Apparent hip osteoarthritis in a 16 year old girl.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
D Goutallier
Publications and source records attributed to D Goutallier.
[Isolated lesions of the subscapularis tendon and internal malpositions of the biceps tendon. Apropos of 45 cases].
Our series consists of 45 lesions of the subscapularis tendon investigated by arthrography and CT arthrography. Arthrography demonstrated opacification of the subacromial bursa in 24% of cases, internal malposition of the long head of biceps in 46% of cases and direct signs of a lesion of the subscapularis tendon in 91% of cases. CT arthrography showed incomplete transverse avulsion in 18% of cases and complete transverse avulsion in 82% of cases. The biceps was dislocated in 35% of cases, and subluxed in 11% of cases. The subscapularis muscle was infiltrated by fat in 46% of cases. Isolated lesions of the subscapularis can be difficult to diagnose clinically and are more frequent than generally thought. CT arthrography must therefore be requested at the slightest doubt, as the intraoperative search for a lesion of the subscapularis tendon is sometimes difficult.
Adult↗
[Effect of osseous torsions of the lower limb on the development of lateral femorotibial knee arthrosis].
PURPOSE OF THE STUDY: Frontal deformation of the knee is certainly not the only factor involved in the occurrence of lateralised tibio-femoral arthrosis. The aim of the study was to analyze if any kind of tibial torsion or femoral torsion could be able to induce lateralized arthrosis. MATERIAL AND METHODS: Femoral torsion, tibial torsion and tibio-femoral index (tibial torsion minus femoral torsion) have been measured on 59 knees with lateral arthrosis (8 knees) or with medial arthrosis (51 knees). For each knee, two frontal deformations were measured: 1) the actual arthrosis deformation was calculated on a hip knee ankle radiograph, 2) the pre arthrosis deformation is the arthrosis deformation minus the angle made by the femoral condyle tangent and the tibial plateau tangent. A knee has no frontal deformation if the angle between the mechanical axis of the femur and the mechanical axis of the tibia is between 178 degrees and 182 degrees; there is a varus deformity if the angle is inferior to 178 degrees; there is a valgus deformation if the angle is superior to 182 degrees. RESULTS: Out of the 8 knees with lateral arthrosis, 2 showed initially no frontal deformation and 6 had a valgus deformation; out of the 51 knees with medial arthrosis, 34 showed initially no frontal deformation, 6 had a valgus deformity and 11 a varus deformity. The tibio-femoral index in lateral FT arthrosis was statistically different from those in medial FT arthrosis (p 0.0001). When a lateral arthrosis appeared whatever the pre arthrosis deformation was the index was always negative (tibial torsion lower than femoral torsion); when a medial FT arthrosis appeared, whatever the pre arthrosis deformation was, the index (except for two cases) was always positive (tibial torsion higher than femoral torsion). CONCLUSION: Femoral and tibial torsions play a part in lateralised arthrosis occurrence together with frontal mechanical factors. Perhaps troubles in torsion explain some spontaneous or post-therapeutic evolutions not explained by frontal mechanical factors.
Biomechanical Phenomena↗
The effects of bolus administration of opioids on cerebrospinal fluid pressure in patients with supratentorial lesions.
In many studies reporting an increase in cerebrospinal fluid pressure (CSFP) after opioid administration, concomitant decreases in mean arterial pressure (MAP) have been observed. Autoregulatory cerebral vasodilation may therefore have been a factor in the CSFP increases. We tested the hypothesis that increases in CSFP after bolus injection of opioids could be minimized by modifying concomitant decreases in MAP with phenylephrine. Thirty-three patients with supratentorial mass lesions were studied in a randomized, prospective, double-blind, saline-controlled comparative trial. The principal outcome measures were lumbar CSFP, MAP, and heart rate (HR). Study drugs, sufentanil 0.8 micrograms/kg (n = 12), fentanyl 4.5 micrograms/kg (n = 11), or normal saline (n = 10), were injected intravenously (IV) during stable general anesthesia with 0.3-0.7 minimum alveolar anesthetic concentration (MAC) of isoflurane in oxygen and controlled ventilation (end-tidal carbon dioxide 32-35 mm Hg). Phenylephrine 50-100 micrograms was injected IV when MAP decreased by more than 15% of initial values, and atropine 0.5 mg IV when HR decreased to less than 45 bpm. Opioid administration was associated with significant decreases in MAP, 21 +/- 9 mm Hg (mean +/- SD) in the sufentanil group and 16 +/- 7 mm Hg in the fentanyl group; P < 0.001. These decreases in MAP were of short duration (i.e., corrected with 1-2 min). Patients in the sufentanil group needed more phenylephrine than patients in the fentanyl group (170 +/- 89 micrograms vs 100 +/- 47 micrograms; P < 0.05). No significant change in the CSFP was seen in either the sufentanil (1 +/- 6 mm Hg) or fentanyl-treated patients (O +/- 2 mm Hg). No significant changes in MAP or CSFP were observed in the saline-treated patients. HR decreased after injection of either study drug (P < 0.01) but remained unchanged in the saline group. In summary, during stable anesthesia with isoflurane in oxygen, bolus injections of fentanyl or sufentanil, despite producing rapidly corrected mean decreases in MAP of 18% and 25%, respectively, were not associated with any change in CSFP.
Adult↗
Isolated subacromial decompression for the treatment of chronic shoulder pain with rotator cuff calcification. A review of twenty-seven shoulders, including eighteen evaluated by magnetic resonance imaging after surgery.
We conducted a retrospective study of functional results and imaging study changes after isolated anterosuperior decompression of 27 chronically painful shoulders with calcification of the supraspinatus tendon at the time of surgery (n = 22) or at an earlier date (n = 5). Mean duration of pain at surgery was 4.5 years. Mean time between surgery and evaluation of results was three years. Absence of pain and full range of motion were noted in most cases (70%), usually after four to six months. There were no postoperative exacerbations of pain. The best results were obtained in those patients with a heterogeneous supraspinatus calcification. Most calcifications (18/22) disappeared within one year of surgery. Magnetic resonance imaging findings at last follow-up are reported for 18 shoulders. Functional results were nearly as good as those reported after calcification removal. In patients with shoulder pain and rotator cuff tendon calcifications who fail to respond to conservative therapy and aspiration with lavage, anterosuperior decompression may be the treatment of choice when the calcification is either heterogeneous and located within the tendon or no longer visible. In contrast, curettage may be the best treatment for superficial homogeneous calcifications that can be removed without damaging the rotator cuff.
Adult↗
[A study of the neurologic risk in tendino-muscular advancement of supra-spinatus and infra-spinatus in the repair of large rotator cuff rupture].
PURPOSE OF THE STUDY: An anatomical study by Warner et al. (1992) showed that an advancement of supra and infra-spinatus of more than 3 cm could be deleterious for the suprascapular nerve or its branches. In pathological conditions, the limit of possible advancement could even be less than 3 cm. The authors wanted to know whether this technique, which they use for the repair of large rotator cuff tears, could have neurological effects in surgical practice. MATERIAL: 24 shoulders among 24 patients having had a rotator cuff repair using a musclar advancement have been studied. In 13 cases only the supraspinatus had been advanced, and in 11 cases both supra and infraspinatus have been advanced. METHODS: The suprascapular nerve status has been studied postoperatively by EMG. EMG was performed at a mean 8.5 months follow-up. Motor unit potentials were studied at rest and after maximal contraction. Electro-stimulation at Erb's point was used to evaluate muscular latency. All repairs have been controlled by opaque arthrography, and a CT scan grading of muscular fatty degeneration was performed. In 19 cases EMG had also been performed preoperatively. RESULTS: At revision, 17 EMG were considered normal. In one case there was an impairment of the first primary trunk, already noticed preoperatively. Only 6 EMG anomalies probably related to surgery have been noticed, although the width of the tear in the coronal plane was nearly always of more than 3 cm. 4 of these 6 shoulders had been explored preoperatively by EMG, and were recorded as normal before surgery. Electric impairment was limited to the supraspinatus in 3 cases (increase of muscular latency after single advancement in two cases, polyphasic motor unit potential after double advancement in one case), to the infraspinatus in one case (polyphasic motor unit potentials recorded in the infraspinatus after single advancement of the supraspinatus), and concerned both muscles in 2 cases (increase of muscular latencies after double advancement). DISCUSSION: Muscular advancement was usually performed for tears of more than 2.5 cm wide, and so should be deleterious for suprascapular nerve, according to Warner et al. studies. But in most cases no neurological impairment could be observed in surgical practice. This could be due to the fact that the gap to repair is due not only to a loss of substance in the tendons but also to muscular retraction. In a first step, the muscular release allows to correct this muscular retraction ("muscular" advancement). The advancement remaining then to be performed is about 2 cm wide ("tendino-muscular" advancement). CONCLUSION: It appears that in surgical practice supra and infraspinatus advancement threatens only moderatly the suprascapular nerve or its branches, even if the width of the tear is greater than 3 cm. Postoperative immobilization in slight lateral elevation further reduces the importance of this advancement.
Arthrography↗
[Fractures of the distal radius with dorsal displacement: a comparative study of the predictive value of 6 classifications].
PURPOSE OF THE STUDY: The authors compare six classifications in a prospective study of distal radius fractures surgical treatment. Classifications included Castaing's, Frykman's, Gartland's, Older's, Lindström's and Jenkins'. MATERIAL: 96 patients presenting a distal radius fracture were included in a protocol comparing two surgical treatments. 42 were treated with styloid pinning and immobilization while 54 with intra-focal pinning and immediate mobilization according to Kapandji's technique. METHODS: Each patient was graded initially according to each six classifications. Patients were reviewed at 6 weeks, 3, 6, 12, and 24 months. Clinical and radiographical evaluation were performed. Clinical and radiological results were compared according to each group of classification. RESULTS: None of the six classifications appeared to have any utility to predict functional or radiological results. None was able to distinguish treatment option. DISCUSSION: The six classifications did not permit to predict clinical or radiological outcome of distal radius fractures treated by radial styloid pinning or Kapandji's technique. All those classifications have been described for conservative treatment rarely performed in France for displaced fractures. CONCLUSION: The six classifications tested showed no predictive value in K-wire treatment of dorsally displaced distal radius fractures.
Adolescent↗
[Report of the 2nd meeting of the Study Group of shoulder and elbow. Paris, 6 November 1995. Traumatic posterior dislocations of the shoulder].
Explore the source record for details and available documents.
Follow-Up Studies↗
[Replacement of infected total hip prosthesis in two stages].
Since 1975 we have treated 36 infected hip replacements by a two stage procedure in which the prosthesis and cement were first removed. Gentamicin impregnated beads were left at the sites of the prosthesis. Not less than 45 days later a fresh prosthesis was inserted into the hip. In two hips revision was not undertaken because of persistence of infection. The remaining 34 hips received a fresh prosthesis when the site was bacteriologically sterile. Gentamicin impregnated cement was used and antibiotics were given for a further three months. The functional results were satisfactory at an average of five years of follow up. Incomplete removal of methylmethacrylate was a factor in the persistence of infection and of pain in the absence of infection. The bacteriological efficacy of Gentamicin impregnated beads is uncertain, but their use gave a better functional result.
Anti-Bacterial Agents↗
Reconstruction of compound tibial and soft tissue loss using a traction histogenesis technique.
We used simultaneous bone and soft tissue transport for reconstruction of large compound tissue loss in the lower leg. We report the results and complications of a 12-patient series. The average age of the patients was 31.2 years (range 20 to 48 years). Seven patients had grade IIIB open tibial fractures, three had complications after grade II or IIIA, and two had an en-bloc resection of bone, muscle, and skin for a malignant bone tumor. Arteriography was routinely performed, and demonstrated at least one patent tibial artery. Every patient had normal sensibility of the sole. The first stage of the reconstruction was an aggressive excision of the all necrotic skin, muscle, and bone. The Ilizarov external fixator was applied and wires were secured under a tension of 100 kg, using a dynamometric tensioner. Cutaneous tissue loss was not replaced in 10 patients, when the bone was not exposed. A medial gastrocnemius flap was performed in two patients and lengthened with the bone. Corticotomy was performed 15 days after the first stage with careful respect for the periosteum. Distraction was initiated 15 days after the corticotomy. The average bone defect was 12.5 cm after initial excision. An average of 9 operative procedures and 18 months of treatment were required before bony union. The mean duration of bone transport was 6.5 months, and the mean duration of external fixation was 12 months. The final functional results were fair and only two patients returned to work. One patient had a below-knee amputation after 10 months of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Fatty infiltration of disrupted rotator cuff muscles.
The extent of fatty infiltration of rotator cuff muscles was evaluated on computed tomography displays using a five-point scoring system in 63 shoulders before surgery for a rotator cuff tear and in 57 of these shoulders after surgical repair of the tear (the quality of cuff repair was evaluated in these 57 shoulders by arthrography, usually coupled with computed tomography, after a mean time interval of 8 months since the procedure). Preoperatively, significant fatty infiltration of the supraspinatus muscle was uncommon. Severe fatty infiltration of the infraspinatus and subscapularis muscles was seen in some patients. In most instances, fat accumulated in those muscles whose tendons were torn; however, tendon cleavage was associated with mild fatty infiltration of the corresponding muscle in some instances, and wide tears of the supraspinatus and subscapularis muscles were sometimes accompanied with severe fatty infiltration of the infraspinatus muscle. In half the cases, fatty degenerescence of the infraspinatus muscle occurred within six months of the tendon rupture. After surgery, in most shoulders without evidence of rotator cuff leakage on the postoperative arthrogram, no further accumulation of fat occurred. However, a decrease in the amount of existing fat was rarely documented and occurred only in the supraspinatus muscle. Before and after surgery, increasing severity of the fatty infiltration of the infraspinatus muscle was associated with increasing functional impairment of the same muscle. Recurrent rotator cuff tears, which involved only the supraspinatus muscle, were considerably more common when there was severe preoperative fatty infiltration of the infraspinatus muscle.(ABSTRACT TRUNCATED AT 250 WORDS)
Adipose Tissue↗
Destructive arthropathy of the hands in chronic hemodialysis patients. A report of seven cases with pathological documentation.
Destructive arthropathy of the hands is common in chronic hemodialysis patients. The clinical and histological features in seven cases are reported. There were five females and two males aged 45 to 78 years. Hemodialysis duration at the time of surgery was 48 to 228 months (mean 92 months). Four patients had arthrodesis, two had insertion of silastic implants and one had a diagnostic surgical biopsy. The site of the surgical procedure was a distal interphalangeal joint in three patients, a proximal interphalangeal joint in one, a trapeziometacarpal joint in two, and both a proximal and a distal interphalangeal joints in one. All seven patients had severe destructive arthropathy responsible for pain and instability. Roentgenograms showed joint space obliteration and subchondral erosions or lysis, without osteophytosis. Several finger joints were involved in six of the seven patients. Histologic studies of the synovial membrane (n = 7) and subchondral bone (n = 4) found no amyloid even in the three patients with clinical or roentgenographic evidence of amyloidosis at other sites. Electron microscopy studies were done in two patients and failed to disclose crystals or amyloid. Our findings demonstrate that destructive arthropathy of the hands in hemodialysis patients is not a manifestation of dialysis-related amyloidosis. The pathophysiology of the condition remains poorly understood.
Aged↗
Fracture of the distal radius. A prospective comparison between trans-styloid and Kapandji fixations.
We performed a prospective study on 96 patients with extra-articular or intra-articular fractures of the distal radius with a dorsally displaced posteromedial fragment. After closed reduction, we compared trans-styloid fixation and immobilisation with Kapandji fixation and early mobilisation. Forty-two patients of mean age 57.1 years +/- 18.1 (SD) were treated by trans-styloid K-wire fixation and 45 days of short-arm cast immobilisation. Fifty-four patients of mean age 57.7 years +/- 18.7 (SD) had Kapandji fixation and immediate mobilisation according to the originator. All the patients had clinical and radiological review at about six weeks and at 3, 6, 12 and 24 months after the operation. Pain, range of movement and grip strength were tested clinically, and changes in dorsal tilt, radial tilt, ulnar variance, and radial shortening were assessed radiologically. Statistical analysis was applied to comparisons with the normal opposite wrist. Pain and reflex sympathetic dystrophy were more frequent after Kapandji fixation and early mobilisation, but the range of motion was better although this became statistically insignificant after six weeks. The radiological reduction was better soon after Kapandji fixation, but there was some loss of reduction and increased radial shortening during the first three postoperative months. The clinical result at two years was similar in both groups.
Adult↗
[Intermediate results in Neer's unrestricted total shoulder prosthesis inserted in glenohumeral arthropathies of arthrotic or arthritic origin].
Explore the source record for details and available documents.
Adult↗
[Fracture dislocation of the ankle with retro-tibial luxation of the fibula (Bosworth fracture) . Apropos of a case].
The authors present a case of fracture dislocation of the ankle joint with the proximal part of the fibula entrapped behind the tibia ; Bosworth's fracture. This fracture was described for the first time in 1848 by Hugier, and classified by Bosworth in 1947. In our case, diagnosis was not done in a first time, and closed reduction failed. This fracture was operated on and open reduction was performed. At the present time, the functional result is good.
Ankle Injuries↗
[Clinical and radiographic results of a continuous series of 124 type Ceraver-Osteal hip prostheses with a 9-year survival analysis].
INTRODUCTION: Since 1979, we have been using a model of cemented total hip arthroplasty (THA) with a titanium femoral stem, a 32 mm femoral head, and for some cases an alumina on alumina browing combination. We tried to appreciate the results of these different modifications with a sufficient follow-up. MATERIALS AND METHODS: Among the 124 THA, 63 sockets were made of alumina, 61 of polyethylen, 22 patients had deceased and 23 were lost for follow-up before seven years, we studied 72 THA followed between 7 and 9 years up. The cementing technique was not modified. The clinical evaluation was done using the Merle d'Aubigné-Postel hip rating scale the radiographic analysis was conducted for 79 hips. RESULTS: After 9 years 8 cups had been removed for loosening, 2 hips were operated for infection, the global survivorship without a new operation was then 88.73 per cent. Among all hips, 80 per cent were clinically rated as "fair" or better. We noticed 8 migrations among the alumina cups and 6 among those made of polyethylene. Among the 31 polyethylene cups, there were 25 lucencies between bone and cement (18 < 1 mm). Among the 48 alumina cups there were 22 lucencies just between bone and cement and 21 between cup and cement and also between bone and cement (double lucencie). The lucencies between cup and cement were more often in the lower third of the cup and 7 of the 8 migrations had double lucencies. Forty-nine percent of the femoral stems had lucencies, 40 per cent in the proximal zones. But there was just one femoral subsidence associated with the lowest distal femoral filling. So just considering the femoral subsidence the survivorship was 98.79 per cent. DISCUSSION: The clinical results of this series were as good as the more recent series. Because of the difference of radiographical aspect between the polyethylene and alumina cups, the high rate of lucencies and migration could have been interpreted as two different mechanisms. For polyethylene cups, the 32 mm femoral head is frequently associated with this complication, as it was already described in other series. For the alumina, the difference of elasticity between bone and cement should have been the principal responsible. As we considered just the migration of the stem, and although the cementing technique was simple, our rate of femoral loosening was as low as in the more recent series. The frequent proximal lucencies should may be not be considered as loosening but as consequence of the elasticity of titanium. The distal fixation obtained by a good distal femoral filling seemed to be the more important point. CONCLUSION: To reduce the acetabular loosening rate we use now a head of 28 mm for the metal on polyethylene combination, the alumina cup has been abandoned and the alumina on polyethylene combination should still be assessed. The encouraging femoral results, due to the good femoral filling and to the titanium elasticity needs to be confirmed after a longer follow-up.
Adult↗
[Radiological changes in uncemented acetabular components. Apropos of 77 hybrid total hip prostheses reviewed with a mean follow-up of 3.5 years].
Seventy-seven total hip arthroplasty procedures performed between 1982 and 1989 for osteoarthritis by the same surgeon using a cementless acetabular component were reviewed retrospectively after a mean follow-up of 3.5 years. Clinical outcomes were similar to those seen with cemented implants. Roentgenographic analysis of acetabular position detected migration of 19 implants (25%). Actuarial survival analysis showed that the migration-free survival rate of acetabular components was 74.5% nine years after insertion. Bony consistency of the acetabulum after reaming was the only factor that significantly influenced the likelihood of acetabular component migration. Increased acetabular density after previous conservative hip surgery was associated with a significant reduction in the risk of migration (p = 0.003). Because anchorage quality was not predictable, we discontinued use of cementless acetabular components.
Acetabulum↗