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Biomedical subjects

E Lenoble

Publications and source records attributed to E Lenoble.

At least 37 records · Page 2Linked to original sources
PubMed1993

Wrist arthrodesis using an embedded iliac crest bone graft.

34 patients treated by the iliac crest bone graft technique for wrist arthrodesis were reviewed. The average age was 45.6 years and the mean follow-up was 45 months. The procedure is performed through a straight ulnar approach and the head of the ulna is removed. A longitudinal trench is created in both distal radius and carpus preserving the anterior, posterior and lateral cortices. A curved trapezoidal monocortical iliac crest bone graft is embedded inside the trench. The position of the arthrodesis automatically follows the curvature of the graft. No fixation device is used. A short-arm cast is applied for 2 to 3 months. All arthrodeses except two fused within 3 months. Pain was completely relieved in 85% of the cases. Pronation and supination returned to normal 5 months post-operatively. Grip strength was increased in 80% of the cases. The carpometacarpal joints remained pain-free even when not fused. Complications were rare: two lesions of the dorsal branch of the ulnar nerve; two cases of delayed union due to errors in technique, and displacement of the graft in one case. Although it is technically demanding, the embedded iliac crest graft wrist arthrodesis improves pronation and supination as a result of resection of the distal radio-ulnar joint, preserves or improves grip strength, and relieves pain.

Arthritis, Rheumatoid↗
PubMed1993

A post-operative regime after digital flexor tenolysis. A series of 72 patients.

Tenolysis of the flexor tendons was performed in 78 fingers (72 patients) by the same surgeon. Two technical modifications were introduced: reconstruction of a robust pulley; and initial immobilization with the tendon in a proximally migrated position, permitting later breakdown of early adhesions by gentle extension either by the surgeon or using an extension spring. After a mean follow-up of 21.5 months, the total active movement was improved from 135 degrees (pre-operative) to 203 degrees (post-operative) in 84% of fingers and from 65 degrees to 115 degrees in 78% of thumbs. This corresponds to a reduction in impairment of 10.1% for the thumb and 21.6% for the fingers. There was no improvement in four digits and nine cases were made worse, averaging a loss of range of 25.4 degrees. Among these were two cases of skin breakdown and two cases of tendon rupture (2.5%), one combined with skin necrosis.

Adult↗
PubMed1993

[Reduction and osteosynthesis of displaced fractures of the distal third of the fifth metacarpal with central medullary bone wires].

We conducted a retrospective study of 80 patients who underwent axial K-wire osteosynthesis for a fracture of the distal third of the fifth metacarpal over an eight year period. We used a technique derived from Foucher's technique. After closed reduction, the fracture was maintained with two or three distal smoothed curved intra-medullary axial K-wires. The final functional result was identical to the opposite side in every case, although with persistent palmar tilt of 14 degrees +/- 11 degrees. The complications were rare. Rotation displacement was always well controlled. In comparison with functional treatment, we recommend this technique in cases of rotation displacement, absence of contact between the fractured ends and marked palmar tilt of the distal fragment.

Bone Wires↗
PubMed1993

[Treatment of fractures of the humeral shaft using Hoffman's external fixator].

Thirty-nine patients treated with the Hoffman external fixator for a diaphyseal fracture of the humerus, were clinically and radiologically assessed with an average follow-up of 3.2 years. Open fractures, failure of a previous treatment, secondary displacement, and polytraumatisms were the usual indications for external fixation. Clinical bone healing was obtained within an average delay of 10.5 weeks. One patient underwent a pseudarthrosis. Six patients with secondary displacement of the fracture were operated on again, and the fracture was easily reduced by simple manipulation of the device under general anesthesia. The enclosing of the fractured extremities statistically diminished the risk of secondary displacement. Twenty CT scan examinations were performed to assess the occurrence of rotational malunion. Fourteen patients were malunited in internal rotation of the distal fragment with an average diminution of the retrotorsion of 19.4 degrees. No iatrogenic vascular or neurological complication occurred. The Hoffman external fixation does not replace the orthopedic treatment of the diaphyseal fractures of the humerus. It is simple to use and ensure satisfactory contention of the fractures' extremities when they are enclosed. If a secondary displacement occurs, it is simple to modify the device to reduce the fracture. If necessary, an additional surgical procedure, such as cancellous bone grafting or radial nerve repair, can be performed without modification of the osteosynthesis.

Adolescent↗
PubMed1993

[Influence of the anatomy of the pedicle on the survival of venous vascularized flaps. Experimental study on the rat].

The aim of this work was to compare the survival of an arteriovenous island flap with the survival of an island flap with a venous supply. The anatomy of the pedicule was modified to assess the conditions of survival. Our experimental studies were performed on 125 Wistar rats randomised into eight groups. Group 1: control group of epigastric flaps deprived of vascularisation. Group 2: control group of abdominal transverse flaps with arteriovenous supply. Group 3: control group of epigastric flaps with arteriovenous supply. Groupe 4: through-flow abdominal transverse venous flaps. Group 5: epigastric through-flow venous flaps with a main venous trunck. Group 6: epigastric flaps with nervous and perivenous pedicule. Group 7: epigastric flaps with nervous and venous pedicule. Group 8: epigastric flaps with through-flow nervous and venous pedicule. Twenty-four additional rats were histologically assessed. The survival of flaps was monitored by direct examination and histological examination. Two out of the 20 flaps of group 4 survived as well as two out of the 30 flaps of group 5. Four of the 15 flaps of group 8 partially survived around the pedicule area. The venous vascularisation does not explain the survival of so-called venous flaps. The survival is increased by through-flow venous supply, and preservation of perivenous tissues.

Animals↗
PubMed1993

[Secondary localization of epithelioid sarcoma of the donor site of an inguinal flap. Apropos of a clinical case].

A secondary localisation of an epithelioid sarcoma appeared on the inguinal scar of a groin flap in a 28 years-old woman, 14 months after resection and coverage of the primary tumor in the palm of the right hand. The evolution was free of recurrence or metastasis, with a two-year follow-up, after surgical resection of the inguinal tumor, radiotherapy and chemotherapy. Secondary localisation of tumors in musculo-cutaneous flaps can be observed after head and neck or chest wall surgery. Contiguity propagation, or venous or lymphatic dissemination are the usual mechanisms. One must realised a biopsy preliminary to the resection of a suspicious tumor of upper or lower limb. When one needs a flap for reconstruction, one must prefer to use a local flap.

Adult↗
PubMed1993

Distal ulnar nerve entrapment due to tumors of Guyon's canal. A series of ten cases.

The authors reviewed ten cases of distal ulnar nerve entrapment neuropathy due to tumors of Guyon's canal. Clinically, there were two sensory, four purely motor, and four mixed neuropalsies. EMG findings correlated with clinical signs. At surgery, six simple ganglia, two intra-osseous tumors of the hook of the hamate (one ganglion, one chondroma), one giant cell tumor, one intraneural ganglion, and one schwannoma were found. Complete recovery was observed in nine out of a total of ten cases within six to eight months after surgery; the tenth case developed recurrent symptoms.

Adult↗
PubMed1992

[The carpal bump].

Fiolle reported the first description of a "carpal boss". The "hump" is cosmetically disturbing and sometimes painful. It has to be distinguished from a ganglion. A lateral X-Ray with 30 degrees of supination reveals a spur or a styloid bone (12.5%). In a series of 44 patients, treated over a period of 7 years, 21 needed operation for pain or a complication of previous surgery. The technique described by Cuono and Watson was successfully used without recurrence of deformity but in 2 cases some pain remained during strenuous efforts.

Adolescent↗
PubMed1992

Open palm technique for Dupuytren's disease. A five-year follow-up.

One hundred and seven patients presenting 140 localizations of Dupuytren's disease were operated upon by a single surgeon before 1985, according to a modified Mac Cash procedure combining a Bruner approach and open transverse digital and/or palmar incisions. All surgery was performed under axillary block on an out-patient basis. A striking feature is the absence of complications such as haematoma, skin necrosis or infection. In the early post-operative follow-up (mean 105 days), the average angular improvement was 79.5% in all patients. Among the 107 patients, 54 (for a total of 67 localizations) were specifically reviewed with an average follow-up of 5.6 years. Improvement averaged 74% in 83.5% of digits. In the remaining 16.5%, the lack of extension averaged 31 degrees. Some factors had a negative effect on final results: early age of onset, major involvement of the PIP joint, localization at fifth ray level. The recurrence rate (41%, 23% of which severe) is identical to other reports on limited fasciectomy. A good indication is therefore a patient older than 50, and the method provided low postoperative morbidity and pain, associated with acceptable results.

Age Factors↗
PubMed1992

[Lesions of the ligaments associated with distal fractures of the radius. 58 intraoperative arthrographies].

Intracarpal ligamentous tears and fractures of the radius often have a similar mechanism. For instance, no prospective studies have defined the real incidence of such associations, which are not antagonistic. The authors performed a systematic operative wrist arthrogram during distal radius fractures in a group of 58 patients with a mean age less than 50 years. Such a population was at low risk of degenerative ligamentous tears. Triangular fibrocartilage complex was torn in two-thirds of all types fractures. Extra-articular radius fractures were associated with an intracarpal ligamentous tear in 25% and always a luno-triquetral lesion type. In contrast, intra-articular and radius styloid fractures were frequently associated with a scapho-lunate lesion.

Adolescent↗
PubMed1992

[Reconstruction of distal loss of substance in the nail-bed by a de-epithelialized flap from the digital pulp].

Twelve patients, presenting with traumatic avulsion of the distal nail bed, repaired by a de-epithelialized palmar advancement flap, were reviewed with an average follow-up of 23 months. Subjective results were considered excellent in two cases, good in seven, fair in two and poor in one patient. Nail adherence with the de-epithelialized flap was observed over almost 90% of the new nail bed. Nail dystrophy was observed in three patients, but was severe in only one. Two patients had slight curvature of their nail, while one had a severe hook-nail deformity. Mobility in the finger was always complete, and only one patient had a slightly decreased two-point discrimination on the flap.

Adolescent↗
PubMed1992

["Open palm" technique in Dupuytren's disease. Postoperative complications and results after more than 5 years].

From 1974 to 1988, 868 open palm and/or finger operations were carried out by a surgeon at the SOS Main emergent hand surgery unit in Strasbourg. Out of these, 107 patients making up 140 fingers were seen again after a period of more than 5 years. The essential advantage of the method is the low rate of postoperative complications relative to the other methods involving skin closure. All patients had an ambulatory treatment with regional anesthesia. The palm was opened in 85% of cases, and both the palm and the base of the fingers in 14%. The average healing time was 26 days, with an average sick leave of 28 days. Postoperative pain was noted in 20% of cases, requiring medication in 10% for an average of 3 days. Postoperative bleeding requiring new dressing occurred in one case, after the patient had already been discharged (0.7%), while 3.5% of all patients had anticoagulants. No hematoma and no flap necrosis were noted, and temporary dysesthesia was noted in 4.6% of cases, nerve involvement in 3.1%, and neurovascular dystrophy in 7%, including 4 only with a functional deficit (2.8%). On the other hand, results after 5-6 years are similar to those of selective aponeurectomies published in the literature, with frequent recurrence (40.6%, including 23% severe enough to require second surgery). Extension was noted in 39% of all cases, and the total activity of the disease was present in 55% of all studied hands.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Treatment of post-traumatic swan-neck deformities of the fingers. Apropos of a series of 43 patients].

Thirty three patients with 51 swan neck deformities were reviewed with a mean follow up of 35 months (6 to 86 months). 8 fingers presenting some stiffness necessitated a first step of splinting before operation giving nevertheless 5 excellent and good results. Among the other fingers with full range of passive motion surgery was performed in 38 cases with 81.5 per cent of excellent and good results. According to etiology, articular or extrinsic, excellent and good results were respectively 71 per cent and 94 per cent. The most frequently used operations were Littler type II (12 cases) and Littler type III (S.O.R.L. 11 cases) giving respectively 75 per cent and 82 per cent of excellent and good results, despite frequent minor complications. Tenodesis with translocation of a lateral extensor band gave in half the cases some extension lack at DIPJ (less than 20 degrees in 62.5 per cent). Finally direct surgery of mallet finger complicated by a swan-neck deformity led constantly to good correlation at the PIP level.

Adolescent↗
PubMed1991

[Escalator flap in the treatment of claw nail].

Nail horn deformity can be corrected by a proximal withdrawal of the nail complex on the distal remaining skeleton. The main problem is the flap coverage and we have combined an "in bloc" O'Brien island flap with the withdrawal of the nail. This "escalator" technique allowed a good correction with a satisfactory palmar skin cover and a decreased "wave" of the dorsal skin.

Amputation, Traumatic↗
PubMed1991

[Treatment of severe callus of the metacarpus and phalanges. Indications and results apropos of a series of 38 patients].

Severe deformities of metacarpals and phalanges, whether isolated or associated with soft tissues lesions impair the hand function and are to be corrected. The authors initial proposal was the fixation after corrective osteotomy by wiring which have been proved to be suitable in the treatment of recent fractures. This technique was used in 25 cases out of 38 treated malunions with 21 satisfactory results. 4 poor results were related to associated lesions of the soft tissues more than to the osteotomy itself. The other 13 malunions were treated by several techniques arthrodeses, callus resections, dynamic splintage, osteotomies with satisfactory results.

Bony Callus↗
PubMed1990

[Cold sensitivity after median or ulnar nerve injury based on a series of 82 cases].

Cold sensitivity often occurs after upper limb nerve injuries. 82 patients were reviewed retrospectively with an average follow-up of 42 months. Cold sensitivity occurred after 50% of median nerve injuries and after 75% of ulnar nerve injuries. Symptoms are localized to the damaged sensory nerve territory, and are related to the level of the lesion after median nerve injury. They are increased by associated arterial damage even when it is repaired. The less attened is the two-point discrimination lest, the less severe are the disorders. The origin is not really known, but we think that cold sensitivity is related to a disturbance of sympathetic and sensory fibers.

Adolescent↗
PubMed1990

Transfer of a composite island homodigital distal interphalangeal joint to replace the proximal interphalangeal joint. Technique and case report.

The authors present an original technique of PIP joint reconstruction by an homo-digital island compound DIP joint transfer. The transfer consists of joint, capsule, volar plate, and ligaments. The distal joint is fused and the islanded joint interposed at the PIP level. In our clinical case, a flexion of 80 degrees was obtained with an extension lack of 15 degrees. This salvage procedure can be useful in selected well motivated patients. It provides rapid bone healing, good lateral stability, potential for growth in children, long term preservation of cartilage and acceptable range of motion.

Adult↗