PubMed Health⌕ Search

Biomedical subjects

E Havet

Publications and source records attributed to E Havet.

At least 19 recordsLinked to original sources
PubMed2005

Relationship between ultrastructure and biomechanical properties of the knee meniscus.

The purpose of this study was to determine the biomechanical properties of the knee meniscus and to relate them to its ultrastructure. The knee joint menisci are semicircular, fibrocartilaginous structures interposed between the femoral and tibial condyles. For a long time, they were considered to be embryologic vestiges. This study describes the response of the knee joint meniscus to circumferential, radial and axial compressive forces. The results show an anisotropic response of the knee joint meniscus to unconfined compression. The Young's modulus increased approximately twofold between vertical and circumferential or radial directions with a 10 mm/min-compression rate. This response is probably a direct consequence of the orientation of collagen fibres.

Animals↗
PubMed2005

[Core decompression of the femoral head for avascular necrosis].

PURPOSE OF THE STUDY: Core decompression of the femoral head is a conservative surgical treatment with controversial efficacy. We studied retrospectively a series of 32 cases of femoral head osteonecrosis treated by core decompression between 1988 and 2000 in 25 patients. We examined the epidemiological and clinical features as well as the laboratory findings, comparing cases requiring secondary hip replacement and those who had a favorable outcome. We search for prognostic factors. MATERIAL AND METHODS: The series included 32 hips, one case was lost to follow-up. Mean age at decompression was 41.3 years (22-55). In eight hips, osteonecrosis was favored by corticosteroid treatment, in three by chronic alcoholism, and in one by hypertriglyceridemia. No favoring factors were present for 20 hips. According to the ARCO classification there were 15 stage I hips, 13 stage II, 3 stage III, and one stage IV. Core decompression was centered in 24 hips and mean time to decompression was 6.4 months (14 days to 40 months). We reviewed hips without a total prosthesis using the Postel-Merle-d'Aubigne function score and for the radiological assessment the ARCO stage and the Koo index. RESULTS: Favorable outcome was noted in 12 hips. Total hip arthroplasty was required for 19, one hip was lost to follow-up. Mean follow-up in the success group was 82 months (26-176) and mean "time of participation" in the failure group was 11 months (1-38). Mean survival after core decompression was 14 months. Time between onset of symptoms and decompression did not influence outcome. Lesions which remained asymptomatic before decompression remained stable. The stage I hips did not have more favorable outcome than the stage II hips (p < 0.05). Stage III or IV hips had unfavorable outcome. Hips with a Koo index > 40 had a poor outcome (p < 0.05). DISCUSSION: Epidemiological factors which can worsen outcome after core decompression for osteonecrosis are controversial in the literature. Early stage disease (I or II) is considered as an ideal indication for decompression, but is insufficient alone to guarantee success. As other authors, we consider that ARCO stage III and IV and a Koo index > 40 are contraindications for decompression. Improved outcome after core decompression can only be achieved by limiting indications.

Adrenal Cortex Hormones↗
PubMed2005

[Recent fractures of the radial head associated with elbow instability treated with floating Judet prosthesis].

PURPOSE OF THE STUDY: Fracture of the radial head associated with elbow instability is infrequent. We report a retrospective series of floating Judet prostheses implanted for comminutive fractures of the radial head associated with elbow laxity caused either by dislocation or rupture of the medial collateral ligaments. MATERIAL AND METHODS: The series included ten patients who underwent surgery from October 1996 to September 2002 at the Amiens University Hospital. The indication for radial head prosthesis was established in the emergency setting for fracture unamendable by osteosyntheis and elbow laxity. Mean age was 48.2 years (25-69). All patients were seen at mean follow-up of 31.7 months (18-48). According to the Mason classification as modified by Johnson, all patients had type 4 fracture. A Judet radial head prosthesis with a floating metallic cup was implanted in all patients. An investigator other than the operators evaluated outcome using the Mayo Clinic criteria. RESULTS: Joint motion as measured by goniometry was: mean flexion 121degrees (90-140 degrees), mean extension deficit 20 degrees (5-60 degrees), mean pronation 45 degrees (0-85 degrees), mean supination 42.5 degrees (0-90 degrees). The Mayo clinic score was excellent in 3, good in 2, fair in 3, and poor in 2 (prosthesis dislocation in one and hung prosthesis requiring removal in one). Four patients developed periarticular ossifications compromising the final result. DISCUSSION: The floating Judet prosthesis allows optimal adaptation of the implant to anatomy and function. For us, these implants are indispensable when the radial head fracture is associated with elbow instability. The indication for prosthesis may be questionable if the non-fixed fracture is free of associated ligament injury, as suggested by the good long-term reported after simple resection. Rigorous operative technique is crucial, with careful restitution of the radial height. The quality of the result is related to the degree of capsule and ligament injury even after optimal implant positioning. Preventive treatment against periarticular ossification should be systematic.

Adult↗
PubMed2004

The myocardial sleeves of the pulmonary veins: potential implications for atrial fibrillation.

Atrial fibrillation (AF) is the most common abnormal heart rhythm and contributes to cardiac morbidity and mortality. Electrophysiological studies with pacing have shown that AF is initiated by ectopic beats localized in the pulmonary vein (PV) walls. The aim of this work was to look for some anatomical or histological particularities to explain these ectopic beats. Ten autopsied hearts were examined (6 males, 4 females). The myocardium was studied from the left atrium to the PV. Histological sections were made from 39 PVs. Myocardial cells were localized to PV between 9 and 38 mm from the PV-atrial junction. The sleeve was composed of circularly and longitudinally oriented bundles of cardiomyocytes. The peripheral end of the myocardial sleeve was irregular. The longest myocardial sleeves were found in the superior veins and were longitudinally oriented. At the PV-atrial junction, the circular bundles were not often circumferential. PV myocardial architecture confirmed the possibility of initiating AF. This fact is important for therapeutic radiofrequency ablation and explains why PV disconnection is essential.

Atrial Fibrillation↗
PubMed2004

[Ankle arthrodesis after failure of a total ankle prosthesis. Eight cases].

UNLABELLED: We report outcome in eight cases of ankle arthrodesis after failure of a total ankle prosthesis. MATERIAL AND METHODS: This series included eight patients, mean age 57 years (range 36-76) who had initially: post-traumatic talocrural joint degeneration (n=4), rheumatoid polyarthritis (n=3), idiopathic talocrural degeneration (n=1). Three patients had a New Jersey (DePuy) cemented prosthesis, four had a Star (Link) uncemented prosthesis and one, whose implantation was performed in another institution, had a spherical cemented prosthesis. The preoperative Kitaoka score was 19.1 (0-32). Seven patients had subtalar joint degeneration; one patient had a subtalar arthrodesis. The tibial component was cemented alone in two patients, the talar piece in three (two with talar fracture). Failure resulted from loosening, talus fracture or deep infection. Bipolar loosening was observed in two patients. Time to revision was 36 months (range 4-108). Arthrodesis was associated with an iliac graft for seven patients: several tricortical grafts (vertical alignment of the corticals) and cancelous grafts for filling. The height of the graft was adjusted to the substance loss. A bone graft could not be used in one patient who had a deep infection. The arthrodesis was fixed with an anterior plate bridging the talocrural space in six patients, with an external fixator in infected patient, with a conventional centromedullary tibial nail transfixing the talocrural joint and planted in the talus and the calcaneus in one. Outcome was assessed with the Kitaoka score. Mean follow-up was 56 Months (range 10-114). RESULTS: The overall Kitaoka score improved to 54/100 (range 42-70) at last follow-up. The arthrodesis provided improvement in all patients although the final outcome was still considered poor in three patients. Radiographic healing was obtained in seven patients at a mean 3.1 months (range 2.5-6). Wound healing was slow in two patients. One patient developed a deep infection early. DISCUSSION: The rate of fusion was 87%. This is in the general range reported in the literature; use of an iliac graft allows preserving joint height but because of the poor bone quality often encountered, residual bone stock may be insufficient to achieve complete fixation with screwing. Plate fixation appears to be a better way of achieving fixation. This provides a rate of fusion comparable with earlier series where external fixation was generally employed. For us, external fixation should be reserved for infected cases. Use of a conventional anterograde nail can be another solution in the event of poor bone quality. The overall result remains relatively modest although all the patients achieved a functional gain with arthrodesis. The results obtained are less satisfactory than after first-intention ankle arthrodesis.

Activities of Daily Living↗
PubMed2004

[The cementless Duraloc acetabular component: 100 cases assessed after a minimum five year follow-up].

PURPOSE OF THE STUDY: The longevity of an acetabular implant depends in part on its resistance to mechanical stress. Long-term stability of an uncemented cup requires stable primary fixation. This can be achieved with press-fit components. MATERIAL AND METHODS: One hundred forty-nine Duroloc press-fit acetabular implants were studied after a minimum follow-up of 60 months. Among these 149 cups, 100 were analyzed with a mean follow-up of 60 months. Twenty-two patients were lost to follow-up, 19 were contacted by telephone, and eight had died. Clinical and radiological criteria were used to assess outcome. Digitalized x-rays were processed with Imagika (View Tec, Saint-Maurice, France) to determine the position of the implant in two-dimensional space, inclinaison, anteversion, polyethylene wear, bone-implant contact, and presence of ossifications. Seventy percent of the patients underwent arthroplasty for degenerative hip disease. RESULTS: The cohort included 40 women and 60 men. Mean age at surgery was 59.4 years, range 30-80 years. The Postel-Merle-d'Aubigne score improved from 10 to 16. Mean polyethylene wear was 0.5 mm with an annual rate of 0.087 mm/yr. Among the 57 cup-bone spaces present postoperatively, 41 had filled at last follow-up (78%). There were no cases of osteolysis. Peri-prosthetic ossifications were observed in 50 patients (16 stage I, 12 stage II, 19 stage II, and 3 stage IV). Medial displacement of the cup > 4 mm was observed in one patient and ascension > 4 mm in four patients who had no other sign of loosening. Complications were: dislocation (n=15), phlebitis (n=2), sciatalgia (n=1) and infection (n=1). DISCUSSION: This retrospective series revealed an unacceptable dislocation rate with no correlation with implant positioning error in comparison with the biomechanical position of the healthy hip. The non-hemispheric shape of the implant and the beveled edge of the polyethylene insert could be implicated, particularly since none of the implants had a polyethylene overhang. The mean annual wear (0.087 mm) was relatively high compared with cemented cups. Age was the only factor correlated with wear. Migrations were difficult to interpret. Medialization or ascension of the implant was not associated with any clinical sign suggestive of loosening. The poor reproducibility of the x-rays cannot explain these findings. Secondary repositioning of the implant might be involved. CONCLUSION: The high rate of dislocation and the frequency of excessive wear have led us to abandon this implant for more hemispheric cups.

Adult↗
PubMed2004

[Dislocation of the proximal tibio-fibular joint due to severe leg and knee trauma].

PURPOSE OF THE STUDY: Dislocation of the proximal tibio-fibular joint is a rare lesion generally described in athletes. In our experience, high-energy trauma in traffic accident victims was a frequent cause. Dislocation of the proximal tibio-fibular joint is generally described as anterolateral, posteromedial, superior, or subluxation. We describe an inferior form of dislocation. MATERIALS AND METHOD: The study population included eight men aged 21-55 years (mean 31 years). One patient had bilateral dislocation. There were four superior, one posterior, and four inferior dislocations. All patients also had an associated fracture of the tibia which was an open fracture in eight cases. Five patients suffered a lesion to the common fibular nerve. Three had tibial nerve involvement in a context of inferior disclocation. The lateral collateral ligament was torn in six cases. The central pivot was involved in four. Two patients had an avulsion of the patellar ligament on the tibial tuberosity. Five patients had vessel damage. Three required emergency amputation. Two patients (one superior and one inferior dislocation) underwent emergency bypass surgery but required below-knee amputation later due to persistent ischemia. All dislocations, excepting the one case of complete fibular avulsion and one emergency above knee amputation were treated by transarticular screw fixation of the proximal tibio-fibular joint. RESULTS: Mean follow-up was 5.8 years (1-9 years). At last follow-up, there were no cases of instability or pain in the proximal tibio-fibular joint. The patient with an initial neurapraxia in territory of the common fibular nerve recovered totally. The five amputated patients had prostheses and walked without crutches. DISCUSSION: Dislocation of the proximal tibio-fibuilar joint is a rare entity, but the frequency is probably underestimated. The dislocation can go unrecognized in patients with multiple injuries. Careful search should nevertheless be undertaken due to the risk of secondary involvement of the common fibular nerve. The Harrisson and Hindenach classification, inspired by the Lyle classification, does not mention inferior dislocation of the proximal tibio-fibular joint, a recently described entity. Our series included dislocations resulting from high-energy trauma associated with numerous ligament, nerve, and vessel injuries. In this context, dislocation of the proximal tibio-fibular joint constitutes an epiphenomenon.

Adult↗
PubMed2003

[Gluteus medius tendon tear and degenerative hip disease].

We report three cases of gluteus medius tendon tears discovered fortuitously in patients undergoing total hip arthroplasty. The tears were not suspected from the initial clinical presentation. Sutures were possible in only one patient. Outcome of the hip arthroplasty was very good in all three patients despite lack of tendon repair in two.

Aged↗
PubMed2001

[Interpositioned metallic prosthesis for hallux rigidus: review of 42 cases with a metatarsophalangeal prosthesis].

PURPOSE OF THE STUDY: We report outcome at a mean 4.8 years follow-up in 42 patients with hallux rigidus treated by metatarsophalangeal interposition thin prosthesis flat concave with a lateral capsular fixation. MATERIALS AND METHODS: The 42 patients were treated from 1987 to 1997. Sixtine prostheses were implanted for osteoarthritis was grade I (n=2), grade II (n=28), and grade III (n=12). Groulier's clinical criteria and Regnauld's radiologic criteria were used to assess outcome. RESULTS: We observed 22 very good, 12 good, 4 fair, and 4 poor results. There was no significant modification in the forefoot morphology. DISCUSSION: The Sixtine prosthesis provided a global improvement in pain and motion though there was an important difference between patients with grade I and grade II osteoarthritis, who experienced major improvement, and those with grade III disease. A good overall result requires proper prosthetic centering. Subluxation or translation does not appear to be compatible with good results. Among 3 cases with overt dislocation, 1 recovered an acceptable articular space with a good overall result. Two poor results and 3 fair results were observed in patients with condensation of the phalangeal base. These bone condensations appeared in postoperative Egyptian feet. The Sixtine prosthesis may protect the interphalangeal articular space of the great toe, avoiding damage and rearward displacement of sesamoid bones. It ensures primary stability and may be left in place. CONCLUSION: We found that the Sixtine prosthesis is best indicated in hallux rigidus patients with grade II osteoarthritis.

Adult↗
PubMed2001

[Complete transverse fractures of the talus: value of magnetic resonance imaging for detection of avascular necrosis].

The authors report a series of 32 complete transverse fractures of the neck or body of the talus. The fractures occurred mostly in young males, as a result of motor vehicle accidents. The fracture line was transverse in the neck or body of the talus in 20 cases, sagittal in four and comminuted in eight cases. Using Hawkins' classification, there were 10 type I, 16 type II, and 6 type III fractures. The treatment was conservative in 8 cases and surgical in 24. The patients were evaluated clinically and radiologically with an average follow-up of 7 years. All patients underwent radiological study at follow-up and 17 underwent NMR evaluation. Eleven underwent NMR evaluation at final follow-up, and the other 6 early in their postoperative evolution. The postoperative results were evaluated based upon clinical and radiological criteria. The clinical result was good or very good in 37.5% of cases. Segmental necrosis of the talar body was noted in 6 cases and complete necrosis in 5, which required arthrodesis in 8 cases. Avascular necrosis is a common complication. Its frequency depends on the type and displacement of the fracture. If it becomes symptomatic, the only treatment is tibiotalar or tibiotalocalcaneal arthrodesis. The contribution of NMR is very important, as it gives the positive diagnosis as well as information regarding evolution. Complete transverse fractures of the talar neck or body are rare; their treatment only gives a little over one third good and very good results in the long term. NMR gives the diagnosis early and shows the extent of necrosis. It can have predictive value for the collapse risk and guide reeducation with or without weight bearing.

Adult↗
PubMed2001

[Recurrent hallux valgus treated with metatarsophalangeal arthrodesis. A series of 32 patients].

PURPOSE OF THE STUDY: We reviewed a series of 32 cases of recurrent hallux valgus treated by great toe metatarsophalangeal arthrodesis with a minimal 5-year follow-up. MATERIAL AND METHOD: Mean delay from the first surgical procedure and revision surgery was 11 years. All patients complained of forefoot pain. The average angle of the phalangeal valgus was 39 degrees. Sixteen patients had metatarsalgia. The first toe metatarsophalangeal joint was evaluated according to Regnauld's classification: two grade 1, eight grade 2a, six grade 2b, sixteen grade 3. Arthrodesis was fixed with an axial screw and associated with adductor hallux plasty. Outcome was assessed at a minimum 5-year follow-up according to Kitaoka's criteria. RESULTS: Seventy-eight percent of the patients were pain free at last follow-up. Valgus deviation of the great toe was corrected with an average angle of 19 degrees. The arthodesis healed in 90.6% of the cases. Statistical analysis showed the importance of great toe valgus pre- and postoperatively and at last assessment. Final outcome was poor in the oldest patients. The overall outcome was rated good in 84% of the cases, average in 6% and poor in 10%. DISCUSSION: Arthrodesis of the great toe is not a disabling surgery. Interphalangeal osteoarthritis may occur due to joint overuse (12 cases). Kitaoka's series compared outcome after arthrodesis with that after conservative surgery and reported better results with arthrodesis. Revision surgery for hallux valgus using great toe metatarsophalangeal arthrodesis remains an acceptable alternative.

Adult↗
PubMed2001

[Anterior tarsectomy for cavus foot. Retrospective study of 52 cases].

The authors reviewed 34 patients treated by tarsectomy for idiopathic pes cavus deformity between 1977 and 1996. Fifty two feet were treated surgically. All patients had undergone previous conservative treatment. The average age was 40 years. Podoscopic examination revealed 24 cavus feet stage 2, 28 cavus feet stage 3, adduction of the forefoot in 15 cases and an equinus deformity in 8 cases. On radiographic examination, Djian-Annonier's angle was 108 degrees on average. All patients were evaluated with a minimum ot two years follow-up, according to the evaluation system of the Massachusetts General Hospital. With an average follow-up of six years and six months, overall results were; 65.5% very good and good, 21% fair, 13.5% poor. The morphological correction was poor in 9 cases. Djian-Annonier's angle was 125 degrees on average. A number of cavus feet do not justify surgical treatment, because they are well tolerated, sometimes with orthopedic orthoses. Tarsectomy must be avoided in neurological conditions. We do not advise release of soft tissue or Dwyer's calcaneal osteotomy. In our opinion, the choice indication for anterior tarsectomy is the nonrigid cavus foot. It must be combined with lengthening of the Achilles tendon when a deficit of dorsiflexion of the foot persists following tarsectomy. According to their importance, associated deformations will be treated in the same operative session or not.

Adolescent↗
PubMed2000

[Malleolar fractures. Predictive factors for secondary osteoarthritis. Retrospective study of 32 cases].

The authors report a series of 32 ankle fractures treated by internal fixation and reviewed with a follow-up of more than 15 years. The series includes 12 fibular, 14 bimalleolar and 6 trimalleolar fractures. Following Weber's classification, there were 4 type A, 18 type B and 10 type C fractures. The postoperative x-ray showed 28 anatomy reductions; shortening of the fibula from 3 to 5 mm was noted in 4 cases. Clinical results were evaluated according to Kitaoka's criteria, and radiological results according to Magnusson's criteria. Statistical analysis was made with a Chi-square test. The retrospective review at an average follow-up of 15 years showed 19 painfree ankles, normal mobility in 22 cases, absence of edema in 18. The shoe-wear was normal in 30 cases. Walking had returned to normal in 23 cases but radiography showed narrowing of the tibiotalar joint line in 12 cases and lengthening of the medial malleolus in 16. Narrowing of the tibiotalar joint space was associated with lengthening of the medial malleolus in 10 cases. The objective results were rated as follows: 23 good, 8 fair, and 1 poor. With a follow-up of 15 years, we noted degenerative changes in the ankle in 37% of cases in spite of an anatomic reconstruction which had been perfect in 28. Shortening of the fibula, observed in 4 cases, was associated with subsequent ossification below the medial malleolus corresponding to avulsion of the non sutured medial collateral ligament. Nevertheless, degenerative changes of the ankle were clinically well-tolerated. The long term result of internal fixation of malleolar fractures was good. This was achieved only through perfect restoration of the joint anatomy. Contrary to other series, non-operative repair of the medial collateral ligament was associated with long team degenerative changes and reduced mobility of the joint. We therefore now advocate surgical repair of the medial collateral ligament.

Adult↗
PubMed2000

[Surgical treatment of chronic Achilles tendiopathies. Report of 52 cases].

PURPOSE OF THE STUDY: We reviewed a series of 52 cases of chronic Achilles tendinopathy treated surgically by release of the fascia cruris, resection of peritendon, longitudinal incision of the tendon and occasional excision of intratendinous lesions. MATERIALS AND METHODS: The mean course prior to surgery was about 18 months. Twenty-six patients practiced sports. Complaints were bilateral in 12 cases. Pain was always present. Ultrasound exploration evidenced paratendinitis (n=21), tendinosis (n=22) and paratendinitis with tendinosis (n=9) (Puddu classification). Patients were reviewed after a minimal 2-year follow-up. Results were assessed on the basis of clinical findings. RESULTS: Mean follow-up was 5 years 6 months. Twenty-nine patients were free of pain. The range of motion was normal in 48 cases and 29 patients resumed sports activities at the same level as prior to surgery. Outcome was very good in 29 patients, good in 14 average in 6 and poor in 3. DISCUSSION: Stiffness of the tibio-tarsal joint can be avoided by proper mobilization. Outcome appears to be better in middle-aged patients. Poor outcome is closely related to amyotrophy. The presence of a foot deformity does not appear to have an unfavorable influence on outcome. The Achilles tendon must not be infiltrated. Ultrasound is highly contributive, but MRI provides a more accurate analysis. CONCLUSION: Surgical treatment of chronic Achilles tendinopathies can be proposed when conservative treatment has been unsuccessful. Outcome is better in young active patients and in cases where paratendinitis predominates.

Achilles Tendon↗
PubMed1999

[Chronic lateral ankle instability: surgical treatment with periosteum ligamentoplasty and capsular ligament tension. 34 cases].

PURPOSE OF THE STUDY: The authors report a series of thirty four ankle ligamentoplasties treated between 1985 and 1995. MATERIAL: Patients presented an average of 10.4 ankle sprains before surgical treatment. Pre-operative examination found instability in all cases, permanent pain in 58.8 p.cent limited mobility in 11.8 p.cent and permanent oedema in 23.5 p.cent. Surgical treatment associated ligamentoplasty with periosteum and capsular ligamentar tensionning. METHODS: Minimal follow up was two years and averaged 4 years 7 months. Post operative results were assessed according to Saillant's clinical criteria (subjective instability, sprain recurrence, pain). Radiological criteria included plain and stress X-rays (anterior drawer and varus laxity). RESULTS: The authors noticed an improvement of clinical and radiographical criteria, without ankle arthrosis or periosteum graft calcification. The global result was: 23 excellent, 4 good, 1 fair and 6 bad results. All athletes went back to sport. DISCUSSION: Results of this series with almost 80 p.cent of excellent and good results are comparabie with others techniques for ankle ligament reconstruction. CONCLUSION: This simple technique has a main advantages: no injury to the fibularis brevis tendon. Periosteum ligamentoplasty can then be suggested if lateral tibio-tarsal instabilities persist after proprioceptive physiotherapy.

Adult↗