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Biomedical subjects

Levon Doursounian

Publications and source records attributed to Levon Doursounian.

6 recordsLinked to original sources
PubMed2007

Three-dimensional computed tomographic scan of the external third of the clavicle.

PURPOSE: The aims of this radiologic study were to explore the anatomic aspect of the external third of the clavicle and to determine anatomic elements that can be useful for surgeons who perform surgery that involves this area. METHODS: Twenty patients with healthy acromioclavicular (AC) joints underwent computed tomographic (CT) scan for assessment of the lateral clavicle. Three-dimensional reconstruction of the AC joint and of the external third of the clavicle was performed. The axis of the external third was determined by CT scan reconstruction. Two-dimensional reconstructions were performed perpendicular to this axis; each involved 5 mm for exploration of the size of the 4 cortical bones and of the inner diameter of the clavicle. RESULTS: The average size of the external third before the anterior curve of the clavicle was 40 mm. The average inner diameter of the clavicle ranged from 8.24 to 4.7 mm when measured medially, but many differences were noted between patients. The upper cortical bone was thicker than 2 mm at an average of 17 mm from the AC joint. Three forms of the external third of the clavicle were identified: truncated (n = 6), conical (n = 4), and cylindrical (n = 10). The projection of the axis of the external third of the clavicle at the external side of the acromial bone ranged from 4.8 to 21 mm (average, 12.42 mm) at the backward anterior side of the acromial bone. CONCLUSIONS: Our study shows the great variability of the anatomy of the external third of the clavicle. CLINICAL RELEVANCE: Anatomic data should be useful for surgeons who perform fixation or resection of the distal part of the clavicle.

Clavicle↗
PubMed2006

Mini-open arthroscopically assisted Bristow-Latarjet procedure for the treatment of patients with anterior shoulder instability: a cadaver study.

PURPOSE: The purpose of this study was to evaluate the arthroscopically assisted Bristow-Latarjet procedure. The aim was to use arthroscopic guidance to assist in positioning of the coracoid bone block onto the anterolateral aspect of the glenoid. The feasibility of this technique and its efficacy, reproducibility, and potential neurovascular complications were evaluated. METHODS: A minimally invasive technique was used to harvest the coracoid bone block and the attached coracobiceps tendon. A portal was created through the subscapularis muscle and, under arthroscopic guidance, the anterior aspect of the glenoid was cleaned and reamed before the bone block was placed. Cannulated screws (3.5 mm) were used to fix the vertically oriented bone block to the glenoid. The size of the bone block, its position on the glenoid, and its relation to the subscapularis tendon and the musculocutaneous and axillary nerves were recorded. RESULTS: In all 5 cadavers, the bone block was well positioned and was fixed to the anteroinferior part of the glenoid. No lesions of the cephalic vein or of the surrounding neurovasculature were observed. CONCLUSIONS: This study demonstrated the safe and effective use of this arthroscopically assisted technique for correct positioning of the coracoid bone block at the anterolateral aspect of the glenoid in the cadaveric shoulder. Arthroscopy facilitated adequate reaming of the anterior glenoid and aided in optimal positioning of the bone block. CLINICAL RELEVANCE: This cadaveric study highlights the advantages offered by an arthroscopically assisted Bristow-Latarjet procedure, which optimizes positioning of the block and ensures adequate reaming of the anterior glenoid, thereby potentially reducing the risks of early nonunion and late arthritis--complications commonly associated with the classical Bristow-Latarjet technique.

Arthroscopy↗
PubMed2004

Coccygectomy for instability of the coccyx.

Between 1993 and 2000, 61 patients with instability-related coccygodynia were operated on by a single surgeon using the same technique. There were 49 women and 12 men, mean age 45.3 (18-72) years. Twenty-seven patients had hypermobility of the coccyx and 33 subluxation. In all cases, the unstable portion was removed through a limited incision directly over the coccyx. The outcome was assessed using a detailed questionnaire. Follow-up was between 12 months and more than 30 months. The outcome was rated excellent or good in 53 patients, fair in one, and poor in seven. There were nine patients with infection requiring reoperation.

Adolescent↗
PubMed2003

Acute torticollis in an adolescent: case report and MRI study.

STUDY DESIGN: A case report is presented. OBJECTIVES: To describe a typical case of acute adolescent torticollis in which a disc lesion was detected with magnetic resonance imaging. SUMMARY OF BACKGROUND DATA: Acute torticollis is attributed to atlantoaxial rotary fixation of unknown etiology. The current view is that the lesion is caused by synovial fold entrapment in the C1-C2 interspace. METHODS: In a 15-year-old male adolescent, magnetic resonance imaging was performed a few hours after the onset of torticollis, and 3 weeks after resolution of symptoms.RESULTS Increased signal intensity compatible with a fluid collection was seen in the right uncovertebral region at C2-C3. This lesion was probably linked to a sudden disruption of the disc collagen fibers, and had caused excessive lateral pressure, pushing C2 toward the left. Magnetic resonance imaging at 3 weeks was unremarkable. CONCLUSIONS: The authors think that the observed disruption was a sudden and abnormal instance of a normal and, usually, very slow process of cleft formation with extension into the fibrocartilaginous core in the uncovertebral region. It is felt that this lesion may be a frequent cause of torticollis in adolescents.

Acute Disease↗
PubMed2003

Bone-retinaculum-bone reconstruction for chronic posttraumatic instability of the metacarpophalangeal joint of the thumb.

PURPOSE: This study presents an autograft technique for the surgical management of chronic posttraumatic instability of the thumb metacarpophalangeal (MCP) joint by using a bone-retinaculum-bone graft from the second compartment of the extensor retinaculum. METHODS: The bone-retinaculum-bone graft was harvested from the second compartment. The graft ends were fixed into the host site with screws. Fourteen patients (12 ulnar, 2 radial collateral ligament tears) had the procedure. All patients were reviewed by an independent observer using objective and subjective criteria, the mean follow-up time was 20 months. RESULTS: Results were satisfactory overall (8 excellent, 4 good, 1 fair, 1 poor that subsequently was fused). All patients returned to their former jobs. All but one had a clinically stable first MCP joint; grasp was 87%, pinch was 80%, MCP joint range of motion (ROM) was 91%, and interphalangeal joint ROM was 98% of the unoperated side. CONCLUSIONS: Early results are encouraging. This procedure preserves ROM of the MCP and interphalangeal joints of the thumb, improves strength, and gives the stability required for proper thumb function.

Adolescent↗