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D G Poitout

Publications and source records attributed to D G Poitout.

8 recordsLinked to original sources
PubMed2000

[Fractures of the shaft of the humerus: systematic plate fixation. Anatomic and functional results in 156 cases and a review of the literature].

PURPOSE OF THE STUDY: Based on our experience with plate fixation of humeral shaft fractures and an analysis of the international literature, we attempted to answer the following questions. What functional outcome and what complications can be expected after surgery? Are the classical complications of open fracture surgery (screw fixation, wiring, plate fixation without compression.) as frequent after plate fixation using the Müller technique? MATERIAL AND METHODS: We reviewed our series of 156 humeral shaft fractures (61 p. 100 men, mean age 45 years) including 21 cases of multiple trauma and 24 multiple fractures. A floating elbow was present in 8 cases and skin opening in 16. Initial radial deficiency was observed in 28 cases. Plate fixation was the only method used for the humeral shaft fractures. We used the modified Stewart and Hundley classification. RESULTS: Postoperative paralysis occurred in 8 cases (5.1 p. 100, 5 complete paralysis); only one patient suffered persistent severe sequelae. There were also 8 malunions and 3 late consolidations. Consolidation rate was 94.2 p. 100, sepsis rate was 1.5 p. 100. Good or very good outcome was achieved in 86.6 p. 100 of the cases. DISCUSSION: In the literature, (71 series, 5 000 patients), plate fixation of humeral shaft fractures has given very good functional results with few initial failures, malunions or cases of sepsis. Radial paralysis is cited as a complication in 6.5 p. 100 of all plate fixations but is reversible in 90 p. 100 of cases. Classical orthopedic methods and centromedullar techniques produce more stiffness. The Sarmiento cuff can give good results after rigorous patient selection. CONCLUSION: Plate fixation according to the Müller technique is a reliable osteosynthesis method with few initial failures or malunions as evidenced by data in the literature. Infection is also rare. Although the radial nerve risk makes this technique rather difficult, excellent functional results can be achieved.

Adolescent↗
PubMed1999

[Interbody arthrodesis using a plasmapore titanium block. Mechanical and histological experimental study in sheep].

UNLABELLED: A Plasmapore-coated titanium alloy block was implanted in ewes for the purpose of providing interbody fusion. Four blocks were implanted in each ewe: one uncoated block (without Plasmapore) serving as a reference specimen and three blocks coated with Plasmapore. Mechanical testing and histological study were performed on five ewes. OBJECTIVES: Determination of the quality of the mechanical and histological anchorage of the Plasmapore implanted in the interbody space in the same animal living under conditions of physical strain exerted on the spine. METHODS: Four months after surgical implantation of the block, the ewes were sacrificed: the removed spines were frozen for subsequent mechanical analysis and preserved in a solution of 40 degrees alcohol for subsequent histological analysis. X-rays were taken to evaluate the positioning of the implant. The mechanical analysis included extraction tests, measuring the maximum extraction force and evaluating the stiffness of the system, being indicative of the mechanical fixation quality. The histological study included both qualitative and quantitative analysis, together with an evaluation of the osteointegration of the blocks coated with Plasmapore. RESULTS: After 4 months of implantation, a mean extraction force of 990 N was necessary for the blocks coated with Plasmapore, and of 1.338 N for the blocks coated with Plasmapore with additional osteosynthesis, whereas a mean extraction force of 332 N was necessary for the uncoated blocks. Anchorage and resistance against uprooting of the blocks coated with Plasmapore were significantly more efficient. The histological study revealed the presence of bone neoformation adhering to the implant. Quantification of this bone formation covering nearly 45% of the implant perimeter, confirmed both osteointegration of the implant perimeter, confirmed both osteointegration of the implant surfaces being in contact with the vertebral endplates and osteoconduction along the lateral surfaces. CONCLUSION: The titanium Plasmapore block enables interbody fusion due to an osteointegration of the vertebral endplates by Plasmapore coating, which was proved by the results of extraction testing and histological study. It should be taken into account that no additional bone grafts have been used and that the implant had not been forced into the spongiosa.

Animals↗
PubMed1996

[Future of bone allografts in massive bone resection for tumor].

Currently cryopreservation offers the best means of preserving bone tissue for allografts. At -196 degrees C all enzyme activity is halted and tissue preservation is unlimited. Perfect sterilization, adapted cryoprotection and controlled freezing and thawing are now part of the well-controlled process of bone preservation in bone banks. At implantation, the mechanical properties of cryopreserved bone is as good as or better than fresh bone, although the diaphyseal cortical bone is more fragile. Anatomic and physiologic reconstruction of the graft area is a major factor in graft resistance. It takes approximately three weeks for vessels to penetrate cancellous allografts and at least one month for total revascularization. The delay may reach several years for cortical bone. The immune response of the host is determined by the antigenic properties of the leukocytes in the bone marrow as well as the blood vessels and nerves. The protein-mineral complex itself has little antigenic effect. A certain number of non-specific immune reactions result from transfusions almost always performed with bone grafting. At the present time, there is no artificial material capable of providing a mechanically acceptable substitute for allograft bone in limb reconstruction. Allograft bone currently stocked in bone banks provides a biologically and clinically acceptable means of reconstruction after major bone loss. Other factors such as public acceptance and administrative authorizations will also play an important role in the future of massive reconstruction with bone allografts.

Bone Neoplasms↗
PubMed1996

[Secondary internal osteosynthesis after external fixation for recent or old open fracture of the lower limb].

PURPOSE: The purpose of our study is to analyse the indications, results and limits of secondary internal fixation after external fixation for open fracture of the lower limb. MATERIAL: Our series covered 21 patients treated between 1991 and 1994. There were 17 men and 4 women. Tibia was affected 17 times and femur 5 times (one bifocal fracture). In Gustilo's classification, we had 1 case of type 1, 12 of type II and 8 of type III. METHODS: We used 15 times the FESSA External Fixator and 6 times a monotube external fixator in emergency. We have done secondary 11 intra medullary nailing and 11 patients were treated by plating (one patient had both) 13 patients had a bone graft (cortico-cancellous graft). In the first group of patients (10 cases), the initial treatment gave us good results for both skin and bone healing. The external fixation was replaced by an internal one in order to accelerate bone consolidation and to allow an early weight-bearing. Removal of the external fixation was made at an average of 4 months postoperative. In the Second group (11 cases) the internal fixation was proposed because of an insufficiency of the external fixation leading to complications as: non union, mal union and bone defects. External fixation was removed in a mean time of 8 months. Internal fixation was completed by local bone autograft. RESULTS: 17 patients have been reviewed. Consolidation occurred with an average of 6 months after internal fixation 1 to 24 months. We had no deep infection but only 2 superficial ones. DISCUSSION: We chose 2 types of indication, and we called them programmed and for necessity. The first group of 10 patients whose stain was moderate and whose initial setting up had permitted a perfect anatomic reduction with a rapid wound healing. Internal fixation was performed after a short duration of external fixator. An early weight bearing was allowed so that the functional recovery could be obtained quickly. The second group is represented by patients whose internal fixation was done for non union, malunion or bone defect. In such a case autogenous cancellous graft was used to fill the defect.

Adolescent↗
PubMed1996

[Reconstruction of the acetabulum after iterative surgery of the hip (report of 38 cases)].

UNLABELLED: The hip revision surgery like oncology surgery may need massive allografts to rebuilt the acetabulum or an hemi pelvis. Since 1982 we have chosen to use deep frozen massive allografts instead of massive metallic prosthesis, resection, or osteosynthesis of the femur to the iliac bone or the sacrum. These last proposal seems for our patients too heavy, the functional results being always bad. PATIENTS AND METHODS: --37 Acetabulum reconstruction has been performed. (18 hemi-pelvis). --The follow-up is from 1 to 12 years with a medical of 5 years and 2 months. --The tumoral pathology (14 cases) was for 50% chondrosarcomas [7]. 6 infections (1 massive echinococcosis and 5 osteomyelitis) --17 hip reconstruction for revision surgery. We use deep frozen allografts cryopreserved with Dimethylsulfoxide 10%. No secondary irradiation. The allografts were used after securisation (after the 6th month after the procurement). Most for the time we used 2 platres, one posterior outside the pelvis, one anterior inside the pelvis. Screwed on the contralateral pubis bone and the sacrum. A hip prosthesis was used in almost all the cases. In tumoral cases, the results were excellent with chondrosarcomas but in the other cases metastasis and death were usually seen in the 2 or 3 years following the surgery. --3 instability of the prosthesis. --2 fractures of the allograft. In the non tumoral cases, the integration of the graft was excellent. --1 instability of the prosthesis needed a antiluxent crescent. --1 fracture of the graft needed adjonction of autografts and new osteosynthesis. --1 superficial infection. Good functional results has been obtained with the use of massive allografts. The fracture of the allografts can heal without a new operation. In some cases we have had some liquid surrounding the grafts which can be a immunological response.

Acetabulum↗
PubMed1995

[Bone biomaterial].

The use of deep frozen allografts is not a recent technic. The evolution of the conservative technics authorize a sufficient preservation of osseous and cartilaginous structure. The clinical results are considered as good in most of the cases. The intra medullary cells are most involved in immunological responses but clinically speaking only 10% to 20% of the case treated has a reject. The becoming of the grafted tissue is best if the recipient is young, the graft well fixed and the muscular surrounding well vascularized. 454 grafts and 64 massive osteochondral allografts have been archived between 1979 and 1993 for traumatic, tumoral, and surgical diseases. The results have been considered as good or excellent in 85% of the cases. The actual problems are the biomechanical behaviour of the ligamentary revascularization and fixation which gives in numerous cases a high percentage of loosening.

Biocompatible Materials↗
PubMedDate not supplied

[Massive reconstruction of the acetabulum and proximal femur].

Bone allografts are used in situations of repeated hip surgery to repair bone loss and allow muscle fixation without excessive use of massive metallic prostheses. We examined 51 cases of hip reconstruction after a mean follow-up of 3 and a half years. Indications were: reoperations on arthroplasties, usually after the weight carrying areas of the acetabulum had been destroyed; repeated operations on the upper extremity pellucid femurs; bone tumours (especially chondrosarcomas). Results have been good based on patient satisfaction, mobility and consolidation of the allograft-bone junction. Complications included: post-operative death after major surgery for invasive tumours (n = 4); sepsis (n = 2); hip luxation requiring an anti-luxation crescent (n = 3); and aseptic serous effusion suggestive of possible immunologic reactions against the bone grafts (n = 3). These operations were compared with massive reconstruction prostheses, with arthrodeses with limb shortening and with hanging limbs, and in certain cases with interilioabdominal amputations.

Acetabulum↗