Biomedical subjects

E Masmejean

Publications and source records attributed to E Masmejean.

7 recordsLinked to original sources

PubMed2000

[Primary carpal bone defect].

We present a review of management options in case of carpal bone defect, a relatively frequent discovery. In the literature, diagnosis is usually a fortuitous radiographic finding showing one or several images of carpal defect. Pain is observed in some cases, more exceptionally pathological fracture. The scaphoid, lunatum and hamatum are most frequently involved. Bilateral defects may be observed. Different mechanisms have been put forward to explain the development of intraosseous defects in the carpal bones including intraosseous penetration of synovial tissue, or in situ metaplasia of bone tissue. The main differential diagnoses are osteonecrosis sequellae (for the lunatum and the scaphoid), subchondral defects due to hyperpression and arthropathies in dialysis patients. All authors propose simple surveillance for asymptomatic images. In case of pain, with soft tissue swelling or pathological fractures, filling-excision is warranted depending on the severity of the clinical signs. Prognosis is generally good and recurrence exceptional.

Bone Diseases↗

PubMed2000

[Lesions of the radial nerve in fractures of the humeral diaphysis. Apropos of 62 cases].

PURPOSE OF THE STUDY: Evaluate outcome of different techniques used for radial nerve repair after humeral shaft fractures. Identify situations where nerve exploration is required or inversely unneeded. Evaluate the risk of more systematic nerve exploration in case of radial nerve palsy. MATERIAL AND METHODS: Over a 10 year period, we cared for 62 patients with humeral fractures associated with radial nerve palsy who were addressed directly to our unit or referred after prior care. There were 54 men (mean age 30 years, 17 - 66) and 8 women (mean age 40 years, 19 - 80). There were 40 fractures of the mid-third and 22 fractures of the distal third of the humerus. Anatomic severity varied although most fractures were displaced or subsequent to high-energy trauma. Orthopedic treatment was used alone in 14 cases. There were 6 plate fixations and 42 intramedullary nailings. Twenty-four of the 62 cases of radial nerve palsy resulted from nerve tears but a continuous nerve was found in 38 cases. Tears were treated by primary suture (n =4), secondary graft (n =17, 5 with 2 torons and 12 with 3 or 4 torons), or primary muscle transfer (n =3). Neurolysis was used in 6 of the 38 cases with continuous nerve. Motor outcome was assessed using composite criteria taking into account the physiological role of each muscle group. RESULTS: All primary sutures gave excellent results. Excellent or good outcome was achieved in 12 of the 17 secondary grafts although a complementary transfer was required in 2 cases. Conversely, outcome was average in 2 cases and a failure in 3. Outcome depended on the length of the graft and the number of torons used. The importance of a proximal resection in healthy tissue sometimes required a complementary medial access and a graft between the biceps and the brachialis. Recovery was achieved in 37 of the 38 lesions with continuous nerve including 31 cases which did not require a second procedure. DISCUSSION: In case of nerve rupture, the outcome of primary suture appears to be better than that of secondary grafts. The success of the graft depends on the length of the tissue loss after sectioning in healthy tissue and on the number of torons used. This difference in prognosis points out the usefulness of systematic exploration in order to use primary or early direct suture in cases of high-energy displaced fractures. Minimally displaced fractures often are accompanied by a simple contusion with spontaneous recovery. However, in intermediary cases, the decision to make a systematic nerve exploration during the osteosynthesis procedure (aimed at early mobilization) is based on the fact that recovery was achieved in 23 cases in which initial exploration of a continuous nerve has been performed. Indirectly, the favorable outcome of postoperative paralyses reported by several authors, also supports this policy.

Adolescent↗

PubMed1998

Results of non-operative and operative treatment of humeral shaft fractures. A series of 104 cases.

The aim of this study was to examine the results of different modalities applied in the treatment of 104 fresh diaphyseal fractures of the adult humerus treated in the department between January 1994 and March 1997. These results were classified according to the criteria described by Stewart and Hundley. 32 patients (30.8%) were treated non-operatively using a sling and a moulded plaster splint. The type of treatment had to be changed in 12 of these patients due to 14 different complications that occurred during the course of non-operative treatment. Thus, 20 patients (62.5%) underwent non-operative treatment until fracture-union. The results in this group were: very good in 12 cases (60%), good in 5 cases (25%), fair in 3 cases (15%). 28 fractures were treated using plates and screws. 4 events (14%) occurred during in the post-operative period and, apart from 2 cases of non-union, the overall result in the 26 patients in whom the fracture united was: very good in 23 cases (88.5%) and good in 3 cases (11.5%). 22 patients (21.1%) underwent fixation using multiple flexible intramedullary wires via a supracondylar approach. Apart from one case of non-union, the final result in the 21 patients in whom the fracture united was: very good in 9 cases (42.8%), good in 9 cases (42.8%), fair in 2 cases (9.5%) and poor in 1 case (4.9%). 22 fractures were treated using an intramedullary Seidel nail. The final result in these patients was: very good in 11 cases (50%), good in 9 cases (41%) and poor in 2 cases (9%). The indications for treatment should be eclectic. Non-operative treatment remains the method of choice for undisplaced or minimally-displaced fractures or comminuted fractures with multiple parallel longitudinal fracture-lines over the middle-third, while surgical treatment is considered for displaced fractures and essentially depends upon the type and level of the fracture. Transverse and short oblique fractures are treated using a plate or a Seidel nail. Fractures with a third fragment require plate osteosynthesis. Multiple flexible intramedullary wires are used for segmental fractures or for diaphyseal fractures associated with fractures of the neck of the humerus. Comminuted fractures are realigned using an intramedullary Seidel nail or multiple flexible wires. As far as the site of fracture is concerned, those of the proximal and middle thirds of the humerus are well treated using an intramedullary nail or multiple wires or with a plate, while plating is most often the method of choice for fractures of the distal-third.

Adolescent↗

PubMed1998

[Fracture of the scaphoid carpal bone secondary to an intraosseous cyst. Apropos of a case].

The authors report a cases of scaphoid fracture secondary to an intraosseous cyst in a young patient performing a high-risk sport. Intraosseous synovial cyst is a frequent and usually asymptomatic disease. Its aetiology remains controversial. No cases of fracture have been previously described. Our patient may have presented several risk factors for scaphoid fracture secondary to a synovial cyst.

Adult↗

PubMed1997

[Bilateral SLAC (scapholunate advanced collapse) wrist: an unusual entity. Apropos of a 7000-year-old prehistoric case].

SLAC (Scapho-Lunate Advanced Collapse) wrist is the most common form of osteoarthritis of the wrist. The main aetiology is ligamentous rotary subluxation of the scaphoid. The authors report on a case of bilateral SLAC wrist, identified on a prehistoric skeleton derived from the Hassi-el-Abiod site in the malian Sahara (Dutour, 1989). The paleopathological study consisted of macroscopic examination and radiological examination. Radiocarbon dating situated this human occupation to 7 thousand years ago. The diseases observed included bilateral radiocarpal lesions in an adult male individual. The degree of preservation of the carpal skeleton was 90%. Lesions were bilateral, but predominantly affected the right side. The radial styloid processes presented a lateral osteophytic cuff, giving a tapered "pen-nib" appearance. The scaphoid has a normal shape, but presented posterior and lateral osteophytes. The scaphoid surfaces of the two distal extremities of the radius and the corresponding parts of the scaphoid showed characteristic polishing. X-rays showed a band of condensation corresponding to the ivory region on the articular surfaces. In this case, the bilateral nature and the absence of any obvious macrotraumatic aetiology suggest that the only aetiology was progressive and bilateral ligamentous distension, due to repeated microtrauma analogous to that observed in sports disease (volley-ball) or in occupational diseases (jackhammer). The manufacture of stone tools (carved or polished) can be incriminated in the pathogenesis of these lesions. These lesions are therefore useful markers of repeated microtraumatic activities or "activity markers". The is the first paleopathological description and the oldest known case of bilateral SLAC wrist.

Carpal Bones↗

PubMed1997

[Fractures of the wrist with cartilage rupture in young adults. Apropos of 18 cases].

Distal radius impaction fractures are not rare. They present a dual problem for the surgeon: the difficulty of establishing the exact pathological anatomy of the fracture, and of obtaining stable anatomic reduction. The authors report their experience of 18 distal radius impaction fractures in young patients after violent trauma (motor vehicle accident). We subdivided these fractures using Kapandji and Müller's classifications: 12 type 9 or C3, 4 type 5 or B1 and 2 type 4 or C1. The mean depth of impaction of the scaphoid fossa or lunate fossa ("die punch fracture"), or centrally was measured at 5 mm on preop X-rays or on CT scan. After radiographs of the wrist in traction under anaesthesia, open reduction was performed in 14 cases (78%). A volar approach with plate fixation was performed in 3 cases. A dorsal approach with internal fixation with k-wires and an external fixator was performed in the other 11 cases. A bone graft was necessary in 10 cases when the bone defect was significant. The four remaining patients were treated with percutaneous k-wires and external fixation. We reviewed these 18 patients after a mean follow-up of 27 months. The mean age at the time of the accident was 37 years. The results were graded on the Green and O'Brien scale. Results were excellent in 1 case, good in 11 cases, fair in 5 cases, and poor in 1 case. We believe that impaction fractures always require open reduction with or without the addition of bone graft depending on the degree of the impaction. This is because of the risk of arthritic degeneration with this kind of fracture, with articular incongruence (more than 2 mm), and with chondral injuries on the radial or the carpal aspect of the wrist joint. Also, when there is a distal radio-ulnar joint injury (D.R.U.J. dislocation or distal head ulna fracture), the joint must always be stabilized to avoid secondary displacement.

Accidents, Traffic↗

PubMed1997

[Resection of the fourth ray for annular lesions: amputations of the fourth ray of the hand].

INTRODUCTION: Several procedures have been reported for amputation of the fourth ray of the hand. Most surgeons recommend translocation of the fifth finger on the proximal end of the fourth metacarpal bone. Others prefer to perform a resection of the fourth metacarpal bone combined with intracarpal osteotomy. MATERIAL AND METHODS: The authors' choice was to perform a resection of the fourth metacarpal bone with conservation of its proximal end. They emphased on two technical details: resection of the interosseous muscles and reconstruction of the intermetacarpal ligament. The present series includes 8 patients operated on with this technique. Results were assessed with an average follow-up of 47 months. Evaluation of the result was based on a personal rating score including 9 clinical scores and on 1 radiological measurement of the hand width. RESULTS: Mobility of the adjacent digits was normal in all cases except one with a retractile scar. In 7 cases out of 8, the aesthetic result was satisfactory. Grip strength was 65 per cent of the contralateral side. Diminution of the hand width was of 12 per cent. Five results were excellent and three were good. DISCUSSION: Translocation with intracarpal osteotomy can produce impairement of carpus function, especially with apparition of pain, but also some rotational malposition. Translocation of the fifth digit on the fourth metacarpal bone can also procedure an imbalance of the extrinsic muscles, but also a rotational malposition. CONCLUSION: Transmetacarpal amputation of the fourth ray has the advantage to be an easy anatomic procedure, and is particularly reliable and reproductible regarding to the results. This procedure does not produce any specific complication comparing with other techniques.

Adult↗