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Biomedical subjects

G Dautel

Publications and source records attributed to G Dautel.

At least 19 recordsLinked to original sources
PubMed2006

[Surgical management of paediatric malignant bone tumours].

The malignant bone tumours in children are rare, concerning 5% of the all paediatric tumours. Among all paediatric bone tumours, 15% of them are malignant. The main bone tumours in children are the osteosarcoma and the Ewing sarcoma. The diagnosis and treatment need a multidisciplinary medical team. It is essential in front of potential clinical or radiological signs, to perform quickly the specific medical exams and biopsy. The treatment needs a paediatric medical and surgical staff.

Adolescent↗
PubMed2006

[Thumb hypoplasia].

All the components of the thumb can be involved in congenital hypoplasia. Blauth's classification continues to be helpful for description of the degree of hypoplasia leading to different options of surgical reconstruction. Surgical strategy includes first web deepening, MP ligamentoplasty, thenar augmentation using tendon transfer and correction of associated abnormalities involving the extensor and flexor tendons. For grade IIIB and grade IV, recommended option for reconstruction is index finger pollicisation.

Child↗
PubMed2004

[Clinical and three-dimensional kinematic features of the upper limb after replantation of the hand].

INTRODUCTION: Functional assessments of hand replantation after traumatic amputation are considered as good although frequent deficits of long fingers mobility and hand sensitiveness occur. AIMS: To evaluate the capability of handling and the compensatory mechanisms involved in handling. METHODS: Prospective study in eight right-handed males who had distal amputation of the left upper limb with hand replantation for more than two years. Eight males with paired age and handedness served as control. Skin sensitiveness (thread test), mobility (TAM), functional capability (Box and Blocks test, 400 points test) and occupational outcome were assessed. Three-dimensional analysis (opto-electronic device) of the motion of the trunk and the upper limbs (arm, forearm, hand) was made during a pointing and gripping-shifting maneuver and the time of the related phases was measured (dynamometric cube device). Correlation between clinical assessments and three-dimensional analysis were tested. RESULTS: Patients with replantation had a remarkable recovery of the absolute and relative times of the various phases of the handling maneuver. Only the gripping phase was significantly prolonged in patients, this result was correlated with the deficit in motor function and sensitiveness of the replanted hand. The visual control was higher because of the lack of superficial and deep sensitiveness. Compensatory mechanisms involved a lateral shift of the replanted limb segments, probably attributed to the lateral shift of the trunk. CONCLUSION: Patient with a replanted hand develops a homogenesis displacement of the trunk and the pectoral girdle to compensate the shortening and the reduction in active mobility of the hand. This compensatory mechanism, observed in a small scale in healthy too, is efficient with respect to the handling phases.

Activities of Daily Living↗
PubMed2004

[MR imaging accuracy in the prediction of bone graft healing potential in scaphoid non-union].

PURPOSE: To determine the accuracy of MR imaging in predicting bone graft healing in patients with scaphoid non-union. MATERIAL AND METHODS: 21 patients with scaphoid non-union were examined with MR imaging prior to bone grafting (conventional bone graft in 14 cases and vascularized bone graft in 7 cases). The protocol included unenhanced and Gadolinium-enhanced sequences. Signal intensity and homogeneity of the proximal fragment was analysed by two independent radiologists. MRI findings were then correlated to the postoperative rate of union. RESULTS: Healing occurred in 17 cases and failed in 4 cases with a mean follow up of 14 months. Intraobserver agreement in MR reading was respectively 0.92 et 0.86. Interobserver agreement was 0.88. On Tl-wi, the proximal fragment was hyperintense in 1 case (with positive surgical result), heterogeneous low signal intensity in 7 cases (healing in n = 7) and homogeneous low signal intensity in 13 cases (healing in n = 9). On T2-wi, the proximal fragment was hypointense in 4 cases (healing in n = 3), homogeneous high signal in 5 cases (healing in n = 4) and heterogeneous high signal intensity in 12 cases (healing in n = 10). After Gadolinium injection, enhancement was homogeneous in 4 cases (healing in n = 4), heterogeneous in 8 cases (healing in n = 7) and absent in 9 cases (healing in n = 6). In the group with no enhancement, 5 patients were treated with vascularized bone graft (healing in n = 4) and 4 with conventional bone graft (healing in n = 2). CONCLUSION: The absence of enhancement of the proximal scaphoid fragment leads to poor surgical results except for vascularized bone graft.

Adolescent↗
PubMed2003

[Impact of 2 strategies of analgesia on postoperative pain after emergency hand surgery performed on an ambulatory basis].

OBJECTIVES: The assessment of the impact of various analgesic regimens on postoperative pain at home, following emergency and ambulatory hand surgery. STUDY DESIGN: Prospective comparative study of "before" and "after" groups by phone questionnaire on the first postoperative day. PATIENTS: All emergency and ambulatory surgery patients undergoing hand surgery in a specialist university hospital unit. METHODS: a) "Before" group (120 patients): analysis of current analgesic practice in the service (prescriptions by surgeon on duty), assessment of the incidence of pain scores with an intensity >/= 4 on a numerical score of 0 to 10, and identification of the most painful surgical interventions; b) formulation for these surgical interventions of multimodal analgesic protocols drown up by the anaesthetists; c) "After" group (51 patients): assessment of the efficacy of these analgesic protocols through comparison with the "before" group. RESULTS: a) "Before" group: the total incidence of pain scores with an intensity >/= 4 was 42% and in the case of conditions involving a joint or sepsis, 88%. Dextropropoxyfen-paracetamol alone was prescribed in 66% of cases and was associated with a 48% analgesic failure rate. Non-steroidal anti-inflammatory drugs were prescribed in 14% of cases, tramadol in 7% and a combination of drugs in 15%; b) "After" group: the incidence of pain scores with an intensity >/= 4 decreased to 21% in surgical interventions involving joints or sepsis (p < 0.001). CONCLUSION: Multimodal analgesic regimens are more effective than free prescriptions. This study underlines the need to further educate surgeons in this area. Despite these written protocols, there remains a 21% incidence of pain at home on day one.

Acetaminophen↗
PubMed2003

[Development of a arthroscopic severity score for scapholunate instability].

INTRODUCTION: We report the development of an arthroscopic severity score for scapholunate instability based on dynamic testing of the scapholunate joint. METHOD: Seventy patients who had a scapholunate instability diagnosed by arthroscopy were reviewed. There were 21 static instabilities, 19 dynamic instabilities and 30 preradiographic instabilities. The arthroscopic finding was systematized. In the radiocarpal space the scapholunate interosseous ligament was seen and palpated. In the midcarpal space, the dynamic manoeuvre of dissociation was done using the examining hook. RESULTS: An arthroscopic classification was developed: in stage 0, it is impossible to put the tip of the hook between the scaphoid and the lunate; in stage 1, it is possible to put the tip of the hook between the scaphoid and the lunate; in stage 2, it is possible to create a scapholunate diastasis with the use of a twisting motion applied to the hook; in the stage 3, the 2.7-mm arthroscope passes between the scaphoid and lunate from the midcarpal to the radiocarpal space. We found 4 stage 1, 43 stage 2 and 23 stage 3. DISCUSSION: Even if other diagnostic tools such as the arthroscanner or MRI are able to diagnose scapholunate interosseous ligament tears, wrist arthroscopy is for us the Gold Standard to quantify and directly explore the scapholunate joint. The goal of the score of severity presented here is to guide the different therapeutic indications.

Adolescent↗
PubMed2003

[Camptodactylies].

Camptodactyly is a permanent non-traumatic flexion contracture at the proximal interphalangeal joint, involving most of the time the fifth finger. This condition is rare (incidence is inferior to 1%). Most of the cases are sporadic, although some authors have traced the transmission through several generations. Two types of camptodactyly have been described, depending on the age of onset (within the first year of age or in adolescent). This condition can also be described as "static" or "dynamic", depending on the effect of MP flexion on the PIP extension lag. Many anatomical abnormalities have been evoked as potential aetiology for camptodactyly, including variations in the lumbrical or flexor superficialis origin or distal insertions. However, after a few years without treatment, permanent flexion position of the joint adds its own effects and leads to joint contracture, regardless of the aetiology of camptodactyly. Treatment is required for this condition for extension deficit greater than 30 degrees. The first step will always consists of dynamic splinting of the PIP joint. If improvement is not obtained through dynamic splinting alone, surgery can be considered. Correction of a well defined anatomical abnormality is part of the treatment. When required, it will be associated to correction of joint and soft tissue contracture.

Adolescent↗
PubMed2003

[Free flap for soft tissue loss of the limbs in trauma victims].

PURPOSE OF STUDY: We report a series of 67 free flaps performed between 1995 and 2001 for soft tissue loss of the limbs in trauma victims. We searched for elements predictive of failure in order to better identify indications. MATERIAL AND METHODS: The series was predominantly masculine (52 men, 15 women). Mean age was 38.7 years (range 18-63). Thirty-four free flaps were performed on the upper limb and 33 on the lower limb. Trauma was caused by: direct crush with or without bone injury (n=23), burns (n=10), stripping (n=5), complications of open fractures (n=29). The free flaps were performed on day 0 (day of trauma) (n=7), on day 1 or 2 (n=5), from day 3 to 7 (n=12), and from day 8 to 31 (n=43). RESULTS: There were 19 complications: hematoma (n=2), infection (n=1), vascular problem (n=16), and 7 flaps were lost (10.4%). Logistic regression analysis demonstrated that the type of trauma and vascular complications were determinant factors predictive of failure. Conversely, the limb (upper versus lower), side, gender, age, or time from trauma to flap were not found to influence chances of success. DISCUSSION: Our series demonstrated that free flap repair performed in a trauma context for loss of soft tissues of the limbs is a relatively reliable surgical technique since the rate of success is similar to that reported for pediculated flaps. The usefulness of free flaps in the trauma setting is thus demonstrated, but the most appropriate modality remains to be determined. Many authors point out the importance of early cover to limit the risk of complications (osteitis, delayed bone healing). Others have not found this factor to be determinant. In everyday practice, emergency cover is not always possible and the question is whether a flap can be successful if performed late after the initial trauma. Our study demonstrates that the chances of success of a free flap are equivalent when performed early or late after trauma. CONCLUSION: Free flaps play an important role in achieving cover of tissue loss of the limbs. The type of trauma appeared to be the only factor predictive of failure.

Adolescent↗
PubMed2002

[Injuries of the first web. Surgical indications].

Treatment of the first web injuries are based on the concept of one stage repair of the complex injuries of the hand with early motion. Radical debridement is specially important in case of muscular attrition. Fasciotomie of the first web is systematic in case of crush injuries for avoiding compartimental syndrome. For prevention of first web retraction, one or two Kirchner wires are placed in emergency between first and second metacarpal, and later a spilt in maximal anti-position of the first ray. In case of communited fractures, skeletal stabilisation use inlay internal devices, such the blocked intramedullary nail. First web reconstruction must take into consideration the cutaneous functionnal units of the hand, described by Michon. Thin and split-thickness grafts are rarely used for covering skin defects of the first web space, because their ability of retraction. Exposition of bone or tendons leads to the realisation of a flap. Soft tissue coverage must be achieved in emergency or after a second look within the first 48 hours. The kite flap is the most useful local flap for the first web space. The interosseous flap is the best choice among the regional pedicled flap. The use of the Chinese flap must be very careful, because the possibility of contusion of the radial pedicle in these types of injuries. It is only in case of contra-indication of the interosseous flap that free flaps can be realised, as the lateral arm flap or the parascapular flap. The groin flap keeps few indications for aesthetic reasons, or when regional flaps and microsurgery are contra-indicated.

Bone Nails↗
PubMed2002

[Four bone versus capito-lunate limited carpal fusion. Report of 40 cases].

Fourty patients with limited carpal fusion have been retrospectively reviewed. The aim of this study was to compare the results of four bone fusions (30 wrists) versus capitolunate fusion (11 wrists). Follow-up averaged 30 months with a range of 15-96 months. Twelve patients presented SLAC-wrist (scapho-lunate advanced collapse) and fourteen with SNAC-wrist (sapho-non union advanced collapse). There were seven cases of primitive wrist arthritis, one mid-carpal instability, one sequella of Fenton's syndrome, one Preiser's disease and two Kienbock's disease. All 40 patients were evaluated by the same observer. In terms of range of motion, the capito-lunate fusion led to better results than the four bone fusions with a gain of 10 degrees in volar flexion and 12 degrees in radial deviation. Results in term of post operative pain are similar in the two groups of patients with 90% painless wrist in four bone fusion and 81% with capito-lunate fusion. Results for strength were equivalent. Radiological bone fusion was obtained within nine weeks. Absence of fusion was observed in two patients with capito-lunate fusion. Our result in terms of joint motion and strength are similar to those found in the literature. Correction or not of the DISI deformity during the procedure did not affect the results (on 19 patients). The Four bone fusion procedure is still a good treatment in SLAC or SNAC wrist. Capito-lunate fusion remains a good choice, despite the risk of non-fusion.

Adult↗
PubMed2002

[Rupture of the radial collateral ligament of the fifth metacarpopharyngeal joint. A case report with Stener effect].

We report a case of complete rupture of the radial collateral ligament of the fifth metacarpophalangeal joint. At surgical exploration, a Stener like lesion was identified in which the ruptured and of the ligament was trapped by the proximal portion of the extensor hood and sagittal band; thus reattachment to its original site (the base of proximal phalanx) was performed. Postoperative care consisted of protected active motion exercises which were begun immediately. An early functional recovery was obtained with full range of motion, normal joint stability and complete pain relief. The purpose of this study was to present an uncommon injury and to analyse the literature.

Adult↗
PubMed2002

Obstetrical brachial plexus palsy. Prediction of outcome in upper root injuries.

Thirty obstetrical brachial plexus palsies involving the upper roots were retrospectively reviewed. There were 20 C5-C6 palsies and ten C5-C6-C7 palsies in which recovery of C7 occurred by the end of the first month. Recovery of elbow flexion at 3 months, C7 involvement and high birthweight were the best early predictors of outcome, but all were unreliable when used separately. In combination, recovery of elbow flexion and birthweight predicted the final outcome reasonably satisfactorily, particularly when elbow flexion at 9 months, and not 3 months was considered (risk of error = 13%). Brachial plexus reconstruction may therefore be justified when there was initial C7 involvement associated with increased birthweight and poor elbow flexion at 6-9 months.

Adolescent↗
PubMed2001

Use of osteocutaneous "double-barrel fibular flaps" in limb reconstruction: four clinical cases.

The use of a vascularized fibular transfer is a technique used for the reconstruction of large defects in long bones. A technical variation that consists of osteotomizing the transplant, giving two distinct segments, is adapted in the reconstruction of long bones with a large diameter, in particular, the femur or the proximal tibia. The results obtained using this technique in four clinical cases are presented here. The length of the bone defects was between 7.5 and 11 cm. There were two cases involving the tibia, one case the distal humerus, and one case the pelvis.

Adolescent↗
PubMed2001

[Rehabilitation protocols after repairs of zone 2 of the flexor tendon of the hand: presentation and indications].

We report the results of a retrospective study of 47 adult patients corresponding to 54 fingers, operated on in the emergency room at Nancy University Hospital between December 1996 and October 1998. These patients were managed using three different postoperative therapy protocols: passive mobilisation according to the Duran technique, active-passive mobilisation according to the Kleinert technique and immediate active mobilisation as described by Strickland. Patients were evaluated in three different ways; active range of movement obtained according to the Strickland scale, the "400 points" flexor function test and the delay in returning to work. Combining all three evaluations showed a 65% rate of satisfactory results, 22% fair and bad results and 13% ruptures. Analysis according to the re-education technique showed a strong superiority of the Strickland protocol. This now needs to be confirmed by a more extensive prospective study. Delay before return to work is not affected by the type or re-education technique chosen, but side-effects are less frequent with the Strickland method. A result in terms of range of active movement alone did not fully evaluate the result of a flexor tendon repair: functional testing was better at this end and the global "400" points test score gave more useful information than each of its component tests taken individually (Purdue pegboard, Minnesota test, Box and Block). Functional testing seemed more helpful in guiding the medical team in its treatment strategy.

Adult↗
PubMed2001

A comparative clinical and electromyographic study of median and ulnar nerve injuries at the wrist in children and adults.

The outcome of 38 median and ulnar nerve injuries at the wrist in 15 adults and 15 children were studied with a follow-up of at least 1 year. Each patient was assessed clinically and with nerve conduction studies. The results confirm a markedly superior sensory recovery in children. However the children had persistent motor deficiencies. This difference in the clinical results of adults and children was not reflected in the nerve conduction results which were similar in both groups.

Adolescent↗
PubMed2001

A comparison between clinical results and electromyographic analysis after median or ulnar nerve injuries in children's wrists.

The purpose of this study was to analyze the results of median or ulnar nerve transections to the wrist in 14 children between 1994 and 1999. On sustaining their injury, all patients underwent treatment at the University Hospital of Nancy. They were all seen afterward for clinical and electromyographic evaluations. The clinical examination was mainly to judge the quality of sensory recovery, using the Weber and Dellon tests, as well as motor recovery. Electromyographic examination of the motor and sensory tissues was carried out systematically on each patient. The analysis of these results highlights discordance between the quality of the clinical results and nerve regrowth identified via electromyography. Good nerve regrowth does not necessarily mean a good sensory recovery.

Adolescent↗