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Biomedical subjects

J L Condamine

Publications and source records attributed to J L Condamine.

13 recordsLinked to original sources
PubMed1998

[Management of motor disability in rural Sahelian environment. Experience of the center for rehabilitation and devices in Bogande, Burkina Faso].

The center for rehabilitation and fitting of the disabled in Bogande, Burkina Faso has been in operation since 1992. It was created by a non-governmental organization named Actions de Solidarité Internationale (ASI). The primary goal of the center is to provide support devices to restore upright position and mobility and allow social reinsertion especially for disabled persons between the ages of 0 and 20 years. Approximately one hundred people are treated annually. Treatment is delivered either directly in villages or in dispensaries if the disabled person can be brought in with the assistance of family members or health care workers. This policy has enhanced the quality of information, training, and prevention. Patients with severe disabilities beyond the scope of treatment at the center are contraindicated. The activities of the center have been organized with a view to covering costs. A welding shop has been set up to produce aid devices and provide revenues to pay for some services. The major lessons of this experience involve the need for active recruitment in villages, for contraindicating patients with severe untreatable disability, for developing economically sustainable programs, for training management staff, and for good financial planning. In 4 years of operation, the rehabilitation and fitting center has demonstrated its ability to meet the needs of the disabled in Bogande.

Activities of Daily Living↗
PubMed1998

[Repetitive release of the medial nerve in the carpal tunnel. Analysis of a series of 18 cases].

PURPOSE OF THE STUDY: This study analyzes 18 revision procedures for carpal tunnel release failure. MATERIAL: This series did not present any difference in terms of age compare to the population suffering from median nerve entrapment: mean age 56 years, 17 female and 1 male, 1 monolateral syndrome and 8 bilateral. Two third of the patients were seen between 2 and 9 months after initial surgical treatment. Most of the first surgical procedures were performed by an orthopedic surgeon (12/18). The approach was open (14/18) with 5 short incisions, and 4 endoscopic releases. Clinical symptoms were worse or unchanged compare to prior to surgery. All the patients had EMG study and 15 had worse electric signs than before. Open surgical approach was always palmar using optic magnification for median nerve neurolysis. RESULTS: 16 times an incomplete section of the anterior retinaculum and 2 median nerve lacerations were found. All patients were seen with a follow up of more than 2 months. Results concerning pain and sensibility were good for 16 of them; regarding motor impairment, only 13 of them had a good result. Grasp was not improved for 50 per cent of them. Two patients had a result considered as bad (one NAD sequela and one median total laceration). DISCUSSION: In our series as well as in literature, failures of carpal tunnel release are due to incomplete section of the anterior retinaculum and sometimes to median nerve laceration. The second look has to be performed when there is no improvement or when the situation is worse after initial surgery. CONCLUSION: Incomplete section of the anterior retinaculum is the most frequent reason for carpal tunnel release failure. An EMG seems necessary to confirm diagnosis before revision surgical procedure.

Aged↗
PubMed1997

[Primary metacarpophalangeal and proximal interphalangeal arthrosis of the hand. Indications and results of 27 DJOA arthroplasty].

The authors report 27 Digital Joint Arthroplasties (DJOA), implanted exclusively in cases of osteoarthritis, between 1985 and 1994. The metacarpophalangeal joint was involved in 8 cases and the proximal interphalangeal joint was involved in 19 cases in a series of 20 patients with a mean age of 58 years (49-84). The mean interval between the first clinical signs and the surgical operation was 34 months (12-72). An anterolateral incision was used in 5 cases for the PIP joint, and an anterior incision was used in one case for the MP joint. All other cases were operated via a dorsal incision. Two early complications were observed: septic ulceration of the skin and dislocation of the PIP prosthesis on the 8th day. Good results were obtained in terms of pain. Range of movement was only slightly improved by arthroplasty and exclusively in the extension sector. The range of movement of the MP joint increased from 35 degrees to 50 degrees, while the range of movement of PIP joint remained unchanged at 50 degrees with a slight displacement of 5 degrees towards the extension sector. This can be explained by the radiological follow-up of our implants which showed impaction of the prosthetic shaft during the first two postoperative years with appearance of signs of periarticular ossification. The results concerning range of movement and pain were analogous to those of other series in the literature, particularly with the use of Swanson implants. On the other hand, DJOA arthroplasty presents a low incidence of axial deviation problem (1 case out of 27). The authors are currently trying to improve the results of DJOA arthroplasty by creating a size 0 to suit anatomical requirements and by adopting the anterolateral incision to preserve the extensor apparatus in order to decrease postoperative flexion deformity.

Aged↗
PubMed1996

[Guépar's total radio-carpal prosthesis in the surgery of the rheumatoid wrist. Apropos of 72 cases reviewed].

PURPOSE OF THE STUDY: Total wrist arthroplasty is an alternative to arthrodesis in the treatment of the rheumatoid wrist. MATERIAL AND METHODS: Seventy-two GUEPAR total wrist arthroplasties in sixty-four patients with rheumatoid arthritis were reviewed 1 to 10 years after the operation (average follow-up of 4 years). GUEPAR total wrist arthroplasty is a bicondylar prosthesis. The radial component made of polyethylene is cemented in the radius. The carpal component made of metal is fixed by two screws in the second and the third metacarpal. This component is constitued by two pieces: a perforated lower part permitting the passage of the screws and its metacarpal fixation and a biconvex cover fixed on the lower part by a micro-screw. RESULTS: In preoperative evaluation, all patients had severe pain and loss of function. Post-operatively, 89 per cent had no pain or mild pain and 96 per cent had better function. The average arc of flexion-extension was 47 degrees preoperatively and 39 degrees postoperatively. There were no deep infections or dislocations. Seventy percent of the patients were satisfied but eleven wrists (15 per cent) required revision: 5 cases for prosthesis revision and 6 cases for implant removal and arthrodesis. Prosthesis revisions were justified by the unscrewing of the carpal component micro-screw: they gived good results. Arthrodesis was required for 4 radial component loosening and for 2 important bone resorptions under the carpal component. Radial component loosening was associated in 3 cases with unscrewing of the micro-screw. Radiographical analysis showed in nearly all cases of this serie a bone resorption under the carpal component. This resorption was 2 mm wide at an average of to 2 years and 4 mm wide at 4 years. DISCUSSION: Clinical results of this study are good but eleven wrists required revision. Nine of these revisions were due to anomalies of first prosthesis: the unscrewing of the carpal component micro-screw was accountable to abnormal use of polyethylene with reaction of the wear products and loosening of the radial component. This problem is now resolved. More disquieting is the bone resorption under the carpal component. In fact, this resorption was constant and evolutive. It was very likely due to micro-movements between the metacarpal screws and the carpal lower part. Also, the conception of the metacarpal-fixation of this prosthesis must be revised. CONCLUSION: In rheumatoid arthritis, wrist arthrodesis gives good results if nothings affects the fingers, elbow or shoulder. If they are affected, total wrist arthroplasty is an alternative. Long term loosening of total wrist arthroplasty is a significant problem so its indication must be reserved for old patients.

Adult↗
PubMed1992

[The Sauvé-Kapandji operation. Analysis and results of 69 cases].

The authors present the results of 69 cases operated between 1983 and 1989. The indications were dominated by two aetiologies: degenerative lesions of the inferior radio-ulnar joint in rheumatoid arthritis: 58% of cases, and traumatic sequelae, predominantly secondary to fractures of the distal radius: 34% of cases. The authors stress the effects of distant lesions: skeletal lesions of the two bones of the forearm or the superior radio-ulnar joint. A third group of rarer indications consisted of painful dislocations of the inferior radio-ulnar joint in Madelung's disease (indication only applied to adults). There were two types of complications: complications due to excessively long or intra-articular screws, which were treated by removal of the screws and, more severe, ossifications of the zone of diaphyseal resection (5 cases) which interfered with the functional result in terms of mobility. Three cases required extensive diaphyseal resection. The results are analysed for each aetiological group in terms of pain, mobility prehensile strength after more than one year of follow-up. Good results were obtained in 80% of cases of post-traumatic lesions (16 cases). The insufficient results were related to associated lesions of the elbow or the 2 bones of the forearm. A good result was obtained in 3 out of 4 cases of Madelung's disease and one case, operated elsewhere and revised by pseudoarthrodesis, obtained a moderate result. Lastly, in rheumatoid arthritis, the results in terms of pain, mobility and prehensile strength were good, apart from 2 failures due to progression of rheumatoid disease (cases unsuitable for this treatment). Radiographic analysis according to Youm and Mac Murtry's criteria showed minimal regression in the carpoulnar translation index (pre-op: 0.28; post-op: 0.22). Overall, the Sauvé-Kapandji operation provided good quality clinical results when the indications and technique were rigorously applied.

Adult↗
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↗
PubMed1986

Analysis of twenty-eight recurrent pseudarthroses of the carpal navicular after the Matti-Russe operation.

The authors present a review of 28 cases of failure of consolidation of the carpal navicular after the Matti-Russe operation (multicentric study of 106 cases). The causes of the failures are analysed. Among the non significant factors, we find the delay, the radiographic character of the pseudarthrosis, the donor site of the graft, the time of immobilization and the site of the fracture. The superior polar fractures do not have a bad prognosis in this series. Five causes seem to be in direct relation with the failure of consolidation: the age, the failure of an initial surgery procedure, the presence of radiologic "necrosis", the quality of the technical performance of the Matti-Russe operation, and finally dorsal carpal instability that seems to be a fundamental cause in the failure of bony union. The future of these pseudarthroses is analysed concerning: the functional results (64% of poor results); the evolution towards the pseudarthrosis (30%); the surgical reoperations (12 cases out of 28) with eight repeat Matti-Russe operations that finished in five consolidations.

Adult↗
PubMed1986

Functional results of seventy-six cases of phalangeal and metacarpal fractures studied using a hand emergency computer card system.

Over a two-year period, the authors analyzed 76 records using a "hand" computer card divided into two parts: "work-up of the initial lesions" and "functional results". Analysis of 102 cases of fractures in this manner led to the conclusion that outcome was most often favorable when the fracture was extra-articular whatever the treatment, except in the case of complex compound fractures. In contrast, treatment of articular fractures often required secondary surgery (50% of cases) and led to 20% poor or average results. This was the case whatever initial treatment (functional, orthopedic or operative) had been undertaken.

Adolescent↗
PubMed1984

[Epithelioid sarcoma. Apropos of 3 cases].

The authors present two cases of epithelioid sarcoma of the hand and one of the foot with clinical interest. This recently described tumor (Enzinger, 1970), is relatively rare. It occurs in the hand, forearm, pretibial region and foot and affects principally young adults. It should be emphasized, and this is borne out in the literature, that this tumor may appear perfectly benign and often has a course of long duration. The difficulty of clinical and especially of histologic diagnosis as well as the difficulty of determining the boundaries of extension of the tumor make it necessary to carry out radical surgery (amputation or rarely block excision). Every author agrees that local excision is to be condemned, there being an 85% recurrence rate. Spread of the tumor is by way of the fascial planes and tendon sheaths. Lymphatic and pulmonary metastases occur particularly when there is vascular invasion.

Adult↗
PubMed1983

Epithelioid sarcomas. Three cases.

The authors present two cases of epithelioid sarcoma of the hand and one of the foot with clinical interest. This recently described tumor (Enzinger, 1970), is relatively rare. It occurs in the hand, forearm, pretibial region and foot and affects principally young adults. It should be emphasized, and this is borne out in the literature, that this tumor may appear perfectly benign and often has a course of long duration. The difficult of clinical and especially of histologic diagnosis as well as the difficulty of determining the boundaries of extension of the tumor makes it necessary to carry out radical surgery (amputation or rarely block excision). Every author agrees that local excision is to be condemned, there being an 85% recurrence rate. Spread of the tumor is by way of the fascial planes and tendon sheaths. Lymphatic and pulmonary metastases occur particularly when there is vascular invasion.

Adult↗
PubMedDate not supplied

[Support program for the implementation of the Bamako initiative: analysis of the creation of eight health districts, Gnagna province].

The implementation of the Bamako initiative is a central pillar of the health policy of Burkina Faso. The NGO, ASI, working with the health authorities, has set up a program involving the creation of eight health districts in the province of Gnagna. The program covers a population of 115,000 inhabitants in 134 villages and was progressively established between 1994 and 1997. The health districts were set up in phases (2 in the first year and 3 in each of the following two years). The method used to select the members of the village management committees is one of the key aspects of the program. It required a large amount of effort to increase the awareness of villages, and much activity because each committee is elected by the various villages of the district. The training of the managers of these committees and of the managers of the pharmaceutical warehouses in each district is also a key element. In our initial assessment, we noted balance in the accounting of the pharmaceutical warehouses of each district, adhesion of the population to the program, dynamics in the management committees and, above all, the autonomy of the committees. The first results in terms of health are very fragmentary and difficult to interpret because the program has been running for such a short time. We considered the long-term elements of the program, the necessity to set up a system for monitoring activities and the quality of care. An initial assessment showed a clear improvement in the availability of drugs in the 8 districts. Health promotion activities have not yet been developed in these districts. This type of program requires the follow up and support of the management committees, and will be the object of the second phase, begun in 1998.

Burkina Faso↗
PubMedDate not supplied

[The role of vascular microsurgery in trauma of the hand].

The author presents the current scope of microvascular techniques in hand surgery. In a first stage, basic techniques are presented: sutures under microscope. Then, the indications are made, stressing emergency procedures, with emphasis on: limb (or segments) reimplantation, revascularization. Indications for reimplantation, operative technique and additional treatments are presented, emphasizing the failure rates (40%) and the contraindications. We are insisting on the fact that the indications for revascularization in simple or complicated wounds of the hand are the most frequent and the most positive for these patient's future. Finally, secondary reconstruction techniques are presented, always compared with classical techniques (free 2nd toe transfer versus pollicization).

Hand↗