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Biomedical subjects

M Assal

Publications and source records attributed to M Assal.

7 recordsLinked to original sources
PubMed2006

[Mini-invasive suture of Achilles tendon ruptures: a concept whose time has come].

Rupture of the Achilles tendon is a frequent injury particularly among sports enthusiasts, and there has been an increased incidence over these past years which parallels the rise in popularity of sporting activities. Traditionally, an open operative repair of the tendon has been proposed. Over the past ten years we have utilized a mini-invasive technique with the help of instrumentation we have developed, with the objective to minimize the surgical trauma and improve the quality of suture fixation. These past ten years of observation have allowed us to objectively assess its clinical and functional benefit. This operative approach is in the process of replacing the traditional open procedure for the management of acute Achilles tendon ruptures in the majority of centers which manage these injuries.

Achilles Tendon↗
PubMed2005

[Ankle arthroplasty. Rationale for interfaculty collaboration].

Arthroplasty has become increasingly popular as a solution for end-stage ankle arthrosis. Good results, with a 90% survival rate at ten years, have been reported with use of recent prostheses. However, the role of ankle arthroplasty needs to be more clearly defined. Due to its particular nature and specific biomechanical aspects, the ankle joint presents a real challenge for arthroplasty. Patient selection and surgical technique need to be optimized to improve long-term results. Careful clinical and biomechanical studies need to be conducted to objectively determine the long term benefit in terms of quality of life. To better address these points the authors of this manuscript have coordinated their expertise in a collaborative approach, so as to optimize surgical indications, prosthesis implantation, postoperative rehabilitation and research.

Ankle Joint↗
PubMed2005

[Hallux valgus: which treatment].

Hallux valgus deformity is characterized by lateral deviation of the proximal phalanx on the metatarsal head. Variable severity of the deviation causes prominence of the medial eminence, giving rise to a painful bunion deformity. Many patients will find permanent or temporary relief with non surgical measures. For those who failed conservative treatment, surgery may cure their symptoms. However unsatisfactory outcomes following hallux valgus surgery is not rare. Therefore a clear understanding of the pathology and of the patient's expectations must anticipate any treatment strategy in order to optimise patient's outcome. Cosmetic considerations should never be an indication for surgery.

Bone Nails↗
PubMed2002

Are drivers more likely to injure their right or left foot in a frontal car crash: a crash and biomechanical investigation.

In this study we hypothesized that for frontal crashes, the driver was more likely to sustain foot injury than the front seated passenger and the right foot was more likely to be injured than the left because the driver's right foot was positioned in dorsiflexion and eversion during the crash and less able to tolerate crash forces. Seventeen CIREN frontal crashes were studied to document the circumstances and resulting foot injuries. NASS data was sampled to determine frequencies of injury to foot side and occupant position. Biomechanically, matched pairs of cadaveric feet were tested in compression with one in dorsiflexion, and the other, dorsiflexion, and eversion. Results showed that drivers were more likely than passengers to sustain a foot or ankle injury and this was almost exclusively due to a higher frequency of right foot injuries in drivers. Braking, with significant toepan intrusion, was associated with an increase in both right and left foot injuries in drivers. Biomechanically, 9 of 15 pairs tested provided useable data. There was a significant decrease in load to failure between specimens forced into dorsiflexion and eversion (mean, 4107 N, sd = 1630 N) compared with dorsiflexion alone (mean, 6468 N, sd = 2435 N, p = 0.001). The majority (16 of 17) of foot injuries in the CIREN cases were to drivers of which 13 injured their right foot and ankle. An implication of this work is that if thresholds based on data from dorsiflexion and compression loading are used to predict foot and ankle injury in frontal crashes they may not represent that population of drivers who are braking at the time of the crash and could suffer injuries at forces lower than current threshold values.

Accidents, Traffic↗
PubMed2000

Osteosynthesis of metastatic lesions of the proximal femur with a solid femoral nail and interlocking spiral blade inserted without reaming.

OBJECTIVES: To evaluate the efficiency of a solid femoral nail and interlocking spiral-blade, inserted without reaming (UFN/ spiral blade, Synthes-Stratec, Oberdorf, Switzerland), for the fixation of pathologic and impending pathologic fractures of the proximal femur, particularly those involving the subtrochanteric area. DESIGN: Retrospective, consecutive series. SETTING AND PATIENTS: All patients treated for pathologic and impending pathologic fractures of the trochanteric or subtrochanteric area, stabilized using a UFN/spiral blade, inserted without reaming, from June 1994 to June 1997. INTERVENTION: Femoral intramedullary nailing was performed without reaming on a radiolucent operating room table. The nail was inserted through a five-centimeter supratrochanteric approach, and the interlocking spiral-blade device was introduced percutaneously. METHODS: The following parameters were assessed: pathology reports, location of bone lesions, patient survival, pain relief, ambulation, hardware failure on successive radiographs, and intraoperative complications. RESULTS: Twelve pathologic and impending pathologic fractures were stabilized in ten patients. Two patients required bilateral nailing that was staged with intervals of two and three weeks, respectively. The average postsurgical survival was six and one-half months. No implant failure was noted, and no surgical revision was performed. One intraoperative death occurred during surgery and was documented on autopsy as massive pulmonary fat embolization. Neither patient with bilateral nailing suffered from fat embolism syndrome. CONCLUSIONS: Femoral nail insertion without reaming using an interlocking spiral blade provides appropriate stabilization of the proximal femur in case of metastatic lesions, even with extensive subtrochanteric involvement. Although the nails were inserted without reaming, this did not avoid the risk of fat embolization syndrome. This study only addressed results in patients with short-term survival.

Activities of Daily Living↗
PubMedDate not supplied

The axial view to measure posterior laxity of the knee. A mathematical analysis.

Posterior laxity of the knee can be assessed clinically, but interpretation of the amount of displacement is highly subjective. Mechanical methods are more efficacious for measuring anterior laxity. Radiologic techniques are available for measurement in a lateral projection, but some variables may interfere with their accuracy. We undertook a trigonometric analysis of the axial view to confirm that it can be used to reliably measure posterior displacement. The ideal radiologic conditions consist of 80 degrees of knee flexion in both knees maintained with a knee support and a 26 degrees x-ray beam incidence with respect to the tibia. Although such accuracy is rarely obtained in routine clinical practice, even with a variability of +/- 10 degrees in the x-ray beam incidence the error factor will be less than 10%. Such a degree of error is in the same range (+/- 2 mm) as noted by investigators using the lateral radiograph to measure anteroposterior displacement. We believe that our study validates the use of a single axial radiograph of both knees to assess the state of the posterior cruciate ligament of an injured knee as compared with a normal knee.

Arthrography↗