Biomedical subjects
Publications and source records attributed to P Merloz.
Congenital pseudarthrosis of the tibia is nearly always the result of a congenital bowing of the tibia when it is unilateral and with an antero-external angle. There is no possible spontaneous consolidation and there may be several associated sequellae (shortening and trophic disorders of the limb). The etiological and therapeutic aspects of the affection are reviewed.
This study is the outcome of multicenter endeavour compiling 87 cases of pseudoarthrosis managed according to principles set forth by G.A. Ilizarov. All clinical forms are described: simple pseudoarthrosis (non-infected and without loss of substance); septic pseudoarthrosis; pseudoarthrosis with loss of bone substance, both septic and aseptic. This method is used in the majority of cases. This method is used in the majority of cases after several consecutive unavailing attempts with conventional therapeutical procedures. Considering all situations, the lesions heal in over 90% of cases and the infection subsides with an equal rate of success. Such results are achieved within a period of 5 months. Sequelae or complications imputable to the method are few. Indications are specified, which depend upon the clinical form of the treated pseudoarthrosis, as well as upon the surgeon's personal skill.
22 axial corrections of limbs in children were performed using the Ilizarov technique between 1984 and 1986. This prospective study has been performed under the auspices of the Association pour l'Etude Systémique et l'Application de la Méthode d'Ilizarov en France (ASAMIF). Total correction of deformity was achieved in 20 cases. A minimal angulation (less than 5 degrees) was observed in two cases. In 9 cases tibia or femoral lengthening was performed simultaneously. After corticotomy and placement of the stimulant effect of limb distraction. The mean lengthenings achieved was 30 mm. Serious complications were are: there was one case of fracture of the regenerating bone. We deplore only two superficial pin track infections, two cases of rarefaction of bone. The bone consolidation was obtained on an average of two months. If inequality was associated (more than 40 mm) technique of double corticotomy was performed. The best and more results were certainly performed in great deformities. On the other hand the Ilizarov method addresses all inequalities of leg length, whatever the aetiology, who are associated with common deformity.
A new type of femoral prosthesis is described by the authors. This non-rigid implant respects the natural elasticity of bone and, because of this, avoids excessive stress protection of the bone. In addition, bone atrophy caused by rigid components and osteolysis provoked by cement are eliminated. Experimental studies and the clinical and radiological results five years after insertion seem to confirm the value of this concept.
Serial cross-sections of the thigh have been used to indicate where osseous transfixion is possible without damaging neuro-vascular structures or major tendons or penetrating a joint. Safe areas for transfixion using fine wires and their corresponding cutaneous zones are indicated. Two cutaneous zones each representing a quarter of the circumference of the thigh form safe zones for transfixion. The first begins on the ventral surface of the hip and ends on the medial aspect of the knee, while the second begins on the posterior aspect of the buttock and ends on the lateral aspect of the knee.
Butel's hip plate was used for osteosynthesis of 241 fractures of upper end of femur (100 true cervical - 141 trochanteric and subtrochanteric fractures). Results for true cervical fractures were assessed as satisfactory in 89.5% of cases, with only 3 pseudarthroses and 4 cases of femoral head necrosis (2 septic, 2 aseptic), a total complication rate of 7.5%. These clinical results confirm the value of screw fixation at several cephalic anchorage sites (demonstrated biomechanically) in true cervical fractures. Results in trochanteric and subtrochanteric fractures were rated as satisfactory in 86.9% of cases, complications including 2 ruptures of plate, 1 sepsis and 4 early loosening of plate. The latter sequela was avoided by an improved choice of indication for the procedure and by substitution of this compound material (screw-plate) for a monobloc piece ("anti-loosening cervicocephalic screw apparatus"), in compound fractures of trochanter.
In patients who have a malunion of the distal part of the radius with a shortened radius, the ulna is too long. A discrepancy between the ulna and the lower radius, and between the ulna and the carpal bones occurs, compromising the mobility and appearance of the wrist. We reviewed ten such patients in whom the ulna was shortened by performing a resection of a diaphysar cylinder followed by a plate osteosynthesis. This method restored the normal anatomy of the distal radio-ulnar joint, markedly reduced the patient's pain and improved pronation and supination. When performed in young patients, when the radial deformity is not very important, this procedure has most satisfying functional results.
We present a case of bilateral Salter-Harris type II epiphyseal injury to the proximal tibial epiphysis that occurred during gentle exercise. The mechanism and the likely contribution of preexisting Osgood-Schlatter disease are discussed.
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Three patients with posterior dislocation of hip associated with fracture of neck of femur were treated by early sanguineous reduction and osteosynthesis. This therapy was very effective since necrosis did not develop either in the short or long-term follow up (1, 3 and 4 years). These findings combined with documented data are in favor of anatomic reconstruction of upper end of femur by stable and solid osteosynthesis, at least in young adults. Early operation, an irreproachable operating tactic (orthopedic table, ventral decubitus, posterior approach), an immediate stable and solid synthesis and a deferred load bearing (beyond 6 months) should reduce the risk of femoral head necrosis to a minimum.