[Optimal management of patients with stress fractures and the role of the orthopedic surgeon in reducing the risk of new fractures].
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Bone Density↗
Biomedical subjects
J M Feron
Publications and source records attributed to J M Feron.
Substantial use of primary health care by prisoners: epidemiological description and possible explanations.
OBJECTIVES: To describe the use of primary care services by a prisoner population so as to understand the great number of demands and therefore to plan services oriented to the specific needs of these patients. DESIGN: Retrospective cohort study of a sample of prisoners' medical records. SETTING: All Belgian prisons (n = 33). PATIENTS: 513 patients over a total of 182 patient years, 3328 general practitioner (GP) contacts, 3655 reasons for encounter. MAIN RESULTS: Prisoners consulted the GP 17 times a year on average (95%CI 15 to 19.4). It is 3.8 times more than a demographically equivalent population in the community. The most common reasons for encounter were administrative procedures (22%) followed by psychological (13.1%), respiratory (12.9%), digestive (12.5%), musculoskeletal (12%), and skin problems (7.7%). Psychological reasons for consultations (n = 481) involved mainly (71%) feeling anxious, sleep disturbance, and prescription of psychoactive drugs. Many other visits concerned common problems that in other circumstances would not require any physician intervention. CONCLUSION: The most probable explanations for the substantial use of primary care in prison are the health status (many similarities noted between health problems at the admission and reasons for consultations during the prison term: mental health problems and health problems related to drug misuse), lack of access to informal health services (many contacts for common problems), prison rules (many consultations for administrative procedures), and mental health problems related to the difficulties of life in prison.
Adolescent↗
The value of suction drainage fluid culture during aseptic and septic orthopedic surgery: a prospective study of 901 patients.
There are no guidelines on the value of suction drainage fluid culture (SDC), and it is difficult to determine whether the organisms cultured from suction drainage fluid samples are pathogenic or simply contaminants. We performed 2989 cultures of suction drainage fluid samples obtained, during a 1-year period, from 901 patients who underwent aseptic or septic orthopedic surgery (946 operations). The culture results were analyzed to evaluate their ability to detect postoperative infection after aseptic operations or to detect either a persistent or new episode of sepsis in patients known to have infection. For aseptic operations, the sensitivity of SDC was 25%, the specificity was 99%, the positive predictive value was 25%, and the negative predictive value was 99%. For septic operations, the sensitivity of SDC was 81%, the specificity was 96%, the positive predictive value was 87%, and the negative predictive value was 94%. We conclude that, for aseptic orthopedic surgery, SDC is not useful in detecting postoperative infection. However, for septic orthopedic surgery, it is of clinical importance.
Adolescent↗
Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period.
Concomitant traumatic injuries in the upper cervical spine are often encountered and rarely reported. We examined the data concerning 784 patients with cervical spine injuries following trauma, including 116 patients with upper cervical spine injuries. Twenty-six percent of patients with upper cervical spine injuries (31 cases) were found to have combined injuries involving either the upper or the upper and lower cervical spine. The frequent patterns were combined type I bipedicular fracture of the axis and dens fracture, and combined dens fracture and fracture of the posterior arch of C 1. Other patterns posed specific problems, such as combined dens and Jefferson fracture and combined dens and C2 articular pillar fracture. Seventy percent of atlas fractures, 30% of C2 traumatic spondylolistheses and 30% of dens fractures were part of a combination. A total of 1.7% of patients with lower cervical spine injuries had a combined injury in the upper cervical spine. A comprehensive therapeutic schedule is outlined. Combined injuries in the upper cervical spine should be sought in any patient with a cervical spine injury.
Adolescent↗
Reducing the cervical flexion tear-drop fracture with a posterior approach and plating technique: an original method.
Flexion tear-drop fractures (FTDF) in the cervical spine constitute a highly unstable condition with a high incidence of neurological complications due to posterior displacement of the fractured vertebra in the spinal canal. The widely accepted surgical management for this condition includes complete excision and grafting of the vertebral body through an anterior approach. Thorough radiological and CT analysis of FTDF shows that the vertebral body is often separated into two parts by a sagittal plane fracture, but remains continuous through the pedicle and anterior arch of the vertebral foramen with the lateral mass and the articular processes. We therefore hypothesized that reduction would be possible by acting on the articular process through a posterior approach with a particular plating technique. Eight patients with FTDF were operated on with the technique we describe. Three had complete tetraplegia, four had incomplete tetraplegia and one was normal. A preoperative CT scan was made in all patients. Local kyphosis, posterior displacement of the vertebral body, and general lordosis in the cervical spine were recorded. In all cases, a satisfactory reduction was achieved on the postoperative radiographs and at the mean follow-up of 18.6+/-12.1 months, with residual posterior displacement being less than 1 mm. No complication occurred. Out of seven neurologically impaired patients, five showed some motor recovery at the latest follow-up. The posterior technique is described, and the rationale and pros and cons are discussed. The study showed that posterior reduction and fixation of flexion tear-drop fracture is not only possible, but permits an accurate restoration of the anatomy of the fractured cervical spine.
Bone Plates↗
Traumatic total axial reversal of the thoracic vertebral body.
Numerous vertebral fracture patterns have been reported in the literature. We present the case of a patient who sustained severe trauma to the back that resulted in a very unusual and not previously reported rotational injury consisting in complete 180 degrees rotation of the T6 vertebral body along a vertical axis, with only limited anteroposterior and lateral displacement. An unsuspected aortic tear resulted in severe evolution with fatal outcome following surgical attempt. The aetiology of such displacement is unknown. The possibility of late vascular complications should be kept in mind while treating thoracic spine fractures with rotational displacement.
Accidents, Occupational↗
MR imaging of posteromedial and posterolateral stabilisers of the knee: anatomic basis and patterns of lesions in knee injuries.
The angular points are the ligamentous and tendinous structures that reinforce the posteromedial and posterolateral capsule of the knee and share in fixation of the posterior horns of the menisci. They are often damaged in acute injuries and this is usually associated with ruptures of the cruciate and collateral ligaments and may add to the degree of laxity. We describe the normal appearance of these structures in terms of the sectional anatomy, correlated with the lesional appearances of complete and incomplete ruptures and associated meniscal detachments as shown by clinical testing and arthrotomy findings.
Collateral Ligaments↗
The meniscofemoral ligaments: magnetic resonance imaging and anatomic correlations.
Examination of the knee joint by magnetic resonance imaging (MRI) is a noninvasive technique of proven reliability as regards lesions of the menisci and ligaments. It provides good definition of the different anatomic structures. The meniscofemoral ligaments have been observed with varying frequency and may be responsible for false images. However, it is important to detect them in cases of hypermobile discoid menisci of the 'Wrisberg ligament type' in order to guide the surgeon in their excision during total meniscectomy. We have attempted to assess the ability of MRI to visualise the meniscofemoral ligaments in correlation with an anatomic study and to identify certain anatomic pitfalls. This study will allow better investigation of the hypermobile menisci associated with the meniscofemoral ligaments. A clinical case is reported to illustrate its practical importance.
Humans↗
[Cartilaginous and bony anatomy of the human cotyloid cavity: preliminary study for the analysis of the specific dynamics of cotyloid cornua].
Recent studies on acetabular and periacetabular deformations help to understand hip functioning. They encourage a new anatomic analysis of the bony and cartilagenous frameworth of the hip. The authors report as biomechanical preleminary, a radiological and anatomical study on the behavior of the periacetabular region. The results are compared to the anatomical litterature and conclusions are drawn.
Acetabulum↗
[Anatomo-radiologic approach of the mechanical pathology of the upper fibulo-tibial joint].
The authors report a study of 150 cadavers dissections. The morphology and topography of the proximal tibiofibular joint were analysed. The numerous anatomo-radiological variations encountered explain the different pathologies seen in clinical practice. The authors insist on the influence of this joint on ankle motion and recommend an association of a distal diaphyseal resection of the fibular when an arthrodesis of the proximal tibio-fibular joint is performed.
Autopsy↗
Fractured odontoid with fractured superior articular process of the axis. Report of three cases.
We report three patients in whom a fractured odontoid process was associated with a fracture of the superior articular process of the second cervical vertebra. Although there were no signs of neurological disorder, damage to the C1-C2 joint in all three patients made fusion necessary. Forced lateral flexion is suggested as the possible mechanism of injury.
Adult↗
[Treatment of recurrent anterior dislocations of the shoulder by the technic of pre-glenoid stapling. Study of a series of 48 cases].
Preservation of local muscular structures, and closure of the capsulo-periosteum detachment, are the two essential principles observed, when treating recurrent anterior shoulder dislocation by pre-glenoid stapling and also afford satisfactory results. This technique is used for capsulo-ligamentar lesions without alterations of the anterior edge of the glenoid cavity. If the strict technique is followed when placing the staple excellent stability result. If physiotherapy is started early, functional recovery is rapid. Sporting activities can be resumed within the third month after the operation.
Adult↗
[Posterior approach to the elbow preserving the extensor apparatus. Its value in the osteosynthesis of humerus plate fractures].
The authors describe a median posterior approach of the elbow with preservation of the triceps mechanism in continuity. Such an approach provides an excellent exposure of the elbow and of the lower part of the humeral shaft which can be used for the osteosynthesis of complex supra and intercondylar fractures. This approach can also be extended to the midshaft of the humerus, the radial head and the ulnar shaft. The repair is easy and strong enough to allow a rapid rehabilitation.
Elbow Joint↗
Anatomical study of digital compression of the vertebral artery at its origin and at the suboccipital triangle.
Manual compression of the vertebral artery is used in routine clinical practice for diagnosis of positional hemodynamic vertebro-basilar insufficiency (VBI). The supraclavicular and suboccipital areas were carefully dissected in 20 cadavers. Anatomical variations observed on dissection were compared to angiographic data from 150 patients and data from the literature. Objective results of manual compression of the vertebral artery can be obtained by sonography. In patients with VBI, such compression induces signs of reversible cerebellar or brain stem ischemia, whereas no signs are observed in patients without VBI.
Cadaver↗
[Technic of C1-C2 fixation by posterior screwing].
A posterior screw fixation technique for C1-C2 is described which respects strict anatomical relations and allows associated posterior arthrodesis limited to C1-C2, using a single approach route. This method of posterior fixation can be used even when anomalies of the posterior arch of C1 or C2 exist, of whatever origin, as well as in the presence of a laminectomy. Four patients were operated upon using this method without any postoperative complications.
Axis, Cervical Vertebra↗
[Lateral atlanto-axial arthrodesis (author's transl)].
The authors describe the surgical technique of atlanto-axial fixation using a bilateral lateral approach. The cartilage of the articular processes of C1 and C2 are excised and the joints grafted. A screw fixation of the articular processes is performed. 8 cases are reported.
Arthrodesis↗
[Surface arthroplasty of the knee by marmor prosthesis. Study of 35 unicompartimental prosthesis seen with a follow-up of 1 to 5 years (author's transl)].
The Marmor prosthesis may be used for a surface arthroplasty of the knee by means of a system of unicompartmental modules including 4 sizes of condylar ramps and 6 thicknesses of tibial plateaux in two widths. It is thus possible to treat one or both compartments and correct any axial deviation. The operative technique must be careful and accurate with regard to the positioning of the prostheses and the choice of thickness of the plateau to be inserted. Preoperative radiological assessment must be very precise, and include in particular films with monopodal weight bearing and in forced position in order to study the joint surfaces and predict the correction which must be applied. Fifty operations have been performed (in 37 cases for osteoarthrosis), but the essential aim of the present study is to report the results of 35 unicompartmental prostheses with a follow-up of 1 to 5 years (mean : 2 years and 2 months). Thirty results were assessed as good or very good. The most spectacular features were freedom from pain and the rapidity with which the results were obtained. They would seem to be clinically stable. Nevertheless, the development of 3 deteriorations of the tibial plateau after Marmor would appear to contraindicate the use of 6 mm thickness plateaux. In contrast to widespread opinion, the remaining compartment does not degenerate, so long as it was normal preoperatively and there has not been any hypercorrection of the deviation after unicompartimental arthroplasty. Nevertheless, the latter has its limits and whilst it may play a role in the treatment of certain cases of osteoarthrosis of the knee, it cannot replace either tibial osteotomy for correction of the axis or bicompartimental prostheses or total prostheses anchored in the diaphysis, which also have their indications.
Follow-Up Studies↗
[Anatomical basis for dislocations and recurring dislocations of the elbow].
The authors report on a static and dynamic study of the lig. collaterale radiale. The essential role of the middle bundle, which can always be isolated on fresh cadaver, is stressed. A new theory on the mechanism of elbow dislocation is thus justified. By analogy with recurring dislocations of the shoulder, the authors consider that operations attempting to reestablish the tension of this ligament are justified. Such operations can be focused on the middle bundle of the lig. collaterale radiale.
Elbow Joint↗