Biomedical subjects

F Dubrana

Publications and source records attributed to F Dubrana.

At least 19 recordsLinked to original sources

PubMed2006

[Chronic instability in the ankle area].

For ankle sprains, the initial radiological work-up must include weight-bearing AP and lateral stress views of the sprained and healthy ankle. Films are taken in auto-varus. Other explorations included arthroMRI, arthroscanner or MRI which can be indicated preoperatively to confirm suspected cartilage injury or an associated ligament tear. These techniques should be employed when pertinent information can be expected according to the clinical situation and the operator's experience. In the emergency setting, ultrasonography can provide a simple low-cost confirmation of joint hematoma which is more precise than x-rays with a positive predictive value of nearly 100%. The objective and subjective clinical outcome after surgical anatomic repair or ligamentoplasty are quite similar. The two principal differences relate to persistent subjective instability and post-operative surgical complications. Thus there are advantages and disadvantages for each option advantage for anatomical repair because of the low rate of surgical complications and advantage for ligament repairs which stabilize the subtalar joint with a low rate of residual instability.

Ankle↗

PubMed2005

[Not Available].

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Journal Article↗

PubMed2004

[Radiological and clinical study of the ulna's end instability after Sauvé-Kapandji procedure].

The aim of the study was to analyse the ulnar proximal stump's behaviour after Sauvé-Kapandji procedure. The procedure was performed for post-traumatic disorders of the distal radio-ulnar joint. This is a retrospective study of 14 patients. The mean age of patients at the operation was 49 years. Most of them began immediate mobilisation into pronation and supination. After a 5 year follow-up period, the clinical examination was centred on the ulnar proximal stump. An original radiologic study was made with static and dynamic X-Ray. Seven patients indicated pain on the ulnar stump during pronosupination. A clunk on the ulnar side of the wrist was noticed by three patients and an instability of the ulnar stump was observed two times. Clinically, there were a sagittal instability in all patients and a frontal instability four times. The sagittal instability was confirmed by dynamic X-Ray on each occasion, but the frontal instability was never confirmed. Every patient had instability of the ulnar stump; however, it was well tolerated. In practice, 12 patients were satisfied or very satisfied (86%). Instability of the proximal ulnar stump remains a problem, because it occurs despite a strict technique.

Female↗

PubMed2004

[Vascularized fibular transplant for avascular necrosis of the femoral head: 16 cases].

PURPOSE OF THE STUDY: We report our experience with vascularized fibular transplant using the technique described by Urbaniak for the treatment of avascular necrosis of the femoral head. MATERIAL AND METHODS: Sixteen patients, mean age 39 years 4 months at surgery, were evaluated at mean 3 years 6 months follow-up (minimum 15 months). Mean pain score (analog visual scale) was 6.25/10. Mean Postel-Merle-d'Aubigné (PMA) function score was 12. The Ficat classification was grade 2A (n=9) or grade 2B (n=7). RESULTS: There were no cases of infection or migration of the fibula. The only complication at the donor site was one case of paresia of the long extensor of the hallux which resolved spontaneously. There were five failures which required a hip prosthesis (31%). Three failures occurred early during the first 18 months. Two were late. These patients had grade 2B (n=4) or grade 2A (n=1) necrosis. At last follow-up, eleven hips had not required prosthetic revision (69%). The pain score improved in 81% of patients: mean score=2.3. Nine patients were satisfied or very satisfied (81%). Among these eleven hips, function was good or excellent in eight (72%). Walking distance was improved in nine patients, unchanged in one and worse in one. Joint motion improved in nine patients, was unchanged in one and decreased in one. Nine patients resumed their full-time job. Mean sick leave was 13.3 months. Radiographically, only two of the initial Ficat grade 2A hips remained at this stage. Likewise only one of the three hips initially rated grade 2B remained at this stage. Overall radiographic results were: failure (n=5), worsening (n=9), stabilization and no improvement (n=2). Among the nine 2A hips, one was converted to a total hip prosthesis and five femoral heads remained spheric. Among the seven 2B hips, four were converted to a total hip prosthesis and two femoral heads collapsed. DISCUSSION: At mean follow-up (3.5 years), 69% of the hips had not required total hip arthroplasty. The grade 2A hips did better but the small sample size did not allow statistical comparison. There was a clear discordance between the clinical presentation and the radiographic findings among the hips which were not treated with a prosthesis: good function score, maintained occupational and daily life activities contrasting with unfavorable radiographic evolution. Results could be improved by detailed quantification of the lesion using 3D imaging and by associating intraoperative navigation.

Adult↗

PubMed2003

[Treatment of piso-triquetral pain by excision of the pisiform: report of fifteen cases].

INTRODUCTION: Piso-triquetral joint could be painful and pisiformectomy can be the best procedure if conservative treatment have failed. The aim of this retrospective study was to evaluate clinical and functional results of pisiformectomy. MATERIAL AND METHOD: Thirteen patients with pisiformectomy were included in this retrospective study, 2 of them have bilateral procedure (n = 15). An ulnar neuropathy was associated in four cases. The average follow-up was 31.5 month. Professional traumatic injuries were the most common etiology. Surgical procedure was the same for all patients. Patients were reviewed clinically and subjective results were evaluated with an analogic scale (Eva). RESULTS: No postoperative complications were found. At the maximal follow-up, result was excellent for 12 cases, good for 2 cases and fair for one case. Analogic evaluation pain at maximal follow-up was 0.8 points compared to 6.4 points preoperatively (p < 0.001). Wrist range of motion was improved. DISCUSSION: Etiologies of piso-triquetral disorders were large and dominated by traumatic or microtraumatic injuries. Pisiformectomy is the best procedure if conservative treatment have failed. There is no place for piso-triquetral arthrodesis considering pisiformectomy's good results. Nevertheless, it's important to know that piso-triqueral disorder could be included in an authentic loco-regional disorder.

Adult↗

PubMed2002

Bone morphing: 3D morphological data for total knee arthroplasty.

OBJECTIVE: The clinical outcome of a total knee arthroplasty (TKA) is mainly determined by the accuracy of the surgical procedure itself. To improve the final result, one must take into account (a) the alignment of the prosthesis with respect to the mechanical axis, and (b) the balance of the soft tissues. Therefore, morphologic data (such as the shape of the epiphysis) and geometric data are essential. We present a new method for performing TKA based on morphologic and geometric data without preoperative images. MATERIALS AND METHODS: The global method is based on the digitization of points with an optical 3D localizer. For the morphologic acquisitions, we use a method based on the registration of sparse point data with a 3D statistical deformable model. To build the mechanical axis, we use a kinematics method for the hip center and digitization of anatomical landmarks for the ankle centers. The knee center is not determined by digitization or kinematics of the knee, as this would not be accurate. The surgical planning relies totally on the soft-tissue balance, which is the key issue for a good kinematics result. RESULTS: We have used this system for 6 months in a randomized clinical trial involving 35 patients to date. For the first 11 patients that could be measured in the navigation group, the postoperative frontal alignment was within the range of 180 +/- 3 degrees. Fluoroscopic assessment of the soft-tissue balancing will be performed at the conclusion of an extended 2-year study to evaluate the results from a functional point of view. CONCLUSION: Bone Morphing is an accurate, fast, and user-friendly method that can provide morphologic as well as geometric data. We have introduced the important notion of soft-tissue balancing into the intraoperative planning step to optimize the kinematics as well as the anatomy. Therefore, this method should be considered as an alternative to the CT-based method.

Algorithms↗

PubMed2002

[Long gamma nail for the treatment of subtrochanteric fracture of the femur].

PURPOSE OF THE STUDY: The standard gamma nail is commonly used for the treatment of trochanteric fractures but cannot be used if the fracture lies at the level of the distal locking. Theoretically, the long gamma nail would overcome this inconvenience and could be used for all cases of subtrochanteric and trochanteric-shaft fractures. MATERIAL AND METHODS: Clinical and radiological charts were established in 1990 for a multicentric study. The radiology work-up included an AP view of the pelvis and an oblique lateral view of the hip. Two classifications were used: Seinsheimer and Muller as modified by Nazarian. Three stages of fracture reduction were recorded: 1=anatomic reduction, 2=acceptable reduction, 3=poor reduction. From January 1995 to December 1999, 46 patients were treated with the long gamma nail. Twenty-four cases were excluded for various reasons (from which 3 early death). 22 remaining patients were followed for more than six months. Mean age was 68 years (range 42-96); there were six women and 16 men. Ten patients were traffic or work accident victims and 12 had had a home accident. RESULTS: Mean duration of surgery was 70 minutes. Three patients required revision surgery within a week of the initial osteosynthesis. Mean hemoglobin level before surgery was 12.9 g/dl; 8.9 g/dl during the first postoperative week. Mean hospital stay was 14 days. Weight-bearing with support was possible early after surgery in 16 patients who walked with crutches or a walker. Mean delay to weight-bearing was 11 days. At three months, all patients were using an aid for walking; at six months, four patients used a walker. Bone healing was achieved on the average at the twelfth week. Radiological reduction was anatomic in four, acceptable in three and poor in 15. DISCUSSION: We advocate the AO classification as it allows a structured analysis of all fractures within a unique system. We compared our results with nine series reported in the literature using other therapeutic methods (screw-plate, nail-plate, Ender nail). The operative time for the long gamma nail (70 min) was comparable with that for other surgical techniques. Treatment with the long gamma nail favors bone healing and limits the risk of infection. Radiological results in our series were poor, but there were no cases with nonunion and the morbidity was low.

Adult↗

PubMed2001

Pedicle island flaps of latissimus dorsi. Applications in surgical repair of ruptures of the rotator cuff.

There are considerable problems in repair of major ruptures of the rotator cuff tendons particularly those of the supra and infraspinatus mm. The Gerber technique only transfers the tendinous insertion of the latissimus dorsi onto the greater tuberosity in massive cuff ruptures. We have extended this approach. In 12 shoulders, we studied the feasibility of a latissimus dorsi transfer harvested to fit and bearing muscle and tendon detached at its two extremities and transposed as a neurovascular island. The muscular part is transferred to the infra or supraspinous fossae and the tendon to the greater tuberosity with the aim of reactivating the infra and supraspinatus muscles. The lateral bundle of the latissimus dorsi is always transferable on its neurovascular pedicle into the infraspinous fossa, even into the supraspinous fossa, or into both if transfer is used as a bilobed flap. This anatomical work allowed a parallel study of the different possibilities of transposing the neurovascular pedicle, which might limit the technique, and also to determine the most appropriate surgical approach.

Adult↗

PubMed2000

[Rehabilitation of the first dorsal interosseous muscle by transfer of the extensor pollicis brevis tendon].

Weakness of the pinch grip between index finger and thumb, in ulnar nerve palsy, leads to severe loss of hand function. The first dorsal interosseous plays a major rôle as it abducts and flexes the index finger at its base and stabilizes the MP joint of this finger. Replacement of this muscle is therefore important. The authors report the results of eight clinical cases of replacement of the first dorsal interosseous by extensor pollicis brevis. They obtained good improvement of hand function, in terms of objective and subjective results, in all cases.

Adolescent↗

PubMed1999

[Bilateral bipartite carpal scaphoid bone: a congenital disease or unrecognized pseudarthrosis? Discussion a propos of a clinical case].

PURPOSE OF THE STUDY: Bipartite scaphoid has long been debated, and is of traumatic origin for some authors or congenital for others. The aim of the study is to distinguish clinical and radiographic criteria for the diagnosis of congenital bipartite scaphoid. MATERIAL AND METHOD: A case of bilateral bipartite scaphoid is presented. To distinguish pseudarthrosis from congenital bipartite scaphoid we used, the revised carpal height ratio of Nattrass, the CT, and magnetic resonance imaging. RESULTS: These examinations showed no collapse and they revealed evidence of articular cartilage around the fragments with the same thickness in all the carpus. CONCLUSION: We believe that congenital origin is more probable but we recommend to follow the patient, with yearly standard wrist radiograph and use, the revised carpal height ratio of Nattrass to research a carpal shift or collapse.

Adult↗

PubMed1997

[Use of muscular flaps for the treatment of open fractures of limbs. Apropos of 42 cases].

PURPOSE OF THE STUDY: Since 1988, skin defect associated with upper (6 cases) or lower (34 cases) limb fractures were treated in our Orthopaedic Department with regional or free muscular flaps. The aim of this study was to demonstrate that muscular flaps represent a treatment of choice for infection prevention and consolidation. MATERIAL AND METHODS: 42 patients have been treated: 29 Cauchoix III or IV, 12 secondary exposed fractures, 1 amputation. A total of 42 flaps, including 28 regional flaps and 14 microvascular free-tissue transfers were performed. A first stage included thorough debridement, fixation with external fixator in 85 per cent, and revascularization (4 cases). A second look was necessary in all but 3 cases: flap coverage was performed at this stage. A bone graft was proposed in 17 cases after a mean time of 3 months and 20 days. RESULTS: Bony healing was found in 37 cases (86.5 per cent) with a mean delay of 7 months 20 days. 5 patients required another method of treatment because of flap necrosis or non-union, with an average time to bony healing of 13 months. 42 tissue transfers were performed with an overall success rate of 95.3 per cent (2 necrosis of latissimus dorsi flaps). 3 partial necrosis involved 2 regional and 1 free flap. One of them needed another treatment. No infection was encountered in 40 cases (95 per cent) even if most of the patients were treated after initial treatment elsewhere. DISCUSSION: Experience with regional muscle transfer has advocated the gastrocnemius and proximal pedicle medial soleus as reliable and excellent choice for reconstruction of the proximal and middle third of the leg. Latissimus dorsi transfer, which can be used totally, partially, or as a "vascular graft flap" represent the treatment choice for extensive upper or lower limb exposed fracture especially for distal lower limb fracture (exposure of the tibia). Muscle flap coverage in the acute period (within 48 or 72 hours) remains for us the best treatment.

Adolescent↗

PubMed1997

[Surgical treatment of freshly closed articular fractures of proximal interphalangeal joints].

Eleven fractures of the base of P2 and 8 fractures of the head of P1 were treated surgically. We review the results after a mean follow-up of 4 years 5 months. Due to their complexity is no real consensus on the treatment of P2 and various treatments were used. This series demonstrated two points: first the was no correlation between the degree of patient satisfaction and the section of digital immobilization; second, residual subluxation and/or arthrosic remodeling was frequent but was not incompatible with a good objective and subjective outcome.

Adult↗

PubMed1996

[Therapeutic possibilities of the lateral supra-malleolar flap and its variations. Apropos of 6 clinical cases].

The distally based lateral supramalleolaire flap with a retrograde blood flow on the perforating branch of the peroneal artery is a good flap to treat loss of skin involving the ankle, the region behind the Achilles tendon, and the foot. Based on the results of an anatomical study, the authors describe a modification of this flap which can be raised on the infero-lateral collateral artery, with an anterograde blood flow. In fact, clinical experience of six cases shows that vascular pedicle component (perforating branch of the peroneal artery, infero-lateral collateral artery) and blood flow (anterograde, retrograde) can be calculated according to the regional vascular network, arc of rotation and the type of flap. Because of the many possible combinations, it can be considered to be a flap with variable vascular pedicle raised "à la carte". However, according to our clinical cases, the anterograde blood flow does not seem to have resolved the problems of venous congestion of this flap.

Adult↗

PubMed1996

[Surgery of congenital radio-ulnar synostosis. Technical error and therapeutic strategy].

PURPOSE OF THE STUDY: A clinical feature of surgery in congenital radioulnar synostosis is described. MATERIAL AND METHODS: A eighteen year old right handed woman, was hampered when she works by a left congenital radio ulnar synostosis. Clinical examination showed a left forearm locked in 75 degrees of pronation. Radiographs showed a proximal synostosis. Surgical treatment associated a resection of the synostosis with silastic interposition, resection of the distal end of the ulna, and derotational middle-third osteotomy of the radius. RESULTS: Three months later, the pronosupination was 90 degrees, but an ischemic retraction of the flexor pollicis longus muscle appeared with a non-union of the radius. A second procedure was necessary to put a plate in compression on bone and to release the muscle. Twenty years later, the forearm was locked in neutral pronosupination, without recurrence of synostosis on radiographs. DISCUSSION: Surgical treatment in congenital radio ulnar synostosis associates many problems: indication (often for discomfort), ideal age (more vascular or nervous post operative complications if older), technical (failure of operations with functional aim). CONCLUSION: A review of international litterature allows the authors to suggest a specific management for congenital radio ulnar synostosis.

Adolescent↗

PubMed1995

[Kirner's deformity. 4 case reports and review of the literature].

Kirner's disease is a rare deformity of the distal phalanx of the little finger, with a combination of camptodactyly and clinodactyly and clinodactyly. A review of the literature and analysis of our cases show that this anomaly appears to result from a unusual insertion of the deep flexor over the growth cartilage. No treatment is required in view of the absence of any clinical and functional symptoms.

Adolescent↗

PubMed1995

[Loss of cutaneous substances of the foot. Retrograde flaps, apropos of 4 cases].

We report our experience with two retrograde flaps for the treatment of cutaneous tissue loss of the foot. A lateral supramalleolar flap and a medial plantar flap pediculated distally were used, the first to cover the dorsal aspect and the second to cover the forefoot. Indications for local flaps are limited essentially because of the small size. In addition they cannot always be used for local trauma. Retrograde vascularization for the forefoot is an interesting alternative to more invasive salvage procedures involving distant flaps (cross-leg or flee flaps) requiring and uncomfortable position or microsurgery.

Adult↗

PubMed1994

[Giant cell tumor of the tendon sheath of the long extensor muscle of the thumb in a 7-year-old child].

The authors report the case of a giant cell tumour of the flexor pollicis longus tendon sheath in a child. This benign tumour, usually observed in women between the ages of 30 to 50 years, has a highly controversial aetiopathogenesis; the existence of initial trauma is found in 50% of cases. The present case concerns a 7-year-old girl with swelling of the right thumb for two years. Surgical resection established the definitive diagnosis by histological examination of the specimen. The follow-up is currently two years, with no local recurrence.

Child↗

PubMed1994

[Traumatic atlanto-axial dislocation in children: 7 cases].

Seven cases of atlantoaxial rotatory dislocation in children are reported. The CT scan permitted differentiation of the lesions in all the cases. Analysis of the results has led us to introduce two modifications for Fielding's classification: a distance between the atlas and odontoid of less than 5 mm is normal. sagittal dislocation must be included in the same classification. We propose the following therapeutic protocol: rotatory luxation without tears of the transverse ligament should receive orthopedic treatment, rotatory luxation with tears of the transverse ligament should have surgical treatment if orthopaedic treatment fails. sagittal luxation with or without rotatory fixation needs surgical treatment.

Adolescent↗