[Reconstruction procedures following total or partial resection of the hemipelvis in the treatment of malignant tumors of the iliac bone. Apropos of 33 cases].
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Adult↗
Biomedical subjects
B Tomeno
Publications and source records attributed to B Tomeno.
[Bone resorption and remodelling in chondrosarcomas of the limbs and pelvis. Diagnostic value in 84 cases].
Aside well known histological and cytological arguments of malignancy, we have analysed the tumoral growth and invasion in periphery for the skeletal chondrosarcoma diagnosis. This study involves 84 cases of chondrosarcoma of limbs, and pelvic limb selected from 176 cases of chondrosarcoma seen in the Cochin hospital. The following constatations were made: the tumor growth is fast in a chondrosarcoma and the lesions are continuous; in a same case, we can assist to tumoral invasion signs and bone reparation signs. In the reverse, this growth is slow in an enchondroma and the lesions are the more often stabilized by a mature peri-tumoral osteogenesis. The residual bone fragments into the tumor are constant in the chondrosarcoma and more rare in the enchondroma. The peri-tumoral osteogenesis, identical to enchondral bone formation, is the more often immature in chondrosarcoma and always mature in enchondroma. The active bone resorption as well as the actual bone remodelling, are more frequent in the chondrosarcoma borders than the enchondroma those. Lastly, the peri-tumoral fibrosis is the own of enchondroma; its existence in the chondrosarcoma is only the reflection of a residual enchondroma.
Adolescent↗
[A peculiar tumor. Adamantinoma of the long bones. Apropos of 7 consecutive cases followed up after resection].
Seven cases of tibial adamantinoma have been reviewed. All were treated by en bloc resection and followed for one to twenty years after operation. Of five patients followed for more than three years, three have had a good result after 3, 12 and 20 years of follow-up. One patient suffered a recurrence in the soft tissues seven years after resection and remained well after thirteen years follow-up. One patient required amputation two years after resection and died from a mediastinal tumour of undetermined nature sixteen years after amputation. The two failures occurred in patients seen secondarily following recurrence after initial curettage. The tibial shaft was reconstructed in three cases by massive allografts. One of these failed because of infection but was reconstructed using autografts; one had a late fracture which united spontaneously. The third, after sound union, had to be amputated for recurrence. Two smaller resections were treated successfully by tibial and iliac autografts. Two cases were treated by free vascularised fibular transplants which united, though one suffered a late fracture which united spontaneously. Curettage, which is almost always followed by recurrence, should be rejected in favour of extensive resection. Resection is successful when done primarily but poses severe problems in reconstruction and requires a prolonged period of treatment. The small numbers in this series do not allow a judgement to be made as to the superiority of one technique over another.
Adolescent↗
[Arthritis of the wrist disclosing osteoid osteoma of the capitate bone].
A 22-year-old woman with an osteoid osteoma of capitate bone presented initially with arthritis of wrist. Bone scan imaging and digital subtraction angiography allowed diagnosis of a nidus. This case draws attention to articular manifestations of osteoid osteoma.
Adult↗
[Combined arthrodesis of tibiotalar and subtalar joints (transtalar approach using a trephine].
The authors describe an original technique of combined tibio-talar and subtalar arthrodesis. They use an anterior approach and remove a bony cylinder, using a trephine driven through the talus and the calcaneus. The cylinder is then replaced upside down, the calcaneal part of the cylinder crossing the subtalar joint. The tibio-talar joint is fixed by two screws. The technique is indicated in cases of talar necrosis with minimal deformity of the foot. It is intended to decrease the incidence of skin necrosis. Four successful cases are reported.
Ankle Joint↗
[Reconstruction prosthesis of the upper part of the femur. Intermediate results in 20 resections for tumor. Current trends].
Twenty total hip prostheses inserted after massive resection of the upper part of the femur for tumour have been reviewed after a 3 year mean follow-up. Fifteen cases were of primary malignant tumour. The mean resection of the femur measured 175 mm in length and was reconstructed using Cochin prostheses. From the oncological standpoint, the results were comparable with those obtained after disarticulation of the hip, but the functional results were, of course, much better. Five patients were able to resume their previous professional work; 13 were able to have a normal type of life and only 2 were severely crippled. Nineteen hips were painless. Nine patients could walk without a stick, 9 used one stick for walking outside and 2 used sticks permanently. Two cases were complicated by dislocation. Despite an extensive resection of the greater trochanter, one third of the hips were stable on standing on one leg, thanks to the design of the prostheses. No prostheses broke. Two loosenings of the acetabular cup had to be revised. No loosening of the femoral stem was found, despite the frequency of osteolysis of the diaphysis to 4-5 cms below the level of resection. The authors intend now to improve the design of the prostheses and to aid the reinsertion of the muscles, which can be improved by using homografts surrounding the femoral prostheses.
Femoral Neoplasms↗
Multifocal nonosteogenic fibroma: report of a case with ultrastructural findings.
The case of a patient in whom multiple nonosteogenic fibromas developed is reported. This condition is very unusual and must be differentiated not only from the multiple lesions that occur in association with well-known entities but also from some occasionally multifocal bone tumors. The lesion is characterized by proliferations of spindle cells disposed in storiform patterns, with numerous scattered multinucleated giant cells. Ultrastructural study revealed that the basic cell of this lesion had fine structural features of both fibroblast and myofibroblast cells.
Adolescent↗
[Swanson silastic implant arthroplasty in pathology of the metatarsophalangeal joint of the great toe].
Fifty-one disorders of the metatarsophalangeal joint of the Great Toe have been treated by implantation of a Swanson silastic prosthesis. A finger-joint device was used in 29 cases and a Great Toe device in 22 cases. The pathological lesions were degenerative arthrosis, rheumatoid arthritis or failure of preceding procedures. The mean follow-up was 3 years. In more than 2 cases out of 3 pain was abolished. Joint movement was only slightly improved but there was a better range of dorsiflexion and an improved gait. The axis of the Great Toe was generally satisfactory and pre-existing deformity was corrected in 3 cases out of 4. These results are satisfactory in the short term and were better with the Great Toe device. Osteophytic reaction may be the cause of long-term failures.
Arthroplasty↗
[Posterior and external transtrochanteric approaches for total hip prosthesis. Comparative study].
1100 total hip prostheses were inserted between 1977 and 1978. Among them, the authors have selected at random 150 cases operated on by the Austin Moore approach and 150 cases by trochanteric division. The pathology and the type of patient were the same in both groups. A study of the late results showed no difference between the two series. In each, there were two early infections and three late infections. The rate of post-operative dislocation was the same, two early and six late in the Moore approach group, and five early, and two late in the trochanteric division group. There were six sciatic involvements after the Moore approach but only three after trochanteric division, but in this last group there were complications relating to the trochanteric division itself. There were no statistical differences in a comparison of the numbers of re-interventions required. Both techniques appeared to be satisfactory. The Moore approach appeared to be better for the comfort of the patient and does not give any additional risk. Trochanteric osteotomy is indicated in particularly stiff hips, when the greater trochanter has to be displaced downwards or in cases of post-operative scarring.
Femur Head↗
[Anatomo-physiological review of the shoulder].
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Humans↗
[Osseous desmoid fibroma of long bones. Review of the literature and diagnostic problems. Apropos of 2 cases including 1 with ultrastructural study].
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Adult↗
[Fibrosarcoma of bone].
The authors have treated forty-five cases of fibrosarcoma of bone between 1949 and 1979. Tumours with chondrogenesis or osteogenesis to any extent have been excluded from the study. The conclusions are that fibrosarcoma represent 10 p. 100 of all bone tumours. Microscopy was difficult and in some cases it was not easy to determine both the fibroblastic origin and the presence of malignancy. Eight per cent of the tumours were primary and 20 p. 100 secondary. The global results indicated 40 p. 100 survival after five years. Twenty-four cases were treated by amputation of which twenty-two were followed up and fifteen were alive after five years. In nine cases, resection was performed. Recurrence occurred in five cases, three of which had to be amputated of which two survived. Two others were treated by irradiation without success. Ten cases were treated primarily by irradiation of which only three survived after heavy dosage. Proximally situated tumours had a very poor prognosis with no survival. The prognosis appeared to be better in those under forty years of age (55 p. 100 survival) than over forty years (11 p. 100 survival).
Adolescent↗
[Fractures of the olecranon. Study of 200 cases].
The authors have reviewed the results of 200 fractures of the olecranon; 177 were treated operatively. They conclude that the articular surface can only be restored by surgical treatment in most instances. Several types of internal fixation were used and compared. Double wiring appears to be the most efficient for the type of fracture. However, the use of screws or a combination of wiring and pinning are also worthwhile when done correctly.
Adolescent↗
[Metatarso-phalangial arthrodesis of the big toe. Reflections apropos of 93 operations].
The authors have reviewed 93 cases of arthrodesis of the first metatarso-phalangeal joint performed for various conditions. In 43 cases it was done as a salvage procedure after other surgical procedures. In these cases, the rate of union was only 70 p. 100 compared with 94 p. 100 when the arthrodesis was done as a primary surgical procedure. The technique is described in detail and the use of bone grafts recommended. Functional results were satisfactory in 3 out of 4 cases. The precise position to be applied to the toe is discussed.
Adolescent↗
Metatarsalgia due to insufficient support by the first ray.
Sixty-five feet with metatarsalgia due to inadequate support by the first ray are presented. A classification of different types of deficient anteromedial support is proposed in relation to the morphology of the first ray. When there is deficient anteromedial support and the first ray is normal, the ray is elevated and may or may not be associated with supination of the forefoot. When there is elevation of the first ray alone, operations are proposed which restore normal anteromedial support. The decision for choosing a particular type of operation is determined by an analysis of the cause of the elevation. There operations can be on the soft tissues, bone or both. When loss of anteromedial support is the consequence of complete supination of the forefoot, this has been corrected by a tarsal derotation osteotomy. Supination of the forefoot may be accompanied by elevation of the first ray. In there cases, the derotation osteotomy has been complemented by one of the operations described in the case of simple elevation of the first ray. The different indications of these surgical procedure are described as well as the results. In the case of deficient anteromedial support with an abnormal first ray, the treatment was conservative or surgical. The results of different operations performed to restore the normal loading under the forefoot are described.
Foot↗