Biomedical subjects
Publications and source records attributed to C Bour.
There is a rare and special type of macrodactyly that is called the hyperostotic variety. This disease occurs later than the classical forms of macrodactyly and shows massive osteocartilaginous deposits around the joints. A new case is reported. The cause of this disease could be previous trauma.
The importance of anatomical reduction of articular fractures and early mobilisation of these severe forms of trauma which frequently damage the extensor apparatus (58% of cases, led us to propose direct miniaturised osteosynthesis as described by the Nancy-Strasbourg team. Of the 1,000 cases of osteosynthesis performed between 1978 and 1985, we selected 12 fractures of the MP joint, 38 fractures of the PIP joint and 10 fractures of the DIP joint, differentiated into 4 stages according to the condition of the skin and tendons and into 9 categories according to the anatomical type and the site of the fracture. Direct osteosynthesis (screw, bolt, pin) was used in every case. The clinical results were evaluated in terms of the Total Active Range of Movements, the local trophic state, the amount of pain and return to work, for each joint. When well conducted and with effective skin cover, this technique allows almost normal reconstruction in simple fractures and is valuable in more complex fractures by preserving sliding of the tendinous apparatus due to early mobilisation.
Transtriquetral triquetro-lunate arthrodesis is an original technique for partial arthrodesis of the wrist. This operation is indicated in the treatment of certain forms of triquetro-lunate instability and represents a new approach to the treatment of Decoulx's stages I and II of Kienböck's disease. The incision is medial and limited. The use of a special trephine guided by a pine allows the extraction of a triquetro-lunate osteocartilaginous cylinder. A cancellous bone graft is then performed to fill in the loss of substance. This new, simple surgical procedure, but demanding in terms of its technique, should decrease the failure rate and should improve the chances of lunate revascularisation.
The surgical treatment of "swan-neck" deformities secondary to mallet finger using Littler's technique (Spiral Oblique Retinacular Ligament) in a series of 35 cases, led to a complete correction of the PIP joint hyperextension in 95% of the cases and a correction of the DIP joint flexure in 70% of the cases. This active tenodesis restores the physiology of the extension of the PIP and DIP joints as far as the surgical technique has been strictly respected.
An automated method is proposed for photographing a microsurgical field that avoids missed photographs and time-consuming manipulations. The basic principles applied to microscopic photography are briefly reviewed and instructions are provided for standardized, reproducible, high quality photographs. A limitation at present is that auto-focusing cameras have not yet been adapted for use with surgical microscopes. One type of microscope is discussed and details about the only camera system currently suitable for such a microscope are described.
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The most common type of gastric metastases secondary to carcinoma of the breast is the one showing a linitis plastica appearance. The roentgenologic aspect when performing an upper gastrointestinal examination with barium contrast is typical and allows the differential diagnosis with the primitive linitis. The linitis plastica type of metastatic breast carcinoma results from transmural infiltration of the stomach wall with initial deposit of tumor cells in the submucosal or subserosal regions. CT provide valuable information concerning the metastatic spread.
We report a case of involvement of a finger flexor tendon by sarcoidosis. A review of twelve cases suggests that this is a rare manifestation of the illness that most often affects the finger extensors at the wrist. It tends to present in established sarcoidosis and is associated with a higher than usual incidence of polyarthritis. The main differential diagnosis would be tuberculous tenosynovitis. We suggest that a histological spectrum exists running from a predominantly cellular picture to one of fibrotic nodules, perhaps explaining previously described instances of pseudo-tumour. We would recommend tenosynovectomy in conjunction with corticosteroid therapy as the treatment of choice.
Digital sympathectomy as proposed by Flatt and al. was performed on 12 Raynaud's diseases, 6 distal arteriopathy and 4 post-trauma ischemic syndrome. Operation was performed under tourniquet. The approach depends on the number of digits involved (Brünner at the proximal part of P1, transversal in the distal palmar crease, zigzag incision at the level of each intermetacarpal space). Under microscope, adventisectomy is started on a lateral side of the artery followed by the posterior side on at least 1 cm, using the adventitia avoid all direct manipulation of the vessels. Closing skin on an aspirative drainage and simple non compressive drainage is maintaining 4 days. Index pressure and arterial blood flow are measured. Results are bad for post-trauma ischemic syndrome and arteritis but encouraging in Raynaud's disease (7 patients asked for the same operation on the opposite side).