Biomedical subjects
B Megy
Publications and source records attributed to B Megy.
Hemodialysis-related lesions of the hand.
Chronic hemodialysis patients often have lesions of the hands characterized by distinctive etiopathogenic mechanisms and functional consequences. We conducted a prospective cross-sectional study in 116 patients with a mean age of 55.9 years and a mean hemodialysis duration of 8.17 years. Carpal tunnel syndrome was present in 28.4% of patients. Median nerve entrapment was bilateral in a large proportion of cases. Wasting of the lateral thenar muscles was often present at diagnosis, denoting advanced nerve compression. Amyloid was demonstrated in the carpal tunnel in 74% of cases of carpal tunnel syndrome. Digital flexor tendon lesions responsible for trigger finger or restriction of active flexion were seen in 21.5% of patients. Erosive arthropathy manifesting as deformities, pain and loss of function affected the distal interphalangeal joints in 11% of patients and the proximal interphalangeal joints or trapeziometacarpal joint in a smaller proportion of patients. Thirty per cent of patients had bony cysts located in the carpometacarpal area, carpal bones, or distal forearm bones; communication with the adjacent joint space was seen occasionally, and intracarpal derangement was a feature in some patients. Most patients had several types of lesions. The rate of occurrence of hand lesions increased markedly after ten years on hemodialysis, with devastating functional consequences.
[Stabilization of the hindfoot by talonavicular arthrodesis. Results apropos of 50 cases].
UNLABELLED: Hindfoot stabilization can be obtained by an isolated talonavicular arthrodesis as well as a triple arthrodesis. MATERIAL: There were 27 cases of unstable neurological foot, 13 cases of Rhumatoid foot, 7 cases of flat feet and 3 cases of post-trauma arthritis of the talonavicular joint. The procedure was, in all cases, a talonavicular arthrodesis, associated in some cases to a lengthening of the Achilles tendon, tendon transfer and forefoot correction. METHOD: 50 cases were reviewed with a mean follow-up of 40 months. RESULTS: There were 18 per cent cases of non-union. This could be explained by 2 technical errors: bad cartilagenous resection of the surfaces and unstable bone fixation. No subtalar mobility was noted in all cases. Only one case had a midtarsal mobility associated to a non-union. 39 feet had a normal heel axation. In most cases functional improvement was significant with a painless gait. DISCUSSION: Hindfoot stabilization can be obtained by an isolated talonavicular arthrodesis. Non-union could be avoided by a better surgical technique and a cast immobilization of 2 and a half months. The pre-operative deformities should be reduced manually, because isolated fixed valgus and varus can not be corrected by an isolated talonavicular arthrodesis. In conclusion, the indications are: An early valgus deformity of the hindfoot in rhumatoid arthritis. The aim is to avoid a fixed valgus deformity. Neurological induced equino varus deformities specially after stroke and other reducible neurological deformities. Flat foot due to posterior tibialis insufficiency. Isolated arthritis of the talonavicular joint.
[Surgery of the foot in equinus deformity in hemiplegic adults].
The authors report the results of surgical treatment of the equinus deformity of the foot in adult hemiplegia performed on 23 patients with a long term follow-up for 20 of them. Surgical treatment required two phases. Firstly, a spasticity correction by scopiform neurotomy of the posterior tibial nerve: this operation had to be done 14 times because of the importance of the spasticity. Secondly, a phase of truly orthopaedic surgery which involved successively, a treatment of the equinus deformity by lengthening of the Achilles tendon, a restoration of the dorsal flexion by anterior muscle transfer and some complementary operations on the forefoot. An astragalo-scaphoid arthrodesis was associated in the 13 most recent cases. Results were subjectively judged very good or good for 17 patients. Objectively, walking appliances have been reduced, gait was more secure and a greater autonomy has been reached. However, the goals of this surgery are limited as it has no incidence on central interferent lesions and neuropsychological troubles resulting from brain damage. The quality of the result is, in other respects, conditional upon the gait pattern of the whole limb, particularly upon the importance of the flexion of the knee during the step cycle.
[Osteosynthesis of radial head fractures in adults].
The authors report their experience and the results of internal fixation of radial head fractures in adults. They studied type 2 and type 3 fractures of Mason classification. Results were appraised with criteria of Radin and Riseborough. They found a rate of 80 per cent of objectively good or fair results. Fractures with one fragment (type 2) and without associated lesions (like sprain or dislocation of elbow) had the best results which depended of the quality of internal fixation. The series reported in the literature using the same operative technique are comparable. The results are equal or better than head resection with or without arthroplasty. Internal fixation is considered as the best operative technique for displaced fractures in adults. Reduction must be perfect. Head resection must be considered per-operatively if a perfect reduction is technically impossible to achieve.