Biomedical subjects

P-F Leyvraz

Publications and source records attributed to P-F Leyvraz.

10 recordsLinked to original sources

PubMed2007

Spontaneous reduction of a traumatic L2-L3 subluxation without fracture in a 14-year-old boy.

OBJECTIVE: To report a rare case of lumbar vertebral subluxation associated with spontaneous reduction in an adolescent treated conservatively. CLINICAL PRESENTATION AND INTERVENTION: A 14-year-old male victim of a snowboard accident, which caused a lumbar spinal injury, was referred to the emergency room with significant lumbar pain. Neurologic examination was normal. Radiographic assessment at admission showed a unilateral left lateral subluxation of the L2-L3 vertebrae without associated fractures. These findings were confirmed by CT scan and a surgical management was decided. The preoperative MRI performed 24 h after the accident, however, revealed the spontaneous reduction of the subluxation, and an associated tear of the quadratus lumborum and the psoas muscles on the right side at the level of L2, L3 and L4. Following these findings conservative treatment with a plaster brace for 2 months was carried out. The brace was removed after 2 months. The patient had no pain and the range of motion of his lumbar spine was normal. Three months after injury, sports activities were resumed. At follow-up of 24 months, the patient was free of pain and radiographs showed a right positional bending without rotational or translation anomaly. CONCLUSION: To date, this is the first case of subluxation without fracture in a child, presenting without neurological deficit and where spontaneous reduction occurred. In this case, conservative treatment was effective and the outcome at 2-year follow-up was excellent.

Adolescent↗

PubMed2005

[Knee replacement].

Total knee replacement is nowadays a surgical technique that has reached maturity and is used as frequently as total hip replacement. It is mainly aimed at patients suffering from knee osteoarthrosis when it becomes invalidating and painful and does not respond anymore to medical conservative treatment and physiotherapy. Long term results are excellent in patients aged over 70 years old. They are still amenable to improvement in young patients who are more active and who put under stress their implants in a longer and more intense way. Infection, loosening and malpositioning of the implants are the most common complications.

Age Factors↗

PubMed2005

[Osteoid osteoma and radiofrequency].

Osteoid osteoma and radiofrequency Osteoid osteoma relates to a benign skeletal neoplasm, smaller than 2 cm in diameter, composed of osteoid, highly vascularized connective tissue and surrounded by a ring of bone sclerosis. Its aetiology remains unknown. It affects twice more males than female patients and occurs usually between 5 and 40 years old. Long bones and spine are the most involved areas but the whole skeleton can be involved. Clinical manifestations can include local pain (increased at night and decreased by activity) and relief with salicylates administration. CT guided radiofrequency ablation of osteoid osteoma is in comparison to surgery less invasive, time saving and economic technique with excellent long term results.

Bone Neoplasms↗

PubMed2005

Percutaneous retrograde screwing for stabilisation of acetabular fractures.

OBJECTIVES: To evaluate the results of retrograde percutaneous screw fixation (PSF) in minimally or undisplaced acetabular fractures in a geriatric population. PATIENTS AND METHODS: Between July 1998 and July 2001, 21 consecutive patients with an acetabular fracture underwent fluoroscopic guided percutaneous fixation. The mean age was 81 years (range 67--90 years). In all cases, the fracture was minimally or undisplaced (<2mm). Two cannulated cancellous 7.3mm screws were inserted in a retrograde fashion to stabilise the posterior and the anterior column. Bed to chair transfer began after 24h. Weight bearing as tolerated was allowed at 4 weeks. RESULTS: Eighteen patients were reviewed at a mean of 3.5 years (range 2--5 years). Soft tissue dissection was minimal. There were no intraoperative or postoperative complications. At the latest follow-up there was no radiographical evidence of secondary displacement of fragments, degenerative changes, or screw failure. Fractures healed at a mean time of 12 weeks (range 8--15 weeks). Clinical results were satisfactory in 17 patients. CONCLUSION: Our results show that percutaneous screw fixation under fluoroscopic control is a safe technique to treat some pattern of acetabular fracture.

Acetabulum↗

PubMed2005

Modified triangular posterior osteosynthesis of unstable sacrum fracture.

We report preliminary results for unstable sacral fractures treated with a modified posterior triangular osteosynthesis. Seven patients were admitted to our trauma center with an unstable sacral fracture. The average age was 31 years (22-41). There were four vertical shear lesions of the pelvis and three transverse fracture of the upper sacrum. The vertical shear injuries were initially treated with an anterior external fixator inserted at the time of admission. Definitive surgery was performed at a mean time of 9 days after trauma. The operation consisted in a posterior fixation combining a vertebropelvic distraction osteosynthesis with pedicle screws and a rod system, whereby the transverse fixation was obtained using a 6 mm rod as a cross-link between the two main rods. Late displacement of the posterior pelvis or fracture was measured on X-ray films according to the criteria of Henderson. The patients were followed-up for a minimum time of 12 months. Four patients who presented with a pre-operative perineal neurological impairment made a complete recovery. No iatrogenic nerve injury was reported. One case of deep infection was managed successfully with surgical debridement and local antibiotics. All patients complained of symptoms related to the prominence of the iliac screws. The metalwork was removed in all cases after healing of the fracture, at a mean time of 4.3 months after surgery. No loss of reduction of fracture was seen at final radiological follow-up. The preliminary results are promising. The fixation is sufficiently stable to allow an immediate progressive weight-bearing, and safe nursing care in polytrauma cases. The only problem seems to be related to prominent heads of the distal screws.

Adult↗

PubMed2005

[Painful total hip arthroplasty].

The results of the total hip prostheses in terms of cost-efficiency make one of the surgical procedures the most efficient. Usually, the articular pains disappear completely and the patient function improves. Outside, turned out failures, which require a revision, some patients present residual pain persisting after the intervention or appearing secondarily. Considering the important number of total hip arthroplasties, this clinical situation is not so rare and the generalist, as the specialist, can be confronted there. The experience shows that the surgical revisions, in the absence of a precise diagnosis are disappointing and often do not improve the patient. This article presents the diagnostic and therapeutic steps advised to face this problem.

Arthroplasty, Replacement, Hip↗

PubMed2004

[Treatment of acetabular fractures in the elderly with primary total hip arthroplasty and modified cerclage. Early results].

This prospective study addresses early results of the treatment of acute acetabular fractures in elderly patients by total hip arthroplasty and cerclage wiring. Fifteen patients with an average age of 81 years were treated at our institution between February 1998 and December 2000. There were two transverse fractures, eight T-shaped fractures, two transverse fractures with associated posterior wall fracture, two posterior column fractures with associated posterior wall fracture, and one fracture of both columns. Treatment consisted of cerclage wiring of the fracture and primary non-cemented total hip replacement. All of the patients were followed for a mean of 36 months. Although there was one patient with three hip dislocations during the first 10 months after the operation, we found an excellent or good result for the entire group. During this relatively short follow-up period, we have not found a radiological loss of fracture reduction of more than 1 mm or a cup migration of more than 3.2 mm. All of the fractures healed and no loosening of the implant was evident. Primary total hip arthroplasty combined with internal fixation is a valid treatment option for acetabular fractures in the elderly. Preliminary results are convincing, but a bigger patient population and a longer follow-up time are necessary before we are able to draw final conclusions.

Acetabulum↗

PubMed2004

Evaluation of an ambulatory system for gait analysis in hip osteoarthritis and after total hip replacement.

Spatial and temporal parameters of gait have clinical relevance in the assessment of motor pathologies, particularly in orthopaedics. A new gait analysis system is proposed which consists of (a) an ambulatory device (Physilog) including a set of miniature gyroscopes and a portable datalogger, and (b) an algorithm for gait analysis. The aim of this study was the validation of this system, for accuracy and clinical applicability. Eleven patients with coxarthrosis, eight patients with total hip arthroplasty and nine control subjects were studied using this portable system and also a reference motion analyzer and force plate. The small differences in the stance period (19 +/- ms), stride length and velocity (0.4 +/- 9.6 cm and 2.5 +/- 8.3 cm/s, respectively), as well as thigh and shank rotations (2.4 +/- 4.3 degrees and 0.3 +/- 3.3 degrees, respectively), confirmed good agreement of the proposed system with the reference system. In addition, nearly the same accuracy was obtained for all three groups. Gait analysis based on Physilog was also in agreement with their Harris Hip Scores (HHS): the subjects with lower scores had a greater limp, a slower walking speed and a shorter stride. This ambulatory gait analysis system provides an easy, reproducible and objective method of quantifying changes in gait after joint replacement surgery for coxarthrosis.

Aged↗

PubMed2002

Spatio-temporal parameters of gait measured by an ambulatory system using miniature gyroscopes.

In this study we describe an ambulatory system for estimation of spatio-temporal parameters during long periods of walking. This original method based on wavelet analysis is proposed to compute the values of temporal gait parameters from the angular velocity of lower limbs. Based on a mechanical model, the medio-lateral rotation of the lower limbs during stance and swing, the stride length and velocity are estimated by integration of the angular velocity. Measurement's accuracy was assessed using as a criterion standard the information provided by foot pressure sensors. To assess the accuracy of the method on a broad range of performance for each gait parameter, we gathered data from young and elderly subjects. No significant error was observed for toe-off detection, while a slight systematic delay (10 ms on average) existed between heelstrike obtained from gyroscopes and footswitch. There was no significant difference between actual spatial parameters (stride length and velocity) and their estimated values. Errors for velocity and stride length estimations were 0.06 m/s and 0.07 m, respectively. This system is light, portable, inexpensive and does not provoke any discomfort to subjects. It can be carried for long periods of time, thus providing new longitudinal information such as stride-to-stride variability of gait. Several clinical applications can be proposed such as outcome evaluation after total knee or hip replacement, external prosthesis adjustment for amputees, monitoring of rehabilitation progress, gait analysis in neurological diseases, and fall risk estimation in elderly.

Adult↗

PubMed2002

Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis.

We conducted this study to determine the relative influence of various mechanical and patient-related factors on the incidence of dislocation after primary total hip asthroplasty (THA). Of 2,023 THAs, 21 patients who had at least 1 dislocation were compared with a control group of 21 patients without dislocation, matched for age, gender, pathology, and year of surgery. Implant positioning, seniority of the surgeon, American Society of Anesthesiologists (ASA) score, and diminished motor coordination were recorded. Data analysis included univariate and multivariate methods. The dislocation risk was 6.9 times higher if total anteversion was not between 40 degrees and 60 degrees and 10 times higher in patients with high ASA scores. Surgeons should pay attention to total anteversion (cup and stem) of THA. The ASA score should be part of the preoperative assessment of the dislocation risk.

Adult↗