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Biomedical subjects

A Lortat-Jacob

Publications and source records attributed to A Lortat-Jacob.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Preoperative angiographic landmarks of the gluteal muscle regions using Patent Blue V].

Use of a gluteus musculocutaneous flap is the most reliable technique for surgical repair of sacral ulcers. Surgery could be ideally performed when the flap is designed using only the upper or the lower half of the glutens maximus muscle depending on the superior gluteal artery or the inferior gluteal artery, respectively. The authors have developed a technique for preoperative demonstration of the vascular supply to both muscle and overlying skin from a single gluteal artery using superselective catheterization and arterial administration of a dye (Patent Blue V). This technique facilitates the surgical procedure but assessment of its usefulness will require further evaluation.

Angiography↗
PubMed1998

Aseptic avascular necrosis of the femoral condyles in renal transplant patients: clinical and radiological aspects on 69 knees.

The purpose of this study was to analyze clinical and radiological aspects of aseptic avascular necrosis (AVN) of the femoral condyles in renal transplant patients. Forty-five renal transplant patients were followed between 1971 and 1993, and 69 knees have been studied. The immunosuppressive protocol comprised in all cases corticosteroids, with aziathioprine and since 1983 cyclosporin in 80% of patients. Episodes of rejection were treated with bolus doses of methylprednisolone. In 53.3% of patients, both knees were involved. The necrosis was bicondylar in 60.8% of knees. In the case of an unicondylar lesion, the lateral condyle was involved in 24.7% of knees vs 14.5% for the medial condyle. Symptoms occurred on average 4.9 years after transplantation (range 3 months-10.5 years). This period appeared significantly shorter for patients who had suffered an episode of rejection. In only 24.4% of patients was the knee involvement isolated. Pain was the initial symptom for 83% of patients. Other symptoms included locked knee (20.7%), effusion (49.2%), instability (14.5%), and loss of motion (15.9%). The diagnosis was established by standard radiographs, and in 8 patients by magnetic resonance imaging. Aseptic AVN of the femoral condyles in renal transplant patients is not rare even if it is less frequent than femoral head necrosis. Medication with corticosteroids is the main risk factor.

Adolescent↗
PubMed1998

Glomus tumor of the fat pad.

The authors report an exceptional glomus tumor location in Hoffa's ligament in a 65-year-old man. Based on this observation and a literature review, the authors provide the clinical and radiographic diagnostic appearances of this type of tumor. Surgical removal of the tumor achieved immediate disappearance of knee pain. Histological examination of the tumor has established the definitive diagnosis.

Adipose Tissue↗
PubMed1996

[Arthroscopic management of recurrent anterior shoulder dislocation by combining a labrum suture with antero-inferior holmium:YAG laser capsular shrinkage].

Current arthroscopic treatments do not address satisfactorily the capsular redundancy frequently associated with the Bankart lesion in recurrent anterior dislocation. Although the Bankart lesion heals, many of the recurrences after arthroscopic procedures are due to capsular redundancy and the laxity of glenohumeral ligaments. We propose that laser-assisted capsular shrinkage (LACS) be combined with arthroscopic labrum reattachment. As shown by Market et al., significant capsular shrinkage can be achieved by the application of non-ablative Ho:YAG laser energy without detrimental effects to the relaxation properties of the tissue. For 1 year we have used LACS together with labrum suture in 18 shoulders in 18 patients (mean age 24.6 years). All patients suffered from chronic anterioinferior recurrent dislocation. The labrum suture was realized by an anterior reattachment (REVO screws, Linvatec, USA) or by transglenoid suture. Two or three sutures were passed through the torn labrum with 2/0 non-absorbable suture material. The LACS procedure was performed with a holmium:YAG laser (VersaPulse, Coherent, USA) at an energy of 10 W (1 J, 10 Hz) with a 30 degrees curved handpiece. All patients were immobilized in a sling for 4 weeks postoperatively. Physical therapy was begun at 1 month with passive and active exercise. To date, none of the patients have had a recurrence. Seven of 18 patients returned to their previous sports activity, and at the same level. None of the patients had an iatrogenic lesion due to the laser application or labrum suture. Compared to the other shoulder, the loss of external rotation with the arm 90 degrees abducted was 30 degrees at 4 weeks and 10 degrees at 4 months. We think that the LACS procedure is a good treatment for the capsular redundancy that is frequently associated with Bankart's lesion in recurrent anterior dislocation and is probably responsible for the high failure rate in current arthroscopic procedures. Our results are short-term results, but we expect the capsular shrinkage associated with the labrum reattachment will provide a long-term success rate that is comparable to open procedures.

Adult↗
PubMed1996

[Fractures of the anterior rim of the distal part of the tibia. Apropos of a series of 38 cases].

PURPOSE OF THE STUDY: Fracture of the anterior rim of the distal tibia is a rare injury. This fracture seems less serious than other pilon fractures but its treatment is often difficult and didn't give better results. The aim of this study was to describe problem we dealed with and to suggest solutions in order to improve long term results. MATERIAL: The study included 38 cases, treated in 5 Paris district trauma centers, with a minimal follow-up of 6 months. All patients were asked for clinical and radiological review between september 92 and march 93 ; otherwise, latest review datas were used. METHODS: Authors suggest a radiological classification based upon type, width and talus anterior displacement. Different surgical procedures were performed for 33 cases (screw, plate, external fixation) ; conservative treatment was used 5 times (non weight bearing plaster cast). Anatomical reconstruction was analysed. Functional results scoring system included pain, global abilities and ankle range of motion. Ankle arthritis was rated according to 1992 SOFCOT scoring system at 1 and 3 year follow-up. RESULTS: Follow-up ranges from 6 months to 11 years (average 28 months). 55 per cent of cases were lost for review with 1 year mean follow-up. 45 per cent of patients were recently tested with 4 year mean follow-up. Three ankles had joint fusion 6 to 18 months after trauma. Functional result was poor. For 35 ankles analysed 1 out of 4 remained totally painless (9 cases), 1 out of 2 had a good function (20 cases) and 1 out of 3 normal X-rays (12 cases). Arthritis was found for 2 ankles out of 3 after one year follow-up (16 cases out of 23). Loss of reduction or incomplete reconstruction seemed the most important point (13 cases out 38, 13 cases after 35 surgical procedures). DISCUSSION: Many patients didn't get a long term evaluation, and this study has no statistical value. Anyway, function loss was always early on a weight bearing joint. A perfect and stable reconstruction gives a higher rate of good result (11 out of 14). Analysis of cases with anatomic imperfection leads to recommendations: fixation of separation fracture, even undisplaced, bone grafting to correct impaction, appropriate use of external fixation for neutralization. CONCLUSION: Better results should come from a better analysis of the bone lesions : separation, impaction or mix fracture. This analysis leads to appropriate surgical procedure which give back a stable and anatomic distal tibia. External fixation can be usefull for immobilization ; this can't avoid open reduction and internal fixation of the fracture. Bone grafting can be useful for impaction fracture.

Adolescent↗
PubMed1995

[Internal plantar flap. Apropos of 30 cases].

Thirty medial plantar flaps were used in twenty seven patients with large defects in soft tissues of the lower extremity. We performed that flap described in 1981 by Harrison for ankle defects (9 cases) and heel defects (21 cases). The etiology of the defect was a traumatic avulsion in 14 cases, a sole pressure in 10 cases and neurologic ulcer in 6 cases. The surgical procedure was performed in 5 operative sequences: 1--excision of the receptor site 2--disection of the posterior tibial artery and plantaris medialis artery 3--raising of the flap including plantar skin and aponeurosis, respecting the flexor hallucis brevis muscle 4--rotation of the flap and suture on the receiptor site 5--skin graft on the donor site Antibiotics were used according to the per-operative swabs. Full weight bearing was authorized on the 45th day. We observed no failure for heel localization. But in dorsal part of the ankle, we deplore 4 failures (on 9 cases). The rotation for ankle defects was rather important and the risk was squeezing the artery. We used 3 times the medial plantar flap as a cross foot. We observed 1 failure; the possibility of long pedicled flap (parallel legs), the innocuity for the donor site, the quality of the transferred skin are arguments for using that flap in a cross leg of rather small dimension. We successfully performed two more cross legs using this technique since that study. We think that the medial plantar flap is the best technique for heel reconstruction. The quality of the skin transferred is very able to make a secondary thickening reproducing exactly the consistence of the heel. The fiability of that flap is very high for the heel localisations (no failures on 21 cases).

Adolescent↗
PubMed1994

[Antibiotic prophylaxis in orthopedic surgery].

The efficiency of prophylactic antibiotics in total hip replacement has been demonstrated by several studies. The rate of infection decreased approximatively from 3% to 1% with a cephalosporine 1 protocol. The rate of infection was not different after a five-day administration of cephalosporine 1 and a 2-day treatment of cephalosporine 2. In open fractures, the value of prophylactic antibiotics has to take in account the usual organisms of peroperative contamination as well as the anaerobes. Short administration can be used, however no randomized studies have proven their efficiency. For clean, planned surgery (grade II in the classification of Health National Research Council), prophylactic antibiotics seem to be of value. However, the prescription should not be systematic, but correlated with the local conditions of surgery and the infection rate of the type of the planned procedure.

Anti-Bacterial Agents↗
PubMed1994

[Pathological fractures of the femoral neck in hemodialyzed patients. Apropos of 26 cases].

PURPOSE OF THE STUDY: This study is based on a retrospective analysis of 26 pathological fractures of the femoral neck in 19 chronic haemodialysis patients. The purpose of this study is to analyze the epidemiological and etiological factors of these fractures in relation to osteo-arthropathy of the dialyzed patient, as well as the results of various treatments, both curative and preventive. MATERIAL AND METHODS: 26 pathological fractures of the femoral neck appeared in 19 chronic haemodialysis patients, 11 men and 8 women, 6 patients presented bilateral fractures. The patient's average age at the time of the fracture was 61 years (27 to 82). The average duration of dialysis was 11 years with a minimum of 2 years and a maximum of 21 years. Hyper parathyroidism was found in 14 patients, aluminic intoxication in 6 and amyloidosis at the level of the coxo-femoral joint 18 times. Surgical treatment consisted of 6 osteosynthesis, 2 cephalic arthroplasties, 13 modular arthroplasties and 5 total hip arthroplasties. For each case, we studied the presence of necrosis of the femoral neck due to aluminic intoxication, osteoporosis due to hyperparathyroidism and also the presence of amyloidosis without aluminic intoxication. RESULTS: Cortisonic necrosis and porosis was found 4 times out of 26 cases, hyperparathyroidism once, aluminic osteomalacy 3 times and beta-2-microglobulin amyloid 18 times. Amyloidosis remains the most frequent etiological factor. All patients had been operated for median nerve compression in the carpal tunnel, usually 2.5 years before appearance of the pathological fracture. Non surgical treatment was used 5 times in undisplaced fractures without any sign of amyloidosis and was successful 3 times and unsuccessful twice necessitating a new operation by osteosynthesis. Out of 6 osteosynthesis performed for fractures either with little or no displacement we observed 4 failures, all of them in the cases with intra-osseous amyloidosis. Best results were obtained by arthroplasties. Modular arthroplasty has given us 11 long term excellent results in 11 of 13 cases. DISCUSSION: The analysis of etiological factors shows two very different groups. The first one consisted of 8 fractures without coxofemoral amyloidosis. The average duration of dialysis was 5 years, average age, 44 years. Etiology was 3 times aluminic osteomalacy, once the only factor found was osteoporosis and 4 times necrosis and porosis as a complication, not of haemodialysis but of renal transplantation with concomittant corticosteroid treatment. The second group consisted of 18 fractures with hip amyloidosis in 14 patients. The average age was 63.5 years, the dialysis duration was 11.5 years, the two extremes 5 and 21 years. Etiology was beta-2-microglobulin amylosis. The pathological fracture was due to the presence of voluminous subchondral amyloidosis geodes. Amyloidosis always associated with hyperparathyroidism and aluminic intoxication in one of 3 cases. Osteosynthesis gave good results only in cases presenting no intra-osseous amyloidosis. Modular arthroplasty has allowed us to obtain excellent long term functional results with simpler outcome. Total arthroplasty should be used only for evident acetabular involvement. CONCLUSION: Amyloidosis remains the etiological factor most frequently found in pathological fractures of the femoral neck in chronic haemodialysis patients. The study of the etiological factors is essential since they will guide us in the choice of the mode or treatment. It is totally licit to propose conservative treatment for non displaced fractures without osseous amylosis. In all other cases, prosthetic replacement is necessary and osteosynthesis contra-indicated. When the acetabulum is not altered a modular arthroplasty must be used. We do not recommend preventive surgical treatment for patients having a threatening geode of the femoral neck as all osteosynthesis realized on amyloidotic bone, even without any displacement, resulted

Adult↗
PubMed1992

[Bipolar endoprosthesis in fractures of the femoral neck. Apropos of 201 cases, 116 after a 6-year follow-up].

We report our experience with 201 SEM bipolar prostheses used to treat femoral neck fractures in patients with a mean age of 70 years and a mean follow-up of 57 months (median 75 months). Clinical outcome was favorable with 94 per cent satisfactory results (very good and good). Femoral complications requiring reoperation (conversion to total hip replacement) occurred in 2.2 per cent of cases. Among the 163 patients for whom roentgenographic data were available, 5 (3.6 per cent) developed evidence of acetabular wear but remained symptom-free and did not require reoperation. As compared with Moore's prosthesis, the SEM bipolar prosthesis seems to provide substantially better clinical and roentgenographic results. For the treatment of femoral neck fractures, total hip replacement seems to provide results comparable to those reported here but requires a more sophisticated operative technique and carries a greater risk of subsequent dislocation. Two factors prevent the widespread use of the bipolar prosthesis at present: the need for femoral grouting which carries a well-documented risk of hemodynamic complications, and the higher cost of the device.

Adult↗
PubMed1991

[Bone allografts revascularized by autogenous endosseous flap. Experimentation in rats].

The experimentation was based on the analysis of revascularization phenomenons and reossification of cross allografts of Wistar rat femoral diaphysis firstly canalized with an epigastric subcutaneous intramedullar autogenous flap. An endosteal revascularization has been observed in addition to the periosteal one which is usually the sole characteristic of classic allografts. The bone transplant, quickly vascularized after a short period of creeping substitution, had normal histomechanical properties which were never observed without the addition of a vascular pedicule. The use of such cortical allografts seems to be useful in human surgery.

Animals↗
PubMed1991

[Luxation of total hip prosthesis. Mathematic modelization, biomechanical approach].

Two particular aspects of total hip prosthesis dislocations were assessed by a mathematical method. A theoretical analysis of the intra-prosthetic motions, in function of the architectural parameters was presented as well as a biomechanical approach of the dynamic stability of the prosthetic hip during the flexion. It showed then two potential causes of dislocations: malposition dislocations, due to the block-effect of the femoral neck on the acetabular border; the position of the acetabular cup appeared as predominant for a given type of prosthesis too anteversed and/or too vertical, it limited the movement of external rotation at the origin of anterior dislocations; too horizontal and not enough anteversed it obstructed the flexion, especially if there was an association of internal rotation and adduction, the dislocation was then posterior. dislocation by muscular discoaptation. Here, the dislocating forces, during the flexion of the hip, were greater than the coaptation phenomenon which became precarious by the arthroplasty and quantified, in our model, by a multifactorial parameter translating the behaviour of the gluteus medius muscle during flexion.

Biomechanical Phenomena↗
PubMed1991

[Luxation of total hip prosthesis. Statistical validation of a modelization, apropos of 52 cases].

A previous modelization of the Total Hip Dislocation phenomenon enabled us to separate two main forms: The malposition dislocation, secondary to an error in the position of one of the prosthetic pieces, and mainly of the acetabular cup; the dislocation by muscular discoaptation, where the arthroplasty has discompensated a precarious muscular balance. The authors present a statistical validation of the model regarding 52 dislocations which occurred during the follow-up of 1196 hip arthroplasties. A "control" group was composed of 50 prostheses taken at random within the non-dislocated hips. The total rate of dislocation was 4.30 per cent. Every second one showed to be of malposition origin with a significant limitation of the theoretical intra-prosthetic amplitudes. These dislocations--all appearing early--were, for half, of the anterior type, and in that case, were mainly due to an excess of acetabular anteversion (average 35.2 degrees), the other half was of posterior type, with, in particular, a low value of acetabular anteversion (average 11.4 degrees when it was 23.4 degrees in the non-dislocated group). The other dislocations (all posterior and more delayed) corresponded to a defect of muscular coaptation in the "high-risk" patients (previously operated hip, weight loss, necrotic etiology, neuromuscular etiology, old age). Thus, in almost 90 per cent of the cases, the clinical study brought a validation of our model giving a different explanation from the too classical "cam-acting", often held responsible for the dislocation phenomena.

Aged↗
PubMed1990

[Dynamic stabilization of a total hip arthroplasty. Apropos of 100 total prostheses of which 52 dislocations].

This paper outlines the principal factors which stabilise a normal hip, and describes the modifications which occur following total joint replacement. Deficiencies in muscle function and mechanical restraints due to the prosthesis may be present. A biomechanical mathematical model has been devised which examines the variations in length of the middle gluteal muscle during movement, particularly in hip flexion, when there is the greatest risk of dislocation. This enables a critical evaluation of the muscle forces surrounding the hip, and allows identification of patients with a high risk of dislocation. These observations have been applied to a group of 100 patients, 52 of whom had experienced a dislocation and 48 with stable prostheses. Patients at high risk according to the statistical model tended to dislocate from one month after operation onwards, and are to be distinguished from those who dislocate early due to malposition of the prosthesis.

Biomechanical Phenomena↗
PubMed1990

[Early reoperation for infection in orthopedic surgery of the leg (arthroplasties and hip surgical procedures excluded)].

The authors report 32 cases of post-operative infections reoperated before the first month of which 12 articular fractures of the tibia. 6 tibial osteotomies of valgisation, 6 tibial diaphyseal fractures, 2 fractures of the lower extremity of the femur, 2 bimalleolar fractures, 1 serious knee sprain, 1 patellar fracture, 1 calcaneum fracture and an arthroscopic arthrolysis of the knee. Twelve of them had an articular infection. Globally, they have obtained 22 satisfactory results (very good or good) and 10 non satisfactory results out of which 2 deaths and 1 amputation. The bad results were due either to a particularly aggressive germ (streptococcus and gas gangrene), or to an articular infection insufficiently controlled: 5 out of the 10 arthrites on infected articular fractures have had a non satisfactory result. As for metaphyseal infections, a simple cleaning has given 4 very good results out of 6, the 2 excluded being very serious and special cases. For the 6 diaphyseal leg infections after osteosynthesis, the early reoperation has not avoided a secundary graft in a picture of infected pseudoarthrosis. In view of this series, the authors propose to adapt the cleaning operation to the localisation and to the presence or not of an articular infection.

Adolescent↗
PubMed1990

[Fractures of the acetabulum operated on by the Sénégas approach. Apropos of 33 cases].

Thirty-three fractures of the acetabulum were operated on through an extended lateral approach described by Sénégas. Exposition of the posterior column was similar to that obtained through a classic Kocher-Langenbeck approach. The anterior column can be simultaneously exposed even though the exposition is relatively limited. Intraarticular control of the fracture through this approach is excellent, allowing de visu reconstruction of the acetabulum. Clinical results were excellent in 28 patients with an average follow-up of 3 1/2 years. Complications were relatively rare. The Sénégas approach is indicated in "T" fractures and in transverse fractures without an associated fracture of the posterior wall. In bicolumnar fractures, the Sénégas approach allows joint reconstruction even in the absence of peripheral control of the fragments.

Acetabulum↗