Search PubMed⌕ Search

Biomedical subjects

Y Allieu

Publications and source records attributed to Y Allieu.

At least 37 records · Page 2Linked to original sources
PubMed1999

Assessment of hand after brain damage with the aim of functional surgery.

The semiology of the hand after brain damage is really rich. Its clinical evaluation remains quite difficult and must be integrated in the neuro-orthopedic and cognitive context. Deficiency, neuropsychological, analytic and functional status, must be assessed before any surgical decision aiming the improvement of prehension. Neuropsychological evaluation precise the hemispheric specialization: right hemisphere lesions conduct to unilateral spatial neglect while left hemispherical lesions determine language troubles and gesture impairment (apraxia). The analytical evaluation describes motor and sensitive function and assesses spasticity and pain. Concerning the functional assessment, the Enjalbert's score seems to be the most adapted to the upper limb. The assessment of hand deficiency and its origin is necessary to orientate the surgical decision and includes the Zancolli classification for the fingers and wrist and the House classification for the thumb. These classification used for cerebral palsy seems to be insufficient for all the different situations occurring after brain damage. A new classification is proposed based on 3 parameters: fingers extension, thumb abduction and supination. Surgical decision should be examined only after an adapted rehabilitation program.

Brain Diseases↗
PubMed1999

Congenital pseudarthrosis of both forearm bones: long-term results of two cases managed by free vascularized fibular graft.

We analyzed the clinical and radiographic outcome of 2 cases of congenital pseudarthrosis of both forearm bones managed by free vascularized fibular grafts. The follow-up periods were 17 and 13 years, respectively. The first patient, a 4-year-old girl, had reconstruction of both the radius and ulna by a vascularized fibular graft, restoring pronation/supination to 110 degrees. The second patient, a 17-year-old boy, underwent a 1-bone forearm procedure using a vascularized fibular graft. After surgery, he had a stable forearm that was shortened by approximately 15 cm. In these 2 cases of congenital pseudarthrosis of both forearm bones, bone union was obtained by means of vascularized fibular graft.

Adult↗
PubMed1999

[Finger replantation after 60 years of age. Apropos of 7 cases].

The authors analysed retrospectively 7 cases of digital replantation in 7 men aged from 60 to 71 years, performed between 1985 and 1996. There were 2 amputations of the thumb, 1 of the index, 2 of the middle finger, 1 of the fourth and 1 of the fifth finger. 4 failures of replantation were noted. These 4 failures always concerned amputations of long digits by a circular saw with associated complex multidigital injuries of bad prognosis and in combination with a poor vascular status. We had 3 successful results: the 2 amputations of the thumb and the ring finger of the auricular. All these 3 patients recovered a good hand function. We found some common characteristics in this group of patients: excellent general condition, non smoker, good motivation and cooperation, injury of one digit, clear amputation (except the ring finger), correct conservation of the amputated part. The advanced patient's age does not represent a contraindication for digital replantation. The injury mechanism and the general condition of the patient represent major criteria of prognosis. In favourable circumstances, a good functional result can be expected.

Age Factors↗
PubMed1998

[Evaluation of the function of the flexor and extensor tendons of the hand].

Evaluation of the function of flexor tendons is a complex problem with a lot of controversies. Many propositions have been done since the first quotation of Boyes in 1950. Were are making a presentation and a critical analysis of the most used methods: T.A.M., Kleinert's classification, and the one described by Buck-Gramcko. We are presenting a personal method, useful in every zone, eliminating the action of the intrinsics and showing certain tenodesis effects. This method has been compared to those of Kleinert, Buck Gramcko and Strickland, using the analysis of the results of 165 tendon sutures. Our results are situated in between the most optimistic method (Buck-Gramcko) and the most severe method (Strickland). Moreover, the authors propose an original method of evaluation of the extensor tendon function extrapolated from the one used for the flexor tendons.

Biomechanical Phenomena↗
PubMed1997

[Development of surgical indications in the treatment of rheumatoid wrist. Report on experience based on 603 surgical cases, 1968-1994].

The author relates his experience in surgical treatment of the rheumatoid wrist based on a consecutive series of 603 cases operated from 1968 to 1994. His therapeutic indications have changed over the years after a retrospective study of the long-term results. He distinguishes conservative surgery, which combines dorsal synovectomy and relaxation stabilisation of the wrist (also called surgery of the dorsal wrist) from total arthrodesis and arthroplasty of the wrist. The results of conservative surgery after a follow-up of more than five years confirm that the disease continues in spite of synovectomy. Furthermore, relaxation stabilisation using soft tissue (extensor retinaculum and tendon transfer) is not sufficient to stabilise the wrist. Most of the time, this has to be completed by a partial radiocarpal arthrodesis. This is indicated when the carpus shows a medial translation or early in potentially progressive forms (Larsen Stage 1). In advanced forms conservative surgery consisting of partial radiocarpal arthrodesis is only indicated when the midcarpal joint appears functional after dynamic radiological examination. The author used the Swanson implant to perform 70 arthroplasties from 1973 to 1988. Long-term results show a large number of complications, which increased progressively with time. The Swanson implant was therefore abandoned in 1988. In 12 cases operated from 1979 to 1984 wrist arthroplasty was performed using Jackson's technique which consists of resection-interposition of a silastic sheath. This technique was also abandoned in 1984 due to the variable and unpredictable results obtained. At the present time, the author:-does not perform arthroplasties; increasingly completes surgery of the dorsal wrist by radiolunate arthrodesis;-has noted an increase in indications for total wrist arthrodesis. He emphasizes the importance of long-term evaluation of surgical results in rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed1997

Fatigue analysis of human reinnervated muscle after microsurgical nerve repair.

The reinnervated elbow flexors, biceps, and brachialis muscles were compared with the elbow flexors on the healthy opposite side in terms of muscle strength and fatigue in 10 patients who sustained sequelae of a unilateral posttraumatic brachial plexus palsy. The patients had recovered an active elbow flexion against resistance after microsurgical nerve repair. The patients were reviewed with an average postoperative followup of 12 years (range, 7.5-16 years). Despite a statistically significant difference in maximum isometric force, this study showed that after peripheral nerve repair, a partially reinnervated muscle has the same characteristics of fatigue and endurance as a normally innervated muscle, if these muscles exert the same percentage of their own maximum force.

Adolescent↗
PubMed1997

[Paralysis of the brachial plexus caused by supraclavicular injuries in the adult. Long-term comparative results of nerve grafts and transfers].

PURPOSE OF THE STUDY: Recovery of active elbow flexion constitutes the first priority in microsurgical repair after closed injuries of the supraclavicular brachial plexus in adults. However, there are many controversial issues between the proponents of nerve grafting from available roots, and the proponents of nerve transfer. MATERIAL AND METHODS: The results concerning elbow flexor muscle recovery following microsurgical nerve repair of supraclavicular brachial plexus lesions were analysed in 62 patients. The average age at operation was 23 years old and the average delay between trauma and nerve repair was 7 months. Nerve grafting from C5 or C6 was performed in 43 patients. Nerve transfer using 3 intercostal nerves was done in 10 patients and using the spinal accessory nerve in 7 patients. A combination of both techniques was performed in 2 patients. Conventional sural nerve grafts were used every time. Functional evaluation was based on the assessment of active range of motion including flexion and supination, and on the assessment of maximum isotonic strength of the elbow flexors. RESULTS: With an average follow up of 8.5 years (range from 3 to 16 years) the average functional score of the elbow flexors was 4.4 out of a possible 11. Sixty six percent of patients had a strength recovery of M3 or more. Nerve repair using nerve graft from a non avulsed root seems to give better functional scores than nerve transfer from intercostal nerves or spinal accessory nerve using interpositional nerve graft, even if the differences were not statistically significant. DISCUSSION: In order to restore elbow flexion in case of supraclavicular brachial plexus lesion, nerve graft from an available root should be preferred to nerve transfer with interpositional nerve graft, when no avulsion exists among C5 and C6. Nerve transfer with interpositional nerve graft to the musculocutaneous nerve is indicated in case of avulsion of one or more roots among C5 and C6.

Adolescent↗
PubMed1997

[Anatomical study of interosseous flaps and the concept of postero-anterior interosseous flap. Preliminary report].

The postero-anterior interosseous flap uses the distal network of the posterior and anterior interosseous arteries. With this flap the authors would like to point out all the possibilities of reverse fascio-cutaneous flaps offered by the interosseus arteries. An anatomic study has been carried out with both a literature review and a cadaveric study. The authors studied the distal interosseous anatomy on 40 fresh upper arms after colored latex injection of the anterior interosseous artery near its origin. A distal anastomosis between anterior and posterior interosseous arteries was present in 38 cases. This anastomosis was situated at an average of 25 mm from the radio-carpal joint. The authors found the fascio-cutaneous artery branch of the anterior interosseous flap in 40 cases, but its origin is variable. Therefore, the anterior interosseous flap was possible in every case but the pedicle length was variable. The surgical technique must begin by a distal exploration of the vascular network. After this exploration the flap is chosen in function with the anatomic possibilities and the cutaneous defect. The authors have already used several kinds of reverse interosseous flap: anterior (6 cases), posterior (11 cases) and recently, postero-anterior (2 cases). With the postero-anterior flap the authors will show the large range of flap possibilities offered by the interosseous arteries for the cutaneous defects of the dorsum of the hand.

Anastomosis, Surgical↗
PubMed1996

Functional and histologic effects of a free nonvascularised muscle graft implanted into a reinnervated muscle after prolonged denervation.

Striated muscle atrophy and degeneration, which increase with the delay of denervation, represent two of the main causes for poor recovery following delayed nerve repair. The present study, using a rat model, tests the hypothesis that an adjunction of small, free, nonvascularised muscle grafts of contralateral healthy triceps into a chronically denervated triceps improves muscle regeneration and recovery following sciatic nerve repair delayed for 3 months. Our experiments seem to show a relative increase in mechanical properties in animals in which free muscle graft into the triceps was performed 3 weeks following nerve repair. The improvement of the regenerative process of muscles which have suffered a long period of denervation should be considered as an additional therapeutic procedure in the case of late nerve repair.

Animals↗
PubMed1996

[Arthroplasty of the wrist by island transfer of the inferior radio-ulnar joint].

In cases of advanced osteoarthritis of the wrist, in which the radiocarpal and midcarpal joint spaces have been destroyed, the authors propose island transfer of the distal radioulnar joint. They studied the blood supply of the distal radioulnar joint from the interosseous arteries on 40 fresh cadaver upper limbs. The anatomical study showed that the dorsal epiphyseal periosteal network was supplied by the lower perforator of the anterior interosseus artery in every case and by the posterior interosseous artery in 38 out of 40 cases. The distal radioulnar joint can be harvested "en bloc" and rotated 90 degrees so that the joint space can be placed in radio-carpal position while preserving its blood supply on the anterior interosseous pedicle. The authors describe their operating technique and present their first clinical case. This new operation represents a non prosthetic alternative to arthrodesis.

Aged↗
PubMed1996

[Transmission of pronation-supination movements in the wrist].

The wrist plays an essential in role the transmission of pronosupination movements. The four main muscles responsible for these movements are situated above the radiocarpal joint. This anatomic configuration allows a passive movement: Radio Metacarpal Rotation or RMR which is analysed here. Radio Metacarpal Rotation varies according to grip and the couple which is applied distally. An apparatus has been designed to simultaneously measure the angle, the force of grip and the couple. Radio Metacarpal Rotation is firstly measured with the wrist relaxed (grip strength < 5 N) and a distally applied rotation couple of 0.2 N.m in the supination direction and 0.5 N.m in the pronation direction. Secondly, the patient is asked to maintain a grip strength between 80 N and 100 N, and a couple of 1 N.m is applied distally in each direction. One hundred wrists were evaluated. We have looked for the rotation centers of active pronosupination and Radio Metacarpal Rotation. A three dimensional motion analysis device was used (ELITE system). Thirty normal wrists were evaluated. An anatomic study of the radiocarpal ligaments stretched by Radio Metacarpal Rotation was carried out on ten cadaver wrists. When the wrist is relaxed: there is an average Radio Metacarpal Rotation of 42 degrees. This Radio Metacarpal Rotation is reduced when grip is tightened. We have defined a locking test based on these two parameters. This clinical test is represented by two curves on a graph. The active pronosupination center and the radio metacarpal center do not coincide. The center of active pronosupination is situated near the center of the ulnar head and the center of radio-metacarpal rotation is always more lateral. On the anatomical preparations, we found a helicoidal configuration of the radiocarpal ligaments: a ligamentous double helix pronosupination. Radio Metacarpal Rotation interferes with transmission of pronosupination movements. When the wrist is not well locked there is a large lateral sweeping between radius and scaphoid. This sliding at the level of the cartilage can head to development of osteoarthritis of the wrist with a horizontal scaphoid and the good cartilage results after proximal row carpectomy. Radio Metacarpal Rotation must be taken into account when a prothesis designing. We propose a wrist locking test. The results of this test are directly related to the capacity of the joint surfaces to transmit pronosupination movements. Radio Metacarpal Rotation shows the importance of the horizontal plane in the wrist and its essential role in the transmission of pronosupination movements.

Biomechanical Phenomena↗
PubMed1996

Transfer of a severely damaged digit to reconstruct an amputated thumb.

We retrospectively reviewed the results of reconstruction of a traumatically amputated thumb with use of an adjacent severely damaged digit in twenty-seven patients (twenty-five male and two female patients). The mean duration of follow-up was nine years (range, two to twenty-one years). The mean age at the time of the reconstruction was thirty-four years (range, thirteen to fifty-six years). Five patients had the reconstruction on the day of the injury and twenty-two, after a mean delay of five months (range, fifteen days to thirteen months). Segments of the index finger were used in twenty-two patients; of the long finger, in four patients; and of the ring finger, in one patient. There were four complications: necrosis of the dorsal skin in one patient, reflex sympathetic dystrophy in one patient, and contracture of the first web space in two patients. Discriminative sensibility was ten millimeters or less, according to the Weber test, in twenty-four thumbs. Cortical integration with reference to the recipient thumb, on stimulation of the pollicized segment, was good in ten patients. Eleven patients could achieve tip-to-tip contact between the thumb and the little finger and twenty-five patients, between the thumb and the most radial finger. The ability to perform activities of daily living was considered good for ten patients, fair for eleven, and poor for six. Only digits with a nail, either present on the transferred segment or as a result of a free vascularized nail transfer, were considered to have a good cosmetic result. Although these results are far from impressive, the reconstruction is a viable alternative for selected patients because it maintains the ability to grasp objects and to oppose the digits.

Activities of Daily Living↗
PubMed1996

[Arthrodesis of the shoulder for post-traumatic palsy of the brachial plexus. Analysis of a series of 18 cases].

PURPOSE OF THE STUDY: In case of severe traction injuries of the supraclavicular brachial plexus in adult, the functional results of direct shoulder nerve repair are less predictable than those of the elbow. Furthermore, the surgical management of the remaining flail shoulder is still controversial. The post-operative results and the indication for shoulder arthrodesis are evaluated in this study. MATERIAL AND METHODS: Between October 1978 and January 1994, 18 gleno-humeral arthrodesis were performed on 18 patients for paralytic shoulder following brachial plexus injury. The average age at the time of operation was 25 years. A C5C6 lesion was present in 2 patients, a C5C6C7 lesion in 8 patients and a C5 to T1 lesion in the remaining 8 patients. Seven patients had a suprascapular nerve reinnervation failure. All these 18 patients recovered an active elbow flexion spontaneously or following direct nerve repair, tendon or free muscle transfer. The average delay between nerve repair and arthrodesis was 2 years and 4 months. For fixation, we always used internal fixation by screws, combined to an external fixator device in 10 cases. RESULTS: 16 patients were reviewed with an average follow-up of 6 years and 10 months (min. 6 months, max. 15 years and 8 months). Two types of complications occurred: 2 cases of gleno-humeral non-union requiring revision with bone-grafting, and 3 humeral fractures in the first 6 months after arthrodesis. The study of the arthrodesis position showed an average abduction of 25 degrees, an average flexion of 18 degrees, an average internal rotation of 22 degrees. The average motion values are 60 degrees of abduction and flexion, 14 degrees of extension, 0 degree of external rotation and 48 degrees of internal rotation. The range of motion depends closely on scapulo-thoracic muscles strength, especially the serratus anterior muscle. A flail hand primarily influences the subjective result. 14 of the 16 patients could easily reach their mouth. The average muscle shoulder strength, evaluated with the Isobex device, is 11 kg for flexion and abduction, 9 kg for adduction, 8 kg for internal rotation and 4 kg for external rotation. DISCUSSION AND CONCLUSION: Gleno-humeral arthrodesis is a reliable method for restoring shoulder function in case of brachial plexus sequellae lesion, giving more strength, but less external rotation than shoulder nerve repair.

Adolescent↗
PubMed1995

Influence of the delay of denervation on slow striated muscle resistance to slow-to-fast conversion following cross-innervation.

Cross-reinnervation, in cases of nerve repair or nerve transfer, can be the consequence of wrong connections which are surgically induced between the different types of motoneurons (fast and slow). A slow muscle nerve is able to convert a fast muscle virtually completely to the slow fibre type, whereas a fast muscle nerve exerts an incomplete control over the properties of a slow muscle. Our experiments show that following delayed cross-reinnervation, a statistically significant slow-to-fast transformation of the soleus muscle was observed, with a maximum when nerve repair was performed 6 weeks following nerve section in the rat model. Thus, the negative consequences on nerve and muscle relationship due to cross-reinnervation in the case of wrong connections between slow and fast motoneurons after conventional nerve suture or in the case of nerve transfer could be minimised by imposing a delay before nerve repair.

Animals↗
PubMed1995

Compression of the ulnar nerve in Guyon's canal by pseudotumoral calcinosis in systemic scleroderma.

We report one case of ulnar nerve compression in Guyon's canal due to calcium deposits in a 50-year-old woman with long standing systemic scleroderma. To our knowledge, this is the second known case. The symptoms consisted of a motor and partial sensory disturbance. Calcification of the piso-triquetral joint was prolonging into Guyon's canal, lifting its contents, and into the subcutaneous tissue of the ulnar border of the wrist. Excision of calcium deposits and of the pisiform in combination with external neurolysis of the ulnar nerve resulted in complete relief of symptoms.

Calcinosis↗
PubMed1995

Dupuytren's disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus.

A comparative prospective study of 120 adult diabetics (60 insulin dependent, 60 non-insulin dependent) and 120 non-diabetic adults as controls showed significantly higher incidence of Dupuytren's disease, limited joint motion, carpal tunnel syndrome, and flexor tenosynovitis in the diabetic population. Of the diabetic patients one third had a mild non-progressive form of Dupuytren's disease, which commonly involved the long and ring rays. Limited joint motion was noted in a third of diabetics, and carpal tunnel syndrome was observed in 15-25%, and flexor tenosynovitis in about a fifth. Limited joint motion co-existed with Dupuytren's disease in 57% of insulin-dependent diabetics. Diabetic polyneuropathy was found in two thirds of insulin-dependent diabetics and in one third of non-insulin dependent diabetics. All these hand changes were more marked in insulin-dependent diabetics and they showed a positive correlation with increasing age of the patient, duration of the diabetes, and the presence of a microangiopathy.

Adult↗