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Biomedical subjects

H Dejour

Publications and source records attributed to H Dejour.

At least 37 records · Page 2Linked to original sources
PubMed1990

An anatomical and radiological study of the femoropatellar articulation.

An analytical study was made of 30 knees by dissection, 200 by conventional radiology, 120 by CT scans, and of 2,400 pathological knees by conventional radiology, and 900 by CT. The radiological and scanning methods most used for a study of the femoropatellar articulation are described and the normal values of each feature determined by a computer study. The femoral trochlea and its shape are very important for the stability of the patella. The normal and pathological types of trochlea are described. This study established a number of anatomical factors which influence patellar stability, and form a basis for proposing the correction of anatomical anomalies in the treatment of instability of the joint.

Fascia↗
PubMed1990

[Dysplasia of the femoral trochlea].

Dysplasia of the trochlea was studied on a strict profile image of the knee. 1305 radiographs were analysed corresponding to several patello-femoral conditions (major and subjective patello-femoral osteoarthritis) and to control subjects. Two criteria are defined: the depth and the eminence of the trochlea. The depth was often minimal in instabilities that give a radiological characteristic image of intersection between the trochlear end line and the lateral condyle. This picture had a great diagnostic value for patellar instability. The eminence represented the owerhang of the trochlear end line in relation to the anterior cortex of the femur. By measuring it, it was possible to establish a statistically significant variability of the degree of instability on one hand, between instabilities, patellar syndromes and controles on the other hand. The intersection sign and the trochlear eminence in isolated patello-femoral osteoarthritis allows the direct filiation between dysplasia of the trochlea and osteoarthritis to be confirmed. Taking into account the size of the eminence, the hollowing out type trochleoplasties appears more fiable than raising of the lateral edge.

Bone Diseases, Developmental↗
PubMed1990

[Bilateral congenital absence of the anterior cruciate ligament and the internal menisci of the knee. A case report].

Bilateral congenital absence of the anterior cruciate ligament associated with the absence of the medial meniscus is reported in a 34-year-old-woman. The simultaneous absence may be explained by a common embryological mesenchymal origin of the anterior cruciate ligament and the menisci. This absence was at the origin of an abnormal development of the condyles and especially of the tibial epiphysis which was tipped over in flexum. Treatment consisted of a central ligamentous plasty associated with a lateral plasty, a medial plasty and a closing anterior tibial osteotomy. The result was good.

Adult↗
PubMed1990

[Unreduced posterior luxations and fractures-luxations of the shoulder. Apropos of 30 cases].

Twenty-seven patients (30 shoulders) presenting with an unreduced posterior dislocation or fracture-dislocation were operated on and followed up for at least 2 years. The lesions were classified in 4 types, after Randelli: posterior dislocation with cephalic fracture inferior to 50 per cent (type I = 10 cases) or superior to 50 per cent (type II = 8 cases) and posterior fracture-dislocations with two fragments (type III = 6 cases) or several fragments (type IV = 6 cases). The first patients of the series underwent a resection of the humeral head (5 cases) or an open reduction (7 cases). During a second period 10 shoulders were reduced by a posterior approach and stabilized by transfer of the subscapularis tendon with or without the lesser tuberosity in the humeral defect 6 shoulders were reduced by an anterior approach together with derotation osteotomy. Lastly, one patient refused to be operated on and we performed a shoulder prosthesis to the last one. Necrosis of the humeral head (9 cases) appeared to be related to the severity of the lesion (type III and IV) and the type of surgical procedure (5 derotation osteotomy out of 6 and 3 open reductions out of 7) rather than to the approach route or the interval from injury to diagnosis. These results show that an anatomical repair may be attempted when the dislocation is less than 6 months old and when the impression defect involved less than 50 per cent of the articular surface. Otherwise and a fortiori in old posterior fracture-dislocations, an arthroplasty seems to be the best solution. Even if it may be clinically difficult, it offers the best chance for a functional shoulder in an active patient.

Adult↗
PubMed1990

[Total hip prosthesis in coxarthrosis following congenital hip dislocation (65 hips reviewed at 5 years)].

In 45 patients, 65 hips with CDH were given a THR after 5 years or more, with an average follow up of 8.5 years. The results and the technical problems are discussed. Of those 65 hips, there were 46 anterior dislocations, 15 intermediate dislocations and 4 cases of posterior dislocation. The mean shortening was 58.3 mm. In all cases, the authors performed a total arthroplasty on the original acetabulum, after lowering and reconstruction of the acetabulum by grafts taken from the femoral head. There are some immediate postoperative complications: 12 thromboembolic complications, hematomas and 2 cases of paralysis of the peroneal nerve. There was loosening in 8 patients (12%), with 3 infections. The functional results were good in 85% and poor in 7.5%. Nevertheless, the limp was maintained in 49 patients. There was residual low back pain in 7 patients. In 14% a second operation on the homolateral knee was performed after an average time of 2 years. The technical problems are discussed: the cup should be placed in the original acetabulum and in evaluating the lowering of the acetabulum, the condition of the lumbar spine should be considered. Posterior luxation is discussed as well; the authors recommend prudence in the indication for THR operations with lowering of the acetabulum shell.

Adult↗
PubMed1989

[What is new about the knee?].

Surgery of the knee applies to the pathology of sports as well as to degenerative lesions. Surgery of the ligaments has benefited from the advances achieved in medical imaging, arthroscopy and rehabilitation. In case of gonarthrosis, prosthetic surgery has become reliable, but it is limited to sedentary subjects. Osteotomy remains very useful in ome indications.

Arthroscopy↗
PubMed1989

[What should be done in a meniscal lesion?].

The treatment of meniscal lesions closely depends on the context in which they occur. In isolated lesions of the medial meniscus, meniscectomy under arthroscopy remains the best method. When the meniscal lesion complicates a rupture of the anterior cruciate ligament, meniscal suture associated with reconstruction of the ligament may be contemplated. In case of degeneration of the medial meniscus or lesion of the lateral meniscus, various therapeutic approaches may be envisaged.

Arthroscopy↗
PubMed1989

[Radiology in femoro-patellar pathology].

For the evaluation of the femoro-patellar joint, the authors use a pure lateral view with 30 degrees flexion without weightbearing- an axial view of the patella with 30 degrees flexion- with neutral rotation- and the same view with external rotation of the foot. With these 3 X-Rays, a precise diagnosis is made possible.

Femur↗
PubMed1989

[Perforation of the cervical esophagus and hypopharynx complicating surgery by an anterior approach to the cervical spine].

Difficult diagnostic and therapeutic problems are raised by perforations of the cervical oesophagus or hypopharynx in patients undergoing surgery to the cervical spine via an anterior approach. Based on their experience of three recent cases, the authors review the diagnostic approach, based on clinical examination and diatrizoate sodium oesophageal series, and propose conservative treatment consisting of surgical drainage with or without suture of the perforation and without removal of the osteosynthesis material, appropriate antibiotic therapy and hypercaloric enteral nutrition via nasogastric tube. The prevention of this complication is based on correct use of surgical retractors.

Adult↗
PubMed1988

[Results of surgically treated chronic anterior laxities. Apropos of 251 cases reviewed with a minimum follow-up of 3 years].

Two hundred and fifty one chronic anterior laxities operated by intra-articular plasty using a free knee-cap tendon and by the Lemaire extra-articular procedure were reviewed with a minimum 3 year follow-up. Eighty-three per cent of the patients obtained a global functional result excellent or good, eight per cent fair and nine per cent poor. Clinical examination disclosed 24% equivocal pivot shifts and 4% true jerks in internal rotation. Most of the patients, at the check-up clinic, underwent a radiographic and dynamic examination, thereby allowing evaluation of postoperative arthrosis and residual anterior laxity in extension. Frontal radiographs of the knee on unilateral weight-bearing showed 29% joint remodelling, 16% "prearthrosis" and 8% arthrosis. These radiological modifications were most often medial femoro-tibial, they were highly correlated with the patient's age at the time of operation, with the state of the medial meniscus and with the residual laxity in extension. The residual anterior laxity in extension measured on the dynamic radiographs was, on average, 9 mm, i.e. an average difference of 5 mm in relation to the healthy knee; it was highly influenced by the pre- or peroperative treatment of the medial meniscus. Indications of precautions to be taken are defined and suggestions are drawn up whereby residual laxity in extension may be limited.

Adolescent↗
PubMed1988

[Intramural internal meniscectomy using the Trillat technic. Long-term results of 258 operations].

A study of 258 meniscectomy (245 patients), with a minimum follow-up of twenty years, confirms the excellent functional result obtained by intramural medial meniscectomy performed for isolated meniscus lesions. The joint remodelling, with absence of joint-space narrowing, represents the radiological cicatrix resulting from this surgery. It is a non-evolutive condition. The incidence of meniscectomy in the occurrence of an arthrosis is low (20%). On the other hand, when the meniscus lesion in associated with rupture of the anterior cruciate ligament, medial meniscectomy often proves to be inadequate. Clinical and radiological evolution is governed by tearing of the ligament. The radiological signs are, in this case, characteristic on unilateral weightbearing in profile at 20 degrees flexion. At the end of this study, the signs described by Fairbank (9) are discussed and the factors liable to determine the onset of a late arthrosis after medial meniscectomy are analysed.

Follow-Up Studies↗
PubMed1988

[The natural history of rupture of the posterior cruciate ligament].

A study has been made in a series of 45 patients, 36 of whom were re-examined and 11 of whom replied to a questionnaire, of the fate of knees that had suffered a rupture of the posterior cruciate ligament which had not had a primary or secondary repair. The follow-up was between 5 and 44 years, with a mean of 15 years. In the 36 who were reviewed, 21 showed an isolated posterior laxity, 8 a postero-lateral laxity and 7 a postero-medial laxity. Even though the posterior cruciate ligament is the strongest ligament in the knee, an isolated rupture of the ligament is often well tolerated after a mean period of adaptation of 12 months. This functional tolerance is remarkable since it allows a return to sporting activity, even at high level. However, the disturbance of the kinematics of the knee resulting from the loss of the posterior cruciate ligament leads, after an average of 25 years, to osteoarthritis, either medial tibio-femoral or generalised depending on the morphological features of the patient. These findings have stimulated us to repair fresh lesions in young persons, especially in the presence of combined lesions but care needs to be exercised about the indications for surgery in chronic laxities during the first year of adaptation.

Adaptation, Physiological↗
PubMed1987

[Recurrent anterior luxation of the shoulder occurring after the age of 40].

Twenty-four recurrent dislocations of the shoulder with an onset after the age of 40 years have been operated on using the Trillat technique. The results have been studied with a mean follow-up of 10 years. This type of lesion, which is not rare, forming five per cent of cases in the authors series between 1953 and 1982, deserves separate consideration because of the frequency of associated rupture of the rotator cuff which seems to arise as a consequence of the first dislocation. There were 75 per cent of indirect tuberosity signs and 20 per cent of elevations of the humeral head before operation. It is responsible for osteoarthritis in the shoulder found in the follow-up. There were 70 per cent of osteoarthritic shoulders and 50 per cent of cases with elevation of the humeral head. The clinical results obtained, without any associated procedures on the cuff, were investigated by the criteria established for the surgery of shoulder instability (Rowe). They were satisfactory, with 63 per cent of good objective results and 88 per cent of satisfied patients. There appears to be a beneficial effect from the downward displacement of the subscapularis which should be taken into account as well as consideration of treatment for the lesions of the rotator cuff.

Adult↗
PubMed1987

[Chronic posterior instabilities].

As an introduction, isolated posterior, posterolateral, posteromedial, as well as combined posterior stability are defined. Rupture of the posterior cruciate ligament leads to pathological patterns for both concentric and eccentric quadriceps movements. Special attention is drawn to the significance of the peripheral stabilizers and their influence on instability. Ruptures of the posterior cruciate ligament are commonly followed by a phase of functional adaptation, functional tolerance, and arthrotic decompensation. Diagnosis should not only be based on the posterior drawer test, but also consider stability tests in the frontal plane and eventual rotational instabilities. What constitutes adequate therapy is still a subject of controversy today. Among the operative procedures, the most common are the pes anserinus graft according to Hey-Groves and Lindemann, the gastrocnemius graft of Hughston and Insall, the free patellar ligament graft, and synthetic replacement. The decision about indications for surgery should not be made earlier than 18 months after the accident, when the phase of functional adaptation has been completed.

Biomechanical Phenomena↗
PubMed1987

[Arthrosis of the knee in chronic anterior laxity].

Arthrosis following rupture of the anterior cruciate ligament has been analysed in two series. The first series was derived from a review of 150 cases of reconstruction of the anterior cruciate ligament with a follow-up of 3 years or more. Arthrosis was seen to have developed in 13.3%. The second series was concerned with 64 cases of unilateral arthrosis treated by upper tibial valgus osteotomy in whom there had been a previous rupture of the anterior cruciate ligament. The "tolerance time"--that is the time between the original ligamentous injury and the time of osteotomy--for the development of arthrosis was very variable, ranging in cases with a "natural history" from 10 to 50 years with a mean of 35 years. It is important to recognise the radiological signs of the onset of arthrosis. These are osteophytosis of the intercondylar notch, osteophyte formation at the posterior part of the medial tibial plateau, and, in particular, narrowing of the medial joint line with posterior subluxation of the medial femoral condyle, well seen in lateral radiographs whilst standing on one lower limb. Early arthroses, appearing after 10 years, may occur as a "natural arthrosis", but it develops much more frequently after surgical treatment that had failed to correct anterior laxity and particularly when it had been performed on knees that were already pre-arthrotic. The main factor in arthrosis is anterior laxity measured radiologically by an "active Lachman" radiograph. Removal of the medial meniscus, which, in itself, is liable to produce arthrosis is even more harmful in anterior cruciate laxity since it doubles the degree of anterior subluxation of the tibia seen on unilateral weight-bearing. The development of varus deformity, which characterises progressive arthrosis, has its origin in wear of the posterior part of the medial tibial plateau caused by anterior cruciate laxity. Other factors play an important part such as associated lateral laxity, constitutional genu varum and weakness of the hamstring muscles which oppose the subluxating action of the quadriceps.

Adult↗
PubMed1986

[Anterior recurrent luxation of the shoulder. Postoperative recurrences].

Seventy-nine recurrences have been seen after surgical procedures for recurrent dislocation of the shoulder. There were 58 "true" recurrences, 17 shoulders with anterior instability and 4 with instability in all directions. The "true" recurrences were more frequent in young people with a mean age of 20 years at the time of the first surgical procedure. Two-thirds of them occurred on the dominant side. Most of the cases had been treated by distal displacement or lengthening of the coracoid process (38 Trillat procedures, 8 Latarjet procedures and 8 Oudart procedures). Only two had been treated by a Bankart procedure. The main cause of recurrence was a failure of repair of the antero-inferior part of the joint. Twenty three cases were operated on again, the most usual procedures being the Trillat procedure and rarely the Latarjet or Eden Hybinette procedures. Six cases recurred once again. Cases with anterior instability were observed after the Trillat procedure. They were due to capsular laxity and did not have to be operated on again. Instability in multiple directions was observed in young women who continued to dislocate their shoulder inferiorly or posteriorly, despite two or three surgical procedures.

Adolescent↗