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Biomedical subjects

C Bour

Publications and source records attributed to C Bour.

At least 19 recordsLinked to original sources
PubMed1992

Scapho-trapezio-trapezoid arthrodesis in the treatment of Kienböck's disease. A study of 16 cases.

Sixteen scapho-trapezio-trapezoid arthrodeses were performed for Kienböck's disease. In ten cases, a prosthetic replacement of the lunate was inserted at the same time. Clinical results were good with regard to pain and fair with regard to grip strength which was improved by an average of 32%. In contrast, the arc of flexion-extension was 38% less than on the unoperated side. Long-term radiographic assessment showed the efficacy of the procedure in maintaining carpal height. Biomechanical observations and a review of poor results showed the limits of the method and the importance of correct positioning of the scaphoid. We concluded that triscaphe arthrodesis was a useful procedure for the treatment of Kienböck's disease in Decoulx's stage 3.

Adult↗
PubMed1992

[Lipofibroma of the median nerve. Apropos of a case].

Lipofibroma is a rare, benign nerve tumour corresponding to diffuse fibroadipose infiltration of the nerve, dissociating the fasciculi without invading them. The authors report a case of lipofibroma of the median nerve in a 32 year old man presenting with a soft swelling of the palmar surface of the thumb. Treatment consisted of intraneurodissection of the tumour arising exclusively from the medial collateral nerve of the thumb. With a follow-up of two years, there has been no recurrence of the tumour, but the patient has persistent decreased sensation of the ulnar half of the thumb pulp. The features of the lipofibroma and the therapeutic options are discussed in the light of the data reported in the literature.

Adult↗
PubMed1991

Human nerve xenografting in nude mouse: experimental study of graft revascularization.

In the nude mouse, the congenital absence of T lymphocytes makes it possible to implant human nerve grafts without rejection or iatrogenic modifications (by immunosuppression) of human and murine tissues. Medial antebrachial cutaneous nerves were harvested from human cadavers 1-18 hours after death. These nerve grafts were implanted using different techniques in nude mice. All the grafts were macroscopically and microscopically revascularized 3 days after implantation. The modifications in time of this vascularization could be studied with precision through the use of repeated biopsies. The absence of human blood group antigens on the neovessel endothelium suggested a murine origin for angiogenesis. In situ DNA hybridizations with human and mouse DNA confirmed this origin. The topography of the revascularization (maximal in the perineurium and endoneurium) and the almost complete absence of human cells other than Schwann cells in the grafts at the peak of angiogenesis (26 days after grafting) suggested that Schwann cells had a determining role in graft vascularization. The irradiation of the nerve grafts with a dose of 30 grays before implantation did not modify significantly their histologic appearance compared to the control group, whereas an irradiation of 60 grays led to massive lesions. The neurotization of murine axons led to chimerical structures of normal histologic appearance, with vascularization similar to that observed in nonneurotized nerves. Through chimerism (human Schwann cells, murine vessels and axons) this model makes it possible to dissociate the respective role of the host and of the nerve graft in angiogenesis and suggests the existence of growth factors produced by the human Schwann cells.

Adult↗
PubMed1991

[Arthrodesis of the wrist in manual workers. Apropos of 36 cases].

We present a review of 36 patients with final radiocarpal arthrodesis done between 1976 and 1987. The series was homogeneous: patients were about 40 years old and lesions were work-related. The most frequent reason for the arthrodesis was fracture of scaphoid bone, followed by Kienbock's disease complex trauma of carpus, severe carpal sprain, and articular fracture of the distal fourth of radial bone. Thirty-one arthrodeses were done by screwed-on iliac graft, 5 by nailing following Mannerfelt technique. The two main factors in functional results were pain and loss of strength. The latter averaged 41 per cent of that of the normal side, and only 8 wrists were completely free of pain. Indications for final radio-carpal arthrodesis are discussed, taking into account the poor functional results and their repercussions on social and professional life of the patient.

Accidents, Occupational↗
PubMed1991

[Partial toe transfers. Functional results: apropos of 26 cases].

We present our results from a series of 26 partial toe transfers (11 pulp transfers and 15 composite tissue transfers) performed in posttraumatic reconstruction of the thumb (22 cases) and fingers II to V (4 cases). There was one failure due to arterial thrombosis. The results for sensitivity were satisfactory after pulp transfer (Weber-average of 9 mm), less satisfactory after composite transfer. Recovery of mobility and strength usually were satisfactory. Problems with the donor foot were mainly slow healing and poor tolerance to cold; the latter was experienced by 1/3 of the patients although functional deficits were rare. Partial toe transfer is used at present for distal reconstruction of the thumb, and leaves the metacarpophalangeal joint intact. There are basically two techniques: "tailored" transfers from the big toe for amputations of the distal phalanx of the thumb, and wrap-around flap of Morrison for amputations proximal to the proximal phalanx.

Adolescent↗
PubMed1991

[Scapho-trapezo-trapezoidal arthrodesis or triscaphe arthrodeses. Study of 36 reviewed cases].

From May 1983 to September 1988, we performed 41 triscaphe arthrodeses, 36 of which underwent clinical and radiologic follow-up examination. The 36 preoperative diagnoses were classified as: Kienböck's disease (16 cases), chronic rotatory subluxation of the scaphoid (static scaphoid-lunate dissociation) (13 cases), degenerative arthritis of the scapho-trapezio-trapezoid joint (4 cases), traumatic lesion of the scapho-trapezio-trapezoid joint (2 cases), 1 case of midcarpal instability with a non-dissociative VISI pattern. Average length of follow-up was 28 months. Analysis of results showed on the whole good improvement on pain and average improvement of strength; range of motion varied greatly with etiology. For example, the range of motion on the fused side in Kienböck's disease averaged 38 per cent of that of the unoperated side, whereas in other conditions it averaged 60 per cent. Radiographic analysis confirmed the efficacy of triscaphe arthrodesis in preserving normal carpal height but revealed radial styloid impingement in 34 per cent of the cases. Use of this procedure should be limited to stage 3 Kienböck's disease and to scaphoid-lunate dissociation without arthritis. Peroperative radiographic study is indispensable to verify appropriate reduction of the scaphoid and to measure the radial-scaphoid angle. Partial radial styloidectomy should be included routinely in the procedure.

Adult↗
PubMed1989

[The socio-economic costs of finger replantation. Apropos of 40 replantations of the thumb].

Microsurgical techniques are becoming increasingly important in the emergency treatment of hand trauma and in secondary reconstructive surgery. In the light of the current concern with financial feasibility, we thought it important to determine whether this surgery, sometimes wrongly described as being luxury surgery, is economically feasible. The cost of 40 reimplantations and revascularisations of the thumb treated in the context of work accidents was studied. Although the short-term cost of reimplantation is higher than that of amputation, in the long-term, a successful reimplantation constitutes a definite economy for society and justifies this type of specialist surgery.

Amputation, Traumatic↗
PubMed1989

[A single-use vascular clamp. An experimental and clinical study].

Twelve rabbit femoral arteries were clamped for one hour with a TKS2 clamp in order to confirm the atraumatic nature of the Tamai disposable clamp. After 15 or 30 minutes of revascularisation, the arteries were excised and studied by light microscopy and scanning electron microscopy. Temporary dilatation of the artery was observed after removal of the clamp, as the patency test was always positive. Light microscopy revealed parietal flattening without any cellular disorganisation and scanning electron microscopy revealed flattening of the endothelial cells without any tearing. On the basis of these favourable results, combined with the ease of use, we now use the Tamai clamp daily.

Animals↗
PubMed1989

[Claw nails. Apropos of 16 cases treated by nail recession flap].

16 patients (75% women) were operated for a claw nail involving one of the three middle fingers. In 14 cases out of 16, a traumatic amputation, treated by directed healing in 60% of cases, was responsible for the deformity. The average loss of bone substance was 49% (range: 0-90%). The average shortening was 5 mm. The loss of substance was repaired by a local flap in 14 cases. Two early recurrences led to one failure and one good result after a second recession flap. One case of arthritis of the distal interphalangeal joint and one case of septic necrosis of the nail bed were also observed. Eleven subjects were reviewed with a mean follow-up of 4 years (1-7 years). The range of movement of the distal interphalangeal joint was always normal. The pinch force and the growth of the nail were normal in 75% of cases. The finger was cumbersome in one half of cases and 60% of patients complained of pain. Recurrences were observed in 50% of cases and the patients were disappointed in 64% of cases. This is a minor operation in terms of vascular elements, but it is associated with a high rate of recurrence and leaves a short finger. Its indications should be limited to losses of bone substance less than 50%.

Adolescent↗
PubMed1989

Tendon transfers for treatment of the paralyzed hand following brachial plexus injury.

The correction of functional deficits of the hand after a brachial plexus lesion is difficult; treatment should be provided by a well-knit team of surgeons and therapists. The patient should be fully aware of the limitations of surgical treatment before surgery, and should be entrusted to the care of a physical therapist during the critical period of nerve regeneration after initial surgical treatment to ensure optimal results. This article presents therapeutic possibilities and discusses specific problems of tendon transfers in brachial plexus palsy.

Brachial Plexus↗
PubMed1988

Effects of cyclosporin A and predegeneration on survival and regeneration of peripheral nerve allografts in rabbits.

Axonal regeneration across 64 median nerve grafts in 34 rabbits was studied histologically to determine the optimal conditions for nerve allografting. Axonal regeneration across allografts in cyclosporin A-treated animals was satisfactory, but it occurred more slowly and with more inflammation and fibrosis than in autografts. Without immunosuppression, fresh allografts were rejected. However, in immunocompetent hosts, allografts rendered less immunogenic by predegeneration were not rejected, and axonal regeneration occurred. The combination of cyclosporin A and nerve graft predegeneration produced the most substantial axonal regeneration, comparable to autografts. The observations suggest that nerve allograft survival may be optimally effected by cyclosporin A treatment coupled with reduction in the immunogenicity of the grafts, such as by predegeneration.

Animals↗
PubMed1988

Hyperostotic macrodactyly.

There is a rare and special type of macrodactyly that is called the hyperostotic variety. This disease occurs later than the classical forms of macrodactyly and shows massive osteocartilaginous deposits around the joints. A new case is reported. The cause of this disease could be previous trauma.

Adult↗
PubMed1988

[Miniaturized osteosynthesis of articular fractures of the fingers. Results of a series of 60 cases].

The importance of anatomical reduction of articular fractures and early mobilisation of these severe forms of trauma which frequently damage the extensor apparatus (58% of cases, led us to propose direct miniaturised osteosynthesis as described by the Nancy-Strasbourg team. Of the 1,000 cases of osteosynthesis performed between 1978 and 1985, we selected 12 fractures of the MP joint, 38 fractures of the PIP joint and 10 fractures of the DIP joint, differentiated into 4 stages according to the condition of the skin and tendons and into 9 categories according to the anatomical type and the site of the fracture. Direct osteosynthesis (screw, bolt, pin) was used in every case. The clinical results were evaluated in terms of the Total Active Range of Movements, the local trophic state, the amount of pain and return to work, for each joint. When well conducted and with effective skin cover, this technique allows almost normal reconstruction in simple fractures and is valuable in more complex fractures by preserving sliding of the tendinous apparatus due to early mobilisation.

Adolescent↗
PubMed1988

[Trans-triquetral triquetral-lunate arthrodesis].

Transtriquetral triquetro-lunate arthrodesis is an original technique for partial arthrodesis of the wrist. This operation is indicated in the treatment of certain forms of triquetro-lunate instability and represents a new approach to the treatment of Decoulx's stages I and II of Kienböck's disease. The incision is medial and limited. The use of a special trephine guided by a pine allows the extraction of a triquetro-lunate osteocartilaginous cylinder. A cancellous bone graft is then performed to fill in the loss of substance. This new, simple surgical procedure, but demanding in terms of its technique, should decrease the failure rate and should improve the chances of lunate revascularisation.

Arthrodesis↗
PubMed1988

[Littler's operation (SORL = spiral oblique retinacular ligament) in the treatment of "swan neck"].

The surgical treatment of "swan-neck" deformities secondary to mallet finger using Littler's technique (Spiral Oblique Retinacular Ligament) in a series of 35 cases, led to a complete correction of the PIP joint hyperextension in 95% of the cases and a correction of the DIP joint flexure in 70% of the cases. This active tenodesis restores the physiology of the extension of the PIP and DIP joints as far as the surgical technique has been strictly respected.

Adolescent↗