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Biomedical subjects

A Kapandji

Publications and source records attributed to A Kapandji.

At least 19 recordsLinked to original sources
PubMed2001

Biomechanics of pronation and supination of the forearm.

Pronation-supination, the rotation of the forearm around its longitudinal axis, is an important motion because it allows the hand to be oriented, allowing one to take food and carry it to the mouth, perform personal hygiene, and live autonomously. The motion depends on the integrity of two bones, the radius and the ulna, as well as joints, ligaments, and muscles. In every pathological case, as described in this article, the anatomical features must be restored for normal function.

Biomechanical Phenomena↗
PubMed1999

[Ulnar clasp failure or again "the nail file sign", a little known sign of disorders of the ulnar nerve].

Besides the well known signs of the ulnar palsy, there is a new sign, unknown till now: the "failing ulnar hook". It could be named the "nail file sign", because it was discovered from a woman who could not file the nail of her little finger. Practically, the patient is asked, in a first time, to roll his little and ring fingers around the index of the same hand of the examinator. As the patient is resisting, the other index of the examinator tries to extend these two fingers. If they cannot resist, there is an ulnar palsy at an upper level. The explanation is that the flexor profundus of the ring and the little fingers are commanded by the ulnar nerf, whereas those of the index and the middle finger are by the median nerve. So, when this sign is present, the block is located from the elbow to the brachial plexus. When it is absent, whereas other signs of ulnar palsy are present, it evoques a lower palsy. This sign is of great interest because it confirms the diagnosis of ulnar palsy and allows the localization of the block. It is very useful to search it in every neurologic examination of the hand. In a carpal tunnel syndrome, it allows to eliminate or not an ulnar participation without using of electrical tests.

Brachial Plexus↗
PubMed1999

[A correction technic using an osteotomy-graft in chronic impaction of the radial socket, called "die punch"].

The central crush of the radial glena, so-called "Die-Punch", may be relatively easy to fix, when it is initially recognized. Unfortunately, it is often ignored, which compromises the future of the radio-carpal joint. When this "die-punch" is at the stage of malunion, the cartilage depression is very difficult to reach to. It is the goal of this described technique: through an antero-lateral way, making a sagittal osteotomy guided on a K-wire, aiming at the lateral limit of the crush; the lateral fragment comprising the radial styloide process is then turned like a door around a posterior hinge, opening the access to the medial bony cut, at the lower part of it, the depressed fragment is clearly visible. This fragment is lowered with a chisel of appropriate width, until it joins its proper level; then a fragment of cancellous bone taken in the upper part of the cut is crammed in the room above the "die-punch". The "door" is then closed and fixed with a screw, without any problem of consolidation, so as the rehabilitation may be initiated immediately. The practice of this procedure is till now limited to a few cases (two), but the results are very encouraging. This technique is worthy to be tried by other hand surgeons.

Bone Screws↗
PubMed1998

[The radio-ulnar unit. Its functional importance in fractures of both bones of the forearm].

The forearm has been composed of two bones since our very old ancestor Ichthyostega, which settled on dry land 300 million years ago. The fish fins, transformed into legs, already comprised two bones, which only became useful much later. This "frame", composed of 2 bones rotating around a longitudinal axis, is the most "practical" mechanical solution to allow longitudinal rotation of the distal extremity, but this rectangle must be pliable in a diagonal plane by means of the two conjoint radioulnar joints and a flexible hinge, the interosseous membrane. This system can only function when certain conditions are respected: strict alignment of the axes and simultaneous functioning of the two joints, maintenance of the "coordinated" shape of the two bones, an intact system of union of the two bones and coaptation of the joints. These anatomical and functional devices may be compromised by many pathological conditions, which is why the pronation-supination function of the forearm is so important and so vulnerable.

Animals↗
PubMed1991

["Reduction-effect" ARUM-type intra-focal pins in the osteosynthesis of fractures of the lower end of the radius].

Used for 13 years, the "Intra-Focal Pinning" procedure for the fixation of the Colles fractures, has been criticized on certain points: pin expulsion, risks of injuring the tendons by the cut end of the pin. A new type of pin in proposed, the "ARUM" pin, that is composed of a 20/10 mm screwed pin and a special nut, which has a curved conical form, with a convex base bearing a cruciform groove. Its axial canal has a little space at the base. There are two ancillary tools: a special wire-cutter with asymmetric cutting blades, that can cut the pin close to the nut, and a compound screwdriver and pin-holder. With this tool, it is possible to put the pin in its right place and to screw the "ARUM" nut very precisely: the concave conical form of the nut makes it possible to slide between the tendons without injuring them and widening the fracture site: this is the "reduction effect". In practice, the pins are introduced in the same way as the previously described procedure, by they must protrude beyond the opposite wall by 6-8 mm; the difference is in the screwing of the "ARUM" nut: first it is screwed as the reduction stress is increased so its conical part penetrates between the fracture edges; then the pin is cut; and the nut is unscrewed so the cut end of the pin will be included in the space of its base. Unscrewing is continued until the sharp end of the pin just extends beyond the cortical wall, but without losing the reduction.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Nails↗
PubMed1989

[Osteosynthesis using the "palm-tree" nail technic in fractures of the surgical neck of the humerus].

Presented in 1974, this technique consists of internal fixation of the humeral neck by means of three divergent K-wires. These are introduced through a proximal entry point located on the lateral aspect of the humeral diaphysis at the lower end of the "V" shaped insertion of the deltoid which is one of the three subcutaneous areas of this bone. The two principles of this technique are: anchorage of the epiphysis by three divergent pins driven into the cancellous bone of the head and introduction of the pins from a very proximal point that allows easy access across the fracture without the disadvantages of nerve and joint proximity, as in other techniques involving other pins through the olecranon fossa (April), or medial epicondyle or lateral (Vichard). Moreover, this technique is quite different from the Hackethal technique by nails introduced through the olecranon fossa. An oblique hole is drilled at the selected point, and three 2 mm K-wires, after bending their ends are introduced into the medullary canal. After reduction of the fracture, they are driven into the cancellous humeral head bone. By turning the handle, the pins are made to diverge. Exceptionally, operative reduction is necessary by a separate axillary approach. X-ray control or the use of an image intensifier permits one to see if a K-wire is too long and to pull it out somewhat. No cast, no operation splinting, is used. Active and passive mobilization is possible the next day so the functional results are excellent in most cases. Pin removal is possible after 3 weeks in children and 5 in adults. The indications are all the upper extremity humeral fractures, and especially in children (epiphyseal fractures); in adults and aged people, except comminuted fractures.

Adolescent↗
PubMed1987

[Intra-focal pinning of fractures of the distal end of the radius 10 years later].

Ten years after its introduction, the technique of intra-focal pinning of fractures of the lower extremity of the radius is now widely used. In view of the large number of operators, it is important to define a number of technical points: insertion of the pins without damaging the nerves or tendons, the number and type of pins, conduct of the operation, clinical and radiological criteria of success, post-operative course and removal of the pins. The author also reviews his experience concerning the frequency and the type of possible complications together with methods designed to avoid them and analyses the development of the indications for this procedure. When correctly performed, this technique, which is simple in principle, but which must be performed meticulously, provides considerable improvement in the results of these extremely common fractures due to the absence of immobilisation.

Bone Nails↗
PubMed1987

[Biomechanics of the carpus and the wrist].

Over the last decade, the classical concept of the single block carpus has been radically transformed to a more dynamic concept of a "carpus with variable geometry". This conceptual revolution is the result of progress in a number of fields: precise information concerning the situation and, more particularly, the variability of "instantaneous axes", a better understanding of the anatomy of ligaments and their role, allowing their grouping into functional units: the anterior and posterior ligamentous straps and the cuneiform sling which determines its stability and basic movements. The role of the articular disk of the inferior radio-ulnar joint involves not only the stability of the inferior radio-ulnar joint, but also the suspension of the ulnar side of the carpus. The extensor retinaculum, considered to be extra-articular slings, also has a similar role: the anterior ligament controls the concavity of the carpal groove and the dorsal ligament stabilises the posterior ulnar tendon. The essential progress consists of the concept of the first row of carpal bones as an intercalated structure, in particular the concept of "useful space" or "useful distance" between the antebrachial joint cavity and the second row of carpal bones, filled in by the elementary movements of the bones of the first row. This discovery leads directly to concepts of "internal coherence of the carpus " or spatial coherence and the "variable geometry" of the carpus. This approach reveals the internal components of the movements associated in the global movements of the wrist. The last essential concept is that of self-locking and facilitation of the fist row of carpal bones as a result of the interosseous ligaments, which clarifies new syndromes of internal instability of the carpus.

Biomechanical Phenomena↗
PubMed1987

[Proposal for a clinical score for flexion-extension of the long fingers].

After many methods of evaluation of the hand function, this last one does not need any measuring of angle nor length because the hand is its own system of reference: the thumb is the scale for the measurement of the flexion and the plane of a table for the extension. The measurements are noted from 5 to 1, from the best to the worst function: so the best hand obtains the best score. The evaluation of off grip between palm and fingers needs cylinders of specified diameters corresponding with common things as pencil or knitting needle, but it is possible to use the opposite hand instead. Adding the measurement of the opposition, it is possible at the end of the examination to fill a hand global function form easy to enter in a computer. The advantage of this method is that it evaluates the result from the patients' point of view: that is to say in terms of different types of grip. It is a global and functional evaluation, easy to use in any circumstances, but other more precise methods may be employed simultaneously for special cases such as results in tendon or joint reconstruction.

Classification↗
PubMed1986

[Functional anatomy of the lst web space].

In order to ensure the efficacy of several types of grips, the first web space and the function of contra-opposition, i.e. spread of the thumb from the rest of the hand, must be normal. The anatomic elements that contribute to this function are as follows: the trapezometacarpal joint, the range of motion which may be limited if cartilage lesions, osteophytosis or ligament contractures are present; the first dorsal interosseous, the adductor pollicis muscles and the fascial clefts between them. Contracture of these fasciae, usually ischemic in nature, may cause contracture of the first web space ; the neurovascular elements, which are implicated in paralysis and Volkmann's contracture ; the teguments of the web space and thenar aponeurotic system in which cord-like thickening (as in Dupuytren's contracture), accidental or surgical incisions, may result in severe contracture of the first web space. Involvement of these anatomic structures may be isolated or, more often, associated. Surgery must be adapted to each case, which means taking painstaking care in the evaluation of these factors by thorough clinical examination, and completed by adequate radiograms.

Biomechanical Phenomena↗
PubMed1986

[Clinical test of apposition and counter-apposition of the thumb].

In order to test the opposition and the counter-opposition (reposition) of the thumb, the method proposed here does not require the measuring of angles; rather, the hand itself is used as the system of reference. The opposition test consists of touching the four long fingers with the tip of the thumb: the score is 1 for the lateral side of the second phalanx of the index finger, 2 for the lateral side of the third phalanx, 3 for the tip of the index finger, 4 for the tip of the middle finger, 5 for the ring finger and 6 for the little finger. Then, moving the thumb proximally along the volar aspect of the little finger, the score is 7 when it touches the DIP crease, 8 on the PIP crease, 9 on the proximal crease of the little finger and 10 when it reaches the distal volar crease of the hand. This test is valid only if the first stages are possible: a crawling thumb in the palm is not an opposition motion. The counter-opposition test (or reposition test) needs the other hand as a reference system. The hand to be tested is set upon the table palm-down while; the other hand is laid on the table on its medial side, close to the tip of the first hand thumb; now this thumb is actively drawn up as high as possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1986

[Biomechanics of the carpus and wrist joint].

During the last decade the classical idea of the rigid carpal block was abandoned in favour of the "carpus of variable geometry". The basic advantage of this new concept is the presumption that the proximal carpal row can be regarded as an intercalated structure, and the idea of the "useful distance" between the forearm socket and the distal carpal row. This "useful distance" can be filled up by elementary movement of the bones of the first carpal row. This directly leads to the concept of the "internal coherence of the carpus" and "variable geometry". The internal components of associated movements in the carpal region are described. Finally, the self-blocking system, the associated movement of the bones of the first carpal row caused by the interosseous ligaments, and the new definition of carpal instability are also discussed.

Biomechanical Phenomena↗
PubMed1985

[Intersesamoid resection-suture of the metacarpophalangeal joint of the thumb. Sesamoidorrhaphy of the metacarpophalangeal joint of the thumb].

In some cases, congenital or acquired posterior instabilities of the MP joint of the thumb may cause pain or create functional disorders. It is possible to stabilize the metacarpophalangeal joint by partial resection of the ligament joining the two sesamoids which makes it possible to move and suture them toward each other. An enlargement plasty of the pulley then is required. This technique prevents hyperextension but without restricting flexion or opposition. The digital nerves must be carefully identified and protected.

Adolescent↗