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P Thoreux

Publications and source records attributed to P Thoreux.

14 recordsLinked to original sources
PubMed2006

Anatomical basis of arthroscopic capsulotomy for elbow stiffness.

Stiffness is a frequent condition in elbow pathologies, both traumatic and non-traumatic, and usually requires an operative treatment including an anterior capsulotomy. Elbow arthroscopy is certainly an alternative to surgery, but the technique of arthroscopic capsulotomy remains controversial. Our aim was to study the anterior elbow capsule anatomy to recommend an efficient and safe arthroscopic capsulotomy. We dissected ten cadaveric elbows and analyzed the insertions of the anterior capsule, their variations and the relationships with the surrounding neurovascular structures (radial and median nerve, brachial artery). The influence of elbow flexion was studied on fresh elbows with radioscopic evaluation. The distances between the anterior capsule and the neurovascular structures were measured at four reference levels. The insertions of the anterior capsule were also studied on the embalmed elbows. The radial nerve is always the closest structure to the capsule, but in this study it was always protected by the brachialis muscle. The distance between the anterior capsule and the neurovascular structures is consistently higher on the proximal side, regardless of which structure is considered. The 90 degrees flexion position allows the best capsular distension and offers optimal security with regard to neurovascular structures. All arthroscopic surgeons are concerned about potential neurovascular complications (varying from 0 to 14% in the literature). Previous anatomical studies examined the relationships between the arthroscopic portals and the neurovascular structures. This study developed a precise description of the relationship between the anterior capsule and the surrounding neurovascular structures, which let us recommend technical parameters to conduct a safe arthroscopic capsulotomy.

Arthroscopy↗
PubMed2005

Neurovascular relationships of the approaches for arthroscopic total trapeziectomy with ligamentous stabilization.

The aim of this study was to define the neurovascular relationships of the approaches used during arthroscopic total trapeziectomy with the Thompson "suspension-plasty." Fifteen fresh cadavers in which trapezio-metacarpal arthritis had been confirmed by preoperative radiographs were chosen. There were 12 women and 3 men (average age: 87 years), and small joint arthroscopy equipment was used. Two approaches for the trapezio-metacarpal joint were used: an ulnar approach situated at the ulnar border of the extensor pollicis brevis tendon and a radial approach placed at the middle of a line joining the tendons of the flexor carpi radialis and the abductor pollicis longus. A new transosseous approach at the base of the first metacarpal ("trans-M1" approach) is suggested and was used to do the ligamento-plasty. After the operation, a large skin flap was elevated in order to measure the distance between each surgical approach and the different neurovascular structures (radial artery, dividing branches of the superficial branch of the radial nerve and the end of the lateral cutaneous nerve of the forearm) and to verify the absence of neurovascular lesions. The different neurovascular structures at risk during this arthroscopic maneuver were the radial artery for the ulnar approach, the branches of the superficial branch of the radial nerve for all of the approaches and the ending of the lateral cutaneous nerve of the forearm for the radial and "trans-M1" approaches. The use of the approaches described allows arthroscopic trapeziectomy with the Thompson suspension-plasty without us having noted neurovascular lesion.

Aged, 80 and over↗
PubMed2005

[Long-term follow-up after leg replantation].

Leg replantation is generally considered to yield good results, particularly since the widespread use of progressive lengthening procedures. This optimism must be weighted against the very long and difficult operative program, the social and occupational implications, and the functional outcome of the replanted limb. We report a case of below knee leg replantation in a young patient whose operative program lasted 29 months. Occupational activities were interrupted for three years. The clinical result was satisfactory but with 14 degrees residual valgus suggesting a potential risk of osteoarthritis and difficult therapeutic decisions. The alternatives to replantation are controversial. Leg transplantation is not a valid option in our opinion. Amputation with orthesis should be considered more often because complications are rare and recovery much shorter. Indications for leg replantation should be considered with prudence.

Adult↗
PubMed2005

[Pre-operative diagnosis of bucket-handle meniscal tears: clinical evaluation and value of arthroscan and MRI radiological criteria].

PURPOSE OF THE STUDY: It is important for both the patient and the surgeon to determine whether a meniscal lesion can be repaired before undertaking surgery. The purpose of this study was to examine the pertinence of clinical signs and determine the value of imaging findings for the preoperative diagnosis of bucket-handle meniscal tears. This preliminary study was conducted before undertaking an analysis of preoperative criteria of reparability in a homogeneous group of meniscal lesions. MATERIAL AND METHODS: This retrospective series included 33 arthroscopically-proven bucket-handle meniscal tears in patients who underwent arthrography and/or arthroscan and/or MRI preoperatively. The images were reviewed by two senior radiologists who established a consensus diagnosis. Clinically, the type of blockage and the presence of permanent flexion before surgery were noted. The following items were noted on the imaging results: fragment displacement (fragment in the notch on the coronal slice) anterior megahorn, double PCL, and serpent sign on the sagittal slice. Longitudinal, transversal extension and position of the bucket-handle were noted. We searched for correlations with the intraoperative findings. RESULTS: Fourteen patients had a history of knee blocking and 15 had permanent flexion before surgery. Only 10 patients had the typical association of blocking and flexion. Certain diagnosis of bucket-handle meniscal tear was provided by MRI (13/15), arthroscan (6/7), and arthrography (10/24) giving an equivalent sensitivity for the two slice imaging techniques. The sign of a fragment in the notch on the coronal slice was a constant finding. The double PCL sign was sensitive for medial meniscal tears and for lateral meniscal tears with associated ACL tears. The diagnosis was successfully established in all 9 patients who underwent several explorations (2 or 3). Buckle-handle meniscal tear was not identified in 9 patients (arthrography 7, MRI 2). DISCUSSION: Our findings demonstrate that the preoperative diagnosis of bucket-handle meniscal tears cannot be properly established on clinical criteria of typical blocking and/or permanent flexion. They confirm that arthrography is not contributive to diagnosis and that the absence of a slice image is detrimental to diagnosis. The sensitivity of the two slice imaging methods was similar. The key sign was the presence of a fragment in the notch on the coronal slice; in the three cases where this sign was absent, the reason was found to be the small size of the displaced fragment (resolution limit) and time between imaging and arthroscopy. The characteristic features of the bucket-handle lesions observed in this series are exactly the same as reported in earlier reports but to our knowledge provide the first data on comparative performance of arthroscan and MRI. CONCLUSION: The noninvasive nature of MRI and the possibility of assessing the meniscal wall and the quality of the meniscal tissue make MRI the exploration of choice for preoperative assessment of meniscal tears.

Adolescent↗
PubMed2005

[Not Available].

Explore the source record for details and available documents.

Journal Article↗
PubMed1996

Magnetic resonance angiographic analysis of atlanto-axial rotation: anatomic bases of compression of the vertebral arteries.

The aim of this study was to identify the functional anatomic factors involved in the maintenance or disturbance of flow in the vertebral aa. during atlanto-axial rotation. Fourteen healthy volunteers were studied by magnetic resonance angiography (MRA) by a three-dimensional sequence in phase contrast centered on the vertebral aa. at the level of the cranio-cervical junction before and after left rotation of the head. A decrease in the signal intensity of the arterial flow was sought for. The results were compared to the posterolateral development of the loop of the vertebral a. in its atlanto-axial segment in neutral position, and to the measurement of the angular opening between the atlas and axis in dynamic position. Seven subjects also had a three-dimensional CT study (3D CT) of the bony relations of C1 and C2 after rotation. In 4 subjects a disturbance of flow in the right vertebral a. was observed in the transverse foramen of C2. This occurred when two factors were combined: an under-developed atlanto-axial arterial loop and a C1-C2 angle exceeding 35 degrees in maximal rotation. In the other subjects a well-developed arterial loop and/or a C1-C2 angle of less than 35 degrees in maximal rotation were factors preserving the arterial flow. The risk factor associated with the C1-C2 angle seemed correlated in 3D CT with loss of the usual asymmetric character of rotation. A clinical application is reported with a case combining chronic rotational dysfunction of the cranio-cervical junction as shown by 3D CT and complete compression of the vertebral a. in MRA, confirmed by conventional angiography. A knowledge of this physiopathologic mechanism allows clinical detection and evaluation of the risk of any effect of pathology of the cranio-cervical junction on the vertebral a.

Adolescent↗
PubMed1994

Three-dimensional CT analysis of atlantoaxial rotation: results in the normal subject.

A three-dimensional analysis of atlantoaxial rotation was made by computed tomography in ten healthy subjects. The method described allowed study of spatial relations between C1 and C2 interspace under both static and dynamic conditions, using a projection in a fixed transverse plane. The results demonstrated an axis of rotation for C2 slightly anterior to that for C1. Asymmetric rotation was observed, the separation between the transverse foramina of C1 and C2 being less marked on the side opposite to the direction of rotation of the head. This use of CT and these anatomic findings may be useful in the study of disorders of atlantoaxial rotation and their effect on the vertebral arteries.

Adult↗
PubMed1994

Haematological effects of postoperative autotransfusion in spinal surgery.

A prospective, randomized, controlled study was performed to determine the haematological and biochemical changes and clinical safety of postoperative autotransfusion (Solcotrans Orthopedic Plus system) in patients undergoing spinal surgery. Fifty patients were studied and were randomly allocated to Control (n = 25) and Solcotrans (n = 25) groups. Both groups had their postoperatively drained blood collected into the Solcotrans reservoir but only the Solcotrans group had this salvaged blood considered for reinfusion. After a 5-h postoperative collection period, analysis of the shed blood showed a haematocrit of 0.26 +/- 0.11, few platelets (80 +/- 63 10g.l-1), a fibrinogen level of less than 0.1 g.l-1 and a high level of D-dimers. The salvaged blood did not clot and aerobic and anaerobic culture produced no growth. The volume of blood collected was greater than 200 ml in 21 patients in the Solcotrans group who were autotransfused (384 +/- 101 ml, range 200-600 ml), and in 16 patients in the Control group. Within 15 min following completion of reinfusion of the salvaged blood there was a significant, but moderate decrease in platelet count (181 +/- 74 vs 223 +/- 90 10g.l-1, P < 0.001) and fibrinogen concentrations (2.1 +/- 0.8 vs 2.3 +/- 0.9 g.l-1, P < 0.02), and an increase in circulating D-dimers (P < 0.001) and plasma free haemoglobin concentrations (236 +/- 155 vs 82 +/- 79 mg.l-1, P < 0.001). Prothrombin time (PT) and activated partial thromboplastin time (APTT) did not increase, and potassium concentrations were not significantly affected.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood↗
PubMed1991

[Achilles tendinitis].

Achilles tendinitis is particularly frequent in athletes. In fact, this entity is made up of various anatomical lesions located in Achilles tendon or at the point where it is attached to the calcaneum. The diagnosis is basically clinical, and it is confirmed by carefully selected paraclinical examinations. Management essentially relies on rest associated with adequate physiotherapy and, when required, with other adjuvant treatments. Management also rests on the prevention of recurrences and on the suppression of the frequently found sport-related causal agent. Surgical treatment is seldom indicated, and only when medical treatment has failed, usually in high-level athletes.

Achilles Tendon↗
PubMed1987

[Surgical treatment of Achilles tendinitis in athletes].

A study of 65 cases of Achilles tendinitis treated surgically has allowed us to define the specific symptomatology of the lesion which particularly affects young athletes. Surgical treatment should only be given for high-level athletes who are well-motivated and in whom tendinitis prevents their sporting activity and has proved resistant to prolonged and adequate medical treatment. The details of the suggested operative technique are described. A review of the results shows that, after unsuccessful medical treatment, surgical treatment allowed the athlete to return to his sporting activity in 86 per cent of cases. Post-operative cutaneous or tendinous complications were rare and were directly linked to intra-tendinous injections with steroids.

Achilles Tendon↗
PubMedDate not supplied

[Neurologic complications of surgery of the spine in adults].

Spine surgery exposes to neurological complications. There were 170 immediate complications of spine surgery at Pitiè-Salpétrière Hospital out of 2,855 reviewed (5.95%) during 9 years. The nature of the complication (radicular or medullar), severity and evolution were quite different but less than 2.76% where permanent. Among them, 1.43% were major neurological complications. The "high risk" etiologies were cervical stenosis and primitive malignant tumors. The major cause for these complications was due to surgical procedure in 60% of the cases.

Adult↗