Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Jan 1997
[Distal humeral fracture in adults: functional evaluation and measurement of isometric strength].
The purpose of the study was to determine prognostic parameters in adult distal humeral fracture. ⋯ The distal humeral fracture produces a decrease of the elbow strength which is more severe for the dominant side. The reason is unknown. The Alonso-Llames approach seems to be the most favorable approach while the V-shaped section of the triceps shows a deleterious effect on strength. Early post-op exercises seem to have a positive effect on the long term ROM. Neither the fracture type (classification) nor the ROM, nor the strength are correlated with the subjective feeling of the patient. On the other hand statistical correlations show that unsatisfied patients are heavy workers (exact Fisher test P = 0.033) and patients younger than 60 years old (exact Fisher test P = 0.029).
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Rev Chir Orthop Reparatrice Appar Mot · Jan 1997
Case Reports[Scaphoid and lunate palmar divergent dislocation. Apropos of a case].
A case of palmar dislocation of the scaphoid and lunate which where dissociated from each other is reported with a 3.5 years follow up. A 32 years old man fell while reading his motorcycle. He landed on his left hand dorsiflexed. There was no skin dilaceration and neuro-vascular status of his hand was intact. X-rays showed a palmar dislocation of the scaphoid and lunate with a large gap between the two bones. The lunate was also completely dissociated from the triquetrum and the capitate. Distal pole of the scaphoid remained in contact with the trapezium. The patient was taken to the operating room, and after unsuccessful closed reduction, an open reduction through a palmar approach was performed. A complete disruption of the anterior capsule was founded and all perilunate ligaments were completely disrupted. Reduction was easy under direct vision, and the anterior capsule was repaired. A non displaced trapezium fracture seen at surgery was fixed with a Kirschner wire. A long arm cast applied for 6 weeks. At 3.5 years follow-up, the patient had an almost full range of motion and no residual pain. Power grip was 25 per cent reduced in comparison with the opposite side. X-rays showed a palmarflexed scaphoid and Magnetic Resonance imaging showed no evidence of avascular necrosis. ⋯ In such a case, and with a low rate of avascular necrosis in perilunate dislocations treated early we suggest an open reduction and internal fixation (O.R.I.F.) to prevent carpal instability. We recommend combined volar and dorsal approaches for repairing anterior and posterior ligaments (especially interosseous ligaments on both sides of the lunate), associated with a stabilization of the entire carpum by scapho-lunate, triquetro-lunate, and capito-lunate Kirschner wire fixation.
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All intramedullary femoral surgery entails embolic phenomena which explain peroperative collapses formally known as bone cement implantation syndrome, as well as perioperative fat embolism syndromes. Locally, the bigger the cavity is, the higher the number of accidents: 2.5-5 per cent for GUEPAR hinged-knee prosthesis, 1.75 per cent for total hip arthroplasty with long stem, and 0.1 per cent during classic THA with cement limited to the metaphysis. Anomalies in bone vascularization also increase risk: 10.5-13 per cent during prophylactic nailing for shaft metastases, 1-11.5 per cent during hemiarthroplasty cemented in osteoporotic bone of femoral neck fractures, and only 0.1 per cent during THA implanted because of arthrosis. ⋯ Preventive treatment is surgical as there is an inverse relation between embolic marrow and marrow eliminated by large volume washes (which is often more effective than draining). Cement indications in older patients as well as the choice of fixation techniques in femoral fractures must take into account the cardio-pulmonary condition of the patient. Resuscitation procedures dealing with these complications end in the patient's death in half of the cases.
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Rev Chir Orthop Reparatrice Appar Mot · Jan 1997
[Conservative treatment of stress fractures of the tarsal navicular in athletes].
The purpose of the study was to propose an algorhythm for nonoperative treatment of partial tarsal navicular stress fractures in athletes, based on the results of the authors prospective research, conducted in 17 athletes. ⋯ If clinical indication of tarsal navicular stress fracture is confirmed by a positive bone-scan, a CT or MRI exploration is required to distinguish stress reaction from stress fracture. In partial tarsal navicular stress fractures, immobilisation in a short-leg cast with nonweightbearing for 6 to 8 weeks depending of the magnitude of the fracture is required. This is followed by a treatment consisting of 4 two-weeks stages which clinically monitored. The previous phase can be repeated for another two weeks, depending of clinical findings. This algorhythm of nonoperative treatment of partial tarsal navicular stress fractures allowed in all athletes a return to competitive activity.
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Rev Chir Orthop Reparatrice Appar Mot · Jan 1997
[Prevention of hemorrhagic complications in the lateral retinacular section of the patella. A study of the lateral arteries of the knee applied to the prevention of knee hemarthrosis].
Arthroscopic lateral retinacular release is one of the most employed procedures for patellar chondromalacia. A literature review show a complication rate of 10 to 18 p. 100 of postoperative hemarthrosis. This work aims to study the vessels anatomy of the lateral side of the knee in order to find anatomical landmarks allowing to avoid or coagulate them. ⋯ Following this anatomical study, we suggest, as a supplementary precaution, a selective hemostasis of the lateral superior genicular vessels through a small incision associated with the location of the lateral inferior genicular vessels by cutaneous transillumination.