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Biomedical subjects

P Groulier

Publications and source records attributed to P Groulier.

At least 19 recordsLinked to original sources
PubMed2002

[Reconstruction-arthrodesis of the first metatarsophalangeal joint iatrogenic bone defects].

PURPOSE OF THE STUDY: Arthrodesis-reconstruction for metatarsophanlangeal bone defects of the great toe after hallux valgus or hallux rigidus is rarely performed and only a few series are found in the literature. In these series, retarded bone fusion, skin rupture, and interphalangeal intolerance (both clinically and radiologically) have been frequent. The purpose of this work was to determine what parameters contribute to minimizing these postoperative risks. MATERIAL AND METHODS: Thirteen patients, mean age 60 years, were reviewed at a mean follow-up of 7 years. Mean delay from initial surgery to revision surgery was greater than 6 years. Preoperative complaints included metatarsophalangeal pain and especially transfer metatarsalgia. The procedure used corticocancellous bone grafting associated with osteosynthesis and unloading of the forefoot for three months. RESULTS: Eleven of the 13 patients achieved full relief of their metatarsophalangeal pain and metatarsalgia. Twelve of the 13 patients had a satisfactory great toe axis, including 2 who had a secondary osteotomy for correction. Bone fusion was achieved in all 13 patients; one at 8 months. Mean lengthening was 5.1 mm; reconstruction with the corticocancellous graft reconstruction generally filled the bone defect resulting from ablation of the joint prosthesis in 7 cases. The interphalangeal joint was pain free at last follow-up in all cases despite radiological evidence of suffering in one (similar to the situation before the revision surgery). DISCUSSION AND CONCLUSION: Correct position of the arthrodesis is essential to alleviate transfer metatarsalgia. A moderate lengthening of the great toe can minimize the risk of skin rupture. In order to preserve the interphalangeal joint, the position of the arthrodesis must be precise both in the sagittal and horizontal plane, leaving sufficient valgus and avoiding the need for temporary interphalangeal pinning.

Adult↗
PubMed2002

[Surgical treatment of recurrent hallux valgus].

PURPOSE OF THE STUDY: Little work has been reported on the treatment of recurrent hallux valgus. We reviewed 64 cases after surgical treatment in order to ascertain the cause of recurrence, results of the treatment given, and deduce therapeutic options and indications. MATERIAL AND METHODS: Fifty-nine patients had 64 recurrent hallux valgus bunions. Mean age of the patients was 58 years, 54 women and 5 men. The clinical and radiographic preoperative work-up led to two categories of treatments. In 35 cases, conservative treatment was used to re-align the axis by procedures on the soft tissues either alone or in combination with MacBride tendon transfers, metatarsal osteotomies, or osteotomies to shorten the first phalange. In 29 cases, metatarsophalangeal arthrodesis was used. Patient satisfaction, pain, deformation, shoe wearing and activity were recorded at follow-up. The same radiological parameters were used postoperatively to assess anatomic results. RESULTS: Mean follow-up was more than 6 years (range 2-18 years). The subjective result was good in 52 cases. The objective result was good in 50 cases and poor in 14 (including 7 cases with insufficient correction). The results were analyzed by type of treatment. DISCUSSION: The preoperative analysis demonstrated that recurrence is due to insufficient initial treatment which must take into account all the components leading to the deformation. Arthrodesis gave a good result in 83% of the cases and conservative treatment gave a good result in 71%. Thus, in our opinion, no one type of treatment of recurrent hallux valgus can be applied for all patients. Nevertheless, conservative treatment should associate complementary procedures that can be deduced from the clinical and radiological analysis.

Adult↗
PubMed2001

[Triple fracture of the superior shoulder suspensory complex].

The authors present the case of a displaced fracture of the coracoid process associated with a displaced fracture of the acromion, an undisplaced fracture of the clavicule and fractures of the first to fifth ribs. Open reduction of the coracoid process fracture was performed. At the last follow-up, the coracohumeral distance was restored (10 mm), but the acromiohumeral distance in the sagittal place was decreased (5 mm). The authors recommend open reduction of displaced fractures around the rotator cuff to limit the risk of impingement between the cuff and the coracoid process or the acromion.

Acromion↗
PubMed1999

Pigmented villonodular synovitis of the foot and ankle: a report of eight cases.

Eight cases of pigmented villonodular synovitis of the foot and ankle are reported. The purpose of this study was to analyze the manifestation of pigmented villonodular synovitis in the foot and to evaluate treatment options. There were four cases in the ankle and hindfoot, one in the first tarsometatarsal joint, and three in the toes. In seven of eight cases, diagnosis was confirmed by magnetic resonance imaging (MRI) scans. The tenosynovial form was found in the toes and the articular form in the hindfoot and ankle. Surgical treatment was performed in all cases: one arthroscopically assisted synovectomy in the ankle joint, two talocrural arthrodeses, one subtalar arthrodesis, one tarsometatarsal arthrodesis, and tumor removal on the toes with arthrodesis of the distal interphalangeal (DIP) joint in two cases. Average follow-up was 4 years. Recurrence occurred in one toe and led to partial amputation. Malunion in one ankle arthrodesis was operated on again with no sign of recurrence. In the toes, the lesion had a tumoral feature; the bone was infiltrated by soft tissue, and the surgical procedure was local removal of the tumor. In the hind-foot, the lesions were intra-articular and required synovectomy, usually with an arthrodesis. In the midfoot, there was a large extraosseous tumor surrounding tendons with destructive articular lesions.

Adult↗
PubMed1999

Application of bone graft to the medial side of the first metatarsal head in the treatment of hallux varus.

BACKGROUND: Hallux varus deformity is not frequent, is usually acquired, and is poorly tolerated by patients. A common cause is the resection of an excessive amount of the head of the first metatarsal during an operation performed to correct a hallux valgus deformity. The purpose of this study was to evaluate the results of application of bone graft to the medial aspect of the first metatarsal head in order to restore missing bone after resection of an excessive amount of bone during a bunionectomy. METHODS: Of thirty patients who had a hallux varus deformity that was treated operatively, eight (ten feet) had bone-grafting to the medial aspect of the first metatarsal head. Six patients (seven feet) were available for evaluation at an average of 8.6 years (range, two to twenty-two years) postoperatively. The original reasons for the consultation for the hallux varus deformity were pain in the great toe, discomfort with shoewear, and the cosmetic appearance of the deformity. The pain typically was located on the medial aspect of the great toe and was caused by the pressure of the shoe; the pain usually was aggravated by walking. Preoperatively, the passive range of dorsiflexion averaged 72 degrees (range, 60 to 80 degrees); the passive range of plantar flexion, 12 degrees (range, 10 to 20 degrees); and the varus deformity, 18 degrees. RESULTS: Six of the seven feet had a satisfactory result. The pain associated with the varus deformity had disappeared in all patients. One patient was dissatisfied because of 20 degrees of valgus angulation. The passive range of dorsiflexion averaged 63 degrees (range, 60 to 70 degrees), and all patients had 10 degrees of plantar flexion. Overall, the valgus angulation of the metatarsophalangeal joint averaged 19 degrees (range, 16 to 22 degrees). There was no recurrence or persistence of the varus deformity. In three feet, the joint space was reduced, but this did not jeopardize the clinical result. CONCLUSIONS: A bone graft screwed onto the medial aspect of the metatarsal head provided a good result. This technique is indicated when the varus deformity is related to a previous resection of an excessive amount of bone during a bunionectomy and when the deformity is passively reducible to neutral.

Adult↗
PubMed1999

[Treatment of spastic equinovarus foot in the hemiplegic adult by retrograde fixation of the peroneus brevis tendon onto the anterior tibialis tendon].

PURPOSE OF THE STUDY: The purpose of the present study was to assess the Bardot procedure in the treatment of equinovarus deformities of the foot in spastic hemiplegia. This procedure associates the fixation of the peroneus brevis distal tendon onto the tibialis anterior, heel-cord lengthening, and tenotomies of the flexores digitorum. MATERIAL AND METHODS: Fifty-six patients underwent this procedure between 1989 and 1996. The indication for surgery was equinovarus deformity in adult spastic hemiplegia. Preoperatively all the patients had an instability and 80.5 per cent of them had to wear an ankle and foot orthesis. Postoperatively forty-one patients with a mean follow up of 3.5 years (range: one to 9 years), were available for examination including 24 females and 17 males with a mean age of 46 years at time of surgery (range: 27 to 76). RESULTS: All the patients were objectively improved. Seven of them had a discreet residual varus deformity, but none felt unstable. They all were able to walk barefooted, only one patient still required an adapted shoe. The gait and the quality of live were subjectively improved for 92.7 per cent of the patients. None of the patients has been worsened. DISCUSSION: When spastic equinovarus disturbs significantly quality of live, tendon re-balancement of the hemiplegic foot should be proposed. The fixation of the distal tendon of the peroneus brevis onto the tibialis anterior is effectively performed only if this latter is efficient in the swing phase of gait. If there is no fixed contracture, neurosurgery or chemotherapy are preferable. In case of irreducible articular deformities arthrodesis could be indicated. CONCLUSION: Tendon re-balancement in hemiplegic foot using a peroneus tendon fixation onto the tibialis anterior should be carried out after examination by a team of specialists (surgeon, neurosurgeon, rehabilitation team). In such conditions it offers constantly an improvement to the patients.

Adult↗
PubMed1999

[Traumatic ruptures of the pectoralis major muscle. Apropos of 3 cases].

INTRODUCTION: Three ruptures of the pectoralis major are reported. The mechanism of injury was excessive external rotation with high muscular tension. Rupture of muscle often occurs at the humeral insertion or musculotendinous junction. MATERIAL AND METHODS: In the three cases, surgical repair was performed. Suture could be made without excessive tension. Patients were immobilized in a sling for three weeks. Passive exercises were begun at 3 weeks. RESULTS: All patients recovered and had postoperatively the same sport level as before. In late surgical repair the consistent fibrosis makes dissection of the ruptured tendon difficult and it's retraction hinders the suture. DISCUSSION: The symptoms are sometimes initially under evaluated. In limited number of cases the treatment may be delayed: functional disability and strength limitation justify surgical treatment. The results, however, are usually good according to the score of Mc Entire. Surgical repair is recommended in distal ruptures in active patients to restore previous muscle strength and contour.

Adult↗
PubMed1999

[Complications associated with the use of first generation Harris-Galante porous-coated acetabular component after a mean follow-up of 7 years].

MATERIAL AND METHODS: Hundred and twelve hip were studied in 107 patients with a mean follow-up of 7 years (range, 6-9 years). Harris and Postel-Merle d'Aubigné clinical hip scores were used. The prosthetic components were evaluated using radiographic criteria. RESULTS: The mean Harris score was 91 (range, 34-100). The incidence of proximal pain was 3.7 p. 100 in anterior area and also 3.7 p. 100 in posterior area. Radiolucent lines were present in one acetabular zone in 28.5 p. 100 of cases, in two zones in 26 p. 100, in all three zones in 5.5 p. 100. No statistical significant corelation was identified relating pain and radiolucent lines. The mean rate of linear wear per year was 0.1 millimeter. A statistically significant corelation was identified relating a linear wear per year above 0.12 millimeter and the presence of radiolucent lines. A major polyethylene wear (from 2.75 to 3.5 millimeters) was found in 5 cases. One of them had an acetabular osteolysis. One acetabular liner was found unstable in the metal shell during a hip revision for a major wear. Two patients had a dislocation of the liner in the metal-back. Eight hips needed a revision surgery, always for a failure of the polyethylene liner, never for a loosening between the socket and the acétabulum. DISCUSSION AND CONCLUSION: The acetabular component bone fixation of this Harris-Galante prosthesis appears optimum. The polyethylene wear and the unstability between the polyethylene cup and the metal socket need to stop using this component. The fixation between his two parts have to be improved.

Acetabulum↗
PubMed1999

[Isokinetic comparative study at the third postoperative month after surgery of the anterior cruciate ligament with arthroscopy or after mini-arthrotomy].

PURPOSE: A double blind prospective study was performed in 64 patients with a clinical and isokinetic assessment three months after anterior cruciate ligament (A.C.L.) reconstruction. MATERIAL AND METHODS: This work included 64 patients (47 males and 17 females), divided in two groups: 41 patients had an arthroscopically assisted bone-tendon-bone A.C.L. reconstruction, 17 had an open procedure. The isokinetic records concerned peak torque and muscular work at two different speeds. RESULTS: Three months after surgery there was no significant difference between both groups particularly what concerns the isokinetic assessment in muscular performances. Peak torque in hamstring averaged 151.4 Nm in the open procedure group and 149.2 Nm in the arthroscopically assisted group (p = 0.7), in quadriceps 156.10 Nm vs 149.3 Nm (p = 0.47). DISCUSSION: The advantages of arthroscopy in early muscular recovery are rarely admitted in medical literature. CONCLUSIONS: The favorable opinion of the authors to the arthroscopically assisted A.C.L. reconstruction concerning its rapid muscular recovery abilities is only based on subjective criterions.

Anterior Cruciate Ligament↗
PubMed1998

Ambulatory treatment of multidrug-resistant Staphylococcus-infected orthopedic implants with high-dose oral co-trimoxazole (trimethoprim-sulfamethoxazole).

We examined the effectiveness and safety of high-dose oral co-trimoxazole (trimethoprim-sulfamethoxazole) for the treatment of orthopedic implants infected with multidrug-resistant Staphylococcus species. The prospective study was conducted between 1989 and 1997 in a university medical center with ambulatory-care services. Patients eligible for the study consisted of those from whom multidrug-resistant Staphylococcus spp. organisms susceptible only to glycopeptides and co-trimoxazole were isolated from their orthopedic implants and for whom there was no contraindication to the treatment. All patients were treated orally with high-dose co-trimoxazole (trimethoprim, 20 mg/kg of body weight/day; sulfamethoxazole, 100 mg/kg/day). Patients with prosthetic hip infections were treated for 6 months, with removal of any unstable prosthesis after 5 months of treatment; patients with prosthetic knee infections were treated for 9 months, with removal of any unstable prosthesis after 6 months of treatment; and patients with infected osteosynthetic devices were treated for 6 months, with removal of the device after 3 months of treatment, if necessary. Monthly clinical evaluations were conducted until the completion of the treatment, and follow-up examinations were conducted regularly for up to 6 years. The overall treatment success rate was 66.7% (26 of 39 patients), with success rates of 62.5% for patients with prosthetic knee infections, 50% for those with prosthetic hip infections, and 78.9% for those with other device infections. Seventeen of the 28 (60.7%) patients who did not have any orthopedic material removed were cured. Eight patients stopped the treatment because of side effects, and one patient was not compliant. In three patients treatment failed because of the appearance of a resistant bacterium. Long-term oral ambulatory treatment with co-trimoxazole appears to be an effective alternative to the conventional medicosurgical treatment of chronic multidrug-resistant Staphylococcus-infected orthopedic implants which includes long-term intravenous antibiotic therapy combined with surgical debridement and removal of foreign material or its subsequent one- or two-stage replacement.

Administration, Oral↗
PubMed1998

[Static instability and dislocation of the 2nd metatarsophalangeal joint. Comparative analysis of 2 different therapeutic modalities].

PURPOSE OF THE STUDY: The authors report the results of instabilities and dislocations treatment of the second metatarsophalangeal joint using two different surgical methods. MATERIAL AND METHODS: This study included 129 patients (131 feet) with 19 instabilities, 43 subluxations and 69 dislocations of the second metatarsophalangeal joint. The first group of 66 patients (75 feet operated before 1994) had an arthrolysis using a dorsal approach associated to a lengthening of the tendon extensor digitorum longus. Reduction of the metatarsophalangeal joint was fixed by a K wire (15 feet of this group had an associated basimetatarsal osteotomy). The second group of 53 patients (56 feet operated since 1994) had the association of arthrolysis, tendon lengthening, and distal metatarsal osteotomy according to S. Weil. RESULTS: Results were appreciated on different criterions: deformity recurrence, emergence of metatarsalgia on the adjacent ray, discomfort in walking and shoe wearing. Results are significantly better in the second group of patients. DISCUSSION: The main cause of second ray lesions is related to metatarsal relative length abnormality. The authors compare different surgical techniques for the metatarsophalangeal joint, distally and proximally to it, and assess indications. CONCLUSION: The better the relative length abnormality is corrected, the better is the prognosis after treatment.

Adult↗
PubMed1998

[Sagittal load-bearing tomography of the forefoot and static metatarsalgia].

We describe the use of weight-bearing foot tomograms. The outline of the food is drawn so as the axes of the metatarsal beyond the toes on the AP plain radiogram and the tomograms are done successively on each metatarsal. This morphological, but also functional, analysis enables exact diagnosis of excessive loading on the metatarsal head. This procedure is used in case of metatarsalgia with normal metatarsal length and in late post-traumatic sequellae of the forefoot. Surgical correction can then be precisely performed.

Arthralgia↗
PubMed1998

[Pigmented villonodular synovitis of the knee. Treatment results in 22 cases].

PURPOSE OF THE STUDY: The authors report their experience about 22 cases of pigmented villonodular synovitis of the knee observed between 1970 and 1997. The authors studied the results of treatments according to localization, evolutionary stage and condition of an early diagnosis. MATERIAL AND METHODS: Among thirty three cases of pigmented villonodular synovitis treated during the same period the knee was involved in twenty two cases. Diagnosis was done or highly suspected in 13 cases because of significant symptoms (iterative hemarthrosis, bony gap in both articular components of the joint) or by MRI. The biopsy performed in each case allowed histological assessment in 22 patients. Surgical treatment was achieved in 19 patients. Three knees were not operated (two patients refused; one had a synoviorthesis) the treatment was a synovectomy alone for fifteen patients; four patients, needed a knee prosthesis, because of important degenerative joint disease. RESULTS: Fourteen patients, with a mean follow-up of five years were reviewed. Four had a recurrence which appeared between three and eight years after subtotal synovectomy for diffuse synovitis. There were no recurrence after arthroplastic treatment and in localized lesions. DISCUSSION: Pigmented villonodular synovitis should be treated as soon as possible but its different clinical features make diagnosis sometimes difficult. Because of an aggressive tendency of the disease which finds expression in extensive lesions in joint and bone, and early diagnosis allowed by MRI could make the prognosis more favourable. CONCLUSION: Surgical synovectomy is the usual treatment. In evolved stages arthroplasties are performed. Localized lesions and recurrences should need arthroscopic treatment.

Adolescent↗
PubMed1998

[Posterior position of acetabular component of a total hip prosthesis: possible cause of lower limb rotation problem].

INTRODUCTION: The authors report the case of an internal rotation of the lower limb, lately ascribed to a posterior placement of the acetabular component during total hip arthroplasty. MATERIAL AND METHOD: A 58 years old female had an irreducible internal rotation of the right hip 3 years after total hip arthroplasty for arthritis. When the hip was extended, the lower limb showed an irreducible internal rotation of 45 degrees. In flexion of the hip this rotation disappeared. AP radiograms showed femur and femoral stem in internal rotation, a healed fracture of the acetabulum, and the acetabular component seemed to be in correct position. On CT scan the acetabular component was 4 cm posterior to the anatomic location, although there was no abnormal anteversion of the stem and acetabular component. Revision, with relocation of the acetabular component, corrected lower limb rotation. DISCUSSION: Posterior position of the acetabular component has not been described as a cause of lower limb malrotation. Normally the strength of the external hip rotators muscles is three times as important as of the internal rotators. The transverse acetabular fracture led to backwards placement of the acetabular component and yelded in an automatic internal rotation of the femur, because the trochanter kept an anatomical position in the horizontal plane. The posteriorised rotation center of the hip had changed the balance of the different rotator muscles, some of them, originally external rotators, becoming internal rotators.

Acetabulum↗
PubMed1997

Oral treatment of Staphylococcus spp. infected orthopaedic implants with fusidic acid or ofloxacin in combination with rifampicin.

Oral therapy of staphylococcal infection of orthopaedic implants with 900 mg/day rifampicin combined with either 1.5 g/day fusidic acid for 5 days followed by 1 g/day thereafter, or 600 mg/day ofloxacin was compared. Patients with an infected hip were treated for 6 months, with removal of any unstable prosthesis after 5 months' treatment and those with an infected knee prosthesis were treated for 9 months, with removal of the prosthesis after 6 months of treatment. Patients with infections of other type of bone implants were treated for 6 months with removal of the implant after 3 months of treatment, if necessary. Cure was defined as the absence of clinical, microbiological and radiological evidence of infection 12 months after completion of treatment. The treatment of 46 of the 52 included in the study was evaluated for safety and that of 42 was assessed for efficacy. Overall treatment was successful for 11 (55%) of 20 patients treated with rifampicin and fusidic acid group and for 11 (50%) of the 22 treated with rifampicin and ofloxacin. Treatment failed in four cases in each treatment group because of persistent infection. One patient given rifampicin and fusidic acid and three patients given rifampicin and ofloxacin failed treatment because of relapse. Superinfection led to failure in the remainder and was due to staphylococci in all but one case in which Acinetobacter calcoaceticus var. anitratus was isolated. There were no side effects related to study treatment. Oral treatment with rifampicin combined with fusidic acid may be a suitable alternative to the combination of rifampicin and ofloxacin for treating implant infections due to Staphylococcus spp. either when the patient is intolerant to quinolones or when the infecting organism is resistant to these drugs.

Administration, Oral↗
PubMed1996

[Synovial cyst of the supracapsular notch of the shoulder with supracapsular nerve compression in a sportsman. Apropos of a case. Review of the literature].

PURPOSE OF THE STUDY: Compression of the supra scapular nerve by a ganglion is rare. The authors report a case evoking rotator cuff tendinitis. MATERIALS AND METHODS: A 28 year old right handed handball player was seen for increasing pain and weakness in the right shoulder. He was treated in a first time for a rotator cuff tendinitis. In a second time a new clinical examination revealed an amyotrophy of the supraspinatus fossa. Electromyographic studies showed a denervation of the infra and supraspinatus muscle. An MRI was performed and showed a ganglion cyst at the suprascapular notch. RESULTS: An excision by posterior approach was performed and led to an uneventful recovery of the patient. DISCUSSION AND CONCLUSION: This case reveals that an entrapment neuropathy of the suprascapular nerve can take the appearance of an ordinary rotator cuff tendinitis.

Adult↗
PubMed1996

[Retrospective analysis of 78 surgically repaired fractures of the radial head].

The authors present a analysis of 78 cases of radial head fracture operated in the same department. 16 cases were added to the first study of 62 cases operated between 1967 and 1988 and published in 1991. According to the Mason classification modified by Morrey, there were 22 type II, 24 type III and 32 type IV. Surgical treatment consisted in an osteosynthesis in 35 cases, a fracture fragment excision in 9 cases, a resection of the head in 24 cases, a silastic prosthesis in 10 cases. The results have been studied on a functional and radiological basis with follow-up from 2 to 23 years (mean 5 years). The authors noted the good results of the type II fractures which had an osteosynthesis, the satisfactory results in more than 50% of the cases with resection of the radial head. The comparison of both series established the absence of prosthesis in the recent one. The poor results of the comminutive fractures with elbow dislocation lead the authors to consider the prothesis in these fractures, as a possible indication.

Adolescent↗