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J Y Alnot

Publications and source records attributed to J Y Alnot.

At least 19 recordsLinked to original sources
PubMed1992

[Chronic ulnar nerve compression syndrome at the elbow. Apropos of 74 cases].

Seventy-four patients were operated at Bichat hospital for chronic ulnar nerve entrapment at the elbow between 1982 and 1988. For 62 of them, the etiology of the compression was idiopathic and these cases were treated by neurolysis only or, if the nerve was unstable, by neurolysis associated with medial epicondylectomy. For 12 of them, the etiology of the compression was post-traumatic and these cases were treated by anterior subcutaneous transposition of the nerve using a fat sling. The average follow-up is 28 months and the results take into account the clinical preoperative grading according Mac Gowan's classification: grade I subjective symptoms combined with hypoesthesia in ulnar fingers grade II: weakness and wasting of the interossei combined with subjective symptoms, grade III: marked weakness and wasting of the interossei, adductor pollicis, and hypothenar muscles combined with anesthesia in ulnar fingers. The 62 idiopathic compressions treated by neurolysis only or, if the nerve was unstable, by neurolysis associated with medial epicondylectomy showed 51 very good and good results. The 12 post-traumatic compressions treated by anterior subcutaneous transposition of the nerve using a fat sling showed 9 very good and good results. The authors stress the importance of their approach which takes account of the clinical preoperative grading and the etiology of the compression in order to apply correct surgical treatment.

Elbow↗
PubMed1992

[Chronic, post-traumatic scaphoid-lunate instability treated by scaphoid-lunate arthrodesis].

The authors after a review of certain elements of the physiology and pathophysiology of the scapho-lunate couple, report a series of 10 patients presenting a post-traumatic scapho-lunate instability stabilized by scapho-lunate bone graft in order to obtain scapho-lunate arthrodesis. The bone fusion was obtained 5 times out of 10, 3 times complete and 2 times by an incomplete bony bridge. In 5 cases, bone fusion was not evident, a fibrous non-union probably occurred which maintained the correction. Nevertheless, the overall results were considered good in 9 out of 10 cases with only one poor result. The outcome with a mean follow-up of 4 years did not show any arthritic changes. The authors consider that scapho-lunate stabilization with an interposed bone graft is a good method which can ensure good stabilization and good clinical results.

Adult↗
PubMed1992

[Resection of the proximal carpal bones in the sequelae of scaphoid fractures].

Proximal row carpectomy has precise indications in cases of severe sequelae of scaphoid fractures. This procedure may be indicated either as first-line treatment in a case of advanced pseudarthrosis with osteoarthritis, particularly radio-scaphoid, or secondarily after scaphoid pseudarthrosis has been unsuccessfully treated by other methods. It is essential to make sure that the head of the capitatum and the radial surface of the lunate bone have a satisfactory appearance on plain X-rays, MRI and occasionally arthroscopy. The overall results of this operation which retains wrist movements and which also preserves a good grip strength are very encouraging, as demonstrated by the series of 48 cases of sequelae of scAphoid fractures treated by this technique.

Activities of Daily Living↗
PubMed1992

[Total paralysis of the brachial plexus caused by supra-clavicular lesions].

From 1983 to 1987, 50 adult patients who suffered total palsy of brachial plexus were operated on. The average follow up was 39 months. They suffered severe supra-clavicular lesions of all the roots. All the roots damaged in the scalenic area were grafted, the avulsed ones were not. One root was grafted in 23 patients, two roots in 9 patients, three roots in 5 patients, four roots in 1 patient. No root was grafted in 12 patients. An active flexion of the elbow (over M3+, M4) was recovered in 39 patients (76 per cent). An active adduction of the shoulder (m. pectoralis major) was recovered in 24 patients (48 per cent), and an active abduction (supraspinatus or deltoid) in 13 patients (26 per cent). Twenty seven patients had severe pain before surgery. After grafting, pain decreased in 17 (62 per cent. At follow-up, 31 of the 50 patients had no pain or mild pain. These results justify for the authors nerve repair in total palsy of brachial plexus by supra-clavicular lesions.

Adolescent↗
PubMed1992

[Synovectomy in the realignment-stabilization of the rheumatoid wrist. Apropos of a series of 104 cases with average follow-up of 5 years].

The authors studied a series of 104 rheumatoid wrists, stages II, III or IV according modified Larsen's grading, treated between 1980-1988 by synovectomy realignment stabilization. The mean follow-up period was 5 years. The operation presents different steps which have an additive effect and must be associated in order long term clinical and radiological stability. They associated: extensor tendons and articular synovectomy stabilization of the distal radio ulnar complex by Sauve-Kapandji's operation, tendon transfert: the extensor carpis radialis longus is transferred on the extensor carpi radialis brevis the extensor carpi ulnaris is relocated with posterior annular dorsal ligament plasty. Results concerning relief of pain were very clear because the patients presented either complete relief of pain (73%) or only intermittent occasional pain. The overall active range of motion is nearly the same, when compared pre- and post-operative ratings. In general the patients who presented good pre-operative mobility usually improved them and the others preserved them. Larsen's radiological grading was modified by the authors to include instability's criteria in frontal and sagittal plane. Carpal height remained stable (75% less than or equal to 1 mm), ulnar deviation has never overreached 3 mm, radial deviation was not modified in 50% of cases. They found only 4 wrists presenting a stage II radiological grading with an evolution to the stage III and 12 of the stage III grading became stage IV. The instable type of the stage IV was stabilized by a surgical radiolunate arthrodesis. The stabilized type was nearly not modified. The different steps of operation (articular and tenosynovectomy, carpus stabilization and realignment with stabilization by stabilization of the radio ulnar complex joint using Sauve-Kapandji operation, tendons transfers and dorsal retinacular plasty) have an additive effect in achieving relief of pain with preservation of the pre-existing mobility. The stabilization of the radio ulnar complex by the Sauve-Kapandji operation constitutes a new approach in rheumatoid arthritis published by the author in 1985 and in our opinion appears to be simple and is very efficient in stabilizing wrist immediately, thus allowing early rehabilitation of these patients. Long term stability is affirmed by clinical and roentgenologic follow-up and globally a painless wrist, a preservation of the pre-operative motion and a stabilization in frontal and sagittal plane is obtained.

Adult↗
PubMed1991

[Surgical repair of the axillary nerve. Apropos of 37 cases].

The authors have reviewed the results of the operative repair of 37 injuries of the axillary nerve. In 25 patients only the axillary nerve was injured, in 8 the suprascapular nerve was also damaged and in a further 4 the musculocutaneous nerve had also sustained injury. There was an associated anterior dislocation of the shoulder in 10 patients and a fracture was present in 8. Eleven patients out of 25 had a nearly normal range of abduction in spite of paralysis of the deltoid muscle, and this accounted for delay in diagnosis. Operation was undertaken 8 months after injury using a combined anterior and posterior approach. In 34 patients disruption of the nerve had occurred in relation to the quadrilateral space. In 32 cases nerve grafts were employed, in 2 direct suture and 1 underwent neurolysis. The results were good or very good in 23 out of the 25 direct repairs of isolated axillary lesions, and in all 4 patients with associated injury to the musculocutaneous nerve. Only 4 good results were obtained in the 8 patients who also had injuries to the suprascapular nerve. The results suggest that repair should be carried out early at between 3 and 6 months. E.M.G. studies are necessary before operation for proper assessment of nerve recovery.

Adolescent↗
PubMed1991

[Sarcoid synovitis. A case report of localization at the level of the flexor tendons of the fingers].

Sarcoidosis without bone involvement or sarcoid dactylitis, is a very unusual cause of flexor synovitis. Our reported patient initially presented with chronic arthralgia of the knees and ankles. The initial diagnosis of rheumatoid arthritis was incorrect. A surgical flexor synovectomy was performed to release painful compression of the median nerve due to the synovitis. The correct diagnosis was suggested by the histopathological examination showing noncaseating epithelioid granulomas. The diagnosis was confirmed by the association of a negative tuberculin test and raised angiotensin converting enzyme. No recurrence of synovitis occurred after surgical excision and colchicine therapy but arthralgia persisted.

Colchicine↗
PubMed1991

[Massive osteolysis of the metacarpal bones. Apropos of a case of an osteolytic form of psoriatic rheumatism].

The authors report a case of massive osteolysis of all of the metacarpal bones of the right hand in a 26 year old man. The disease commenced 9 years previously with painful symptoms associated with inflammation and the initial X-rays showed periosteal reaction of the 2nd and 3rd metacarpals. Massive osteolysis of all of the metacarpal bones, including the 1st metacarpal, developed progressively over a period of one year, although no signs of osteolysis were observed in the carpal bones or phalanges. A surgical operation, performed to realign the ring and little fingers, revealed a 4 mm thick periosteal sheath explaining the maintenance of a certain degree of stability of the metacarpals despite the massive osteolysis. Histological examination eliminated any neoplastic or infectious aetiology and confirmed the inflammatory origin with vascular and lymphocytic proliferation. The development of palmo-plantar psoriasis several months after the onset of the painful symptoms suggested the diagnosis of psoriatic rheumatism. This is a rare site with an unusual clinical course with massive osteolysis of all of the metacarpal bones, but it appears to be the most likely hypothesis. The clinical course was stabilised by non-steroidal anti-inflammatory agents but there was no bony reconstruction.

Adult↗
PubMed1991

[Digital flap autografts for pulp coverage in distal amputations of the fingers. 68 flaps].

Sixty-one patients underwent 68 digital pulp amputations involving the distal phalanx (Zone 2 and 3). 46 unipedicular Vankataswami-Subramanian island flaps (VS flap) and 22 bipedicular Moberg-O'Brien flaps (MOB flap) were performed. All distal thumb amputations were treated by MOB flap, whereas all lateral finger distal amputations of the long digits were treated by VS flap. Both flaps were used for the other types of amputation. Four digits developed complications and needed a delayed regularisation. The mean follow-up for the 46 flaps was two years. Pulp reconstruction was satisfactory in all flaps. Sensation was normal or slightly decreased in 66%. Nail dystrophy was considered to be poor in 56% and was attributed to initial trauma and the distal phalanx shortening. 20 degrees of extension deficit was found in 8 patients. We obtained 61 excellent and good results justifying our indications: MOB flap for all types of distal amputation of thumb in zone 2 and 3, VS flap for lateral distal amputations of the long fingers. In transverse amputation of the long fingers, MOB flaps seem to give better results than VS flaps.

Adult↗
PubMed1991

[Necrotizing fasciitis of the upper limb. 12 cases].

Twelve cases of necrotizing fasciitis or streptococcal cellulitis of the upper limb are reported. Four cases presented with a low grade aggressive for and one case was chronic. Seven fulminating cases resulted in two deaths. These different presentations are in fact different stages of the same disease which is a group A beta-hemolytic streptococcal necrotizing infection of the subcutaneous tissue. It is a medical emergency in which surgery is the main treatment. In cases seen early, surgery helps by making an early diagnosis by showing the typical appearance of the subcutaneous tissue and by isolating organisms in wound culture. In fulminant cases, only extensive surgical debridement can control infection. Delayed or incomplete radical excision may lead to disseminated infection. Infection spreading beyond one upper limb worsens the vital prognosis.

Adult↗
PubMed1990

[Anatomy of the articular nerves of the wrist. Implications for wrist denervation techniques].

The knowledge of the anatomy of the wrist articular nerves is at the base of the denervation technique. After a dissection of 12 adult wrists, we specify the situation and the relation of these nerves at the level where they are accessible to a surgical approach. The 10 articular branches of Wilhelm are described successively. The posterior interosseous is the most voluminous and most constant. Some branches need a specific surgical approach: anterior and posterior interosseous nerve, lateral cutaneous nerve, articular branch of the first web. Other nerves are cut blindly after skin undermining (perforating branches from cutaneous nerves). Some branches appear inaccessible to a cautious surgery because they are closely tight to other motor branches (deep branches of the cubital nerve). Finally some branches described by Wilhelm were not found in our dissections: branches of the median palmar cutaneous nerve, and direct branch of the cubital nerve.

Classification↗
PubMed1990

[Surgery of rheumatoid polyarthritis of the upper limb in adults. Review of current data].

In a surgical population of adult patients with incipient rheumatoid arthritis, most often women aged 40 to 50 years, the various clinical pictures are difficult to outline, but they include: dominant involvement of the lower limbs, acroarthritis with essentially distal lesions of the wrists, hands and feet, and rheumatoid arthritis with multiple joint involvement, requiring multiple surgery in the upper and lower limbs. The involvement of the upper limb follows Eiken's phases of evolution, which must be studied along with Larsen's stages in order to accurately define the indications for treatment. Synovectomy is indicated at Larsen's stages II and III, but if instability is already noted, isolates synovectomy, whether chemical or surgical, is not to be used. It is essential to associate surgical synovectomy with a procedure aimed at realigning and stabilizing the joints, especially in the wrists and the fingers. Synovectomy, realignment and stabilization make up 75% of the current surgery of the rheumatoid wrist. At Larsen's stages IV and V, the extent of osteoarticular destruction makes either arthrodesis or arthroplasty necessary. The indications depend on the location of the lesions, and arthrodesis produces excellent results on the metacarpophalangeal joint of the thumb, the distal interphalangeal joints and the wrist. On the other hand, arthroplasty is indicated for the other joints, the mobility of which must be preserved, even more so as the over- and underlying joints are most often affected.

Arm↗