PubMed Health⌕ Search

Biomedical subjects

J J Comtet

Publications and source records attributed to J J Comtet.

At least 19 recordsLinked to original sources
PubMed1996

Experimentally induced ulno-carpal instability. A study on 13 cadaver wrists.

This experimental work studies the role of ligamentous structures in suspending the carpal bones from the radius and ulna. Thirteen human cadaver wrists underwent a distal radio-ulnar arthrodesis in a neutral position and an arthrodesis between the three bones of the first carpal row. Progressive postero-anterior forces in a palmar direction were applied to the fused carpal bones. Displacement was measured by two dial gauges before and after sequential section of the different fibrous structures. The largest absolute average displacement (both, dorso-palmar and induced rotational displacement) was observed after section of the ulnar styloid process. No significant differences were observed after section of the extensor retinaculum, extensor carpi ulnaris sheath, posterior ulno-carpal and posterior radio-carpal ligaments. This work suggests that the carpus is suspended not only from the radius, but also from the distal ulna and particularly at the ulnar styloid and the structures which insert onto it.

Arthrodesis↗
PubMed1996

[Cover of the Achilles tendon by peroneus brevis and flexor hallucis longus flaps. Apropos of 5 clinical cases].

Exposure of the Achilles tendon may be secondary to injury, trophic ulceration or surgical management of Achilles tendon rupture. We used peroneus brevis (PB) and flexor hallucis longus (FHL) muscle flaps to cover the Achilles tendon. The muscular portion of these muscles extends very distally, allowing their transposition to the Achilles region. PB and FHL are narrow (about 4 centimeters); the use of both muscles increases their possibilities of coverage. We used PB alone in one case and both muscles in four cases. In every case we obtained a good functional and cosmetic result. Various fascio-cutaneous flaps have been described for the reconstruction of the Achilles region. When there is an infection, muscle flaps are preferable to fascio-cutaneous flaps because they provide well vascularized tissue. We consequently suggest the use of PB and FHL to cover the Achilles tendon when it has been exposed for a long time or when it is infected. It seems especially indicated when skin necrosis occurs after surgical management of Achilles tendon rupture.

Achilles Tendon↗
PubMed1995

Decision making and results in subtotal and total lower leg amputations: reconstruction versus amputation.

As a result of modern therapeutic and technological advances, the surgeon has the ability to salvage even the most severely injured lower limbs. However, the success of replantation nowadays is no longer measured simply on the basis of restoration of viability but also on functional outcome compared with primary amputation with early prosthetic fitting, the risk to the patient during and after replantation and the overall time of treatment which should not exceed 2 years. Although every major limb replantation has to be considered individually, the decision-making process for reconstruction (replantation/revascularisation) versus amputation with subsequent early prosthetic fitting should be determined by objective criteria. Based on personal experience and an extensive literature search, an algorithm for treatment of amputation or amputation-like injuries to the lower leg has been developed and tested in a clinical study. A 100% viability success rate was achieved. There was not only a significant increase in the percentage of "functional extremities" but also a doubling in grade I results. Moreover, there was a 50% reduction in patients presenting a "non-functional extremity", and no patient required a secondary re-amputation. The replantation risk (e.g., risk of severe systemic disturbance during and/or after replantation) was about 16.6% (2/12) in our study. There was a significant decrease in the postoperative complication rate and no patient died during or after replantation. Based on our experience, if reconstruction in subtotal or total lower leg amputation is done for a well-selected patient group, good functional results with a reasonable replantation risk and a reasonable time for social re-integration can be achieved.

Adult↗
PubMed1995

[Ulnar parametacarpal flap. Anatomical study and clinical application].

The ulnar border of the hand provides a new skin flap which is very useful in the reconstruction of defects of the palm of the hand and ulnar fingers. An anatomical study of the dorsal carpal branch of the ulnar artery and its various branches has led us to propose the ulnar parametacarpal flap either as a pedicle or free microsurgical transfer. The territory of the dorsal carpal branch of the ulnar artery allows harvesting of a simple sensitive skin flap or a composite flap comprising a bone or tendon island flap. Description of the distal communicating vessels with the ulnar collateral artery of the little finger extends the territory of the ulnar parametacarpal flap; based on a retrograde blood supply, it can reach the dorsal and palmar surfaces of the ulnar fingers. The authors present several clinical applications and define the place of this new flap among the various treatment options for the hand.

Hand↗
PubMed1994

[Arthroscopy of the wrist].

Wrist arthroscopy may add specific datas to that provided by standard or motion view radiographs, arthrography, bone scan, TDM or RMN. Eight portals allow direct visualization of articular surfaces of radio-carpal and medio-carpal joints, triangular fibrocartilage, spaces between the carpal bones, interosseous and extrinsic ligaments. Wrist arthroscopy may be useful to evaluate lesions involving ligaments or cartilages, in degenerative or post-traumatic conditions. Arthroscopy may help to the decision in treatment of carpal instabilities, scaphoid pseudarthrosis, or Kienbock disease. Operative arthroscopy may allow shaving of damaged cartilage or fibrocartilage, bone resection or triangular fibrocartilage reinsertion.

Arthroscopy↗
PubMed1993

Two-point discrimination tests versus functional sensory recovery in both median and ulnar nerve complete transections.

Transection of both median and ulnar nerves provides an objective model to compare sensory and functional recovery. 22 patients were evaluated after nerve repair. The mean age was 30 years and the mean time since surgery 80 months. Primary direct suture was performed in 15 patients and six grafts were necessary. Median nerve suture and ulnar nerve graft were combined in one case. Both sensory and functional evaluation were completed. Statistical evaluation analyzed the relationship between age, injury location, mechanism, type of rehabilitation and the result, and the relationship between two-point discrimination distance (2-PD) and the functional score. According to the S0 to S4 grading, only 26.5% (ulnar) and 31% (median) of direct suture cases achieved S3+ or more. All nerve grafts in adults were poor. A strong relationship was found between two-point discrimination distance (moving and static) and the functional result, even after multivariate analysis. A modification of the Medical Research Council's classification is suggested.

Adolescent↗
PubMed1993

Perilunate dislocations and fracture-dislocations: a multicenter study.

A series of 166 perilunate dislocations and fracture-dislocations from 7 centers was retrospectively studied. The diagnosis was missed initially in 41 cases (25%). A classification system was presented. The perilunate fracture-dislocations were more frequent than the perilunate dislocations at a ratio of two to one. The displacement was dorsal in 161 cases (97%) and palmar in only 5 (3%). The dorsal transscaphoid perilunate fracture-dislocations represented 96% of the dorsal perilunate fracture-dislocations and 61% of the whole series. The clinical and radiologic outcome of 115 perilunate dislocations and fracture-dislocations with at least 1 year and an average of 6 years 3 months of follow-up was studied. Open injury and delay of treatment had an adverse effect on clinical results, whereas anatomical type had less influence. In cases treated early, the clinical results were satisfactory but the incidence of post-traumatic arthritis was high (56%). In the dorsal perilunate dislocation group of pure ligamentous injuries and in the dorsal transscaphoid group, the best radiologic results were observed after open reduction and internal fixation. In the latter group, the fixation of the scaphoid alone was not always sufficient and left occasionally scapholunate dissociation, lunotriquetral dissociation, ulnar translation of the carpus, or other carpal collapse patterns. The initial appraisal of both the osseous and ligamentous pathology was very important.

Adult↗
PubMed1993

Intraoperative histopathologic nerve examination in brachial plexus injury.

A new method of indirect intraoperative evaluation of axonal quality in a proximal nerve stump by immediate observation of the myelin sheath is presented. Using this method in 18 cases of brachial plexus injuries, the proximal stumps of particular roots or trunks were classified as unfavorable, favorable, or fair. This histologic grading was compared to the clinical result obtained after surgical repair of these nerves in the corresponding territory. In three cases, the proximal stump of the brachial plexus root was sacrificed because of an unfavorable grade, and a nerve transfer was performed: the results were useful in two cases and "academic" in one case. Among 12 cases with favorable histologic grades, nine were associated with useful function and three were "academic". Among three cases with a fair histologic grade, two were associated with an "academic" result and one was useful in a nine-year-old child. Retrospective comparison with classic examination after axon staining showed that intraoperative histopathologic grading was somewhat too optimistic in six cases and was relevant in 12 cases. This method may be helpful in choosing proper methods for brachial plexus repair. A normal or almost normal histopathologic condition in the proximal stump of the nerve is mandatory for obtaining a useful clinical result after repair.

Adolescent↗
PubMed1989

Emergency knee joint salvage utilizing a free musculofasciocutaneous flap based on the anterior tibial artery: case report.

A young adult male presented with a traumatic amputation at the upper third of his left leg and an extensive soft tissue loss around his left knee. A free musculofasciocutaneous flap was elevated on the anterolateral part of the amputated segment and transferred to the soft tissue defect around the proximal left tibia in order to avoid an above-knee amputation. The entire flap depends on the anterior tibial artery for its blood supply. The anatomy of the flap is outlined. The importance of the musculocutaneous blood supply as well as the presence of an extensive fascial component make the flap very reliable. An 18-month follow-up period showed a uniformly well-contoured soft tissue coverage and an optimal functional result.

Adult↗
PubMed1989

Biomechanical basis of transfers for shoulder paralysis.

Elevation of the scapulohumeral joint can be executed by two different and distinct systems, both capable of separately performing this movement. The deltoid muscle is composed of several parts contracting independently, sometimes antagonistically between them and providing elevation in different directions. Parts two and three (Fick) of the deltoid are essential because they are lateral to the centers of rotation and work in the plane of the scapula. The supraspinatus and adjacent muscle system can produce compensatory movements with full elevation in the plane of the scapula. Lateral rotation is absolutely necessary for abduction in the coronal plane. Rotatory muscles inserted on the tuberosities of the proximal part of the humerus are more efficient than those inserted on the humeral diaphysis. Vertical and horizontal stabilization of the humeral head in the glenoid fossa is the result of a complex balance between several muscles and passive factors. Trapezius and serratus anterior are essential for the rotation of the scapula around its centers of rotation.

Biomechanical Phenomena↗
PubMed1988

Proposed digital arthroplasty critical study of the preliminary results.

In view of the results of Swanson implants, particularly the long-term course of silicone implants, the authors studied and developed semi-constrained sliding arthroplasty designed for metacarpo-phalangeal and proximal interphalangeal joints. The preliminary study on bones and then on cadaver hands and finally on the knee of the rabbit allowed the design and experimentation of a prototype which led to the creation of a semi-constrained arthroplasty for which the elastic diaphyseal anchoring is ensured without cement and which possesses sliding surfaces composed of a metallic (proximal piece)--polyethylene (distal piece) interface. We therefore describe the principles of functioning of this arthroplasty, its technique of insertion, dorsal trans-tendon incision, its accessory (drill for diaphyseal preparations), its anatomical requirements (preservation of the palmar plate and lateral ligaments, bone section) and the postoperative course. To date, 52 arthroplasties have been inserted and we present the results of the first 36 cases for which the follow-up is equal to or a greater than one year (20 MP-16 PIP), indicating the technical modalities according to the various aetiologies (21 cases of rheumatoid arthritis--15 post-traumatic cases) and the complications. The average gain in mobility is 40 degrees with a mean range of movement of 64 degrees. In terms of pain, none of the arthroplasties were associated with pain apart from pain on cold in certain post-traumatic cases. The global and thumb-finger prehensile forces were evaluated to be an average of 90% in relation to the healthy side. Radiological assessment demonstrated fixation of the pieces in every case. Lastly, we discuss the outcome of this arthroplasty and its current indications in relation to the problems of instability essentially occurring in dislocated MP joints of rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed1988

Duchenne-Erb palsy. Experience with direct surgery.

Between 1973 and 1984, 31 direct explorations of traumatic Duchenne-Erb palsy (C5 and C6) were performed in two hospitals. Simple neurolysis was performed in 12 cases, in which C5 and C6 were found to be in continuity; the operation resulted in useful motor function in nine of the 12 cases. A cause-and-effect relationship of neurolysis to the recovery of function was difficult to prove. In five cases where only one root was completely damaged, four nerve graftings produced useful motor results but the function of one graft was not demonstrable when the other root was in continuity. In 14 cases of complete lesions of both C5 and C6 treated by nerve grafting, there were seven functional motor results that were attributable to the grafts. Both the overall results and the result of elbow flexion were statistically correlated with the number of grafts used to repair the corresponding nerve structure (p less than 0.01). Favorable results were not obtained when the graft had been delayed for more than nine months. All of the patients who had nerve grafts within five months had favorable results.

Adolescent↗
PubMed1987

[Sensitivity: physiology, examination, principles of rehabilitation of sensation].

This is the text of a lecture devoted to the physiology of sensibility studied in the recent publications. The author describes successively the role of the peripheral receptors, clinical and electrophysiological assessment of sensibility, central mechanism of sensation, sequential recovery or sensibility after peripheral nerve lesion, rational basis for reeducation of sensation.

Humans↗
PubMed1985

Biodynamics of the wrist: radiologic approach to scapholunate instability.

A study of 126 normal wrists has allowed us to determine the normal laxity of the scapholunate complex (36 degrees) by measuring and comparing the range of movement of each of these two bones on sagittal views on x-ray films. There was no difference between dominant and nondominant hands. A study of eight cadaver wrists and 13 pathologic wrists has shown greater SL in the presence of scapholunate ligament lesions. The measurement of SL on dynamic sagittal views on x-ray films can detect a pathologic laxity between these two bones. A minimal 15 degrees difference between a normal and a pathologic wrist is reliable.

Biomechanical Phenomena↗
PubMed1985

Lesions of digital arteries in Dupuytren's disease. A study of twelve cases.

Twelve cases of histologically examined digital collateral arteries severed accidentally during surgery for Dupuytren's disease are presented. All arteries were repaired immediately after specimen retrieval for histological examination. Only one artery had a normal structure; 11 cases showed subendothelial fibrosis while two arteries thrombosed. These changes might account for the confusion of these arteries with adhesions and might explain their severance. Typically the zone involved was the distal part of the palm, in which the neurovascular bundle twists around the spiral cord. We believe that the lesions are a consequence rather than a cause of Dupuytren's disease.

Aged↗