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P Garbuio

Publications and source records attributed to P Garbuio.

At least 19 recordsLinked to original sources
PubMed2000

[One-stage emergency treatment of open tibial shaft fractures with bone loss. Specifics and indications].

OBJECTIVES: The purpose of this study was to report our experience in the reconstruction of severe tibial shaft fractures in emergency treatment. PATIENTS: Five male patients were admitted to the emergency room with a grade IIIB open tibial shaft fracture with bone loss, one patient with a grade IIIA open tibial fracture with massive articular bone loss and one patient with a grade IIIC open tibial fracture. INTERVENTION: Primary one-stage management was the same for the five patients with a grade IIIB: debridement, stabilization by locked intramedullary nailing, bone grafting from iliac crest. Skin loss was covered in the same operative time using free muscle flaps (four latissimus dorsi, one gracilis). For the patient with massive articular and diaphyseal bone loss, a vascularized fibula transfer with arthrodesis was performed one day after the trauma. For the patient with grade IIIC open tibial fracture, a shortening was performed in emergency treatment. RESULTS: The average follow-up was 21 months (range: eight months to 3.5 years). Partial weight-bearing was started at three months and the time of full weight-bearing was five months after the trauma. No angular complication and no non-union were observed. We noted one superficial infection without osteitis. All fractures healed within five to ten months (mean: 8.5 months). At the last follow-up, ankle and knee motion was normal and no pain was noted, except for the patient who had an arthrodesis and another who had associated lesions. CONCLUSION: We think that "aggressive" emergency management for severe open tibial fractures gives good results. It significantly reduces tissue loss from infection and improves healing and rehabilitation times.

Adolescent↗
PubMed1999

Emergency management of type IIIB open tibial fractures.

We present our therapeutic strategy for the treatment of type IIIB open tibial fractures. It involves emergency internal stabilisation of the bone by locked intra-medullary nailing when appropriate and skin cover using either a pedicled or free muscle flap. Where there is bone loss, a cancellous iliac graft is performed at the same time. Eighteen cases of type IIIB open tibial fractures treated between 1986 and 1995 were analysed. There were 17 men and 1 woman; the average age was 35 years. Each of the 18 patients underwent wound debridement as a primary emergency procedure with no secondary reoperation. Bone fixation was performed by locked intra-medullary nailing (AO nail, How Medica) 6-10 h after trauma. A primary cancellous iliac bone graft was performed in three cases. Cover was applied immediately after nailing (muscular pedicle flaps in 12 cases, muscular free flaps in 6 cases). Local flap cover led to two failures: both these fractures were followed by postoperative complications. The 6 free muscle flaps were successful. The average time to bone union was 6.5 months (range: 3-18.5 months) according to clinical criteria and 9 months (range: 4-27 months) according to radiological criteria. Out of the 18 fractures, 13 were primarily united (72.2% of cases); 3 involved osteitis and 2 nonunion. Sixteen patients were examined again with a mean follow-up of 4.8 years (range: 1-11 years). Six moderate malunions occurred; none needed surgical reoperation. Ankle motion was normal in 7 cases and reduced to below 50% in 9 cases when compared with the healthy ankle. Thirteen patients resumed their previous professional activities. This surgical strategy reduces bone union time, the number of operations and the time spent in hospital; it improves functional results.

Adolescent↗
PubMed1999

[A turning point in the therapeutic history of open leg fractures: osteosynthesis coupled to the immediate dressing in the presence of major damage to the soft tissues].

A brief history of the treatment of open leg fractures (OLF) points out the problems posed by the present therapy with regard to the soft tissues in the most serious cases (type III from cauchoix, Duparc, type III A and B from Gustilo). Which strategy should be foremost, knowing that the debridement, stabilization and cover are the three essential procedures? Rigorous debridement certainly carries unanimous approval but some are opposed to this procedure during the first few days. Also widely recognized is the beneficial aspect of early cover when regarding aseptic evolution, consolidation, low rate of complications, rehabilitation and the patient's helplessness. However, despite the well demonstrated results of BYRD [14] and GODINA [15] and because of the debridement concept and logistical insufficiencies, thorough treatment in a true emergency has not achieved full acceptance. In general, the majority of surgeons first clear, stabilize with the use of an external fixator in true emergency situations and cover several days later. For the past ten years, in real emergencies, in the Department of Orthopedics, Traumatology and Plastic Surgery at the Besançon University Hospital Center we have subscribed to a radical treatment which simultaneously combines debridement, osteosynthesis (locked centro-medullary nailing) and cover with the use of free flaps in the same operating period. A study based on 27 wounded patients seeks to validate the advantages of looked centro-medullary nailing over the use of an external fixator and the use of free flaps rather than local flaps in the most serious cases.

Adult↗
PubMed1998

[Hand replantation: long-term functional results (apropos of 8 cases)].

STUDY AIM: The aim of this study was to report the long term functional results after replantation of the hand in eight patients. MATERIALS AND METHODS: Between 1977 and 1995, hand replantation was performed in eight cases (six males and two females). Mean age at the time of injury was 31 years (24-47 years). The dominant hand was amputated in half of the cases. In two cases, the soft tissue lesions were severe; in the six other cases, the wound was clean-cut. The level of amputation was transmetacarpal (n = 2), carpal (n = 2), wrist (n = 2), distal part of the forearm (n = 2). RESULTS: The mean convalescence time was 16 months (from 6 months to 2 years). The degree of disability ranged from 40 to 65%. Patient follow-up lasted 2 to 20 years (mean: 11 years). The return of discriminative sensitivity of the digits was noted in six cases. The active motion of the fingers was satisfactory in all cases, but intrinsic muscle function was weak or absent. Pinch and grasp strength was reduced from 10 to 60% (when compared to the non-damaged hand). One patient resumed his prior occupation, and another resumed his occupation part-time. The six other patients found new occupations. CONCLUSION: All the patients achieved a useful function of their replanted hand in their daily, spare-time and professional activities.

Adult↗
PubMed1998

Immediate active mobilisation after flexor tendon repairs in Verdan's zones I and II. A prospective study of 20 cases.

The authors report their experience with early active mobilisation after repair of complete sections of the flexor tendons within the digital tendon sheath. This is a prospective study carried out over 2 years and represents 20 repairs. The tendons were repaired using a double-loop looking suture of Tsuge (with PDS 4/0) associated with a peritendinous overrun using Prolene 6/0 via a volar Bruner-type incision. Post-operatively, a plaster splint holding the wrist in 30 degrees of flexion, the MP joints in 90 degrees of flexion and allowing complete active flexion of the finger protected the suture site. As soon as the dressings could be reduced (the 5th day post-operatively), the patient was encouraged to actively and synchronously flex all the fingers together as many times as possible during the day. After removal of the plaster splint at one month, the patients were entrusted to a physiotherapist with a view to regain full extension of the wrist and the fingers. We did not note a single case of breakdown of the repair. The mean active mobility (TAM according to Strickland) of the repairs in zone I was of the order of 70% while that for repairs in zone II was 85%. Immediate active mobilisation was not found to compromise, in any way, the results of associated digital nerve repairs. Despite the modest results, this simple-to-understand protocol is directed at present for injuries with a poor initial prognosis (contused and lacerated tendons, associated fractures, and non-motivated patients). Improvement in the quality of suture material should, in future, extend the indications for immediate active mobilisation to all fresh sutures of the flexor tendons.

Adolescent↗
PubMed1998

Irreducible dorsal dislocation of the interphalangeal joint of the thumb due to the palmar plate. A case report.

Dorsal dislocation of the thumb interphalangeal joint is rare. Only very few cases of irreducible dislocation has been reported at this joint. The authors report a case of compound irreducible dislocation due to the palmar plate interposition. The sesamoid, the flexor pollicis longus have been reported to block reduction of the dorsal dislocation of the thumb interphalangeal joint doctors on casualities should not insist if reduction is not easily obtained, the patient should then be guide towards a surgical team for surgical treatment.

Adult↗
PubMed1998

[Distal traumatic avulsion of the triceps brachii. Apropos of a treated cases].

Traumatic distal avulsion of triceps brachii is a rare injury, usually due to a fall on the outstre ched elbow, with sudden contraction of the triceps muscle. Examination reveals pain, swelling, and a palpable depression just proximal to the olecranon. Lateral X rays show avulsed osseous material. Surgical therapy was advisable for complete avulsion. In this case, the authors used absorbable sutures for this reinsertion. Immediate surgical repair always achieves good results.

Adult↗
PubMed1998

[Gunshot wounds of the extremities in civilian practice. Therapeutic approach in five cases with diaphyseal bone involvement].

The authors analyse 5 cases of gunshot wounds involving limbs with a diaphyseal fracture of the radius and ulna: 3 of the cases concern the radius and ulna and the remaining 2 involve the tibial bone. These wounds were encountered in civilian practice (3 rixes, 2 gun-shot injuries). In all of the cases, the emergency treatment consisted of extensive debridment, bone fixation by intramedullary nailing in most cases, cancellous iliac bone grafting in 2 cases, cover with a Latissimus dorsi free flap in 1 case. In all of the cases, development was free of infections bone union time was 3 to 12 months; last functional results were satisfactory.

Adult↗
PubMed1997

[Imaging of abdominal trauma].

Imaging technique strategies in abdominal traumas should be aimed at determining the best strategy allowing a reliable and quick diagnosis of a potential surgical lesion. The introduction and development of modern imaging methods including CT and US thus nowadays, have a clear impact on the diagnosis and treatment of abdominal traumas.

Abdominal Injuries↗
PubMed1997

[Functional treatment of isolated fractures of the ulnar diaphysis in adults. A prospective study apropos of 10 cases and review of the literature].

In this prospective study, ten consecutive isolated fractures of the ulna were treated by short-arm plaster cast (an average of 16.8 days) with immediate mobilization in our institution since January 1995. The minimum follow-up was eight months and the longest was two years. All fractures were closed. The median age of the patients was 36.7 years (17 to 61), the male to female ratio was 7 to 3. The patients were seen and radiographed every two weeks until bridging external callus was detected by same surgeon. Monteggia fractures-dislocation, open fractures, fractures with elbow or wrist dislocation and gunshot fractures were also excluded. The fracture involved the distal third in 5 cases, the distal quarter in 4 cases and the middle third in one case. Seven fractures were displaced between 2.5 and 6 mm, but no fracture needed reduction. All patients returned to work a mean of 4 months after the accident. Some angulation was found in most cases, but it rarely exceeded 10 degrees. In this study, the average healing time was 8 weeks and there were no non-unions. We did not encounter any synostosis between the radius and ulna in our patients. Motion at the wrist and elbow was always restored. All patients were satisfied by the functional method. The method that we have described can be safely recommended as treatment of choice for these fractures. Completely displaced, Monteggia fractures, comminuted or gunshot fractures of the ulna should be treated by other methods.

Adolescent↗
PubMed1997

[Recent, closed trapezio-metacarpal luxation, treated by pinning.Apropos of 7 cases with a median follow-up of 8 years].

Seven cases of acute and closed traumatic dislocation of the trapezio-metacarpal joint treated by percutaneous pinning adapted by Wiggins are reported with an average follow-up of eight years. Seven patients (five men and two women) aged 18 to 62 were treated. The injury was due to a road traffic accident in four cases. The dominant hand was injured in six cases. The metacarpal base was always dislocated dorsally and closed reduction always remained unstable. All cases consisted of closed dislocation but in two cases dislocation was associated with upper limb fractures. On the initial radiographs no patients had degenerative changes. All patients were treated as an emergency or the following during the days injury by reduction and stabilization by one or two percutaneous kirschner wires followed by a scaphoid cast for three to six weeks. All patients were followed and reviewed for this study between two and thirteen years (mean eight years) after injury. Enquiries were made about return to work, pain, stability, range of movement, key-pinch and grasp compared with the uninjured side. The joint was examined radiographically with particular attention to the presence of subluxation and degenerative changes. 2 patients with associated complex injury of the upper limb developed reflex sympathetic dystrophy. 2 patients had moderate pain, 2 patients had limitation of joint movement, 1 patient presented a reduction of strength (pinch and grasp) but none had subluxation, instability, or degenerative changes. Closed reduction and stabilization by percutaneous pinning is a simple method and gives good or excellent results in the treatment of acute traumatic dislocation of the trapezio-metacarpal joint.

Accidents, Traffic↗
PubMed1997

[Treatment of complex fractures of the ankle and their sequellae using trans-plantar intramedullary nailing].

UNLABELLED: Nine patients were treated for complex tibial pilon and talus fractures or non unions from 1990 to 1997 using intramedullary nails introduced through the calcaneus. All patients were followed until healing. The average follow-up was 14 months. Failure of the procedure was defined by the occurrence of complications or reintervention. We used a modified Seidel nail in 5 cases, a tibial shaft nail in 3 cases, and a special nail in one case. All nails but two were locked. CASES: These arthrodeses were performed for treatment of sequels from open talus fractures. Transplantar nailing was performed between 9 months and 3 years after arthrodesis, because of non union. In two cases fusion was obtained at 3 and 8 months postoperatively. In the third case non union occurred due to instability of fixation (the nail was unlocked). Replacement by an interlocked nail was performed through a proximal tibial approach, and healing was obtained in 6 months. PSEUDARTHROSES: 2 CASES: These two cases presented comminuted tibial pilon and open talus fractures in association with vascular and tendon lesions. They had previously undergone debridement and external fixation. Transplantar nailing was performed 8 and 10 months after trauma using a locked modified Seidel nail. Radiographic fusion was obtained in 5 months. PRIMARY SURGERY: 4 CASES: The first two cases were foot reimplantations after traumatic amputation. Skeletal stabilization was obtained using a transplantar locked tibial nail. Revascularization attempts failed and an amputation was performed on the fourth day in one case. The reimplantation succeeded in the second case. Radiographic fusion was obtained in 2 months. The third case was a distal tibial shaft fracture. The patient was an obese mentally deficient and invalid woman. Bone union was achieved in four months. The last case was a primary arthrodesis for post-trauma necrosis of the talus. Radiographic fusion was observed 45 days after operation. Transplantar locked nailing offers an optimal stabilization for complex ankle fractures. We had two failures not related with the principle of the technique. We think that transplantar nailing is best indicated to obtain tibiotalar or tibiocalcaneal arthrodesis and to treat compound ankle fractures. Another indication could be distal tibial shaft fractures in invalid or mentally deficient patients.

Adolescent↗
PubMed1997

[Complex injuries of the dorsum of the hand. Therapeutic reflections apropos of 2 cases].

UNLABELLED: We report 2 similar cases of severe injury of the dorsum of the hand, both treated in emergency. FIRST CASE: A 37-year-old right handed male truck driver was admitted with a complex severe injury of the dorsum of his right hand following a traffic accident. He had a combined large defect involving skin, tendons and bone. A complex reconstruction was performed using a massive iliac crest allograft, a tendon graft and a free serratus anterior flap in a one stage procedure, eight hours after the injury. A skin graft was done later. Two years later the functional and esthetic results are good. SECOND CASE: A 37-year-old woman was admitted with a severe injury of the dorsum of her right hand following a traffic accident. She had a large combined defect involving skin, tendon and bone. A complex reconstruction was carried out using a large iliac crest autograft, a multiple tendon graft and a free latissimus dorsi flap, in one stage 6 hours after the trauma. Eight months later the functional result is partial but useful for the daily activities of the patient.

Adult↗
PubMed1997

[Reflections on recent ruptures of the diaphragm. Apropos of 45 cases].

Trauma-induced ruptures of the diaphragm are very exceptional but are regularly encountered in trauma surgery units. Closed ruptures occur in 60 to 80% of diaphragm lesions in European series, 9 times out of 10 after traffic accidents. Large American trauma centers however, have had more experience with stab of firearm wounds. The diagnosis raises many problems and requires further exploration after the standard chest x-ray. We discuss the different explorations which can be contributive in both emergency and non-emergency situations. The most appropriate therapeutic approach is also discussed. Should thoracotomy or laparotomy be used? What precautions are required prior to surgery? Can laparoscopy be useful?

Adult↗