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Biomedical subjects

O Jarde

Publications and source records attributed to O Jarde.

At least 19 recordsLinked to original sources
PubMed2004

[Surgery and transfusion in Jehovah's witness patient. Medical legal review].

The religious convictions of the witnesses of Jehovah leads them to refuse transfusion of blood, of its major components and of blood sparing procedures breaking the physical contact between the patient and his blood. We recall the rules of good practice in case of elective surgery concerning exhaustive information of the patient within multidisciplinary team associating anesthetist and surgeon advised by the forensic pathologist. This consultation must, to our point of view, be concluded by a report which summarizes what is accepted or not by the patient. This report will be initialed by the patient. This consultation can never lead the physician to swear to never use a transfusion whatever the circumstances. In case of emergency if and only some conditions are met (everything was made to convince the patient, vital emergency, no therapeutic choice, therapeutic care adapted to the patient heath status), the physician can be brought to overpass the patient's will to not receive blood transfusion. Current jurisprudence has, to date, never recognized as faulty the physicians having practiced such transfusions whenever they took place within a precise framework.

Benchmarking↗
PubMed2002

[Triple arthrodesis in the management of acquired flatfoot deformity in the adult secondary to posterior tibial tendon dysfunction. A retrospective study of 20 cases].

The authors have reviewed 20 cases of valgus flatfoot deformity in the adult, secondary to insufficiency of the tibialis posterior tendon, which were treated by triple arthrodesis from 1983 to 1998. The longitudinal arch was flat grade 3 in 18 cases and grade 2 in two. The rearfoot was in valgus in all cases. Dorsal flexion of the ankle was limited to 5 degrees with a short Achilles tendon in 10 cases Djian-Annonier's angle was 134 degrees on average. The talocalcaneal divergence was 32 degrees. Diffuse osteoarthritis was present preoperatively in 14 cases. Fusion of the arthrodesis was achieved in 18 cases. There were two nonunions: one affecting the talonavicular joint, and the other, the talonavicular and calcaneocuboid joint. Results evaluated according to Kitaoka's criteria were excellent in 35%, good in 35%, fair in 20% and poor in 10%. Xrays showed progression of osteoarthritis. These results were not as good as in Fortin and Waling's series but we did not use iliac grafts. There was no instance of talus necrosis. The nonunion rate was higher than in other series at the talonavicular level. In order to improve the results, we now believe that bone resection must be kept minimal and bone grafts should be used, in addition to internal fixation. Triple arthrodesis was found to give good result in the treatment of acquired flat foot deformity due to insufficiency of the tibialis posterior tendon. However on the long term it promotes degenerative changes in neighbouring joints.

Aged↗
PubMed2002

[Equinovarus of the foot in adults treated with tibiocalcaneal arthrodesis. Review of 18 cases].

The authors have retrospectively studied 18 cases of tibiocalcaneal arthrodesis performed to treat a fixed equinovarus deformity of the foot in 13 adult patients. The operations were performed between 1981 and 1998; there were 9 neurologic and 9 post-traumatic deformities. The mean calcaneal varus deformity was 50 degrees and the mean equinus deformity was 75 degrees. The results were evaluated using Kitaoka's criteria. We noted one postoperative cutaneous necrosis, two nonunions, one of which was reoperated by bone freshening and osteotomy of the midfoot. All rearfeet were in neutral alignment and were stable. Shortening was on average 2.8 cm. Plantar support was achieved in 10 feet, with improved autonomy, walking capacity and footwear. Overall, there were 10 good, 2 fair and 1 poor result. In the group with neurologic deformities there were 4 good, 1 fair and 1 poor result. In the group with post-traumatic deformities, there were 6 good and one fair results. Other series published also showed satisfactory results comparable to or better than those obtained with triple arthrodesis, which generates severe stiffness of the rear- and midfoot, disturbing gait. Fixed equinovarus deformity of the foot in the adult is a good indication for tibiocalcaneal arthrodesis, allowing in the majority of cases to achieve stable and painless plantar support.

Adult↗
PubMed2002

[Ankle instability with involvement of the subtalar joint demonstrated by MRI. Results with the Castaing procedure in 45 cases].

The authors report 46 cases of instability of the hindfoot involving the subtalar joint, with or without combined involvement of the tibiotalar ligaments, which were treated using Castaing's technique of ligament plasty between 1988 and 1999. Preoperatively, the patients complained of instability, recurrent sprains and pain. A tarsal sinus syndrome was present in 39%. Forty six patients underwent NMR examination which demonstrated capsuloligamentous lesions in every case. The results were evaluated using Kitaoka's score. With an average follow-up of 5.7 years after operation, instability was no more present in 80% and 63% were painfree. Clinical examination showed a reduction in the range of inversion of the hindfoot in 43%, with values between 50 and 70% of the contralateral foot, but without any significant clinical repercussion. Incipient osteoarthritis was noted on xrays in three patients. The overall results were very good in 82%, fair in 11% and poor in 7%. Eighty seven percent of the patients were satisfied with the result of the operation. The authors found a significant correlation between fair or poor results and a body mass index above 26 kg/m2 or constitutional laxity. Besides, results got worse as the time interval between the first sprain and the operative treatment increased. Comparison of these results with those of other techniques shows that they are essentially similar. Ligament plasty using Castaing's technique is a reliable operation but direct repair of ruptured ligaments at the subtalar joint should be preferred for primary treatment, leaving the possibility for secondary ligament plasty if necessary.

Adolescent↗
PubMed2001

[Interpositioned metallic prosthesis for hallux rigidus: review of 42 cases with a metatarsophalangeal prosthesis].

PURPOSE OF THE STUDY: We report outcome at a mean 4.8 years follow-up in 42 patients with hallux rigidus treated by metatarsophalangeal interposition thin prosthesis flat concave with a lateral capsular fixation. MATERIALS AND METHODS: The 42 patients were treated from 1987 to 1997. Sixtine prostheses were implanted for osteoarthritis was grade I (n=2), grade II (n=28), and grade III (n=12). Groulier's clinical criteria and Regnauld's radiologic criteria were used to assess outcome. RESULTS: We observed 22 very good, 12 good, 4 fair, and 4 poor results. There was no significant modification in the forefoot morphology. DISCUSSION: The Sixtine prosthesis provided a global improvement in pain and motion though there was an important difference between patients with grade I and grade II osteoarthritis, who experienced major improvement, and those with grade III disease. A good overall result requires proper prosthetic centering. Subluxation or translation does not appear to be compatible with good results. Among 3 cases with overt dislocation, 1 recovered an acceptable articular space with a good overall result. Two poor results and 3 fair results were observed in patients with condensation of the phalangeal base. These bone condensations appeared in postoperative Egyptian feet. The Sixtine prosthesis may protect the interphalangeal articular space of the great toe, avoiding damage and rearward displacement of sesamoid bones. It ensures primary stability and may be left in place. CONCLUSION: We found that the Sixtine prosthesis is best indicated in hallux rigidus patients with grade II osteoarthritis.

Adult↗
PubMed2001

[Complete transverse fractures of the talus: value of magnetic resonance imaging for detection of avascular necrosis].

The authors report a series of 32 complete transverse fractures of the neck or body of the talus. The fractures occurred mostly in young males, as a result of motor vehicle accidents. The fracture line was transverse in the neck or body of the talus in 20 cases, sagittal in four and comminuted in eight cases. Using Hawkins' classification, there were 10 type I, 16 type II, and 6 type III fractures. The treatment was conservative in 8 cases and surgical in 24. The patients were evaluated clinically and radiologically with an average follow-up of 7 years. All patients underwent radiological study at follow-up and 17 underwent NMR evaluation. Eleven underwent NMR evaluation at final follow-up, and the other 6 early in their postoperative evolution. The postoperative results were evaluated based upon clinical and radiological criteria. The clinical result was good or very good in 37.5% of cases. Segmental necrosis of the talar body was noted in 6 cases and complete necrosis in 5, which required arthrodesis in 8 cases. Avascular necrosis is a common complication. Its frequency depends on the type and displacement of the fracture. If it becomes symptomatic, the only treatment is tibiotalar or tibiotalocalcaneal arthrodesis. The contribution of NMR is very important, as it gives the positive diagnosis as well as information regarding evolution. Complete transverse fractures of the talar neck or body are rare; their treatment only gives a little over one third good and very good results in the long term. NMR gives the diagnosis early and shows the extent of necrosis. It can have predictive value for the collapse risk and guide reeducation with or without weight bearing.

Adult↗
PubMed2001

[Recurrent hallux valgus treated with metatarsophalangeal arthrodesis. A series of 32 patients].

PURPOSE OF THE STUDY: We reviewed a series of 32 cases of recurrent hallux valgus treated by great toe metatarsophalangeal arthrodesis with a minimal 5-year follow-up. MATERIAL AND METHOD: Mean delay from the first surgical procedure and revision surgery was 11 years. All patients complained of forefoot pain. The average angle of the phalangeal valgus was 39 degrees. Sixteen patients had metatarsalgia. The first toe metatarsophalangeal joint was evaluated according to Regnauld's classification: two grade 1, eight grade 2a, six grade 2b, sixteen grade 3. Arthrodesis was fixed with an axial screw and associated with adductor hallux plasty. Outcome was assessed at a minimum 5-year follow-up according to Kitaoka's criteria. RESULTS: Seventy-eight percent of the patients were pain free at last follow-up. Valgus deviation of the great toe was corrected with an average angle of 19 degrees. The arthodesis healed in 90.6% of the cases. Statistical analysis showed the importance of great toe valgus pre- and postoperatively and at last assessment. Final outcome was poor in the oldest patients. The overall outcome was rated good in 84% of the cases, average in 6% and poor in 10%. DISCUSSION: Arthrodesis of the great toe is not a disabling surgery. Interphalangeal osteoarthritis may occur due to joint overuse (12 cases). Kitaoka's series compared outcome after arthrodesis with that after conservative surgery and reported better results with arthrodesis. Revision surgery for hallux valgus using great toe metatarsophalangeal arthrodesis remains an acceptable alternative.

Adult↗
PubMed2001

[Weil's cervicocapital osteotomy for median metatarsalgia. Report of 70 cases].

The authors report a series of Weil's cervicocapital metatarsal osteotomies which were performed to treat central metatarsalgias. The series included 70 central metatarsalgias treated by osteotomy of one to four metatarsals. There was an excess of length of one or several metatarsals in all cases; there were 30 metatarsophalangeal dislocations. The results were evaluated according to Kitaoka's criteria: 20 were quoted very good, 26 good, 9 fair and 3 poor. The osteotomy gave an overall improvement regarding pain and shoe fitting but the mobility of the MP joint was reduced in all cases. The results were satisfactory in cavus feet and in cases where the osteotomy was combined with correction of a hallux valgus. Weil's osteotomy allows accurate adjustment of the shortening and early weight-bearing. This is indicated in cases with excessive length of the central metatarsals and also in cases with metatarsophalangeal dislocations.

Adult↗
PubMed2001

[Anterior tarsectomy for cavus foot. Retrospective study of 52 cases].

The authors reviewed 34 patients treated by tarsectomy for idiopathic pes cavus deformity between 1977 and 1996. Fifty two feet were treated surgically. All patients had undergone previous conservative treatment. The average age was 40 years. Podoscopic examination revealed 24 cavus feet stage 2, 28 cavus feet stage 3, adduction of the forefoot in 15 cases and an equinus deformity in 8 cases. On radiographic examination, Djian-Annonier's angle was 108 degrees on average. All patients were evaluated with a minimum ot two years follow-up, according to the evaluation system of the Massachusetts General Hospital. With an average follow-up of six years and six months, overall results were; 65.5% very good and good, 21% fair, 13.5% poor. The morphological correction was poor in 9 cases. Djian-Annonier's angle was 125 degrees on average. A number of cavus feet do not justify surgical treatment, because they are well tolerated, sometimes with orthopedic orthoses. Tarsectomy must be avoided in neurological conditions. We do not advise release of soft tissue or Dwyer's calcaneal osteotomy. In our opinion, the choice indication for anterior tarsectomy is the nonrigid cavus foot. It must be combined with lengthening of the Achilles tendon when a deficit of dorsiflexion of the foot persists following tarsectomy. According to their importance, associated deformations will be treated in the same operative session or not.

Adolescent↗
PubMed2000

[Osteochondral lesions of the talar dome: surgical treatment in a series of 30 cases].

PURPOSE OF THE STUDY: We reviewed 30 cases of osteochondral lesions of the astragalar vault treated surgically. MATERIAL AND METHODS: Among the 30 patients, 17 participated in sports activities and 24 had a history of trauma. Mean delay to surgery was 10 months. Treatment included osteochondritis curettage and Pridie perforations. Direct access was used in 11 cases, malleolar osteotomy in 13 and arthroscopy in 6. Cancellous bone grafts were used in 6 cases. RESULTS: Mean follow-up was 3 years 7 months (minimum 2 years). All patients had an arthroscan at last follow-up. Evaluation of post-operative outcome was based on clinical assessment and arthroscan findings. Surgical treatment provided very good results in 75 p. 100 of cases with pain relief and improved walking distance. DISCUSSION: Our cases pointed out the important contribution of the FOG (Fracture Osteonecrosis Geode) classification to pathogenic and prognostic analysis. The Berndt and Harty classifications were not found to be useful. CONCLUSION: In case of localized necrosis, we propose arthroscopic perforation curettage. In case of bone loss, a direct cancellous graft may be used.

Adolescent↗
PubMed2000

[Malleolar fractures. Predictive factors for secondary osteoarthritis. Retrospective study of 32 cases].

The authors report a series of 32 ankle fractures treated by internal fixation and reviewed with a follow-up of more than 15 years. The series includes 12 fibular, 14 bimalleolar and 6 trimalleolar fractures. Following Weber's classification, there were 4 type A, 18 type B and 10 type C fractures. The postoperative x-ray showed 28 anatomy reductions; shortening of the fibula from 3 to 5 mm was noted in 4 cases. Clinical results were evaluated according to Kitaoka's criteria, and radiological results according to Magnusson's criteria. Statistical analysis was made with a Chi-square test. The retrospective review at an average follow-up of 15 years showed 19 painfree ankles, normal mobility in 22 cases, absence of edema in 18. The shoe-wear was normal in 30 cases. Walking had returned to normal in 23 cases but radiography showed narrowing of the tibiotalar joint line in 12 cases and lengthening of the medial malleolus in 16. Narrowing of the tibiotalar joint space was associated with lengthening of the medial malleolus in 10 cases. The objective results were rated as follows: 23 good, 8 fair, and 1 poor. With a follow-up of 15 years, we noted degenerative changes in the ankle in 37% of cases in spite of an anatomic reconstruction which had been perfect in 28. Shortening of the fibula, observed in 4 cases, was associated with subsequent ossification below the medial malleolus corresponding to avulsion of the non sutured medial collateral ligament. Nevertheless, degenerative changes of the ankle were clinically well-tolerated. The long term result of internal fixation of malleolar fractures was good. This was achieved only through perfect restoration of the joint anatomy. Contrary to other series, non-operative repair of the medial collateral ligament was associated with long team degenerative changes and reduced mobility of the joint. We therefore now advocate surgical repair of the medial collateral ligament.

Adult↗
PubMed2000

[Surgical treatment of chronic Achilles tendiopathies. Report of 52 cases].

PURPOSE OF THE STUDY: We reviewed a series of 52 cases of chronic Achilles tendinopathy treated surgically by release of the fascia cruris, resection of peritendon, longitudinal incision of the tendon and occasional excision of intratendinous lesions. MATERIALS AND METHODS: The mean course prior to surgery was about 18 months. Twenty-six patients practiced sports. Complaints were bilateral in 12 cases. Pain was always present. Ultrasound exploration evidenced paratendinitis (n=21), tendinosis (n=22) and paratendinitis with tendinosis (n=9) (Puddu classification). Patients were reviewed after a minimal 2-year follow-up. Results were assessed on the basis of clinical findings. RESULTS: Mean follow-up was 5 years 6 months. Twenty-nine patients were free of pain. The range of motion was normal in 48 cases and 29 patients resumed sports activities at the same level as prior to surgery. Outcome was very good in 29 patients, good in 14 average in 6 and poor in 3. DISCUSSION: Stiffness of the tibio-tarsal joint can be avoided by proper mobilization. Outcome appears to be better in middle-aged patients. Poor outcome is closely related to amyotrophy. The presence of a foot deformity does not appear to have an unfavorable influence on outcome. The Achilles tendon must not be infiltrated. Ultrasound is highly contributive, but MRI provides a more accurate analysis. CONCLUSION: Surgical treatment of chronic Achilles tendinopathies can be proposed when conservative treatment has been unsuccessful. Outcome is better in young active patients and in cases where paratendinitis predominates.

Achilles Tendon↗
PubMed1999

[Chronic lateral ankle instability: surgical treatment with periosteum ligamentoplasty and capsular ligament tension. 34 cases].

PURPOSE OF THE STUDY: The authors report a series of thirty four ankle ligamentoplasties treated between 1985 and 1995. MATERIAL: Patients presented an average of 10.4 ankle sprains before surgical treatment. Pre-operative examination found instability in all cases, permanent pain in 58.8 p.cent limited mobility in 11.8 p.cent and permanent oedema in 23.5 p.cent. Surgical treatment associated ligamentoplasty with periosteum and capsular ligamentar tensionning. METHODS: Minimal follow up was two years and averaged 4 years 7 months. Post operative results were assessed according to Saillant's clinical criteria (subjective instability, sprain recurrence, pain). Radiological criteria included plain and stress X-rays (anterior drawer and varus laxity). RESULTS: The authors noticed an improvement of clinical and radiographical criteria, without ankle arthrosis or periosteum graft calcification. The global result was: 23 excellent, 4 good, 1 fair and 6 bad results. All athletes went back to sport. DISCUSSION: Results of this series with almost 80 p.cent of excellent and good results are comparabie with others techniques for ankle ligament reconstruction. CONCLUSION: This simple technique has a main advantages: no injury to the fibularis brevis tendon. Periosteum ligamentoplasty can then be suggested if lateral tibio-tarsal instabilities persist after proprioceptive physiotherapy.

Adult↗
PubMed1999

[Percutaneous tenorrhaphy for Achilles tendon rupture. Study of 29 cases].

PURPOSE OF THE STUDY: Closed percutaneous repair, described first by Ma and Griffith in 1977, have bridged the gap between surgical and conservative treatment of Achilles tendon rupture. The purpose of this study was to evaluate the results of percutaneous repair. MATERIAL AND METHODS: Between 1994 and 1996, 28 patients (18 male, 10 female) with 29 spontaneous ruptures of the Achilles tendon (one bilateral case) underwent percutaneous repair based on approximation and bringing closer both ends of the ruptured tendon using a subcutaneous suture. Material used was 2 Dacron yarn suture 30 cm length fitted with a 5 mm wide harpon and with its other end crimped into a malleable needle 12 cm length. Early mobilization was encouraged, partial weight bearing allowed at 3 weeks and full weight bearing at 6 weeks. Sutures were removed at 8 weeks without anesthesia. Two patients were lost for follow up after complication, one foreign patient returned to his country with good results, 26 tendons underwent physical examination at an average follow up of 15 months; 20 underwent ultrasound examination and Cybex testing. RESULTS: Two patients experienced reruptures after suture removal; 2 patients fell a few days after repair and had rupture of the suture; both were treated with a cast. There were no infection, skin necrosis, hematoma, neurological injuries, or deep vein thrombosis. Eighteen patients were free of pain, 7 had intermittent pain and one permanent pain. Active and passive ankle motion were similar to the contralateral side. Calf circumference measurements on the repaired and normal extremities showed a difference of less than 3 cm in 4 cases, less than 2 cm in 13 cases and 9 patients had symmetrical calves. The average difference between the width of the repaired and normal tendon was 0.5 cm. Clinical documentation of muscle strength was normal in 9 cases, decreased in 14 cases. Three tendons could not be tested. Using the Trillat and Mounier-Kuhn score, 12 patients were rated excellent; 7 good, 7 fair and 4 poor (4 complications). Ultrasound examination demonstrated homogeneous and fibrilate structure in 10 cases. The width of the tendon was found increased in all cases. The strength, power and endurance testing performed on Cybex at 90 degrees and 180 degrees/second and compared to the normal ankle, averaged 65 p. 100 for plantar flexion. DISCUSSION: Complication rate of operative and conservative treatment were compared to percutaneous repair. The results of Cybex testing points out the advantages of early mobilization after Achilles tendon rupture treatment. Ultrasound examination is useful to guide post operative rehabilitation and sports activities. All patients return to work more quickly after percutaneous repair. CONCLUSION: Percutaneous repair of the Achilles tendon is a simple, easy and reliable technique. It seems to fulfil the required conditions: bringing closer tendon ends, maintenance of strong contact, preservation of all anatomical and histological factors inducing healing and a rapid return to social and working activities.

Accidents↗
PubMed1999

[Hallux valgus treated by Scarf osteotomy of the first metatarsus and the first phalanx associated with an adductor plasty. Apropos of 50 cases with a 2-year follow up].

PURPOSE OF THE STUDY: Fifty hallux-valgus were treated with Scarf Osteotomy of the first metatarsal, associated to a phalangeal varisation or shortening osteotomy and an adductor plasty. Patients were evaluated with a minimum follow-up of two years. MATERIAL AND METHODS: Forty five females and two males were operated with an average age of fifty years. The pre operative metatarsus varus was of 15 degrees 8. Mean alignment of metatarsal bar was 31 degrees 4. The cuneo-metatarsal joint was twenty two times spheric and twenty eight times plane. The average metatarso-phalangeal great toe valgus was 39 degrees 8. RESULTS: They were appreciated with a minimal follow-up of two years, according to the 3 Groulier's criteria: correction of deformation, statics troubles, functional activity. The metatarsus varus improved with an average of 10 degrees 4, as well as the alignment of the metatarsal bar (25 degrees). The post operative average phalangeal valgus was 22 degrees 7. These results were statistically significant. Cuneo-metatarsal joint type did not influenced final result. Articular joint line was normal in 64% of cases. Global result was excellent or good in 70%, passable in 22%, and bad in 8% of cases. DISCUSSION: Scarf Osteotomy of the first metatarsal allows complete correction of metatarsus varus. The surgical approach can be proposed at every age. There are no vascular trouble or arthrosis worsening. It must be completed with a phalangeal varisation or shortening osteotomy and adductor plasty.

Adolescent↗
PubMed1999

[Long-term outcome following surgical repair of ruptures of the fibular collateral ligament of the ankle. A report of 50 cases].

The authors report their findings in a series of 49 patients with 50 acute ankle sprains, who underwent surgical repair of their ruptured fibular collateral ligaments. All patients were selected for surgical treatment based upon the findings on stress-films taken under anesthesia, showing a laxity at least superior by 10 degrees to the value found on the contralateral ankle. All patients were reviewed 2 to 12 years after operation. Clinical evaluation was based upon Duquennoy's criteria, and dynamic x-rays were performed in all patients to evaluate residual laxity. The clinical results were good or excellent in 78% of patients, fair in 14% and poor in 8%. Seven patients (14%) complained of subjective instability. Stress films showed residual laxity from 5 to 10 degrees in 10 patients (20%). The authors conclude that their findings do not support the alleged superiority of surgical repair over conservative management of severe ankle sprains.

Adolescent↗
PubMed1999

[Gauthier's subcapital osteotomy in the treatment of metatarsophalangeal luxation of the 2nd ray. Apropos of 44 cases with 5 year followup].

The authors report on a series of 44 metatarsophalangeal dislocations of the second ray which were treated surgically using Gauthier's technique. The patients were 44 middle-aged women. The surgical indication was a dislocation of the 2nd metatarsophalangeal joint with hallux valgus. There was excess length of the second metatarsal ray or acquired shortness of the first metatarsal. The treatment always included an osteotomy of the neck maintained by a transosseous pin. The average follow-up was 8 years and 3 months (minimum 5 years). Postoperative results were evaluated using clinical and radiological criteria. Surgical treatment gave 68.2% very good and good results and 4 recurrences of dislocation. The results in this series are identical with those in other series reported, but the backward displacement of the head of second metatarsal was found to be limited. Weil's osteotomy seems to provide better results because it better restores the relative lengths of the metatarsals and often makes interphalangeal arthroplasty unnecessary. Gauthier's metatarsal osteotomy is an easy procedure which effectively improves static metatarsalgia, but it provides limited metatarsal shortening. Weil's osteotomy is preferable in cases with long lateral metatarsals.

Adult↗