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Biomedical subjects

E Gagneux

Publications and source records attributed to E Gagneux.

At least 19 recordsLinked to original sources
PubMed2002

[Imaging of complications following hip arthroplasty].

Acute complications include fractures and prosthesis dislocations. Most chronic complications involve mechanical or septic loosening and aggressive granulomatosis. Greater trochanteric pseudarthrosis, periprosthetic soft tissue ossifications or prosthesis conflict with the psoas muscle can also be responsible for groin pain. Most complications are detected with serial plain radiographs, but additional imaging techniques including CT scan and scintigraphy are sometimes necessary for pretreatment diagnosis. Pain generally indicates a complication but aggressive granulomatosis can be asymptomatic, thus warranting systematic annual plain radiographic control.

Acute Disease↗
PubMed1998

Trauma emergency unit: long-term evaluation of a quality assurance programme.

OBJECTIVE: Long-term evaluation of a quality assurance programme (after an assessment in 1993). DESIGN: Review of medical records. SETTING: Emergency area of an orthopaedic, trauma, and plastic surgery unit in a French teaching hospital (Besancon). SUBJECTS: 1187 consecutive ambulatory patients' records, from July 1995. MAIN MEASURES: Occurrence of near adverse events (at risk events causing situations which could lead to the occurrence of an adverse event). RESULTS: 71 near adverse events were identified (5.9% of the ambulatory visits). There was a significant decrease in the rate of near adverse events between 1993 (9.9% (2056 ambulatory visits, 204 near adverse events)), and 1995 (5.9% (1187 ambulatory visits, 71 near adverse events)), and significant change in the proportion of each category of adverse event (decrease in departures from prevention protocols). CONCLUSIONS: Despite their limitations, the effectiveness and efficiency of quality assurance programmes seem to be real and valuable. Maintaining quality improvement requires conditions which include some of the basic principles of total quality management (leadership, participatory management, openness, continuous feed back). The organisation of this unit as a specialised trauma centre was also a determining factor in the feasibility of a quality assurance programme (specialisation and small size, high activity volume, management of the complete care process). Quality assurance is an important initial step towards quality improvement, that should precede consideration of a total quality management programme.

France↗
PubMed1997

[Treatment of complex fractures of the ankle and their sequellae using trans-plantar intramedullary nailing].

UNLABELLED: Nine patients were treated for complex tibial pilon and talus fractures or non unions from 1990 to 1997 using intramedullary nails introduced through the calcaneus. All patients were followed until healing. The average follow-up was 14 months. Failure of the procedure was defined by the occurrence of complications or reintervention. We used a modified Seidel nail in 5 cases, a tibial shaft nail in 3 cases, and a special nail in one case. All nails but two were locked. CASES: These arthrodeses were performed for treatment of sequels from open talus fractures. Transplantar nailing was performed between 9 months and 3 years after arthrodesis, because of non union. In two cases fusion was obtained at 3 and 8 months postoperatively. In the third case non union occurred due to instability of fixation (the nail was unlocked). Replacement by an interlocked nail was performed through a proximal tibial approach, and healing was obtained in 6 months. PSEUDARTHROSES: 2 CASES: These two cases presented comminuted tibial pilon and open talus fractures in association with vascular and tendon lesions. They had previously undergone debridement and external fixation. Transplantar nailing was performed 8 and 10 months after trauma using a locked modified Seidel nail. Radiographic fusion was obtained in 5 months. PRIMARY SURGERY: 4 CASES: The first two cases were foot reimplantations after traumatic amputation. Skeletal stabilization was obtained using a transplantar locked tibial nail. Revascularization attempts failed and an amputation was performed on the fourth day in one case. The reimplantation succeeded in the second case. Radiographic fusion was obtained in 2 months. The third case was a distal tibial shaft fracture. The patient was an obese mentally deficient and invalid woman. Bone union was achieved in four months. The last case was a primary arthrodesis for post-trauma necrosis of the talus. Radiographic fusion was observed 45 days after operation. Transplantar locked nailing offers an optimal stabilization for complex ankle fractures. We had two failures not related with the principle of the technique. We think that transplantar nailing is best indicated to obtain tibiotalar or tibiocalcaneal arthrodesis and to treat compound ankle fractures. Another indication could be distal tibial shaft fractures in invalid or mentally deficient patients.

Adolescent↗
PubMed1997

[Reflections on recent ruptures of the diaphragm. Apropos of 45 cases].

Trauma-induced ruptures of the diaphragm are very exceptional but are regularly encountered in trauma surgery units. Closed ruptures occur in 60 to 80% of diaphragm lesions in European series, 9 times out of 10 after traffic accidents. Large American trauma centers however, have had more experience with stab of firearm wounds. The diagnosis raises many problems and requires further exploration after the standard chest x-ray. We discuss the different explorations which can be contributive in both emergency and non-emergency situations. The most appropriate therapeutic approach is also discussed. Should thoracotomy or laparotomy be used? What precautions are required prior to surgery? Can laparoscopy be useful?

Adult↗
PubMed1997

[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↗
PubMed1996

Incidence and preventability of adverse events in the emergency room of an orthopaedic traumatologic surgery unit.

This paper reviews the nature and the frequency of adverse events in the everyday functioning of a French trauma emergency unit, and evaluates the feasibility of their detection by the means of a daily record review. A senior surgeon identified the adverse events by reviewing the complete record with a minimal 6-months follow-up for every patient attending the emergency unit during a 10-week period. To test the reliability of this review, a blind re-review of all records corresponding to the detected adverse events, mixed with an equal number of controls, was carried out by two independent experts. The review of the 2604 records identified 210 medical adverse events, most of them occurring early in the care process. Sixty-seven per cent of the adverse events involved prevention failure, mainly for tetanus but also for thrombosis and rabies. For the other 33% it was possible to determine two situations with a high risk of adverse event: body contusions following a traffic accident and metacarpo-phalangeal thumb sprains. The re-review evaluated the positive predictive value of the initial review to be 97.5% and its negative predictive value to be 96%. It is concluded that the review of the initial record by a single senior is effective in detecting the adverse events. Prevention of two-thirds of them could be possible by the implementation and monitoring of protocols.

Aftercare↗
PubMed1996

Fractures of the radial head and associated elbow injuries in children.

Fractures of the radial head are frequently associated with elbow injuries in children. Thirty-seven patients with this association treated at the Nancy Children's Hospital were analyzed to ascertain the mechanism and the unfavorable factors of prognosis. The mechanism responsible was a valgus strain on the elbow at the moment of impact, associated with forces of compression and distraction. At an average follow-up of 2 years, 76% excellent and good results were obtained. Conservative treatment was always effective in minimally displaced fractures. With surgical reduction by closed intramedullary pinning (CIMP), there were only three failures in severely displaced fractures. With open reduction, results were always poor; 88% patients with fair and poor results had an associated fracture of the olecranon. The unfavorable prognostic factors were the severity of the initial tilting and displacement, the presence of associated elbow injuries, the inadequacy of reduction, and the open reduction procedure.

Adolescent↗
PubMed1996

[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↗
PubMed1996

[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↗
PubMed1996

[Osteosynthesis of the odontoid process by a clover-shaped plate].

UNLABELLED: The goal was to design an osteosynthesis material able to stabilize after reduction a fracture of the odontoid process without C1-C2 arthrodesis. MATERIAL AND METHODS: The implant comprises a clover shaped plate which has to be applied on one hand on the anterior face of the dens (one leaf), and on the other hand on the anterior face of C3 (2 leaves are applied with a screw one screw for each leaf). A barrel fastened to the 3 leaves (implanted on the anterior face of the leaves, at their junction) gives way to a vertically oriented screw which will carry out dens fixation. The screw makes the compression possible. Placement through a pre-sterno-mastoid-approach, needs a special plate support and 18/10 Kirchner pins preparing the passage of the screw. RESULTS: This screw-plate designed for dens fractures (especially those with anterior displacement incompatible with a simple screwing) led to bone union in all cases. A C2-C3 subluxation operated on with the same technique was reduced and stabilized: a C2-C3 ankylosis was the consequence of a C2-C3 arthrodesis combined with the osteosynthesis. No complication was observed. DISCUSSION AND CONCLUSION: This technique is the only one able to perform dens osteosynthesis without implying postoperative immobilization. It is a significant advantage in elderly or multitrauma patients. A part from dens fractures, it can also help to manage dislocations, subluxations and serious C2-C3 sprains and even combinations as fractures of the odontoid process with axis pedicles fractures.

Bone Plates↗
PubMed1995

[Pure dislocations of the tibio-talar joint. Apropos of 9 cases].

PURPOSE OF THE STUDY: The authors relate nine cases of pure traumatic dislocation of the tibio talar joint and propose to evaluate the clinical and radiological results at a long term follow-up (mean 12 years). MATERIAL AND METHODS: The series included 9 patients (7 men and 2 women) the average age was 33,2 years. The injury was a road traffic accident in 5 cases. Pure dislocation variety of the ankle joint was medial and posteromedial in 6 cases. Open skin injury was found in 7 cases. The mean follow-up was 12 years (5-19 years). 6 patients were reviewed by the same surgeon, 6 patients were examined clinically and with ankle X-rays. All patients except one were treated by reduction, immobilization with a plaster cast for 6 to 8 weeks. The joint was examined radiographically to detect the presence of tibio talar diastasis and degenerative arthritis. RESULTS: At term we had two very good results and 3 good results (no pain or pain occasionally). We have found in 5 cases a degenerative arthritis to the ankle joint (joint narrowing <50 per cent in 3 cases, > to 50 per cent in 2 cases). No joint instability was noted at revision. DISCUSSION: Pure traumatic dislocation of the tibio talar joint is a rare injury. Medial and posteromedial variety are not frequent. Immediate gravity is dominated by vascular and septic complications and long term result by degenerative arthritis. CONCLUSION: The authors think that closed dislocations need orthopedic treatment (closed reduction and immobilization with a plaster cast for 6 weeks), on the other hand, open dislocation need surgical treatment (reduction, ligamentous reconstruction and immobilization in a plaster cast for 6 weeks).

Adult↗
PubMed1995

[Inter-trochleo-bicondylar fracture of the femur. An unusually traumatic lesion. Mechanism. Therapeutic implications].

UNLABELLED: The authors present a curious type of fracture of the distal end of the femur. They discuss the mechanism and the factors responsible for that lesion. The treatment and results are finally presented. MATERIAL: A 65 years old female, submitted to a crash accident while driving a car, with a seat in maximaly low position. She presented a bilateral open transverse fracture of the patella associated in the right limb to a fracture line between condyles and the patellar surface of the femur. METHOD: Bilateral osteosynthesis of both patella had been realised in emergency through a transverse approach. Through the fractured right patella two anteroposterior screws had been used to fix the fractured femur. RESULT: A plaster cst had been used for three weeks. Full weight bearing was permitted after three months. Full range of motion of both knees was noticed after six months follow-up. DISCUSSION: The femoral fracture could have been fixed by another device like D.C.S. platescreen but it would be weaker. That type of fracture was produced because of flexed low position of the knee at the moment of the accident. Usually, supra-condylar femoral fractures are due to a force vector applied on the upper extremity of the tibia without any patellar fracture. In our case, the patella involved associated to a fracture line between the condyles and the patellar surface. The structural anatomy (noeud sutural de Chevrier) explains the solidarity of the two femoral condyles.

Accidents, Traffic↗
PubMed1994

[The role of posterior bracket plate osteosynthesis in the treatment of compression-extension fractures of the distal end of the radius].

Osteosynthesis without immobilisation of compression-extension fractures by means of a posterior plate was studied in prospective series with a minimum follow-up of six months (first group: 73 patients) and a minimum follow-up of one year (second group: 63 patients). The clinical results were evaluated and showed several complications (no infection, but reflex sympathetic dystrophy, paresthesia, unsightly scars). The clinical and radiological findings (radio-ulnar index) could improve with several technical devices, now used.

Adolescent↗
PubMed1991

[Correction of malunion of femoral fractures by Ilizarov's device in children].

Cast immobilisation of femoral fractures in children may sometimes be subject to important displacements. Absence of survey leads to malunions which may make a secondary correction necessary. In two such cases the authors used Ilizarov's external fixation which allowed correction of both angulation and shortening without direct approach. Rapid healing occurred. The authors made a comparative analysis of the different possibilities for treatment of these severe femoral malunions.

Bony Callus↗
PubMed1990

[A mucoid pseudo-cyst of the peripheral nerve. Apropos of a surgical case].

The authors report a case of a twelve old young man, operated on for a ganglion cyst of the common peroneal nerve. The lesion is rare, and is characterized by an accumulation of a mucoïd substance in the sheath, compressing progressively the fibres of the nerve. The case was revealed with pain, paralysis and tumefaction of the nerve. The pathogenic is uncertain. An early treatment, consisting of evacuation of the cyst and interfascicular neurolysis through the dissecting microscope, obtains usually a good functional result.

Child↗
PubMed1990

[Arm lengthening in children. Report of 4 cases].

The principle of osteogenesis under stretch elaborated by Pr. G.A. Ilizarov around 1970 comfort our decision for limb lengthening for it does not need in most cases hemorrhagic operations nor use of bone grafts. Pathological shortening of the humerus may be due to various causes: monomelic dystrophy due to epiphysiodesis of humeral superior growing plate with or without humerus varus, sequelae of neonatal septic osteoarthritis of the shoulder joint are the more frequent etiologies. On the other hand, the fibrous dysplasia, osteochondromatosis (Ollier's disease), sequelae to trauma or iatrogenic etiologies are infrequent. Resulting length discrepancy are very important from 11 to 15 cm and more when growth is achieved. Functional disorders are delayed as compared to the lower limb for each upper limb acts independently to each other. However above 6 cm discrepancy coordinated movements become more difficult or impossible especially above 8 cm discrepancy. The authors reported 4 cases of arm lengthening concerning teenagers by Ilizarov's technique with a discrepancy between 10 to 14 cm. One of the humerus was previously treated by Wagner's technique which allow us to make a comparative analysis of both methods. Technical instructions, incidents and accidents occurring during lengthening, healing delays and functional and esthetic results are discussed in recent publications on this subject.

Adolescent↗
PubMed1990

[Centro-medullary nailing in fractures of the upper end of the humerus in children and adolescents].

The authors report a series of 55 fractures of the upper extremity of the humerus in children and adolescents surgically treated by elastic intramedullary nailing. The place of this surgical technique is evaluated in the general treatment of these fractures, which have the prognostic always favorable. The results, with a 1 year follow-up, are all excellent or good on the functional and anatomical plan. The cases of mal union have been rare and the correction is obtained with growth. This way be explained by the capacity of remodeling of the upper humerus. The treatment of fractures of the upper extremity of the humerus is first orthopaedic in children and adolescents, but the osteosynthesis by elastic intramedullary nailing can represent a surgical method of choice in the fractures which are displaced, unstable or which need a thoraco-branchial plaster.

Adolescent↗