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ABSTRACT: INTRODUCTION: Conventional capsulolabral reconstruction for anterior shoulder instability fails with recurrent instability in up to 23% of cases. Few studies have evaluated surgical revision strategies and outcomes. The objective of this study was to evaluate clinical and radiographic outcomes in a homogeneous series of surgical revisions after selective capsular repair (SCR). HYPOTHESIS: Observed anatomic lesions can guide the choice between repeat SCR and coracoid transfer (Latarjet procedure). MATERIALS AND METHODS: From January 2005 to January 2009, 11 patients with trauma-related recurrent anterior shoulder instability (episodes of subluxation and/or dislocation) after SCR were included. Mean age was 31 years (range, 19-45 years). At revision, a glenoid bony defect was present in six patients. Repeat SCR was performed in five patients and coracoid transfer in six patients. RESULTS: After a mean follow-up of 40 months (range, 24-65 months), no patient had experienced further episodes of instability. However, four patients had a positive apprehension test. External rotation decreased significantly by more than 20° after both techniques. The Simple Shoulder Test, Walch-Duplay, and Rowe scores were 10.5, 79, and 85, respectively. No patient had a subscapularis tear. Of these 11 patients, nine were able to resume their sporting activities and eight reported being satisfied or very satisfied with the subjective outcome. Radiographs showed fibrous non-union of the coracoid transfer in one patient. CONCLUSION: In patients with recurrent anterior shoulder instability after SCR, repeat SCR and coracoid transfer produce similarly satisfactory outcomes. The size of the glenoid bone defect may be the best criterion for choosing between these two procedures. However, open revision surgery may decrease the range of motion, most notably in external rotation. LEVEL OF EVIDENCE: Level IV.
Orthopaedics & Traumatology Surgery & Research 05/2013; · 0.94 Impact Factor
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ABSTRACT: Distal radius fractures represent 20% of fractures in adults. Although good results are usually obtained with treatment, functional sequelae are not uncommon, with injury of the distal radio-ulnar joint (DRUJ) being the most frequent. Various treatments have been described to address these disorders. Distal ulna resection-stabilisation (DURS) is our technique of choice when preservation of the DRUJ is impossible.
Twenty patients operated between 1985 and 1996 were reviewed with minimum 6-year follow-up. Nine of them were men and 11 were women, with an average age 45 years. The initial trauma was a distal radius fracture in all cases. The main complaint was ulnar pain with no limitation of mobility in five patients, painful limitation of prono-supination in 14, and palmar subluxation of the ulna in one case. Radiographic evaluation and CT scan showed DRUJ incongruence in 14 patients with ulna head instability, and ulno-carpal abutment with degenerative changes at the DRUJ in six cases. In three patients, malunion of the distal radius was associated with degenerative DRUJ lesions.
The satisfaction rate was 95% at an average follow-up of 11 years (range 6.7 to 18.6 years). Pain scores decreased progressively from 2.2 to 0.5 post-operatively. Range of motion improved in supination from 37 degrees to 80 degrees , and in pronation from 66 degrees to 84 degrees . Improvements were 15 degrees in ulnar inclination, 9 degrees in radial inclination, 16 degrees in flexion, and 23 degrees in extension. Distal ulna palpation was not painful, and no instability was observed on movement. Wrist strength was equivalent to 80.8% of the healthy contra-lateral side. Radiographic results showed no anomaly of the resected ulna, no sign of abutment on the radius and no ulnar translation of the carpus at follow-up. Only one patient, who presented algoneurodystrophic syndrome after the initial trauma, had a recurrence after DURS.
DRUJ injuries are frequent in the context of wrist trauma. If not well-treated, they could lead to significant functional sequelae of the wrist. Radiographic evaluation should clarify the status of the DRUJ to choose between conservative or radical surgical treatment. If the DRUJ surfaces are preserved, conservative treatment, which consists of correcting the distal radius malunion and stabilising or shortening the ulna, is the treatment of choice. When the DRUJ surfaces are injured, DURS is our treatment of choice. This approach presents a low complication rate and more than 90% of satisfactory results, often with a pain-free wrist, functional range of motion and good strength. However, a rigorous technique, with limited ulna head resection, dorsal capsuloplasty, reconstruction of the extensor retinaculum and dorsal placement of the extensor carpi ulnaris tendon, is a prerequisite for success.
Level IV retrospective therapeutic study.
Orthopaedics & Traumatology Surgery & Research 05/2010; 96(3):216-21. · 0.94 Impact Factor
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ABSTRACT: Thrombosis is still the first cause of microsurgery failure. Lots of publications have been made but no consensus exists. We first analysed the results of our study in 53 French expert surgeons, then we compared them with the last published datas, most of all, with the similar surveys. If a big majority (81 %) of the surgeons use a preventing method, we observed majors variations between them and also compared to the anglosaxons surgeons habits. This survey permits to make the point on today's practice and to show that some of them are based on low proof level and something even done without any medical references. After datas analysis, we observed that none of the medical treatments proved efficiency on preventing vascular thrombosis. The low molecular weight heparins (LMWH) could be used on postops without increase bleeding but not to lower specially the microvascular thrombosis rate. Aspirin did not improve the positive rates and its adjonction to LMWH increased the bleeding. Until scientific studies prove efficacy of a treatment, the surgeon has to make a personal choice: keeping habits or following evidence-based medicine.
Chirurgie de la Main 03/2010; 29(2):100-8. · 0.53 Impact Factor
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ABSTRACT: Total trapeziectomy remains the main surgical treatment of trapeziometacarpal osteoarthritis. Little has been reported on the long-term results of this technique. We report in this study our experience with our technique of trapeziectomy associated with interposition and suspension tendinoplasty using the abductor pollicis longus tendon with 78 months average follow-up.
Eighteen patients (22 thumbs) of 62.7 years average age underwent this procedure. According to Dell classification, there were two stage II, five stage III and 15 stage IV. Signs of osteoarthritis of the scaphotrapezoidal joint were associated in 19 cases.
At 78 months average follow-up, 73 % of the patients were painfree. Average opposition was 9.4 out of 10 according to Kapandji, the grip strength was equal to 18.5 kg and the key pinch to 4.4 kg. The quick DASH was equal to 20 over 100. Ninety-one percent of the patients were satisfied or very satisfied with the results. Space between scaphoïd and thumb metacarpal was 3.2mm and was down by 27 %. There were only two complications related to a reflex sympathetic dystrophy.
Trapeziectomy associated with interposition and suspension tendinoplasty gives satisfactory functional results which are maintained with follow-up with high satisfaction rate and low complication rate.
Chirurgie de la Main 02/2010; 29(1):16-22. · 0.53 Impact Factor
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ABSTRACT: Traumatic avulsion of the flexor digitorum profundus tendon or "jersey" finger is uncommon. Twenty patients have been reviewed at an average follow-up of seven years. Patients were seen less than three weeks from trauma in two-thirds of the cases, whereas in one third it was later. Loss of active flexion of the distal interphalangeal joint was the main complaint. Pure avulsions seen less than three weeks from the injury were all reinserted except one (10 out of 11). When the tendon avulsion was associated with a bone fragment (three cases), an osteosynthesis with K-wires was performed. Patients seen more than three weeks from the injury were treated with tendon resection in six, with a capsulodesis in four, and with a palmaris longus tendon graft in one. All reinsertions of the flexor digitorum profundus tendon performed less than three weeks from injury gave satisfactory results but a secondary rupture was observed in two. Satisfactory results were also obtained after avulsion of the tendon associated with bone fracture, but one patient developed osteoarthritis. Three out of five patients operated more than three weeks following the injury with tendon resection had satisfactory results. The patient with a palmaris longus tendon graft obtained an unsatisfactory result.
Chirurgie de la Main 08/2009; 28(5):288-93; quiz 277, 334. · 0.53 Impact Factor
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ABSTRACT: Partial trapezectomy with suspension and interposition tendinoplasty is an alternative to total trapezectomy or trapezometacarpal arthroplasty for the treatment of trapezometacarpal osteoarthritis. This technique preserves the thumb length allowing good motion and satisfactory pollicidigital strength. The purpose of the present study is to report our experience with this procedure reviewing a continuous monocentric series of 41 thumbs with an averaged follow-up of 5 years. Surgical technique, clinical and radiographic results, and indications are discussed.
Thirty-three patients (41 thumbs) of 57.4 years average age underwent this procedure. According to Dell classification there were 23 stage II, 15 stage III, and 3 stage IV. No sign of osteoarthritis of the scapho-trapezo-trapezoidal joint were noted. Clinical and radiographic evaluations were available for all the patients. Pollicidigital strength was measured with a dynamometer.
At 57 months average follow-up, 71% of the patients had no pain. Average opposition was 9.56 out of 10 according to Kapandji, the key pinch was equal to 6.51 kg, and M1M2 space was 34 degrees . Trapezometacarpal space was 2.52 mm on average. There were only 3 complications related to a reflex sympathetic dystrophy.
Partial trapezectomy with tendinoplasty gives satisfactory functional results which is maintained with follow-up. It allows recovery of a functional pollicidigital strength by limiting thumb shortening. It is a reliable procedure with a low rate of complication indicated for isolated thumb trapezometacarpal joint osteoarthritis without scapho-trapezo-trapezoidal joint involvement.
Chirurgie de la Main 05/2007; 26(2):103-9. · 0.53 Impact Factor
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ABSTRACT: The GUEPAR I total elbow arthroplasty is a nonconstrained implant used since 1985. Only one multicenter study has reported the mid-term results of this implant in rheumatoid arthritis. We presented a monocentric retrospective study evaluating the results of 19 GUEPAR I total elbow arthroplasty in rheumatoid arthritis with a mean follow-up of 67 months.
Between 1988 and 1996, 19 GUEPAR I total elbow arthroplasties have been performed on 16 patients (3 bilateral). There were 15 women and one man, averaged age 58 years. Radiographically, the elbow was classified as stage IIIA in 8 cases, and stage IIIB in 11 cases, according to the Mayo Clinic classification. A triceps splitting approach with tendon reflection was performed in all cases. A postoperative immobilization at 45 degrees extension was used for all patients during 21 days averaged, and active mobilization was then started.
At 67 months averaged follow-up (range, 2 to 12 years) the Mayo Elbow score improved from 36 to 75 points. The overall results were considered as excellent for 8, good for 5, fair for 2, and poor for 4. Nine elbows were totally painfree and six had minimum pain. Postoperative arc of motion reached 36 to 126 degrees in extension-flexion and 147 degrees in rotation. Eleven out of 19 elbows had a normal functional score. Two elbows dislocated and two others had a valgus instability lower than 10 degrees. There were thirteen complications affecting 11 of the 19 elbows (68%), and six of these eleven elbows had a revision procedure (31%): 3 peroperative medial column fractures, one postoperative medial column fracture which has been fixed, two elbow dislocated with one ulnar component revision, and 3 loosed implants which has been revised. There were persistent ulnar paresthesiae in two cases with a secondary neurolysis performed in one. Finally two infections developed 6 years after the initial procedure, one superficial, and one deep, which lead to removal of the total elbow arthroplasty.
The GUEPAR I total elbow arthroplasty is a nonconstrained implant indicated essentially in rheumatoid arthritis. Without intrinsic stability this implant must be contraindicated in front of bone stock deficiency, or chronic instability of the elbow. In selected cases the GUEPAR I total elbow arthroplasty offers a painfree elbow with a functional range of motion.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 06/2003; 89(3):210-7. · 0.37 Impact Factor
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ABSTRACT: Treatment options for unreduced anterior dislocation of the shoulder have varied from nonoperative treatment to different surgical options. Little has been written in the literature on the management of unreduced anterior dislocation or on the results of the different procedures. We report our experience and present the outcome after an open reduction joint-saving procedure used in five patients.
Five patients, mean age 39 years (range 17-69 years) underwent the joint-saving procedure for chronic anterior shoulder dislocation. Pain was predominant for two patients and functional impairment for three. The shoulder had been anteriorly dislocated for six weeks to up to 36 months (average 14 months). Open reduction was performed in all cases with reinsertion of the capsulo-labral complex onto the anterior glenoid rim. A bone graft was used in one patient to reconstruct an anterior glenoid bone defect involving more than half of the joint surface. No graft was used to fill the humeral head defect.
At an average follow-up of 25 months (range 12-36 months), outcome was excellent in one patient, good in three, and poor in one (Rowe and Zarins score). Postoperatively, the overall score averaged 75 points (range 40-90). Pain score improved from 12 to 27 points. Three shoulders were totally pain free and two had mild to moderate pain. Motion improved from 12 to 28 points. Anterior active elevation averaged 126 degrees, external active rotation 17 degrees, and internal active rotation to the level of the first lumbar vertebral body. Functional score improved from 9 to 20 points. All the patients were able to perform daily living activities. The radiographic evaluation showed anterior subluxation of one shoulder one year after surgery. Osteoarthritis was also noted in one patient. No peroperative or postoperative complication was seen.
Unreduced anterior shoulder dislocation should be treated with an open reduction and reconstruction of the specific lesions, unless the patient is old or debilitated. This operation can however be difficult and requires extensive soft tissue release, and occasionally use of a bone graft to reconstruct the anterior defect of the glenoid. The long-term results remain modest. When the humeral head cannot be saved because of extensive osteochondral lesions, shoulder arthroplasty must be the treatment of choice.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 03/2003; 89(1):19-26. · 0.37 Impact Factor
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ABSTRACT: Primary osteoarthritis of the glenohumeral joint is less common than that of the hip and knee, but it is not so rare. The use of prosthetic arthroplasty for the management of end-stage osteoarthritis remains the treatment of choice. We reviewed our experience of shoulder arthroplasties in 48 patients (51 shoulders) with 60 months average follow-up (24-124).
Forty-eight patients (51 shoulders) underwent shoulder replacement for primary osteoarthritis. There were 15 men and 36 women. Average age was 65 years. A total shoulder arthroplasty was performed in 43, and a hemiarthroplasty in 8. A Neer II monobloc implant was used in 27, and a modular implant in 24. The humeral implant was cemented in all cases but 3. An all-polyethylene cemented glenoid implant was used in all total shoulder arthroplasties. A rotator cuff tear was found in 8 cases.
According to Neer rating scale, an excellent result was found in 19 cases (37%), a satisfactory result in 27 (53%), and a non-satisfactory result in 5 (10%). According to Constant's criteriae, pain improved from 1.5 to 12 points, activity from 7 to 16.5 points, and mobility from 14 to 31 points. Active anterior elevation improved from 73 to 140 degrees, with a gain of 67 degrees; active external rotation improved from 9 to 40 degrees, with a gain of 31 degrees. Internal rotation improved also from the ability of the thumb to reach the sacrum to T12. The ponderated Constant score calculated for 22 patients was 91 p.cent. Radiographic analysis showed lucent lines around the humeral component in 10 cases (19%), and around the glenoid in 29 cases (67%). A complete lucent line not greater than 1mm size, was present in only 15 glenoid implants (35%). There was no case of component loosening in our series at the longest follow-up, as well as no revision procedure. Only the preoperative rotator cuff status influenced statistically the final result. Best results were obtained with total shoulder arthroplasties compared to hemiarthroplasty, and with modular implants compared to monobloc.
Shoulder arthroplasty has become the standard for the treatment of primary osteoarthritis. Proximal humeral head prosthetic replacement can be a very successful procedure in patients with glenohumeral arthritis; however the degree and consistency of pain relief is not as great nor as predictable as in total shoulder arthroplasties. Also, clinical results seem to deteriorate with time. Revision rate is approximatively of 20%, usually for persistant pain. The clinical results of total shoulder arthroplasty continue to be excellent with longer follow-up period. The frequency of complications and the need for revision is low. However, when revision surgery is needed, the most common reason is for glenoid loosening. Good results can be expected especially in primary osteoarthritis with pain relief in almost all cases, good motion (three-fourths or four-fifths normal), improvement of functional activities, and patient satisfaction in at least 90% of the cases.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 11/2002; 88(6):544-52. · 0.37 Impact Factor
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ABSTRACT: Little work has been devoted to femoral shaft fractures in the elderly, contrasting with the data available for proximal neck or trochanteric fractures. The purpose of this study was to determine the epidemiological and clinical features of femoral shaft fractures in the elderly from a retrospective series of 58 patients who underwent locked intramedullary nailing procedures with Grosse and Kempf (GK) or long gamma (GL) nails.
The series included 38 women and 20 men, mean age 83.6 years, who suffered a fracture of the femoral diaphysis due to a fall at home (49 fractures), a traffic accident (8 fractures) or a high-energy fall (1 fracture). Prior to the fracture, 10 patients had homolateral osteoarthritis and two had a contralateral hip arthroplasty. Twenty-six patients were in very good health, 19 had a history of cardiovascular disease, 9 had diabetes and 12 suffered parkinsonian syndromes or dementia. The ASA score was I in 24, II in 23 and III in 11. The diaphyseal fracture was isolated in 31 cases and associated with trochanteric involvement in 27. The upper third of the femur was involved in 37 cases, the middle third in 7 and the lower third in 14. Generally there was a simple spiroid subtrochanteric fracture line (36 cases), or a torsion wedge with or without a proximal extension. Mean delay to surgery was 1.9 days. Subtrochanteric fractures with a proximal line were stabilized with a GL (34 nails) and diaphyseal fractures with a GK (24 nails). Mean duration of the procedure was 1.9 for GL and 2 hours for GK. In 22 cases (17 GL and 5 GK), a minimally invasive access was needed to achieve reduction or stabilization during reaming and insertion of complementary fixation (3 screw fixations, 7 cerclages).
Six patients died before six months, 4 during the initial hospitalization. Twenty patients experienced general complications: 7 cases of phlebitis and 5 "end-of-life" syndromes. Infection occurred in 3 cases including one septic arthritis leading to a bedridden situation. A new fracture beyond the ends of the implant occurred in 2 others. The upright position was achieved within 31 days and total weight bearing within 69 days. Bone fusion was achieved at 4 months (mean). Six patients died between 6 and 12 months, giving a 20.6% mortality at 1 year. Clinical outcome at 12 months was available for 42 living patients: 21 were walking without assistance, 7 used a cane, 8 required crutches or another assistance device and 6 were bedridden.
The general and functional prognosis of femoral shaft fractures in the elderly is the same as for proximal fractures. These diaphyseal fractures can be individualized due to their characteristic mechanical and anatomic features: composite fracture with a rotation element involving the distal portion of the trochanter and the proximal quarter of the diaphysis. Several types of ostheosynthesis have been proposed for fixation. Locked intramedullary nailing has been found to be effective despite the difficulty in reduction, especially for particularly proximal fractures. There is a risk of iterative fracture in the transition zones between the femoral component and the osteoporotic bone.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 03/2002; 88(1):41-50. · 0.37 Impact Factor
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ABSTRACT: The question remains unanswered regarding the role of repair of medial ligament injuries associated with subluxation of the elbow and non-reconstructable radial head fracture and whether or not this will decrease the risk of chronic instability and cubitus valgus. The goal of this study was to define the role of the medial ligamentous complex of the elbow in elbow instability and to describe the anatomy of the complex in 35 fresh-frozen cadaver elbows. We documented medial ligamentous complex anatomy and compared our results to those in the literature. 25 elbows were dissected in order to describe the different bundles of the medial ligament complex and to precise the positions of the elbow that placed each in tension; section of the different ligamentous bundles was done to study the role of each in elbow stability. 10 other elbows were dissected and used for the ligamentous section studies which were performed subcutaneously. We found two bundles at the level of the anterior portion and termed them superficial and deep. Section of the anterior bundle lead to posterior subluxation of the elbow at 30-100 degrees flexion in both supination and pronation. Posterior subluxation was obtained after an anterior capsulotomy; medial epicondylectomy did not compromise the stability of the elbow after a complete section of the insertion of the deep fibers of the anterior bundle. Elements thus required for stability of the elbow are integrity of the articular surface of the humerus and the ulna, and the anterior bundle of the medial ligamentous complex.
Surgical and Radiologic Anatomy 10/2001; 23(5):301-5. · 1.06 Impact Factor
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ABSTRACT: A retrospective series of 40 patients who underwent simultaneous intramedullary nailings for bilateral femoral shaft fractures was analyzed. The aim of our study was to verify that simultaneous nailing without reaming does not increased risk of fat embolism and to assess clinical and radiological outcome.
This series included 27 men and 13 women, mean age 27.8 years, who underwent first intention intramedullary nailing between 1986 and February 1999. Thirty-two patients had multiple fractures. Mean ISS was 23 (range 9 to 59). Among the 80 femoral shaft fractures, 15 were open fractures, 3 were associated with sciatic paralysis, and 4 were complicated by an interruption of the femoral vessels. The AO classification was: type A=44; type B=25; type C=11. Mean delay to simultaneous centromedullary nailing was 3. 8 days: surgery was performed on the day of arrival for 25 patients. General anesthesia was used in all cases with respiratory assistance (FIO(2) =50 to 100 p. 100). Mean nail diameter was 11.6 (range 10-14). Gurd criteria and PaO(2) were followed to assess pulmonary function. Clinical and radiological outcome was assessed using the modified Thorensen criteria.
Preoperatively, PaO(2) was< 87 mmHg in 8 patients. Four of these patients showed a discrete drop off and three improved well above the normal level. Only one patient experienced an important decrease but did not develop respiratory distress. Among the 32 patients with a normal level preoperatively, PaO(2) remained in the normal range in 18, fell to a limit level but below 87 mmHg in 4, and showed a substantial drop off of 46 to 172 mmHg in 10. Two of these 10 patients developed respiratory distress due to fat embolism which was fatal in one case. One other patient died in the immediate postoperative period of an undetermined cause. All of the other patients recovered normal gas levels within a few hours or days. There were four cases of phlebitis, including one with pulmonary embolism, one case of respiratory distress by pulmonary superinfection, and one case of septicemia. Both femoral fracture sites became infected in one patient. Malunion occurred in two cases. Two vascular repairs of the femoropopliteal axis were unsuccessful, leading to above knee amputations. Thirty-four patients have been examined after a minimal 12 months follow-up (mean 30 months). Outcome was excellent for 48 femurs, good for 10 and fair for 10.
This continuous series of simultaneous bilateral femoral shaft intramedullary nailings appears to be the only such report to date. The clinical and radiological outcomes were comparable with those achieved in one-side femoral fractures. The risk of fat embolism is inevitable after long bone fractures. Many factors favoring the risk are recognized, the most important being delay to fixation. Reaming creates excessive pressure in the medullary canal and could thus contribute to the risk. The presence of an associated chest trauma is not a formal contraindication if effective hematosis is preserved as evidenced by the blood gases.
Simultaneous nailing of bilateral femoral shaft fractures can be performed if blood gases remain acceptable and minimal reaming is used.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 10/2000; 86(6):598-607. · 0.37 Impact Factor
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ABSTRACT: We retrospectively determined by computed tomography torsionnal abnormalities and length discrepancies after diaphyseal tibial and femoral fractures treated by intramedullary nailing.
Eighty femoral fractures and 89 tibial fractures were evaluated after healing. All these patients were treated by Grosse-Kempf intramedullary locked nail. AO classification was used: there were 16 type A, 32 type B and 32 type C, femoral fractures. Tibial fractures were 48 type A, 29 type B, and 12 type C. Reaming was systematic, 90 per cent of the nailing were static.
We measured comparatively length and torsion of tibias and femurs after bone healing and tried to find statistical correlation between clinical, epidemiological, anatomical factors and CT measurements.
For the femur the mean difference in torsion was 9.9 degrees (max. -21 degrees min. +45 degrees) 52.5 per cent had the same measurements in intact and fractured side. For tibias the mean torsionnal value was 6.84 degrees. Seventy three per cent of patients had the same torsion in intact and fractured side. The mean femoral length discrepancy was 6.3 mm (max. -25 mm min. +19 mm) and 4.1 mm (max. -19, min. 20 mm) for the tibia. There were no statistical correlation.
Even though there is no clinical sign after torsionnal abnormalities in our patients, hip, knee or ankle arthrosis is possible after nailed shaft fracture. A long term follow-up is necessary. A prospective study will be necessary in order to assess the exact frequency of these malalignements.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 10/1998; 84(5):397-410. · 0.37 Impact Factor
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ABSTRACT: This study is a retrospective analysis of 38 extra-articular distal tibial fractures treated by intramedullary locked nailing.
38 patients with a distal metaphyseal extra-articular fracture (43 A AO type) or with minimal ankle joint extension were managed. There was 26 men and 12 women with a mean age of 32.3 years, 10 fractures were open. The fractures were transverse or oblique in 13 cases, with torsional or flexion wedge in 12 cases and spiroïd in 13 cases. In only 2 cases was the fibula intact. AO classification was not useful because many fractures began more proximally than the limit described by Müller. All the fractures were fixed by closed locked intramedullary nailing : the nail was cut just after the distal hole and impacted close to the subchondral plate. In 7 cases the fibula was fixed too.
There was no postoperative complication in 27 cases. Three patients had a transient nerve palsy (one tibial nerve and two common fibular nerve). In ten cases the nail was dynamized. One patient had a non union but healed with a new dynamic nail. Two patients had a delayed union and healed after dynamization and osteotomy of the fibula. The mean time to union was 5 months (2 to 8). 8 patients had a varus or a valgus deformity of 3 to 6 degrees. 11 patients suffered from anterior knee pain and in 5 patients the fracture site was painful. In 18 patients a CT scan was performed : 6 had a rotational deformity from 4 to 26 degrees, and 2 a tibial lengthening (discrepancy of 7 and 9 mm).
Closed intramedullary nailing is a safe and effective method for the treatment of distal metaphyseal tibial fractures. The authors propose a new classification.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 02/1996; 82(5):428-36. · 0.37 Impact Factor
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ABSTRACT: The aim of this study was a better understanding of the role of the vascular supply as a pathogenic factor in rotator cuff disease. Twenty-five shoulders from unembalmed cadavers were studied after injection of the upper limb aa. with barium sulfate. The predominant arteries were the vessels of the subscapularis m. These branches originated from the axillary a. the anterior circumflex humeral a., and the posterior circumflex humeral a. The supraspinatus m. was supplied by the suprascapular a. but the acromial branch of the thoracoacromial a. supplied the tendon of the supraspinatus. The infraspinatus and teres minor tendons were vascularised by the ascending branches of the posterior circumflex humeral a. The tendon of the long head of the biceps brachii m. was supplied by a branch termed the "arcuate artery" and by a branch we describe derived from the brachial a. at the level of the latissimus dorsi tendon and travelling in a true mesotendon. There is a very real critical zone, with a lesser blood-flow, 1.5 cm from greater tubercle, situated mainly at the supraspinatus tendon. This is a convergence zone of the anterior and posterior circumflex humeral aa., the suprahumeral a. and the thoracoacromial a. The histologic studies confirmed the poor vascularity of this critical zone.
Surgical and Radiologic Anatomy 02/1996; 18(3):195-200. · 1.06 Impact Factor
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ABSTRACT: The authors present a short series of 30 displaced fractures of the neck of the fifth metacarpal. All fractures were treated by K-wire nailing according to the method described by Fourcher in 1976. The good results confirm the advantages of this technique, allowing early mobilization and rehabilitation. The poor results are due to faults in the use of the method, and the authors emphasize these technical errors.
Annales de Chirurgie de la Main et du Membre Supérieur 02/1991; 10(5):463-8.
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ABSTRACT: Twenty-nine patients were treated in the department of orthopedic surgery of Purpan (Toulouse), with thirty-five chondromata of the hand. Follow-up was over one year. Chondroma is a bone tumor predominantly of the left side, second ray of the hand and phalanx. Some multifocal cases have been observed. The diagnosis was made in half the cases through a pathological fracture. Chondroma is characterized by a diaphyseal or a metaphyso-diaphyseal lacuna, wearing away the cortical bone. Treatment consisted of curetting the tumor and filling the cavity with iliac cancellous bone graft. The clinical result was been excellent in 15 cases (60%), good in 6 cases (25%), with only some residual pain, and/or digital swelling. In two cases the finger was stiff, but functionally not disabling. In one case the stiffness was important and very disabling; after several recurrences it evolved into a chondrosarcoma.
Annales de Chirurgie de la Main 02/1988; 7(1):32-44.
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Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 02/1988; 74(8):718-20. · 0.37 Impact Factor
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Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 02/1988; 74(8):689-92. · 0.37 Impact Factor
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ABSTRACT: In this experimental study the authors show that partial intercarpal fusions performed on the first carpal row, and not involving the mediocarpal joint, only very slightly limit the mobility of carpal movements: particularly dorsal flexion and radial deviation. Thirty intercarpal fusions were performed with 15 wrists from embalmed cadavers using staples. The range of motions was measured on roentgenograms before and after stapling. The loss of motion was calculated for each type of "partial intercarpal fusion". We present the results with the average loss of motion in percentage and we discuss the indications of these intercarpal fusions, giving for each one the biomechanical explanation of the effects of these intercarpal fusions.
Annales de Chirurgie de la Main 02/1987; 6(4):269-75.
