Biomedical subjects

J N Goubier

Publications and source records attributed to J N Goubier.

16 recordsLinked to original sources

PubMed2006

[Scapho-trapezio-trapezoidal arthrodesis for scapho-trapezio-trapezoidal osteoarthritis].

Scapho-trapezio-trapezoid arthrodesis was originally performed for the treatment of scapho-lunate instability. However, only a few publications have described this technique for treatment of osteoarthritis of the scapho-trapezio-trapezoid (STT) joint. The purpose of this paper is to analyze the results of triscaphoid arthrodesis for STT osteoarthritis with a long-term follow-up. Thirteen cases of osteoarthritis of the STT joint in twelve patients, all treated by STT arthrodesis, were reviewed with an average follow-up of 60 months. Pain was classified according to Alnot's classification: eight patients were classified as grade III, two as grade IV and two as grade II. The average preoperative range of motion of the wrist was 51 degrees for flexion, 39 degrees for extension, 9 degrees for radial deviation and 28 degrees for ulnar deviation. Grip strength was compared to the contralateral side. Radiographic changes were classified according to Crosby's classification, including sublevels for carpal instability. Four wrists were classified 2a and nine wrists were classified 2b. The average radio-lunate and scapho-lunate angles were 14 and 45 degrees respectively. Pain was improved in all patients (P = 0.05) all of whom were subjectively satisfied. Strength and range-of-motion did not statistically decrease after STT arthrodesis except for wrist extension (P = 0.03). Radio-lunate and scapho-lunate angles were unchanged in five patients and improved in five patients. There were four non-unions of whom two patients without pain were not re-operated. The other two were re-operated with the same technique leading to fusion. Scapho-trapezio-trapezoid arthrodesis is an efficient procedure for STT osteoarthritis with regard to pain reduction. Strength and global range-of-motion are not modified by this procedure. Moreover, as it limits carpal instability, this procedure is preferable in active patients.

Adult↗

PubMed2005

[Neonatal Volkmann's compartment syndrome. A report of two cases].

Neonatal Volkmann's compartment syndrome is a rare entity. This diagnosis may be suspected when a case presents cutaneous damage associated with poor hand and wrist function after delivery. We present two such cases of neonatal Volkmann compartment syndrome with long term clinical and x-ray follow-up. In our patients, a hand surgeon was not consulted in the perinatal period and early fasciotomy was not performed. No particular aetiology or associated cerebrovascular accident was found. A series of operations was necessary in order to improve function of the hand. Neonatal Volkmann compartment syndrome must be recognised early in order to enable further investigation of any underlying condition and to perform early surgical decompression. Long term clinical and x-ray follow-up is necessary to prevent and treat wrist deformation and finger contractures.

Compartment Syndromes↗

PubMed2004

Rotations of three-joint fingers: a radiological study.

The aim of the current study was to test a protocol of quantification of phalangeal three-dimensional (3D) rotations during flexion of three-joint digits. Three-dimensional-specific software was developed to analyze CT reconstruction images. A protocol was carried out with six fresh-frozen upper limbs from human cadavers free from any visible pathology (three females, three males). CT millimetric slices were done for reconstruction of hand bone units. Orthonormal coordinate systems of inertia were calculated for each unit. Three-dimensional phalangeal rotations were estimated between two static positions (fingers in extension and in a fist position). Results were displayed for the joints of each three-joint finger with calculation of 3D rotations. Mean longitudinal axial rotations of metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints ranged from 14 degrees pronation to 19 degrees supination. The index finger was in a global pronation position (4/6 specimens). The fourth and fifth fingers were in a global supination position in every case. The third finger was in a more variable global rotation (pronation in 2/6 specimens). MCP, PIP and DIP flexion angles ranged respectively from 71 degrees to 89 degrees, 65 degrees to 87 degrees, and 41degrees to 77 degrees. Lateral angles ranged from 19 degrees (ulnar angulation) to 23 degrees (radial angulation). The study of phalangeal rotations was possible in spite of a heavy protocol. This protocol could be partially automatated to speed up the analyses. Longitudinal axial rotations could be analyzed, in addition to flexion/extension or abduction/adduction rotations. CT scan reconstructions would be helpful for investigating pathological fingers. Abnormal rotations of digits could be quantified more precisely than during a current clinical examination of the hand.

Aged↗

PubMed2004

Glenohumeral arthrodesis in upper and total brachial plexus palsy. A comparison of functional results.

We have compared the functional outcome after glenohumeral fusion for the sequelae of trauma to the brachial plexus between two groups of adult patients reviewed after a mean interval of 70 months. Group A (11 patients) had upper palsy with a functional hand and group B (16 patients) total palsy with a flail hand. All 27 patients had recovered active elbow flexion against resistance before shoulder fusion. Both groups showed increased functional capabilities after glenohumeral arthrodesis and a flail hand did not influence the post-operative active range of movement. The strength of pectoralis major is a significant prognostic factor in terms of ultimate excursion of the hand and of shoulder strength. Glenohumeral arthrodesis improves function in patients who have recovered active elbow flexion after brachial plexus palsy even when the hand remains paralysed.

Activities of Daily Living↗

PubMed2003

[Venous drainage in retrograde pedicle flaps: experimental study in rats].

This study was performed to investigate the venous drainage in reverse island groin flaps in a rat model. Two groups of 10 rats were studied. All rats of group A had a groin reverse flap with a complete pedicle (artery and venae comitantes). In rats of group B, an arterial groin reverse flap (artery without venae comitantes) was performed. For the two groups, the perivascular tissue was excised. Nine flaps in the group A and seven flaps in the group B, survived without partial or complete necrosis. Microscopic examination showed venous dilatation in the two groups. There was no significant difference between the two groups. These results confirm that venous drainage of the arterial reverse flow flap without venae comitantes is performed by venae arteriosa. However, venae comitantes probably ensure venous drainage when they are respected.

Animals↗

PubMed2003

[Desmoid tumors and brachial plexus].

The aim of our paper is to assess the functional results and specific difficulties encountered in the treatment of desmoid tumors located near the brachial plexus. Seven patients with a desmoid tumor in this region were followed for at least 2 years (average 59 months). All patients were managed operatively. The resection was marginal in 6 patients and intralesional in one. Three patient had postoperatively chemotherapy and 1 patient had radiation therapy. At review, none of the 7 patients had had to undergo upper limb amputation and the mean functional results were good or excellent in 6 patients (mean MSTS = 72.8). The margins of desmoid tumor resection have to be wide to avoid local recurrence. However, nerves and blood vessels have to be preserved in order to maintain upper limb function and there may well be a need for adjuvant therapy.

Adult↗

PubMed2003

Chronic compartment syndrome of the forearm in competitive motor cyclists: a report of two cases.

Exertional compartment syndrome of the forearm is rare. However, it should be considered in cases of a painful forearm during motorcycle racing. Pressure measurements of all compartments during exercises that simulate the actions of racing confirm the diagnosis. An exertional electromyography may be useful to reveal a nerve compression associated with the compartment syndrome. Fasciotomy of the affected compartments allows relief of symptoms and return to previous activities in all cases.

Adult↗

PubMed2002

[The posterior interosseous flap in the child: 13 case reports].

INTRODUCTION: The posterior interosseous flap is used to cover skin defects in the hand, wrist, forearm and elbow. It is currently, commonly indicated for adults, but it may be used for child too. MATERIALS AND METHOD: Twelve children underwent a posterior interosseus flap (13 flaps). Their ages ranged from 3 to 17.5 years with a mean of 6.5 years. There were seven boys and five girls. The flaps were used to treat different type of lesions: the most frequent etiology was burn injuries or sequels (nine patients), there were one extravasation of anticarcinogenic agent, one syndactyly and one arthrogryposis. The localizations of the skin loss were the first web space (six patients), the dorsal hand (five patients) and the elbow (two patients). RESULTS: The average of the operation was eighty minutes. The survival of the flaps was excellent. Only one flap had a partial necrosis. CONCLUSION: Posterior interosseus flap may be used in coverage of children's limb. The diameter of the vessels is not a difficulty in the flap dissection. As the adults, the viability of the flap is excellent and allows to cover most of the skin defect of the dorsal hand or elbow.

Adolescent↗

PubMed2002

Exertion induced rhabdomyolysis of the long head of the triceps.

The case is reported of bilateral rhabdomyolysis of the long head of the triceps following intensive exercise in a 30 year old male weightlifter. The diagnosis was based on myalgias localised to one muscle and raised levels of muscle enzymes. Magnetic resonance imaging helped to locate the site and extent of muscular involvement. Treatment consisted of complete rest and adequate intravenous perfusion to allow clearance of the clinical and biological abnormalities and prevent renal involvement.

Adult↗

PubMed2002

[The superolateral approach for shoulder prosthesis].

We describe a superolateral approach to the shoulder for implantation of total shoulder prostheses or humeral prostheses. The advantages of this approach include preservation of the supraspinatus tendon and an excellent exposure of the posterior part of the glenoid cavity. We illustrate this approach with three clinical examples: total shoulder arthroplasty with reconstruction of the posterior part of the glenoid using a screwed autograft for central degeneration with posterior wear of the glenoid, intermediate arthroplasty for excentric degeneration with irreparable rotator cuff tears, and simple humeral arthroplasty with bone suture of the tuberosities for cephalotuberosity fracture.

Arthroplasty, Replacement↗

PubMed2002

[Surgical decompression of cervical arthrotic myelopathies: comparison of surgical anterior and posterior approaches].

PURPOSE OF THE STUDY: Operative treatment of cervical myelopathy has focused on decompression of the spinal cord to avoid neurological deterioration. Anterior or posterior operative techniques have been used to decompress the canal with variable success. The purpose of this study was to compare surgical results after subtotal corporectomy or discectomy with an anterior approach and laminectomy or laminoplasty with a posterior approach. MATERIAL AND METHODS: We reviewed 30 patients with cervical spondylolitic myelopathy who had undergone surgery between 1989 and 1998. Mean age was 55.8 years (range 28 to 82). There were 23 men and 7 women. An anterior approach was used for 14 patients to achieve subtotal corporectomy or anterior discectomy with strut grafting. A posterior approach was used in another 14 patients to achieve laminectomy or laminoplasty. Both anterior and posterior approaches were used for two patients. The severity of the pre- and postoperative neurological deficits was assessed with the Nurick scale. RESULTS: Average follow-up was 35.7 months (range 8 to 120). Neurological status improved in 83% of the patients. Improvement was better for those operated with the anterior approach for pain or brachialgia. The duration of the posterior procedures was, however, shorter with less blood loss. There was no statistical difference between the anterior or posterior approaches for motor function, sensory function, gait anomalies, or complications. CONCLUSION: Surgical treatment is effective in cervical spondylolitic myelopathy. The anterior approach is preferred in case of pain or brachialgia; the posterior approach is indicated in case of poor health status or for bedridden patients.

Activities of Daily Living↗

PubMed2001

[Isolated fifth digit localization in Dupuytren's disease].

Isolated fifth digit localisation in Dupuytren's disease has a bad reputation. A series of this injury is reported with a special attention on recurrences. This series is composed of 30 cases in 26 patients (four bilateral cases): the majority of patients were male and 53.5 y was the average age. Extension loss of MP and PIP joints were present in 25 cases, MP isolated extension loss in two cases and PIP in three cases. The treatment performed was a percutaneous needle technique in five cases, surgical fasciectomy in 24 cases using a zigzag palmodigital longitudinal fasciectomy approach in 18 cases, an open palm technique in six cases and one isolated laterodigital flap. Assessment of correction was based on Tubiana's classification. Average follow-up was 22 months. Postoperative course was uneventful except for one case of precarious vascularisation which leads to an amputation. For the digitopalmar localisations: 15 stage 0 or 1, 7 stage 2, 1 stage 3 and 1 stage 4. Improvement percentage was 0.60 in combined cases, 0.65 in cases with a MP loss and 0.46 in PIP loss. Five recurrences were noted. Literature on this topic is coherent with the fact that isolated involvement of the fifth digit carry a bad prognosis, mainly due to the high recurrence rate in our series as in other papers. In severe injuries, an imperfect result should be the aim to prevent vasculonervous complications.

Adolescent↗

PubMed2000

[False popliteal aneurysm after tibial osteotomy: a case report].

A 55-year-old man developed a pseudoaneurysm of the popliteal artery after tibial valgization osteotomy performed for degenerative genu varum. A tourniquet was used for the procedure. A wedge osteotomy was performed two centimeters under the joint line; the correction angle was ten degrees. Immediately after the end of the procedure, the distal pulses disappeared for ten minutes. Doppler exploration of the arterial network did not demonstrate any anomaly. Ten days postoperatively, the patient complained of sudden onset pain in the knee and tension in the popliteal fossa. Arteriography demonstrated a pseudo-aneurysm of the popliteal artery. The lesion caused an interruption of arterial flow and was successfully treated by emergency resection and suture.

Aneurysm, False↗

PubMed2000

Coverage of large skin defects of the pediatric upper extremity.

Reconstructive surgery of the locomotion apparatus in children has been built from several surgical advances. It is a specific activity that cannot be detached from all other orthopedic pediatric surgery. The care of problems in a child must be provided with a holistic point of view: It cannot be the addition of different techniques done by different surgeons. Bone morphology has a close relationship with the soft tissues; an injury of the envelope has consequences for growth harmony.

Arm Injuries↗

PubMedDate not supplied

[A new cause for iatrogenic lesion of the ulnar nerve at the arm: contraceptive hormonal implant. Report of two cases].

The authors describe two cases of iatrogenic lesions of the ulnar nerve at the arm level after insertion of contraceptive hormonal implants. The presence of only a thin subcutaneous fat layer on the medial side of the arm in slim women, exposes the ulnar nerve to danger during the insertion or withdrawal of the implant. We therefore advise the insertion of such implants on the medial side of the thigh in slim women. We equally recommend that withdrawal of non-tangible devices implanted on the medial side of the arm or in case of neurologic symptoms, even transitory, be done by a trained microsurgeon.

Adult↗

PubMedDate not supplied

The posterolateral portal: A new approach for shoulder arthroscopy.

Since the beginning of shoulder arthroscopy, many different approaches were described for Bankart repair to allow visualization and treatment. The anterior portals do not allow access to the posterior and inferior part of the glenoid. We present a new instrumental portal for shoulder arthroscopy. This approach is perfectly safe, without any anatomic risk. It is particularly helpful in the correct treatment of an anterior Bankart lesion, in repairing posterior and inferior extensions of a Bankart lesion, and in performing a plication in multidirectional hyperlaxity.

Arthroscopy↗