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L Pidhorz

Publications and source records attributed to L Pidhorz.

At least 19 recordsLinked to original sources
PubMed2006

[Dislocation and fractures around the knee with popliteal artery injury: A retrospective analysis of 54 cases].

A retrospective multicentric series of 54 cases of knee trauma with acute ischemia by popliteal artery injury were analyzed. These high-energy traumas involved 25 dislocations and 29 fractures, 11 involving distal femur, 15 the proximal tibia and 3 a floating knee. There were 45 men and 7 women, mean age 42 years. Thirty-three patients suffered multiple injuries. The knee injury was open in 25 cases and associated with sciatic paralysis in 32. Vascular repair was almost always achieved with bypass surgery. An external fixator was used in 39 patients. Vascular repair was unsuccessful in three cases requiring amputation, all three cases involving fractures. There were also six secondary amputations due to muscle necrosis or septic nonunion. The rate of complete recovery of the sciatic was 25%. The rate of nonunion was 37%, half due to infection. Outcome assessed at at least one year follow-up was moderate with frequent functional sequelae. The analysis of these results and data reported in the literature provided indications for diagnostic and therapeutic propositions.

Adolescent↗
PubMed2005

[Mid-term results of Wallaby I posterior cruciate retaining total knee arthroplasty: a prospective study of the first 425 cases].

PURPOSE OF THE STUDY: Posterior Wallaby I is a fixed polyethylene tibial plateau prosthesis enabling preservation of the posterior cruciate ligament (PCL). Its asymmetrical and divergent femoral condyles articulate with also asymmetrical tibial plateaus. The purpose of this prospective study was to analyze outcome of the first 425 Wallaby I prosthesis of the Guepar group implanted for first-intention treatment. MATERIALS AND METHODS: These 425 prostheses were implanted from December 1992 to February 1995 by senior and junior surgeons. Mean patient age at implantation was 70.5 years. 91% had primary or secondary osteoarthritis and only 8.9% had inflammatory rheumatoid disease. The mean preoperative IKS score was 25.34 points and the IKS function score was 29.04. 10.35% of knees were aligned normally (mechanical axis between 2 degrees varus and 3 degrees valgus) according to the IKS criteria (Ewald), 24% presented valgus > or = 4 degrees and 65.6% varus > or = 3 degrees. All tibial and patellar components (except one) were cemented, 5.8% of the femoral pieces were inserted without cement. All but 11 patellae were resurfaced. Clinical outcome was assessed with the IKS score and radiological outcome with the IKS criteria. The patella was considered to be tilted when the alpha angle was > 5 degrees and dislocated when the AA' distance was > 5 mm. The chi-square test was used for comparison of quantitative variables (significance set at 0.05). RESULTS: Early postoperative complications were rare: two infections cured with debridement-lavage and antibiotics without removal of the prosthesis, one peronal nerve palsy which regressed partially, ten late unions without clinical consequence (particularly in the inflammatory rheumatoid patients). Twenty-six prostheses were followed less than one year (eight patients died and eighteen were lost to follow-up) and 84 less than five years (27 patients died and 57 lost to follow-up before five years). 315 prostheses were followed for more than five years (5-9 years) with a mean follow-up of 6.3 years. Among the 399 prostheses followed for one year or more, we noted: four infections including three requiring change of the prosthesis (one cured by arthroscopic lavage), two aseptic loosenings which were revised (one global one tibial), one tibial loosening and three patellar loosenings which were not revised, and two femoral ossifications limiting joint motion but improved by arthrolysis and resection of the ossifications. Three patients experienced anterior pain requiring secondary patellar resurfacing in two and section of the lateral patellar wing in one. Ninteen patellar fractures (4.7%) were noted, including 17 with no significant functional impact which were not revised. The mean IKS knee score among prostheses followed for five years was 90.5 points, with mean motion 110.5 degrees. Mean IKS function score was 61.63 points. 72.9% of the knees were aligned, 22.2% in varus and 4.9% in valgus. The mechanical axis of 94.3% of the knees was between 5 degrees varus and 5 degrees valgus. Prosthesis survival at eight years (Kaplan-Meier method) was 97.7% considering all reasons for prosthesis removal and 98.5% for removal for aseptic loosening. CONCLUSION: This prospective multicentric study demonstrated that the results obtained with the Wallaby I prosthesis are as good as those obtained with other prostheses sparing the PCL and published in the literature. Preservation of the PCL enables better knee stability, correct motion (110.5 degrees in our series) with almost no radiological wear of the tibial polyethylene at eight years. The only worrisome complication is patellar fracture.

Adult↗
PubMed2004

[Factors affecting quality of care for elderly subjects undergoing surgery for hip fracture: review of the literature].

Hip fractures are one of the leading causes for admission of elderly subjects to healthcare facilities. Because of population aging, the incidence of hip fractures has increased considerably over the last years and will continue to increase in industrialized countries. Hip fracture in an elderly subject may be life threatening and has a significant functional and social impact not only because of the fracture itself, but also because of the risk of complications related to the patient's health status and the long hospital stay. The purpose of this work was to identify in the published literature professional practices, excepting the surgical procedure, associated with better early and long-term outcome in elderly patients with hip fracture. Questions raised concerning the patient's hospital stay include factors related to the preoperative phase (time to surgery, usefulness of traction), the operation itself (antibiotic prophylaxis, anesthesia technique), and the postoperative phase (prevention of venous thrombosis, malnutrition, episodes of confusion, duration of indwelling bladder catheter, correction of anemia, geriatric care during the stay in the orthopedic ward, early and intense rehabilitation, prevention of recurrence). Among these factors, several appear to be associated with better outcome, including long-term outcome--surgery as early as possible in light of the patient's general status, antibiotic prophylaxis in accordance with standard recommendations (SFAR), prevention of venous thrombosis with low-molecular-weight heparin initiated at admission and associated with elastic contention. Oral nutritional support is probably beneficial and should be proposed for all patients. Particular attention must be given to prevention of confusion in order to reduce the rate of institutionalization. The rythm of rehabilitation exercises should be at least five sessions per week. Finally, there are several methods, which are effective in preventing recurrence, taking into account osteoporosis, risk of falls. Preventive measures should be instituted for all patients undergoing surgery for hip fracture.

Aged↗
PubMed1999

Does venous microemboli detection add to the interpretation of D-dimer values following orthopedic surgery?

The identification of risk factors for deep venous thrombosis (DVT) following orthopedic surgery remains unclear. We have investigated the relationship between plasma levels of D-dimer (DD), the presence or absence of microemboli 1 day after surgery, and the occurrence of DVT 7 days after total hip or knee replacement. The prevalence of DVT was 25 (13.3%) among 188 patients and was lower in 112 patients with DD < 2808 ng mL(-1) than in the 56 patients with higher DD levels: respectively, 8.0% vs. 21.4% (p < 0.05). D-dimer is not suitable for individual estimation of DVT risk. Microemboli were found in 112 (60%) of 186 subjects. The presence/absence or the frequency of the microemboli showed no relationship with the occurrence of DVT. Last, when evaluating the risk of DVT in orthopedic surgery, microemboli detection does not add to the interpretation of DD concentration.

Aged↗
PubMed1997

Prolonged asymptomatic micro-embolism after hip or knee arthroplasty.

We studied the time course of micro-embolism by recording high intensity transient signals (HITS) on Doppler venous blood flow studies during a 7-day period in 57 of 63 consecutive patients after hip or knee replacement. No HITS were found before surgery, or in the non-operated leg after surgery. In the operated leg, the median number of HITS per minute showed an exponential decrease with time; a 50% reduction in the number of HITS took 72 minutes. Regardless of the duration and severity of HITS, we found no clinically apparent embolic event. Colour Doppler imaging at days 8 to 10 after operation showed a deep venous thrombosis in 17% of our patients with one thrombosis of the long saphenous vein. The presence or severity of HITS did not predict the venous thrombi. Although we found no pulmonary complications, we detected micro-emboli over a longer period after surgery than is usually reported. Spectral analysis of the Doppler venous signal is a repeatable and non-invasive monitoring technique in the post-surgical period. We failed to prove a correlation between deep venous thrombi and micro-emboli detected by this method.

Aged↗
PubMed1996

[Guépar's total radio-carpal prosthesis in the surgery of the rheumatoid wrist. Apropos of 72 cases reviewed].

PURPOSE OF THE STUDY: Total wrist arthroplasty is an alternative to arthrodesis in the treatment of the rheumatoid wrist. MATERIAL AND METHODS: Seventy-two GUEPAR total wrist arthroplasties in sixty-four patients with rheumatoid arthritis were reviewed 1 to 10 years after the operation (average follow-up of 4 years). GUEPAR total wrist arthroplasty is a bicondylar prosthesis. The radial component made of polyethylene is cemented in the radius. The carpal component made of metal is fixed by two screws in the second and the third metacarpal. This component is constitued by two pieces: a perforated lower part permitting the passage of the screws and its metacarpal fixation and a biconvex cover fixed on the lower part by a micro-screw. RESULTS: In preoperative evaluation, all patients had severe pain and loss of function. Post-operatively, 89 per cent had no pain or mild pain and 96 per cent had better function. The average arc of flexion-extension was 47 degrees preoperatively and 39 degrees postoperatively. There were no deep infections or dislocations. Seventy percent of the patients were satisfied but eleven wrists (15 per cent) required revision: 5 cases for prosthesis revision and 6 cases for implant removal and arthrodesis. Prosthesis revisions were justified by the unscrewing of the carpal component micro-screw: they gived good results. Arthrodesis was required for 4 radial component loosening and for 2 important bone resorptions under the carpal component. Radial component loosening was associated in 3 cases with unscrewing of the micro-screw. Radiographical analysis showed in nearly all cases of this serie a bone resorption under the carpal component. This resorption was 2 mm wide at an average of to 2 years and 4 mm wide at 4 years. DISCUSSION: Clinical results of this study are good but eleven wrists required revision. Nine of these revisions were due to anomalies of first prosthesis: the unscrewing of the carpal component micro-screw was accountable to abnormal use of polyethylene with reaction of the wear products and loosening of the radial component. This problem is now resolved. More disquieting is the bone resorption under the carpal component. In fact, this resorption was constant and evolutive. It was very likely due to micro-movements between the metacarpal screws and the carpal lower part. Also, the conception of the metacarpal-fixation of this prosthesis must be revised. CONCLUSION: In rheumatoid arthritis, wrist arthrodesis gives good results if nothings affects the fingers, elbow or shoulder. If they are affected, total wrist arthroplasty is an alternative. Long term loosening of total wrist arthroplasty is a significant problem so its indication must be reserved for old patients.

Adult↗
PubMed1995

Iliac osteosarcoma in a patient with SAPHO syndrome.

Extrathoracic sclerotic bone involvement of SAPHO syndrome are sometimes very difficult to differentiate from a bone infection or bone tumor. The authors report the case of a 46-year-old patient with a history of palmo-plantar pustulosis, recurrent suppurative hidradenitis, and bilateral sternocostal arthropathy who was evaluated for a sclerotic lesion in an iliac wing. The clinical course, computed tomography findings, and histologic features of a surgical biopsy specimen established the diagnosis of osteoblastic osteosarcoma with SAPHO syndrome.

Arthritis, Psoriatic↗
PubMed1994

[Osteomyelitis in the pagetic tibia].

Osteomyelitis developing in pagetic bone is a very rare event, of which only one instance has been reported to date, in a patient with mandibular disease. We have managed three patients with osteomyelitis of a pagetic tibia. The portal of entry was a skin lesion in all three cases. A Gram-negative organism was found in all three cases and was associated with the anaerobe Bacteroides melaninogenicus in one case. One of the patients was lost to follow up before eradication of the infection. Amputation was required in the other two after unsuccessful antimicrobial therapy for 23 and four years, respectively.

Aged↗
PubMed1994

[Calcifying fibrous pseudotumor].

The case of a 17-year-young woman with Calcifying Fibrous Pseudotumor is reported. This observation emphasizes 1) A distinctive histologic appearance and the broad spectrum of this entity, 2) The differential diagnosis to consider, 3) The excellent prognostic and the low risk of local recurrence.

Adolescent↗
PubMed1993

Metastatic lesions of the cervical spine. A retrospective analysis of 20 cases.

Twenty patients were surgically treated for metastatic lesions of the cervical spine. The primary cancer was known in 14 patients, breast cancer being the most prevalent. In six patients, the cervical metastasis was revelatory of cancer. Fourteen patients showed neurologic deficit. For the upper cervical spine, a posterior approach was employed. From C3 to C7, an anterior surgical approach was preferred. Since 1986, the authors have performed, after a corpectomy of one or more vertebrae, an acrylic corpoplasty reinforced with an anterior plate. Two cases of neurologic deterioration and one instability in lesions involving the lower cervical spine were encountered. The survival period for 17 patients was, on average, 11 months (ranging from 8 days to 46 months). Nineteen patients had pain relief. Of 14 patients with neurologic deficit, 9 experienced partial or total improvement. Three patients showed no neural recovery, whereas surgery worsened the conditions of two patients. For lower cervical lesions, the anterior approach is recommended even for C3 (retropharyngeal approach) or for cervicothoracic lesions.

Adult↗
PubMed1989

[Harris and Galante non-cemented total hip prosthesis. 1st results].

Amongst the various models of total hip prosthesis available on the market, the Harris and Galante non-cemented implant constitutes an attractive alternative. The authors report their preliminary experience on the basis of a limited series (77 hips) and a follow-up of 6 to 30 months. The hemispherical acetabular prosthesis, which is very easy to use, induces a local reaction in about 10% of cases. The femoral pivot, inserted by means of a very sophisticated apparatus, is more frequently responsible for local reactions (4 circumferential rings, 2 of which were asymptomatic, and 24 partial rings particularly in Gruen's zone 1). Although the preliminary results of this short series appear to be encouraging (59 operated patients out of 63 were scored as D5 - D6), a longer follow-up is nevertheless essential.

Acetabulum↗
PubMed1988

[Prevention of thromboembolic complications during total hip arthroplasty by pre- and postoperative heparinotherapy with adapted doses. Apropos of 356 cases].

From January 1980 to July 1987, a continuous series of 356 total hip replacement underwent preventive treatment of subcutaneous Heparin, prescribed in adapted doses, both before and after surgery, and relayed at the 7th postoperative day by Ethyl Biscoumacetate. This medication was continued for 45 days. Modern methods of detection were used to detect thromboembolic complications: up to the 7th day radioactive labeled Fibrinogen and, at the slightest hint of problem, phlebocavography of the lower limbs. The established procedure made it possible to lower significantly the rate of phlebothromboses to 14 cases (3.9%) of which 3 (0.8%) developed non lethal pulmonary embolisms. The surgical site revealed an hematoma in 5% of the case, of which 1.4% had to be subjected to a surgical relief. Of the 4 deaths observed in this series, two resulted from the anticoagulant preventive method. The biological monitoring disclosed a lasting fall in the Antithrombin III in the three days following the operation and significant drop in the coagulation tests between the 4th and 6th day in the case of the patients who were to develop a thromboembolism.

Adolescent↗
PubMed1987

[Diaphyseal fractures of the lower extremity].

The authors present a series of 26 cases of ipsilateral fractures of the shafts of the femur and tibia treated by internal fixation. Twenty have been followed up for more than 2 years. Thirteen healed without incident and achieved excellent function. Six others regained a similar level of mobility after complications had been treated. The early surgical stabilisation of such fractures is advocated, allowing recognition of simultaneous injuries to ligaments of the knee.

Adolescent↗