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Biomedical subjects

F Duparc

Publications and source records attributed to F Duparc.

At least 19 recordsLinked to original sources
PubMed2003

Embryology of the walls of the lateral sellar compartment: apropos of a continuous series of 39 embryos and fetuses representing the first six months of intra-uterine life.

The aim of this study was a continuous and rather exhaustive description of the embryological development of the lateral sellar compartment. The histological sections of 39 embryos and fetuses were studied, and represent the first six months of intra-uterine life. The embryological period showed the organization of the content of the compartment. The medial and lateral walls appeared during the 15th week of amenorrhoea, and did not modify later. The medial wall was constituted in its rostral part by the hypophyseal lodge and in its caudal part by the periosteum of the sphenoid bone. Two layers formed the lateral wall: the superficial layer was an expansion of the dura mater that surrounded the oculomotor nerves along their course to the superior orbital fissure; the deep layer was weaker, and surrounded and joined the nerves together. The results of this study advocate the evolution of the nomenclature of this region, as the term "inter-periosto-dural space" would better reflect the real pattern of the lateral sellar compartment. Furthermore, the presence of a communication between the two lateral sellar compartments has led to a discussion of the previous hypothesis about the development of the lateral sellar compartment. The venous network was located on both the medial and lateral sides of the internal carotid artery, but expanded in the lateral wall of the lateral sellar compartment. That is of interest to surgeons and radiologists because it could explain some hemorrhagic complications.

Carotid Artery, Internal↗
PubMed2002

The synovial fold of the humeroradial joint: anatomical and histological features, and clinical relevance in lateral epicondylalgia of the elbow.

The synovial fold of the humeroradial joint is known, and sometimes considered as a meniscus that could be injured by chronic repeated trauma related to pronation and supination. The aims of this study were to determine the gross anatomy and histological structure of this fold, and to clarify its participation in the painful lateral syndromes of the elbow. Fifty elbows from adult cadavers were dissected. The capsule of the humeroradial part of the elbow joint was resected with the annular ligament. The presence of a synovial fold, and its location relative to the cranial edge of the annular ligament divided into five sectors (ventral, ventrolateral, lateral, laterodorsal and dorsal) were noted; morphological parameters such as thickness, width and length were measured. The histological examination determined the structure of the folds. Five synovial folds were resected during surgery for epicondylalgia in five patients who suffered from pain precisely at the level of the joint between the capitulum and the fovea radialis, and were also examined. A fold was present in 43 cases, and in two cases two folds were seen at the deep side of the junction between the capsule and the annular ligament. The most frequent positions were: dorsal ( n=11), laterodorsal and dorsal ( n=6;), lateral to dorsal ( n=5), lateral ( n=5), ventral ( n=4) and circular ( n=4). The mean length was 21.4 mm (range from 9-51 mm). The mean width was 2.9 mm (range 1-10 mm), and the mean maximal thickness 1.7 mm (range 1-4 mm). The histological study showed two types of folds: a rigid structure, with oriented fibrous tissue, triangular with a peripheral capsular base, covered on its two sides and along the free edge by a synovial layer; and a pliable structure, formed of two synovial layers that surrounded a thin fatty tissue, with a villous appearance of the free edge. No fibromyxoid structure, as in a real meniscus, was observed. Some nerve fibers were seen in the folds. The five folds resected in operated patients were hypertrophic, and showed an increased number of nerve fibers, along the capsule but also close to the synovial layer. Some painful syndromes of the lateral side of the elbow are not related to tendinitis or to posterior interosseous nerve compression, but have an intra-articular origin. This study showed that the synovial fold is not a meniscus, and may be involved in the etiology of lateral epicondylalgia.

Adult↗
PubMed2002

[Constitutional anomalies of the terminal branches of the brachial plexus in the axial and brachial regions. Results of 42 cases and review of the literature].

The authors report anatomical variations of the terminal brachial plexus branches in 42 cadaveric dissections. The results are compared with results reported in literature which revealed a new variation: ulnar nerve originating in posterior beam. This study demonstrates that there exist not one but several brachial plexes which could have potential clinical implications.

Arm↗
PubMed2002

Determining humeral retroversion with computed tomography.

BACKGROUND: The purpose of this study was to develop and standardize a technique in which computed tomography images are used to determine the humeral torsion angle with landmarks that can be used during surgery. METHODS: One hundred and twenty cadaveric humeri were studied. The retroversion of these anatomical specimens was measured on a computed tomography scan and compared with the direct measurements of the specimens. The retroversion of the humerus was measured by determining the orientation of the proximal articular surface of the humerus with respect to the transepicondylar line of the distal part of the humerus and the forearm axis. To evaluate this method of measuring retroversion, the protocol was tested in patients before and after shoulder arthroplasty. RESULTS: The degree of reproducibility of the measurements made on the computed tomography scan was evaluated by determining the interclass correlation coefficient. The interclass correlation coefficient was considered good (between 0.85 and 0.90) for the measurements of the normal humeri when the orientation of the articular surface measured in the distal part of the humeral head, the epicondylar axis, and the ulnar axis were used as references. There was a significant difference (p < 0.01) between the mean angular orientation of the proximal articular surface with respect to the epicondylar axis (17.6 degrees ) and the mean angular orientation of the proximal articular surface with respect to a line perpendicular to the forearm axis (28.8 degrees ). Despite a wide variation in the humeral torsion angle among the specimens from the different cadavera, the angle varied little between the two normal humeri of the same individual (mean side-to-side difference, 2.1 degrees ). CONCLUSION: This study demonstrated that retroversion of the proximal part of the humerus can be reliably measured with computed tomography. CLINICAL RELEVANCE: Determining retroversion with computed tomography is more accurate than palpating the epicondylar axis or using the forearm as a goniometer during surgery. Computed tomography is useful for measuring the amount of rotation of humeri with a malunited fracture or severe arthritic deformity.

Aged↗
PubMed2001

Arterial blood supply of the proximal humeral epiphysis.

The arterial blood supply of the proximal humeral epiphysis is known to derive mainly from the anterior humeral circumflex a. (ACA), but this description may minimize the role of the posterior circumflex humeral a. (PCA). The studies of Laing [9] and Gerber [3] emphasized the role of the ACA and of its branches, the ascending anterolateral artery and arcuate artery Thus, this description could not explain either the necrosis or the absence of necrosis in all the cases of fracture or dislocation of the glenohumeral joint. The evaluation of the risk of a vascular post-traumatic necrosis of the humeral head requires a knowledge of its arterial vascularization, and the aim of this study was to determine the respective areas of vascularization of both the humeral circumflex aa. 32 shoulders of adult cadavers were studied: the ACA and the PCA were injected with latex containing two differently colored fluids. The proximal humeral epiphysis was removed with the arteries. The extraosseous vessels and the coloration of the capsule were noted; then the epiphysis was sectioned in 5 mm horizontal scans, and the bone staining was studied in order to define the distribution of the arterial supplies. The origin of the ACA and PCA was common in only 10 cases. The mean diameters were: ACA 0.8 mm (0.3 to 2) and PCA 2.1 mm (1.5 to 4). The subchondral bone was colored in 29 specimens by the PCA, and by both the ACA in the cranial part and PCA in the caudal part in 3. The apex of the head was colored by the ACA in 7 cases, the PCA in 7 and both ACA and ACP in 1 case; the head was colored by the PCA in 17 and the ACA in 12 cases; the lesser tubercle by the ACA in 23, the PCA in 2 and both arteries in 7 cases; the greater tubercle by the PCA in 19, the ACA in 5 cases and both in 1 case; the intertubercular groove by the ACA in 29, the PCA in 1 and both arteries in 2 specimens. The arcuate a. was distributed along the metaphyseal side of the epiphyseal plate, and small branches crossed the plate to reach the epiphyseal side and give numerous anastomoses to the branches of the ACA or the PCA. The diameter of the ACA was constantly smaller than that of the PCA. Exclusive vascularization of the humeral head by the ACA was not confirmed. The roles of both the ACA and PCA remain important, and must be taken into account in evaluating the risk of necrosis after a fracture, by carefully considering the topography of the separation and the displacement of the different parts.

Adult↗
PubMed2001

[Osteoid osteoma after an old femoral shaft fracture].

An osteoid osteoma was discovered at the site of fusion of a mid-third femoral shaft fracture in an 18-year-old girl. This unusual localization was revealed by persistent pain after ablation of the material after fracture healing. Postoperatively, a discharge from the skin wound that persisted for a few days, raised the differential diagnosis between low-grade bone infection and an osteoid osteoma suggested by the patient's age and the clinical presentation. Computed tomography and leukocyte-labeled bone scintigraphy provided the diagnosis of osteoid osteoma that was confirmed at pathology examination after resection. Isotopic mapping of this very small intraosseous lesion that exhibited strong isotope uptake was particularly contributive.

Adolescent↗
PubMed2001

[Experimental study of compression by Herbert screw in carpal scaphoid fracture].

PURPOSE OF THE STUDY: The purpose of this experimental work was to obtain a radiographical assessment of the effect of the compression achieved with the Herbert screw due to its different thread diameters by comparing the real and expected reduction of interfragment gap (IFG) on cadaver bones. To better understand and define the limits of this "self-compressing" effect and to study the usefulness of screw sizes smaller than the scaphoid, we measured the maximal and mean reduction of IFG without using the instrumentation. MATERIAL AND METHODS: Twelve scaphoids were obtained from fresh cadavers. The scaphoid holes were drilled and tapped in the largest axis of the scaphoid, in a central position parallel to an anti-rotation wire. A transverse osteotomy was made in the mid third of the scaphoid to simulate a Schernberg grade III fracture. The real IFG reduction was defined as the difference between the gap measured before and after screwing. The expected IFG reduction was defined by multiplying the number of screw turns by the pitch height per turn. RESULTS: On the reduction average, a Herbert screw produced a 1.1 mm IFG reduction. The maximal reduction IFG measured was 1.5 mm. For 7 cases, the real IFG reduction was larger than expected, for 4 cases it was smaller than expected and for 1 case the difference was considered negligible. The Fisher test did not demonstrate any significant statistical difference between the real and expected IFG reduction for all scaphoids. The operator perceived a subjective sensation of compression after one screw turn that continued up through the last turn. DISCUSSION: The Herbert screw develops maximal compression force when all the screw threads are totally anchored in the bone. The interfragment gap closes linearly, bringing the two bone fragments together. However, failure can result if the gap is too wide (>2 mm), the screw is poorly positioned, or there is an inappropriate correspondence between screw length and diameter and scaphoid size. Unlike spongy bone screws, the Herbert screw has a round non-conical tip thread and a shallow thread that do not bring the bone fragments together. The perception of compression corresponds to the passage of the screw through the spongy bone and not to real narrowing of the gap between the fragments. In clinical practice, because of the use of instrumentation for open surgery in carpal scaphoid fracture, it is not necessary to rely on these data, but they can be useful for percutaneous screw insertion without a guidewire and without prior compression or for another localization. Peroperative radiographs should be obtained to assess the quality of the screw position and check reduction and the reality of the compression.

Aged↗
PubMed2000

Chronic destructive oligoarthritis associated with Propionibacterium acnes in a female patient with acne vulgaris: septic-reactive arthritis?

Propionibacterium acnes is an anaerobic bacillus implicated in certain chronic arthritides. This report describes an HLA-B27+ 17-year-old woman with acne vulgaris who presented with rapidly destructive arthritis in the left shoulder as well as an evolving left subclavicular adenopathy. One year later, arthritis was detected in the left knee; the inflammatory synovial fluid was sterile. Growth of P acnes was observed in cultures of the shoulder synovium and lymph nodes, but polymerase chain reaction was negative for Borrelia, Chlamydia, and Ureaplasma DNA. Three months of treatment with amoxicillin and rifampicin led to clinical disappearance of the oligoarthritis, but arthritis recurred in the left knee after discontinuation of therapy. On biopsy, bacteria were undetectable in the knee synovium, but chronic arthritis was evident histologically. Antibiotics were reintroduced for 12 months and were again effective against the clinical symptoms. Although the asymmetry, histologic features, arthritis-acne association, and genetic predisposition of this chronic destructive oligoarthritis would seem to indicate a reactive arthropathy, the isolation of P acnes from 2 distinct specimens prompted us to propose calling this a case of septic-reactive arthritis, which is further supported by the absence of progression after antibiotic therapy and the persistence of the rheumatism. To our knowledge, this is the first demonstration of the efficacy of prolonged antibiotic therapy on the joint manifestations of chronic rheumatism associated with acne.

Acne Vulgaris↗
PubMed2000

[Failure of locked centro-medullary nailing in pseudarthrosis of the humeral diaphysis].

PURPOSE OF THE STUDY: The aim of this work was to assess results after treatment by nailing of nonunion of the humeral shaft. In particular, we focused on consolidation and factors predictive of failure. MATERIAL AND METHOD: A prospective study was conducted in 13 consecutive patients presenting aseptic nonunion of the humeral diaphysis. There were five cases after orthopedic treatment and eight cases after internal fixation. Two patients had iterative nonunions. Locked nailing was performed with three successive types of nails: the Seidel nail in four cases, the Russel Taylor nail in seven, and the ACE nail in two. Anterograde nailing was used for the first three cases and retrograde nailing for the others. All patients were followed regularly in our department. Last follow-up was one to seven years after nailing. RESULTS: Five nonunions (38%) did not consolidate after locked nailing. Consolidation was achieved in the other patients after four to 18 months. The anatomic result was good in these patients. Between the success and failure groups, there was no significant difference in age, gender, type of fracture, first intention treatment, delay from fracture to nailing, type or diameter of the nail, surgical access or not to the fracture site during nailing, or duration of complementary fixation. Anterograde nail insertion, used in our first three patients in this series, appeared to affect shoulder function. The retrograde route was used in other patients and did not appear to have any impact on the elbow itself or the elbow region. DISCUSSION: This clinical study was unable to identify clinical factors explaining failures but did provide several arguments suggesting that defective primary stability of the initial fixation could be incriminated in the failures. CONCLUSION: Centromedullary locked nailing is a simple technique with potential for resolving difficult problems of nonunion. Good functional outcome can be obtained when consolidation is achieved. Rather than abandoning this technique, it would be advisable to conduct further research to determine what factors are determinant in its failures.

Adult↗
PubMed2000

[Experimental study of the primary stability of locked centro-medullary nailing of the humeral diaphysis].

PURPOSE OF THE STUDY: A clinical trial on the treatment of humeral shaft nonunions with locked nailing evidenced 5 failures among 13 cases. The circumstances leading to the nonunion, the patient's condition, and the nailing method were not found to have a predominant effect explaining this outcome. Inversely, clinical data suggested that abnormal mobility of the nonunion appeared to result from play in the assembly. To check this hypothesis, we measured primary stability in three nailing models using cadaver bones. MATERIALS AND METHODS: Three nailing models, Seidel (S), Russel-Taylor (RT) and ACE were tested, each on 5 cadaver specimens. A 1 cm segmental resection was made in the mid third of the humerus to simulate an unstable nonunion. The nailing was performed in accordance with the instructions furnished by the manufacturers. The nailed specimens were placed in a testing device which alternatively applied a rotation force around the longitudinal axis (+/- 0.5 Nm), an axial compression-traction force (+/- 20 N) and a transverse shear force applied at the level of the osteotomy (+/- 20 N). RESULTS: This study demonstrated an instability of the three nails when submitted to a rotation force or a shear force: 14 to 28 degrees and 1.6 to 3.4 mm respectively for the RT nail; 8 to 20 degrees and 1 to 3 mm for the S nail; 5 to 15 degrees and 1.7 to 3.2 mm for the ACE nail. The ACE nail appeared to be more stable when submitted to compression-traction force; the S nail accepted a 0.05 to 0.65 mm play which reached 9.7 mm for the RT nail. This instability appeared to result from play in the locking systems. DISCUSSION: These findings would demonstrate that these nailing systems cannot, in themselves, provide satisfactory primary stability. The experimentally evidenced instability would contribute, probably in association with locally unfavorable physiological or biological conditions, to the failure rate observed when nailing is used alone. CONCLUSION: The locking system for tested nails would have to be modified to eliminate play in the assembly before continuing their use for the treatment nonunion of the humeral shaft.

Aged↗
PubMed1999

[Transgluteal approach to the hip by anterior hemimyotomy of the gluteus medius].

Authors describe a transgluteal approach of the hip which is not based on the somewhat unsure common insertion of gluteus medius and vastus lateralis. Anatomical basis and technical particularities of division of anterior part of gluteus medius, of gluteus minimus and capsule are given which allow preservation of gluteal nerve, stability of the joint, and solid reparation of abductor muscles.

Buttocks↗
PubMed1998

[Kinematics of the healthy and arthritic hip joint during walking. A study of 136 subjects].

PURPOSE OF THE STUDY: The study aimed to analyze the spatiotemporal parameters and 3-dimensional pelvic and hip kinematic components during gait in two groups: patients with a primitive osteoarthritis of the hip and control normal subjects. MATERIAL: The study included 51 patients, ranged from 42 to 81 years, and 86 normal subjects. METHOD: Gait analysis was performed using the optoelectronic system VICON with 5 cameras in free-speed conditions. Functional grading of the patients was assessed by Lequesne's score. Thickness of the hip cartilage was measured on pelvis AP radiograph. A preliminary study was performed to measure reliability of the data on 11 patients. RESULTS: At the initial stage of osteoarthritis, speed, cadence, stride length and hip flexion-extension motion appeared as very close to normal data. After this initial stage, there was a statistical relationship between these parameters and arthritis functional grading. Pelvis rotation around the vertical axis did not change according to severity of functional grading. The mean value of this component of pelvis motion was 10 degrees in the pathological group, whereas it was 8 degrees in the female normal group, and 7 degrees in the male group. There were no significant relationship between radiographical thickness of hip cartilage and functional grading of patients or gait parameters. DISCUSSION: This study demonstrates that spatiotemporal gait parameters and kinematic data appear as quantitative index which could be used in future studies. It also shows that pelvic rotation is greater in pathological group than in normal subjects, even in the extreme beginning of the hip osteoarthritis. This particularity can be explained as a very early consequence of the arthritis or, in the opposite, as risk factor.

Adult↗
PubMed1998

[Embryology of the human carpal bones (triangular cartilage, central carpal bone, morphogenesis of the scaphoid)].

Wax reconstructions according to Born's methods were performed from serial 10-micron sections of the wrists of human embryos (B. Tardif) to study the triangular cartilage and central bone of the carpus. A subsequent morphological study of the adult scaphoid bone was conducted in the light of embryological data. The triangular cartilage was observed in 4 of 38 carpi of embryos with a craniocaudal length of 40 to 69 mm, flatten between the ulna and triquetrum, on the inferior surface of the mesenchymal bud of the triangular ligament. The central bone of the carpus is constant in the embryo, between the inferior surface of the radial chondrification centre, capitatum, trapezium and trapezoid. In one case, the two wrists of the same embryo presented two central nuclei, leading to the distinction of two different formations:--the constant C2 embryonic central bone, trapped between capitatum, trapezoid and trapezium, which participates in the constitution of the scaphoid by fusion with the radial chondrification centre;--the C1 central bone, a rare supernumerary bone in adults, close to the inferolateral angle of the lunatum, on the dorsal surface of the carpus. These embryological data support. Westoll's theory concerning the filiation of the thoracic limb since the fin of crossopterygians, with deviation of the mechanical axis related to the development of weightbearing on the ground. The scaphoid bone must to be assimilated to a cube, but to an irregular tetrahedron, composed of two inverted pyramids joined by their bases. The inferior pyramid, articulating with he trapezium, trapezoid and capitatum, is concerned by morphological variations of the bone, which can present variable configurations between the two extreme morphotypes: the massive type and the strangulated type. The inferior pyramid, constituting the scaphoid, is derived from the central cartilage and presents the same relations. Variations of the volume of this inferior part of the bone are related to the more or less marked regression of this chondrification centre of the embryonic carpus. These variations of the bone can be expressed in terms of a scaphoid index, by calculating the relationship between the greatest dimension and the width of the narrowed portion.

Adult↗
PubMed1997

Anatomical basis of the variable aspects of injuries of the axillary nerve (excluding the terminal branches in the deltoid muscle).

The course of the axillary n. is complex with three points of angulation that may be used to delineate four segments and a fifth segment that corresponds to the intramuscular ending of the nerve in the deltoid m. The purpose of this study was to determine the precise anatomy of the nerve and of its branches, and some morphologic features for each segment. Thirty-two shoulders from embalmed adult cadavers have been studied. The axillary n. was divided in five segments: 1) from its origin to the inferior border of the subscapularis m., 2) from the subscapularis m. to the anterolateral border of the tendon of the long head of the triceps brachii m., 3) from the triceps to the posteromedial part of the surgical neck of the humerus, 4) from the humerus to the entry into the deltoid m., 5) the intramuscular distribution of the nerve in the deltoid m. In each segment from 1 to 4 were noted the origins of the branches to the subscapularis and teres minor mm. and to the scapulohumeral joint, and the origins of the lateral cutaneous branchial n. and of the terminal motor branches to the deltoid m. The length and the diameter of the nerve in the segments and the distance from the segment S1 to the musculotendinous junction of the subscapularis m. were measured. The results showed that the mean diameters were about 4.1 mm in segment 1, 4.1 mm in segment 2 and 3.4 mm in segment 3. The mean distance to the musculotendinous junction was 7.7 mm. Many variations in the levels of origin of the different muscular, articular or cutaneous branches were found without symmetry between the right and left sides. The lateral cutaneous brachial n. was absent in four cases. The results are compared with those in the literature. The division into five segments is proposed to radiologists and surgeons for evaluation or operative procedures on the axillary n., and to provide a hypothesis about the variable aspects of injuries of the nerve.

Adult↗
PubMed1997

Anatomic basis of the transgluteal approach to the hip-joint by anterior hemimyotomy of the gluteus medius.

The authors present a study of the intrinsic anatomy of the gluteus medius m, and of its innervation through the caudal branch of the superior gluteal n. The existence of an intramuscular tendon in the thickness of the gluteus medius was constantly prooved in 40 muscles. The relations of the intrinsic fibrous structure of the muscle and its innervation were studied. The authors deduce from that the topography of a gluteus medius incision, with respect to a safety area towards its innervation, which leads to an exposure of the acetabulum that is satisfying and gives opportunities of a sound repair after the surgery of the hip joint through the transgluteal approach. They propose the "anterior hemimyotomy of the gluteus medius m" designation.

Buttocks↗