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J L Rouvillain

Publications and source records attributed to J L Rouvillain.

17 recordsLinked to original sources
PubMed2006

[Allograft-prosthesis composite arthroplasty for posttraumatic floating elbow].

Loss of bone stock in the elbow joint raises serious problems for reconstruction surgery. Total allograft-prosthesis composite arthroplasty is an attractive alternative to revision prosthesis and isolated osteoarticular allografts known to have many drawbacks. Use of this method is rather recent for revision procedures and tumor surgery and posttraumatic cases are rare (five reported cases). We report a case of posttraumatic floating elbow treated with this technique. At 75 months follow-up, the clinical result was excellent with the Mayo Clinic performance score at 100/100. Allograft-native bone fusion was complete and there were no complications, particularly no loosening. This composite technique is particularly well adapted for patients with major bone and joint loss. It can avoid the specific problems associated with each of the techniques used alone. The allograft reconstructs bone stock while the prosthetic component avoids the clinical expression of graft epiphyseal lysis.

Arthroplasty, Replacement↗
PubMed2004

[Biphasic ceramic wedge and plate fixation with locked adjustable screws for open wedge tibial osteotomy].

PURPOSE OF THE STUDY: The aim of this radiological study was to evaluate the use of a biphasic ceramic wedge combined with plate fixation with locked adjustable screws for open wedge tibial osteotomy. MATERIAL AND METHODS: Twenty-six consecutive patients (27 knees) underwent surgery between December 1999 and March 2002 to establish a normal lower-limb axis. The series included 6 women and 20 men, mean age 50 years (16 right knees and 11 left knees). Partial weight-bearing with crutches was allowed on day 1. A standard radiological assessment was performed on day 1, 90, and 360 (plain AP and lateral stance films of the knee). A pangonogram was performed before surgery and at day 360. Presence of a lateral metaphyseal space, development of peripheral cortical bridges, and osteointegration of the bone substitute-bone interface were evaluated used to assess bone healing. The medial tibial angle between the line tangent to the tibial plateau and the anatomic axis of the tibia (beta) was evaluated to assess preservation of postoperative correction. The HKA angle was determined. RESULTS: Three patients were lost to follow-up and 23 patients (24 knees) were retained for analysis. At last follow-up, presence of peripheral cortical bridges and complete filling of the lateral metaphyseal space demonstrated bone healing in all patients. Good quality osteointegration was achieved since 21 knees did not present an interface between the bone substitute and native bone (homogeneous transition zone). The beta angle was unchanged for 23 knees. A normal axis was observed in patients (16 knees) postoperatively. DISCUSSION: Use of a biphasic ceramic wedge in combination with plate fixation with locked adjustable screws is a reliable option for open wedge tibial osteotomy. The bone substitute fills the gap well. Tolerance and integration are optimal. Bone healing is achieved. Plate fixation with protected weight bearing appears to be a solid assembly, maintaining these corrections.

Adult↗
PubMed2002

Cytocompatibility study of organic matrix extracted from Caribbean coral porites astroides.

Since 1980, natural coral exoskeleton has been widely used as bone graft substitute. Despite numerous in vitro and in vivo studies. there is still a lack of knowledge concerning the organic matrix associated with coral exoskeleton (COM). In fact, some surgical interventions have failed and this has sometimes been attributed to the exoskeleton organic matrix. For others, only amino acids are present in the matrix after coral preparation for clinical use. The objective of this study was to extract the exoskeleton organic matrix to carry out biochemical analysis and study its specific cytocompatibility. Demineralized bone powder (DBP) was used as control. A decalcification process was used to extract COM and DBP. Protein, carbohydrate and glycosaminoglycan analysis was carried out in DBP and COM using classical staining methods. Human bone marrow cells were cultured in the presence of 20, 40, 80, 160 microg of COM or DBP for 24, 48 and 72 h. The methods used to analyze COM and DBP effects were scanning electron microscopy immunocytochemistry, manual cell count, and cyto-compatibility assay (Neutral red and MTT tests). Results showed that in spite of treating coral before clinical use, a COM was present in which GAG, protein and carbohydrate were found. The in vitro cytocompatibility of COM was confirmed for 20 and 40 microg values but was less pronounced for 80 and 160 microg levels.

Alkaline Phosphatase↗
PubMed2002

[Developmental lumbar stenosis in eleven French Antilles patients].

PURPOSE OF THE STUDY: Developmental lumbar stenosis is a rare entity, exceptionally described in the literature. No study has been directly devoted to this condition. The purpose of the present study was to examine specific features, particularly clinical and anatomic expression, observed in a series of operated patients. MATERIAL AND METHODS: Eleven patients from the French Antilles were treated for developmental lumbar stenosis between 1996 and 2000. The Verbiest criteria were used to define canal narrowness. Signs of degeneration and presence of discal herniation were exclusion criteria. Epidemiological and clinical data were collected for the 11 patients. The degree of sagittal stenosis (fixed diameter at the bone level and mobile diameter at the discal level) was measured on computed tomography images. Transverse stenosis was determined by measuring the interpedicular and interapophyseal distances. Lateral stenosis was determined by measuring the depth of the recessus. RESULTS: These patients were young (mean age 42.4 years). Most of the clinical signs were monoradicular. Discal level stenosis predominated, generally at level L4-L5. It was generally central and lateral, sagittal and transverse. The interpedicular distance was the only diameter that remained within normal limits. Soft tissues (yellow ligaments and joint capsules) played an important role in the stenosis. DISCUSSION: The rare reports of developmental lumbar stenosis describe decompensated stenosis due to discal herniation in the adolescent. Developmental lumbar stenosis is considered to be a genetic disease and its particular high frequency in the French Antilles favors this hypothesis. The stenosis results from bony (short pedicles, hypertrophic lateral masses) and ligament (hypertrophy of the yellow ligament and joint capsules) structures. CONCLUSION: Developmental lumbar stenosis produces a global (sagittal, transverse, central, lateral) narrowing of the lumbar canal where soft tissue structures apparently play a greater role than usually thought. A prospective study examining the impact of ethnic origin is required to analyze the genetic hypothesis.

Adult↗
PubMed1999

[Elastic intramedullary nailing of the tibia with the Marchetti-Vicenzi nail. 43 treated cases].

PURPOSE OF THE STUDY: The purpose of this study was to analyse the results of tibial intramedullary nailing using an unreamed "Universal Elastic Bundle Nail". MATERIAL AND METHODS: Forty-three intramedullary nailing of tibial shaft were done in 43 patients with recents fractures, from May 1993 and May 1996. There were 36 males and 7 females. The average age was 31.5 years (range 17-68 years). Thirty-three were injured in a traffic accident (20 motorcycles, 5 pedestrians and 8 car passengers), seven were injured in a home accident (fall) and three had a sport injury. There were 13 open fractures according to Gustilo: 5 grade I, 7 grade II and one grade III B. Eight fractures involved the proximal metaphyseal part of the tibia, 16 the distal metaphyseal part and 14 the tibial shaft; in five cases there were segmental fractures. According to AO classification there were: 10 fractures type A, 24 fractures type B and 9 fractures type C (5 segmental fractures). In 5 cases there were associated femoral fractures: three ipsilaterals and two controlaterals. All were treated in the same time: four by UEBN device and one by AO's nail. All the patients with type B and C fractures were positioned on a Maquet table with a boot traction or transcalcaneal pin traction (in the distal fractures). The nail was introduced after closed reduction through a vertical transpatellar tendon incision, without reaming procedure. RESULTS: Forty one fractures healed after an average time of 96 days (60-120). In 11 open fractures bone union occurred after 98 days (85-120). The distal fractures healed after a mean time of 86 days (60-120), proximal fractures in 123 days and mid shaft fractures in 98 days. In type A fractures bone union occurred after an average time of 68 days, while bone union occurred after a mean time of 100 days in type B and C fractures. Two patients with an open proximal type B fracture, had a delayed union: both healed after proximal screws removal. Two fractures healed with a valgus angulaton 5 degrees and 10 degrees. No infection, no loss of reduction and no bundle migration has been noted. DISCUSSION: The Marchetti-Vicenzi's nail (UEBN) permitted a stable fixation in tibial fractures. The use of this unreamed nailing coupled with an automatic distal locking in the metaphyseal cancellous bone, reduced operative time and shortened X Ray's radiation exposure. At the follow-up fracture healing occurred in 41 cases 95.3 p. 100 at four months. Two delayed union occurred after four months, the two cases were open fractures grade II. All the two cases healed after secondary procedure without any loss of function. Malunion occurred in two patients (in only one case there was a major valgus angulation 10 degrees), the two cases were related to technical error. We had no cases of infection or leg shortening or bundle migration in the ankle joint. CONCLUSION: We believe that Universal Elastic Bundle Nail allows a stable and safety fixation in open or closed tibial fractures without pseudarthrosis and without infection (in our series).

Accidents↗
PubMed1999

[Tibia vara in adolescents. Apropos of 19 cases].

PURPOSE OF THE STUDY: Clinical, and radiological aspects and treatment of adolescent tibia have been studied in a review of 19 children native of the Caribbean. MATERIAL: 23 cases of adolescent tibia vara in 19 children have been collected (14 males and 5 females, aged from 9 to 14). METHODS: Clinical aspects (weight, lower limb axis), radiological signs (aspect of the physis, mechanical axis, epiphyseal slope) were studied pre and post-operatively. RESULTS: All the boys presented an important overweight. Pain was the first symptom, characterized by a progressive varus deformity on a leg which was previously straight. Radiological findings consisted in metaphyseal varus and widening of the medial part of the physis. Mechanical femoro-tibial axis varied from 10 degrees to 55 degrees varus, medial epiphyseal slope from 12 degrees to 30 degrees. Average mechanical femoral angle was 92 degrees and accounted for a mean femoral varus deformity of 4 degrees. 23 knees were operated, 4 after fusion of the whole physis. 10 lateral hemi-epiphysiodesis were performed with a mean correction of 4 degrees every year until fusion. In 3 cases a tibial osteotomy was made in a second time, at the end of growth. In 6 cases of late treated patients, an isolated tibial osteotomy of valgisation was performed. In 7 cases of important deformity before closure of the physis, tibial osteotomy was associated with lateral epiphysiodesis. In one case, a lateral closing wedge osteotomy was performed, associated to an elevation of the medial tibial plateau and a lateral hemi-epiphysiodesis. DISCUSSION: Histopathological examination of the physis showed similarities between adolescent tibia vara, infantile tibia vara and Slipped capital femoral epiphysis: the entire physeal plate was involved. Concerning pathogenesis of adolescent tibia vara, mechanical factors are predominant, with abnormal pressures across the medial part of the physis. CONCLUSION: Adolescent tibia vara occur in obese black children and can be considered as an epiphysiolysis of the upper end of the tibia.

Adolescent↗
PubMed1999

[Sagittal changes induced by knee arthroplasty: a radiologic study].

PURPOSE OF THE STUDY: To quantify the modifications occurring on the femoral side, after Total Knee Arthroplasty, we describe a method of measurements in the sagittal plane on standardized X-rays. MATERIAL AND METHODS: We report the clinical and radiologic results of a prospective study of 80 cases of Total Knee Arthroplasty performed with the same prosthesis. We eliminated twenty cases with incorrect X-rays. Measurements were done on 60 preoperative X-rays and 60 postoperative X-rays. The aim of the measure was to quantify the modifications induced by the prosthesis on the trochlear groove and on the tibio-femoral joint line in full extension and in flexion, to eliminate individual femoral diameter was used as a reference in order to cancel variations in X-rays magnification. We first validated the two perpendicular reference axis on which we based all the measurements. RESULTS: No significative difference was found on the position of the tibio-femoral joint line in flexion. The tibio-femoral joint line in extension was significantly moved distally. The prosthesis was placed too distally, therefore we changed the operative procedure. No significative difference was found on the position of the anterior trochlear groove. DISCUSSION: With this method, the anatomic variations of the femoral profiles can be quantified, therefore, further prosthesis shapes can be improved. Radiological follow-up of knee prosthesis and comparison of the influence of different prosthesis can be made by these measures.

Aged↗
PubMed1998

[A familial form of bilateral recurrent dislocation of the patella with major trochlea dysplasia].

PURPOSE OF THE STUDY: We report four cases of bilateral recurrent dislocation of the patella with major trochlear dysplasia, in the same family. MATERIAL AND METHODS: Details of clinical examination of all members of this family and measurements on knee radiographs are reported. RESULTS: In all cases a severe proximal dysplasia of the trochlea was described on lateral views. The patella and the trochlea had a normal shape on the axial view. DISCUSSION: In some recurrent dislocation, with no associated disease, possibility of a genetic transmission have been suggested in some publications. Cases involving the same family have never been reported to confirm a genetic transmission of a bilateral and major trochlear dysplasia. CONCLUSION: This report points out a genetic origin of severe trochlear dysplasia. To know more about transmission and chromosomic localisation, careful investigations on others families of bilateral dislocations with trochlear dysplasia must be done.

Adolescent↗
PubMed1997

[Shortening arthrodesis of three wrist bones].

In advanced cases of wrist osteoarthritis with lesions of the radio-scaphoid and mediocarpal joints, and when a proximal row carpectomy is not possible because of lesions of the head of the capitate, we suggest a new technique: The hamate-capitate-lunate shortening arthrodesis with a scaphoid-triquetral resection. The good results observed with proximal row carpectomies, and particularly their long-term reliability, have encouraged us on this new path. Effectively, this operation takes the concept of proximal row carpectomy one step further by reconstructing the head of the capitate with the lunate whose proximal articular surface is often not deteriorated even in very advanced cases of radio and mediocarpal osteoarthritis. The two theoretical concepts of this operation are the shortening of the carpus and respect of the physiological congruence of the radio-lunate joint, the goal being obtain similar results those with proximal row carpectomy, particularly concerning mobility. We present our first two cases with this technique. This new procedure is an alternative to the four bone arthrodesis, particularly in SLAC wrist sequellae when they have evolved to the stage of radio and mediocarpal osteoarthritis.

Aged↗
PubMed1997

[Apropos of a case of chondromyxoid fibroma of the talus. A review of the literature].

PURPOSE OF THE STUDY: Chondromyxoid fibroma (CMF) is a very rare tumor. CMF represents less than 1p. 100 of all benign osseous tumors. The upper part of the tibia is the most frequent localization. We report the second case of talus tumor published in the world literature. MATERIAL AND METHODS: A 20 years old man presented a lytic tumor of the talus. The histology diagnosed a Chondromyxoid fibroma. A complete excision was made. An autologous bone graft associated with blocks of coral were used for reconstruction. RESULTS: After six months sport activities were authorized. After 10 years follow-up, there is no recurrence, the coral has progressively disappeared, replaced by host bone. DISCUSSION: Only one case of talus tumor has been published in world literature. Feldman has collected 189 cases of CMF published before 1970. After 1970, 297 new cases published. Analysis of these 486 cases pointed out the frequency of differents localizations. CONCLUSION: This very rare tumor frequent between 10 and 30 years of age. The foot is the second localization after the tibia. A surgical conservative treatment with complete excision is recommended even in case of recurrence. Radiotherapy must be avoided in any case because of the risk of malignant degeneration.

Adult↗
PubMed1996

[Disruption of the pubic symphysis with overriding impacted symphysis. Apropos of a case].

INTRODUCTION: The authors report one case of overriding impacted symphysis by lateral compression injury of the pelvis. MATERIAL AND METHODS: A 30 year old male presented a disruption of the symphysis pubis following a motor vehicle accident with lateral injury. Radiographs of the pelvis revealed a displacement of the right part of the symphysis behind the left one and a protrusion of the left pubic body through the right obturator foramen. CT scan did not show any sacro-iliac disruption but a fracture of the lateral part of the sacrum. An urethral injury with a complete urethral disruption was associated. Open reduction and internal fixation was necessary to reduce displacement. Urethral disruption was treated after retrograde urethrogram, four months after injury. RESULTS: Two years after injury, there was no pain in the pelvis and urinal function was normal. A sexual dysfunction remained. DISCUSSION: This lesion is secondary to lateral compression injury with internal rotation of the right part of the pelvis. It can be classified in type B2 of Tile's classification. It is a rare condition because this mechanism very often leeds to a fracture of the pelvic ring.

Accidents, Traffic↗
PubMed1995

The resorption of bone-implanted corals varies with porosity but also with the host reaction.

Three different exoskeletons of coral species Porites asteroides (P), Montastrea annularis (M), and Dichocoenia stokesi (D) were implanted for 2-20 weeks in rabbits. At 2, 4, 8, or 20 weeks, the exoskeletons presented variations in their resorptions depending on the species. To understand the variations in the decreasing speed of the implants despite their similar chemical composition, a study of the surface and architecture of the coral was carried out using scanning electronic microscopy, porosity was evaluated, and growth and differentiation of osteogenic cells cultured in vitro were observed for more than 1 month. At the cellular level, the surface of the implants was identical. Three-dimensional structures of the implants were variable, but the porosity values [P = 42.7%, M = 40.7%, and D = 17.4%] could not completely account for the differences in the resorbing process of the species. Standard histologic studies performed at 2, 4, 8, and 20 weeks after implantation produced the same pattern with P or M, showing aspects of rapid resorption; however, with D there were images resembling those of a foreign-body reaction. It seems that when resorption is not quick enough, a foreign body reaction develops which further slows down the process. This work focuses on the importance of porosity when using coral as bone substitute.

Animals↗
PubMed1995

[Treatment of posterior cruciate ligament rupture and recent knee dislocations by olecranisation of the patella without surgical repair].

Olecranisation of the patella was described and first used by Grammont (1984) to maintain reduction of the knee joint after posterior cruciate repair and reconstruction. Since 1985 we used this technique in 18 acute posterior ruptures and knee dislocations which did not undergo surgery. Knee laxity is assessed under general anaesthesia with radiographic control. A 4 or 5 mm. Steinmann pin is introduced medially at the top of the patella and drilled vertically through the bone to continue behind the patella tendon. After reduction of the posterior drawer, the pin is passed into the anterior part of the tibia. Full mobility between 0 degrees and 90 degrees is maintained. Physiotherapy started immediately and early weight bearing is allowed with a posterior splint. Olecranisation prevents posterior subluxation of the tibia and gives an anterior tibial subluxation force which is minor in flexion but major in extension. We followed up our patients for 1 to 8 years. The latest testing with radiographs demonstrate posterior drawer but all patients report good results. Early physiotherapy avoids stiffness, amyotrophy, and reflex sympathetic dystrophy. Olecranisation appears to give similar results more quickly and with fewer complications than P. C. L. surgery.

Acute Disease↗
PubMed1995

[Rupture of the distal tendon of the biceps brachialis: apropos of 43 cases].

PURPOSE OF THE STUDY: Rupture of the distal tendon of the biceps is an uncommon occurrence. 43 cases were analyzed in a multicentric study in order to define etiological factors and treatment of this lesion. MATERIAL AND METHODS: 43 cases were reviewed from Fort de France, Paris, Marseille, Lyon and Suresnes. There were only male patients with an average age of 50 years. The mechanism of injury, the clinical and radiographic features, the anatomical findings and the results of surgical treatment were analyzed. 4 patients were treated conservatively and 39 surgically. In 28 cases, anatomical reattachment of the tendon was performed. In 11 cases the tendon was simply attached to the brachialis anterior muscle. RESULTS: The mechanism of injury in all patients was passive extension against active flexion 17 patients had sustained injury while engaged in sports activities and 17 during domestic activities. Most of the patients were diagnosed clinically. Ultrasound and CT scan was useful in cases seen a long time after injury. In 34 cases avulsion of the bicipital tuberosity was found. Subjective results were good in 28 cases and poor in 5 cases. Objective testing was performed one year after injury using the criteria described by Baker: flexion and suppination force (maximum force) and endurance (ability to perform repeated contractions). Following attachment to the brachialis anterior, there was an average loss of 33 per cent of flexion strength and 52 per cent of supination strength. Following anatomical reattachment, the loss was 5 per cent for flexion and 15 per cent for supination. There were two cases of radial nerve palsies and 1 case of radio-ulnar synostosis. DISCUSSION: Attachment of the biceps brachialis tendon to the brachialis anterior muscle is unable to restore supination force. Complications only occur following anatomical reattachment. Radial nerve palsies can be avoided by using two separate incisions as described by Boyd. CONCLUSION: Surgical reinsertion onto the radial tuberosity restore more strength. Attachment to the brachialis muscle can be sued in cases seen a long time after injury.

Adult↗
PubMed1992

[Coxa vara in children. Apropos of 28 cases].

Infantile coxa-vara is an infrequent lesion and two etiologic factors have been recognised: mechanical and genetic. As in Blount's disease, the same populations (black and scandinavian people) are usually affected. Twenty eight patients with 42 infantile coxa vara were reviewed. The diagnosis was often late. The radiographs showed the decrease of the neck-shaft angle and the signs of cervical dystrophy. The aggravation of the coxa vara is usual and pseudarthrosis or osteo-arthritis can be observed. Thirty six femoral valgus sub-trochanteric osteotomies were done. The results were best when the surgery was done before the age of 9 years. When the surgery was done later, an epiphysiodesis of the greater trochanter was associated to the femoral osteotomy if the epiphyseal cartilage was fused. Langenskiold's osteotomy was used only when the neck-shaft angle was lower than 80 degrees. The results were evaluated according to the neck shaft angle and the morphology of the femoral head: 22 very good and good, 11 fair and 3 bad results were noted.

Adolescent↗