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Biomedical subjects

J Tonetti

Publications and source records attributed to J Tonetti.

4 recordsLinked to original sources
PubMed1998

Feasibility of orthopaedic teleconsulting in a geriatric rehabilitation service.

Fifteen elderly patients participated in a teleconsultation with an orthopaedic surgeon, which was then followed by a conventional, face-to-face consultation. The comparison between the surgeon's ratings for both types of consultation suggested that the telemedicine consultation was satisfactory in terms of the quality of image and sound, the clinical examination and general simplicity. The telemedicine consultations did not generate a need for any additional clinical investigations, although in two cases a face-to-face consultation was necessary to clarify clinical signs (shortening of a limb and scar tissue). The surgeon's rating of his decision level was superior in the face-to-face situation in four cases, and for 11 patients it was equal. Similarly, the surgeon's level of confidence in decision making was superior in the conventional situation for five patients and equal for 10 patients. Patient attitudes towards teleconsulting were favourable. There was a high level of patient satisfaction. Teleconsulting between orthopaedic surgeons and elderly patients therefore appears to be possible, provided that certain technical, clinical and psychological considerations are addressed.

Aged↗
PubMed1997

Computer assisted spine surgery.

When inserting screws into a vertebral pedicle, the surgeon usually exposes the back part of the vertebra and uses his or her anatomic knowledge to align the drill in the proper direction. A slight error in direction may result in an important error in the position of the tip of the screw. This is done with no direct visibility of crucial structures (spinal cord, pleura, vessels). Statistical analysis of a series of surgical procedures has shown that 10% to 40% of the screws are not installed correctly. To reduce the risk of complication, a computer assisted method is proposed that enables the surgeon to place a screw at a position preoperatively defined in 3 dimensions using computed tomography images. This allows the surgeon to align a standard surgical drill with the optimal position and direction. The depth of the pilot hole during drilling also is monitored by the system to prevent penetration of the anterior cortex of the vertebral body. Using this procedure, in vitro tests were performed and showed that an accuracy of less than 1 mm can be obtained. Clinical trials were done in 10 patients who suffered severe scoliosis or spondylolisthesis. The trajectory of the holes drilled in L2, L3, L4, and L5 vertebrae were checked for all clinical tests. Postoperative radiographs and computed tomography scans showed that the screws were well inserted in each plane for each pedicle. This technique also can be used to perform osteosynthesis at the thoracic and cervical levels.

Adult↗
PubMed1997

[Proximal femoral fractures in patients over 75 years. Vital and functional prognosis of a cohort of 78 patients followed during 2.5 years].

PURPOSE OF THE STUDY: The purpose of this study was to highlight factors influencing vital and functional prognosis at 2.5 years of elderly people being treated for a proximal femoral fracture. MATERIAL: The study was based on 78 patients more than 75 years old admitted to the orthopedic department for emergency treatment. After post-operative care, patients were transferred to a geriatric readaptation unit. The average patient age at the time of surgery was 85 years. METHODS: This was a retrospective study. Survival graphs were established for the entire population as well as for the sub-populations characterized by a studied parameter. Mortality factors were compared via a univariable analysis. A multivariable logistical regression analysis isolated the factors explaining mortality at 12, 18, and 30 months and survival at 30 months, as well as factors explaining functional prognosis at 1 year. RESULTS: The overall mortality rate was 41 per cent, 48.5 per cent of deaths occur within the first year. Factors which are harmful for vital prognosis are the following: high degree of dependence before the fracture, the existence of a neuropsychiatric pathology, and age factor (more than 85 years). 61.5 per cent of surviving patients were independent for daily activities. 77 per cent of surviving patients lived in their usual place of residence. Factors which were harmful for functional prognosis were the following: type of the fall, symptomatic of an underlying pathological state, and existence of a neuropsychiatric pathology. Nutrition was also a predictive factor concerning the patient's out come. DISCUSSION: The average age of the studied population was higher than in most studies in literature. The treatment is mainly based on hip arthroplasty. The group of patients of over 85 have the highest mortality rate. However, a better survival rate at 18 months has been observed for patients older than 90 years. The delay before surgical care was significantly negative if longer than 6 days. However, a delay of 3 to 6 days was not significantly harmful for survival. Within the studied population, the maximum autonomy gain was observed during the first 6 months. The type of non-accidental fall, symptomatic of an associated pathology, was a factor for functional prognosis which has not been often mentioned. So was the biological deficit of nutrition. Social status acted as an indicator of functional status evolution. CONCLUSION: Therapeutic choices can only be guided by assessments of patients' vital and functional prognosis. A sophisticated or even expensive device should be demanded for patients with favorable prognosis. For patients with precarious functional and vital prognosis, priority should be given to less invasive techniques with immediate walking. The cost of the device should be correlated with patient's functional investment.

Age Factors↗