Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
-
Rev Chir Orthop Reparatrice Appar Mot · Jan 1996
[Four part valgus impacted fractures of the upper extremity of humerus: ilium graft reconstruction. Apropos of 8 cases].
We present the results of an original technique for reconstruction of valgus-impacted humeral head using autologous iliac bone. ⋯ This specific type of displaced four-part fracture of the proximal humerus which consists of valgus impaction of the head fragment without lateral displacement has a rate of avascular necrosis lower than that of other displaced four-part fractures. Blood supply of the articular segment is maintained via the periosteum extending to the medial part of the anatomic humeral neck. These data authorized the authors to propose a new conservative treatment for four-part valgus impacted proximal humeral fractures.
-
Rev Chir Orthop Reparatrice Appar Mot · Jan 1996
[Arthrodesis of the shoulder for post-traumatic palsy of the brachial plexus. Analysis of a series of 18 cases].
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. ⋯ 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.
-
Rev Chir Orthop Reparatrice Appar Mot · Jan 1996
[Reconstruction of digital pulp by pulp tissue transfer of the toe. Apropos of 15 cases].
The authors report their experience of digital pulp reconstruction by free toe pulp transfer. Fifteen patients were treated with the lateral great toe hemipulp. ⋯ A wide range of procedures from spontaneous healing to thenar flap, neuro vascular flap or toe pulp transfer can be proposed to treat digital pulp loss. In the case of moderate thumb pulp avulsion and homodigital volar flap can be proposed; if microsurgery is contra-indicated, an hetero-digital flap from the index can be performed. When the other fingers are concerned, a homodigital flap can be proposed for moderate defects. For more important trauma, the thenar flap is convenient to cover the index and the medius pulp. Ring and little fingers can be treated by a reverse digital artery flap or by a cross finger flap. When a toe pulp transfer is indicated we recommend the lateral great toe hemipulp for the thumb and a second or third toe pulp transfer for the other fingers when digital vascular anastomosis are possible. The great toe hemipulp transfer represented a good indication for complete digital pulp loss reconstruction where the thumb is concerned. Performing this reconstruction during the acute phase may improve the management of those trauma by reducing the time needed for cicatrisation and the length of work inability.
-
Rev Chir Orthop Reparatrice Appar Mot · Jan 1996
[Ipsilateral fractures of the femoral and tibial diaphyses].
Simultaneous ipsilateral femoral and tibial fractures cause a floating knee. Treatment of such patients is complicated by fat-embolism syndrome (12 per cent), local soft tissue damage, ipsilateral knee ligament tear (5 to 39 per cent) and delayed shortening or torsional deformity. Our study aimed to determine the frequency of complaints about the knee and to study the causes of malunion. ⋯ Simultaneous ipsilaterla femoral and tibial fracture, or so called floating knee, occurs in patients who are involved in a high-velocity injury. Knee instability is however the major cause of poor results.
-
Rev Chir Orthop Reparatrice Appar Mot · Jan 1996
[Results of posterior lumbar intersomatic fusion in the treatment of isthmic spondylolisthesis. Apropos of 27 cases followed over more than 10 years].
Posterior lumbar interbody fusion (PLIF) as described by Cloward, with laminectomy of the entire separate neural arch in spondylolisthesis, is a difficult operation. The purpose of this study is to evaluate the results of PLIF with autologous bony graft, without reduction or instrumentation in grade I and II spondylolisthesis. ⋯ This study confirms the good results obtained by PLIF with nerve roots decompression in spondylolisthesis. Fusion is stable and does not accelerate degenerative lesion of the upper disc.