Capitolunate arthrodesis: the lateral approach.
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Journal Article↗
Biomedical subjects
M Merle
Publications and source records attributed to M Merle.
[Antecubital flap: advantages in elbow coverage. An anatomical study and experience of five clinical cases].
The antecubital flap is a fasciocutaneous strip that has its blood supply provided by the first proximal collateral of the radial artery. This flap was described for the first time in 1983 by Lamberty and Cormack, but it has not been widely used and there have been only a few reports in the literature concerning this procedure. The aim of the present investigation was to demonstrate via an anatomical study and a report on five cases the viability of the various anatomical features of this cutaneous flap, and also its positive contribution to elbow reconstruction. The anatomical study involved eight fresh cadavers (eight upper limbs). An injection of colored prevulcanized latex was made in the humeral artery in the lower third of the arm. The aim was to determine which artery provided blood supply to the flap, its anatomical location, and also to look for possible distal anastomoses which would permit a distal pedicled flap to be removed. Contrary to the findings of other authors, in the present study it was found that the vessel providing blood to the antecubital flap always branched off from the radial artery. However, no anastomoses with distal vascularization were detected, which would have permitted a distal pedicled flap to be obtained. The use of the antecubital flap for elbow coverage was then illustrated by five clinical cases of soft tissue defects of the elbow. This method was found to be reliable, practical, and the flap could be rapidly dissected. Moreover, this particular technique is sensitive, and has an interesting rotational arc. The distal cutaneous island flap has the advantage of limiting scar tissue. A comparison between the antecubital flap and other pedicled flaps has then been made. In conclusion, it appears that this little-known procedure has definite advantages, and that it should be included in the range of surgical techniques that are available for soft tissue reconstruction in the case of elbow defects.
Adult↗
[Comminutive fracture of the trapezium treated by ligamentotaxis. A case report].
We report a case of trapezium fracture treated by continuous traction. The fracture involved the trapezium alone and was associated with scapho-trapezium subluxation. Three percutaneously inserted pins were used for traction, one scapho-capitate pin and two pins in the first and second metacarpal bones. This allowed distraction of the entire first row. Good anatomic reconstruction of the trapezium was evidenced radiographically. The functional outcome was quite satisfactory with mobility strictly the same as the healthy side and complete pain relief.
Accidents, Occupational↗
[Non-articular malunions of the distal radius: evaluation and techniques of correction].
Malunion remains the most common complication following fracture of the distal radius. Deformities can be observed in all three planes with displacement in dorsal or palmar tilt, translation, shortening and axial rotation. Preoperative evaluation requires a comparative analysis with clinical, radiological and scanographic assessment. The functional consequences affect the radiocarpal and distal radio-ulnar joints and the carpus. Biomechanical aspects include changes in pressure forces on the distal radius and ulna, and displacement of the centers of rotation. If present, associated lesions should be evaluated. The degree of clinical acceptance depends on each patient, but generally functional outcome is closely correlated with the anatomic result. Limits of radiological acceptance should be defined at 20 degrees dorsal tilt, 5 degrees radial inclination, and a - 4 mm distal radio-ulnar index. Corrective osteotomy is performed on the radius, with or without a complementary ulnar procedure. Closing wedge and re-orientation osteotomies are no longer used. Opening wedge osteotomy with or without lengthening is preferred, generally with an access on the same side as the sagittal tilt. The osteotomy should be performed just above the distal radio-ulnar joint. A temporary external fixator provides the best way to check peroperative corrections. Bone grafts may be harvested from the radius or the iliac crest. Pins and cast are sufficient to immobilize the dorsal tilt corrections. In case of volar tilt, an internal plate fixation is best. Depending on the status of the distal radio-ulnar joint, a conservative (shortening osteotomy, wafer procedure) or non-conservative (Darrach-Moore, Kapandji-Sauvé.) procedure should be performed on the ulna. If needed, associated lesions of the carpus must be treated. Surgical correction is mainly indicated in case of a functionally unacceptable deformation, but should be discussed if the radiographical limits have been overrun. The goal of such corrective procedures is to recover anatomical restitution.
Activities of Daily Living↗
[Tuberculosis or clear-cell chondrosarcoma of the elbow?].
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Antitubercular Agents↗
Mitochondrial impairment and recovery after heat shock treatment in a human microglial cell line.
The application of a heat shock on the human microglial cell line (CHME 5) has been shown to cause cytoskeleton modifications and alterations in phosphorylated metabolite content (Macouillard-Poulletier de Gannes et al., 1998a Metabolic and cellular characterization of immortalized human microglial cells under heat stress. Neurochem. Int. 33, 61-73). In this study, we focused on the possible involvement of mitochondria in this heat stress response. The cell respiratory properties were followed during the recovering period and the possible relationships between mitochondria and the cytoskeleton were studied. We observed that the heat shock induced changes in mitochondrial activity due to protein denaturation, rather than mitochondrial loss. Furthermore, these alterations were correlated with cytoskeleton disorganization since vimentine, tubuline and mitochondria shift, simultaneously, to a perinuclear location. The perturbations of the mitochondrial distribution persisted until cytoskeleton networks had recovered. Nevertheless, the respiratory properties recovered rapidly suggesting a renaturation of mitochondrial proteins in connection with mitochondrial cytoplasmic redistribution.
Actins↗
[Postoperative pain and surgical treatment of trapeziometacarpal osteoarthritis of the thumb after ambulatory surgery].
OBJECTIVE: The course of pain and the incidence of the side effects from analgesics were evaluated for 15 days in 26 consecutive outpatients who underwent a surgical cure of trapeziometacarpal osteoarthritis of the thumb under regional block. STUDY DESIGN: Prospective study. METHODS: The analgesic regimen prescribed at discharge consisted on a regular administration of a combination of ketoprofen (50 mg.6.h-1) plus the association of acetaminophen and propoxyphene (two tablets.6.h-1). Patients were asked to evaluate their pain using a numerical rating scale graduated from 0 to 10. Data were collected during a telephone interview at day 4, 8 and 15. RESULTS: Overall, patients scrupulously followed the medical prescription. At day four, 80% of patients still needed analgesics. The mean period during which NSAID, acetaminophen and propoxyphene were maintained was 4 and 6 days respectively. Fifty percent of patients reported severe pain during postoperative day 1 and 2. Moderate pain was reported at day 3 and 4 in respectively 54% and 42% of cases. Beyond this period, most patients indicated pain of weak intensity (71% at day 8). Epigastric pain has been noticed for 27% of patients. CONCLUSION: The surgical correction of trapeziometacarpal osteoarthritis of the thumb is frequently performed according to an ambulatory setting. The fact that 50% of patients reported severe pain during the early postoperative period emphasize the inadequacy of our postoperative pain management for this surgical procedure.
Acetaminophen↗
[A retrospective study of 69 primary rhizarthrosis surgically treated by total trapeziectomy followed in 34 cases by interpositional tendinoplasty and in 35 cases by suspensioplasty].
INTRODUCTION: We compare retrospectively two groups of total trapezectomy did as treatment for primary osteoarthritis of trapeziometacarpal joint combined in 34 cases with tendon interposition arthroplasty (group A) and in 35 cases with suspensioplasty (group B). METHOD: In group A an 'anchovy' was made with half band of the abductor pollicis longus tendon and the palmarus longus tendon; in group B the same tendon samples were rolled around the flexor capi radialis tendon. The follow up is at least 18 months. RESULTS: Strength was nearly the same in the two groups. The suspensioplasty of the group B allows a better stability after trapezectomy than the anchovy of the group A, but with a small decrease in range of motion, without functional consequence. In both groups of patients, the range of motion was good. In the group B, the persistent pain was more frequent than in group A. Patients were satisfied with the ability of perform activities of daily life, but working patients were bothered by poor endurance. There was no statistical correlation between the power of the thumb and thumb shortening, but there was one between increasing of hyperextension of thumb metacarpophalangeal joint and decreasing power of pinch. DISCUSSION: Since the suspensioplasty has been tightenedless, the relief of pain has been better in the group B. Overall, the results in the two groups were nearly the same; the two procedures studied are satisfactory in most cases, but their result is too often inadequate with performance at work.
Activities of Daily Living↗
[Surgical aspects of the cervicothoracobrachial outlet].
Poitevin has described six levels of entrapment of the brachial plexus observed in the thoracic outlet syndromes. The diagnosis remains difficult due to the association between the vascular and neurological symptoms. The EMG study and the ultrasonic examination orient in a significant manner the diagnosis of the level of the lesions in the interim of progress by magnetic resonance imaging. Our surgical experience shows that the cervical approach without resection of the first rib makes it possible to treat entrapment of the roots C5-C6-C7 and the only entrapment of the roots C8-TH1 without vascular lesion. The vascular syndrome requires resection of the first rib by the axillary surgical approach described by Ross or by the supra- and infraclavicular approach described by Cormier. This surgery requires a strict indication and a precise technical realization.
Diagnostic Imaging↗
The metabolism of [3-(13)C]lactate in the rat brain is specific of a pyruvate carboxylase-deprived compartment.
Lactate metabolism in the adult rat brain was investigated in relation with the concept of lactate trafficking between astrocytes and neurons. Wistar rats were infused intravenously with a solution containing either [3-(13)C]lactate (534 mM) or both glucose (750 mM) and [3-(13)C]lactate (534 mM). The time courses of both the concentration and (13)C enrichment of blood glucose and lactate were determined. The data indicated the occurrence of [3-(13)C]lactate recycling through liver gluconeogenesis. The yield of glucose labeling was, however, reduced when using the glucose-containing infusate. After a 20-min or 1-h infusion, perchloric acid extracts of the brain tissue were prepared and subsequently analyzed by (13)C- and (1)H-observed/(13)C-edited NMR spectroscopy. The (13)C labeling of amino acids indicated that [3-(13)C]lactate was metabolized in the brain. Based on the alanine C3 enrichment, lactate contribution to brain metabolism amounted to 35% under the most favorable conditions used. By contrast with what happens with [1-(13)C]glucose metabolism, no difference in glutamine C2 and C3 labeling was evidenced, indicating that lactate was metabolized in a compartment deprived of pyruvate carboxylase activity. This result confirms, for the first time from an in vivo study, that lactate is more specifically a neuronal substrate.
Animals↗
Functional assessment of misdirected axon growth after nerve repair in the rat.
Age, late repair, loss of nerve tissue, tension, and other factors are now known to influence axon regeneration and the quality of recovery after nerve repair. Many of the factors cannot be controlled by surgery. However, a few important ones depend on surgical technique, and some could be minimized, e.g., suture with tension, scarring due to foreign material, and misdirected axon growth. In this study, the authors tried to assess the functional consequences of misdirected axon growth in the sciatic nerve of the rat. They used a strainless coaptation nerve-repair technique with bioabsorbable plate support (polylactic acid), permitting them to study only the consequences of misdirected axon growth, without tension or suture in the area of nerve repair. Sixty rats were divided into three groups. In Group 1, 20 sciatic nerves were repaired without rotation of the distal nerve stump. In Group 2, 20 sciatic nerves were repaired with a 90-degree rotation of the distal nerve stump. In Group 3, 20 sciatic nerves were repaired with a 180-degree rotation of the distal nerve stump. Functional analyses were performed with the sciatic functional index. The results showed the poor consequences of incorrect nerve-end alignment in nerve repair (p < 0.05). Nerve repair with bioabsorbable plate support is known to allow good stump coaptation, without tension and without foreign material. The authors suggest an adaptation or modification of this technique, which might minimize misdirected axon growth, one of the factors whose effects can be mitigated by surgical technique.
Absorbable Implants↗
Evaluation of low-pressure arterial and venous clamps: electron microscopic study and possible clinical applications.
These authors report on validating their choice of disposable clamps in arterial and venous microsurgery in a comparative and experimental study using the scanning electron microscope. This appears to be the first evaluation of venous endothelial clamping lesions. Early intimal clamping lesions were studied using three different clamps and two protocols in 18 femoral arteries and veins in rabbits. Results were evaluated using a new classification that can be applied to both arterial and venous lesions: Grade I: cellular disorientation and disorganization; endothelial lamination; and absent or very few platelet deposits; Grade II: alterations of the cytoplasmic membranes in fusiform cells; presence of at least one breach of endothelial continuity; and moderate number of platelet deposits; Grade III: presence of endothelial detachment; and large numbers of platelet deposits. They showed that in arteries, all the clamps tested caused only low-grade lesions. In contrast, in veins, they demonstrated both the very fragile nature of the endothelium, and also the comparative safety of the low-pressure venous clamp. Their choice of specific clamps for venous anastomoses was validated.
Animals↗
Use of mitek anchors in the digits.
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Journal Article↗
[Isolated palsy of the flexor pollicis longus in anterior interosseous nerve syndrome].
Anterior interosseous nerve palsy are relatively rare, specialy in traumatic cases. Two case of incomplete anterior interosseous nerve palsy with isolated total loss of function of flexor pollicis longus are reported. Partial palsy of the A.I.N. have been previously reported, but their mechanism is unclear. The incomplete anterior interosseous nerve palsy has to be known. They can be mistaken with tendon rupture, specialy in traumatic cases, and lead to unnecessary surgery.
Adult↗
[Hand injuries caused by self-made bombs. Observations and reconstructoin techniques. Report of 7 cases].
The authors report on their experience of sodium chlorate bomb injuries of the hand observed in seven boys. The thumb was damaged in all cases. This digit was amputated in five cases, was totally saved in one case and partially saved in another case. In four cases, the preservation of damaged tissues in the emergency procedure allowed a secondary reconstruction of the thumb, thus making it possible to achieve a prehensile and sensitive hand. In these former four cases, a posterior interosseous flap was performed to ensure the primary or secondary skin coverage. In two cases, the major lesions necessitated an amputation at the radiocarpal level. In one of these two cases, coverage of the amputated stump by a free gracilis muscle flap made it possible to minimize the level of amputation and to wear a functional prosthesis. Sodium chlorate bombs are made with an unstable chemical mixture. These reactives provoke high-energy injuries with a short range of dispersion. The damages depend on the prehensile mode, which explains why the thumb and the index finger are always injured. These blast injuries were limited to the hand and the skin coverage could be done with a distally based posterior interosseous flap. In spite of the impressive lesions observed in such young patients, a conservative attitude could be taken in an emergency situation with the aim to perform further reconstructive procedures.
Adolescent↗
[1-(13)C]glucose metabolism in the tumoral and nontumoral cerebral tissue of a glioma-bearing rat.
C6 cells were used to establish a glioma-bearing rat model by stereotaxic injection in the left caudate nucleus. The tumor status was evaluated by magnetic resonance imaging and conventional histology. The glioma-bearing rats were infused for 1 h with a [1-(13)C]glucose solution. Perchloric acid extracts of the tumor and the ipsilateral and contralateral hemispheres were analyzed by 13C-NMR spectroscopy. The 13C-labeling patterns in compounds, mainly amino acids, indicated no drastic modification of carbon metabolism in both ipsilateral and contralateral hemispheres, as compared with control rats, whereas profound metabolic differences between brain tissue and tumor were observed. Glutamine C4 enrichment was lower in the glioma than in the brain [mean +/- SD values, 5.4 +/- 2.3 (n = 5) and 15.0 +/- 0.8% (n = 10), respectively] and also lower than the glutamate C4 enrichment in the glioma (mean +/- SD value, 22.6 +/- 4.2%; n = 5), indicating that tumor glutamine was neither synthesized inside the glioma nor taken up from the surrounding brain. The glutamine C4 enrichment in the serum (6.7 +/- 0.5%; n = 10) suggested that the glioma imported glutamine from the blood, a process probably connected with angiogenesis.
Alanine↗
No enhancement of sensory and motor blockade by neostigmine added to mepivacaine axillary plexus block.
BACKGROUND: Intrathecal neostigmine induces analgesia but also several side effects. Recently, 500 microg neostigmine administered intraarticularly was shown to produce postoperative analgesia without side effects. The authors' goal was to determine whether 500 microg neostigmine added to mepivacaine in axillary plexus block prolongs postoperative analgesia. In addition, they wanted to determine the incidence of side effects in patients undergoing hand surgery. METHODS: Sixty-nine outpatients scheduled for carpal tunnel syndrome repair with axillary plexus block were randomly assigned to one of three groups that received saline solution in the axillary plexus and subcutaneously (group 1), 500 microg neostigmine in the axillary plexus and saline solution subcutaneously (group 2), or saline solution in the axillary plexus and 500 microg neostigmine subcutaneously (group 3). Sensory and motor block in the four hand nerve distributions were assessed every 5 min for 30 min The duration of the sensory and motor blocks were assessed after operation. Side effects were also recorded. RESULTS: Neostigmine had no effect on sensory and motor block in any of the four nerve distributions, nor did it increase the median duration of sensory block (215 min; range, 120-330 min) compared with group 1 (247 min; range, 190-287 min) or group 3 (236 min; range, 160-280 min). Motor block was slightly shorter (P = 0.045) in group 3 (190 min; range, 135-285 min) compared with group 1 (218 min; range, 145257 min) and group 2 (215 min; range, 105-343 min). Gastrointestinal side effects occurred in 30% of patients in both neostigmine groups but not in group 1 (P < 0.05). CONCLUSIONS: This study suggests that 500 microg neostigmine added to mepivacaine in axillary plexus block does not prolong postoperative sensory block, but it does cause a relatively high incidence of side effects. These two findings raise doubts about the use of neostigmine associated with local anesthetics for plexus neural block.
Adult↗
[Temporary external fixation in the correction of non articular mal-unions of the distal radius].
PURPOSE OF THE STUDY: The authors reviewed 21 cases of extra articular malunions of the distal radius treated by osteotomy, temporary external fixation, then osteosynthesis. Two groups were studied: Group A of 14 patients with dorsal tilt of the distal radius and Group B of 7 patients with palmar tilt of the distal radius. Mean follow-up of this series was 69 months ranged from 12 to 109 months. MATERIAL AND METHODS: In Group A, after exposure of the distal radius through a dorsal approach, the site of osteotomy, proximal to the distal radio-ulnar joint, was determined by fluoroscopy. The angular correction was done by progressive opening using a small external fixator. After checking on the correction, the bone graft was harvested 7 times on the radius as described by Watson et Castle, 7 times on the iliac crest. Bone fixation was done by two K-wires and a cast for 8 to 10 weeks. Three Sauvé-Kapandji procedures was done at the same time. In Group B, the approach was palmar, extended distally to open the carpal tunnel. The distraction was done with a distal T-shaped external fixator. The bone graft was always harvested on the iliac crest. Bone fixation was done with a T-shaped palmar plate. Two Sauvé-Kapandji procedures was done at the same time. RESULTS: Group A: Flexion-extension arc was improved of 15.5 p. 100, pronation-supination of 83.7 p. 100 and grip strength of 80 per cent of the pre-operative values. Radiological evaluation showed good correction except one case of undercorrection of the dorsal tilt (-7 degrees) and one case of undercorrection of the radial inclination (+6 degrees). The distal radio-ulnar index was measured at the mean of 0mm postoperatively compared to +5 mm pre-operatively. One patient developed a postoperative radiocarpal arthritis. Group B: Flexion-extension arc was improved of 96.2 p. 100, pronation-supination of 76.9 p. 100 and grip strength of 108.3 p. 100 of the preoperative values. Radiological evaluation showed good correction except one case of overcorrection of the palmar tilt (-10 degrees) and one case of undercorrection of the radial inclination (+7 degrees). The distal radio-ulnar index was measured at the mean of 0mm postoperatively compared to +7 mm pre-operatively. DISCUSSION: The functional consequences of malunions of the distal radius have been stressed by others for more than sixty years. Since, many authors have contributed to refine and improve their surgical correction. Several displacements should be taked into account for the preoperative planning. They are sagittal tilt, frontal horizontalisation, shortening, sagittal and frontal translation, and axial rotation. Many types of osteotomies could be done; closing wedge, opening wedge or reorientation. In some cases, an operative procedure of the distal radio-ulnar joint should be done at the same time. We chose an opening-wedge osteotomy and the use of a temporary external fixator to ensure progressive distraction and good adjustment in the correction of angular deformities. In the dorsal tilt group we were satisfied in using on 7 patients a trapezoidal cortico-cancellous bone graft harvested on the radius. CONCLUSION: The authors would like to stress two points: The technical interest of using a temporary external fixator to adjust the angular correction of the distal radius. The importance of an adequate treatment of distal radius fractures in emergency situation, considering the functional and cosmetic alterations due to malunions and their need for surgical corrections in main instances.
Colles' Fracture↗