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Biomedical subjects

D Goutallier

Publications and source records attributed to D Goutallier.

At least 55 records · Page 3Linked to original sources
PubMed1994

Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan.

A preoperative computed tomography (CT) scan grading muscular fatty degeneration in five stages was done in 63 patients scheduled for repair of a torn rotator cuff. The results were compared with postoperative evaluation done after a mean of 17.7 months in 57 patients. Postoperative arthrographies were also performed in 56 patients. Preoperative CT scans demonstrated that infraspinatus fatty degeneration can occur in the presence of large anterosuperior tears even when the infraspinatus tendon is not torn; it worsens with time. The subscapularis rarely degenerates, and when it does it degenerates moderately, even when its tendon is not torn. After an effective surgical repair, moderate supraspinatus degeneration regressed in six of 14 patients; that of the infraspinatus never regressed but rather, increased, in three patients. One of these deteriorations, involving both supra- and infraspinatus, could probably be attributed to a partial subscapular nerve injury. Infraspinatus degeneration was correlated with functional pre- and postoperative impairment of active external rotation. Recurrence of infraspinatus tear was never observed, but recurrence occurred in 25% of supraspinatus repairs. Infraspinatus degeneration had a highly negative influence on the outcome of supraspinatus repairs. It seems preferable to operate on wide tears before irreversible muscular damage takes place.

Adipose Tissue↗
PubMed1994

Magnetic resonance imaging findings in shoulders of hemodialyzed patients.

Twenty two patients (24 shoulders) who had undergone hemodialysis for a mean of 13.4 years, and who had reported chronic shoulder pain for > 6 months, were examined by magnetic resonance imaging (MRI), including T1 and T2 echo gradient images in the frontal plane and T1 images after gadolinium. An increase in thickness of the rotator cuff as well as synovitis and bursitis were documented. Twenty shoulders demonstrated a mean thickness of 8.05 mm. Most often, the signal intensity of T2 and T1 weighted images was intermediate, and T1 images failed to show an uptake of gadolinium. Of the 24 shoulders, 20 had subacromial subdeltoid bursitis and 21 had glenohumeral synovitis. These results indicate that MRI is of help in the early diagnosis of arthropathy in long term hemodialyzed patients. Magnetic resonance imaging findings are more precise than those of ultrasound, particularly for thickness measurements. Moreover, MRI films are easier to read and permit the detection of synovial involvements. The therapeutic value of MRI lies in the fact that it can isolate the two principal causes of shoulder pain in hemodialyzed patients. The increase in cuff thickness leading to impingement syndrome can be treated by surgical decompression; the synovitis can be treated by radioisotope synovectomy.

Adult↗
PubMed1993

Observations on experimental flow-through venous flaps.

The aim of this work was to compare the survival of an arteriovenous island flap with the survival of an island flap with a flow-through venous supply. Our experimental studies were performed on 95 Wistar rats randomised into six groups: Group 1: Indian ink injection of flow-through venous flaps with capillary network; Group 2: control group deprived of vascularisation; Group 3: control group with arteriovenous supply; Group 4: flow-through venous flaps of group 1; Group 5: epigastric flow-through venous flaps with a main venous trunk; Group 6: histological examination of flow-through venous flaps. The survival of flaps was monitored by direct examination, histological examination, capillaroscopy, and laser Doppler. Three out of 50 flow-through venous flaps survived. There was a statistically significant difference in the delay of clinical necrosis between the composite non vascularised free grafts (2.8 +/- 1.2 days) and the flow-through venous flaps (4.1 +/- 1.3 to 4.9 +/- 1.1 days depending on the type of flap). A 20% decreased venous blood flow was observed in the flow-through venous flaps.

Adipose Tissue↗
PubMed1993

Wrist arthrodesis using an embedded iliac crest bone graft.

34 patients treated by the iliac crest bone graft technique for wrist arthrodesis were reviewed. The average age was 45.6 years and the mean follow-up was 45 months. The procedure is performed through a straight ulnar approach and the head of the ulna is removed. A longitudinal trench is created in both distal radius and carpus preserving the anterior, posterior and lateral cortices. A curved trapezoidal monocortical iliac crest bone graft is embedded inside the trench. The position of the arthrodesis automatically follows the curvature of the graft. No fixation device is used. A short-arm cast is applied for 2 to 3 months. All arthrodeses except two fused within 3 months. Pain was completely relieved in 85% of the cases. Pronation and supination returned to normal 5 months post-operatively. Grip strength was increased in 80% of the cases. The carpometacarpal joints remained pain-free even when not fused. Complications were rare: two lesions of the dorsal branch of the ulnar nerve; two cases of delayed union due to errors in technique, and displacement of the graft in one case. Although it is technically demanding, the embedded iliac crest graft wrist arthrodesis improves pronation and supination as a result of resection of the distal radio-ulnar joint, preserves or improves grip strength, and relieves pain.

Arthritis, Rheumatoid↗
PubMed1993

[Reduction and osteosynthesis of displaced fractures of the distal third of the fifth metacarpal with central medullary bone wires].

We conducted a retrospective study of 80 patients who underwent axial K-wire osteosynthesis for a fracture of the distal third of the fifth metacarpal over an eight year period. We used a technique derived from Foucher's technique. After closed reduction, the fracture was maintained with two or three distal smoothed curved intra-medullary axial K-wires. The final functional result was identical to the opposite side in every case, although with persistent palmar tilt of 14 degrees +/- 11 degrees. The complications were rare. Rotation displacement was always well controlled. In comparison with functional treatment, we recommend this technique in cases of rotation displacement, absence of contact between the fractured ends and marked palmar tilt of the distal fragment.

Bone Wires↗
PubMed1993

Massive allografts sterilised by irradiation. Clinical results.

From 1984 to 1988 we implanted 127 massive allografts irradiated with a dose of 25,000 grays. These were reviewed at a minimum follow-up of three years to determine the effect of irradiation on infection, the complications and the functional result. No bacteriological infection was seen in the 44 patients who had allografts for revision of joint arthroplasty or for a tumour with no adjuvant therapy. For the 83 patients who also had chemotherapy or radiotherapy or both for a bone tumour, the rate of infection was 13%. The major mechanical complications were nonunion in seven grafts (5.5%) and fracture in eight (6%). These rates do not differ greatly from those reported for non-irradiated grafts. Our results suggest that irradiation, which remains the most convenient and acceptable method of sterilisation, does not jeopardize the clinical results.

Adolescent↗
PubMed1993

[Treatment of fractures of the humeral shaft using Hoffman's external fixator].

Thirty-nine patients treated with the Hoffman external fixator for a diaphyseal fracture of the humerus, were clinically and radiologically assessed with an average follow-up of 3.2 years. Open fractures, failure of a previous treatment, secondary displacement, and polytraumatisms were the usual indications for external fixation. Clinical bone healing was obtained within an average delay of 10.5 weeks. One patient underwent a pseudarthrosis. Six patients with secondary displacement of the fracture were operated on again, and the fracture was easily reduced by simple manipulation of the device under general anesthesia. The enclosing of the fractured extremities statistically diminished the risk of secondary displacement. Twenty CT scan examinations were performed to assess the occurrence of rotational malunion. Fourteen patients were malunited in internal rotation of the distal fragment with an average diminution of the retrotorsion of 19.4 degrees. No iatrogenic vascular or neurological complication occurred. The Hoffman external fixation does not replace the orthopedic treatment of the diaphyseal fractures of the humerus. It is simple to use and ensure satisfactory contention of the fractures' extremities when they are enclosed. If a secondary displacement occurs, it is simple to modify the device to reduce the fracture. If necessary, an additional surgical procedure, such as cancellous bone grafting or radial nerve repair, can be performed without modification of the osteosynthesis.

Adolescent↗
PubMed1993

[Influence of the anatomy of the pedicle on the survival of venous vascularized flaps. Experimental study on the rat].

The aim of this work was to compare the survival of an arteriovenous island flap with the survival of an island flap with a venous supply. The anatomy of the pedicule was modified to assess the conditions of survival. Our experimental studies were performed on 125 Wistar rats randomised into eight groups. Group 1: control group of epigastric flaps deprived of vascularisation. Group 2: control group of abdominal transverse flaps with arteriovenous supply. Group 3: control group of epigastric flaps with arteriovenous supply. Groupe 4: through-flow abdominal transverse venous flaps. Group 5: epigastric through-flow venous flaps with a main venous trunck. Group 6: epigastric flaps with nervous and perivenous pedicule. Group 7: epigastric flaps with nervous and venous pedicule. Group 8: epigastric flaps with through-flow nervous and venous pedicule. Twenty-four additional rats were histologically assessed. The survival of flaps was monitored by direct examination and histological examination. Two out of the 20 flaps of group 4 survived as well as two out of the 30 flaps of group 5. Four of the 15 flaps of group 8 partially survived around the pedicule area. The venous vascularisation does not explain the survival of so-called venous flaps. The survival is increased by through-flow venous supply, and preservation of perivenous tissues.

Animals↗
PubMed1993

[Surgical treatment of non-osteoarthritic femoropatellar diseases].

Patellar instability, associated with varying degrees of pain, is the major symptom of non-osteoarthritic femoropatellar diseases. This patellar instability is due to either mechanical (femoropatellar "derailment") or pain (due to chondropathy) disruption of quadriceps function. The result of surgical treatment of painful femoropatellar instability, regardless of its type, is governed by the same postoperative factors. A good result can only be obtained when the postoperative TA-GT lies within a certain range of the ideal value which varies according to the trochlear angle; the quality of the result essentially depends on the postoperative height of the patella. Preoperative radiological measurement of the trochlear angle on femoropatellar views in 30 degrees of flexion, of the TA-GT angle in 30 degrees of flexion and the height of the patella is therefore necessary to select and modulate the therapeutic procedures designed to treat non-osteoarthritic femoropatellar diseases.

Humans↗
PubMed1993

[Outcome of femoral osteochondritis dissecans of the knee].

Osteochondritis dissecans is a radiological entity, corresponding to a juxta-articular bone fragment separated from the rest of the epiphysis by a radiolucent zone. Diagnosed prior to closure of the femoral growth plate, the abnormal image generally disappears without leaving any sequelae. No aggressive treatment is therefore indicated. The course of osteochondritis detected after closure of the femoral growth plate is different: the sequestrum always evolves spontaneously towards separation from the epiphysis to become an intra-articular foreign body. Osteochondritis in adults also predisposes to early osteoarthritis. Fixation of the sequestrum while it is still in place clearly protects the knee form osteoarthritic deterioration and should be proposed without hesitation whenever a periosteochondritic fissure is observed.

Adolescent↗
PubMed1993

[Periprosthetic ossifications of the hip: role of the duration of postoperative indomethacin therapy in the prevention of ossifications and role of screwed acetabulum in the occurrence of ossification].

After showing, as many others did, in an article published in 1987, that indomethacin administered immediately after surgery and for about 3 weeks at a dose of 75 mg/day effectively protected THA against heterotopic ossification, the authors have searched whether treatment duration could be reduced, and to investigate the existence of risk factors other than those classically known. They studied the prevalence of heterotopic ossification in two groups of THA with known risks of ossification, one with one-week prophylaxis, the other with two-week prophylaxis using Indomethacin. The results obtained were compared with a third group of THA performed during the same period, which presented no known risk of ossification and were not treated with indomethacin, and with the THAs of the initial study, where indomethacin had been administered for 3 weeks. Occurrence of heterotopic ossification was equally prevented by an 8-day course and by a longer one. No etiological, radiological or pathological risk factor other than those described in 1987 were fund (with all due caution given to hips re-operated on that had not ossified the first time): in contrast, the type or acetabular cup appears to have some influence on the occurrence of HO: uncemented prosthesis clearly favours ossification.

Acetabulum↗
PubMed1993

[HIV virus and orthopedic surgery].

The risks of HIV viral transmission by blood transfusion or by bone transplantation during planned surgical orthopaedic procedures has been studied from French epidemiological data on the subject. The authors outline methods which may be used to reduce these risks: planned auto-transfusion of blood, serological assessment of a donor and quarantine of allograft material. Finally, the authors have examined the risks of contamination of the surgical team during an operation.

Bone Transplantation↗
PubMed1992

[Treatment of metastases of thoracic and lumbar vertebrae with predominant corporeal involvement by osteotomy of the vertebral body and anterior approach with cement and screwed plate].

Forty-seven patients with predominant corporeal thoracic, thoraco-lumbar or lumbar vertebral metastases were treated surgically by corporectomy. The vertebral body was replaced by acrylic cement sustained by a vertebral U shaped plate screwed to the adjacent vertebral bodies: this corporectomy was completed in 17 cases by a posterior approach. In 9 cases it allowed to treat a posterior epiduritis. The spinal metastases were symptomatic in 45 cases (pain and/or neurologic deficit); 22 of the operated patients were bed-ridden, either due to an important pain (16), or due to a severe neurological deficit (6). In 36 cases, the intervention was done on the spinal lord segment (7 times on the upper thoracic column). The patients were authorized to get up the fifth or sixth postoperative day. The functional results, at a price of 15 per cent of mortality during the first two postoperative months, were satisfactory and stable in time (particularly, 70 per cent of the operated patients with neurologic deficits were improved and 13 of the 21 bed-ridden became autonomous). The intracanalar decompressions controlled by a postoperative myelography, were nearly always total. The sets were stables in time when the block of cement was sustained by a metallic device. The mortality and the functional failure with pain and neurological impairment occurred essentially, when there was spreading of the tumor to the peri-vertebral soft tissues and when there was epiduritis extending beyond the bone lesion. Thus, to be perfectly efficacious, the anterior surgery of the vertebral metastasis, which gives durable and better results than the posterior one, should be soon enough integrated, in the global treatment of the metastatic disease.

Acrylates↗
PubMed1992

[Cement wedge replacing iliac graft in tibial wedge osteotomy].

The authors report their experience in substituting cement for full-thickness iliac crest wedge in medial tibial wedge osteotomy using buttress plate fixation. A review of 107 osteotomies performed between January 1985 and March 1989, demonstrated that using cement wedge do not expose to any special complication and raise the accuracy of frontal mechanical axes correction. At last, cement wedge seems not to evolve as a stranger corpus able to give long or mean terms complications; it perhaps make unnecessary bone substitute or allografts wedges.

Adult↗
PubMed1992

[A case of benign chondroblastoma of the iliac wing treated by extensive exeresis and reconstruction with methylmethacrylate].

Complete remission can be achieved by extensive surgical exeresis in patients with benign chondroblastoma of the iliac wing despite the reputation of these tumors for aggressive behavior. The case of a 28-year-old male treated with extensive surgery and acrylic cement reconstruction is reported. After seven years follow-up, the functional result is satisfactory and there is no evidence of local recurrence. Use of cement obviated the need for bone grafting. However, subsequent removal of the cement proved necessary because of skin intolerance. Data from a review of the literature confirmed that iliac chondroblastoma carries a poor prognosis, mainly because of the potential for mechanical complications. The cases of malignant transformation reported occurred after radiotherapy. In the authors' opinion, extensive surgical exeresis performed as early as possible is the treatment of choice.

Adult↗