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T Judet

Publications and source records attributed to T Judet.

At least 37 records · Page 2Linked to original sources
PubMed2000

L5 radicular pain related to a cystic lesion of the posterior longitudinal ligament.

A 35-year-old man with a long history of left L5 radicular pain was found to have an intraspinal cystic lesion causing radicular compression. Magnetic resonance imaging demonstrated a round lesion situated in the anterior epidural space, with uniform high signal intensity on T2-weighted sequences characteristic of a cystic lesion. During surgery a liquid-containing cyst originating from the posterior longitudinal ligament was punctured and resected. The histologic aspect was that of a ganglion cyst without synovial layers. The radiologic differential diagnoses are discussed.

Adult↗
PubMed2000

[Subcutaneous tenotomy of Achille's tendon in adults for ankle stiffness. A review of 80 cases].

PURPOSE OF THE STUDY: Lengthening of Achille's tendon is part of surgical program for ankle stiffness in equinus deformity. Usually this lengthening is done by opened surgery with all the well-knowned advantages in term of adjustment. We used a percutaneous method for Achille lengthening with a two stages tenotomy. The purpose of this study is to evaluate advantages, inconvenients and efficiency of the subcutaneous method versus the open method. MATERIALS AND METHODS: We present a retrospective study of a 80 percutaneous lengthening of Achille's tendon in 78 patients done between August 85 and January 96. All patients who went to surgery during this period were reviewed. Mean age was 36 years old and there was 39 left sides and 41 right sides. We separated the extra-articular stiffness (48 cases) and the intra-articular stiffness (32 cases) because in extra-articular etiology the stiffness is a consequence of a primitive neuro-muscular disease as the ankle joint is healthy. 46 ankles had a past history of surgery. The kind of surgery was directely related to the etiology of the equinus. Most of the time, Achille lengthening was the last time of joint mobilisation. Only 15 times lengthening of the equinus tendon was done isolated. We looked at the early results for all patients and late results were only evaluated for the patients who had an isolated lengthening of the Achille tendon the for stastitical reasons. RESULTS: Median follow-up is two and an half years. There was preoperatively 59 ankles equinus and correction was constantly obtained with surgery postoperative improvment was 12 degrees of dorsal ankle flexion. In sub population of isolated achillus lengthening mean gain is 17 degrees. Only one patient had a per-operative complication with an heel anesthesia. We had no late complication related to the method. DISCUSSION: Results of this reviewal confirms efficency of the percutaneous technique in adult. Litterature is very poor concerning Achille's tendon lengthening in adult surgery. It is a very widelly spread method in children. Only few authors have published about it in adults mainly about hemiplegic patients. Our method saves tourniquet time in heavy ankle surgery. There are no painful and sticky scar. Morbidity is very low because we only had one complication related to the method. Healing up of tendon is very good, all patients being able to rase up on their toes. CONCLUSION: A review of our cases showed us the real efficency of this technique. It's a very simple and quick method giving good results with low morbidity. For us there is no indication of open surgery for achille's tendon lengthening.

Achilles Tendon↗
PubMed1999

Preliminary results of partial surface replacement of the femoral head in osteonecrosis.

We report our initial results using a partial surface replacement for osteonecrosis of the femoral head. We believe the prosthesis has the most minimalist design that has been reported either in Europe or North America. The surgical technique, implant design, and instrumentation cause minor soft tissue disruption and require little bony resection. We report the results of our first 25 prostheses performed over the past 5 years in 19 patients. The mean age was 42.5 years, (range, 24-59 years), with a preoperative Ficat classification of 15 hips, stage III; 9 hips, stage IV; and I hip, stage II. For the surviving prostheses, mean follow-up was 43 months, (range, 20-60 months). Of these 19 surviving implants, 15 continue to function well with excellent or good hip scores according to the Merle d'Aubigne system. We have had 6 failures: 1 owing to technical error, 4 owing to local tissue factors, and 1 owing to a progression of the osteonecrosis. The parameters for the use of this prosthesis are defined with our increasing experience, and the prosthesis is compared with other prosthetic implants available. In comparison with alternative techniques, the operative surgery is straightforward requiring little preoperative planning; immediate weight bearing is allowed postoperatively. Should failure occur, little bone stock loss is incurred, and revision to a total hip replacement is as simple as primary hip arthroplasty.

Adult↗
PubMed1999

Neuropathic arthropathy: a forgotten diagnosis? Two recent cases involving the hip.

Two cases of neuropathic arthropathy of the hip are reported. One was the first manifestation of tabes dorsalis in a 74-year-old man, whereas the second occurred in a 47-year-old woman with a history of spina bifida and L2-L5 epidural lipoma. Radiographic joint destruction occurred within five and three months, respectively. The main clinical and radiological features of neuropathic arthropathy are reviewed, and diagnostic pitfalls are discussed. There are no specific laboratory tests or histologic findings. This now rare condition should be routinely considered in patients with severe joint destruction contrasting with minimal pain. The reasons for the decision to use trochanteric-iliac coaptation in one of our patients and a wait-and-see approach in the other are explained. The literature is reviewed. Ten cases treated by joint replacement have been reported. However, neither joint replacement nor arthrodesis seem capable of restoring satisfactory hip function.

Aged↗
PubMed1999

Osteoarthritis caused by Neocosmospora vasinfecta.

We report the case of a patient who developed an ankle osteoarthritis due to the Ascomycete Neocosmospora vasinfecta, following accidental multiple trauma to his legs in whilst in Africa. Antifungal susceptibility testing was performed. Despite a low amphotericin B minimal inhibitory concentration, parenteral antifungal therapy failed and amputation was required to resolve the osteoarthritis. Possible reasons for the failure of this antifungal treatment are examined.

Adult↗
PubMed1998

[Simple puncture versus trocar puncture biopsy for the bacterial diagnostic evaluation of osteoarticular infections. A prospective study of 54 cases].

PURPOSE OF THE STUDY: We have performed a prospective study in 54 patients with suspected osteoarticular deep infection. The purpose of the study was to compare notch needle-biopsy versus simple punction in term of bacteriological efficiency. MATERIAL AND METHODS: Among 54 patients (32 males, 22 females), 16 cases of deep infections were proven. There was 29 hips, 17 knees, 6 ankles, 2 elbows and 1 shoulder. Each patient was investigated with simple punction and notch needle-biopsy. Diagnostic value of both methods were evaluated by comparison with results of surgical prelevement which was the gold standard for evaluating both tests. The study was made using usual diagnostic test criteria: sensitivity, specificity, positive predictive value, negative predictive value and also likelihood ratio method. RESULTS: Sensibility for the simple punction was 31.25 per cent and sensibility for notch needle-biopsy was 69 per cent. Specificity for simple punction was 97 per cent but for notch needle-biopsy it was 100 per cent. Positive predictive value was respectively 83.33 per cent for simple punction and 100 per cent for notch needle-biopsy. Negative predictive value was 0.71 per cent for simple punction and 0.31 per cent for notch needle-biopsy. Likelihood ratios for simple punction was 11.87 and likelihood ratios for notch needle-biopsy was infinite. DISCUSSION: Sensibility for notch needle-biopsy of 69 per cent is two time superior to sensibility of simple punction. Notch needle-biopsy had no false positive. It is a completely specific test. Methodology was valuable because all patients who had negative result of non invasive test had no preoperative antibiotherapy, and underwent surgery for bacteriological diagnostic only. CONCLUSION: Notch needle-biopsy is always superior to simple punction. This study leads us to modify our practice. From now on we will never use again simple punction but we will only perform notch needle-biopsy which diagnostical efficiency is superior.

Adult↗
PubMed1996

Excision of heterotopic ossification around the knee following brain injury.

We present the results of five patients who underwent resection of heterotopic ossification around the knee following traumatic brain injury. All the patients had improved function and no pain at a minimum of 1 year follow up, irrespective of their preoperative neurological status. Our philosophy for such surgery is outlined and, although the surgical goals may seem small, the outcome for any individual patient may be considerable.

Adult↗
PubMed1996

Articulated radial head replacement and elbow release for post head-injury heterotopic ossification.

This is a case report of the release of an elbow ankylosed by post-head-injury heterotopic ossification. An extensive bony resection and soft-tissue release was required. At surgery a pathological, osteoporotic fracture of the radial head was found that could not be preserved and thus was removed. In its place an articulated "floating radial head prosthesis" was used that allowed immediate rehabilitation and avoided the need for temporary joint distraction or stabilization. The initial excellent function achieved has been maintained, at a > 3-year follow-up and without the complications experienced with silicone radial head prostheses.

Adult↗
PubMed1996

A floating prosthesis for radial-head fractures.

We report our experience over seven years with a floating radial-head prosthesis for acute fractures of the radial head and the complications which may result from such injury. The prosthesis has an integrated articulation which allows change of position during movement of the elbow. We present the results in 12 patients with a minimum follow-up of two years. Five prostheses had been implanted shortly after injury with an average follow-up of 49 months and seven for the treatment of sequelae with an average follow-up of 43 months. All prostheses have performed well with an improved functional score (modified from Broberg and Morrey 1986). We have not experienced any of the complications previously reported with silicone radial-head replacement. Our initial results suggest that the prosthesis may be suitable for the early or delayed treatment of Mason type-III fractures and more complex injuries involving the radial head.

Adolescent↗
PubMed1995

[Treatment of comminuted fractures of the lower end of the radius with internal osteosynthesis, traction and early mobilization].

Goals for treatment of comminutive fractures of the distal radius include restoration of the articular profile of the proximal part of the joint, while axial loading forces must be avoided as much as possible to prevent secondary displacement. The choice of an internal fixation protected by an external wrist distractor-fixator, with early activo-passive mobilisation, seems to achieve the goal. Twelve patients with a comminuted fracture of the distal radius, including axial articular impigment displacement were reviewed for this study. All fractures were Frykman's type III, IV, VII or VIII. Distraction was done with a specific external apparatus, allowing an internal fixation, using an anterior plate and posterior Kirschner wires for the more complex cases. Distraction was released at the end of the surgical procedure, while the distractor was left in place. The wrist was mobilised early in the post-operative period, and the distractor was removed two months later. At a mean follow-up of 8.5 months, two patients were still painful. Mean motion of the wrist joint was 115 degrees for flexion-extension and 35 degrees for radio-ulnar deviation. Radiological results were good (10 cases), in both planes sagittal and frontal, and stable with time. The radio-ulnar index was correct in 11 cases. Only two cases of Sudeck's atrophy were noted. Authors use a specific external wrist distractor to obtain and maintain reduction in comminuted fractures of the distal end of the radius, using internal fixation in combination. Early motion of the wrist, protected by the wrist distractor seems to lower rates of Sudeck's atrophy.

Biomechanical Phenomena↗
PubMed1994

[Limits and insufficiencies of the treatments of recent double-break articular fractures of the lower fourth of the radius].

The authors present a series of 39 intra-articular fractures of the distal part of the radius classified as Frykman VII and VIII. Clinical results showed 77% of good and very good results. Radiographs showed 71% of reduced articular surfaces but only 37% of radiuses were considered to be anatomical. The authors emphasize the high rate of secondary displacement due to the epiphyseal comminution, and the importance of pre-operative radiographs obtained under traction, allowing good analysis of the fracture and evaluation of the comminution.

Adult↗
PubMed1994

[Radial head prosthesis with floating cup in recent and old injuries of the elbow: preliminary results].

PURPOSE OF THE STUDY: In recent traumatology (complex radial head fractures with severe sprain of the medial collateral ligament), as well as in sequellae (extensive release for severe elbow stiffness), the implantation of a radial head prosthesis may be necessary to stabilize the humero-ulnar joint and the radial shaft. Its major advantage consists of allowing immediate postoperative mobilization. Swanson first proposed a silastic replacement of the radial head which turned out to have serious mechanical and biological disadvantages. MATERIAL AND METHODS: We propose a new Titanium implant, which is stiffer, and made of 2 parts connected by a spherical joint, thus maintaining an optimum congruence between the prosthetic component and the humeral condyle in any position of the joint (flexion/extension or pronosupination). This prosthesis was implanted in 4 recent fractures and reviewed after an average follow-up of 23 months [12-36]. RESULTS: Results were excellent in 2 cases, and good in 1 case: functional assessment was fair in the last case, in which the initial lesion consisted of a complex ulnar fracture associated with a Mason 3 fracture of the radial head. An osteosynthesis of the ulnar shaft and olecranon had preceeded implantation of the radial head prosthesis. In 5 additional cases with severe posttraumatic elbow stiffness, the prosthesis was implanted during elbow release, regularly allowing durable stabilization of the joint in an anatomic position, and in 2 of these cases, permanent correction of the radio-ulnar index. In these last cases, proximal migration of the radial shaft had occurred after resection of the radial head. In one case, this migration had resulted in ulnar fusion complicating a Sauve-Kapandji procedure. In the other case, proximal migration of the radius had resulted in painful distal radio-ulnar dislocation. In this second group, patients were followed-up an average of 31 months [12-46]. No complication has yet been recorded (no osteolysis, no stem breakage, no wear, no loosening). DISCUSSION: Indications for implantation of a radial head prosthesis were deduced from these observations: in recent trauma, implantation of the prosthesis should only be indicated in those fractures, in which osteosynthesis appears not to be possible (Mason 3 or 4), with the following associations: radial head fracture with severe sprain of the medical collateral ligament--patients with positive radio-ulnar index--extensive lesions of the interosseous membrane (Essex-Lopresti, or Monteggia affecting the ulnar shaft)--associated fracture of the proximal ulna (olecranon, coronoid process...). In sequellae, we propose the following indications: extensive elbow release compromising elbow stability--painful inferior radio-ulnar dislocation complicating resection of the radial head--valgus instability complicating radial head resection.

Adolescent↗
PubMed1994

[Reconstruction of acetabular insufficiency in initial total hip endoprosthesis surgery using a massive autograft (fate of the implanted autograft more than one year after surgery)].

The authors present a method of reconstruction of insufficient acetabula by autografts from heads of femurs before primary implantation of the cemented total endoprosthesis of the coxa. They reconstruct the osseous acetabulum of the patient by prolonging it, filling or reinforcing its floor, although in one third of the patients it is difficult to find a borderline between these three groups. Coxarthroses are primary and secondary and of those almost half are secondary dysplastic coxarthroses. The group of patients comprises 32 women and 17 men, their mean age at the time of operation was 58.5 years. The authors follow-up, using clinical and X-ray methods, the fate of "massive autografts". Within six months the autograft is already firmly linked with bone and within 12 months it is reconstructed. A bone graft, unless burdened, is gradually reabsorbed. This process is intensive in particular between the 3rd and 6th month after operation and by the 12th month the graft is reabsorbed.

Acetabulum↗
PubMed1993

[Free transfer of the vascularized fibula in pseudarthrosis and femoral bone loss].

The authors report their experience of femoral reconstruction by free fibular graft transfer. Twenty eight patients were operated on between 1977 and 1988. The average follow-up was 7 years and 3 months. The etiology of most of the cases was a post traumatic lesion (70 per cent). Loss of substance was found in 19 cases. 60 per cent of these were septic. The approach was usually posterior and vessels from the sciatic nerve were used. Union was obtained in 89 per cent of the cases. In 65 per cent of the cases union occurred in less than 1 year. In 1 out of 4 cases graft thickening was necessary and achieved by secondary bone grafts. The comparison of this technique with standard treatments evidenced a definite superiority of vascularized bone grafts in cases of septic pseudarthrosis and significant losses of bone.

Adolescent↗