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Biomedical subjects

P Vives

Publications and source records attributed to P Vives.

At least 19 recordsLinked to original sources
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↗
PubMed1995

[Treatment of Morton neuroma by neurectomy. Apropos of 43 cases].

PURPOSE OF THE STUDY: Morton's neuroma is a frequent cause of metatarsalgia. Its diagnosis is clinical but progress in medical imaging: ultrasound, evoked potentials and above all MRI allows an improvement of para-clinical diagnosis. MATERIAL AND METHODS: 48 neuromas were treated surgically between 1979 and 1990. That represents 46 feet in 43 patients. Female predominance was clear with an average age of 53 years. The follow-up period was 6 years and 10 months. 3 patients had multiple injuries. Medical treatment had been prescribed prior to surgery in 24 patients (15 had injections, 9 orthopedic shoe inserts and 5 both injections and inserts). The interval between the first symptoms and surgery was long since it was on average of 3 years and 6 months. The neuroma was located 36 times in the third interdigital space. The initial incision was plantar 11 times dorsal 32 times. Only neurectomies were performed. The neuroma was very large 9 times. 10 patients had treatment for other affections in the same operative time. RESULTS: At review, 41 feet were completely painless. Shoe wear was normal for 32 patients. 12 pulpar hypoesthesia and 7 commissural and pulpary hypoesthesia were noted. 3 of 11 patients operated by the plantar approach had a painful hyperkeratosic scar. DISCUSSION: None of our cases had preoperative MRI because our most recent case has 4 years of evaluation. At the present time the MRI could contribute to diagnosis owing to good tissular differentiation. The neurectomy led to a total disappearance of pain but hypoesthesia was frequent. The dorsal approach induces cutaneous complication. Neurolysis induces a sensitive postoperative deficit but recurrence occurs in 77 per cent of cases after neurolysis. CONCLUSION: Morton's neuroma is located essentially in the third interdigital space. Neurectomy is a simple operation that often leads to recovery.

Adult↗
PubMed1994

[Subtalar arthrodesis for sequelae of calcaneal fractures. Apropos of 57 cases].

PURPOSE OF THE STUDY: 57 subtalar arthrodesis for sequelae of calcaneal fractures were reviewed with a minimum follow up of 6 years 11 months. MATERIAL AND METHODS: Bone resection and interposition of bone grafts, stabilized by screws were used in 36 cases. Iliac crest grafts were used in 20 cases, cryopreserved grafts 15 times and local graft taken on the anterior tibial epiphysis once. No surgery was performed on the mid foot. RESULTS: Results were evaluated using the grading system described by Mestdagh with 33 good global results, 18 fair results and 6 poor results for a total of only 58 per cent of good global results. Of the 57 cases reviewed, 18 remained painful with a limited range of motion for inversion and eversion of the foot. In 18 patients monopodal weight-bearing was unstable. Residual oedema persisted in 5 patients. 16 patients continued to limp and 3 required the use of a crutch. 7 valgus and 3 varus deviations of the hindfoot were noted at follow up with poor tolerance of the varus when compared to exaggerated valgus. Podoscopic examination revealed increase anterior pressure zones responsible for metatarsalgia which was relieved by corrective shoe inserts in 10 patients. Radiographic evidence of fusion could be demonstrated in 55 cases. There was little or no repercussion on the tibio-talar joint. In the Chopart joint we noted 4 cases of osteoarthritis; there were 6 lesions in the talo-navicular joint and no repercussion in Lisfranc's joint. 16 complications of varying severity were noted with 2 nonunions following use of cryopreserved grafts. DISCUSSION: Subtalar arthrodesis for sequelae of traumatic lesion in the hindfoot gives good results in 2 cases out of 3. In our series, 26 per cent of the patients showed degenerative changes in the mid foot unlike the series published by Kempf. As Meary and Mestdagh noted, we found that residual varus or valgus deformity > 10 degrees was poorly tolerated as well as modifications > 20-30 degrees in the vertical ratio between the talus and the calcaneum in the horizontal plane. CONCLUSION: Subtalar arthrodesis is a useful technique giving good results in 2 out of 3 cases of traumatic sequelae in the hindfoot. Triple arthrodesis does not seem indicated when the talus and the calcaneus can be realigned before fusion. Talo-navicular arthrodesis, though more easily realized, requires blocking a normal joint in order to immobilize a painful joint.

Arthrodesis↗
PubMed1994

[The Sixtine metatarsophalangeal prosthesis at first glance. Preliminary results in 74 cases].

The Sixtine prosthesis is a metallic, hemiconical, flat concave, metatarsophalangeal interposition prosthesis, with a rim on the phalangeal end, with a lateral capsular fixation or a temporary fixation by axial pinning. Seventy-four cases using a Sixtine prosthesis were reviewed with a minimum follow-up of 2 years. The range of motion was improved (+12.4 degrees), as was the phalangeal valgus (18.2 degrees for 30.2 degrees), but weight bearing on the ventral side of the first toe was very often lost in spite of the complete preservation of the flexor hallucis brevis. The complication rate was 9.5% with 8% subluxations, which do not influence the final result. The comparison of patients who kept the prosthesis, and of patients in whom the prosthesis was systematically retrieved after one year, shows that the prosthesis may be left in place and that retrieval is only indicated in cases of complications or subluxation.

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

[Rehabilitation of the rheumatoid dorsal wrist by the Sauve-Kapandji operation combined with a realignment-stabilization synovectomy].

The authors present a series of 25 cases of rheumatoid wrists, operated by tendon and intra-carpal synovectomy, accompanied by an arthrodesis of the lower ulnar articulation following a metaphyseal resection of the lower extremity of the ulnar according to Sauve and Kapandji. This series is "young", as the mean follow-up is 2 years. It involves 25 patients, including 4 operated on both wrists. This series has the advantage of being coherent as all the operations were performed by the same surgeon. The results concerning pain are good; 87% of the wrists were painless or only periodically painful, and 88% of the patients say they are well or very much better. This operation offers the satisfying aspect of prevention; an absence of pain in the wrist when inflamed and the absence of complications such as ruptured tendons. The study of the range of motion shows a global loss of 9% in the sagittal plane and a significant reduction in the score for motion in palmar flexion. The radiological signs of deterioration of carpitis are not stopped despite the operation but it does seem to be slowed down after intra-carpal synovectomy. Ulnar sliding has been carefully studied. We observe that a further sliding is more obvious in the Larsen 2 phase than in the Larsen 3 phase. This sliding is very slight. The comparison between the different series shows that operation protects the wrist from ulnar sliding more than ulnar head resections.

Adult↗
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↗
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↗
PubMed1992

[Revision of interlocking rod for loosening of THP. Concept--preliminary results].

This revision rod, used temporarily, is interlocked in the distal healthy part of the femur. It is indicated in the treatment of loosening, even with extensive destruction, whether this is done by filling the fragile part of the femur with bone chips and marrow or by reconstruction accomplished by gliding the femoral heads on the rod. The clinical results were observed for 21 replacements, performed between 1987 and 1990, for the following indications: 14 loosenings, of which 10 had major bone defects; 4 fractures, of which 3 received a prosthesis; 2 infected resection prostheses; and one broken porous metal Judet prosthesis. There was one failure due to flare-up of infection in a prosthesis that was initially infected. The complete treatment, with implantation of a standard prosthesis, was only performed in 5 cases. We left the revision rod in place in elderly patients, in major reconstructions, or when the patients refused a new operation. The anatomical results are encouraging. There was good assimilation of the bone grafts, confirmed by histology in cases of revision. There was no rupture or displacement of the material. The functional results were good with respect to pain and range of motion; they were less good with respect to stability, as could be expected in repeatedly operated patients.

Female↗
PubMed1991

[Achromic ungual melanoma. Apropos of a case].

A 55-year-old woman presented with suppurative paronychia that became chronic. In fact, this was an exceptional case of amelanotic subungual melanoma. This case is compared with a general review of subungual melanomas. Diagnosis is often delayed, due to the difficulty caused by the misleading clinical symptoms.

Chronic Disease↗
PubMed1991

[Chondrosarcoma of the foot. Apropos of a case--literature review].

Primitive chondrosarcoma of the foot is rare. About 50 cases have been reported. It often poses diagnostic problems, and the confirmation of malignancy necessitates a broad resection. The tumor is radioresistant and chemotherapy is minimally effective, as illustrated by the present report.

Adult↗
PubMed1991

[Fractures-luxations of the Lisfranc joint. Apropos of 39 cases].

Lisfranc fracture-dislocations are relatively rare (two per thousand). They generally occur in multiple trauma victims and may pass unnoticed. Open reduction followed by pinned osteosynthesis and plaster immobilisation ensures a good anatomical and functional result.

Adult↗
PubMed1990

[Fracture of the base of the first metacarpus].

The authors report a group of 73 cases of fractures of the base of the first metacarpal treated between 1974 and 1989. Fifty-three articular fractures (73%) and 20 non-articular fractures are described. Sixty-eight patients were treated surgically: 49 diverging pin insertions were used, 15 Lars Thoren technique, 5 rigid osteosyntheses with AO miniaturized material. Forty-two patients were seen again after one year or more. We classify the results as follows: very good: 29 (69%), good: 10 (24%), bad: 3 (7%). The relative simplicity, the reliability and the good results of the double diverging pin insertion lead the authors to apply this method in most fractures of the base of the first metacarpal, either articular or extra-articular.

Adolescent↗