and indications for surgery are thus difficult to establish. Only full clinical examination and exhaustive imaging assessment allow microinstability and associated lesions to be identified.

Parez N.,Hopital Louis Mourier | Mory O.,CHU Nord Saint etienne | Pozzetto B.,CHU Nord Saint etienne | Garbag-Chenon A.,University Paris Est Creteil | And 3 more authors.
Pathologie Biologie | Year: 2012

Background: In France, Rotavirus infections are responsible for approximately 300,000 cases of acute gastroenteritis (AGE) in children less than 5 years every year, 138,000 outpatient consultations and 18,000 hospitalizations. Surveillance for Rotavirus Infections in Hospitalized Kids (SHRIK) is a European prospective observational study conducted to assess the burden related to Rotavirus gastroenteritis (RVGE) in these children. Methods: Patients less than 5 years visiting emergency rooms for AGE (U-AGE), who were hospitalized (H-AGE) or who developed RVGE 48 hours after hospitalization (N-AGE) were included in the study over a year. A stool sample was collected for every child and analyzed by ELISA. Results: Results are presented for patients enrolled in France. A total of 755 eligible patients with AGE were included (357 for U-AGE, 372 for H-AGE and 26 for N-AGE). Among them, the proportion of RVGE was 49.1% (n= 114) for U-AGE and 64.4% (n= 186) for H-AGE. Most cases of RVGE (89%) involved children less than 2 years. GERV were frequently more severe than GEA non related to Rotavirus (NRVGE), according to the Vesikari scale, (68.4% against 41.9%, P< 0.0001). Oral rehydration was performed for nearly 50% of RVGE patients before coming to hospital, versus 36.2% for NRVGE (P< 0.002). All RV-positive strains were genotyped: the most frequent strains were G1P[8] (U-AGE, 42%; H-AGE, 46%) and G9P[8] (U-AGE, 38%; H-AGE, 31%). Conclusion: SHRIK study followed up all GEA visiting emergency room or requiring hospitalization for one year and showed that the burden of Rotavirus disease is high with a ratio over 70% of all hospital GEA during the winter peak. © 2011 Elsevier Masson SAS.

PubMed | CHU Nord Saint Etienne and Jean Monnet University
Type: | Journal: Annals of physical and rehabilitation medicine | Year: 2016

Hip internal rotation (HIR) during gait is one of the main functional disorders related to cerebral palsy (CP) in children. Most of the procedures proposed rotational osteotomy of the femur (FRO), (and/or tibia). However, multilevel surgery (SEMLS) including bone procedure, implicates more difficult and longer rehabilitation. When bone deformity is moderate, the authors hypothesized that FRO could be avoided. They developed a soft tissues procedure to improve HIR. The aim of the study was assessment of the procedure.In walking CP the authors selected patients presented with femoral anteversion less than 40 who were proposed for soft tissue procedure alone. Patients were previously tested with botulinum toxin injection of the hamstring muscles. The soft tissue procedure was: lengthening of semimembranosus, transfer of semitendinosus associated with tenotomy of the gracilis and gluteus minimus muscles. All the patients with pre and postoperative full data (clinical, kinematics and kinetics) were included. Data (i.e. foot intoeing, dynamic hip internal rotation in stance phase, hip rotation moment) were collected. Follow-up was at least one year after SEMLS.We collected 20 selected patients with 24 lower limbs studied. Rotation of the pelvis did not differ significantly (P=0.21). Hip rotation in stance phase (50%), presented significant improvement from 16.5 intoeing to 0.5 external rotation (P<0.0001). Feet angulation related to walking direction was significantly improved, from 13 intoeing to 0.5 external rotation (P<0.0001).HIR is a frequent gait disorder in CP. The etiology of the HIR seems to be related to muscles contractures and spasticity. Recently, soft tissue procedures were reported of interest in HIR. The soft tissue procedures presented improved significantly HIR making pointless FRO. Rehabilitation should be making easier.the authors improve significantly the HIR using a soft tissues procedure and advocated reducing indication for FRO in internal rotation of lower limbs in order to make easier rehabilitation after SEMLS.

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