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Biomedical subjects

J M Thomine

Publications and source records attributed to J M Thomine.

At least 37 records · Page 2Linked to original sources
PubMed1996

Quantitative assessment of cortical bone remodelling from routine radiographs of total hip arthroplasty.

In orthopaedic clinical studies, quantitative X-ray bone densitometric analysis could provide precise means of detecting alterations within the bone. With duel-energy X-ray absorptiometry and diphotonic absorptiometry precise and reproducible measures are possible, but they require a specific and costly examination. The use of routine and past available radiographs could facilitate long-term follow-up retrospective studies, but when femoral X-ray bone density is assessed by the naked eye on conventional radiographs, the percentage of errors may be very high (80%). The advantage of a method using conventional radiographs has led us to look for an original technology to estimate X-ray bone density from routine radiographs using both soft tissues and prostheses as X-ray absorptiometric phantoms. In theory, this calculation requires several approximations. An experimental study based on 40 subjects aimed at determining the rate of error due to these approximations. Three radiographs were made for every subject with very different exposure settings. They were computerized by a CCD camera to measure the grey levels (256 scale) of soft tissue and prosthesis, as well as variations in contrast. The statistical analysis showed that when comparing X-ray bone density on different routine radiographs, the percentage of error could be lower than 10% but only under these conditions: (a) grey levels of soft tissue > 26; (b) grey levels of prosthesis < 212; (c) variation of contrast between radiographs > 0.79; (d) radiographs made with the same incidence, and (e) weight of the subject remaining constant during the whole period. It therefore seems possible to compare retrospectively the cortical X-ray bone density from routine radiographs, and to quantify bone remodelling around total hip arthroplasty, but only for the same subject.

Absorptiometry, Photon↗
PubMed1996

Micromotion, fit, and fill of custom made femoral stems designed with an automated process.

This study presents an automated process for the design of custom made femoral stems. Two software programs have been developed to obtain the inner bone contours from computed tomography scan images and to design the optimal stem that can be inserted into the femur. This process requires only 2 hours of computer use, therefore reducing the price of the stem. It is also possible to control the amount of bone sacrifice necessary to facilitate the insertion of the stem. Micromotion for 6 specimens was measured using a special machine simulating the load supported by the hip joint during single-limb stance. Three prostheses were tested successively: anatomic cementless stem, custom made stem, and modified custom made stem in which the distal part was thinned out. To be stabilized, the anatomic prosthesis required a greater number of cycles than custom made stems associated with a more important total vertical migration. The micromotion of custom made prostheses was significantly less than that of the other prostheses. The fill of custom made stems also was measured, having a range from 93% to 100% (mean, 97.5%-98.8%) of the medullary canal. The metaphyseal fill was significantly linked with the vertical and rotational components of instability. These results showed that it was possible, using a computerized automated and controlled process, to obtain low price femoral stems well fitted to the medullary canal that provide an excellent primary stability.

Adult↗
PubMed1996

[Anatomical and functional results of the external fixation of upper metaphyseal tibial fractures].

PURPOSE OF THE STUDY: This study aimed to evaluate a method for the treatment of upper tibial metaphyseal fractures using an external epiphysodiaphyseal fixation with the double-frame Hoffmann device. MATERIALS AND METHODS: The study included 48 patients (37 men and 11 women) aged 16 to 82 years. The tibial fracture was simple in 15 cases, included a metaphyseal comminution, partial in 3 cases and total in 30. In 13 patients, there was also a simple articular fracture. The fracture was opened in 24 cases (type I in 10, type II in 7 and type III in 7 cases). METHODS: The gap and displacement evaluation between the fragments after reduction was made on postsurgical roentgenograms; its was considered as complete when all fragments were in contact with each other, without frontal or anteroposterior translation above 5 mm. Healing was defined as a complete bone continuity providing a painless load bearing. The patients were clinically and radiologically reexamined with a mean follow-up of 15.45 months (5 to 62 months). RESULTS: After healing, there were 2 cases of angular deformities in patients whose autonomy was otherwise already reduced. Twenty-three patients had a minor pin tract infection. There was 3 cases of secondary osteitis after a type-III open fractures and 3 other deep septic complications without functional consequences. Forty-one fractures healed without bone graft in a mean time of 18 +/- 7.6 weeks. Healing did not seem to statistically depend on the opening nor on the type of fracture, but rather on the association with a peroneal fracture and the loss of cohesion between the fragments. The duration of professional invalidity evaluated in 20 cases, varied between 4 to 21 months (means: 11.3 months), and none of the patients had to modify his activity because of the tibial fracture. At follow-up, no patient complained of invalidating pain. Thirty-two patients recovered a satisfactory knee joint mobility and among the 16 others, in only 3 no particular reason was found to explain the deficit. DISCUSSION: While good anatomic and functional results lead us to keep the principle of external fixation, it seems however necessary to modify the modalities of the treatment in order to improve healing conditions, especially by improving the cohesion of the fragments through secondary minimal internal fixation. The use of dynamic axial fixation devices could therefore bring a theoretical advantage, but it must be proven that they produce in this site a primary stabilization which is a good as that obtained with Hoffmann's device.

Adolescent↗
PubMed1996

[Experimental study of the stabilization capability of upper metaphyseal tibial fractures by different types of external fixators].

PURPOSE OF THE STUDY: The major problem in external fixation of upper metaphyseal tibial fractures with a double-frame Hoffmann device is poor healing. With a dynamic fixation, it would be possible, with no change in technique, to compress the fracture site in a second phase, and therefore to facilitate the healing process. However, a new fixation device should not compromise the primary stability of the fixation. The aim of this experimental study on cadavers was to compare, in conditions very close to a clinical situation, the initial stabilization capability of five types of external fixation. MATERIAL: Five types of external fixators were tested on cadavers specimens: 1. a standard double-frame Hoffmann device; 2. a double-frame Hoffmann's device sagittaly reinforced with two additional anterior-posterior half-pins; 3. a type-1 axial dynamic fixation device using 6-mm conical pins; 4.a type-2 dynamic axial fixation device with 5-mm cylindrical pins; and 5. a mixed device including an lizarov-type epiphyseal fixation and a monoplane diaphyseal fixation. METHODS: The metaphyseal fracture was simulated by a transversal resection of a 20-mm segment. Specimens received by increments a load of up to 310 N, with which it was possible to determine stiffness components in valgus/varus, flexion/extension, rotation around the vertical axis and axial vertical displacement. The bone mineral content of the specimens was measured by Di Energy X-ray Absorptiometry. RESULTS: The stabilization characteristics of type-1 axial dynamic fixation were identical to those of the standard Hofmann's device in flexion/extension and in rotation as well as axially, but a greater mobility in valgus/varus was observed. The sagittal reinforcement of Hoffmann's device increased its rigidity in flexion/extension. The mixed lizarov fixation was stiffer than the standard Hoffmann's device in rotation; it was equivalent in valgus/varus and flexion/extension and less stiff in axial vertical displacement. In this study it was showed that the individual variability of bone mineral content is a negligible parameter. DISCUSSION: The experimental behaviour of the mixed Ilizarov device gives to assume that it may facilitate the healing process without endangering the primary stability of the fixation. However, this theoretical advantage should be validated in a randomized prospective clinical study.

Aged↗
PubMed1995

[Elongation and coverage of an inguinal flap over a short forearm traumatic amputation stump].

A particularly short traumatic amputated forearm finally led to a simplified under-elbow prosthesis after a long surgical program including: 1) A progressive 8 cm ulnar lengthening with a Wagner device; 2) and a secondary groin flap resurfacing the distal stump. Complications essentially concerned the ulnar lengthening particularly because of a weak osseous callus. Final aesthetic and functional results are satisfying with a 6 years follow-up.

Adult↗
PubMed1995

[Recent post-traumatic luxation of the trapeziometacarpal joint. Apropos of 8 cases].

PURPOSE OF THE STUDY: Eight cases of acute traumatic dislocation of the trapezio-metacarpal joint treated by percutaneous pinning without ligamentoplasty are reported in order to evaluate this method. MATERIAL: Eight patients, two women aged 32 to 38 and six men aged 17 to 43, were treated for acute traumatic dislocation of the trapezio-metacarpal joint between 1986 and 1993. The injury happened in a road traffic accident in five cases, during a fight in one case, and in a fall in two cases. The mechanism of injury could be determined only twice as a longitudinal force applied on the first metacarpal bone with the trapeziometacarpal joint in flexion. The dominant hand was injured in five cases. The metacarpal base was always dislocated dorsally. Closed reduction was always easy but remained unstable. On the initial radiographs, one patient had a small fragment avulsed from the volar aspect of the metacarpal base, another had a small osteochondral fragment avulsed from the joint surfaces and two patients presented asymptomatic degenerative changes with osteophytes. METHODS: All patients were treated on the day of injury by reduction and stabilization by one (in four cases) or two (in four cases) percutaneous Kirchner wires followed by a scaphoid-type cast for six weeks. In only one case an arthrotomy was performed to remove a small osteochondral fragment lodged in the joint, and showed a disruption of the dorsal ligament. All patients were followed-up until the tenth postoperative week, and five of them were reviewed for this study between eight and seventy-eight months (mean 27.5 months) after injury. Enquiries were made about return to work, pain, stability, and range of motion, keypinch and grasp compared with the uninjured side. The joint was examined radiographically with particular attention to the presence of subluxation and degenerative changes. RESULTS: One patient with a dislocation of the five carpometacarpal joints had reflex algodystrophy; she was not seen for review. Five patients had a completely satisfactory early result at ten week's follow-up examination that maintained at late review for this study. There were no symptoms, no subluxations on the radiographs, and the patients had returned to work between ten to sixteen weeks (mean 11 weeks) post injury. The two patients with degenerative changes on the initial radiographs had early unsatisfactory results with early dorsal subluxation, loss of strength of 30 per cent, but no limitation of joint motion and pain in one case. DISCUSSION: Acute traumatic dislocation of the trapezio-metacarpal joint is an uncommon injury; it may be associated with a small fragment of bone avulsed from the volar aspect of the metacarpal base or from the articular surfaces. Péquignot and coll. in 1988, and Fontes in 1992 recommended opened reduction and ligamentous reconstruction in acute injuries. Our experience indicates that closed reduction followed by stabilization by percutaneous pinning gives satisfactory results. An arthrotomy may be necessary when an osteochondral fragment avulsed causes incoercibility. CONCLUSION: Closed reduction followed by stabilization by percutaneous pinning gives good results in the treatment of acute traumatic dislocation of the trapezio-metacarpal joint. It finds its limits with patients with degenerative changes on the initial radiographs, and in this case ligamentous reconstruction, arthrodesis or arthroplasty might be advocated.

Adolescent↗
PubMed1995

[Intra and interindividual variations of pelvic mobility in normal adult walk].

PURPOSE OF THE STUDY: Pelvis motion appears as a main human gait component, it is linked to the lower limb joints and to the spine. Current devices, especially the opto-electronical systems, allow quantitative and tri-dimensional gait studies. The purpose of this study was to quantify the pelvic motion individual variability in a sample of healthy subjects. MATERIALS AND METHODS: The study based on a 18 volunters sample. There were 14 men and 4 women, ranged in age from 25 to 37 years. A clinical examination and a AP radiograph of pelvis allowed to include healthy subjects. We used the three-dimensional analysis VICON system with five cameras. Nine records were performed for each subject during a free-speed walking. These nine records were distributed on three different days. RESULTS: The step length medianes varied from 1100 to 1600 mm with a significantly (p < 0.05) regression between the step length, the walking speed and the subjects height. Vertical pelvic oscillations varied in this sample from 25 to 60 mm and linked with step length and walking speed. Pelvic rotation around the vertical axis varied from 1.5 to 15 degrees. We did not found regression between this pelvic rotation and the length step. It seems there are three types of pelvic rotation around the vertical axis. At the beginning of the stance phase, in type I, the pelvis is in the transversal plane whereas in the type II, it appears with the maximal rotation. In type III, the value of pelvic rotation is very low. The successive lateral inclinations of pelvic described a complex motion which varied from 1.5 to 9 degrees. The rotation of shoulders around the vertical axis varied from 4 degrees to 13 degrees and the successive inclinations varied from 3.25 degrees to 12 degrees. We did not found any regression between the pelvic and shoulders motion values. DISCUSSION: This study showed that the pelvis motion varied considerably from one subject to another. These variations induce different ways of walking with various consequences on the hip joint and the spine. We suppose that these variations could take a part in etiology of some diseases as hip arthritis or in total hip arthroplasty failure, especially in cup wearing.

Adult↗
PubMed1994

[A classification proposal for compression-flexion articular fractures of the distal extremity of the radius. A radiographic study of 40 cases].

40 articular fractures of the distal radius with palmar displacement, have been analyzed with Roentnograms. An original classification is proposed for a better initial evaluation of detailed articular damages and displacement. 4 main different types of fracture are described considering for elementary fragments constituted with antero-medial margin, radial styloid and dorsal margin; type A: total anterior margin, type B: separated anterior margin, type C: antero-lateral margin, and type D: antero-medial margin. The two types I and II described by Cauchoix, Duparc and Postel concerning the integrity of the dorsal margin have been incorporated. The quantity of radial gene fractured is determined on lateral view: < 1/2, > or = 1/2, and total. Finally the displacement is typed: anterior dislocation, or anterior translation. An original case of volar dislocated fracture with an intact radial styloid is reported. This classification could drive to specific orientations for treatment: even external fixation often associated with pinning, or alternative buttress plating.

Female↗
PubMed1994

[Femoral osteotomy for severe hip osteoarthritis: an actuarial analysis of results].

INTRODUCTION: In cases of severe hip osteoarthritis in young patients, the intertrochanteric osteotomy can delay total hip arthroplasty. The main advantage of the osteotomy is to preserve the bone stock. The main disadvantages are the lasting postoperative invalidity and the varying longterm success rate. Our aim was to quantify these disadvantages using survivorship analysis. MATERIAL AND METHODS: The study included 64 patients (65 osteotomies) ranging from 16 to 68 years. The osteotomies were performed between 1975 and 1987. The osteoarthritis was stage III or IV, with a joint space less than 50 per cent. Osteoarthritis was primitive in 25 cases and secondary in the others. The osteotomy always included a medial displacement of the shaft according to the principle of Mac Murray's procedure, but also 22 cases (33.8 per cent) had a varus angulation and 19 (29.2 per cent) a valgus angulation. The preoperative pain score according to the Merle d'Aubigné (MDA) grading was 2.6 (1 to 4) and the global functional score was 11.1 (5 to 15). The patients were reviewed in 1991 and examined clinically and radiographically. RESULTS: The results of the 65 cases were distributed into 3 groups: -29 cases having reached the follow-up without difficulty, -7 patients were lost for follow-up examination, 6 of these latter than 9 years, -29 patients taking osteotomy failure as a pain lesser than the 3 MDA score. The postoperative delay to obtain the best functional result was 6 to 24 months (mean: 13.65). This result ranged from 5 to 17 MDA score (mean: 15) with pain ranging from 2 to 6 (mean: 5). The survivorship analysis curve showed 67.5 +/- 19.5 per cent survival for all osteotomies to the interval of 9-10 years. There were 3 types of results: -3 early failures (4.6 per cent) one because of a deep infection, -in 7 cases, after a short initial functional improvement, there was a progressive degradation leading to failure in 3.7 years (2 to 6 years), -55 cases with a lasting period of functional improvement, 26 osteotomies leading to failure in 3.5 to 15 postoperative years and, 29 cases having reached the follow-up (7 to 16 years mean 10 years). There was radiographic improvement of the osteoarthritis increasing the joint space in 59 cases (90.7 per cent). There was no radiographic improvement in the 6 other cases, including the 2 functional failures. The functional degradation appeared parallel to the radiographic degradation leading to a decrease of joint space to 90 per cent. We tested differences between various groups using Log Rank test. We found no difference in survival between the 3 different types of osteotomy. DISCUSSION: The results of this study can help to choose between intertrochanteric osteotomy and THA in the case of severe osteoarthritis. The best functional result of the osteotomy is in one postoperative year, with a mean MDA score of 15 and a mean pain score of 5. It appears that we do not predict the duration of functional improvement, the patient has 2/3 chances that this improvement reaches 10 years.

Actuarial Analysis↗
PubMed1993

An unusual variety of scapho-capitate syndrome.

We report a patient who sustained a displaced fracture of the lunate in association with fractures of the scaphoid and capitate. Union of the scaphoid and capitate fractures followed fixation with Herbert screws, 25 additional cases from the literature have been reviewed.

Adult↗
PubMed1993

[Radiological improvement following isolated tectoplasty on advanced secondary osteoarthritis of the hip].

Tectoplasty was performed 10 times on adult dysplasic hips with advanced secondary OA for which femoral osteotomy could be considered. The 5 hips with pre-operative osteoarthritis staged IV according to De Mourgues scale and 3 of the 5 hips pre-operatively staged III displayed at maximal follow-up (on an average of 9.6 years), improvement of the radiographic articular space. The other 2 hips showed a stabilization of the x-ray osteoarthritis. Clinical improvement with an average gain of 2.5 points according to Merle d'Aubigné scale was always noted along with these improvements or these x-ray stabilizations.

Adult↗
PubMed1993

[Closed locked nailing of complex femoral fractures in adults. Apropos of 68 cases].

Complex fractures of the femoral shaft rise problems due to high energy trauma with major soft-tissues injuries and bone comminution so increasing operative difficulties, risk of infection and delayed union. Our aim was to appraise the outcome of these problems when using a closed intramedullary locked nailing. There were 52 men and 16 women. Aged 16 to 83 years. 52 patients had multiple-injuries. There were 17 open fractures. The 68 cases were subdivided according to a classification in 3 types. Stable fractures type A and B1 were excluded. The shaft was divided into 5 zones. Patients were initially treated by skeletal traction closed nailing was performed 1-36 days later (average 9.5). All patients were reviewed until complete healing. Final follow-up was 6 to 35 months postoperatively (average 15). A dynamisation was performed in 19 cases at a average delay of 12 weeks. Sixty six of the 68 fractures united. Open fractures united after 26.4 weeks, in average and closed fractures after 23.25 weeks (p < .05). There was no correlation between time of surgery following the injury and the delay of healing. Shortening was noted in 4 cases. 8 patients had an angulation 5-15 degrees of in the varus or the valgus plane. 3 patients (4.4 per cent) had more than 5 degrees of angulation in the AP plane. An external rotation deformity of 10-35 degrees was noted in 4 patients. The incidence of deformities was the main problem. It could be minimize by a precise technique. Mobility of the knee was the other problem, but it appeared generally to depend much more on knee injury than on femoral fracture.

Adolescent↗
PubMed1993

[Evaluation and utilization patterns of antibiotic therapy. A study in 4 hospital departments].

The use of antibiotics in 480 cases in 4 hospital wards during 1988 was assessed by examination of medical records. Only the first antibiotic therapy administered during the first stay in the ward for each patient was included. Antibiotics were administered to 163 in-patients (37% of hospitalizations) for infections in 113 (26%) cases. Amoxycillin and macrolides were the drugs most frequently used. Sixty-eight percent of the treatments were administered in the absence of microbiological data. Single drug therapy was used in 60% of treatments. Fifty in-patients (11% overall; 41% of patients undergoing surgery) received antibiotics for prophylaxis. The exact indication(s) for the choice of therapy was not given in the medical records of 39% of cases. Treatment started within 48 hours of infection in 15% of the cases. Overall, 93% of the treatments given were indicated, but 53% were inappropriate because they were too expensive, unlikely to be effective or were multiple drug therapy without justification. There are a variety of factors that cause such inappropriate administration of antibiotics.

Adult↗
PubMed1992

[Effect of early mobilization following Kapandji's method of intrafocal wiring in fractures of the distal end of the radius. Results of a prospective study of 60 cases].

We have undertaken a prospective study of the management of fractures of the distal radius using three Kirschner wires as advocated by Kapandji. 30 were immobilised and the other 30 allowed early movement. Complications involving pin migration and rupture of extensor tendons occurred only in the latter group, and one patient in the other group developed Reflex Sympathetic Dystrophy. At three months there was no statistically significant difference in movement or level of pain between the two groups. Grip was better after two months in those mobilised early. The final radiographic appearances were similar in both groups. Early mobilisation should only be used in patients who have good quality bone and will carefully observe instructions after operation.

Adolescent↗
PubMed1992

[Lesions of the distal radio-ulnar joint in compression-extension fractures of the distal extremity of the radius. Six cases with associated anterior dislocation of the ulnar head].

A particular course of markedly displaced wrist fracture associated with complete dislocation of the distal radio-ulnar joint and a real anterior dislocation of the ulnar head is related. In 5 other identical cases, treatment with external fixation achieved a more favourable result. These 6 cases concerning a particular type of wrist fracture, and a review of the literature, led us to suggest a potential pattern of TFCC lesions. Finally, from an anatomical classification of the ulnar compartment, we propose some therapeutic guidelines concerning the ulnar side for more common fractures.

Adult↗
PubMed1992

[Femoral and tibial bone torsions associated with internal femoro-tibial osteoarthritis. Index of cumulative torsions].

Among the hypothesis about pathogenesis of medial knee osteoarthritis, the participation of modifications of the alignment of the limb in the frontal plane is known. The participation of the femoral and tibial torsions had been assessed by a few authors. In this study, the torsions have been measured by computerized tomodensitometry. The global torsional morphology of the limb has been defined by the measure of the Index of Cumulated Torsions. The values of torsions have been compared with the angle deformities measured in the frontal plane. The effects of the bone torsions on the position of the lower limb during the weight-bearing phase of the gait and the consequences about the knee have been studied.

Aged↗
PubMed1991

[Idiopathic aseptic osteonecrosis of the capitate bone. Literature review apropos of 3 new cases].

The authors report 3 cases of idiopathic avascular necrosis of the capitate and review them together with published reports of 16 further cases. The patients are normally young and the diagnosis delayed. The radiographs may demonstrate an eggshell appearance, a sequestrum, marked sclerosis, or cystic changes. A classification is proposed based on the portion of the bone involved. Early osteoarthritic changes occur and carpal instability may develop. It is suggested that there are features in the blood supply which may be significant. Treatment is by operation, involving either excision of the capitate with replacement with a prosthetic spacer, or else by arthrodesis.

Adult↗