Anne-Laure Simon

A Descriptive Study of Lower Limb Torsional Kinematic Profiles in Children With Spastic Diplegia.

Background: Lower limb rotational anomalies in spastic diplegic children with cerebral palsy (CP) are common and difficult to identify through physical examination alone. The identification and treatment of the overall rotational disorders must be considered to restore physiological lever-arms lengths and lever-arms orientation. The aims of the study were to assess the prevalence of lower limb rotational malalignment and to describe the distribution of the different kinematic torsional profiles in children with spastic diplegia. Methods: Instrumented gait analysis data from 188 children with spastic diplegia were retrospectively reviewed. None of the patients had undergone surgery previously or received botulinum toxin treatment within 6 months before the review. Kinematic data, collected at the midstance phase, included: pelvic, hip, and ankle rotation and foot progression angle. Results: The prevalence of kinematic rotational deviations was 98.4%. Sixty-one percent of the children walked with an internal foot progression angle and 21% exhibited external alignment. The pelvis was internally rotated in 41% of the cases and externally in another 27%. Hip rotation was internal in 29% and external in 27% of the cases. Ankle rotation was internal in 55% and external in 16% of the cases. Lower limb rotational anomalies involved more than one level in 77% of the limbs. A kinematic compensatory deviation was identified in at least one level in 48% of the limbs. Conclusions: Kinematic rotational anomalies were identified in nearly all the 188 children in the study. The multilevel involvement of lower limb malalignment was not systematically associated with compensatory mechanisms between the levels. Ankle rotational anomalies were the most frequent cause of lower limb torsional deviations followed by pelvic malalignment. Level of Evidence: Level IV.

Can turned inward patella predict an excess of femoral anteversion during gait in spastic diplegic children

Background: Determining patellar orientation in the transverse plane during observational gait analysis is a fundamental aspect of physical examinations. Many physicians consider that an abnormal position of the patella in the transverse planes is only explained by a rotational abnormality of the proximal femur. Methods: A total of 188 spastic diplegic children with cerebral palsy were reviewed (376 lower limbs). The physical examination included observation of patellar orientation at midstride and measuring femoral anteversion (FA). All patients also underwent 3-dimensional (3D) computerized gait analysis of pelvic and hip rotation kinematics. Results: Observational gait analysis and videotapes found 103 children (206 lower limbs) with inturned patella at midstance. Kinematic data from 3D gait analysis showed that the visual impression of turned inward patella was erroneous in 48 limbs. Of the remaining 158 lower limbs, 117 (74%) exhibited excessive FA and 41 (26%) did not. Of the 117 with excessive FA, kinematics showed only 66 (56%) with excessive internal hip rotation (with or without excessive internal pelvic rotation). Of the 41 lower limbs without excessive FA, 25 were explained by excessive internal pelvic rotation and 16 were explained by excessive internal hip rotation (isolated spasticity and/or contracture of internal rotator muscles). Turned inward patella was caused by isolated excessive internal pelvic rotation in 48%, excessive internal hip rotation in 35% (including 44 cases with excessive FA and 12 cases with isolated spasticity and/or contracture of internal hip rotators), and excessive internal hip rotation combined with excessive internal pelvic rotation in 17%. Conclusions: Excessive FA was not the only cause of turned inward patella gait and could not explain this gait anomaly by itself. Excessive internal pelvic rotation was the most frequent cause of turned inward patella gait. Level of Evidence: Level IV.

Temporal Association between Rhinovirus Activity and Kingella kingae Osteoarticular Infections

Objective To determine whether the seasonal distribution of Kingella kingae osteoarticular infections is similar to that of common respiratory viruses. Study design Between October 2009 and September 2016, we extracted the results of K kingae–specific real‐time polymerase chain reaction analyses performed for bone or joint specimens in patients from 2 pediatric tertiary care centers in Paris. We used data of respiratory virus detection from the Réseau National des Laboratoires network with coordination with the National Influenza Center of France. The Spearman rank correlation was used to assess a correlation between weekly distributions, with P < .05 denoting a significant correlation. Results During the 7‐year study period, 322 children were diagnosed with K kingae osteoarticular infection, and 317 testing episodes were K kingae–negative. We observed high activity for both K kingae osteoarticular infection and human rhinovirus (HRV) during the fall (98 [30.4%] and 2401 [39.1%] cases, respectively) and low activity during summer (59 [18.3%] and 681 [11.1%] cases, respectively). Weekly distributions of K kingae osteoarticular infection and rhinovirus activity were significantly correlated (r = 0.30; P = .03). In contrast, no significant correlation was found between the weekly distribution of K kingae osteoarticular infection and other respiratory viruses (r = −0.17, P = .34 compared with respiratory syncytial virus; r = −0.13, P = .34 compared with influenza virus; and r = −0.22, P = .11 compared with metapneumovirus). Conclusion A significant temporal association was observed between HRV circulation and K kingae osteoarticular infection, strengthening the hypothesis of a role of viral infections in the pathophysiology of K kingae invasive infection.

Test-retest reliability of an instrumented electronic walkway system (GAITRite) for the measurement of spatio-temporal gait parameters in young patients with Friedreich’s ataxia

BACKGROUND Friedreich ataxia (FRDA) affects the spatio-temporal parameters (STP) of gait. To our knowledge, proper tools to measure the variability of ataxic gait have not been validated yet. The aims of the present study were: (1) to measure the reproducibility of STP and gait scores in young patients with FRDA and (2) to describe the characteristics of gait parameters in this population. METHODS Thirty-six patients (18 males, 18 females) with diagnosis of FRDA (mean age 16.4 ± 4.5 years) were asked to walk barefoot at a self-selected pace along the pressure sensitive walkway (GAITRite®). Three trials were recorded for each patient and repeated 48 h later. Collected data was put into statistical analysis tests to determine reliability and variability of STPs and two other gait scores: The Functional Ambulation Performance score (FAP) and the Gait Variability Index (GVI). RESULTS All STPs showed strong or very strong reliability (ICC > 0.7) and a low variability. The two parameters showing the lowest reliability (0.71 and 0.74) were the base of support and the foot progression angle. The FAP score and the GVI showed strong reliability (ICC > 0.8). CONCLUSIONS The GAITRite system allows feasible and reliable measurements of gait parameters in young patients with FRDA. Lower reliability found for the weakest parameters was attributed to the software automatic errors and the ankle laxity noted in every patient.

Conservative treatment of pediatric thoracic and lumbar spinal fractures: outcomes in the sagittal plane.

To assess sagittal plane spinopelvic balance and functional outcomes in a pediatric cohort of patients with a thoracic and/or a lumbar fracture treated conservatively. A multicentric study retrospectively reviewed radiological and functional outcomes (mean follow-up 49 months) of 48 patients (mean age 12 years) with thoracic and/or lumbar spinal fractures that occurred between 1996 and 2014. Demographic data and radiological spinopelvic parameters were analyzed. Functional outcome was evaluated by a telephone interview. First, a comparison between the initial and the last follow-up full-spine radiographs was performed for the assessment of bone remodeling and sagittal plane balance. Then, patients were classified into two groups (group 1: Risser⩽2 and group 2, Risser>2) to assess the influence of skeletal maturity on the restoration of a correct sagittal balance. A total of 62% of the patients were at skeletal maturity at the final follow-up (Risser 4 and 5). Patients with a Risser grade of 2 or less had a higher remodeling potential. The mean residual local kyphosis in thoracic and lumbar fractures was, respectively, 8.2° and 8.7°. The mean thoracic global kyphosis remains stable at the last follow-up, in contrast to lumbar lordosis, which increased significantly. Sagittal plane global measurements on the basis of the C7-plumbline remained unchanged at the last follow-up. There was no change in the pelvic parameters, except for the sacral slope in the group 1 for patients with a lumbar fracture. The current study confirms a greater correction in younger patients (Risser⩽2) in spinal fractures and reported that thoracic fractures have a higher remodeling potential than lumbar fracture. A local kyphosis of almost 10° remained at the last follow-up. However, no deterioration in the sagittal plane balance was found. This suggests compensatory mechanisms in adjacent structures for children and adolescents and excludes the only hypothesis of bone remodeling.

Correlation between transverse plan kinematics and foot progression angle in children with spastic diplegia.

In diplegic patients, the orientation of foot progression depends on multiple factors. We investigated the relationship between foot progression alignment, hip and pelvic rotations during gait, femoral anteversion, and tibial torsion. Kinematic and clinical parameters were evaluated for 114 children who walked independently and had not undergone previous surgery. Causes of intoeing presented combined in 72% of cases. Internal foot progression correlated with internal hip rotation and showed an inverse correlation with tibial torsion. Our results indicate that data from clinical examination and gait analysis should be evaluated carefully before making treatment recommendations, especially in terms of the correction of torsional problems, in patients with cerebral palsy.

Post-traumatic cyst-like lesion in children: case report and the literature review.

Reports of post-traumatic cyst-like lesions in children are rare. These lesions occur between 1.5 and 3 months after a fracture. They are more frequent after a distal radius greenstick fracture. Conventional radiographs show a metaphyseal radiolucent lesion inside the most recent subperiosteal bone, adjacent to the initial fracture line. Post-traumatic cyst-like lesions are benign, asymptomatic, nonexpansive, and regress spontaneously. Two typical cases are described in the following report with a literature review of the etiology and main features of these lesions.

La rotation du bassin : une donnée trop souvent méconnue dans l’évaluation des troubles rotatoires de l’enfant paralysé cérébral diplégique spastique

CO04-003-f La rotation du bassin : une donnée trop souvent méconnue dans l’évaluation des troubles rotatoires de l’enfant paralysé cérébral diplégique spastique A.L. Simon *, C. Mallet, A. Presedo, B. Ilharreborde, K. Mazda, G.-F. Penneçot Service de chirurgie infantile traumatologique et orthopédique du Pr. Mazda, hôpital Robert-Debré, 48, boulevard Serrurier, 75019 Paris, France *Auteur correspondant. Adresse e-mail : annelaure_simon@hotmail.com.