[AO unreamed femur nails. Initial results].
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Adult↗
Biomedical subjects
B E Elias
Publications and source records attributed to B E Elias.
[Retrograde centromedullary locked nailing for fractures of the lower portion of the femur].
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Adolescent↗
[Value of the surgical approach through the patellar tendon for intramedullary nailing of the tibia and the femur].
The goal of this study was to propose a new approach of the upper tibia for intramedullary nailing. Since two years, the authors performed a transversal skin incision superior to the distal end of the patella. The patellar tendon is dissociated and the tibia is perforated through the anterior intercondylar area. The advantages of this approach versus classical techniques are discussed. This approach allows isolated tibial or femoral nailing but also both nailings during the same procedure.
Bone Nails↗
[Additional supra-malleolar osteotomy].
This old operation is rarely practiced and it appeared interesting to precise its technique and indications from a short series. In the majority of our cases, a valgus type osteotomy by medial graft addition was performed. One or more prismatic triangular graft are taken from the full thickness of the iliac crest. The respect of the fibula protects the periostal hinge on the other side of the surgical approach; so the graft under pressure will have rapid and constant consolidation. Tibial osteosynthesis is facultative. We can distinguish major indications of that type of osteotomies: supramalleolar malunion, while the fracture of the fibula associated to the tibia is a contra-indication for that operation. The other indications are the distortion of the pilon articular surface and old ligamentous lesions leading to osteoarthritis. In some cases, it is appropriate to realise valgisation of the articular surface, with an overcorrection to harmonise the pressure on articular surfaces; on that condition, an osteotomy of the fibula has to be discussed. The rapid and constant good results obtained with those iliac crest grafts interposed between the two fragments of the tibia contrast with those hazardous results of inlay or onlay grafts, free from all mecanical sollicitations.
Adult↗
[Ascending intramedullary nailing of the femur. Technique. Initial results. Indications].
Some fractures of the distal third of the femur are not good indications for the centromedular locked nailing technique where the nail in inserted through the greater trochanter. Indeed, unsatisfactory reduction and stabilization are often obtained. Inversely, when the nail is inserted upwardly from the knee joint after drilling an orifice in the trochlea and the condyles, the mechanical locking is very close to the knee joint and, when the subtrochanter region is reached, the nail automatically aligns the fracture. The implant temporarily used was a centromedular tibial nail rotated by 180 degrees and mechanically locked near the knee under fluoroscopic control near the lesser trochanter. Five trauma cases were treated with this technique. Early results have been encouraging, similar to those obtained for nailing with closed surgery. These results would suggest that upward nailing should be conceived for particular indications: fractures of the supracondyle area, spiral and comminutive fractures of the distal third of the femur, certain fractures of the supra and inter condyle area.
Adult↗
[Results of the primary repair of the collateral palmar digital nerves].
The aim of this study was to analyse the results of primary collateral digital nerve repair as a function of several factors: age, surgeon's experience, type of lesion and associated lesions, etc. The conclusions are based on a homogeneous series of 64 patients with 83 nerve lesions treated by primary microsurgical nerve repair with a follow-up of at least one year.
Adolescent↗
[Treatment of extensive traumatic loss of substance of the foot and ankle by free flaps. Apropos of 7 clinical cases].
The authors report 7 cases of extensive skin defects of the foot and/or the ankle treated by using a free flap. All cases presented with major trauma of the lower limb with obvious exposure of bone and joint tissues. The skin defect was covered: as an emergency in 4 cases; within the 48 hours following the trauma in 3 cases; on the 7th day after the injury in 1 case. The free flap used was: the latissimus dorsi muscle, 2 cases; the gracilis muscle, 1 case; the serratus anterior muscle, 1 case; the greater omentum, 2 cases. Arterial microanastomoses were performed onto the anterior tibial or pedal arteries, in 4 cases, and onto the posterior tibial artery in 4 cases. Except for 1 failure on the 8th day after the operation due to thrombosis of the venous anastomosis, requiring arthrodesis of the ankle, the outcome was favorable in all other cases, free of osteitis or arthritis. The authors emphasize the importance of covering defects the lower limb as quickly as possible, ideally as an emergency, when a free flap is required.
Adult↗
[Procedures for repairing skin losses of the knee with joint exposure].
The authors analyse the various procedures for covering skin defects at the knee region exposing either the bones or the joint. Actually, various local flaps allowed in most cases coverage in this area using either a pedicular muscle flap or fasciocutaneous, or even an island flap. For every local flap, its vascularisation, its technique of elevation and its arc of rotation are described. Occasionally, free flaps or cross leg flaps have been used. Indications depended on the patient age, topographic size of the defect, time of covering in emergency or secondarily, trophicity of the surrounding soft-tissues and also the eventual associated vascular injuries.
Humans↗
[Global exposure of the lower extremity of the radius by extended external approach].
With classical lateral access to the lower radius, only the styloid process is correctly exposed and many surgeons prefer elective anterior routes, or more rarely posterior access. Our experience with posterior compression-extension fractures of the lower radius using a posterior plate has led us to describe the modalities of progression to the bone without injury to the tendons and vasculo-nervous bundles. The technique described scrupulously avoids injury and also allows safe iterative access. Finally, and most importantly, this technique also exposes all the aspects of the bone. It can be successfully used for internal fixation in difficult cases and also for the treatment of former acquired or congenital deformations of the epiphysis. This route has been shown to be safe and successful in a prospective series of 187 applications of posterior plates for compression-extension fractures.
Bone Plates↗