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ABSTRACT: We present our therapeutic strategy for the treatment of type IIIB open tibial fractures. It involves emergency internal stabilisation of the bone by locked intra-medullary nailing when appropriate and skin cover using either a pedicled or free muscle flap. Where there is bone loss, a cancellous iliac graft is performed at the same time. Eighteen cases of type IIIB open tibial fractures treated between 1986 and 1995 were analysed. There were 17 men and 1 woman; the average age was 35 years. Each of the 18 patients underwent wound debridement as a primary emergency procedure with no secondary reoperation. Bone fixation was performed by locked intra-medullary nailing (AO nail, How Medica) 6-10 h after trauma. A primary cancellous iliac bone graft was performed in three cases. Cover was applied immediately after nailing (muscular pedicle flaps in 12 cases, muscular free flaps in 6 cases). Local flap cover led to two failures: both these fractures were followed by postoperative complications. The 6 free muscle flaps were successful. The average time to bone union was 6.5 months (range: 3-18.5 months) according to clinical criteria and 9 months (range: 4-27 months) according to radiological criteria. Out of the 18 fractures, 13 were primarily united (72.2% of cases); 3 involved osteitis and 2 nonunion. Sixteen patients were examined again with a mean follow-up of 4.8 years (range: 1-11 years). Six moderate malunions occurred; none needed surgical reoperation. Ankle motion was normal in 7 cases and reduced to below 50% in 9 cases when compared with the healthy ankle. Thirteen patients resumed their previous professional activities. This surgical strategy reduces bone union time, the number of operations and the time spent in hospital; it improves functional results.
British Journal of Plastic Surgery 10/1999; 52(6):462-70. · 1.29 Impact Factor
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ABSTRACT: The authors present their experience about intramedullary nailing in tibial shaft fractures in a serie of 551 cases. Closed fractures represent 330 cases (60%) and open fractures type I, II, III represent 221 cases (40%). intramedullary nailing had been performed in emergency, especially in open fractures (even type III) associated whenever it was necessary with a plastic procedure in the same operative stage. Patients had been reviewed up to consolidation and the mean follow up date was 20 months. The main complication (6.7%) was infection. The authors noticed an infection rate directly proportional to the open type of fracture. The mean consolidation time based on objective radiologic data was 24 weeks. Other complications were few in particular malunion (3%). The functional results and articular motion were very good. The authors defend intramedullary nailing because of the low rate of complications and the possibility of early mobilisation. Finally, they suggest the possibility of using this technic in emergency in open fractures type III under cover of the management of the cutaneous problem.Les auteurs prsentent leur exprience de l''enclouage centro-mdullaire des fractures de jambes propos d''une srie de 551 cas. Les fractures fermes reprsentaient 330 cas (60 %) alors que les fractures ouvertes de type I, II et III reprsentaient 221 cas (40 %). L''enclouage a t ralis en urgence et tout particulirement dans les fractures ouvertes (y compris pour les fractures de type III) avec quand cela tait ncessaire des gestes de couverture dans le mme temps opratoire. Les patients ont t suivis jusqu'' consolidation avec un recul moyen pour la srie de 20 mois.La principale complication (6,7 %) tait l''infection. Les auteurs ont not un taux d''infection croissant en fonction du type d''ouverture. La moyenne de consolidation sur des critres objectifs radiologiques tait de 24 semaines. Les autres complications taient trs faibles avec en particulier un taux de cals vicieux de 3%. Les rsultats fonctionnels et la mobilit articulaire taient trs bons. Les auteurs dfendent la technique de l''enclouage centro-mdullaire en raison du faible taux de complication et de la possibilit de mobilisation prcoce. Enfin, ils suggrent la possibilit d''utilisation de cette technique en urgence dans les fractures ouvertes de type III sous rserve d''une matrise dans le mme temps opratoire des problmes de couverture.
European Journal of Orthopaedic Surgery & Traumatology 08/1997; 7(3):153-157. · 0.10 Impact Factor
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ABSTRACT: Seven cases of acute and closed traumatic dislocation of the trapezio-metacarpal joint treated by percutaneous pinning adapted by Wiggins are reported with an average follow-up of eight years. Seven patients (five men and two women) aged 18 to 62 were treated. The injury was due to a road traffic accident in four cases. The dominant hand was injured in six cases. The metacarpal base was always dislocated dorsally and closed reduction always remained unstable. All cases consisted of closed dislocation but in two cases dislocation was associated with upper limb fractures. On the initial radiographs no patients had degenerative changes. All patients were treated as an emergency or the following during the days injury by reduction and stabilization by one or two percutaneous kirschner wires followed by a scaphoid cast for three to six weeks. All patients were followed and reviewed for this study between two and thirteen years (mean eight years) after injury. Enquiries were made about return to work, pain, stability, range of movement, key-pinch and grasp compared with the uninjured side. The joint was examined radiographically with particular attention to the presence of subluxation and degenerative changes. 2 patients with associated complex injury of the upper limb developed reflex sympathetic dystrophy. 2 patients had moderate pain, 2 patients had limitation of joint movement, 1 patient presented a reduction of strength (pinch and grasp) but none had subluxation, instability, or degenerative changes. Closed reduction and stabilization by percutaneous pinning is a simple method and gives good or excellent results in the treatment of acute traumatic dislocation of the trapezio-metacarpal joint.
Annales de Chirurgie de la Main et du Membre Supérieur 02/1997; 16(2):102-10.
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ABSTRACT: PURPOSE OF THE STUDY: The authors report a rare case of an isolated palmar dislocation of the distal radio-ulnar joint (DRU). Diagnosis was easily established in emergency even though this lesion is usually unknown in 50 per cent of cases, according to literature. CASE REPORT: A surgical approach was necessary because of irreducibility of the lesion: ulna and radius were hitched with no other anatomical interposition. Treatment succeeded and the functional result was good with only 25 degrees of loss of pronation. This suggests a commentary on DRU joint physiology, on the mechanism of dislocation, and on the methods of treatment.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 02/1996; 82(3):255-59. · 0.37 Impact Factor
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ABSTRACT: Les résultats de 27 implants de Swanson de trapèze sont analysés avec un recul moyen de trois ans. 56 % des opérés s’estiment
satisfaits de l’opération alors que 46 % sont peu satisfaits voire mécontents. Les mauvais résultats sont en rapport avec
une synovite péri-prothétique (4 cas), une luxation de l’implant (2 cas), ou une algodystrophie (4 cas). Au total, dans 4
cas une ablation simple de l’implant a été nécessaire. Dans les cas favorables, l’amélioration porte sur la douleur constamment.
La mobilité est améliorée pour un effectif majoritaire. En revanche, la force n’est pas augmentée de façon significative.
The results of 27 silicone implant arthroplasties using in the treatment of trapezo-metacarpal osteoarthritis are analysed
with 3 years follow-up : 56 % of the patients are satisfied with the operation ; 46 % are disappointed or displeased. Bad
results are in relation to synovitis (4 cases), dislocation of the implant (2 cases), algodystrophy (4 cases). In total, in
4 cases, a excision of the implant was necessary. In the group “good results”, improvement concern the pain ; thumb motion
is not increase in all cases ; post-operative strenght is similar to pre-operative strenght.
European Journal of Orthopaedic Surgery & Traumatology 11/1995; 5(1):7-14. · 0.10 Impact Factor
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ABSTRACT: A 37-year-old right-handed male truck driver was admitted with a severe injury of the dorsum of his right hand following a traffic accident. He had a large combined defect involving skin, tendons and bone. A complex reconstruction was performed using a large iliac crest allograft, a tendon graft and a free serratus anterior flap in one stage, 8 hours after the injury. A skin graft was performed later. 2 years later the functional and aesthetic result are good.
The Journal of Hand Surgery British & European Volume 11/1995; 20(5):591-5. · 0.04 Impact Factor
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ABSTRACT: The blood supply to the non-weight bearing midsole area is not derived exclusively from the medial plantar artery. This allows elevation of a subfascial mid-plantar cutaneous flap for the reconstruction of the heel. The technique of elevation of the flap is described. This plantar flap can be designed to include sensation without the need for deep dissection. Five clinical cases are discussed. This flap is useful for medium-sized chronic ulcerations of the heel.
Annales de Chirurgie Plastique Esthétique 05/1995; 40(2):162-8. · 0.41 Impact Factor
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ABSTRACT: Osteosynthesis without immobilisation of compression-extension fractures by means of a posterior plate was studied in prospective series with a minimum follow-up of six months (first group: 73 patients) and a minimum follow-up of one year (second group: 63 patients). The clinical results were evaluated and showed several complications (no infection, but reflex sympathetic dystrophy, paresthesia, unsightly scars). The clinical and radiological findings (radio-ulnar index) could improve with several technical devices, now used.
Annales de Chirurgie de la Main et du Membre Supérieur 02/1994; 13(2):87-100.
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ABSTRACT: The purpose of the study was to evaluate the anatomical and functional results of Anterior Cruciate Ligament reconstruction with the synthetic ligament Ligastic.
72 patients have been reviewed clinically and radiologically and their functional abilities have been evaluated with Lysholm and Arpege score. 46 have been operated for recent ruptures (group A) and 26 for chronic ACL tears (group B). Follow up was 2 to 4,5 years.
The results showed in group A a Lachman test > 3 mm in 57 per cent cases, a positive pivot shift in 29 per cent and ruptures of the ligament in 22 per cent. In group B, the Lachman test was > 3 mm in 47 per cent of the cases the pivot shift was positive in 54 per cent and the rupture of the ligament occurred in 35 per cent. The functional evaluation showed that only one third was stable but painful, and one third was unstable and painful.
As many authors, we found an increase of bad anatomical and functional results with time. The ligament can't be considered as a scaffold for ingrowth tissue. Two thirds of the patients had painful knees at effort.
The high percentage of ruptures of the ligament, and the non satisfactory functional results led us not to recommend the ACL reconstruction with a Ligastic implant.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 01/1994; 80(5):413-9. · 0.37 Impact Factor
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ABSTRACT: Four cases of Carpal Tunnel syndrome during childhood are reported. Two of them are post traumatic cases; for one child, the syndrome was caused by hypertrophic cal six months after trauma. The other child has been operated because of a median and ulnar nerve deficit syndrome, which appeared one month after fracture. In the third observation, the authors have seen an abnormal muscle just in front of annular anterior ligament of the carpus during surgery. This muscle was assimilated to hypertrophic Palmaris Brevis muscle. In the last observation, the adolescent had a Poland syndrome with Sprengel malformation. In this paper, the authors point out clinical particularities due to musculo-tendinous malformation which can lead to Carpal Tunnel syndrome.
Chirurgie pédiatrique 02/1990; 31(6):310-3.
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ABSTRACT: A 37-year-old right-handed male truck driver was admitted with a severe injury of the dorsum of his right hand following a traffic accident.He had a large combined defect involving skin, tendons and bone. A complex reconstruction was performed using a large iliac crest allograft, a tendon graft and a free serratus anterior flap in one stage, 8 hours after the injury. A skin graft was performed later. 2 years later the functional and aesthetic result are good.
The Journal of Hand Surgery: British & European Volume.
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ABSTRACT: With classical lateral access to the lower radius, only the styloid process is correctly exposed and many surgeons prefer elective anterior routes, or more rarely posterior access. Our experience with posterior compression-extension fractures of the lower radius using a posterior plate has led us to describe the modalities of progression to the bone without injury to the tendons and vasculo-nervous bundles. The technique described scrupulously avoids injury and also allows safe iterative access. Finally, and most importantly, this technique also exposes all the aspects of the bone. It can be successfully used for internal fixation in difficult cases and also for the treatment of former acquired or congenital deformations of the epiphysis. This route has been shown to be safe and successful in a prospective series of 187 applications of posterior plates for compression-extension fractures.
Chirurgie 119(8):411-7; discussion 417-8.
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ABSTRACT: Seven cases of acute and closed traumatic dislocation of the trapezio-metacarpal joint treated by percutaneous pinning adapted by Wiggins are reported with an average follow-up of eight years. Seven patients (five men and two women) aged 18 to 62 were treated. The injury was due to a road traffic accident in four cases. The dominant hand was injured in six cases. The metacarpal base was always dislocated dorsally and closed reduction always remained unstable. All cases consisted of closed dislocation but in two cases dislocation was associated with upper limb fractures. On the initial radiographs no patients had degenerative changes. All patients were treated as an emergency or the following during the days injury by reduction and stabilization by one or two percutaneous kirschner wires followed by a scaphoid cast for three to six weeks. All patients were followed and reviewed for this study between two and thirteen years (mean eight years) after injury. Enquiries were made about return to work, pain, stability, range of movement, key-pinch and grasp compared with the uninjured side. The joint was examined radiographically with particular attention to the presence of subluxation and degenerative changes. 2 patients with associated complex injury of the upper limb developed reflex sympathetic dystrophy. 2 patients had moderate pain, 2 patients had limitation of joint movement, 1 patient presented a reduction of strength (pinch and grasp) but none had subluxation, instability, or degenerative changes. Closed reduction and stabilization by percutaneous pinning is a simple method and gives good or excellent results in the treatment of acute traumatic dislocation of the trapezio-metacarpal joint.ResúmenLos autores presentan un estudio retrospectivo de luxaciones trapezo-metacarpianas recientes tratadas mediante reducción y enclavijamiento según Wiggins. En 6/7 casos se trataba de la mano dominante. En 5 casos se trataba de un traumatismo aislado de la articulación trapezo-metacarpiana con una luxación cerrada. En los otros dos casos, se hallaron lesiones asociadas (traumatismo múltiple del miembro superior). Un caso se consideró como accidente de trabajo, dos casos accidentes deportivos o de « recreo , los otros 4 casos fueron secundarios a un accidente automovilístico. La intervención se realizó el mismo día del diagnóstico (2 pacientes) o al dia siguiente (3 pacientes). Dos pacientes fueron operados al tercer y al octavo dia post accidente, pero el mismo día del diagnóstico. Todos los pacientes fueron tratados mediante reducción asociada a un enclavijamiento axial transcutáneo según Wiggins. La reducción fué fácil pero inestable en todos los casos. Todos los pacientes fueron immovilizados con una escayola en post operatorio incluyendo la primera columna. Las clavijas se retiraron entre 3 a 6 semanas. Con un seguimiento promedio de 8 años (extremos 2 a 13 años) solamente dos pacientes presentaban dolores moderados con los cambios de tiempo. No se presentaron cambios de actividad profesional. El movimiento de la primera columna, apreciado según Kapandji y según Duparc y de la Caffinière era comparable al lado sano en 5 casos. Solamente un paciente presentaba una disminución moderada de la fuerza. No existen inestabilidades objetivas. Las imágenes radiográficas de control no mostraron ni incongruencia articular, ni rizartrosis. Las complicaciones de la serie fueron 2 distrofias simpáticas reflejas (traumatismos múltiples del miembro superior). El enclavijamiento percutáneo trapezo metacarpiano según Wiggins constituye por lo tanto una alternativa terapéutica simple y eficaz.
Annales de Chirurgie de la Main et du Membre Supérieur.
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ABSTRACT: Osteosynthesis without immobilisation of compression-extension fractures by means of a posterior plate was studied in prospective series with a minimum follow-up of six months (first group : 73 patients) and a minimum follow-up of one year (second group : 63 patients). The clinical results were evaluated and showed several complications (no infection, but reflex sympathetic dystrophy, paresthesia, unsightly scars). The clinical and radiological findings (radio-ulnar index) could improve with several technical devices, now used.ResúmenLa osteosíntesis estable (sin immovilización) de las fracturas mediante compresiónextensión utilizando una placa consola posterior fue ensayada en una serie prospectiva con un seguimiento superior a 6 meses (primer grupo de 73 lesionados) o superior a un año (segundo grupo con 63 lesionados). Los resultados clínicos fueron evaluados. Se observa la existencia de numerosas complicaciones (no hubo infección más sinembargo distrofias simpáticas reflejas, parestesias, cicatrices mediocres). La evaluación clínica así como radiológica (índice radio cubital) debería mejorarse mediante artificios técnicos que se utilizan actualmente.
Annales de Chirurgie de la Main et du Membre Supérieur.
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ABSTRACT: The authors have studied the results of a personal technique concerning the treatment of trapezo-metacarpal arthritis: a partial trapezectomy is associated with a antogenous rib cartilage graft. 13 cases were treated using the procedure. 9 patients are reviewed with a follow up mean one year. 4 patients are free of pain, 5 are improved. Strength is improve in 4 cases (pinch), similar or inferior to the pre-operative status in 5 cases. Increase of motion concern Kapandji test and first web space. Follow up is insufficient to allow a conclusion about the long term behaviour of cartilage graft.
Chirurgie 120(10):563-7.
