[Trial revascularization of the femur head with a pediculed fibular transplant].
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Biomedical subjects
Publications and source records attributed to H Judet.
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Since 1962, the authors have used a technique of sub-talar arthrodesis combined with talar-calcaneal reposition ("horseman" operation) in cases of valgus flat foot, accompanied by symptoms, in moderate forms with exaggerated talar-calcaneal divergence and verticalisation of the talus. This operation involves only the sub-talar joint. The mid-tarsal joint is untouched. Technique must be precise in order to avoid hyper or hypo-correction. The results are constantly good. The mid-tarsal joint remains free, which offers a definite advantage in comparison with classical double tarsectomy.
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Low-back pain may originate in the thoraco-lumbar joints. Due to motion and stress, the latter constitute a high-risk transitional zone. Pain is transmitted by the posterior branches of the D11, D12 or L1 spinal nerves, which innervate the cutaneous and subcutaneous levels of the low-back and upper buttocks region. It is experienced as a deep-seated pain. Clinical examination makes it possible to determine the level responsible. The lumbar pain disappears with anesthesia of the interapophysary articulation. Appropriate medical treatment most often succeeds. If its fails, surgery can provide a solution. It consists of a capsulectomy on the level responsible, and on the upper and lower adjoining regions. This operation also destroys the posterior branch, which is closely joined to the capsule. Out of the 10 cases operated on, there was 1 failure, 6 very good results and 3 good results after follow-up periods of 20 months to 6 months. Without prejudging the future, it seems that there is hope for the treatment of unexplained back pains or those persisting after operations on lumbar disks that are not relieved by appropriate medical treatment of the thoraco-lumbar joints.
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A 37 year-old-man with suppurative pseudoarthrosis of the leg with major loss of skin and bone substance, cure was cured by the autotransplant of a cutaneous-osseous block taken from the iliac crest, its vascularisation being ensured by microanastomosis of its vascular pedicle.
Low back pain may be of dorso-lumbar spinal origin. Pain is transmitted via the posterior branches of the D11, D12, and L1 spinal nerves. The existence in the patient with lumbago of an area of localised pain along the iliac crest, of subcutaneous tenderness or pain in the buttock and of pain over the dorso-lumbar joints is indicative of the diagnosis. Local infiltration at the site of dorso-lumbar tenderness often causes the low back pain to disappear, often temporarily. Since the posterior branches of the spinal nerves are struck down to the capsules of the inter-apophyseal joints, it was felt that excision of these capsules would reproduce, in a permanent manner, the effects of these infiltrations. On the basis of initial results these are grounds for hope relief for certain cases of unexplained lumbar pain or of the sequellae of low lumbar surgery.
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