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E Stindel

Publications and source records attributed to E Stindel.

15 recordsLinked to original sources
PubMed2004

[Vascularized fibular transplant for avascular necrosis of the femoral head: 16 cases].

PURPOSE OF THE STUDY: We report our experience with vascularized fibular transplant using the technique described by Urbaniak for the treatment of avascular necrosis of the femoral head. MATERIAL AND METHODS: Sixteen patients, mean age 39 years 4 months at surgery, were evaluated at mean 3 years 6 months follow-up (minimum 15 months). Mean pain score (analog visual scale) was 6.25/10. Mean Postel-Merle-d'Aubigné (PMA) function score was 12. The Ficat classification was grade 2A (n=9) or grade 2B (n=7). RESULTS: There were no cases of infection or migration of the fibula. The only complication at the donor site was one case of paresia of the long extensor of the hallux which resolved spontaneously. There were five failures which required a hip prosthesis (31%). Three failures occurred early during the first 18 months. Two were late. These patients had grade 2B (n=4) or grade 2A (n=1) necrosis. At last follow-up, eleven hips had not required prosthetic revision (69%). The pain score improved in 81% of patients: mean score=2.3. Nine patients were satisfied or very satisfied (81%). Among these eleven hips, function was good or excellent in eight (72%). Walking distance was improved in nine patients, unchanged in one and worse in one. Joint motion improved in nine patients, was unchanged in one and decreased in one. Nine patients resumed their full-time job. Mean sick leave was 13.3 months. Radiographically, only two of the initial Ficat grade 2A hips remained at this stage. Likewise only one of the three hips initially rated grade 2B remained at this stage. Overall radiographic results were: failure (n=5), worsening (n=9), stabilization and no improvement (n=2). Among the nine 2A hips, one was converted to a total hip prosthesis and five femoral heads remained spheric. Among the seven 2B hips, four were converted to a total hip prosthesis and two femoral heads collapsed. DISCUSSION: At mean follow-up (3.5 years), 69% of the hips had not required total hip arthroplasty. The grade 2A hips did better but the small sample size did not allow statistical comparison. There was a clear discordance between the clinical presentation and the radiographic findings among the hips which were not treated with a prosthesis: good function score, maintained occupational and daily life activities contrasting with unfavorable radiographic evolution. Results could be improved by detailed quantification of the lesion using 3D imaging and by associating intraoperative navigation.

Adult↗
PubMed2002

Bone morphing: 3D morphological data for total knee arthroplasty.

OBJECTIVE: The clinical outcome of a total knee arthroplasty (TKA) is mainly determined by the accuracy of the surgical procedure itself. To improve the final result, one must take into account (a) the alignment of the prosthesis with respect to the mechanical axis, and (b) the balance of the soft tissues. Therefore, morphologic data (such as the shape of the epiphysis) and geometric data are essential. We present a new method for performing TKA based on morphologic and geometric data without preoperative images. MATERIALS AND METHODS: The global method is based on the digitization of points with an optical 3D localizer. For the morphologic acquisitions, we use a method based on the registration of sparse point data with a 3D statistical deformable model. To build the mechanical axis, we use a kinematics method for the hip center and digitization of anatomical landmarks for the ankle centers. The knee center is not determined by digitization or kinematics of the knee, as this would not be accurate. The surgical planning relies totally on the soft-tissue balance, which is the key issue for a good kinematics result. RESULTS: We have used this system for 6 months in a randomized clinical trial involving 35 patients to date. For the first 11 patients that could be measured in the navigation group, the postoperative frontal alignment was within the range of 180 +/- 3 degrees. Fluoroscopic assessment of the soft-tissue balancing will be performed at the conclusion of an extended 2-year study to evaluate the results from a functional point of view. CONCLUSION: Bone Morphing is an accurate, fast, and user-friendly method that can provide morphologic as well as geometric data. We have introduced the important notion of soft-tissue balancing into the intraoperative planning step to optimize the kinematics as well as the anatomy. Therefore, this method should be considered as an alternative to the CT-based method.

Algorithms↗
PubMed2001

The use of MR images to evaluate the risks associated with proximal locking of intramedullary tibial nails.

Vascular complications associated with locked intramedullary tibial nailing are infrequent but always serious, with a secondary amputation rate of 30%. These complications, based on an MR study of the anatomic relationships between the interlocking screws and the neurovascular or articular structures at the proximal end of the tibia, have been analysed. Two types of nails were used: one with anterior-posterior locking and a specially designed prototype with oblique locking. In particular this study emphasised the anatomic risk of injury to the popliteal structures when using anterior-posterior locking, as well as to the anterior tibial vessels and proximal tibiofibular joint when using oblique locking. As no locking method appears to be better than any other, the best is that associated with the lowest morbidity. Consequently, the use of frontal instead of anterior-posterior locking is recommended; the use of oblique locking, which this study has shown carries a much higher risk of complications, is strongly advised against.

Bone Nails↗
PubMed2001

Pedicle island flaps of latissimus dorsi. Applications in surgical repair of ruptures of the rotator cuff.

There are considerable problems in repair of major ruptures of the rotator cuff tendons particularly those of the supra and infraspinatus mm. The Gerber technique only transfers the tendinous insertion of the latissimus dorsi onto the greater tuberosity in massive cuff ruptures. We have extended this approach. In 12 shoulders, we studied the feasibility of a latissimus dorsi transfer harvested to fit and bearing muscle and tendon detached at its two extremities and transposed as a neurovascular island. The muscular part is transferred to the infra or supraspinous fossae and the tendon to the greater tuberosity with the aim of reactivating the infra and supraspinatus muscles. The lateral bundle of the latissimus dorsi is always transferable on its neurovascular pedicle into the infraspinous fossa, even into the supraspinous fossa, or into both if transfer is used as a bilobed flap. This anatomical work allowed a parallel study of the different possibilities of transposing the neurovascular pedicle, which might limit the technique, and also to determine the most appropriate surgical approach.

Adult↗
PubMed2001

An in vivo analysis of the motion of the peri-talar joint complex based on MR imaging.

The purpose of this work is to characterize the three-dimensional (3-D) motion of the peritalar joint complex in vivo using magnetic resonance imaging (MRI). Each image data set utilized in this study is made of 60 longitudinal MR slices of the foot in each of eight positions from extreme pronation to extreme supination. We acquired and analyzed ten such data sets from normal subjects, seven data sets from pathological joints and two postoperative data sets. We segmented and formed the surfaces of the calcaneus, talus, cuboid and navicular from all data sets. About 30 geometrical parameters are computed for each joint in each position. The results present features of normal motion and show how normal and abnormal motion can be distinguished. They also show the consequences of surgery on the motion. This non- invasive method offers a unique tool to characterize and quantify the 3-D motion of the rearfoot in vivo from MR images.

Adult↗
PubMed1999

Fracture of the distal part of the radius associated with severed ulnar nerve.

We report a case of a severed ulnar nerve after fracture of the distal part of the radius. The most likely hypothesis is stretching of the ulnar nerve fixed by Guyon's canal and severed on the sharp edge of the proximal radius. Although very rare, this lesion must be investigated particularly in cases with marked displacement, especially ulnar and/or volar.

Accidents, Traffic↗
PubMed1999

A characterization of the geometric architecture of the peritalar joint complex via MRI: an aid to the classification of foot type.

The purpose of this work is to study the architecture of the rearfoot using in vivo MR image data. Each data set used in this study is made of sixty sagittal slices of the foot acquired in a 1.5-T commercial GE MR system. We use the live-wire method to delineate boundaries and form the surfaces of the bones. In the first part of this work, we describe a new method to characterize the three-dimensional (3-D) relationships of four bones of the peritalar complex and apply this description technique to data sets from ten normal subjects and from seven pathological cases. In the second part, we propose a procedure to classify feet, based on the values of these new architectural parameters. We conclude that this noninvasive method offers a unique tool to characterize the 3-D architecture of the feet in live patients, based on a set of new architectural parameters. This can be integrated into a set of tools to improve diagnosis and treatment of foot malformations.

Algorithms↗
PubMed1999

[Free musculo-tendinous flap stabilization-interposition of the palmaris longus tendon after trapezium surgery in rhizarthrosis].

Complete resection of the trapezium combined with interposition and ligament reconstruction with flexor carpi radialis remains the author's preferred method thumb basal joint arthritis the surgical treatment. Elevating half of the tendon takes a long time and is not so easy to perform. Using palmaris longus tendon with a fragment of muscle seemed to be more practical and quicker. It allowed simultaneously stabilization (tendon part) and an effective interposition (muscle part).

Arthritis↗
PubMed1999

[Perineural fibrosis of the median nerve at the wrist. Treatment by neurolysis and dermal-hypodermal graft].

UNLABELLED: In the treatment of multiple recurrences of carpal tunnel syndrome due to fibrosis, following repeated nerve release, the authors propose interposition of a composite dermal fat graft raised from the inguinal region, and report four clinical cases using this technique. The objective of this study was to evaluate the efficacy of the graft in terms of clinical and electromyographic results and determine the course of the graft by a postoperative MRI study and a longer follow-up. CLINICAL RESULTS: Nocturnal paraesthesiae resolved in 2 patients, was improved in one patient and remained unchanged in another patient. Objectively, neurological examination showed improvement in 3 cases and no change in 1 case. Electromyographic results: At last follow-up, EMG was improved in only one case. Magnetic resonance imaging: MRI visualized the graft with a fat signal on T1-weighted sequences in every case, with an increase in size over time in 3 cases. The efficacy of the dermal fat graft may seem disappointing, as none of the patients were cured. However, with a mean follow-up of more than two years, we have not observed any deterioration of the clinical features, and no surgical revision for carpal tunnel syndrome. This technique appears to increase graft survival, as the blood supply to the subdermis is restored more rapidly via the dermis, which is anatomically a very vascular tissue. There is nevertheless a discrepancy between the clinical results, and EMG and MRI findings, which could be explained by the anatomical lesion of the median nerve, surgically released several times, and by alterations of the perineurium.

Adipose Tissue↗
PubMed1996

[Therapeutic possibilities of the lateral supra-malleolar flap and its variations. Apropos of 6 clinical cases].

The distally based lateral supramalleolaire flap with a retrograde blood flow on the perforating branch of the peroneal artery is a good flap to treat loss of skin involving the ankle, the region behind the Achilles tendon, and the foot. Based on the results of an anatomical study, the authors describe a modification of this flap which can be raised on the infero-lateral collateral artery, with an anterograde blood flow. In fact, clinical experience of six cases shows that vascular pedicle component (perforating branch of the peroneal artery, infero-lateral collateral artery) and blood flow (anterograde, retrograde) can be calculated according to the regional vascular network, arc of rotation and the type of flap. Because of the many possible combinations, it can be considered to be a flap with variable vascular pedicle raised "à la carte". However, according to our clinical cases, the anterograde blood flow does not seem to have resolved the problems of venous congestion of this flap.

Adult↗
PubMed1995

[Kirner's deformity. 4 case reports and review of the literature].

Kirner's disease is a rare deformity of the distal phalanx of the little finger, with a combination of camptodactyly and clinodactyly and clinodactyly. A review of the literature and analysis of our cases show that this anomaly appears to result from a unusual insertion of the deep flexor over the growth cartilage. No treatment is required in view of the absence of any clinical and functional symptoms.

Adolescent↗
PubMed1993

[Controlled mobilisation after suture of extensor tendons of the hand. Apropos of 30 consecutive cases].

From January 1988 to May 1991, 30 patients (mean age: 27 years old; range: 15 to 45) sustained 57 tendon injuries in 49 fingers. They were treated by primary repair with assisted post-operative mobilisation by a dynamic splint. Adhesion of extensor apparatus rate was 12 p. cent but only one had a functional impairment. No other complications were noted. At the thumb level (3 out of 49 fingers) the Kapandji-test was respectively at 8.8 and 9/10 without any extensor lack. At the long fingers level TAM was excellent in 91 p. cent of cases, good in 4 p. cent, fair and poor in 2 p. cent. According to Allieu classification results were good and excellent in 9 p. cent of cases. These results were better when injury was localised to or up to zone 5 according to Verdan's classification, and when there was no associated bone nor articular injuries or cutaneous defects. Subjective results were less good (70 p. cent of satisfactory results) because of pain, grip strength lack or disability. Assisted mobilisation allowed intrinsic healing and avoided adhesion when application date and rehabilitation protocol were respected. It was more beneficial for distal and complex injuries.

Adolescent↗
PubMedDate not supplied

3D MR image analysis of the morphology of the rear foot: application to classification of bones.

The purpose of this work is to characterize the three-dimensional (3D) morphology of the bones of the rear foot using MR image data. It has two sub-aims: (i) to study the variability of the various computed architectural measures caused by the subjectivity and variations in the various processing operations; (ii) to study the morphology of the bones included in the peritalar complex. Each image data set utilized in this study consists of sixty sagittal slices of the foot acquired on a 1.5 T commercial GE MR system. The description of the rear foot morphology is based mainly on the principal axes, which represent the inertia axes of the bones, and on the bone surfaces. We use the live-wire method [Falcao AX, Udupa JK, Samarasekera S, Shoba S, Hirsch BE, Lotufo RA. User-steered image segmentation paradigms: live wire and live lane. Proceedings of the Society of Photo-optical Instrumentation Engineers 1996;2710:278-288] for segmenting and forming the surfaces of the bones. In the first part of this work, we focus on the analysis of the dependence of the principal axes system on segmentation and on scan orientation. In the second part, we describe the normal morphology of the rear foot considering the four bones namely calcaneus, cuboid, navicular, and talus, and compare this to a population from the upper Pleistocene. We conclude that this non-invasive method offers a unique tool to characterize the bone morphology in live patients towards the goal of understanding the architecture and kinematics of normal and pathological joints in vivo.

Adult↗