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Biomedical subjects

P Vives

Publications and source records attributed to P Vives.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Labeled leukocyte scintigraphy and total hip prosthesis].

During the last few years, labelled leukocyte scintigraphy has become a decisive tool in the diagnosis of bone infections. However, this test may sometimes be deceptive as far as hip prostheses are concerned. The authors have carried out a retrospective study of 62 labelled leucocyte scintigraphies performed for suspected infection of a hip prosthesis. The comparison of the results with the different clinical, biological and radiological factors and the follow up of the patients allows determination of the sensitivity and specificity of this test which are 41% and 100% respectively. The results reported in the literature and the indications for this examination are discussed.

Adult↗
PubMed1996

[Aponeurotomy and degenerative lesions of the plantar aponeurosis. Contribution of magnetic imaging].

PURPOSE OF THE STUDY: Talalgia are frequent. Their etiologies are various and diagnosis is sometimes difficult. MATERIAL: From 1980 to 1993, 12 cases of degenerative lesions of plantar aponeurosis were treated surgically. M.R.I. revealed 6 chronic aponeurositis and 6 old tears. The treatment was an aponeurectomy with resection of calcaneal spine after a conservative treatment for several months. The histological examination found inflammation in all cases (aponeurositis or rupture), a calcification of aponeurosis, a cartilaginous metaplasia and fibromatosis. METHODS: Patients were evaluated at a minimum of 2 years follow-up and a maximum of 6 years. The post-operative results were estimated using 3 criteria: pain disappearance, results on the foot static, patients functional activity. RESULTS: Global score was : 9 very good and good results, one fair result and 2 bad results. The M.R.I. realized at the time of revision revealed a good healing of plantar aponeurosis in 5 cases, defect in 1 case, inflammation in 3 cases and defect associated with inflammation in 3 cases. DISCUSSION: Surgical treatment can be suggested in failures of talalgia conservative treatment. Degenerative injuries of plantar aponeurosis, as rupture or aponeurositis may take advantage of an aponeurectomy. Short term results show pain disappearance in 75 per cent of cases without modification of the plantar arch. CONCLUSION: M.R.I. allows to explain exactly the origin of talalgia. After a failure of conservative treatment, some talalgia may take advantage of an aponeurectomy.

Adult↗
PubMed1996

[Tenography in tenosynoviopathies of the posterior tibial tendon].

PURPOSE OF THE STUDY: The authors wanted to study diagnosis contribution and therapeutic importance of tenography in posterior tibial tendon tenosynoviopathies. MATERIAL: The series included 42 patients (26 females and 16 males) from 23 to 69 years old. The affection had a course for about two years. A trigger or promoter factor was founded in 32 cases. Clinical examination found only 12 standard feet. Biological exams were normal. METHODS: All patients had a tenography. When tenosynoviopathy was diagnosed, the surgeon injected cortivazol in the sheath by the catheter, within the extra-tendinous space. In case of treatment failure, a synovectomy was realized with possible tendinous suture, under the protection of a weight bearing plaster cast for 21 days. RESULTS: Pathological features: we have founded 26 major irregularities of the sheath, extensive with scalloped outlines of which 8 were supra-malleolar and 18 sub-malleolar, 15 irregularities located at the level of the sheath outline of which 4 were supra-malleolar and 11 sub-malleolar and with a tear of 1 cm length. Long term results: among 36 reviewed patients, pain disappeared in 29 cases, after only one injection (21 cases), or after a surgical treatment (8 cases). DISCUSSION: Tenography has for us great interest for the diagnosis of a tenosynoviopathy, allowing in the same time an extra-tendinous injection of corticoid in the sheath itself. But it doesn't always allow to make a diagnosis of a tendinous tear. A part of our failures can be secondary to these tears. According to our results it could be recommended to practice in a first time a tenotomodensitometry (teno TDM). In case of a tear, a surgical treatment by synovectomy with suture may be proposed first, for a tenosynoviopathy an injection must be realizes. CONCLUSION: Tenography allows a precise diagnosis and in the same time, a treatment by injection. The tendinous tears require a surgical suture but are better diagnosed on a teno TDM.

Adult↗
PubMed1996

[Treatment of hallux valgus by varus osteotomy of the first phalanx associated with adductor plasty].

PURPOSE OF THE STUDY: Sixty two hallux valgus treated by first phalanx varus osteotomy associated to adductor hallux plasty were reviewed with a minimum follow-up of 4 years. MATERIAL AND METHODS: 48 females and 2 males were operated. Average age was 46 years. The forefoot was grecian 40 times. The pre-operative metatarsus varus was at an average of 14.2 degrees when the metatarso-phalangeal valgus was 33.3 degrees. The interphalangeal valgus was 8.25 degrees. The first phalanx base lateral translation measured an average of 5.8 mm. Sesamoids were always dislocated. 36 patients were treated in the same operative time, using this associated approach at different level. RESULTS: Results were evaluated according to 3 Groulier's criteria. In 10 cases, a post-operative pain persisted. Shoe wearing continually improved. The great toe valgus was corrected in 31 cases (50 per cent). The correction was partial in 20 cases (32.3 per cent) but on radiographs, only 34 cases (54.8 per cent) conserved a normal joint space. The first phalanx base lateral translation only improved partially. It measured an average of 408 mm. The global result was good in and very good, 67 per cent, while patients subjective estimation was good or very good in 90.3 per cent. DISCUSSION: The study of this series of first phalanx varus osteotomy associated to adductor plasty shows lateral subluxation partial correction, factor of long term modification on articular metatarso-phalangeal joint space. The adductor plasty associated to abductor disinsertion showed a results improvement compared with other published series. CONCLUSION: The first phalanx varus osteotomy associated to adductor plasty should be limited to moderate hallux valgus deformity with interphalangeal valgus and without any major articular incongruity.

Adult↗
PubMed1995

Subcutaneous sarcoidosis with dactylitis.

Subcutaneous sarcoidosis appears to be rare and is usually associated with hiliar adenopathy. Finger swelling is well recognized in patients with sarcoidosis and usually results from bony involvement or tenosynovitis. We report a patient with subcutaneous sarcoidosis and dactylitis. Biopsy of a finger and of subcutaneous nodules showed similar features with a granulomatous infiltrate. There were no osseus or tendinous lesions.

Female↗
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↗
PubMed1995

[Bipolar dislocation of the first metatarsal bone].

Simultaneous dislocation of the first cuneometatarsal joint and metatarsophalangeal joint is a rare injury. The case of a 22-year-old man is reported, but no previous cases have been reported in the literature. The treatment by closed reduction and pinning was very classical. Occasionally the reducibility of the metatarsophalangeal joint may be made more difficult by the interposition of a sesamoid bone. The simultaneous dislocation occurred because the injury was very severe. After 2 years, the function and mobility of the toe were normal, but radiographs revealed modifications of the Lisfranc joint.

Adult↗
PubMed1995

[Value of a direct approach to the calcaneum].

The authors describe an approach to the calcaneus: the incision follows the Achilles tendon and curves anteriorly between the lateral and plantar skin of the foot. The subtalar joint is opened using a Müller distractor, with one pin in the tibia and the other in the calcaneus. Sixty-one crush fractures of the thalamus were treated using this approach. There were 6 cases with skin problems; in 4 cases the skin necrosis was limited. This approach is useful in all cases: it provides excellent exposure of the subtalar joint, making a precise reduction of the fracture possible. When a distractor is used, varus of the calcaneus should first be reduced.

Ankle Injuries↗
PubMed1995

[Removal through the coronal approach of the upper wisdom teeth. Apropos of a case of bilateral migration into the temporal fossa].

This report presents a case of double migration of third maxillary molar in temporal fossa and their removal by a coronal approach. A 15 years of old boy, was seen for major trismus. 2 months before, he underwent under general anaesthesy impacted third maxillary molar removal. The radiologic examination showed that superior third molar has been pushed and left into the temporal fossa in both sides. After computed tomography examination, teeth were removed by a coronal approach. This was the only approach in order to preserve facial nerve and to allow with good chances to remove the teeth. Intervention was successful. Postoperative course was uneventful. The buccal apperture was normalized three months after surgery.

Adolescent↗
PubMed1995

[Lisfranc's fracture-dislocations].

PURPOSE OF THE STUDY: Classicaly Lisfranc fractures dislocations are unusual. Our study is based on 69 observations from January 1974 to January 1992. MATERIAL AND METHODS: Fractures occured during tremendous impacts with a sex ratio of two men for one woman. The authors insist on the diagnostic value of good quality standard x-rays. Using Trillat's classification, we had 19 homolateral spatular fractures dislocations, 22 homolateral columno-spatular, 8 divergent columnar and 19 divergent columno spatular. A dislocation was reduced in emergency before radiography. The treatment consisted in orthopedic reduction and plaster 7 times, percutaneous kwire 2 times, immediate arthrodesis 5 times, open reduction and internal fixation with kwires 55 times. Post-operatively, 8 complications were noticed. 11 secondary arthrodesis were made with reference to failures of previous methods. They have been performed from 9 months to 5 years after the initial traumatism due to a painful ankylosis in bad position or arthrosis. The arthrodesis was total 6 times, partial lateral 2 times, partial medial 3 times. RESULTS: 63 patients were reviewed with a minimum follow-up evaluation of two years and a maximum of 9 years. The results show that we must reduce the tarsometatarsal fracture dislocations even if the displacement is minimal and we must fix them. The most satisfactory means seem to be open reduction if the least anatomical defect exists. Immediate, total arthrodesis reposition is suitable when an important articular comminution exists. If the total secondary arthrodesis reposition gives good results, its realization is sometimes difficult. The lateral partial arthrodesis must be discontinued, because they don't seem logical. The medial partial arthrodesis didn't prove its superiority, compared with total arthrodesis. DISCUSSION: The reduction of Lisfranc's dislocation is essential. The single case not unreduced has given a bad result as shown in the litterature. When the orthopedic treatment is well-made, the result is good. The open reduction followed by an axial fixation has only given 56 per cent of good results. The main reason of these bad results is an important comminution which should have practised an immediate arthrodesis reposition and a bad reduction. We must be aware on the quality of the anatomical reduction. The secondary arthrosis appeared principally in cases where the reduction was defective (13 observations out of 50). The 5 immediate arthrodesis have all given a good result. CONCLUSION: The retrospective study of the series teaches us to reduce the tarsometatarsal fractures dislocations even if the displacement is minimal and to fix them. We must make a wider place to the immediate arthrodesis reposition.

Accidents, Traffic↗
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↗