Biomedical subjects

A Talha

Publications and source records attributed to A Talha.

10 recordsLinked to original sources

PubMed2006

[Retrograde locked nailing of humeral shaft fractures: a prospective study of 58 cases].

PURPOSE OF THE STUDY: Appropriate treatment for humeral shaft fractures remains a debated issue. Among the classical osteosynthesis techniques proposed, closed nailing was adapted to the humerus rather late, using the anterograde method. Use of retrograde nailing, which spares the rotator cuff, is more recent. The purpose of this study was to report outcome in 58 humeral shaft fractures in adults treated using the universal humeral nail between January 2000 and December 2003. MATERIAL AND METHODS: This work was limited to recent shaft fractures in adults with non-pathological bones. The fractures included were all situated between the insertion of the pectoralis major and a point situated 2 cm above the apex of the olecraneum fossa. The series included 58 patients with 58 humeral shaft fractures. All fractures were closed except four (Gustilo type I and II). Two patients presented preoperative radial paralysis which was not considered to be a contraindication for retrograde locking nailing. The paralysis recovered in both patients, after neurolysis performed during the nailing procedure in one. Osteosynthesis was performed without opening the fracture focus under fluoroscopic control using a static locking nail inserted retrograde in patients in the supine position. RESULTS: There were two early deaths unrelated to the method. Healing was obtained in the surviving patients within fifteen weeks on average. Bone healing was primary in 53 patients and after secondary compression in three. At last follow-up, shoulder motion was normal in 88% of patients and elbow motion in 91%. The Rommens functional score was good in 84%. Complications included three cases of spontaneously regressive postoperative radial paralysis, three cases of reflex dystrophy including two which regressed, and two cases of humeral palette fracture requiring surgical osteosynthesis. The proximal screws were removed in six patients because of pain or migration. To date, implants have been removed in three patients without problem. There were no infections. CONCLUSION: Retrograde insertion of this nail facilitates treatment of humeral shaft fractures by allowing immediate joint motion and the advantages of closed reduction: no infection, no late bone healing requiring conversion to another method of fixation. The residual technical problems concern proximal nailing and nail introduction.

Adolescent↗

PubMed1997

Fracture of the vertebral limbus.

An 18-year-old young man suffering from fracture of the limbus of L4 was admitted to the emergency ward after a car collision. Radiological evidence of the lesion was visible on plain film radiographs and CT scans. On surgery the posterior column was found to be intact. Treatment included a wide laminectomy, excision of the fragment, and osteosynthesis with Cotrel-Dubous-set instrumentation. The characteristics of these lesions are reviewed on the basis of the latest reports. The possibility of misreading these fractures is emphasized, especially in traumatic adult spine surgery.

Accidents, Traffic↗

PubMed1996

Hyperbaric oxygen therapy in the management of crush injuries: a randomized double-blind placebo-controlled clinical trial.

Hyperbaric Oxygen (HBO) therapy is advocated for the treatment of severe trauma of the limbs in association with surgery because of its effects on peripheral oxygen transport, muscular ischemic necrosis, compartment syndrome, and infection prevention. However, no controlled human trial had been performed until now to specify the role of HBO in the management of crush injuries. Thirty-six patients with crush injuries were assigned in a blinded randomized fashion, within 24 hours after surgery, to treatment with HBO (session of 100% O2 at 2.5 atmosphere absolute (ata) for 90 minutes, twice daily, over 6 days) or placebo (session of 21% O2 at 1.1 ata for 90 minutes, twice daily, over 6 days). All the patients received the same standard therapies (anticoagulant, antibiotics, wound dressings). Transcutaneous oxygen pressure (PtCO2) measurements were done before (patient breathing normal air) and during treatment (HBO or placebo) at the first, fourth, eighth, and twelfth sessions. The two groups (HBO group, n = 18; placebo group, n = 18) were similar in terms of age; risk factors; number, type or location of vascular injuries, neurologic injuries, or fractures; and type, location, or timing of surgical procedures. Complete healing was obtained for 17 patients in the HBO group vs. 10 patients in the placebo group (p < 0.01). New surgical procedures (such as skin flaps and grafts, vascular surgery, or even amputation) were performed on one patient in the HBO group vs. six patients in the placebo group (p < 0.05). Analysis of groups of patients matched for age and severity of injury showed that in the subgroup of patients older than 40 with grade III soft-tissue injury, wound healing was obtained for seven patients (87.5%) in the HBO group vs. three patients (30%) in the placebo group (p < 0.05). No significant differences were found in the length of hospital stay and number of wound dressings between groups. For the patients with complete healing, the PtCO2 values of the traumatized limb, measured in normal air, rose significantly between the first and the twelfth sessions (p < 0.001). No significant change in PtCO2 value was found for the patients whose healing failed. The Bilateral Perfusion Index (BPI = PtCO2 of the injured limb/PtCO2 of the uninjured limb) at the first session increased significantly from 1 ata air to 2.5 ata O2 (p < 0.05). In patients with complete healing, the BPI was constantly greater than 0.9 to 2.5 ata O2 during the following sessions, whereas the BPI in air progressively rose between the first and the twelfth sessions (p < 0.05), reaching normal values at the end of the treatment. In conclusion, this study shows the effectiveness of HBO in improving wound healing and reducing repetitive surgery. We believe that HBO is a useful adjunct in the management of severe (grade III) crush injuries of the limbs in patients more than 40 years old.

Adult↗

PubMed1991

[Results of distraction by way of external metacarporadial fixation in fracture of the distal end of the radius. Apropos of 97 cases].

104 fractures cases were treated over 5 years using this method, which is reserved for the most critical cases (less than one fourth the total number of fractures of the distal end of the radius); 97 of those were reviewed by an impartial observer. The technique consists in distractive reduction, maintained by a small external holding device interconnecting two pins inside the radius and two pins in the 2nd metacarpal bone. Usually, the device is removed after 45 days. Subjective results were rated "very good" in 62.8% of cases, while post-mobilization, radiological and overall findings rated likewise in 61.8%, 40.2% and 63.9% of cases, respectively. Half the patients presented secondary displacement, which although usually minimal, did necessitate in 6 cases a new reduction (using the same device). Algodystrophy occurred in 17 cases and constituted the main source of complications. It increased in frequency proportionally to the degree of distraction applied. At long term, important finger stiffness persisted only in 3 cases. Thus, the quality of results obtained makes external fixator distraction a choice therapeutic method in hard-to-manage fractures.

Follow-Up Studies↗

PubMed1990

[Osteosynthesis of articular fractures of the heelbone using a reconstruction plate].

The authors describe in detail this technique which employs a reconstruction plate which can be moulded in all directions. The plate, fashioned in a stereotyped way extemporaneously or even during the pre-operative period, perfectly fits the lateral surface of the calcaneus, curves behind the tuberosity and descends in front to the junction of the lateral and inferior surfaces of the greater apophysis. With its screws anchored in the sustentaculum tali, it supports the previously reduced thalamic body which is itself fixed to the sustentaculum by screws, thereby avoiding further slippage. The very solid union thus obtained allows early weight bearing. This technique allows logical treatment of all types of fractures. Numerous technical details provide surgical guidelines for these technically difficult fractures. The operating protocol may thus be used by all operators. There are plans to market a pre-moulded plate which would further simplify the procedure. Currently, 55 fractures have been treated by this technique. The median interval to weight bearing was 7 days and 6 weeks to walking without crutches (45 cases). The functional results in 34 cases with sufficient follow-up (16 Months) showed 71% satisfactory results (very good, good or quite good), 21% mediocre and 8% poor results.

Adult↗

PubMed1989

[Supra- and intercondylar fractures of the distal humerus in adults. Apropos of 28 osteosynthesis].

The authors report their experience of the surgical fixation of supra- and intercondylar fractures over a 13 year period. Twenty eight cases were reviewed with a mean follow-up of 3 years and 85% good and very good results. Postoperative complications were related to defective fixation and inappropriate material. The 4 poor or tolerable results involved compound and comminutive fractures in the context of polytrauma or complicated by sepsis. Amongst the various plates used, A0 3.5 plates (strong and mouldable) provided satisfactory fixation with the possibility of early physical rehabilitation (between 3 and 21 days).

Adolescent↗

PubMed1989

[Hemihepatectomy].

Controlled right hemi-hepatectomy is a major operation reserved for primary or secondary malignant tumours, a few very large benign tumour and, more rarely, rupture of the right lobe of the liver. The surgical technique of hemi-hepatectomy respects several general rules concerning positioning of the patient, the surgical incision, haemostasis of the various pedicles, biliary stasis and drainage. Six technical variants are discussed together with their advantages and disadvantages and respective indications according to the size, nature and situation of the lesion in relation to the glissonian and hepato-caval pedicles. On the basis of this very detailed basic technique, tactical modalities according to the features of the lesion are proposed: extra or intra-hepatic control of the pedicles, initial or terminal opening of the median fissure, initial or terminal mobilisation of the right hemi-liver, total vascular exclusion. Controlled left hemi-hepatectomy is a less complicated technique which can be performed according to tactical variant identical to those described for right hemi-hepatectomy, but total vascular exclusion is rarely essential.

Constriction↗

PubMed1988

Scanographic study of the calcaneus: normal anatomy and clinical applications.

To facilitate the interpretation of the scanographic findings in fractures of the calcaneus, the authors have achieved an anatomo-radiologic correlation in terms of the classical coronal, sagittal and horizontal planes. Clinically, the sagittal plane can be obtained only by reconstruction. The 2 other planes permit study of the sustentaculum tali and posterior talar surface only in different sections, without their respective relationships. The authors therefore suggest a new double-oblique view, practicable in the injured patient, with a forward tilt of 20 degrees and medial rotation of 35 degrees, perpendicular to the sinus tarsi. This serves for anatomo-radiologic correlation and shows both anatomic structures together. By itself, it provides as much information as the three classical views and appears adequate for the assessment of fractures.

Calcaneus↗

PubMed1988

[Ovarian metastases of digestive cancers. Diagnostic and therapeutic management].

Although ovarian metastasis of digestive cancers were well known since more 80 years, the management of ovaries is still discussed. The authors reviewed 112 cases of digestive tumors in female patients operated between 1973 and 1987, excluding the peritoneal carcinomatosis, and report 7 cases of ovarian metastasis. The primary carcinoma was gastric (2 cases) colonic (2 cases) appendicular (1 case) small bowel (1 case) and biliary tract (1 case). Because the severe prognosis and the frequent revealing and isolated feature of the ovarian metastases the authors review the literature in order to propose recommendations regarding the diagnosis and treatment according to the localisation, the grading of the primary tumor particularly in non menopausal patients. When the primary tumor is a mucinous signet-ring carcinoma with spread to the serosa and a gross abnormality of an ovary is discovered the oophorectomy should be performed. In every cases an immediate histological examination is absolutely necessary. Clinical and sonographic findings are included in the operative staging and the follow up of patients operated for a digestive adenocarcinoma. Especially if the ovarian tumor is bilateral a complete digestive check-up including appendix and biliary tract is necessary.

Adult↗

PubMedDate not supplied

[How to visualize one additional vertebra on profile radiographs of the cervical spine?].

The authors describe a simple technical trick allowing a better study of the cervical spine in subjects with a brevilineal morphology: this consists in placing a small sans block between, the patient's shoulder blades, while exerting the usual traction, thus causing appropriate backward displacement of the shoulders and clearing the lower cervical spine.

Cervical Vertebrae↗