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Biomedical subjects

P Mertl

Publications and source records attributed to P Mertl.

29 records · Page 2Linked to original sources
PubMed1996

[Fractures of the tarsal scaphoid].

PURPOSE OF THE STUDY: The authors relate a series of 47 cases of tarsal scaphoid fractures, between 1976 and 1992. MATERIAL AND METHODS: These fractures occurred 11 times after a high level fall, 28 times after a motor vehicle accident and 8 times after a direct traumatism. The fracture line was vertical 35 times; horizontal 27 times. An impaction was often associated (32 cases). In 17 observations, a true enucleation occurred as a part of the fracture dislocation. Many periscaphoidal lesional associations were found. 39 fractures were fixed. Radiographs showed 30 consolidations with an anatomical reduction. 37 patients were reviewed with an average follow up of 7 years and 6 months. RESULTS: Results were assessed using Mestagh's scoring system: 7 very good, 15 good, 6 fair and 9 bad. The very good and good results represent 59 per cent. In 37 patients reviewed, the clinical investigation showed 8 deformities of valgus flat foot, a varus foot, requiring 11 times orthopedic soles wearing. 11 patients had a lameness. Radiological results showed 11 times a peri-scaphoidal arthrosis, a necrosis and 2 non union. A narrowing of the astragalo-cuneate joint line was found 8 times. DISCUSSION: Various anatomical types don't have the same prognosis. Vertical and horizontal fractures gave 18 times a very good and good result when in 11 reviewed patients with a fracture dislocation, we noticed 7 poor or bad result. An osteosynthesis by screw gives goods results when fragments are large. For compound fracture when a surgical procedure will be insufficient, the conservative treatment, if keeps a sufficient breadth of medial arch, can give a satisfactory result. An immediate astragalo-scaphoïdal arthrodesis can be suggested in front of a multi-fragmentary dislocation fracture. CONCLUSION: The scaphoïdal tarsal fracture is unusual and its diagnosis remains sometimes difficult. The treatment is often surgical by direct approach. In consideration of the pejorative post-operative outcome of fracture dislocations, some authors suggest an immediate astragalo-scapho-cuneate arthrodesis.

Adolescent↗
PubMed1996

[Subtalar dislocations. Apropos of 35 cases].

PURPOSE OF THE STUDY: The subtalar dislocation is a rare injury. The authors appreciate the difference of frequency between medial and lateral displacement, the factors likely to increase a classical favorable prognosis and the therapeutic attitude to suggest. MATERIAL AND METHODS: 35 observations were included of which two bilateral, 26 had a medial displacement, 9 a lateral displacement. Treatment was conservative in 21 cases and surgical in 14 cases. The results were analysed using Gay and Evrard's clinical scoring system at which we added radiological results. RESULTS: The average follow-up was 7 years and 7 months. The global results are 11 excellent, 13 good, 9 fair, 2 poor. DISCUSSION: The high frequency of medial displacement is explained by the fact that the subtalar joint is only really unstable in inversion. The lateral displacement is rare. The prognosis is good in pure dislocation. It is only good enough every time a fragmentary talar fracture is associated as a factor of stiffness. The 11 arthrosis cases are secondary to a dislocation associated with a talar dislocation, a scaphoid dislocation or a vascular injury. In the series, there is no syndrome of tarsal sinus, and no post traumatic instability. Talar necrosis are rare: 3 cases in this series. They occur following large dislocations at the limit of enucleation. The reduction is urgent. The treatment is more often conservative. It must be surgical in case of associated injury requiring a surgical procedure or in front of widely open dislocation. CONCLUSION: Subtalar dislocation is a rare injury. In the majority of cases, the displacement is medial. The prognosis is good in pure cases. It's only good enough every time a fragmentary talar fracture is associated as a factor of joint stiffness.

Accidental Falls↗
PubMed1995

[Hallux valgus treated by shortening of the first phalanx with trans-epiphyseal impaction and adductor plasty. Apropos of 49 cases with 5-years follow-up].

PURPOSE OF THE STUDY: 49 cases of hallux-valgus were treated by a shortening of the phalanx with impaction according to the technic described by Regnauld, associated with a plasty of the adductor. Patients were evaluated with a follow-up greater than 5 years. MATERIAL AND METHODS: 32 female and 5 male patients were treated. 63 per cent patients were between 30 and 60 years old. The preoperative average of metatarsus varus was 12 degrees 1. The length of first metatarsal was inferior to the second in 30 cases. The preoperative average of first phalange valgus was 30 degrees. Every operated foot had an Egyptian morphotype. Sesamoids were consistently dislocated. Associated lesion were: 19 flat feet, 10 round fore-feet, 9 clinodactylies treated during the same procedure. RESULTS: They were evaluated according 3 Groulier's criteria: the correction of deformation, static disturbances, and professional activities. The phalangeal valgus was corrected in 37 cases (72 per cent). 33 feet were painless (67 per cent). The dorsal flexion of the first toe was superior to 60 degrees in 38 cases (77 per cent). Metatarsus varus was consistently reduced. 2 permanent metatarsalgia and 4 plantar corns persisted. 76 per cent of operated patients were able to wear shoes normally with a normal perimeter of walking. At X-ray examination, the head of first metatarsal was unchanged in all cases. The joint space was normal in 39 cases (79 per cent). The base of first phalanx was normal in 25 cases (51 per cent). 37 feet had centered sesamoïds. In total, we noticed: 37 very good and good results (72 per cent), 8 moderate results (17 per cent), bad results (9 per cent). DISCUSSION: The operative technic gives a stable shortening of the first phalanx without material and allows the early weight bearing. The abductor of the great toe is a stronger muscle than adductor, allows rotational correction and the alignment of the first phalanx on the first metatarsal. We agree with criteria of bad prognosis proposed by Groulier: age, valgus flat foot, the duration and the importance of deformation, the presence of osteoarthritis. CONCLUSION: The abductor plasty and soft tissue operation contributes to the durable correction of hallux valgus. Shortening must preserve the vascularization of the proximal end of the phalangeal. This operation should be reserved for young patients, without signs of articular cartilage degeneration and having an Egyptian foot.

Adult↗
PubMed1994

[10-year radiologic results of a cemented stem in close contact with the bone].

The femoral stem "Contact", conceived in 1981, provides an excellent contact with metaphyseal-diaphyseal bone, on the medial and lateral cortices. The stress on the cement is not high; the cement fills the medulla in the anteroposterior direction. Five-year results in 92 prostheses were published at the annual meeting of the SO.F.C.O.T. in 1986. The follow-up after 10 years of 76 prostheses with a complete radiological evaluation showed neither loosening, nor space between cortex and prosthesis. The calcar remained unchanged after 5 years in 60 cases; in 11 patients the density was diminished and in 5 hips, a cavitation was seen. Around the top of the stem, 11 partial or total "wall-forming" deposits were seen. On 42 lateral x rays the bone cement interface was satisfactory. Cortical resorption, which was not seen before, is now apparent on the most recent controls. The cortical index (Hoffman), measured on 49 prostheses, was unchanged in 15 cases (30%). The narrowing of the cortex increases with age, being more frequent and significant and occurring earlier in women. This process was seen from the age of 65 years in females and about 75 in males. This natural increase in the size of the medulla induces a loosening of the stem. Loosening may be limited by the use of a snugly fitting cemented stem, with limited stress on the cement.

Age Factors↗
PubMed1993

[Metatarsalgia and modified Helal's operation. Apropos of a series of 40 cases].

The authors report a series of 40 cases of metatarsalgia operated according to a modified Helal technique. The mid-diaphyseal osteotomy was situated obliquely inferoanteriorly at an angle of 45 degrees on the metatarsal diaphysis. Twenty cases of hallux valgus were operated during the same procedure Surgery allowed a reduction in pain and hyperkeratosis in 67.5% of patients. Comparison of the results obtained with those reported in the literature confirms that the osteotomy must be metaphyseal and that weight bearing must be early and effective.

Adult↗
PubMed1993

[Fractures of the navicular bone. Apropos of 48 cases].

Fracture of the navicular bone is rare and sometimes difficult to diagnose. Surgical treatment with direct osteosynthesis gives good results except in the case of fractures of the tubercles. In view of the poor postoperative course of fracture-dislocations, immediate talo-navicular-cuneiform arthrodesis may be proposed.

Adolescent↗
PubMed1992

[Lateral approach of the knee with tibial tubercle osteotomy for prosthetic surgery].

The authors describe a lateral approach to the knee associated with a tibial tubercle osteotomy and a plasty using the fat pad to provide a complete closure of the wound. This lateral approach has been performed successfully in 98 cases, with only 3 skin necrosis. It offers a large exposure of the joint, facilitates placement of tibial component trial fit, and allows the self centering of the quadriceps patellar-tendon mechanism at the end of the intervention. The lateral approach disputable in case of genu varum is recommended in all cases of genu valgum or important deformities.

Humans↗
PubMed1989

[Arthroscopic meniscectomy complicated by lesions to the popliteal artery and vein].

Endoscopic surgery can replace operative procedures. The evolution of arthroscopy leads to realize intra articular surgery more and more complicated. However, any surgical procedure involve some risks, and surgeons have to be prudent in use of new instruments or new technics. These need a radio surgical environment adapted to all surgery.

Arthroscopy↗