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F Chevalley

Publications and source records attributed to F Chevalley.

At least 19 recordsLinked to original sources
PubMed2005

[Surgical indications in spinal trauma].

Surgical indications in spinal trauma remain a controversial topic. In general, unstable cervical injuries such as displaced odontoid fractures, burst fractures or tear drop fractures require surgical intervention. Thoracolumbar compression injuries without posterior wall involvement or significant kyphosis can be treated conservatively. Surgery is indicated in fractures-dislocations and burst fractures with significant canal narrowing and/or major kyphosis. The role of emergency decompression as well as that of steroids remain uncertain since no study to date has convincingly proven their efficacy.

Decompression, Surgical↗
PubMed2005

[Percutaneous vertebroplasty].

Although vertebroplasty was initially a treatment of vertebral haemangioma or metastases, this procedure is now frequent option to the treatment of osteoporotic vertebral fractures. In this review article, we will discuss the indication, the techniques and the follow-up of the vertebroplasty. This is a risky procedure, which should be performed by experimented physicians working with high-resolution fluoroscopic equipments, by biplane fluoroscopy, to reduce the risk and irradiation to the patient. According to the available follow-up studies, there is clear evidence of a strong improvement of quality of life after vertebroplasty by rapid decreasing of back pain at least during the first six months. Other new studies will analyze the long-term follow-up after vertebroplasty.

Humans↗
PubMed2001

[Treatment of diaphyseal pseudarthrosis by circular external fixator].

The aim of this retrospective study was to evaluate the effectiveness of circular external fixator according with Ilisarov technique for the treatment of diaphyseal pseudarthrosis. The union rate obtained in our serie was 91%. We assessed the complications related to surgery and analysed the reasons for failed technique. Between january 1986 and february 1996, 23 patients were included in this study with a mean follow-up of 65 months. The period of external fixation was 209 days on average. 21 patients had united fractures. The failures were attributed to inadequate interfragmentary contact. The main problem during treatment was pin tract infection. The late complications included axial deformities, re-fractures and joint stiffness. Circular external fixator proved to be useful for the treatment of diaphyseal pseudarthrosis, particularly those complicated by infection or post-traumatic shortening.

Adolescent↗
PubMed2001

[Preliminary results of retrograde nailing of the humerus].

A group of nine patients with a diaphyseal fracture of the humerus and treated with retrograde nailing were studied with a mean follow-up of 15.3 months. Six patients with a humeral fracture without neurological deficit showed a good shoulder and elbow mobility at the last visit. Three patients with neurological lesion preoperatively suffer from a diminished range of movement not related to the surgical procedure. During the operation and postoperatively we found no complication related to the implant and more precisely we could not find a iatrogenic fracture or nervous lesion except one intraoperative lesion of the radial nerve probably related to an important traction movement during reduction with complete remission. Consolidation has been achieved for all fractures but one. This patient suffers from a lesion of the brachial plexus with complete plegia of the arm and a vascular lesion. This patient had to be reoperated for an atrophic non-union by bone grafting and plate fixation. The retrograde nail is a good implant and must be considered in our treatment plans as much as conservative treatment or surgical treatment with plating, anterograde nailing or the use of an external fixator. Only then will we be able to give to the patient the most adapted treatment for his fracture.

Adult↗
PubMed2001

[Osteosynthesis of per- and subtrochanteric fractures by blade plate versus gamma nail. A randomized prospective study].

AIM: To compare clinical and radiological results in per- and subtrochanteric fractures' management with 90 degrees blade plate or Gamma nail fixation; an implant allowing early weight-bearing and fracture healing in correct position remains still difficult. METHOD: Between 1993 and 1995, 26 patients addressed to our Center for a Kyle IV [1] fracture were divided into 2 groups, one fixed with blade plate and the other with Gamma nail. The follow-up for all patients is 12 months. RESULTS: Gamma nail allows early weight-bearing in all patients, fracture healing is acquired at 4.2 months; an operative diaphyseal fracture needed conversion to a long Gamma nail. We observed a slight cut-out that didn't need reoperation. In the blade plate group, we noticed three femoral head necrosis without major flattening, two non-unions, one plate's breakage and two malunions; fracture healing is acquired at 6.3 months. The two non-unions and the plate's breakage didn't need reoperation because of low functional demand. CONCLUSION: We prefer Gamma nail in per- and subtrochanteric femoral fractures' management, it allows early and fast weight-bearing and fracture healing is acquired in all cases.

Adult↗
PubMed2001

[Strain gauge measurements on a one-side external fixation: a prospective series of 11 tibial shaft fractures].

PURPOSE OF THE STUDY: External fixation is often the treatment of choice for open complex fractures of the tibia. For closed tibial shaft fractures, it is generally a second choice alternative. The purpose of this study was to determine whether fusion of closed and open fractures of the tibia can be successfully achieved with a one-side external fixator equipped with strain gauges and to evaluate complications of this type of treatment. MATERIAL AND METHODS: A consecutive series of 11 mid shaft fractures of the tibia (4 closed fractures and 7 Gustilo grade I and II open fractures) in 11 patients (mean age 29 years) were treated with a one-side external fixator. Strain was measured weekly to adjust the treatment. A Sarmiento walking cast was applied in all cases 4 weeks after removal of the external fixator. RESULTS: All 11 fractures healed without complications and without pin tract infection. Mean delay to consolidation was 20.5 weeks (range 13 - 29.5 weeks). One patient required a revision procedure for decortication and bone graft at 12 weeks. Weight bearing (50% of body weight on the injured limb) was achieved at 6.7 weeks (mean) and total weight bearing at 11.9 weeks. The external fixator's strain curves were compatible with normal healing in 3 cases, with slow healing in 3 and with retarded healing in 3 others. Two of the curves did not show recognizable patterns despite a favorable clinical and radiological course to healing. DISCUSSION: Early detection of a pathological pattern of fracture healing followed with a strain gauge enabled adaptation of treatment in all cases. Decortication with bone grafting was necessary in one patient. In two other cases, compression of the fracture with the external fixator or dynamic locking were sufficient to achieve a favorable healing pattern. This small series demonstrated that bone healing can be achieved within usual delays with external fixation and without major complications. Use of strain gauges on the external fixator allowed early detection of retarded healing and subsequent modification of the treatment protocol. This type of treatment might be an interesting therapeutic alternative for the treatment of closed fractures of the tibial shaft.

Adult↗
PubMed2000

[The place of surgery in the treatment of advanced localized, recurrent and metastatic breast cancer].

In the multidisciplinary treatment of locally advanced and metastatic breast cancer, aggressive surgical options can be chosen in selected cases. They may allow: survival to be prolonged by the resection of metastases (liver, ovary, lung), symptomatic treatment (bone pain, local recurrence, infiltration of the chest wall), prevention of potentially disabling complications (pathologic fractures, medullary compression), exclusion of another tumoural or non tumoural diseases. The decision to perform surgery has to be discussed between the surgeon and the oncologist so as to optimise its timing. Surgical treatment can follow induction therapy or can precede chemo- or hormonotherapy.

Abdominal Neoplasms↗
PubMed1998

[Acute ruptures of the Achilles tendon--apropos of 14 conservatively treated cases].

GOAL OF THE STUDY: To analyse the results of non surgical treatment (cast for 12 weeks) for complete and recent rupture of Achilles tendon. MATERIAL AND METHODS: We reviewed with an average follow up of 2 years 14 patients (14 ruptures). All patients evaluated subjective results on a linear scale. Objective results were given by clinical examination, ultrasonography and performance testing. RESULTS: Subjective results were excellent for 50% of cases, good for 29% and fair for 21%. Amyotrophy of the calf was always noted (mean 15 cm). The maximum force was reduced by 22% and the endurance by 47% in comparison with the healthy calf. All sportsmen but one were able to continue their sport as before. None of them had to change their job. DISCUSSION: The conservative treatment of fresh ruptured Achilles tendon by plaster cast for 12 weeks gives satisfactory results in comparison with surgical treatment followed by 6 weeks immobilisation. The results are not so good when compared to conservative or surgical treatment followed by immediate mobilisation. CONCLUSION: Conservative treatment by plaster cast for 12 weeks should be applied to non compliant patients or to patients who are not concerned by the functional results or unable to follow a programme of reeducation or to patients with chronic skin lesions.

Achilles Tendon↗
PubMed1998

[Fractures of the tibial pilon. Long-term retrospective study of 51 fractures treated with open reduction and osteosynthesis].

PURPOSE OF THE STUDY: Fracture of the tibial pilon is a rare injury and its treatment remains difficult. The aim of this study was to report the complications and long term results of internal fixation using a technique which respects soft tissues and in which little material was used. MATERIAL: From 1985 to 1990, 48 patients with 51 fractures of the tibial pilon were treated by open reduction and internal fixation. All patients were submitted to a clinical and radiological review. METHODS: Both the Rüedi/Allgöwer and the AO-classification were used and determined by standard X-rays. Surgical procedure was performed with a 2 or 3 1/3 tube AO-plates and the peroneus was always fixed if fractured. Intraoperative reconstruction was analyzed. Subjective and objective scoring were used according to Olerud and Molander and the ankle arthritis was scored according to the classification determined by the SOFCOT in 1992. RESULTS: A minimal follow-up of 1 year for all cases was obtained, based on our own files. Thirty-eight patients (40 fractures) were evaluated after an average period of 88 months (56 to 124 months). Five patients developed cutaneous infection, three developed deep infection and four developed superficial skin necrosis. One aseptic non-union necessitated reoperation after 14 months. Two ankles had joint fusion after 19 and 25 months respectively due to severe arthritis. In six cases infectious and non-infectious complications led to surgical revision. According to the Olerud and Molander score, 15 per cent of the results were excellent, 45 per cent were good, 30 per cent were fair and 10 per cent poor. DISCUSSION: Literature shows a wide range of results following this surgical procedure. This is due to the difference in the type of trauma, classification system used, material used for the internal fixation and method of evaluation. The classification system of Rüedi and Allgöwer is the most commonly used but has a rather subjective tendency, especially between type II and type III. Treatment is difficult, especially for comminutive fractures associated with soft tissue damage. In this case, open reduction and internal fixation could increase iatrogenic lesions. For this reason surgical procedure can be delayed for several days, little material is used and soft tissue manipulation is reduced to minimum. In other study reports, the use of external fixation with or without minimal internal fixation have produced less complications without improving long term results. CONCLUSION: Analysis and comparison of study reports are difficult because of the absence of consensus in classification system and evaluation methods. The AO-classification, apparently the most objective, will probably be more and more used in the future. Treatment must be adapted to the bony lesion and soft tissue damage. Open reduction and internal fixation must be reserved for a specific group of lesion.

Adult↗
PubMed1997

Gamma nailing of pertrochanteric and subtrochanteric fractures: clinical results of a series of 63 consecutive cases.

OBJECTIVE: To analyze the use of the gamma nail in the treatment of pertrochanteric fractures. DESIGN: Prospective. SETTING: University. PATIENTS: Sixty-three fractures in sixty-three patients treated with gamma nails. RESULTS: Forty-five of the sixty-three patients (71 percent) were followed until the end of treatment, for an average follow-up period of 7.2 months. Of the remaining eighteen, eleven died and seven were lost to follow-up. Reduction was classified as good in thirty-eight cases, acceptable in nineteen, and unsatisfactory in six. CONCLUSION: The findings from this series indicate that, compared with other methods, the gamma nail enables the surgeon to treat more types of hip fractures with a less invasive technique and achieve equal or better results.

Adult↗
PubMed1996

Chordoma of the spine above the sacrum. Treatment and outcome in 21 cases.

STUDY DESIGN: Twenty-one cases of chordoma arising in the mobile spine were retrospectively reviewed. OBJECTIVES: All the cases were submitted to oncologic and surgical staging to correlate treatment and outcome. SUMMARY OF BACKGROUND DATA: Excluding plasmacytomas, chordoma is the most frequent primary malignant tumor of the spine, occurring mainly in elderly men. The course of the disease is slow, metastases occur late, and death can result from complications related to local extension of the disease. Complete excision of the tumor according to oncologic criteria can be hampered by extension of the tumor and by anatomic constraints in the mobile spine. METHODS: All charts, radiographs, and images were reviewed. The composite information provided by this review allowed for oncologic and surgical staging of these cases. Treatment was defined according to Ennekings criteria. All the patients were followed for determination of their status clinically and radiographically. RESULTS: Ten patients died (1 to 137 months after treatment, mean 65 months); four patients are alive with the disease; only seven patients (33%) are symptom free at the final follow-up (39 to 112 months after treatment, mean 65 months). Conventional radiation therapy was not effective in eradicating the tumor, even if associated with palliative or debulking surgery: of 15 cases, 12 were associated with recurrence or progression. Intralesional surgery also was not effective (two recurrences in two cases, 18 to 41 months later). En bloc excision of the lesion, sometimes combined with radiation therapy as an adjuvant, obtained the best results (four patients disease free at 39 to 112 months, mean 77 months). CONCLUSIONS: En bloc excision--even if marginal--is the treatment of choice of chordomas of the spine. Early diagnosis and careful surgical staging and planning are necessary. Megavoltage radiation can be administered as an adjuvant.

Adult↗
PubMed1996

[External fixator in severe traumatic injuries of the pelvis: results apropos of 20 consecutive cases].

From August 91 to December 94, 20 external fixators were used for severely injured patients (avg. ISS 25.2). The fractures were essentially open book with or without lateral compression and vertical lesions. The indication for fixation was treatment of shock and stabilization in 8 cases, stabilization alone in 9 cases, and in 3 cases as complementary fixation after internal fixation of posterior lesions. The fixation of the pelvis was effective on the amount of blood loss. One acetabulum fracture required surgery, two patients had internal fixation for loss of reduction and two others for late pubic and posterior pain. The clinical results are good; they are more related to the severity of the initial lesion than to the mode of fixation or the quality of the reduction. No superficial sepsis or osteitis was observed in relation to the pins.

Adult↗
PubMed1995

[Interlocking nailing of the tibia].

Centromedullary nailing is a well-established method of treatment for diaphyseal long bone fractures. The indications have been broadened greatly since the introduction in 1974 of interlocking centromedullary nailing. The purpose of this paper is to review our first results with locked intramedullary nailing of the tibia. We report our experience with the first 19 cases of interlocking tibia nails (15 fractures, 1 delayed union, 2 pseudarthrosis, 1 osteotomy). On the extension table, the insertion of the nail and the placement of the interlocking screws did not cause any problem. In 3 cases, a proximal screw had to be removed within two weeks because of spontaneous displacement. Complications have been noticed in three patients (15.8%) (pulmonary embolism on day 1, and compartment syndrome two days later in one case, sciatic nerve neuroapraxia in the other two). The other patients have been mobilized 24 to 48 hours after surgery. 94% of the fractures were consolidated 4 months post-operatively, with no major deformation. Interlocking tibia nailing seems to be an attractive method in the treatment of certain fractures of the tibia. Early mobilisation and weight-bearing are provided. The indications, the technical aspects as well as the dangers of the method must be carefully respected in order to avoid complications and poor results.

Bone Nails↗
PubMed1995

[Treatment by external fixator of open Gustilo stage III A and III B leg fractures].

From June 1992 to July 1993, we treated 10 consecutive open tibial fractures (6 III A and 4 III B according to the classification of Gustilo). All fractures were treated by external fixation (9 Hoffmann external fixators and 1 Orthofix). Only one patients needed a primary facsiocutaneous flap; the remaining patients were treated by skin grafting (7 cases), secondary wound (1 cases) and granulation (1 case). In 8 cases we realised a decortication and autologous bone grafting. Consolidation time was inferior or equal to 6 months in 5 patients, equal to 8 months in one and equal to 11 months in one. One patient was lost to follow-up and one ist still in treatment. In 2 patients we changed the stabilisation system and we used the Ilizarov technique, once for pseudoarthosis at 7.5 months from injury and once for bone-transfer at 3.5 months. We do not deplore any other case of pseudoarthrosis nor any case of osteitis. None of our patients needed amputation. Early and adequate soft tissue treatment is essential and decoration and bone grafting, which we used 8 times at mean of 12 weeks from injury, should be done earlier.

Adult↗
PubMed1994

[Necrotizing fasciitis of the foot. An unknown surgical emergency. Apropos of a case].

INTRODUCTION: The purpose of this study was to review the literature concerning Necrotizing Fasciitis (N.F.) and to discuss a typical case where late diagnosis led to severe consequences. MATERIAL AND METHODS: A young male patient with no pertinent medical history, progressively developed a large swelling of his foot and severe pain 3-4 days following a simple contusion. The absence of an entry site lead to local incision without microbiological study. The patient developed blistering on the leg, then septic shock necessitating amputation. DISCUSSION: N.F. is an infectious necrosis of the sub-cutaneous tissue appearing frequently in surgical or post traumatic contexts. Streptococcal origin is classical but multibacterial anaerobic infection is more and more frequently observed. An entry site is not always found while the affected site becomes red, hot and painful. Evolution is extremely rapid with the appearance of blisters and cutaneous necrotic sites and a severe alteration in the general condition of the patient. The extent of sub-cutaneous necrosis is larger than the affected area of skin. N.F. is a surgical emergency. Treatment consists of complete debridement, sometimes very extensive and mutilating. High dose intra-venous antibiotic therapy is necessary while the benefits of hyperbaric therapy are discussed. Because of the lack of specific clinical signs, diagnosis is difficult and is often made too late. The rapidity of the evolution shows that vital and functional prognosis is better with early diagnosis and treatment even for patients without associated pathology. The rate of mortality is approximately 50 per cent. CONCLUSION: Better information of practitioners allowing a rapid clinical diagnosis could improve the prognosis which is still life-threatening in 1994.

Adult↗
PubMed1993

Treatment of large bone defects with the Ilizarov technique.

Between 1985 and 1990 we treated 11 large segmental bone defects (average 6.7 cm) in ten patients with the Ilizarov technique. Open fractures, type III according to Gustilo, represented the largest group (8 of 11 cases). The average delay before the Ilizarov technique was initiated was 8.9 months. The external fixator was usually maintained for 1 year. Bone regeneration was obtained in every case. Consolidation was not fulfilled with this technique in three cases. The complications observed were one refracture, four leg-length discrepancies (average 1.5 cm), and five axial deformities exceeding 5 degrees. No pin-track infection was observed. In our limited series of four type IIIC open fractures treated by the Ilizarov technique, no patients required amputation. The Ilizarov technique is particularly useful in the treatment of large bone defects, without major complications, especially if there is an adequate initial debridement.

Adolescent↗
PubMed1993

[Prospective surveillance of nosocomial infections in a traumatology and orthopedics service].

From May 1989 to February 1990, 1164 patients were followed in the Service of Orthopaedic Surgery and Traumatology at the CHUV, for the development of nosocomial infections (N.I.), in particular postoperative wound infections. Among them, 439 patients were treated conservatively and 725 underwent 833 operations. The global incidence of N.I. was 7.7/100 admissions. Urinary tract infections represented 57% of all N.I., postoperative wound infections represented 21% (with 12% superficial and 9% deep infections), pneumonias represented 20% (5 deaths), bacteriemias represented 2% (1 death) of the cases. The rate of infections was 1.1% for clean surgical interventions (n = 549), 0% for clean-contaminated operations (n = 87), 7.5% for contaminated operations (n = 40), 22.8% for dirty operations and 1.6% for unclassified operations (n = 122). Among the 19 postoperative wound infections, 6 were diagnosed after the patients were discharged. In conclusion, postoperative wound infections constituted only 20% of all N.I. observed in the Service of Orthopaedic Surgery and Traumatology and the rates of infection according to the types of interventions were low. On the other hand, 80% of the N.I. were observed at sites other then the wounds and were associated with a 0.5% mortality rate.

Cross Infection↗