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Biomedical subjects

P Vichard

Publications and source records attributed to P Vichard.

At least 37 records · Page 2Linked to original sources
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

Incidence and preventability of adverse events in the emergency room of an orthopaedic traumatologic surgery unit.

This paper reviews the nature and the frequency of adverse events in the everyday functioning of a French trauma emergency unit, and evaluates the feasibility of their detection by the means of a daily record review. A senior surgeon identified the adverse events by reviewing the complete record with a minimal 6-months follow-up for every patient attending the emergency unit during a 10-week period. To test the reliability of this review, a blind re-review of all records corresponding to the detected adverse events, mixed with an equal number of controls, was carried out by two independent experts. The review of the 2604 records identified 210 medical adverse events, most of them occurring early in the care process. Sixty-seven per cent of the adverse events involved prevention failure, mainly for tetanus but also for thrombosis and rabies. For the other 33% it was possible to determine two situations with a high risk of adverse event: body contusions following a traffic accident and metacarpo-phalangeal thumb sprains. The re-review evaluated the positive predictive value of the initial review to be 97.5% and its negative predictive value to be 96%. It is concluded that the review of the initial record by a single senior is effective in detecting the adverse events. Prevention of two-thirds of them could be possible by the implementation and monitoring of protocols.

Aftercare↗
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

[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

[Uretero-vesival rupture with vaginal fistula following pelvic fracture. Value of early diagnosis and emergency surgery].

Traumatic fracture of the pelvis led to the rare combination of urethra and bladder rupture and fistulization into the vagina. This unusual lesion can go undiagnosed initially and must be properly identified during the emergency gynaecology and urology examination. Tissue damage involved nearly the entire length of the urethra including both the smooth and striated sphincters. Reconstructive surgery produced good anatomic and functional results.

Accidents, Traffic↗
PubMed1995

[Inter-trochleo-bicondylar fracture of the femur. An unusually traumatic lesion. Mechanism. Therapeutic implications].

UNLABELLED: The authors present a curious type of fracture of the distal end of the femur. They discuss the mechanism and the factors responsible for that lesion. The treatment and results are finally presented. MATERIAL: A 65 years old female, submitted to a crash accident while driving a car, with a seat in maximaly low position. She presented a bilateral open transverse fracture of the patella associated in the right limb to a fracture line between condyles and the patellar surface of the femur. METHOD: Bilateral osteosynthesis of both patella had been realised in emergency through a transverse approach. Through the fractured right patella two anteroposterior screws had been used to fix the fractured femur. RESULT: A plaster cst had been used for three weeks. Full weight bearing was permitted after three months. Full range of motion of both knees was noticed after six months follow-up. DISCUSSION: The femoral fracture could have been fixed by another device like D.C.S. platescreen but it would be weaker. That type of fracture was produced because of flexed low position of the knee at the moment of the accident. Usually, supra-condylar femoral fractures are due to a force vector applied on the upper extremity of the tibia without any patellar fracture. In our case, the patella involved associated to a fracture line between the condyles and the patellar surface. The structural anatomy (noeud sutural de Chevrier) explains the solidarity of the two femoral condyles.

Accidents, Traffic↗
PubMed1995

[Surgery for severe traumas of the kidney. Value of initial computed tomography, problem of surgical indication and use of a perirenal resorbable prosthesis of polyglactin 910].

We report our recent experience in the surgical treatment of severe closed renal trauma, describing the value of the initial tomography scan, the problems encountered with indications for surgery, and use of a resorbable peri-renal prosthesis made of polyglactine 910. During the last 4 years, 41 patients were hospitalized for renal trauma. Eleven of these patients were operated for severe lesions (Chatelain stage 3 and 4). Surgical treatment was as conservative as possible: total organ repair was possible in 5 cases and partial repair in 3, the kidney was lost in 3 cases.

Accidents, Occupational↗
PubMed1994

[The role of posterior bracket plate osteosynthesis in the treatment of compression-extension fractures of the distal end of the radius].

Osteosynthesis without immobilisation of compression-extension fractures by means of a posterior plate was studied in prospective series with a minimum follow-up of six months (first group: 73 patients) and a minimum follow-up of one year (second group: 63 patients). The clinical results were evaluated and showed several complications (no infection, but reflex sympathetic dystrophy, paresthesia, unsightly scars). The clinical and radiological findings (radio-ulnar index) could improve with several technical devices, now used.

Adolescent↗
PubMed1994

[Lesions of the little finger in Dupuytren's disease].

One hundred and twenty six patients (148 hands) with Dupuytren's disease of the fifth finger were reviewed with an average follow-up of 5 years. Twenty-nine dermo-fasciectomies were performed on the palmar area of the fifth finger. The improvement in the MP joint was complete in all cases. A classification in to 4 grades according to the degree of pre- and postoperative retraction is proposed. The average improvement at the PIP joint was 50 degrees. 26 recurrences were observed. The recurrence rate was similar with or without a skin graft but the functional result was better with a digital graft, as recurrences were located away from the PIP joint.

Adult↗
PubMed1994

[Results of the primary repair of the collateral palmar digital nerves].

The aim of this study was to analyse the results of primary collateral digital nerve repair as a function of several factors: age, surgeon's experience, type of lesion and associated lesions, etc. The conclusions are based on a homogeneous series of 64 patients with 83 nerve lesions treated by primary microsurgical nerve repair with a follow-up of at least one year.

Adolescent↗
PubMed1994

[Emergency cover of open fractures of the leg. Apropos of a series of 24 clinical cases].

The authors present 24 emergency covering procedures for 24 open leg fractures: 6 free flaps and 18 pedicled flaps. The procedure was selected according to the site dimensions and topography of the defect. Topographically, the division of the leg into 3 zones: middle, upper and lower seems to be some what artificial because in practice the junction between the middle and lower segments is still a source of error in the choice of the local flap which can be used. It is preferable to use pedicled flaps in the proximal half of the tibia and free flaps in the distal half. Many failures were observed with the use of fascio-cutaneous flaps. 18 of 24 fractures were internally fixed, which allowed emergency covering. In fact, although bony covering can wait 48 hours, the presence of osteosynthesis material means that covering must be performed at the same time. This makes the plastic and microsurgical procedures easier and ensures greater patient comfort during the consolidation period and rehabilitation. The authors present their results according to the method of soft tissue coverage, their reliability, the type of osteosynthesis, the complications, number of operations and time to bony consolidation. Encouraged by their results, the authors continue with this approach.

Emergencies↗
PubMed1993

[Treatment of extensive traumatic loss of substance of the foot and ankle by free flaps. Apropos of 7 clinical cases].

The authors report 7 cases of extensive skin defects of the foot and/or the ankle treated by using a free flap. All cases presented with major trauma of the lower limb with obvious exposure of bone and joint tissues. The skin defect was covered: as an emergency in 4 cases; within the 48 hours following the trauma in 3 cases; on the 7th day after the injury in 1 case. The free flap used was: the latissimus dorsi muscle, 2 cases; the gracilis muscle, 1 case; the serratus anterior muscle, 1 case; the greater omentum, 2 cases. Arterial microanastomoses were performed onto the anterior tibial or pedal arteries, in 4 cases, and onto the posterior tibial artery in 4 cases. Except for 1 failure on the 8th day after the operation due to thrombosis of the venous anastomosis, requiring arthrodesis of the ankle, the outcome was favorable in all other cases, free of osteitis or arthritis. The authors emphasize the importance of covering defects the lower limb as quickly as possible, ideally as an emergency, when a free flap is required.

Adult↗
PubMed1992

[Rupture of the female urethra in fractures of the pelvic bones. Apropos of 2 new cases].

Female urethra ruptures associated with pelvic ring fractures are exceptionally observed. The authors compared these 2 cases (Besançon and Toulon) to already published cases. This diagnosis must be contemplated and established by the surgeon or in his/her presence using urethral catheterization. The surgical approach (most of time abdominoperineal) allows an accurate injury repair and prevents from fearsome complications due to late diagnosis and treatment. An active attitude following this urological act is highly required, in case of osteoarticular injuries, whose instability and rules are currently known.

Adult↗