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Biomedical subjects

R Roy-Camille

Publications and source records attributed to R Roy-Camille.

At least 37 records · Page 2Linked to original sources
PubMed1992

Management of fracture separations of the articular mass using posterior cervical plating.

Fracture separations of the articular mass are a specific group of unilateral facet fractures that must be considered separately because of their unique two-level instability. This fracture pattern involves a longitudinal fracture of the lamina and a fracture of the pedicle on the same side of the spine at the same level. It is characterized roentgenographically by horizontalization of the lateral mass, with a mean translation of 4.6 mm and a mean angulation of 6.9 degrees. In this study the deformity most commonly occurs at the level below the fracture (19 patients) but also occurred at the level above (5 patients). There is a high incidence of neurologic involvement (14 of 24 patients), most often radicular in nature. This injury results in two level instability requiring a three-level, two-interspace stabilization. All twenty-four patients in this series underwent posterior cervical plating with either an asymmetric (8), symmetric (9) or porte manteau (7) construct. Statistically significantly better results (P < 0.05) were achieved with either a symmetric or porte manteau construct. Complications including neurologic deficit and loss of correction were more frequent in the asymmetric group.

Adult↗
PubMed1992

[Stress fractures of the tarsal navicular. Apropos of 20 cases].

Twenty cases of tarsal navicular stress fractures were observed in 17 patients. These fractures are rare, often go unrecognized, and are reputed to unite with difficulty. A clue to diagnosis was given by the description (young athletic person in sports involving sudden starts and stops). The lesion was not always visible on X-rays of the foot in supination and dorsal flexion (only 10 out of 20 in this series). Use of tomography and tomodensitometry was essential. Treatment was based on compressing the fracture with a screw without grafting or freshening, followed by immobilization of the foot with a cast and no weight bearing for 45 days. Union occurred in 19 out of the 20 cases. Thirteen patients were able to practice their sport without a loss of performance after a period ranging from 3 to 14 months. Treatment varied given the risk of spontaneous non union: incomplete fractures discovered early often responded to orthopedic treatment; fractures associated with large intra-osseous lytic lesions required addition of bone grafting. These fractures can be prevented through the use of inner arch supports especially if a predisposing factor exists such as a short first metatarsal bone.

Adolescent↗
PubMed1991

[Achilles tendinitis].

Achilles tendinitis is particularly frequent in athletes. In fact, this entity is made up of various anatomical lesions located in Achilles tendon or at the point where it is attached to the calcaneum. The diagnosis is basically clinical, and it is confirmed by carefully selected paraclinical examinations. Management essentially relies on rest associated with adequate physiotherapy and, when required, with other adjuvant treatments. Management also rests on the prevention of recurrences and on the suppression of the frequently found sport-related causal agent. Surgical treatment is seldom indicated, and only when medical treatment has failed, usually in high-level athletes.

Achilles Tendon↗
PubMed1991

Symptomatic spinal epidural lipomatosis induced by a long-term steroid treatment. Review of the literature and report of two additional cases.

Spinal epidural lipomatosis associated with Cushing's syndrome is an uncommon complication (11 reported cases). Two additional symptomatic cases with neurologic deficit are described. Steroid treatment was systemic in the first case and local with epidural injections in the second. The second case is unique because no similar observations have yet been reported. In most cases, a preoperative computed tomographic scan establishes the diagnosis by demonstrating dural compression by an adipose mass. Myelography is far less specific. In some cases, the exact diagnosis is made at the time of surgery. The treatment is primarily surgical, with laminectomy over the length of the compression and the removal of the compressing fat. Neurologic recovery is dependent on two factors: the level of the compression and the adequacy of decompression.

Epidural Neoplasms↗
PubMed1991

[Old traumatic lesions of the dorsal and lumbar spine].

The authors present 71 cases of malunion or old traumatic lesions. They result from an unadapted initial surgical or functional treatment. The pain symptoms are in the form of vertebral pain or nerve root pain, often associated with signs of neurological deficit. The authors emphasize the stability or instability of the lesion in order to assess its reducibility. The radiographic exploration (dynamic views, MRI, CT, medullary arteriography) would serve as a guide for the treatment strategy. The authors do not report any case of permanent postoperative neurological aggravation. Three surgical options are analyzed (anterior approach, posterior approach and "three-stage" surgery). An enlarged posterior approach enables treatment and reduction of all malunions, except if a medullary feeder artery is present on the site of the lesion. The pain symptoms improve in 87% of all cases. The authors do not report any permanent postoperative neurological aggravation.

Adolescent↗
PubMed1991

[Severe multiple injuries. Strategy and results. Experience at the Hôpital de la Pitié in 1988 and 1989].

In our series of 97 patients with multiple in juries observed in 2 consecutive years (1988-1989), we have selected only the most severe injuries, of which the patients died within 48 hours, and those that required a long stay in the intensive care department. On admission, we recorded 49 cases of stage II or more severe coma, and 67% of patients under respiratory assistance with an instable hemodynamic state. Out of the 44 deaths recorded, 30 subjects were comatose from the beginning. The justifies the confrontation of 3 specialist teams in 2/3 of cases. The specific recruitment of the hospital and the selection of the most severe cases of these "people under a death sentence" for the study shows a heavy toll of mortality (45,4%), including 60% on the first day. The main cause of death is head injuries (81%). The multivisceral and infectious consequences of long-lasting, heavy intensive care and pulmonary or myocardial contusions account fort secondary deaths in 25% of the patients who had survived. Emergent neurosurgical operations are exceptional, but a neurosurgeon's opinion is always essential. Orthopedic surgical issues are not specific, but the frequency of spinal lesions must be emphasized (27,2%). In this series, 85% of the patients with multiple trauma presented with a lesion of the locomotive apparatus and underwent emergent surgery in every second case in satisfactory conditions. Severe thoracic and maxillofacial lesions requiring surgery are rare. Abdominal lesions are more frequent (17%) and must be dealt with in priority, but they rarely cause death. On the contrary, lesions to the major blood vessels and retroperitoneal compound lesions have a very poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergencies↗
PubMed1991

[Surgical treatment of spinal metastases].

Spinal metastasis often lead to two main complications: back pain and para or tetraplegia. Performed alone radiotherapy may be too slowly efficient to allow a neurological recovery. Laminectomy may improve the neurological signs but does not induce any change on root pain and it increases instability. A surgical procedure by a posterior approach including laminectomy and fixation by plates and transpedicular screws fits these two goals: decompression and stabilisation. The first 189 cases are reported: the first month lethality is about 15%. 81% of fixations remained unchanged. 21 out of the 62 patients with loss of autonomy recovered an ability to walk. Besides this palliative surgery, a total spondylectomy has been done 13 times in order to perform a curative surgery for unique metastasis of cancers with long life expectancy. An early walking is often possible and after healing of the wound, a complementary treatment with radio or chemo therapy may be started without any risk of pain or neurological compression.

Adult↗
PubMed1991

[Treatment of complete lumbar disk herniation by percutaneous discectomy].

Percutaneous diskectomy is a new treatment used in surgery of the spine for the treatment of herniated lumbar disks. The idea is to carry out an exeresis with a posterolateral percutaneous approach on a part of the herniated intervertebral disk; while always remaining outside the spinal canal. This technique eliminates the risks of fibrosis or arachnoiditis. It is carried out under local anesthesia, reduces the surgical insult and requires only a short stay in hospital. Between 1984 and 1988, 188 operations using this technique were carried out on L3-L4, L4-L5 and L5-S1. Of the first 100 cases studied, we note: 71% good and very good results for radiculalgia after a time lapse of more than a year, 51% good and very good results for low back pain; 16% of the patients required a surgical approach after percutaneous diskectomy. The authors specify the advantages and the indications of this surgical technique, which complements the traditional lumbar intervertebral disk surgery.

Back Pain↗
PubMed1990

[Ruptures of the tibialis posterior tendon. A clinical and therapeutic study apropos of 13 cases].

The authors have observed 13 cases of ruptures of the tibialis posterior tendon. Two types were described: either sudden and frank ruptures after traumas in younger patients or progressive ruptures in older patients, of degenerative origin. Clinical examination was based on the isometric test of the tibialis posterior, either after an acute trauma or in valgus painful progressive flat feet. The diagnosis was confirmed mainly by CT scan. Eleven cases were operated on, several techniques being used: suture (4 cases) resection (4 cases) plastic transfers or plastic operations (4 cases). The results were analysed according to the strength of the muscle, the ability to stand on the tip of the foot with inversion of the heel and resume of the previous sports. The pain disappeared 4 to 6 months after surgery. The results were satisfactory in nine cases. However the shape of the foot could not be completely restored and the use of a foot support had to be continued.

Adult↗
PubMed1990

[Giant cell tumor of the radius: resection-reconstruction by vascularized peroneal graft].

The radius location of a giant-cell tumor is not rare. Treatment sets the surgeon with the reconstruction procedure after block excision, specially when localized in the distal end of the bone. The authors present one case of a grade I giant-cell tumor of the distal radius, treated after a first recurrence. A block excision was done and the distal end of the radius was reconstructed by a free vascularized fibular transplant. Healing succeeded in 2 months and a half. The wrist motion recovery was good. No recurrence was observed for eighteen months after surgery. Radius reconstruction after block excision can be done by using free vascularized bone transfers. Healing occurs after a shorter period due to the graft's living characteristics.

Adult↗
PubMed1989

[Recent ligament lesions of the knee].

In every case knee injury, it is imperative not to miss a possible lesion of the ligaments and, when such a lesion is present, to evaluate its severity. The practitioner who examines the injured knee in an emergency therefore plays a crucial role in taking a definite attitude when faced with lesions. Before any treatment is envisaged the lesion must be precisely diagnosed. This requires a very strict examination based on the patient's history and on clinical tests that are often simple. At the slightest suspicion of severe lesion of the ligaments, a specialist must be called in to complete the investigation, if necessary by testing under general anaesthesia and/or by performing an arthroscopy.

Humans↗
PubMed1989

[Current trends in surgery of the spine].

This paper is based on an invited lecture given at the SICOT 87 meeting in Munich. The topics discussed include: selective spinal arteriography in the management of tumours, which enables definition of the vascular supply of the cord and of the tumour and may facilitate preoperative embolisation; MRI, which allows visualisation of both bone and soft tissue; the pathogenesis of transverse fractures of the upper sacrum; the management of malunion of fractures of the thoracolumbar spine by a three stage procedure, in which an initial posterior approach allows osteotomy and definition of the pedicle, a second anterior procedure for correction of the deformity by appropriate resection of the vertebral body, and a final posterior operation in which internal fixation is carried out using pedicular screws and plates. Operation on extradural tumours of the spine is usually palliative for metastases and aims to decompress the cord by laminectomy, stabilising the spine by osteosynthesis. Total removal of a vertebral body may be needed; percutaneous resection is being used increasingly for lumbar disc resection; the development of the Cotrel-Dubousset system and the use of long transpedicular plates allows better reduction of the deformity in scoliosis.

Diagnostic Imaging↗
PubMed1989

[Treatment of fracture of the thoracolumbar spine using Böhler's method].

The treatment of stable thoracolumbar compressive fractures by the Böhler cast is worth while in cases of kyphosis with integrity of articular apophysis. The best reductions concern T12, L1 and L2. This method, studied on 92 patients, regularly succeeded in reducing and maintaining the kyphosis beneath 20 degrees, provided a complete reduction of the vertebral body and an early and intensive reeducation in the cast, and despite an early, constant but partial loss of reduction. The long term functional results appear to be satisfactory with such a residual deformation. This treatment seems to be particularly indicated in kyphosis of more than 20 degrees.

Adolescent↗