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J Y Alnot

Publications and source records attributed to J Y Alnot.

At least 37 records · Page 2Linked to original sources
PubMed2001

Intraneural mucoid pseudocysts. A report of ten cases.

A mucoid pseudocyst of a peripheral nerve is a rare and benign tumour of controversial origin. We have reviewed ten patients with a mean follow-up of 3.2 years. The tumour affected the common peroneal nerve in eight and the ulnar nerve in two. The mean time between the onset of symptoms and diagnosis was 7.4 months (1.2 months to 2 years). On examination, there was pain in eight patients and swelling in seven. Motor deficit in the corresponding nerve territory was found in all. The diagnosis was usually confirmed by MRI. Treatment was always surgical. All the patients recovered, with a mean time to neurological recovery of 10.75 months. Recurrence was seen in only one patient and was treated successfully by further surgery. Our results are similar to those reported by other authors. A successful surgical outcome depends on early diagnosis before neurological damage has occurred.

Adult↗
PubMed2001

[GUEPAR total elbow prosthesis in rheumatoid arthritis. A multicentric retrospective study of 38 cases with an average 4-year follow-up].

PURPOSE OF THE STUDY: We conducted a multicentric retrospective analysis of outcome after implantation of 38 GUEPAR elbow prostheses in 36 patients with rheumatoid polyarthritis. MATERIAL AND METHODS: The GUEPAR elbow prosthesis is an anatomic prosthesis developed in 1985 by the Groupe pour l'Utilisation et l'Etude des Prothèses Articulaires (GUEPAR). The recommended surgical technique is described. Patients included in this series had moderate to severe persistent elbow pain. Preoperative motion was 113 degrees flexion with a mean 41 degrees extension deficit. The mean global Mayo Clinic score was 32/100; clinically, the overall assessment was poor in 8 and mediocre in 30. Radiographically there were 16 grade III, 16 grade IV and 4 grade V elbows in the Larsen classification. Two cases were arthroplasty revisions. RESULTS: All patients were seen at a mean 47.6 months follow-up (12 to 97 months). There were two early failures (1 infection and 1 instability) leading to ablation of the prosthesis. Results were analyzed for the 36 remaining arthroplasties. Total pain relief was achieved in 18 cases with only occasional pain in 17 others. Postoperative motion was 132 degrees flexion with a 30 degrees extension deficit, giving a mean 30 degrees gain. The global Mayo Clinic score was 85/100 with 32 excellent, 3 good and 1 mediocre results. Radiography revealed 2 cases of loosening of the humeral component and 1 bipolar loosening that had not required revision at last follow-up. Prosthetic instability was the most frequent among the early and late complications. DISCUSSION: Total elbow arthroplasty is a useful therapeutic option among the treatments proposed (including chemical or isotopic synoviothesis, synovectomy, arthroplastic resection) for rheumatoid elbows. It is indicated for Larsen grades III, IV and V and provides good functional outcome and nearly constant pain relief with an amplitude greater than the 100 degrees, generally accepted as functionally useful. In light of our experience we propose certain modifications of the current GUEPAR implant: adjunction of a condylar extension to the humeral component in order to reduce rotation stress and thus avoid humeral loosening and a radial head element to limit the risk of instability.

Adult↗
PubMed2000

[Jaccoud's arthropathy].

Jaccoud's arthropathy, which was first described in 1869, is a rare syndrome that is characterized by a painless or relatively painless deformity of the digits II, II, IV and V with a dislocation of the extensor tendons in the metacarpal fossae. When the thumb is affected, a Z-deformity is observed. The present analysis was based on 21 patients (30 hands, 24 of which were operated on over the period 1989 to 1996). A distinction should be made between Jaccoud's disease following a known inflammatory arthropathy (15 hands; average patient age 55 years) and the idiopathic form of the disease (9 hands; average patient age 70 years). From a clinical point of view, a classification of the deformities is needed so that appropriate surgical treatment can be determined. In the present study, four groups were therefore proposed: in groups I and II, the realignment to centre of the extensor tendons over the metacarpophalangeal joint and joint stabilization yielded 87% positive results. In groups III and IV, the results were not as satisfactory either for the Swanson implant or for metacarpal shortening osteotomy. The pathogenesis of Jaccoud's disease has not yet been determined, but now that more information has become available and a better analysis can be made of its various clinical and anatomopathological characteristics, these should assist in defining precise surgical indications.

Aged↗
PubMed2000

Brachial plexus injuries in scapulothoracic dissociation.

The rare condition of scapulothoracic dissociation (STD) is characterized by a lateral displacement of the scapula from the thoracic cage following severe trauma to the scapular girdle. This study presents an analysis of five STDs. There were three supraclavicular brachial plexus palsies and two retro- and infraclavicular palsies. Recovery of elbow flexion was obtained in only two cases. Nerve damage dominates the prognosis and nerve recovery only rarely occurs. Nerve surgery should attempt to reestablish elbow flexion.

Acromioclavicular Joint↗
PubMed2000

[Rheumatoid arthritis of the wrist with adult onset].

The author reviews the consequences of rheumatoid synovitis of tendons and joints at the wrist, consequences which are different on the volar and dorsal aspects of the wrist. He refers to a modified Larsen classification to describe the consequences of instability in the radiocarpal (RC), midcarpal (MC) and radioulnar (RU) joints, both in the coronal and sagittal planes. A. On the volar aspect, tenosynovitis of the flexor tendons is frequent but may be difficult to diagnose. Synovitis in the carpal tunnel, although frequent, rarely results in compression of the median nerve; persistence of synovitis despite medical treatment is an indication to synovectomy. The latter may have to be extended into the palm and over the proximal phalanges, using the appropriate approach in the individual cases. Flexor tendon ruptures may occur, mostly of the flexor pollicis longus (FPL) and the flexor tendons to the index finger. Rupture of the FPL may be treated by a tendon graft or by arthrodesis of the i.p. joint. Rupture of the deep flexor tendon to the index may be treated by anastomosis to that of the medius; rupture of the superficial flexor tendon to the index may be treated similarly; rupture of both flexor tendons requires a tendon graft. B. On the dorsal aspect, the indications vary according to the stage of the disease. In Larsen's stage IV or V (destruction of one or more of the radiocarpal and intracarpal joints with navicular dislocation), arthrodesis or arthroplasty is indicated; the latter is ruled out however if extensor tendons are ruptured or the bone stock is insufficient. An original or modified Mannerfelt technique is used for arthrodesis, with the wrist in neutral or slightly extended position. Several wrist prostheses are available. Swanson's silastic implant has been discontinued; the Meuli, CFV, Biax, Trispherical, ATW, and GUEPAR prostheses have all been used with varying degrees of success. The choice between arthrodesis and arthroplasty is based on the severity of articular and tendon pathology, on uni- or bilateral involvement and on the condition of other joints, particularly in the upper limb. In less advanced stages, the author advocates using a combined operation with synovectomy of the extensor tendons and of the RC, MC and RU joints, relaxation by tendon transfers and Sauvé-Kapandji's technique; he stresses important technical points. The specific indications for radiolunate arthrodesis are discussed.

Adult↗
PubMed2000

[Partial replantation following proximal limb injury].

PURPOSE OF THE STUDY: Proximal replantation is a technically feasible but life-threatening procedure. Indications must be restricted to patients in good condition with a good functional prognosis. The goal of replantation must be focused not only on reimplanting the amputated limb but also on achieving a good functional outcome. For the lower limb, simple terminalization remains the best choice in many cases. When a proximal amputation is not suitable for replantation, the main aim of the surgical procedure must be to reconstruct a stump long enough to permit fitting a prosthesis preserving the function of the adjacent joint. If the proximal stump beyond the last joint is very short, it may be possible to restore some length by partial replantation of spared tissues from the amputated part. We present here the results we obtained following this policy. MATERIALS AND METHODS: This series included 16 cases of partial replantations, 14 involving the lower limb and 2 the upper limb. All were osteocutaneous microsurgical transfers. For the lower limb, all transfers recovered protective sensitivity following tibial nerve repair. The functional calcaeoplantar unit was used in 13 cases. The transfer of this specialized weight bearing tissue provided a stable distal surface making higher support unnecessary. In one case, we raised a 13-cm vascularized tibial segment covered with foot skin for additional length. For the upper limb, the osteocutaneous transfer, based on the radial artery, was not reinnervated, but this lack of sensitivity did not impair prosthesis fitting. RESULTS: One vascular failure was finally amputated. This was the only unsuccessful result. For all other patients, the surgical procedure facilitated prosthesis fitting and preserved the proximal joint function despite an initially very proximal amputation. DISCUSSION: The advantages of partial replantation are obvious compared with simple terminalization or secondary reconstruction. There is no secondary donor site and, because there is no major muscle mass in the distal fragment, the overall risk is very low compared with the risk of total proximal leg replantation.

Adolescent↗
PubMed2000

[Benign solitary tumors of the peripheral nerves].

Solitary tumors of the peripheral nerves are uncommon and found to be benign in 90 p. 100 of the cases. They develop from the elements constituting the nerve and are generally schwannomas (80 p. 100). Other tumors are much more exceptional and exhibit wide histological variability. The diagnosis of a tumor of the peripheral nerve must be envisaged for all cases with tumefaction or pain on the path of a nerve exacerbated at percussion. Magnetic resonance imaging is the preferred exploration technique, particularly useful in case of a deep tumor. Preservation of nerve continuity is the underlying goal of the therapeutic strategy, irrespective of the type of tumor. Extricable tumors are to be distinguished from inextricable tumors. Extricable tumors (schwannomas, intranervous lipomas) displace nerve fiber bundles without penetrating into the bundle itself and can thus be resected without interrupting nerve continuity. Prognosis is excellent if no recurrence or degeneration occurs. In case of persistent symptoms, a new exploration may be required to search for other localized tumor(s) unperceived at the first procedure. Inextricable tumors (solitary neurofibromas, hemangiomas of the Schwann sheath, neurofibrolipomas) infiltrate the structural elements of the nerve fibers making complete excision impossible without altering the nerve fibers. Epineurotomy (associated with an interfascicular biopsy for pathology examination) allows decompression and can often provide symptom relief although moderate paresthesia may persist. Patients must be informed of this possibility prior to surgery. Any recent and rapidly evolving modification in the clinical findings is suggestive of recurrence and should be followed by revision exploration. Malignant degeneration has not been observed in solitary tumors to our knowledge. Our own experience with 51 cases is generally in agreement with reports in the literature.

Adult↗
PubMed1999

Martin-Gruber communicating branch: anatomical and histological study.

We dissected 72 upper limbs of fresh cadavers and found 17 cases with a Martin-Gruber communicating branch (23.6%). These were classified into 4 types: type I (n = 5, 29.4%): communicating branch between the anterior interosseous and ulnar nn, type II (n = 3, 17.6%): Communicating branch between the median and ulnar nn., type III (n = 3, 17.6%): Communicating branch between the muscular branches to the flexor digitorum profundus m., type IV (n = 6, 35.3%): combination of type I or II and type III. At histologic examination the number and size of the nerve bundles each communicating branch contained proved to be very different. In one case of type II only a single nerve bundle was found. We suggest that the different numbers of nerve bundles innervate different amounts of the intrinsic hand musculature. The communicating branch with a single nerve bundle probably innervated only the first dorsal interosseous muscle.

Aged↗
PubMed1999

The wrist of the formula 1 driver.

OBJECTIVES: During formula 1 driving, repetitive cumulative trauma may provoke nerve disorders such as nerve compression syndrome as well as osteoligament injuries. A study based on interrogatory and clinical examination of 22 drivers was carried out during the 1998 formula 1 World Championship in order to better define the type and frequency of these lesions. METHODS: The questions investigated nervous symptoms, such as paraesthesia and diminishment of sensitivity, and osteoligamentous symptoms, such as pain, specifying the localisation (ulnar side, dorsal aspect of the wrist, snuff box) and the effect of the wrist position on the intensity of the pain. Clinical examination was carried out bilaterally and symmetrically. RESULTS: Fourteen of the 22 drivers reported symptoms. One suffered cramp in his hands at the end of each race and one described a typical forearm effort compartment syndrome. Six drivers had effort "osteoligamentous" symptoms: three scapholunate pain; one medial hypercompression of the wrist; two sequellae of a distal radius fracture. Seven reported nerve disorders: two effort carpal tunnel syndromes; one typical carpal tunnel syndrome; one effort cubital tunnel syndrome; three paraesthesia in all fingers at the end of a race, without any objective signs. CONCLUSIONS: This appears to be the first report of upper extremity disorders in competition drivers. The use of a wrist pad to reduce the effects of vibration may help to prevent trauma to the wrist in formula 1 drivers.

Adult↗
PubMed1999

[Paralytic shoulder secondary to post-traumatic peripheral nerve lesions in the adult].

A critical review is presented of the indications for nerve repair or transfer and for palliative operations in the management of paralytic shoulder following traumatic neurological injuries in the adult. Different situations are considered: paralytic shoulder following supraclavicular lesions of the brachial plexus, following retro- and infraclavicular lesions and following lesions to the terminal branches of the plexus (axillary, suprascapular and musculocutaneous nerves) and finally problems related to lesions of the accessory nerve and the long thoracic nerve. I. Supraclavicular lesions of the brachial plexus. In complete (C5 to T1) lesions, the possibilities for nerve repair or transfer are at best limited, and the aim is to restore active flexion of the elbow. Palliative operations may be associated in order to stabilize the shoulder. In case of a complete C5 to T1 root avulsion, amputation at the distal humerus may be considered but is rarely performed combined with shoulder arthrodesis if the trapezius and serratus anterior muscles are functioning. The shoulder may also be stabilized by a ligament plasty using the coracoacromial ligament. In cases where the supraspinatus and long head of the biceps have recovered, but where active external rotation is absent, function may be improved by derotation osteotomy of the humerus. In partial C5,6 or C5,6,7 lesions, the indications for nerve repair and transfer are wider, as well as the indications for muscle transfers. In C5,6 lesions, a neurotization from the accessory nerve to the suprascapular nerve gives 60% satisfactory results; this is also true following treatment of C5,6,7 lesions, whereas restoration of active elbow flexion is obtained in 100% of cases in C5,6 lesions but only in 86% in C5,6,7 lesions. In cases where shoulder function has not been restored, palliative operations may be considered: arthrodesis or, more often, derotation osteotomy of the humerus which can be combined with transfer of the teres major and latissimus dorsi. II. Retro- and infraclavicular lesions of the brachial plexus. Twenty-five percent of the lesions of the brachial plexus occur in the retro- or infraclavicular region and involve the secondary trunks, most commonly the posterior trunk. Nerve repair should be performed early. The shoulder may be affected owing to involvement of the axillary nerve in cases of lesions of the posterior trunk, often associated with a lesion of the suprascapular nerve. Regarding the terminal branches (axillary, suprascapular and musculocutaneous nerves), spontaneous recovery may be expected in a significant proportion of cases but is often delayed (6-9 months), and the problem is to avoid unnecessary operations while not unduly delaying surgical repair in cases where it is indicated. MRI may be useful to delineate those cases where surgery is indicated: repair is usually performed around 6 months following trauma. Isolated lesions of the axillary nerve may be repaired with good results using a nerve graft. The lesion may occur in combination with a lesion of the suprascapular nerve; the latter may be interrupted at several levels. Proximal repair may be performed using a nerve graft; distal lesions are more difficult to repair and may require intramuscular neurotization. Lesions of the musculocutaneous nerve may be repaired with good results using a nerve graft. Lesions of the axillary nerve may be seen associated with lesions of the rotator cuff. The treatment varies according to the age and condition of the patient and according to the condition of the cuff muscles and tendons: in a young patient with avulsion of the tendons from bone, cuff reinsertion is indicated; in an older patient, the cuff must be evaluated by MRI or arthroscan, and repair is indicated unless the cuff tear is not amenable to surgery or there is fatty degeneration of the muscles. Palliative surgery may be indicated in cases seen late or after failed attempts at nerve repair. (ABSTRACT

Accessory Nerve↗
PubMed1999

[Anatomic study and review of the literature on the Martin Gruber anastomosis].

We dissected 72 upper limbs of fresh cadavers and found 17 cases of the Martin-Gruber anastomosis. The incidence was 23.6%. They can be classified into 5 types. Type I (n = 5, 29.4%): Communication between the anterior interosseous and the ulnar nerves. Type II (n = 3, 17.6%): Communication between the median and the ulnar nerves. Type III (n = 3, 17.6%): Communication between the muscular branches of the flexor digitorum profundus muscle (FDP). Type IV (n = 3, 17.6%): Communication between the anterior interosseous and the ulnar nerves, the muscular branches of the flexor digitorum profundus muscle (FDP) originated from the connection. Type V (n = 3, 17.6%): The anastomotic branch originated from the median nerve and joined the ulnar at two different points as well as connecting with the ulnar branch of the FDP. Through histologic examination, we found the number and size of nerve fascicles which every connection contained to be very different. In one case of type II only one single nerve fascicle was found. We propose the hypothesis that the different amounts of nerve fascicles innervate different amounts of intrinsic hand musculature. The communication which contained one single nerve fascicle only innervate the first dorsal interosseous muscle (FDI).

Aged↗
PubMed1999

[Reconstruction of the proximal quarter of the ulna after post-traumatic destruction. 3 case reports].

Serious injuries of the elbow with of bone loss of the proximal ulna or of the two bones of the forearm may result in a loss of function in flexion-extension and pronation supination with painful instability of the elbow. The treatment of these functional sequelae is difficult because it must reestablish the mobility and the stability of the elbow. We report three cases of post-traumatic loss of the proximal quarter of the ulna. In two cases, the radius was intact and we transferred the proximal radius according to Young's method modified by Piollet. In the third case, the loss of the proximal extremity of the two bones of the forearm was treated with the transfer of the proximal extremity of the fibula. By means of these techniques, our three patients had very satisfying functional results as evaluated at 18 years, 18 months and 17 years follow-up respectively.

Adult↗
PubMed1998

Closed ruptures of the flexor digitorum tendons: MRI evaluation.

OBJECTIVE: To assess the MRI findings in cases of closed rupture of the flexor digitorum tendons (FDT). PATIENTS AND DESIGN: Ten patients with a clinical suspicion of rupture of FDT underwent MRI before surgery. None of the patients presented a skin injury. Fingers were imaged using axial T1-weighted SE sequences, three-dimensional GE images, and curved reconstructions. RESULTS: Twelve FDT had surgical confirmation of rupture. Flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons were more frequently ruptured (n=8) than flexor digitorum superficialis (FDS) tendons (n=4). MR images accurately depicted the level of the rupture. The gap between the tendon ends (mean 45 mm, range 21-70 mm) was assessed best with curved reconstructions and was well correlated with the surgical findings. The proximal end mainly retracted into the palm or the carpal tunnel (n=8), and less frequently into the digital canal (n=4). In two cases, the proximal end curled up in the palm, clinically simulating a rupture of a lumbrical muscle in one case. MRI also showed the appearance of the adjacent tendons. CONCLUSION: MRI accurately depicted the level of rupture and the gap between the tendon ends, which assisted the surgical choice between suture, graft or tendon transfer.

Adult↗
PubMed1998

Tendon transfers to restore elbow flexion after traumatic paralysis of the brachial plexus in adults.

Loss of elbow flexion after traumatic brachial palsy produces significant functional and cosmetic problems. Although a direct approach to the neurological lesion with an attempt to reinnervate the biceps has given some encouraging results, these can be incomplete and for this reason tendon transfers still have an important role. We report the results of our series of 60 patients (54 men and 6 women) who have undergone tendon transfer between 1984 and 1994. The transfers were performed during or after nerve surgery, and we used the muscles arising from the medial epicondyle, the pectoralis minor and the triceps. Our results were judged on any improvement in shoulder stability and in the power of lateral rotation, together with the power and range of active and passive flexion of the elbow. Good results were achieved in 74% of the patients in our study, with more than 120 degrees of elbow flexion and an ability to support at least 1 kg with the elbow flexed to 90 degrees.

Adult↗
PubMed1998

Sprains of the radial collateral ligament of the metacarpophalangeal joint of the thumb. A series of 14 cases.

Fourteen surgically treated radial sprains of the M.P. joint of the thumb, are reported. 8 were recent cases, 6 were longstanding. At the time of surgery, the extensor head was severed in 4 cases, the APB tendon in 6 cases, the dorsal articular capsule in 9. The radial collateral ligament was elongated 6 times, ruptured 4 times, and presented bony avulsion in 4 cases. The mean postoperative immobilization was 37 days. 13 patients were reviewed with a mean follow-up of 22 months. Only eight were satisfied. The mean loss of motion was 27 degrees. The mean laxity, assessed on specific dynamic X-rays, was 6 degrees. 3 patients presented with radiographic arthritis, all of them with chondral lesions at the time of surgery. Despite the absence of Stener's lesion, the authors recommend surgery when volar subluxation or radial laxity is observed > 10 degrees.

Adult↗
PubMed1998

Results of non-operative and operative treatment of humeral shaft fractures. A series of 104 cases.

The aim of this study was to examine the results of different modalities applied in the treatment of 104 fresh diaphyseal fractures of the adult humerus treated in the department between January 1994 and March 1997. These results were classified according to the criteria described by Stewart and Hundley. 32 patients (30.8%) were treated non-operatively using a sling and a moulded plaster splint. The type of treatment had to be changed in 12 of these patients due to 14 different complications that occurred during the course of non-operative treatment. Thus, 20 patients (62.5%) underwent non-operative treatment until fracture-union. The results in this group were: very good in 12 cases (60%), good in 5 cases (25%), fair in 3 cases (15%). 28 fractures were treated using plates and screws. 4 events (14%) occurred during in the post-operative period and, apart from 2 cases of non-union, the overall result in the 26 patients in whom the fracture united was: very good in 23 cases (88.5%) and good in 3 cases (11.5%). 22 patients (21.1%) underwent fixation using multiple flexible intramedullary wires via a supracondylar approach. Apart from one case of non-union, the final result in the 21 patients in whom the fracture united was: very good in 9 cases (42.8%), good in 9 cases (42.8%), fair in 2 cases (9.5%) and poor in 1 case (4.9%). 22 fractures were treated using an intramedullary Seidel nail. The final result in these patients was: very good in 11 cases (50%), good in 9 cases (41%) and poor in 2 cases (9%). The indications for treatment should be eclectic. Non-operative treatment remains the method of choice for undisplaced or minimally-displaced fractures or comminuted fractures with multiple parallel longitudinal fracture-lines over the middle-third, while surgical treatment is considered for displaced fractures and essentially depends upon the type and level of the fracture. Transverse and short oblique fractures are treated using a plate or a Seidel nail. Fractures with a third fragment require plate osteosynthesis. Multiple flexible intramedullary wires are used for segmental fractures or for diaphyseal fractures associated with fractures of the neck of the humerus. Comminuted fractures are realigned using an intramedullary Seidel nail or multiple flexible wires. As far as the site of fracture is concerned, those of the proximal and middle thirds of the humerus are well treated using an intramedullary nail or multiple wires or with a plate, while plating is most often the method of choice for fractures of the distal-third.

Adolescent↗
PubMed1998

A retrospective review of 115 cases of surgically-treated trapeziometacarpal osteoarthritis.

The trapeziometacarpal joint is among the main targets for osteoarthritis at the hand. The objective of surgical treatment is to obtain a painless, stable, and mobile joint. One hundred fifteen cases treated either by a GUEPAR prosthesis (n = 90; group A) or by excision of the trapezium followed by ligament reconstruction and tendon interposition (n = 25; group B) were studied retrospectively. The choice between the two procedures was based on a number of clinical and radiological criteria. Of the 90 group A patients, 79 were reevaluated, after a mean follow-up of 5.75 years. Clinical results were good in 92% of cases. Loosening of the cup was seen in seven cases, of which three (3.8%) were treated by implantation of a Swanson prosthesis within three years of the first procedure. Six patients had loosening of the metacarpal component only, which was stable over time and had no adverse effect on clinical results. Of the 25 group B patients, 19 were reevaluated, after a mean follow-up of 3.5 years. Clinical results were good in 18 cases; the height of the scaphometacarpal space decreased by a mean of 51% versus its preoperative value. We conclude that the GUEPAR prosthesis provides good results with a low revision rate and deserves to be widely used in patients with a trapezium of at least 7 mm in height. Indications for the excision-reconstruction-interposition procedure include severe osteoarthritis, trapezium height less than 7 mm, younger age, and intensive hand use.

Adult↗