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Biomedical subjects

P Garbuio

Publications and source records attributed to P Garbuio.

51 records · Page 3Linked to original sources
PubMed1997

[Value of the surgical approach through the patellar tendon for intramedullary nailing of the tibia and the femur].

The goal of this study was to propose a new approach of the upper tibia for intramedullary nailing. Since two years, the authors performed a transversal skin incision superior to the distal end of the patella. The patellar tendon is dissociated and the tibia is perforated through the anterior intercondylar area. The advantages of this approach versus classical techniques are discussed. This approach allows isolated tibial or femoral nailing but also both nailings during the same procedure.

Bone Nails↗
PubMed1997

[Syringomatous tumor of the nipple. A case report and review of the literature].

The authors report a case of syringomatous tumor of the nipple in a 35-year-old woman, discovered incidentally during investigation of dysmenorrhea. After limited resection-biopsy of a cystic nipple tumor, histological results indicated the need for a partial central mastectomy with areola and nipple amputation. Although this tumor is classified as an adenoma, considered to be a benign lesion, syringomatous adenoma of the nipple is a potentially locally aggressive tumor, at risk of local recurrence and deep invasion of the mammary gland. This is a rare tumor (only 18 cases have been reported in the literature), and the histological diagnosis can be difficult, with possible confusion with a nipple duct adenoma, or tubular carcinoma.

Adult↗
PubMed1996

[Value of Swanson implants in complex traumatic lesions of the proximal interphalangeal joint].

The authors report the results of 30 Swanson implants, inserted immediately, or secondarily in complex trauma of the proximal interphalangeal joint of long fingers in 24 patients (19 men, 5 women). All patients were reviewed by the same examiner with a mean follow-up of 7 years (range: 17 months-17.2 years). All implants were inserted secondarily after the accident, except in 7 cases in which the local conditions led the operator to insert the implant immediately. At review, 20 implants were still in place, 6 patients had requested amputation, and arthrodesis had been performed in 4 cases. The mean range of movement was -13,4 degrees to 37 degrees, i.e. a mean amplitude of 23.6 degrees. The lateral stability of the operated finger was considered to be satisfactory in 50% of cases, and the patient was satisfied with the operation in 65% of cases. The authors consider that useful mobility of the proximal interphalangeal joint should be preserved whenever possible. The Swanson implant is currently a useful alternative to amputation or arthrodesis, especially as it does not compromise these procedures if they are required subsequently.

Adult↗
PubMed1996

[Results of primary repair of isolated flexor digitorum profundis lesions in the digital canal. 51 cases].

Isolation section of the flexor tendon in the digital canal of the long fingers is classically considered to have a good prognosis. The authors evaluate the repercussions on the mobility of the proximal and distal interphalangeal joints, based on a series of 51 sections (44 patients). The mean follow-up at the time of review was 7.7 years. 84% good or very good results were observed in this homogeneous series of simple lesions. Poor results included 2 cases of secondary rupture and 2 infections. They were essentially due to "whiplash" retraction of the proximal end in the palm for lesions in zone 1, and contuse section of tendons in poorly motivated patients. The results of sections in zone I are comparable to the results of sections in zone II. Stiffness of the PIP joint, even moderate, is frequent, whether the lesion is situated in zone I or zone II. The mobility of the metacarpophalangeal joint remains normal in every case. The authors did not observe better results in cases mobilized according to Kleinert's procedure compared to cases immobilized by plaster, and do not have a satisfactory explanation for this result.

Adolescent↗
PubMed1996

[Kienböck's disease treated by shortening osteotomy of the radius. Analysis of the results apropos of 13 cases].

A series of 13 cases of Kienbock's disease, treated by shortening of the radius, operated between 1975 and 1995, is presented. This series consisted of 7 males and 6 females with a mean age of 27.5 years (range: 17 to 37 years). The dominant hand was affected in 12 cases. 6 men and 5 women performed heavy work. The mean period between the first symptoms and the operation was 18 months (range: 3 months to 6 years). In 10 cases, pain was severe and limited activities; in 3 cases, pain was moderate with partial limitation of activity. 8 cases had a mobility greater than 75% compared to the healthy side. 5 cases had a mobility of approximately 50%. None of the cases had a mobility less than 25%. Strength was not measured preoperatively with the JAMAR dynamometer. The standard radiographic assessment included an AP palm-plate film (raised palm) and a true profile on a small board. This radiographic assessment established, for each case: the Decoulx and Lichtmann classification, the radioulnar index, the angle of the radial slope and the lunate fossa, collapse of the carpus according to Youm and McMurtry. There were two stage 1, three stage 2, eight stage 3 (six stage 3A, and two stage 3B) and no stage 4. The radioulnar index was negative in 10 cases, zero in 1 case, and positive in 2 cases. The mean angle of the radial slope was 23 degrees, the mean angle of the lunate fossa was 10.8 degrees, the mean height of the carpus was 0.476. The incision was anterior in 7 cases, and posterolateral in 6 cases. The mean shortening was 5 mm (range: 4 to 6 mm). Patients were reviewed with a mean follow-up of 5 years (range: 10 months to 12 years). The analysis according to Michon's criteria revealed 3 excellent results, 9 good results, 1 moderate result and no poor results. All patients were able to resume their previous occupation. Five no longer had any pain, 6 had moderate and rare pain, 2 patients presented pain limiting activity. 10 patients presented a mobility greater than 75% compared to the healthy side. In 2 cases, the mobility was greater than 50%. In 9 cases, the strength was greater than 75% compared to the healthy side, and in 4 cases, it was greater than 50%. Radiological assessment, all stages combined, showed 4 improvements, 7 stabilizations, 2 deteriorations. There was no correlation between the height of the carpus (which varied only very slightly postoperatively) and the clinical or radiological course. In this series of 13 patients; shortening osteotomy gave results on all stages of the disease. There was no correlation between the clinical and radiological course of the lunate, and the following factors: age, preoperative radiographic stage, instability of the carpus, position of the plate. On the basis of the results of our series, it appears important to increase the angle of the lunate fossa and to obtain an angulation greater than 12 degrees 5 and to maintain a negative radioulnar index. The 2 cases of radiological deteriorations corresponded to a positive postoperative radioulnar index, while the index remained negative in the 4 cases of improvement; all cases in which the angulation of the lunate fossa was greater than 12 degrees stabilized or improved radiologically, regardless of the preoperative stage. Despite contradictory theories, we believe, in the light of our series, that an angulation of the lunate fossa greater than 12 degrees and that a negative radioulnar index appear to be decisive criteria in the course of Kienböck's disease treated by shortening of the radius.

Adolescent↗
PubMed1996

[Additional supra-malleolar osteotomy].

This old operation is rarely practiced and it appeared interesting to precise its technique and indications from a short series. In the majority of our cases, a valgus type osteotomy by medial graft addition was performed. One or more prismatic triangular graft are taken from the full thickness of the iliac crest. The respect of the fibula protects the periostal hinge on the other side of the surgical approach; so the graft under pressure will have rapid and constant consolidation. Tibial osteosynthesis is facultative. We can distinguish major indications of that type of osteotomies: supramalleolar malunion, while the fracture of the fibula associated to the tibia is a contra-indication for that operation. The other indications are the distortion of the pilon articular surface and old ligamentous lesions leading to osteoarthritis. In some cases, it is appropriate to realise valgisation of the articular surface, with an overcorrection to harmonise the pressure on articular surfaces; on that condition, an osteotomy of the fibula has to be discussed. The rapid and constant good results obtained with those iliac crest grafts interposed between the two fragments of the tibia contrast with those hazardous results of inlay or onlay grafts, free from all mecanical sollicitations.

Adult↗
PubMed1996

[Ascending intramedullary nailing of the femur. Technique. Initial results. Indications].

Some fractures of the distal third of the femur are not good indications for the centromedular locked nailing technique where the nail in inserted through the greater trochanter. Indeed, unsatisfactory reduction and stabilization are often obtained. Inversely, when the nail is inserted upwardly from the knee joint after drilling an orifice in the trochlea and the condyles, the mechanical locking is very close to the knee joint and, when the subtrochanter region is reached, the nail automatically aligns the fracture. The implant temporarily used was a centromedular tibial nail rotated by 180 degrees and mechanically locked near the knee under fluoroscopic control near the lesser trochanter. Five trauma cases were treated with this technique. Early results have been encouraging, similar to those obtained for nailing with closed surgery. These results would suggest that upward nailing should be conceived for particular indications: fractures of the supracondyle area, spiral and comminutive fractures of the distal third of the femur, certain fractures of the supra and inter condyle area.

Adult↗
PubMed1996

[Streptococcus cellulitis. Apropos of 3 clinical cases].

We report three cases of streptococci cellulitis of the hand. The characteristic clinical presentation suggested streptococcus infection; locoregional edema, rash, echymosis, phlyctena and signs of finger ischemia. Operative findings also suggested streptococcus infection: swelling of brownish subcutaneous tissue and local thrombus formation. There was no true pus formation. Streptococcus was identified in all 3 cases. Emergency surgical treatment is needed. The portal is opened, followed by extensive fasciotomy and debridement of all necrosed tissue. Partial suture is indicated. Antibiotics can be used as an adjunct but are not sufficient alone.

Adult↗
PubMed1996

[Traumatic isolated palmar dislocation of the distal radio-ulnar joint. Apropos of a case].

PURPOSE OF THE STUDY: The authors report a rare case of an isolated palmar dislocation of the distal radio-ulnar joint (DRU). Diagnosis was easily established in emergency even though this lesion is usually unknown in 50 per cent of cases, according to literature. CASE REPORT: A surgical approach was necessary because of irreducibility of the lesion: ulna and radius were hitched with no other anatomical interposition. Treatment succeeded and the functional result was good with only 25 degrees of loss of pronation. This suggests a commentary on DRU joint physiology, on the mechanism of dislocation, and on the methods of treatment.

Female↗
PubMed1996

[Osteosynthesis of the odontoid process by a clover-shaped plate].

UNLABELLED: The goal was to design an osteosynthesis material able to stabilize after reduction a fracture of the odontoid process without C1-C2 arthrodesis. MATERIAL AND METHODS: The implant comprises a clover shaped plate which has to be applied on one hand on the anterior face of the dens (one leaf), and on the other hand on the anterior face of C3 (2 leaves are applied with a screw one screw for each leaf). A barrel fastened to the 3 leaves (implanted on the anterior face of the leaves, at their junction) gives way to a vertically oriented screw which will carry out dens fixation. The screw makes the compression possible. Placement through a pre-sterno-mastoid-approach, needs a special plate support and 18/10 Kirchner pins preparing the passage of the screw. RESULTS: This screw-plate designed for dens fractures (especially those with anterior displacement incompatible with a simple screwing) led to bone union in all cases. A C2-C3 subluxation operated on with the same technique was reduced and stabilized: a C2-C3 ankylosis was the consequence of a C2-C3 arthrodesis combined with the osteosynthesis. No complication was observed. DISCUSSION AND CONCLUSION: This technique is the only one able to perform dens osteosynthesis without implying postoperative immobilization. It is a significant advantage in elderly or multitrauma patients. A part from dens fractures, it can also help to manage dislocations, subluxations and serious C2-C3 sprains and even combinations as fractures of the odontoid process with axis pedicles fractures.

Bone Plates↗
PubMed1995

Reconstruction of a complex defect of the dorsum of the hand.

A 37-year-old right-handed male truck driver was admitted with a severe injury of the dorsum of his right hand following a traffic accident. He had a large combined defect involving skin, tendons and bone. A complex reconstruction was performed using a large iliac crest allograft, a tendon graft and a free serratus anterior flap in one stage, 8 hours after the injury. A skin graft was performed later. 2 years later the functional and aesthetic result are good.

Adult↗
PubMed1995

[Pure dislocations of the tibio-talar joint. Apropos of 9 cases].

PURPOSE OF THE STUDY: The authors relate nine cases of pure traumatic dislocation of the tibio talar joint and propose to evaluate the clinical and radiological results at a long term follow-up (mean 12 years). MATERIAL AND METHODS: The series included 9 patients (7 men and 2 women) the average age was 33,2 years. The injury was a road traffic accident in 5 cases. Pure dislocation variety of the ankle joint was medial and posteromedial in 6 cases. Open skin injury was found in 7 cases. The mean follow-up was 12 years (5-19 years). 6 patients were reviewed by the same surgeon, 6 patients were examined clinically and with ankle X-rays. All patients except one were treated by reduction, immobilization with a plaster cast for 6 to 8 weeks. The joint was examined radiographically to detect the presence of tibio talar diastasis and degenerative arthritis. RESULTS: At term we had two very good results and 3 good results (no pain or pain occasionally). We have found in 5 cases a degenerative arthritis to the ankle joint (joint narrowing <50 per cent in 3 cases, > to 50 per cent in 2 cases). No joint instability was noted at revision. DISCUSSION: Pure traumatic dislocation of the tibio talar joint is a rare injury. Medial and posteromedial variety are not frequent. Immediate gravity is dominated by vascular and septic complications and long term result by degenerative arthritis. CONCLUSION: The authors think that closed dislocations need orthopedic treatment (closed reduction and immobilization with a plaster cast for 6 weeks), on the other hand, open dislocation need surgical treatment (reduction, ligamentous reconstruction and immobilization in a plaster cast for 6 weeks).

Adult↗
PubMed1991

[Role of a "watch and wait" policy in the treatment of blunt traumatic lesions of the spleen in adults].

Modern imaging has considerably modified our therapeutic indications, as it allows appreciating the nature of traumatic lesion s of the spleen. We now know that part of the damage sustained by this organ does not evolve towards major internal hemorrhages. In addition, it is advisable to avoid splenectomy, which entails its own complications. It is therefore justified, not only to preserve the spleen, but also to perform no laparotomy whenever this is possible. A series of 22 injured patients, following several isolate cases of "watch and wait policy", confirms the validity of our attitude.

Adolescent↗
PubMedDate not supplied

[Treatment of rhizomelic arthrosis of the thumb by partial resection of the trapezium and rib cartilage autograft. Preliminary results].

The authors have studied the results of a personal technique concerning the treatment of trapezo-metacarpal arthritis: a partial trapezectomy is associated with a antogenous rib cartilage graft. 13 cases were treated using the procedure. 9 patients are reviewed with a follow up mean one year. 4 patients are free of pain, 5 are improved. Strength is improve in 4 cases (pinch), similar or inferior to the pre-operative status in 5 cases. Increase of motion concern Kapandji test and first web space. Follow up is insufficient to allow a conclusion about the long term behaviour of cartilage graft.

Aged↗