Capitolunate arthrodesis: the lateral approach.
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Journal Article↗
Biomedical subjects
G Dautel
Publications and source records attributed to G Dautel.
[Antecubital flap: advantages in elbow coverage. An anatomical study and experience of five clinical cases].
The antecubital flap is a fasciocutaneous strip that has its blood supply provided by the first proximal collateral of the radial artery. This flap was described for the first time in 1983 by Lamberty and Cormack, but it has not been widely used and there have been only a few reports in the literature concerning this procedure. The aim of the present investigation was to demonstrate via an anatomical study and a report on five cases the viability of the various anatomical features of this cutaneous flap, and also its positive contribution to elbow reconstruction. The anatomical study involved eight fresh cadavers (eight upper limbs). An injection of colored prevulcanized latex was made in the humeral artery in the lower third of the arm. The aim was to determine which artery provided blood supply to the flap, its anatomical location, and also to look for possible distal anastomoses which would permit a distal pedicled flap to be removed. Contrary to the findings of other authors, in the present study it was found that the vessel providing blood to the antecubital flap always branched off from the radial artery. However, no anastomoses with distal vascularization were detected, which would have permitted a distal pedicled flap to be obtained. The use of the antecubital flap for elbow coverage was then illustrated by five clinical cases of soft tissue defects of the elbow. This method was found to be reliable, practical, and the flap could be rapidly dissected. Moreover, this particular technique is sensitive, and has an interesting rotational arc. The distal cutaneous island flap has the advantage of limiting scar tissue. A comparison between the antecubital flap and other pedicled flaps has then been made. In conclusion, it appears that this little-known procedure has definite advantages, and that it should be included in the range of surgical techniques that are available for soft tissue reconstruction in the case of elbow defects.
Adult↗
[Comminutive fracture of the trapezium treated by ligamentotaxis. A case report].
We report a case of trapezium fracture treated by continuous traction. The fracture involved the trapezium alone and was associated with scapho-trapezium subluxation. Three percutaneously inserted pins were used for traction, one scapho-capitate pin and two pins in the first and second metacarpal bones. This allowed distraction of the entire first row. Good anatomic reconstruction of the trapezium was evidenced radiographically. The functional outcome was quite satisfactory with mobility strictly the same as the healthy side and complete pain relief.
Accidents, Occupational↗
[Non-articular malunions of the distal radius: evaluation and techniques of correction].
Malunion remains the most common complication following fracture of the distal radius. Deformities can be observed in all three planes with displacement in dorsal or palmar tilt, translation, shortening and axial rotation. Preoperative evaluation requires a comparative analysis with clinical, radiological and scanographic assessment. The functional consequences affect the radiocarpal and distal radio-ulnar joints and the carpus. Biomechanical aspects include changes in pressure forces on the distal radius and ulna, and displacement of the centers of rotation. If present, associated lesions should be evaluated. The degree of clinical acceptance depends on each patient, but generally functional outcome is closely correlated with the anatomic result. Limits of radiological acceptance should be defined at 20 degrees dorsal tilt, 5 degrees radial inclination, and a - 4 mm distal radio-ulnar index. Corrective osteotomy is performed on the radius, with or without a complementary ulnar procedure. Closing wedge and re-orientation osteotomies are no longer used. Opening wedge osteotomy with or without lengthening is preferred, generally with an access on the same side as the sagittal tilt. The osteotomy should be performed just above the distal radio-ulnar joint. A temporary external fixator provides the best way to check peroperative corrections. Bone grafts may be harvested from the radius or the iliac crest. Pins and cast are sufficient to immobilize the dorsal tilt corrections. In case of volar tilt, an internal plate fixation is best. Depending on the status of the distal radio-ulnar joint, a conservative (shortening osteotomy, wafer procedure) or non-conservative (Darrach-Moore, Kapandji-Sauvé.) procedure should be performed on the ulna. If needed, associated lesions of the carpus must be treated. Surgical correction is mainly indicated in case of a functionally unacceptable deformation, but should be discussed if the radiographical limits have been overrun. The goal of such corrective procedures is to recover anatomical restitution.
Activities of Daily Living↗
Transplantation of the proximal fibula based on the anterior tibial artery. Anatomical study and clinical application.
The purpose of this study was to investigate the feasibility of microvascular transplantation, based on the anterior tibial artery, of the epiphysis and the proximal half of the diaphysis of the fibula. India ink injections into the anterior tibial artery were performed in 13 unembalmed adult cadavers, following which transverse frozen sections were taken. Dye was observed in the fibula, both within the intramedullary cavity and at the level of the periosteum, in all specimens. The average distal limit reached by the dye, measured from the tip of the epiphysis, was 10.4 cm in the intramedullary cavity and 11.8 cm in the periosteum. Based on these anatomical findings one case of humeral reconstruction has been performed with a fibular transplant, including both the epiphysis and a segment of diaphysis, vascularized solely by the anterior tibial artery.
Adult↗
Evaluation of low-pressure arterial and venous clamps: electron microscopic study and possible clinical applications.
These authors report on validating their choice of disposable clamps in arterial and venous microsurgery in a comparative and experimental study using the scanning electron microscope. This appears to be the first evaluation of venous endothelial clamping lesions. Early intimal clamping lesions were studied using three different clamps and two protocols in 18 femoral arteries and veins in rabbits. Results were evaluated using a new classification that can be applied to both arterial and venous lesions: Grade I: cellular disorientation and disorganization; endothelial lamination; and absent or very few platelet deposits; Grade II: alterations of the cytoplasmic membranes in fusiform cells; presence of at least one breach of endothelial continuity; and moderate number of platelet deposits; Grade III: presence of endothelial detachment; and large numbers of platelet deposits. They showed that in arteries, all the clamps tested caused only low-grade lesions. In contrast, in veins, they demonstrated both the very fragile nature of the endothelium, and also the comparative safety of the low-pressure venous clamp. Their choice of specific clamps for venous anastomoses was validated.
Animals↗
[Isolated palsy of the flexor pollicis longus in anterior interosseous nerve syndrome].
Anterior interosseous nerve palsy are relatively rare, specialy in traumatic cases. Two case of incomplete anterior interosseous nerve palsy with isolated total loss of function of flexor pollicis longus are reported. Partial palsy of the A.I.N. have been previously reported, but their mechanism is unclear. The incomplete anterior interosseous nerve palsy has to be known. They can be mistaken with tendon rupture, specialy in traumatic cases, and lead to unnecessary surgery.
Adult↗
Fingertip replantation in children.
Despite common unfavorable mechanisms, fingertip replantation is a rewarding procedure in children. Cosmetic final results are usually better than those obtained by local or pedicled flaps. The success rate and the sensory reinnervation are also better than what can be expected in adult patients.
Amputation, Traumatic↗
Desmoid tumours of the hand.
We report a case of a 3-year-old child with a desmoid tumour of the hand, which is an exceedingly rare location. Desmoid tumours of the hand are difficult to treat because of the many important structures concentrated in the area as well as the infiltrative and recurrent character of these tumours.
Biopsy, Needle↗
Technique for distal replantation.
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Journal Article↗
[Temporary external fixation in the correction of non articular mal-unions of the distal radius].
PURPOSE OF THE STUDY: The authors reviewed 21 cases of extra articular malunions of the distal radius treated by osteotomy, temporary external fixation, then osteosynthesis. Two groups were studied: Group A of 14 patients with dorsal tilt of the distal radius and Group B of 7 patients with palmar tilt of the distal radius. Mean follow-up of this series was 69 months ranged from 12 to 109 months. MATERIAL AND METHODS: In Group A, after exposure of the distal radius through a dorsal approach, the site of osteotomy, proximal to the distal radio-ulnar joint, was determined by fluoroscopy. The angular correction was done by progressive opening using a small external fixator. After checking on the correction, the bone graft was harvested 7 times on the radius as described by Watson et Castle, 7 times on the iliac crest. Bone fixation was done by two K-wires and a cast for 8 to 10 weeks. Three Sauvé-Kapandji procedures was done at the same time. In Group B, the approach was palmar, extended distally to open the carpal tunnel. The distraction was done with a distal T-shaped external fixator. The bone graft was always harvested on the iliac crest. Bone fixation was done with a T-shaped palmar plate. Two Sauvé-Kapandji procedures was done at the same time. RESULTS: Group A: Flexion-extension arc was improved of 15.5 p. 100, pronation-supination of 83.7 p. 100 and grip strength of 80 per cent of the pre-operative values. Radiological evaluation showed good correction except one case of undercorrection of the dorsal tilt (-7 degrees) and one case of undercorrection of the radial inclination (+6 degrees). The distal radio-ulnar index was measured at the mean of 0mm postoperatively compared to +5 mm pre-operatively. One patient developed a postoperative radiocarpal arthritis. Group B: Flexion-extension arc was improved of 96.2 p. 100, pronation-supination of 76.9 p. 100 and grip strength of 108.3 p. 100 of the preoperative values. Radiological evaluation showed good correction except one case of overcorrection of the palmar tilt (-10 degrees) and one case of undercorrection of the radial inclination (+7 degrees). The distal radio-ulnar index was measured at the mean of 0mm postoperatively compared to +7 mm pre-operatively. DISCUSSION: The functional consequences of malunions of the distal radius have been stressed by others for more than sixty years. Since, many authors have contributed to refine and improve their surgical correction. Several displacements should be taked into account for the preoperative planning. They are sagittal tilt, frontal horizontalisation, shortening, sagittal and frontal translation, and axial rotation. Many types of osteotomies could be done; closing wedge, opening wedge or reorientation. In some cases, an operative procedure of the distal radio-ulnar joint should be done at the same time. We chose an opening-wedge osteotomy and the use of a temporary external fixator to ensure progressive distraction and good adjustment in the correction of angular deformities. In the dorsal tilt group we were satisfied in using on 7 patients a trapezoidal cortico-cancellous bone graft harvested on the radius. CONCLUSION: The authors would like to stress two points: The technical interest of using a temporary external fixator to adjust the angular correction of the distal radius. The importance of an adequate treatment of distal radius fractures in emergency situation, considering the functional and cosmetic alterations due to malunions and their need for surgical corrections in main instances.
Colles' Fracture↗
Reconstruction of fingertip amputations by partial composite toe transfer with short vascular pedicle.
Five patients under 15 years-of-age, with a fingertip amputation through the nail plate, were treated with a custom-made partial toe transfer. Two of the patients had had previous attempts at surgical reconstruction using either a local flap or replantation. Delay between initial injury and reconstruction ranged from 2 to 60 days. In all cases the flap was harvested from the second toe. This "custom-made" compound transfer included the exact amount of pulp, nail bed and bone required for reconstruction. All flaps were harvested on a short vascular pedicle, with anastomoses performed at a digital level on the recipient site. Good to excellent cosmetic results were obtained in all cases, with a nearly normal-looking fingertip. Duration of hospital stay ranged from 4 to 7 days. We recommend this technique for treatment of distal amputation close to the proximal nail fold, in young individuals.
Adolescent↗
Scapholunate dissociation in the skeletally immature carpus.
Scapholunate dissociation is well documented as a condition occurring in adult patients. We report it in a 14-year-old female patient. Persistent wrist pain 9 months after a well healed fracture of the distal radius triggered further investigation. Dynamic clinical and radiological studies demonstrated the instability.
Adolescent↗
Chondral lesions of the midcarpal joint.
Wrist arthroscopy performed on 78 patients showed 35 lunates of Type I (44.9%) i.e., having only one facet on their distal (midcarpal) aspect, and 43 lunates of Type II (55.1%), i.e., having two facets on this aspect. Chondral defects and/or arthritic lesions of the ulnar portion of the midcarpal joints were observed in 22.8% of Type I lunates and in 30.2% of Type II lunates. Chondral lesions of the midcarpal joints in Type I lunates were always associated with other ligamentous and/or osteochondral lesions, whereas the same lesions could be found isolated in Type II lunates. The observed association of lesions seemed to point to a trauma as the cause of some chondral lesions. The results of our clinical study were compared with anatomical studies by Viegas, all which showed no hamate pathologic conditions in Type I lunates.
Adult↗
A modified Kapandji procedure for Smith's fracture in children.
Anteriorly displaced fractures of the wrist can be treated by the Kapandji technique of percutaneous intrafocal pinning with pins inserted through an anterior approach to give good reduction and stabilisation of the fracture. We have modified this technique by placing the pins through a posterior approach which decreases the risks of neurovascular damage. We have used this method to treat six children with distal radial fractures showing anterior displacement or instability. Good anterior stabilisation was achieved. The pins were removed at an average of eight weeks and the patients were then able to return to full activity. This simple technique can be used for unstable fractures after the failure of conservative treatment or in bilateral fractures in adolescents.
Adolescent↗
Advances in digital replantation.
Technical advances in revascularization and in skin cover have resulted in increases in the possibilities of digital replantation. In cases of multiple digital lesions and isolated avulsions of the thumb, all attempts to ensure recovery of basic pinch capacity are justified. On the other hand, in cases of proximal amputations with extensive avulsion or crush injury such attempts should be abandoned if results on function are important. Primary and secondary surgery must confront two difficult problems namely, repair of the avulsed flexor tendons and resensibilization. But in the field of replantation one should not be too dogmatic because for cosmetic reasons, some patients may find even a stiff or insensitive finger satisfactory. Distal and very distal replantations yield the best results in all fields. This information should be brought to the attention of all trauma teams that tend to consider such replantations useless. These replantations are both rapid and simple, requiring only mastery of suturing vessels 0.5 mm in diameter. The surgeon responsible for replantation should weigh the indications after assessing the patient's needs and explaining the advantages and drawbacks of this type of surgery and its results on function.
Amputation, Traumatic↗
[A tumorous lesion of the thumb in an adolescent].
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Adolescent↗
[Loss cutaneous substance on fingers in children. Indications for local flaps].
In the absence of work-related injuries, major hand trauma and large soft tissue defects are rare in children, but small defects involving the fingertips are frequent. Better reinnervation and increased capacity for sensory recovery must be considered when selecting the appropriate treatment option in this pediatric population.
Amputation, Traumatic↗