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Biomedical subjects

C Kénési

Publications and source records attributed to C Kénési.

15 recordsLinked to original sources
PubMed1998

Arterial and lymphatic supply of the knee integuments.

The surgical approach to the anterior knee region carries a risk for postoperative integument infection and skin necrosis. A hypothesis is that surgical approach may damage integumental blood supply and additionally the lymphatic drainage from the foot and leg. The goal of this study was to describe the arteries and lymphatics directly affected by the antero-medial approach. Injection of the femoral a. was used to identify the femoral and popliteal aa. and their branches distributed to the integument of the anterior, medial and lateral aspects of the knee. Lymphatic injection into the plantar aspect of the first toe was also performed to identify the subdermal lymphatics traversing the area. Our results showed that most of the blood supply arises from the medial aspect of the knee integuments. However, subcutaneous arterial anastomoses provide a significant blood-supply when there is interruption of the medial vessels as seen in the medial surgical approach to the knee. Most of the lymphatic drainage originating from the foot crosses the knee region on the medial side, opposite or below the tibial tuberosity. Because the subdermal arterial network is well-developed, the medial approach for knee surgery does not endanger the anterior knee integuments as long as the lateral vascular supply is preserved. However, this approach may interrupt the lymphatic circulation, particularly in the case of an extended incision, which could explain postoperative edema and an increased rate of wound infection.

Cadaver↗
PubMed1998

[The unstable shoulder in young subjects. Surgical experience].

The stability of the scapulo humeral joint depends on three anatomical factors: bony: surface and integrity of the glenoid cavity. ligamentous: joint capsula and labrum glenoïdale. muscular: coordination and condition of the components of the rotator cuff that maintains the humeral head in the center of the joint, whatever be the position of the arm. Clinically, the most frequent aspect is the anterior recurrent dislocation, occurring in young patients.... Other forms are possible: posterior, multi directional, associated with a lesion of the rotator cuff in elderly patients.... Lately a new aspect was described: the painful and unstable shoulder. It is observed in high level sportsmen, who practice throwing sports. The only treatment is surgical. Two kinds of techniques are currently used: preglenoid transfer of the coracoid process, and different kinds-of capsuloplasty. Arthroscopy allows a more precise diagnose, but is not yet a good therapeutic procedure. Surgical treatment avoids recurrence in more than 95% of cases, but clinical osteoarthritis of the gleno humeral joint is observed in about 10% of cases after a long follow up (more than 10 years).

Adolescent↗
PubMed1996

[Surgical treatment of the rheumatoid hand].

In rheumatoid arthritis, involvement of the hand is serious, frequent and occurs early. It reaches synovial sheets, articular or tendinous, and causes painful and invalidating deformities. Our experience, based on 537 operations of the hand, indicates that reconstructive surgery can be practised at all levels. For the wrist, inferior radio ulnar arthrodesis strengthens the articulation and eradicates pain when performed in the early stage. Segmentar resection of ulnar diaphysis ensures the conservation of "prono- supination". In the case of destruction or luxation of the wrist, a choice has to be made between prosthesis and arthrodesis. We tend to prefer the latter which confers a strong, painless and definitive articulation. Ulnar deviation of metacarpo-phalangeal articulations of long fingers can be corrected by ligamentar or tendinous plasties. But the results are not always durable and they cannot be used when the articulations are destroyed. In that case prostheses have to be implanted. Swanson's silastic implants enable to straighten the fingers and to suppress pain but ensure a limited mobility. Likewise, interphalangeal deviations generally call for implants or arthrodeses. Trapezo-metacarpal or phalangeo-metacarpal deformities of the thumb are stabilised by arthrodeses, ensuring a strong and painless prehension. In conclusion, reconstructive surgery allows many possibilities but its results are often incomplete. It is therefore advisable to perform synovectomy as early as possible before the occurrence of deformities. Surgical synovectomy competes with isotopic, chemical or corticoid synoviosthesis. But at tendinous level, synovectomy alone should be used, since it gives excellent results. Even though rehabilitation after synovectomies is not always easy, we hope that it will prevent the occurrence of articular or tendinous destruction for many years.

Arthritis, Rheumatoid↗
PubMed1994

[Biomechanics of the shoulder and its surgical consequences: personal experience operating on 250 shoulders].

Functional anatomy induces functional surgery. According to the anatomy of the locomotor apparatus, biomechanics opens the way to a more logical surgery. Two main concepts rule the study of the shoulder: the articular complex; the muscular chain. The articular complex: the scapulo- humeral joint is the main of the motion. The 50% remaining are due to the movements of the scapula around the thorax. The muscular chain: sixteen muscles are concerned in shoulder motion. They are classified in two principal groups: long muscles, fixing the scapula upon the thorax short muscles are disposed in two plans: superficial (deltoïd) deep, called the rotator cuff (subs scapularis; supraspinatus; infra-spinatus; teres minor). They only produce motion of the humerus on the scapula. The lateral elevation of the arm relies on the harmonious contraction of all these muscles. The mechanical environment of the cuff, particularly of the supra spinatus is not a favorable one: poorly vascularised, overworking, it goes through a narrow osteo fibrous tunnel. This produces irritation or rupture of the muscle. The surgery is indicated only in case of medical treatment failure. It has two alternative purposes, either to suppress the anterior conflict between the acromial vault and the cuff, or to repair a rupture of the supra spinatus. The acromioplasty is a benign operation that gives excellent results: 65% recover a normal shoulder. We notice 10 to 15% failures (105 cases. Follow up one to ten years). The surgery of reinsertion of the supra spinatus is a little more difficult and the results are less convincing: 36% good and excellent results; 43% fair; 21% failures (82 cases. Follow up one to fifteen years).

Biomechanical Phenomena↗
PubMed1992

[Plexus nerve blocks for postoperative analgesia after orthopedic surgery of the lower limbs].

In our institution, plexus nerves blocks have been performed in seventy patients after lower limb surgery. The technique is considered as simple and reliable. The administration of a 0.375 per cent bupivacaine epinephrine containing solution allows to obtain analgesia longer than 15 hours in 45 p. 100 of the patients, devoided of side effects. Lower limb plexus nerves blocks appear as an efficient technique for postoperative analgesia following orthopaedic surgery.

Adult↗
PubMed1991

[Surgical debridement of epicondyles. A 10-year follow up of 100 cases].

A single method was used in all cases: debridement of the radial head and exeresis of the apophysis. The statistics presented are derived from 100 elbows operated in 90 patients between 1970 and 1988. Fifty-four (54%) of the patients were men. Thirty-one (31) of the patients regularly took part in sport. Eighty-seven (87) cases were subjected to histopathological examination. Eighty-two (82) showed major signs of insertion tendinitis. With a mean follow-up of 7 years 4 months, the rate of good or very good results was 88% in subjective terms and 85% in objective terms. It was possible to examine 34 elbows on two occasions, 4 and 12 years after the surgery. No long-term self-deterioration or recurrence was observed. Fair or poor results were obtained in cases of malingerers claiming occupational accident, patients who had too quickly recommended physically demanding work, and cases associating other lesions (cervico-brachial neuralgia, epitrochleitis). All of these cases involved dubious indications for surgery. To conclude, this method is obviously intended only for cases in which medical treatment has been unsuccessful (and these are unusual). In nearly 9 out of 10 such cases, the procedure achieves an improvement.

Adult↗
PubMed1985

Orientation of the articular processes at L4, L5, and S1. Possible role in pathology of the intervertebral disc.

In the synergistic complex formed by the intervertebral disc and posterior articular processes, the latter play a significant role to protect the disc and block forward movement of the spine. This role is of special importance at the level of the lumbosacral interface whose inclination contributes to increase shearing forces acting on the disc. The orientation of the lumbosacral articular processes modifies the distribution of the mechanical stress acting at their level. The relationship between the orientation of the articular processes and the stress transmitted to the disc was studied by computerized tomography (31 subjects without disc prolapse, 35 subjects with disc prolapse, 110 operative reports). Sagittal orientation of the facet joints, which is consistently more pronounced on the right side, seems to promote the occurrence of disc prolapse at the lumbosacral level.

Humans↗
PubMed1985

[Acromioplasty].

Explore the source record for details and available documents.

Adult↗
PubMed1983

The mechanical role of the digital fibrous sheath: application to reconstructive surgery of the flexor tendons.

The movements of flexion of the digital articular chain are dependent upon a vast functional complex comprising the long flexor tendons, their antagonist long extensor tendons, and the coupled action of the interosseous and lumbricales muscles. Based on theoretical biomechanical data backed up by experimental investigation, the authors emphasize the important role of the digital fibrous sheath in the mechanism of action of the long flexor tendon. Any proximal resection (even of minor degree) of the proximal pulley of the digit induces severe mechanical disturbances by enhancing flexion of the metacarpophalangeal joint to the detriment of the proximal interphalangeal joint. Conversely, distal resection of the pulley enhances flexion of the interphalangeal joint to the detriment of the metacarpophalangeal articulation, although the resulting abnormalities are less pronounced than those due to proximal resection. The fibrous pulley plays a role in tendinous orientation in the frontal plane and in digital orientation of the index finger where the angulation between the pulley and flexor tendon is most pronounced. In this latter case ulnar deviation of the second finger occurs on flexion. Reconstructive surgery of the long flexor tendons requires that the digital fibrous sheath, especially its proximal segment, be preserved. The metacarpophalangeal joint seems to be the most vulnerable to morphological modifications of the pulley, as stressed from the anatomical standpoint by the absence of insertion of the long flexor tendons on the proximal phalanx.

Biomechanical Phenomena↗