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Biomedical subjects

G Pajardi

Publications and source records attributed to G Pajardi.

At least 19 recordsLinked to original sources
PubMed2006

Scaphotrapeziotrapezoid joint arthritis: a pilot study of treatment with the scaphoid trapezium pyrocarbon implant.

Isolated scaphotrapeziotrapezoid osteoarthritis is rare but can cause weakness and wrist pain. We present the results of a pilot study of interposition arthoplasty with a scaphoid trapezium pyrocarbon implant (STPI) by an open and arthroscopic approach for this problem. We performed this procedure in 10 hands in eight patients, all women, with a mean age of 60.5 (range 51-70) years. The average follow-up was 19 (range 2-24) months. Pre-operative X-rays in all cases identified an isolated degenerative arthritis of the scaphotrapeziotrapezoid joint. Average DASH evaluation pre-operatively of 49 was reduced to 39. All of the patients had functional improvement and returned to daily activities after 3 months. The results of this pilot study suggest that the STPI may prove a useful compromise treatment for this problem.

Aged↗
PubMed2005

The surgical treatment of the first carpometacarpal joint arthritis: evaluation of 400 consecutive patients treated by suspension arthroplasty.

Arthritis of the first carpometacarpal joint is a widespread disease in Western countries. It affects predominantly women with marked impairment in daily life activities. Its aetiopathogenesis is well described, while its treatment still controversial. The authors report their experience with 400 consecutive patients with established clinical and radiological findings of carpometacarpal joint arthritis treated by suspension arthroplasty with Ceruso's modified Weilby's technique. At 12 months follow-up, we were able to assess 315 patients using MAYO's score pre- and post-operatively, obtaining 86 excellent results, 134 good, 62 fair and 33 poor. As for complications, there were seven infections, 32 persistent pain and 42 limited range of motion. According to our experience the treatment modality of suspension arthroplasty with Ceruso's modified Weilby's technique represents the procedure of choice in indicated cases of first carpometacarpal joint arthritis in advanced stages according to Eaton-Littler classification.

Adult↗
PubMed2004

[The ulnar longitudinal deficiency: proposition of a descriptive classification].

Ulnar longitudinal deficiency is an extended malformation sometimes involving the whole upper extremity, even including sometimes the opposite side. The clinical and radiological aspects are variable and none of the existing classifications takes into account all the possible deformities. Multiple decisive factors in the surgical indications are missing such as shoulder stability, elbow position (extension or flexion with or without pterygium), orientation of the hand (internal rotation), wrist inclination and number of digits. Based on a review of our 46 clinical cases as well as the published cases in the literature we have developed a simple way to describe each level.

Humans↗
PubMed2002

[Secondary treatment of digital mutilations: reconstruction or amputation].

Decision for stump improvement, shortening or reconstruction after finger mutilation is based on multiple factors. Some of them belong to the patient, age, psychological background, job and leisure activities and cosmetic expectation. Others belong to the injury, its mechanism and the anatomical lesions. Abstention, prostheses and rehabilitation are among the options. Conventional techniques are not to be forgotten as age remains an ultimate frontier in microsurgical reconstruction to obtain a good sensory result. Function and appearance are closely linked for a useful and a used hand.

Adolescent↗
PubMed2001

[Progressive bone lengthening of the hand in congenital malformations. 41 cases].

PURPOSE OF THE STUDY: We retrospectively reviewed the experience of two Hand Units with progressive bone distraction lengthening, collecting 41 cases of hand skeleton lengthening for congenital malformations. MATERIAL AND METHODS: The Ilizarov callostasis method was used in 31 cases and in 10 cases bone union was reestablished at a second stage with an iliac graft (2 cases), vascularized metacarpal bone graft (one case), and vascularized (one case) or nonvascularized (3 cases) toe epiphysis. In the last three cases of index lengthening, the distal part was translocated to the tip of the third, deepening at the same stage the first web. The most frequently treated malformation was symbrachydactyly (22 cases). RESULTS: Mean lengthening was 2.3 cm (0.9 to 3.5) with a mean treatment duration of 3.8 months (1.5 - 8.2). The "lengthening index" was 0.59. There was a significant difference between phalanx and metacarpal lengthening, but the amount of lengthening or treatment duration were not affected by technique (Ilizarov vs bone grafting) or age. The complication rate was 32%. There were two complete failures, one extensor tendon tear, 3 pin tract infections (one requiring interruption of the lengthening), 2 cases of relevant pain, 2 delayed unions, 2 angulations and 1 callus fracture, 1 metacarpophalangeal dislocation and 1 joint stiffness. DISCUSSION: Despite advances in micorsurgical toe transfer, there are still indications for bone lengthening in congenital malformations. The apparent simplicity of the technique can mask a certain number of complications, emphasizing the need for surgical experience. Progressive bone lengthening in congenital deformity has the advantage of preserving sensitivity and avoiding bone resorption. Callostasis does not increase the duration of treatment compared to bone graft.

Adolescent↗
PubMed2000

[Value of a new first web space reconstruction in congenital hand deformities. A study of 54 patients].

INTRODUCTION: Only a few studies are available in the literature on the specific problem of the congenital contracture or absence of the first web in hand deformities, and first web reconstruction. MATERIAL AND METHODS: Sixty-seven first web plasties in 54 patients were retrospectively analyzed: they included 44 cases of classical plasties, i.e., Z-plasty (21 cases); dorsal flap plasty of the index (19 cases), thumb (1 case), or the hand (10 cases), and 16 cases of' pseudo-kite flap. RESULTS: The results were difficult to assess, as the syndromes were dissimilar and the deformities were not comparable (e.g., Apert syndrome versus Poland syndrome). However, it was found that the 'pseudo-kite' technique which was applicable to certain cases resulted in a web extension of 3.2 cm without any deepening. DISCUSSION: No method of classical assessment can be used to comprehensively evaluate the results of first web reconstruction due to the wide variability in clinical characteristics, the lack of patient cooperation in this young age group, the possible MPJ articular thumb instability, and growth factors. Although 4-flap Z-plasty is an adequate technique for non-severe first web deformities, the 'pseudo-kite' flap approach is useful in more severe cases. In 13 cases, a peroperative measurement before and following plasty was made, and a significant increase (205%) in planimetric and stereotactic gain compared to pre-plasty findings was noted. CONCLUSION: It does not seem logical to have a particular preference for a certain approach when considering first web reconstruction in congenital malformations. Each technique has its advantages and disadvantages, depending on patient age, the type of malformation, the state of the thumb, the extent of the first web deformity and the possible presence of scar tissue.

Acrocephalosyndactylia↗
PubMed2000

[Classification and treatment of symbrachydactyly. A series of 117 cases].

In the present study, a modification has been proposed of the Blauth and Gekeler classification, aimed at a more accurate definition of appropriate surgical treatment. An analysis was made of a series of 120 cases of symbrachydactyly (117 patients); however, surgery was only performed in 86 cases (51 toe transfers in 49 patients; mean age at surgery 12 months). Type I included the separation of short and sometimes stiff fingers; type II, the 'pseudo-cleft', could be subdivided into three groups. Type IIA included those hands with more than two long and frequently hypoplastic digits, regarding which a decision had to be made between removal of rudimentary fingers or their stabilization. In type IIB, hand function was good and surgery was rarely needed. Type III (monodactylous) could also be subdivided into two categories, i.e., normal thumb in type IIIA and hypoplasia in IIIB. Finally, in type IVA, toe transfer surgery was performed on condition that wrist mobility was sufficient to compensate for the insufficient mobility of the artificial thumb on the anterior aspect of the radius. In all cases, a weak but useful pincer movement was obtained, with poor cosmetic results. In the case of toe transfers, surgery was advocated before the age of one year; and although mobility was disappointing (35 degrees active motion), good growth and excellent discrimination (5 mm on average) was observed. Symbrachydactyly is a fairly frequent congenital malformation; its diverse clinical features require a precise classification to better determine adequate treatment management.

Adolescent↗
PubMed1999

[Glomus tumor of the nail area. Apropos of a series of 55 patients].

PURPOSE OF THE STUDY: Glomus tumors are infrequent in the hand. We have review 55 cases, localized in the nail area to discuss their diagnosis and surgical approach. MATERIAL AND METHODS: Out of 80 glomus tumors of the hand seen in two hand units, 55 were located around the nail area, 33 in the nail bed area, 8 at the nail root and 14 laterally. The population was predominantly female (42 cases) and the mean age 43 years. The mean delay before presentation was 37 months. Pain was the main symptom (97 per cent) increased by trauma and cold. A blue spot was visible in 15 cases and diagnosis was performed on clinical ground in all cases except two. A notch was present on X-ray in 16 cases. A prospective study with MRI allow a diagnosis in 18 of 21 cases. All tumors were removed through a lateral approach elevating the nail complex and confirmed histologically. RESULTS: The diagnosis was per-operatively confirmed in 53 cases and performed in one case. The last case of supposed hemangioma was modified at histological examination. No case of nail dystrophy (not existing pre-operatively) or residual pain was seen at the 81 months of follow up. Seven recurrences were observed, 4 of them having been operated initially in our units. DISCUSSION: Clinical diagnosis could be performed on clinical grounds. MRI is to be reserved to recurrences or multi-operated patients. Risk of recurrence has to be mentioned pre-operatively to the patient. CONCLUSION: Lateral approach with nail complex elevation is safe, allowing excision of the tumor without nail dystrophy.

Adolescent↗
PubMed1999

[Reconstructive surgery of Blauth type III hypoplasia of the thumb].

Thumb hypoplasia type III according to Blauth remains a rare congenital malformation. Recently Manske has promoted reconstruction versus pollicization in the sub-type IIIA where a first carpometacarpal joint is present. However we felt that pollicization is the solution for sub-type IIB where the basal joint is absent. We have reviewed 14 cases of thumb hypoplasia type III, four of them being type IIIB. After performing a first step with a free vascularized second metatarso-phalangeal joint transfer, the secondary steps were identical in both sub-groups. After a mean follow up of five years, no great difference was found in the two sub-groups and basal stability was even better in type IIIB. However the results were functionally and cosmetically inferior to the ones observed after pollicization. When the relatives refuse pollicization or the patient consults late for functional improvement, reconstruction remains worthwhile.

Adolescent↗
PubMed1998

[What's new in the treatment of Dupuytren's disease?].

Among the recent advances in the field of Dupuytren's contracture, the authors reviewed a series of 171 patients treated by percutaneous needle fasciotomy. Among the 198 hands (241 fingers), 65 were reviewed with a mean follow-up of 2.5 years. Mean age was 62 years and delay between onset and treatment 6.8 years. Rupture of the cords was performed only in the palm in 154 cases, palmo-digital in 82 and purely digital in 5 cases. Complications were rare and benign without tendon or vascular bundle injury. Postoperative gain was essentially observed on the metacarpo-phalangeal joint and recurrence rate was high despite the short follow-up (progression of the disease 54% of cases). The ideal indication for this simple and reliable technique is an elderly patient with a prominent cord and predominant lack of metacarpophalangeal extension.

Adult↗
PubMed1997

A new protocol for the treatment of hand deformities in recessive dystrophic epidermolysis bullosa (13 cases).

The recessive form of dystrophic epidermolysis bullosa creates severe hand deformities with disabling functional limitations in the main daily activities. Typically, the thumb is contracted in adduction, the first web space is obliterated, the palm and digits are contracted in flexion and interdigital spaces are lost (pseudo-syndactyly). In this paper, we present our experience with a protocol based on the association of various internationally developed techniques: brachial plexus anesthesia with ketamine sedation, dynamic splinting and coverage of the wounds with allogenic keratinocytes sheets. The overall results obtained in the first 13 patients showed a good tolerance of the procedure, no anesthesiologic complication and marked improvement of the hand deformities. The long-term follow-up revealed a recurrence before 2 years in 2 hands, between 2 and 4 years in 7 hands and after 4 years in 6 hands. The conclusion is that an aggressive surgical attitude, along with an adequate intra and post-operative rehabilitation, ensures a good restoration of hand function and a satisfying delay of inevitable recurrence.

Activities of Daily Living↗
PubMed1996

[Cover plasties of distal finger amputations. Focus on techniques and indications].

Distal finger amputations could be responsible for prolonged time off work and disability. Although delayed healing is the simplest method, a deep defect with exposed skeleton or tendon is an indication for a flap to provide cover with good padding and discrimination. Local flaps are the first choice and selection is based on a number of parameters, the most important of which is the real possibility of advancement. Although V-Y flaps are sufficient to cover a guillotine amputation, a very large defect requires more sophisticated techniques like such as two-pedicle or single-pedicled island flaps.

Amputation, Traumatic↗
PubMed1995

[Upper limb lengthening. 47 clinical cases].

Between 1989 and 1993, the authors treated 39 patients by progressive bone lengthening in a total of 47 hands (17 post-traumatic and 30 congenital deformities). The Hoffman distractor was used in 34 cases and the Orthofix device was used in 13 cases. The percentage of lengthening obtained, compared to the initial bone length, was 87% for the hand skeleton and 47% for the forearm bones in congenital malformations while only 51% was obtained in post traumatic cases due to their older age and frequently associated skin problems. In 4 (8.5%) of these post-traumatic cases, the skin conditions had to be improved surgically. The average duration of treatment was 6.7 months, with a "healing" index (months/centimeters of lengthening obtained of 1.7. The time necessary to achieve complete bone healing was as long as the lengthening period. The complication rate was 34% (severe pain 8.5% delayed bone healing 8.5%, pin infections 6.3%, bone grafts 4.2%, tendon complications 2.1%), however none of these problems required pin removal. A complete failure was observed in two cases, followed by a second successful operation.

Adolescent↗
PubMed1995

[Ear prostheses in burns of the external ear. Technical notes].

Ear reconstruction is best performed with autologous tissue. However, there are selected cases in which a prosthesis may be preferred. Some patients are unwilling to undertake multiple surgical procedures, others do not accept the chest wall scar. More importantly, in severe post burn cases, the scars in the periauricular region can truly compromise the outcome of an autologous reconstruction. In such cases, the authors perform a prosthetic reconstruction which is anchored to the cranial bone by means of osteointegrated titanium screws. The method described here has been modified compared to the original Bränemark system. A new microscrew design allows the implants to be inserted in a single surgical procedure. A magnetic anchoring system avoids cumbersome external rods, and the overall size of the masses emerging from the skin is significantly reduced. These improvements increase patient comfort and compliance.

Bioprosthesis↗
PubMed1994

Self-expanding prostheses complicating augmentation mammoplasties.

A new and serious complication was experienced by patients of three independent surgeons following routine augmentation procedures. In each case reported, double-lumen prostheses had been used. All cases were reoperated with a diagnosis of capsular contracture. However, at surgery it was found that the outer lumen of the prostheses had overfilled with 60-160 cc of interstitial fluid, probably because of an osmotic gradient. The possible causes of this unfortunate complication are considered.

Adult↗