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Biomedical subjects

E Letournel

Publications and source records attributed to E Letournel.

At least 19 recordsLinked to original sources
PubMed1995

Nosocomial meningitis caused by multiresistant enterococcus as a life-threatening complication of pelvic injury: case report.

Bacterial meningitis after pelvic trauma has never been described. We recently treated a patient who developed, during the course of his hospitalization, multiresistant enterococcal meningitis after severe pelvic injury, including a comminutive sacral fracture. Dural tear may have been the main factor leading to secondary infection of the cerebrospinal fluid. Treatment with intravenous continuous infusion of vancomycin plus rifampin, associated with closed subarachnoid drainage, resulted in a complete cure. Therapeutic cerebrospinal fluid levels of vancomycin were obtained only during the first 8 days of treatment. Use of glycopeptides in meningitis and the role of cerebrospinal fluid drainage are discussed. Physicians should be aware of the diagnosis and therapeutic features of this life-threatening complication.

Adult↗
PubMed1994

Low-dose irradiation and indomethacin prevent heterotopic ossification after acetabular fracture surgery.

From 1987 to 1991, we treated 53 patients with 54 fractures of the acetabulum by reconstruction through a posterior or an extended iliofemoral surgical approach. For prophylaxis against heterotopic ossification we used perioperative irradiation and indomethacin. Indomethacin was given as daily doses of 25 mg started within 24 hours of operation and continued for four weeks. Irradiation was by either 1200 cGy in three daily doses or by a single 700 cGy dose on the first postoperative day. All patients were followed for at least one year postoperatively and the severity of heterotopic ossification was recorded using the Brooker classification and correlated with hip mobility. The combination therapy proved very effective; 44 fractures showed no heterotopic ossification and ten showed Brooker class I. The functional results were good and there were no complications of this therapy. Irradiation with 1200 cGy did not appear to offer any therapeutic advantage over the 700 cGy dose.

Acetabulum↗
PubMed1994

Delayed reconstruction of acetabular fractures 21-120 days following injury.

A retrospective review was performed of 207 patients treated by delayed reconstruction of acetabular fracture between 21 and 120 days following injury. Nineteen patients were lost to followup. One hundred eighty seven patients had 188 fractures classified as follows; 35 posterior wall, 9 posterior column, 5 anterior wall, 4 anterior column, 13 transverse, 49 transverse/posterior wall, 21 T shape, 8 posterior column/posterior wall, 8 anterior column posterior hemitransverse, and 34 both column fractures. The average preoperative delay was 43 days. Followup averaged 6.5 years (range, 9 months-30 years). Overall good to excellent results were achieved in 65% of patients, fair in 9%, and poor in 26%. Good to excellent results by fracture type were; posterior wall (51%), posterior column (89%), anterior wall (60%), anterior column (100%), transverse (69%), transverse/posterior wall (59%), T shape (62%), posterior column/posterior wall (88%), anterior column/posterior hemitransverse (75%), and both column (72%). Heterotopic ossification developed in 49 of 168 patients without prophylactic treatment, in 6 of 12 treated prophylactically with diphosphonate, and in 2 of 27 receiving prophylactic indomethacin therapy. There were 20 postoperative sciatic nerve palsies, 3 immediate and 5 delayed infections, 5 cases of pulmonary embolism, and 26 cases of avascular necrosis. Delayed management of acetabular fractures increases the difficulty of operative treatment and may result in a significant reduction in good to excellent results. Simple anterior or posterior wall fractures, associated transverse + posterior wall fractures, and T shape fractures have an increased risk of failure when treated within this time period.

Acetabulum↗
PubMed1994

Surgical revision of malreduced acetabular fractures.

Early failure of open reduction and internal fixation of fractures of the acetabulum presents a treatment challenge even more difficult than that of the primary injury. This study evaluates the success of reoperation for 64 patients with surgical malreduction or secondary loss of reduction. In 36 patients (56%) the reconstruction achieved was within 2 mm of being anatomic as judged by plain radiography. Overall, 27 patients (42%) had excellent or good outcomes at an average 4.2 year followup. Delay to reoperation appeared to have an adverse affect on the result of surgery. At followup 57% of patients reoperated on within 3 weeks of injury were rated good or excellent. This figure dropped to 29% when the delay exceeded 12 weeks. These data do not compare favorably with results obtained in large series of singly operated fractures; however, they do indicate that it is possible to salvage a significant number of failed open reductions by reoperation.

Acetabulum↗
PubMed1993

Open treatment of acute calcaneal fractures.

Displaced intraarticular fractures of the calcaneus require operative intervention to restore the anatomy of the bone, which in turn is the requirement for recovery of subtalar joint mobility. Surgery through a lateral incision, without opening the sheath of the peroneal tendons, and the use of lag screws and a "Y-plate," must restore not only the respective positions of the "three poles" of the calcaneus but also the respective orientations of the articular surfaces. Stable internal fixation allows early active and passive mobilization of the subtalar and ankle joints. If this is not achieved, the functional outcome will be poor.

Bone Plates↗
PubMed1993

The treatment of acetabular fractures through the ilioinguinal approach.

The ilioinguinal approach was developed in 1965 as an anterior approach to the pelvis and acetabulum. Before this date, the Smith-Petersen incision or a modification of it called the iliofemoral approach provided the only access to the upper part of the anterior column of the acetabulum. In the current study of 195 acetabular fractures, the ilioinguinal approach was used alone in 178 cases (90%) and in combination with the Kocker-Langenbeck as a double incision in 17 cases (10%). There were 39 simple and 156 complex associated fracture patterns. There were two large groups of associated fractures: anterior column posterior hemitransverse (39 fractures) and both column fractures (98 cases). Of these fracture patterns stabilized through the ilioinguinal approach, there was a rate of perfect reduction of 85% and 73%, respectively. Of 70 fractures involving the anterior column, anterior wall, and anterior column posterior hemitransverse, there were 61 perfect reductions (87%). The complication rate was extremely low, without any evidence of external iliac fossa heterotopic ossification. The ilioinguinal approach provides total and complete access to the anterior column from the sacroiliac joint to the pubic symphysis. An experienced acetabular surgeon may achieve excellent results even with complex fracture patterns.

Acetabulum↗
PubMed1990

[Indications for surgical treatment of fractures of the acetabulum].

The indications for surgery in fractures of the acetabulum within 3 weeks from the accident are currently based on 2 main factors: 1) post-traumatic articular incongruence doubtlessly is the cause of traumatic coxitis: 2) however, it has been proved that fractures with partial post-traumatic incongruence that have not been treated may produce very good results. The current problem is that it is impossible to assess the degree of incongruence that can be tolerated to avoid surgery and guarantee good long-term results. Computers will maybe help to solve this problem. The indications are currently based on the approximate assessment of congruence on the basis of 3 plain radiographs, tomography and CT. Osteonecrosis of the femoral head is much less frequent than it is said to be, and most often actually consists in the wear of the femoral head on a non-reduced line of fracture, whether or not the patient has been operated.

Acetabulum↗
PubMed1990

Diagnosis and treatment of nonunions and malunions of acetabular fractures.

The surgical treatment of nonunions and malunions of acetabular fractures is often a challenge. The diagnosis of a nonunion or malunion rests on clinical and radiologic examination. Apart from the union troubles involving only one column, all other cases justify the use of the extensile approach.

Acetabulum↗
PubMed1990

Scapulothoracic arthrodesis for patients who have fascioscapulohumeral muscular dystrophy.

In nine patients who had fascioscapulohumeral muscular dystrophy, thoracoscapular arthrodesis was done for the treatment of symptomatic winging of the scapula. The objective was to improve the use of the upper extremity in the performance of activities of daily living. Seven patients had a bilateral procedure. The active range of motion of the shoulder improved in all patients, with flexion increasing an average of 33 degrees and abduction, 25 degrees. Complications included pneumothorax, pleural effusion, atelectasis, fracture of the scapula, and pseudarthrosis. The length of follow-up averaged sixty-nine months, and the results did not deteriorate with time.

Adolescent↗
PubMed1987

Non cemented hip implants. Failures of biologically fixed devices: causes and treatment.

Complications of cementless prostheses are similar to those presented by the cemented ones. They are all the consequence of a failure (lack) of the bony fixation, which may be primary (the components never become fixed) or secondary (the components lose their bony attachments that were initially achieved). The bony fixation is often very difficult to assess, and a localized radiolucent line is always a bad indication. Failure of fixation may be partial or total for one or both components. Removal of distal broken cementless stems is much more difficult than for the cemented ones. Loosening may damage the bone at least as much as a mobile cemented mantle, and bone grafting at revision is often needed. Revisions for loosening of uncemented prostheses are at least as difficult as for the cemented ones. The lifetime of the Judet prosthesis has been shortened by an initially poor manufacturing process. Perhaps this has allowed us to get information about the outcome of uncemented prostheses in a shorter period. Finally, I believe in the concept of uncemented prostheses because their possible fixation by bony ingrowth is proved, but the definitive solutions have to be found and improvements are needed: A screwed socket appears to be good. A better plastic than HDP with less wearability and better mechanical properties is needed. A stem better adapted to the shape of the medullary canal bedding would probably facilitate bony ingrowth. The kind of porosity does not affect many things in my experience. Failures of prostheses that are no longer commonly used today have been reported. These were state-of-the-art devices 10 years ago--perhaps that is good food for thought.

Acetabulum↗
PubMed1987

Extrinsic femoral artery occlusion following internal fixation of an acetabular fracture. A case report.

Vascular injury is one of the drastic complications that can arise from internal fixation of acetabular fractures. A 29-year-old, obese man sustained multiple trauma, including a displaced transverse acetabular fracture. Extreme obesity made adequate exposure to the posterior acetabular area difficult, causing placement of a large lag screw in malposition, such that it penetrated the superior pubic ramus at a point adjacent to the superficial femoral artery. Angiography, immediately after operation, revealed extrinsic compression of this vessel. The lag screw was successfully repositioned, with immediate return of vessel patency and no sequelae. The surgical approach and anatomic landmarks for placement of posterior to anterior lag screws are reviewed in an effort to prevent this complication.

Accidents, Traffic↗
PubMed1986

Surgical management of acetabular fractures.

We have each experienced a significant learning phase for surgical treatment of these fractures. However, problems of articular reduction remain significant, particularly for complex fractures. It is our opinion that a certain degree of centralization of acetabulum fracture treatment--especially for the associated types--can lead to an improved standard of care overall.

Acetabulum↗
PubMed1981

[Surgical fixation of displaced pelvic fractures and dislocations of the symphysis pubis (excluding acetabular fractures) (author's transl)].

For many years, the author has advocated systematic surgical fixation of displaced acetabular fractures. In this study he analyses the indications and technique of fixation of pubic dislocations (22 cases), sacro iliac dislocations (18 cases) combined dislocations (5 cases) and pelvic fractures associated with acetabular fractures (48 cases). The choice of a satisfactory approach is important. Accurate reduction and sound fixation is always possible within a week following the trauma, but in some cases operation was made after one month or even later. Surgical management aims to avoid malunion which is difficult to correct.

Fracture Fixation, Internal↗