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Biomedical subjects

J Y Alnot

Publications and source records attributed to J Y Alnot.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Traumatic lesions of the deep branch of the radial nerve].

PURPOSE OF THE STUDY: We report a retrospective study of 21 patients treated for an injury of the deep branch of the radial nerve. The aim of this study was to precise the indication and to evaluate the results of nerve surgery and tendon transfer. MATERIAL: 21 patients, mean age 32, with complete divided lesion of the nerve due to open injury were included. 5 cases with fresh discision of the deep branch of the radial nerve were treated in emergency by suture repair. 16 cases were old lesions. 6 of them had initially severe associated lesions involving skin, forearm muscles or radius. In this case, the treatment of the nerve lesion was delayed after the treatment of the associated lesions. 10 were simple lesions of the nerve who were initially misknowned (6 cases) or caused by a surgical procedure at the proximal forearm (4 cases). METHODS: 4 patients had tendon transfers, due to a very old lesion for one of them and a severe muscle involvement for the 3 others. Twelve nerve graft repairs were performed. Their were 8 troncular grafts and 4 fascicular grafts because the lesion was in the posterior forearm at the level of the terminating branches of the nerve. They required a mean length of 5.8 cm and an average of 3 to 4 cables for nerve graft. RESULTS: The mean follow up was 25 months. Results were appreciated on the recovery of 5 functions (supination, fingers extension, thumb abduction, thumb retropulsion, wrist postero-ulnar extension). Primitive nerve repairs had full recovery in all cases. Tendon transfers had good results. The 12 nerve grafts had 2 excellent results, 8 good results, 1 fair and 1 poor result. These 2 last cases required secondary tendon transfers. DISCUSSION: Traumatic lesions of the deep branch of the radial nerve are often misknowned and often iatrogenic. Nerve surgery provides better functional results than tendon transfers. Nerve grafts in delayed nerve repairs are possible even if the lesion is distal. They give excellent or good functional recovery in most cases after a delay of 7 months. Tendon transfers are indicated if nerve surgery fails or in case of large forearm muscle defect, old patient, and when the delay after the injury is superior to 12 months.

Adult↗
PubMed1998

[C5-C6 and C5-C6-C7 traumatic paralysis of the brachial plexus of the adult caused by supraclavicular lesions].

PURPOSE OF THE STUDY: In C5-C6 and C5-C6-C7 brachial plexus palsies, prognoses was based on the recovery of a useful shoulder and elbow in order to control a normal or partially impaired hand. Treatment was an integrated procedure combining direct nerve surgery and muscle transfers. MATERIAL: Our study was performed on 27 cases of C5-C6 plexus palsy and 43 cases of C5-C6-C7 plexus palsy operated between 1984 and 1994, with an average delay between trauma and surgery of 8 months. METHODS: Elbow flexion was obtained by nerve surgery on the anterior part of the primary trunk or directly on the musculo-cutaneous nerve and after muscle transfer. Nerve surgery on supra-scapular nerve, on posterior part of primary trunk or directly on axillary nerve was also performed. RESULTS: The results were analyzed separately for shoulder and elbow flexion and globally. In C5-C6 palsies, elbow flexion was a goal which has been reached in 100 per cent of cases. Only 56 per cent of cases obtained a stable shoulder with active external rotation. In C5-C6-C7 palsies, elbow flexion was reached in 86 per cent of cases and stable shoulder with active external rotation only in 26 per cent. Reinnervation of the elbow flexors was reached by direct nerve surgery in 60 per cent of C5-C6 and 52 per cent of C5-C6-C7. Active external rotation was reached by spinal-suprascapularis nerve neurotization in 60 per cent of C5-C6 and 54 per cent of C5-C6-C7. DISCUSSION: No significant difference after nerve surgery for elbow flexion was found between C5-C6 and C5-C6-C7 plexus palsies. Failures of nerve surgery will undergo muscle transfer. When C7 is damaged, less muscles are transferable and results are less good. For shoulder, best results were obtained after spinal suprascapularis nerve neurotization with direct suture. In case of failure, a derotation osteotomy was performed. If shoulder was still unstable, transposition of the coracoacromial ligament to the humerus was also performed. CONCLUSION: In C5-C6 palsies, elbow flexion is a goal which must be reached in 100 per cent of cases. Prognosis depends of shoulder function. In C5-C6-C7 palsies, results are less good. 6 patients did not recover elbow flexion, no active mobility of the shoulder was observed in 63 per cent of them. The results obtained for elbow flexion are satisfactory if the program does not separate nerve surgery and muscle transfers.

Adolescent↗
PubMed1998

[Proximal median and ulnar resections. Results of primary and secondary repairs].

PURPOSE OF THE STUDY: Recovery after median and ulnar nerve proximal repair is widely appreciated. The place and time for secondary functional reconstruction remains controversial. MATERIAL AND METHOD: From January 1983 to January 1990, 66 patients suffering from proximal injury of the median or ulnar nerves underwent nerve repair. Forty-five patients had a postoperative follow-up of more than 24 months: 24 isolated ulnar nerve lesions, 12 isolated median nerve lesions, and 9 combined median and ulnar nerve lesions. Ten patients were given a primary microsurgical nerve suture in our department. Thirty-eight patients underwent a delayed or secondary nerve repair of one or both nerves: 8 secondary nerve sutures, and 35 nerve grafts in 31 patients. RESULTS: Muscular strength, sensitivity, motion, and pain were better after primary nerve sutures (when technically possible) or after shortly delayed secondary sutures, although 40 per cent of patients treated with nerve grafts get final "good" or "very good" results. The time between the injury and nerve repair was the most significant prognosis factor. Results of ulnar nerve repairs at the elbow were statistically better with anterior transposition as compared to in situ repairs (p < 0.005). Fourteen patients required secondary functional reconstruction. Tendon transfers were performed at least 24 months after nerve repair. DISCUSSION: Nerve repair of proximal lesion to the median or ulnar nerves depends on the type of injury, but is advised even when delayed. Residual deficit following nerve repair should require functional transfers depending on hand sensitivity and extrinsic function.

Adolescent↗
PubMed1997

Resection of the proximal row of the carpus. A review of 45 cases.

The authors present a review of 45 proximal carpectomies performed for various reasons between 1986 and 1995. The pre- and postoperative assessment was clinical and radiological, and the intra-operative analysis was based on the status of the cartilage of the radiolunate joint, and of the head of the capitate. Postoperative assessment was based on the biomechanical behaviour of the wrist after surgery. At the final follow-up, the authors noted that pain was improved in 90% and functional movement was preserved in 70% of patients. There was approximately 20% loss of strength when compared to the opposite hand.

Adult↗
PubMed1997

Anatomical and biomechanical studies of the pathogenesis of trapeziometacarpal degenerative arthritis.

An anatomical and biomechanical study of the stabilizing ligaments of the thumb trapeziometacarpal joint was conducted on 32 hand specimens. Five main ligamentous structures could be identified. The mechanical properties (in particular, strength) of the five ligaments using a strain-rate failure test were determined and evaluated quantitatively. The maximum tensile strength of each ligament was correlated with the condition of the trapeziometacarpal articular cartilage. In studying the anterior oblique ligament, maximum strength decreased from Grade 0 to Grade 1 by 51%. With the first intermetacarpal ligament, the drop from Grade 1 to Grade 2 was 53%. With the posterior oblique ligament, the decrease was closely related to the grade of the deterioration of the trapeziometacarpal articular surface. These three ligaments also significantly decreased in strength with age. Our results may suggest that the anterior oblique ligament, intermetacarpal ligament and posterior oblique ligament play a large role in stabilizing the trapeziometacarpal joint and that the decrease in their strength is related to the pathogenesis of trapeziometacarpal osteoarthritis.

Aged↗
PubMed1997

[Fractures of the wrist with cartilage rupture in young adults. Apropos of 18 cases].

Distal radius impaction fractures are not rare. They present a dual problem for the surgeon: the difficulty of establishing the exact pathological anatomy of the fracture, and of obtaining stable anatomic reduction. The authors report their experience of 18 distal radius impaction fractures in young patients after violent trauma (motor vehicle accident). We subdivided these fractures using Kapandji and Müller's classifications: 12 type 9 or C3, 4 type 5 or B1 and 2 type 4 or C1. The mean depth of impaction of the scaphoid fossa or lunate fossa ("die punch fracture"), or centrally was measured at 5 mm on preop X-rays or on CT scan. After radiographs of the wrist in traction under anaesthesia, open reduction was performed in 14 cases (78%). A volar approach with plate fixation was performed in 3 cases. A dorsal approach with internal fixation with k-wires and an external fixator was performed in the other 11 cases. A bone graft was necessary in 10 cases when the bone defect was significant. The four remaining patients were treated with percutaneous k-wires and external fixation. We reviewed these 18 patients after a mean follow-up of 27 months. The mean age at the time of the accident was 37 years. The results were graded on the Green and O'Brien scale. Results were excellent in 1 case, good in 11 cases, fair in 5 cases, and poor in 1 case. We believe that impaction fractures always require open reduction with or without the addition of bone graft depending on the degree of the impaction. This is because of the risk of arthritic degeneration with this kind of fracture, with articular incongruence (more than 2 mm), and with chondral injuries on the radial or the carpal aspect of the wrist joint. Also, when there is a distal radio-ulnar joint injury (D.R.U.J. dislocation or distal head ulna fracture), the joint must always be stabilized to avoid secondary displacement.

Accidents, Traffic↗
PubMed1997

[Resection of the fourth ray for annular lesions: amputations of the fourth ray of the hand].

INTRODUCTION: Several procedures have been reported for amputation of the fourth ray of the hand. Most surgeons recommend translocation of the fifth finger on the proximal end of the fourth metacarpal bone. Others prefer to perform a resection of the fourth metacarpal bone combined with intracarpal osteotomy. MATERIAL AND METHODS: The authors' choice was to perform a resection of the fourth metacarpal bone with conservation of its proximal end. They emphased on two technical details: resection of the interosseous muscles and reconstruction of the intermetacarpal ligament. The present series includes 8 patients operated on with this technique. Results were assessed with an average follow-up of 47 months. Evaluation of the result was based on a personal rating score including 9 clinical scores and on 1 radiological measurement of the hand width. RESULTS: Mobility of the adjacent digits was normal in all cases except one with a retractile scar. In 7 cases out of 8, the aesthetic result was satisfactory. Grip strength was 65 per cent of the contralateral side. Diminution of the hand width was of 12 per cent. Five results were excellent and three were good. DISCUSSION: Translocation with intracarpal osteotomy can produce impairement of carpus function, especially with apparition of pain, but also some rotational malposition. Translocation of the fifth digit on the fourth metacarpal bone can also procedure an imbalance of the extrinsic muscles, but also a rotational malposition. CONCLUSION: Transmetacarpal amputation of the fourth ray has the advantage to be an easy anatomic procedure, and is particularly reliable and reproductible regarding to the results. This procedure does not produce any specific complication comparing with other techniques.

Adult↗
PubMed1996

[Longstanding flexor tendon lesions treated by two-stage tendon graft].

46 fingers in 42 patients undergoing 2-stage flexor tendon grafting for traumatic injury in zone 2 were evaluated with an average follow up of 13 months (range 6 to 120 months). 24 anastomoses between FDS and FDP were performed according to the Paneva Holevitch procedure. In all other cases, palmaris longus or plantaris were used as tendon grafts during the second stage. Proximal fixation was always performed in the palm. 3 or more pulleys were reconstructed in all cases. In 21 cases, pulley reconstruction required the use of excised tendon remnants or retina-culum dorsalis. Distal fixation was performed to the distal phalanx in 42 cases and to the second phalanx in 4 cases, during the second stage. Overall, 85% patients obtained a good or fair result in terms of TAM (total active motion) with < >. 7 cases obtained a poor result. 12 fingers required complementary surgery: --2 cases with poor active flexion had been treated by shortened suture. --3 ruptures of tendon graft required P2 fixation and DIP arthrodesis in distal rupture (2 cases), and anastomosis with next flexor tendon in proximal rupture (1 case). --7 cases of PIP stiffness were treated by PIP arthrolysis. DIP arthrodesis was associated in 2 cases.

Adolescent↗
PubMed1996

Median nerve suture in the distal part of the forearm. MRI evaluation.

The aim of the study was to assess MR images of median nerve suture in the distal part of the forearm on fresh cadavers and injured patients. The median nerve was dissected in the distal one-third of the forearm in four fresh cadaveric specimens, divided and repaired in three of them in two cases with 3/0 nylon (one with well-apposed edges and the other with a lateral gap) and, in the third specimen, with 9/0 nylon with well apposed edges. The course of the median nerve was then studied on MR imaging in different planes and the quality of the nerve repair was evaluated. A good correlation was found between the MR images and the type of nerve suture. These findings were applied in management of two clinical cases in whom reexploration and revision of the median nerve repair was carried out.

Adult↗
PubMed1996

Complications of flexor tendon repair in the hand: MR imaging assessment.

PURPOSE: To determine if magnetic resonance (MR) imaging enables differentiation of adhesions from tendon rupture after repair of digital flexor tendon injuries. MATERIALS AND METHODS: The reference group comprised eight tendon sutures with a good clinical outcome. Axial and sagittal spin-echo sequences and three-dimensional gradient-echo sequences with curved reconstructions were analyzed in 63 injured fingers. Reoperation was performed in 41 fingers. RESULTS: MR imaging depicted isolated peritendinous adhesions (n = 31), most often with a continuous, uniform tendon (sensitivity 91%, specificity 100%). There were two types of rupture: frank rupture (n = 140; sensitivity 100%, specificity 100%) or elongated callus (n = 18; sensitivity 100%, specificity 94%). Tendon gap was significantly longer in frank rupture (P = .0011). Thin fibrous continuity existed with elongated callus. Tenolysis was sufficient when the callus was short and mature with predominant new collagen fibers. Axial spin-echo sections were essential, as they showed the maturation of the callus. CONCLUSION: MR imaging may enable distinction among several complications that occur after repair of an injured digital flexor tendon.

Adolescent↗
PubMed1996

[Lesions to the axillary nerve].

PURPOSE OF THE STUDY: The authors have reviewed 67 axillary nerve lesions from 1987 to 1993. 35 times the lesion was isolated; 20 times it was associated to other nerve lesions (9 times supra scapular nerve, 3 times musculocutaneous nerve, 8 times posterior cord) and 12 times lesions were associated to rotator cuff injury. MATERIAL AND METHODS RESULTS DISCUSSION: Injury corresponded 9 times to stretching mechanism in upper limb traction and came 58 times with osteoarticular lesions (30 anterior dislocations and 28 shoulder fractures). In 11 cases, shoulder active abduction was normal, inspite of deltoïd's complete palsy and this accounted for diagnosis delay. Concerning axillary nerve isolated lesions (35 cases), 7 recovered spontaneously and 28 have been operated. Surgical operation was undertaken 9 months after injury using a combined anterior and posterior approach. Rupture was located in the quadrilateral space and 23 nerve grafts, 4 neurolysis and 1 direct suture were performed. Results were good (muscle measured to M4) and excellent (muscle measured to M5) in 57 per cent of cases. Concerning axillary nerve lesions associated to suprascapular nerve lesions (9 cases) and musculocutaneous nerve (3 cases), all axillary nerve lesions were grafted with 50 per cent of good and very good results. The scapular nerve was neurolysed 6 times with 4 good and excellent results and evaluated irreparable in 3 cases. Musculocutaneous nerve was grafted in all cases with 2 good results out of 3. Posterior cord lesions (8 cases) required an osteotomy of the clavicle. Five grafts and 3 neurolysis were performed with aleatory results. At last, when associated lesions of the rotator cuff muscle were found (12 cases), 6 cases recovered spontaneously and 3 times cuff rupture was small enough to be reinserted with 2 good results. The 6 other cases corresponded to an axillary nerve rupture which were all grafted with 2 good results. On the cuff, result was in relation with lesion's type. Twice a supraspinatus tendon rupture was reinserted with 1 good result and 1 fair result. In 3 older patients, there was a small size rupture which has been reinserted with 1 good result, 1 fair result and 1 failure. At last, one surgical repair of a large rupture couldn't be justified. CONCLUSION: These encouraging results suggest to propose repair of axillary nerve when deltoid muscle palsy does not recover until 3 to 6 months. Rupture diagnosis is then suspected and the best surgical technique is a nerve graft.

Accidents, Traffic↗
PubMed1995

[Surgical treatment of closed articular fractures of the proximal interphalangeal joints (20 cases)].

20 cases of intra-articular fractures of proximal interphalangeal joints were reviewed with a mean follow-up of 3 years 9 months, and a minimum follow-up of 1 year, corresponding to 10 fractures of the head of P1 (7 condylar fractures, 2 supra-intercondylar fractures and 1 diaphyseal fracture with an articular crevice) and 10 fractures of the basis of P2 corresponding to distraction-impaction fractures in 8 cases. The fractures were treated by open reduction and osteosynthesis by screws, mini-screws, or pins, completed by an arthrodesis pin in 3 cases. All fractures were closed, isolated, and too unstable to be treated orthopaedically. Global results were: 14 excellent and good results, 4 moderate results and 2 poor results according to Steel's criteria. No serious early complications were observed. The difficulty of treatment and the duration of rehabilitation are greater in fractures of the base of P2 than for fractures of the head of P1. No statistically significant factor was identified due to the small size of this series, but, the factors of poor prognosis essentially consist of late mobilization and reoperations for failure of percutaneous pinning of a fracture of the basis of P2.

Adult↗
PubMed1994

[Recent injuries of the nerves of the wrist and hand].

The advent of microsurgery has in the last few decades considerably improved the results of treatment of lesions of nerves in the wrist and the hand, both with regard to functional restoration of sensation and movement and to reduction of local irritant factors or those linked to cold injury. Peripheral nerves are frequently injured at the wrist and the hand by contusion, compression, straining or total or partial section. In the case of wrist, hand or finger wound, only well-directed, precise and systematic clinical examination can determine the neurological deficit. Surgery is always indicated. There are often associated complex lesions, and all injured elements must be completely repaired. The order of this repair is always the same: tendons, nerves, then vessels. Concerning nerves, therapy depends on the severity of the contusion and (or) the loss of substance. If the section is distinct, direct suture with physiological tension can be made. On the other hand, if there is contusion or loss of substance, direct suture cannot be performed since nonphysiological tension leads to endoneural ischaemia and fibrosis. Rather, the extremities should be brought closer together in order to avoid retraction and subsequent secondary sutures or short grafts should be made.

Hand↗
PubMed1994

[The Guepar total elbow arthroplasty].

The Guepar total elbow replacement is a low friction, minimally constrained gliding prosthesis. The humeral and ulnar components are of metal with intramedullary stems, which are cemented. There is a sigmoid shaped, high density polyethylene interposition bearing. The authors have used the prosthesis in 33 patients with rheumatoid arthritis, 4 with post-traumatic problems, one with chondrocalcinosis and another with degenerative changes of uncertain aetiology. In the patients with rheumatoid arthritis, one sustained a posterior dislocation and two suffered deep infection. In the remaining 30, the overall results were good at an average review of 32 months. The mean range of movement had increased by 31 degrees and pain was absent in 28 elbows. In the management of rheumatoid arthritis total elbow arthroplasty must be part of an overall plan of treatment. Severe involvement of the wrist and shoulder must be dealt with before elbow replacement is considered.

Adult↗
PubMed1994

[The spinal accessory nerve (n. accessorius) I: anatomical study].

INTRODUCTION: In order to increase knowledge of the spinal accessory nerve concerning its situation, trajectory and terminal branches and also the connections with the cervical plexus, the authors report an anatomical study based on 11 dissections of the trapezius muscle mode of innervation and the connections between the accessory nerve, the sternocleidomastoid and trapezius muscles. DISCUSSION: The accessory nerve is a muscular nerve and supplies the main innervation to the trapezius muscle especially for the superior and middle sections. There is a clear participation of the cervical plexus either through the trapezius muscle by nerve anastomosis behind the trapezius or directly especially in the distal portion. CONCLUSION: This anatomical study allows a better understanding of the clinical aspects and the indications of nerve repairs.

Aged↗