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Biomedical subjects

F Iselin

Publications and source records attributed to F Iselin.

At least 19 recordsLinked to original sources
PubMed1999

Fractures of the base of the first metacarpal in children. Role of K-wire stabilisation.

In order to define the factors of instability of fractures of the base of the first metacarpal in children, the authors reviewed 30 children presenting this lesion with a follow-up greater than 10 months. Patients in whom the growth cartilage of the base of the first metacarpal was still open and presenting a fracture with angular displacement greater than 30 degrees or metaphyso-epiphyseal sliding greater than 1 mm were included. Three groups were defined on the basis of radiographic findings: Group A: pure metaphyseal fractures (14 cases: 10 pinnings and 4 orthopaedic treatments); Group B: Salter II epiphyseal detachment fractures with a medial metaphyso-epiphyseal corner (10 cases: 1 pinning and 9 orthopaedic treatments); group C: Salter II epiphyseal detachment fractures with a lateral metaphyso-epiphyseal corner (6 cases: 2 pinnings and 4 orthopaedic treatments). The authors studied early secondary displacements as a function of the emergency treatment modality. No secondary displacement was observed for group B lesions regardless of treatment and for lesions stabilized immediately by intermetacarpal pinning. In contrast, one half of group A and C lesions treated orthopaedically subsequently became displaced, requiring surgical revision with stabilization by pinning. The authors recommend orthopaedic treatment for group B lesions and immediate surgical stabilization for group A and C lesions.

Adolescent↗
PubMed1995

[The chronically painful hand].

The usual concept of pain, constituting a warning signal corresponding to an identifiable peripheral lesion, is very different from that of chronic pain, a real pathological syndrome with a dual aspect, an organic component and a psychological component, with no obvious relationship to the original cause. The authors distinguish pain due to excessive nociception, which can be cured by treatment of the cause, from disafferentation pain due to a defect of transmission of nerve impulses to processing centres and which is refractory to surgical treatment. The approach to pain must be multidisciplinary: surgery, drugs, percutaneous neurostimulation, physiotherapy and psychotherapeutic management ensure a "therapeutic alliance" in difficult chronic pain patients.

Afferent Pathways↗
PubMed1995

[Long-term results of proximal interphalangeal resection-arthroplasty using the Swanson silastic implant].

238 PIP joint arthroplasties with "Silastic" implant were performed between 1969 and 1990. Their results were evaluated after 12 to 24 months. We reviewed 25 patients operated between 1971 and 1988 with a follow-up of 4 to 23 years. The results are evaluated in terms of joint mobility, pain, stability, strength, radiological appearance and patient satisfaction. These results are identical to those observed at short follow-up indicating the absence of any significant deterioration. The result obtained at 12 months postoperatively will therefore be maintained at 12 years. Our conclusion is that unless an ideal arthroplasty with joint prosthesis can be shown to be effective, joint resection-arthroplasty remains a valuable and durable solution for the treatment of PIP joint stiffness.

Adolescent↗
PubMed1991

[Ballistic hand trauma].

46 victims of projectile accidents or explosions were treated over a 5 years period between 1984 and 1989. 3 categories were distinguished: injuries due to a single projectile (12 cases), only inducing serious bone damage and, apart from 3 immediate amputations, the final result was satisfactory. Injuries due to multiple scattered projectiles (11 cases), less severe in terms of the initial lesions, not requiring any amputations, with good results in 8 cases. Explosion injuries (23 cases) in which the effect of the explosion induced considerable initial lesions leading to one hand amputation and 33 finger amputations; the association of skeletal and soft tissue lesions raises the problem of excision and primary cover, requiring large flaps. The course is long and 8 out of 26 hands had serious sequelae, while the reconstruction of an elementary pinch can be considered to be an acceptable result in the other cases.

Amputation, Traumatic↗
PubMed1991

[The chronically painful hand. A consecutive series of 60 cases].

This study was based on 60 patients presenting with hand pain refractory to usual treatment. The aim of this study was to assess the pathophysiological and neuropsychological factors involved in a population of patients recruited in a hand surgery unit. Analysis of this series revealed the frequency of desafferentation mechanisms. These symptoms can be treated by means of antidepressants, antiepileptics and peripheral neurostimulation. Anxio-depressive factors were of limited importance in this series, at least in comparison with the population usually examined in a pain treatment centre. However, their presence in a subgroup of patients (26% of cases) and the limitations of symptomatic analgesic treatment justifie a global approach to chronic pain in order to establish the participation of the various factors in each particular case. It is useful to combine aetiological treatments with psychological treatments (antidepressants, relaxation therapy, for example) to increase the patient's tolerance of their persistent painful symptoms.

Adult↗
PubMed1990

[Comparative study of the effects of a local antibiotic and a local antiseptic in emergency hand surgery].

An open randomised comparative study was conducted in patients presenting with a hand injury requiring a surgical operation, in order to compare the efficacy of topical application of rifamycin SV with that of iodinated polyvidone dermal solution, in terms of the quality and rate of healing evaluated by the clinician, 268 patients were included in the study and 223 of them participated in the analysis of the results. Analysis of the results demonstrated the following conclusions: signs of infection developed in 8 patients in the rifamycin SV group (7%) and in 20 patients in the iodinated polyvidone group (18.5%). This difference was significant (p = 0.011) in favour of rifamycin SV. The rate of healing was considered to be rapid in 10% of patients in the rifamycin SV group and in 4% of patients in the iodinated polyvidone group. It was considered to be slow in 14% of the subjects in the rifamycin SV group and in 21% of those in the iodinated polyvidone group. This difference was also significant in favour of the rifamycin SV group (p = 0.038). In terms of local tolerance, 32 patients equally distributed between the two treatment groups developed signs of cutaneous intolerance.

Administration, Topical↗
PubMed1989

[Acute ischemia of the fingers].

Chronic vascular insufficiency of the fingers may turn in acute ischemia with cold. The authors report three cases. The first patient showed on his forefinger a distal thrombosis of the ulnar collateral artery and a very thin radial collateral artery. The second patient has interruption of both indicis collateral arteries. The third patient presented an ischemic fifth finger secondary to a distal ulnar artery stenosis. All of the patients complained of pain, numbness, cyanosis or necrosis of the tip aggravated by cold. Laboratory and vascular investigations included digital Allen Test, plethysmography, Doppler examination, axillary block and angiography. The cause may be local and easily cured by surgery, but sometimes the vasospastic component is predominant. If stopping smoking, vasodilators and calcium-inhibitors are ineffective, Flatt has proposed distal digital artery sympathectomy.

Acute Disease↗
PubMed1989

[Treatment of thumb arthrosis using Swanson's trapezial silicone implant].

Complications related to silicone implants have been widely described since 1985. As trapezial replacement with a silicone implant constitutes our preferred treatment for osteoarthritis of the base of the thumb, we decided to evaluate our results by means of a retrospective critical study. Fifty records of patients operated or between 1975 and 1980 constitute an homogeneous study group as all were operated according to the same technique and by the same surgeon. Seven cases of implant instability have led us to modify our fixation technique. The results in terms of mobility, stability and pain relief are good and comparable to other published series. Only two cases presented bony changes around the implant but they both existed before surgery. Our conclusion is that trapezial resection with replacement by a silicone implant can still be recommended as elective treatment for CMC thumb osteoarthritis because of its simplicity effectiveness and reversibility.

Aged↗
PubMed1989

[Expansion of the facial integument in children].

In the light of four clinical cases of paediatric facial reconstruction, the authors discuss the advantages and indications of the cutaneous expansion technique which can be combined with other plastic surgery procedures to obtain an abundant skin with ideal texture and sensitivity and minimal scars. Operations for cicatricial alopecia, very extensive forehead naevus, preauricular tumour and nasal mutilation are described.

Adolescent↗
PubMed1988

[Dorsal Dupuytren's disease].

Two different manifestations of the disease are discussed: hyperextension of the distal interphalangeal joint through mechanical fibrous contracture or through pathological involvement of the retinacular ligaments. Surgical correction is performed by transection of the contracted structures but this manifestation tends to be found in severe disease and thus to presage a poor prognosis. Dorsal localisations of the disease itself in the form of (1) knuckle pads when localized on the dorsal aspect of the PIP joint where they do not impair flexion, or (2) distal nodules situated dorsal to the extensor tendon and the IP joints and restricting the range of flexion. Surgical excision in group 2, when requested by patients, has enabled us to determine that the histological aspect is of Dupuytren's disease and that the post-operative course has been uneventful in our 12 operated cases.

Adult↗
PubMed1988

Conversion to arthroplasty from proximal interphalangeal joint arthrodesis.

Fifteen patients, interested by the functional results of certain arthroplasties and discouraged by those of their arthrodesis, agreed to undergo disarthrodesis. This operation was performed by arthroplasty with Swanson implant under the following 4 conditions: excellent skin cover, an intact flexor system, articular fusion in good position with preservation of the normal length and axis of the finger, the understanding by the patient that an arthroplasty does not mean normal range of movement but, at best, recovery of a limited but functional, stable and pain-free range of movement. 12 cases operated between 1971 and 1984 have been followed for a mean of 39 postoperative months. The mean gain of active movement from a fused joint was 56.8. The postoperative course was always uneventful in these particularly motivated patients and 11 out of 12 were satisfied with their result.

Adult↗