Biomedical subjects
Publications and source records attributed to C Camelot.
An unusual case of vertical atlantoaxial dislocation without medulla oblongata or spinal cord injury is reported. The pathogenic process suggested occipito-axial dislocation. The case was treated surgically with excellent results on mobility and pain.
PURPOSE OF THE STUDY: The authors evaluated the anatomical results and limits of the conservative treatment for displaced Colle's fracture. MATERIAL AND METHODS: The anatomical results of 280 consecutive fractures were retrospectively analysed. Conservative treatment was performed according to Judet. Stability of the reduction was assessed for grade 0, 1, 2 of Kapandji's classification. Radiographical mean follow-up for all patient was three months (2 months to 8 years). RESULTS: In 122 cases (64 per cent) mal-union was observed. Mal-union was due in 93.5 per cent of cases (114) to secondary displacement of the distal fragment and in 6.5 per cent (8 cases) to poor reduction. Secondary displacement was essentially posterior in the sagittal plane. The principal factors of instability were radial shortening superior to 3 mm (p = 0.005), patient age of 55 years of more (p = 0.004), metaphyseal comminution (p = 0.004) and degree of primary displacement in the frontal plane (p = 0.01). Stability after reduction was determined by crossing the distal fragment in relation to the anterior cortex of the proximal fragment. There were 10.5 per cent algodystrophies and 9 per cent median nerve paresthesiae which were avoided by 45 degrees of wrist flexion. DISCUSSION: Judet's conservative treatment is indicated in extra-articular Colle's fractures (grade 0, 1, 2 of Kapandji's classification), after evaluation of factors of instability, secondary displacement and mal-union. Minor mal-unions may be well tolerated, and do not seem to affect wrist function with 3 mm of radial shortening and 10 degrees of radial glenoid posterior angulation on the sagittal plane.
From 1981 to 1994, 16 patients with 18 thoracic disk hernias due to degenerative disease (n = 13), trauma (n = 4) or Scheuermann's disease (n = 1) received surgical treatment. Most were situated from T6 to T12. There were 10 medial hernias and 8 lateral hernias. Symptom duration was a mean 23 months at surgery including spinal pain (n = 13) and spinal syndrome (n = 9). Posterolateral access was used in 13 cases and the anterior route in 2, both requiring a graft. After a follow-up of 5 years 1 month, functional and subjective results were excellent or good in 83% of the cases, acceptable in 6% and poor in 11%. Two failures with the posterolateral route corresponded to one patient with initial trauma-induced paraplegia and another with neurological aggravation after the first laminectomy. In our experience, the posteriolateral route is preferred to allow good visual control even in cases involving several levels. Secondary laminectomy may be performed without risking displacement. The presence of the Adamkiewicz artery on the same side and at the same level dictates use of the anterior route which may soon be replaced by video-assisted thoracoscopy to avoid resection of the rib.