X. Chaufour

Centre Hospitalier Universitaire de Toulouse, Toulouse, Midi-Pyrenees, France

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Publications (14)8.79 Total impact

  • Revue de Chirurgie Orthopédique et Traumatologique. 09/2009; 95(5).
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    ABSTRACT: Elbow dislocations are the most frequently encountered dislocations after shoulder dislocations. In their vast majority these injuries involve only the joint and carry a good prognosis. Close anatomic proximity to the joint of neurovascular structures put them at risk of concomitant injury but this occurrence remains, actually very rare. The objective of this study is to retrospectively analyze the results of nine cases of elbow dislocations with brachial artery complications and to propose coherent therapeutic guidelines derived from this experience. From 1999 to 2004, 357 elbow dislocations were treated by the traumatology team at the Purpan University Hospital and 340 at the Rangueil University Hospital in Toulouse, France. These two teaching institutions combined their series, contributing to seven dislocations associated with a brachial artery partial rupture, resulting in ischemia. Between 2001 and 2006 at the Le Mans Regional Hospital Center, 138 dislocations of the elbow were treated, and included two cases involving rupture of the brachial artery. In all these institutions' emergency departments, elbow dislocations were mainly treated on an outpatient basis: closed reduction under ultra short-acting products general anesthesia, with stability evaluation followed by cast immobilization. In the rare instances of ischemia, the artery was repaired in concert with the vascular surgery team. All the nine cases had a similar treatment protocol and were submitted to an identical outcome evaluation method. The patients were all males with a mean age of 37.3 years (range, 18-58 years). The combined injury occurred at sports in two cases, because of a fall in three cases and as a result of a traffic accident in four cases. Ischemia was complete in three cases (no radial or ulnar pulse and devascularized hand). In the six other cases, the clinical presentation was subacute. An arteriogram was obtained in five cases after reduction of the dislocation, confirming the brachial axis disruption. Median and/or ulnar nerve injury was suspected in six patients. Only five elbows remained stable after reduction allowing plaster cast immobilization. In the other cases, dislocation recurrence or consequential residual varus/valgus laxity required external fixation or a cross-pinning fixation. An autologous vein, brachial artery bypass was performed in eight cases and an end-to-end anastomosis was carried out in one case. Revascularization was reestablished between 4 and 19 h after injury (mean 10.5 h). All the patients were seen at a minimum of 2 years' follow-up (mean of 4.3 years). On the basis of Mayo Clinic score, the results were considered excellent in three cases, good in four cases, and poor in two cases. No patients complained of elbow instability. The X-rays showed a reduced elbow in all cases and heterotopic ossifications in three cases. No degenerative lesion was observed at the longest follow-up. The incidence of a combined vascular injury with dislocation remains difficult to establish because the literature reports sporadic short series of clinical cases. The prevalence of this association is estimated to be between 0.3 and 1.7% in hospitals. The vascular lesion risk is probably related to the displacement extent and this later as a consequence of the injury intensity. This context calls for a diagnostic warning signal of possibly associated vascular involvement. Assessment of arterial vascularization should be systematic and mandatory with any osteoarticular injury. The slightest vascular status clinical doubt after reducing any dislocation presses for vascular patency work-up: echo-Doppler, angio-scan, arteriography. The multi-parametric nature of these combined injuries explain why their sometimes disappointing outcome remains dependent on the ability to deal with contradictory healing concerns: skin condition, capsular, and ligaments damages, type of revascularization procedure used, joint stability after closed reduction. This last parameter, being a substantial determinant for the period of immobilization, appears crucial to the final functional outcome, particularly in terms of range of motion loss or residual flexion contracture. Level IV. Therapeutic retrospective study.
    Orthopaedics & Traumatology Surgery & Research 08/2009; 95(5):343-51. · 1.06 Impact Factor
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    ABSTRACT: Complex femorotibial dislocation of the knee joint generally results from high-energy trauma caused by a traffic or a contact sport accident. Besides disruption of the cruciate ligaments, in 10-25% of patients present concomitant palsy of the common peroneal nerve and more rarely disruption of the popliteal artery. The purpose of this work was to assess outcome in a monocentric consecutive series of knee dislocations with ischemia due to disruption of the popliteal artery and to focus on specific aspects of management. This retrospective series included eleven men and three women, aged 18 to 74 years (mean 47 years). The right knee was injured in five and the left knee in six. Trauma resulted from a farm accident in six patients, fall from a high level in two, a traffic accident in three and a skiing accident (fall) in one. Two other patients with morbid obesity were fall victims. Nine patients had a single injury, two presented an associated serious head injury, one a severe chest injury, and one multiple trauma with coma, chest contusion, and abdominal lesions. One patient had a fracture of the distal femur with associated ischemia. Five knee dislocations were open with a popliteal wound for three and a posteromedial wound for two. Four patients presented total sciatic nerve palsy and nine palsy of the common peroneal nerve. The dislocation was documented in ten cases: lateral (n=1), anterior (n=4), posterior (n=5). For four patients, the dislocation had been reduced during pre-hospital care. Preoperative arteriography was available for eight patients and confirmed the disruption of the popliteal artery; the diagnosis was obvious in six other patients who were directed immediately to the operative theatre without pre-operative imaging. Revascularization was achieved with a upper popliteal-lower popliteal bypass using an inverted saphenous graft. The graft was harvested from the homolateral greater saphenous vein in eight patients and the contralateral vein in six. On average, limb revascularization was achieved after 10.07 hours ischemia. Intravenous heparin was instituted for 810 days followed by low-molecular-weight heparin. The dislocation was stabilized by a femorotibial fixator in nine patients and a cruropedious cast in five. An incision was made in the anterolateral and posterior leg compartments in twelve patients. A revision procedure was necessary on day one in one patient because of recurrent ischemia; a second bypass using an autologous venous graft was successful. One other 75-year-old patient also presented recurrent ischemia on day five; the bypass was reconstructed but the patient died from multiple injuries. Seven thin skin grafts were used to cover the aponeurotomy surfaces. Mean duration of the external fixator was 3.4 months. The five patients treated with a plaster case were immobilized for 2.7 months on average. Ligament repair was performed in three patients (one lateral reconstruction and one double reconstruction of the central pivot for the two others). A total prosthesis with a rotating hinge was implanted in two patients aged 67 and 74 years after removal of the external fixator at six and seven months. Failure of the ligament repair also led to arthroplasty in a third patient. Blood supply to the lower limb was successfully restored as proven by the renewed coloration of the teguments and-or presence of distal pulses in 13 patients. Transient acute renal failure required dialysis in one patient. Four patients developed pin track discharges and there was one case of septic arthritis of the knee joint which was cured after arthrotomy for wash-out and adapted antibiotics. Outcome was assessed a minimum 18 months follow-up (average 22 months) for the 13 survivors. The three sciatic palsies recovered partially at five and six months in the tibial territory but with persistent paralysis in the territory of the common peroneal nerve. The nine cases of common peroneal nerve palsy noted initially regressed completely or nearly completely in three patients, partially in three and remained unchanged in three. The results were assessed as a function of the final knee procedure: outcome was satisfactory for the patients with a total knee arthroplasty. Outcome of the three ligamentoplasties was good in one, fair in one, and a failure in one (revision arthroplasty). Patients treated by immobilization without a second surgical procedure complained of joint instability with a variable clinical impact; their knee retained active flexion greater than 90 degrees and complete extension. An analysis of the literature and the critical review of our clinical experience was conducted to propose a coherent therapeutic attitude for patients presenting this type of trauma. The prevalence of disruption of the popliteal vascular supply in patients with knee dislocation is between 4 and 20%. The rate is closely related to that of injury to nerves and soft tissue. Ischemia should be immediately suspected in all cases of knee dislocation. The pedious and tibial pulses must be carefully noted before and after reduction of the dislocation to determine whether or not there is an organic arterial lesion. If the pulses are absent initially, they should be expected to reappear strong, rapidly and permanently after reduction. Otherwise, arteriography should be performed. Dislocation stretches the artery between two points of relative anchorage in the adductor ring and the soleus arcade to the point of rupture. Repair requires a bypass between the upper popliteal artery and the tibioperoneal trunk using an inverted saphenous graft because the walls are torn over several centimeters. The traumatology and vascular surgical teams must work in concert from the beginning of the surgical work-up in order to establish a coherent operative strategy founded on primary reduction of the dislocation, installation of a fixator and then vascular repair and aponeurotomy incisions. It would be preferable to wait until the bypass is proven patent and wound healing is complete before proposing ligament repair. This should be done after a precise anatomic work-up to assess each ligament lesion. Bony avulsion or simple disinsertion can however be repaired in the emergency setting at the time of the bypass as well as any ligament rupture which is obvious and-or situated on the medial collateral approach. Secondarily, elements of the central pivot can be repaired in young patients with an important functional demand. Arthroplasty is not warranted except in the elderly patient. Dissection of the popliteal fossa or debridement of the wound enables a careful anatomic assessment of the nerve trunks. In the event of a peroneal nerve disruption, it is advisable to fix the nerve ends to avoid retraction. Beyond three months without clinical or electromyography recovery, surgical exploration is indicated. In the event more than 15 cm is lost, there is no hope for a successful graft. Complete knee dislocation is extremely rare. It can be caused by high-energy trauma associated with several ligament ruptures, particularly rupture of the central pivot observed in 10-25% of cases with common peroneal nerve palsy. Compression, contusion or disruption of the popliteal artery is very rarely caused by the displacement of the femur or the tibia. Limb survival may be compromised. Mandatory emergency restoration of blood supply will modify immediate and subsequent surgical strategies. There has not however been any study exclusively devoted to double joint and vascular involvement. Our objective was to present a critical retrospective analysis of a consecutive series of knee dislocations with ischemia due to disruption of the common popliteal artery treated in a single center and to describe the specific features of management strategies for a coherent diagnostic and therapeutic approach.
    Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 01/2007; 92(8):768-77. · 0.37 Impact Factor
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    ABSTRACT: Quatorze luxations du genou avec interruption de l’axe artériel poplité ont été rétrospectivement analysées. Les circonstances du traumatisme étaient 6 accidents agricoles, 2 chutes d’un lieu élevé, 3 accidents de la voie publique et une chute à ski. Deux patientes, victimes d’une simple chute présentaient une obésité morbide. Neuf étaient mono traumatisés, 4 polytraumatisés et un patient présentait une fracture du fémur opposé. Cinq des luxations étaient ouvertes et 13 s’accompagnaient d’une paralysie partielle ou totale dans le territoire sciatique. Une luxation était latérale, 4 antérieures et 5 postérieures. Dans quatre cas, elle avait été réduite sur place. Huit artériographies préopératoires ont été réalisées. En moyenne, la revascularisation s’est faite en 10,07 heures après pontage poplité haut-poplité bas avec un greffon veineux saphénien. La luxation a été stabilisée par 9 fixateurs externes fémoro-tibiaux et par plâtre 5 fois. Des aponévrotomies des loges antéro-latérales et postérieures de jambe ont été pratiquées 12 fois. Deux patients ont présenté une récidive de l’ischémie : un patient a bénéficié avec succès d’un nouveau pontage, le second est décédé de son polytraumatisme. Les 3 syndromes paralytiques sciatiques totaux n’ont partiellement récupéré que dans le territoire tibial postérieur ; les 9 paralysies initiales du fibulaire commun n’ont régressé complètement que 3 fois et partiellement 3 fois. Une réparation ligamentaire a été effectuée chez 3 patients et une arthroplasties à charnière rotatoire chez 3 patients, deux en programmé chez deux hommes de 67 et 74 ans, l’autre après échec de la réparation ligamentaire. Parmi les patients traités uniquement par immobilisation, 5 se plaignaient d’une instabilité. Une analyse de la littérature et la révision critique des dossiers ont abouti à proposer une attitude cohérente devant ce type de traumatisme qui réclame une prise en charge multidisciplinaire, des indications larges de l’artériographie et doit intégrer dans les décisions thérapeutiques l’âge, les demandes fonctionnelles et la récupération neurologique.
    Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur. 12/2006; 92(8):768–777.
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    ABSTRACT: We report the case of traffic accident victim who suffered multiple injuries after being ejected from the vehicle. The patient suffered blunt trauma of the pelvis followed by acute ischemia of the lower limb. The initial work-up revealed minimally displaced fractures of the right and left obturator rings and the left sacral wing, as well as a non-displaced fracture of the anterior wall of the acetabulum. Computed tomography eliminated a compressive retroperitoneal hematoma. The mechanism of the injury was direct blunt trauma rupturing an atheroma plaque which led to thrombosis of the left common femoral artery. Thrombectomy three hours 30 minutes after onset of ischemia enabled complete sensorial and motor recovery. Awareness of this unusual type of injury can be helpful in conducting a rigorous physical examination to ensure rapid diagnosis and treatment.
    Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 03/2006; 92(1):64-7. · 0.37 Impact Factor
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    ABSTRACT: purpos of the studyComplex femorotibial dislocation of the knee joint generally results from high-energy trauma caused by a traffic or a contact sport accident. Besides disruption of the cruciate ligaments, in 10-25% of patients present concomitant palsy of the common peroneal nerve and more rarely disruption of the popliteal artery. The purpose of this work was to assess outcome in a monocentric consecutive series of knee dislocations with ischemia due to disruption of the popliteal artery and to focus on specific aspects of management.
    Revue De Chirurgie Orthopedique Et Reparatrice De L Appareil Moteur - REV CHIR ORTHOP REPARAT APP. 01/2006; 92(8):768-777.
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    ABSTRACT: Although elbow dislocations are common orthopaedic lesions, vascular complications remain rare. We report the cases of three patients who presented with a rupture of the brachial artery after closed posterior dislocation, which is even more uncommon. Arteriograms were performed in all cases because of the persistent absence of pulses at the wrist after emergency reduction. In each patient, the treatment consisted of the insertion of reversed end-to-end saphenous bridges. None of them presented mid-term vascular complications (mean follow-up, 17 months). Brachial artery disruption can result from closed posterior elbow dislocation and responds well to vascular repair.
    Journal of Vascular Surgery 01/2006; 42(6):1230-2. · 2.88 Impact Factor
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    ABSTRACT: We report the case of traffic accident victim who suffered multiple injuries after being ejected from the vehicle. The patient suffered blunt trauma of the pelvis followed by acute ischemia of the lower limb. The initial work-up revealed minimally displaced fractures of the right and left obturator rings and the left sacral wing, as well as a non-displaced fracture of the anterior wall of the acetabulum. Computed tomography eliminated a compressive retroperitoneal hematoma. The mechanism of the injury was direct blunt trauma rupturing an atheroma plaque which led to thrombosis of the left common femoral artery. Thrombectomy three hours 30 minutes after onset of ischemia enabled complete sensorial and motor recovery. Awareness of this unusual type of injury can be helpful in conducting a rigorous physical examination to ensure rapid diagnosis and treatment.
    Revue De Chirurgie Orthopedique Et Reparatrice De L Appareil Moteur - REV CHIR ORTHOP REPARAT APP. 01/2006; 92(1):64-67.
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    ABSTRACT: On the basis of our experience with more than 71 cases of totally laparoscopic aortic surgery by the retrocolic approach, we have developed a new technique by a simple transperitoneal approach. The purpose of this report is to describe that technique and the novel laparoscopic bowel retractor used to ensure stable exposure of the aorta.
    Journal of Vascular Surgery 06/2005; 41(5):902-6. · 2.88 Impact Factor
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    ABSTRACT: Upper thoracic sympathectomies, performed most of the time by coelioscopy, have become mildly aggressive interventions. Such procedure is primarily indicated for palmar and axillary hyperhidroses; it is also indicated in case of collagenosis-related disabling syndromes of Raynaud's disease, causalgias, distal arterial occlusions with thrombotic or embolic digital lesions, and lesions due to Buerger's disease. Thoracotomy is considered only in case of thoracoscopy failure or infeasibility. Other accesses are far less utilized. Ablation of the 2nd and 3rd thoracic sympathetic ganglia is sufficient for hand lesions; in case of axillary hyperhidrosis, further exeresis of the 4th and 5th ganglia is necessary. The only disadvantage related to this indication is the frequent postoperative compensatory hypersudation that involves both the thorax and the lumbar area, but which doesn't constitute a real complaint for the patients.
    EMC - Chirurgie 01/2005; 2(4):453-464.
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    ABSTRACT: Lower limb amputations related to progressive chronic occlusive arterial diseases have some specific patterns that differentiate them substantially from amputations due to traumas or tumours. Precise evaluation of the underlying arterial circulation, minimal surgical aggression, concern for the stump healing, nursing care, nutrition, diabetes and all risk factors control, are of up most importance in this disease; nevertheless, functional prognosis remains also an important concern. The goal is to determine the most adequate amputation level for preventing life-threatening infectious gangrene while preserving optimal functional status for walking, after a reinforcement and device fitting as rapid as possible.
    EMC - Chirurgie 01/2005; 2(4):396-409.
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    ABSTRACT: Splenic artery aneurysm is a rare but serious vascular disease. The mortality risk is 36% when one is ruptured. Surgical therapy has traditionally consisted in resection through a laparotomy. The authors' experience of a case of laparoscopic exclusion of a splenic artery aneurysm is reported. This surgical approach is simple, safe, and minimally invasive. This procedure should increase the indication for surgical treatment of a splenic artery aneurysm.
    Vascular and Endovascular Surgery 01/2003; 37(4):297-300. · 0.88 Impact Factor
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    ABSTRACT: To evaluate symptoms and results of the treatment of aneurysms of digestive arteries. Retrospective study of 23 patients (14 male and 9 female, mean age = 51 years) treated in two departments of academic hospital. We studied the aneurysms characteristics (location, number, size, etiology) the type of treatment, and occurrence of post-operative complications. The aneurysms involved the splenic artery in 13 patients (56%), the superior mesenteric artery in 5 patients (22%), the hepatic artery in 3 patients (13%), the gastroepiploic artery in 2 patients (9%). There were thirty-one aneurysms (24 true aneurysms and 7 pseudo-aneurysms) in 23 patients. Diagnosis was mainly done by the CT-scan. An aneurysm rupture occurred in 7 patients (30%). Treatment was surgery for 26 aneurysms (84%) or a radiological embolization in 3; abstention was decided for 2 aneurysms (6%). No death was observed. The bad prognosis after rupture, the lack of predictive factors of rupture combined with the good results of surgical treatment suggest to prefer a surgical treatment at first. Embolization could be reserved for the contra-indication of surgery and when aneurysms are poorly accessible to surgery.
    Annales de Chirurgie 05/2002; 127(4):281-8. · 0.35 Impact Factor
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    ABSTRACT: Study aim: To evaluate symptoms and results of the treatment of aneuryms of digestive arteries.Patients and method: Retrospective study of 23 patients (14 male and 9 female, mean age=51 years) treated in two departements of academic hospital. We studied the aneurysm caracteristics (location, number, size, etiology) the type of treatment, and occurence of post-operative complications.Results: The aneurysms involved the splenic artery in 13 patients (56%), the superior mesenteric artery in 5 patients (22%), the hepatic artery in 3 patients (13%), the gastro-epiploic artery in 2 patients (9%). There were thirty-one aneurysms (24 true aneurysms and 7 pseudo-aneurysms) in 23 patients. Diagnosis was mainly done by the CT-scan. An aneurysm rupture occured in 7 patients (30%). Treatment was surgery for 26 aneurysms (84%) or a radiological embolization in 3; abstention was decided for 2 aneurysms (6%). No death was observed.Conclusion: The bad prognosis after rupture, the lack of predictive factors of rupture combined with the good results of surgical treatment suggest to prefer a surgical treatment at first. Embolization could be reserved for the contre-indication of surgery and when aneurysms are poorly accessible to surgery.
    Annales de Chirurgie. 04/2002; 127(4):281–288.

Publication Stats

51 Citations
8.79 Total Impact Points

Institutions

  • 2006–2007
    • Centre Hospitalier Universitaire de Toulouse
      • • Service de Chirurgie Orthopédique et Traumatologique
      • • Service de Chirurgie Cardiovasculaire
      Toulouse, Midi-Pyrenees, France