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P Vives

Publications and source records attributed to P Vives.

At least 19 recordsLinked to original sources
PubMed1996

[Fractures of the tarsal scaphoid].

PURPOSE OF THE STUDY: The authors relate a series of 47 cases of tarsal scaphoid fractures, between 1976 and 1992. MATERIAL AND METHODS: These fractures occurred 11 times after a high level fall, 28 times after a motor vehicle accident and 8 times after a direct traumatism. The fracture line was vertical 35 times; horizontal 27 times. An impaction was often associated (32 cases). In 17 observations, a true enucleation occurred as a part of the fracture dislocation. Many periscaphoidal lesional associations were found. 39 fractures were fixed. Radiographs showed 30 consolidations with an anatomical reduction. 37 patients were reviewed with an average follow up of 7 years and 6 months. RESULTS: Results were assessed using Mestagh's scoring system: 7 very good, 15 good, 6 fair and 9 bad. The very good and good results represent 59 per cent. In 37 patients reviewed, the clinical investigation showed 8 deformities of valgus flat foot, a varus foot, requiring 11 times orthopedic soles wearing. 11 patients had a lameness. Radiological results showed 11 times a peri-scaphoidal arthrosis, a necrosis and 2 non union. A narrowing of the astragalo-cuneate joint line was found 8 times. DISCUSSION: Various anatomical types don't have the same prognosis. Vertical and horizontal fractures gave 18 times a very good and good result when in 11 reviewed patients with a fracture dislocation, we noticed 7 poor or bad result. An osteosynthesis by screw gives goods results when fragments are large. For compound fracture when a surgical procedure will be insufficient, the conservative treatment, if keeps a sufficient breadth of medial arch, can give a satisfactory result. An immediate astragalo-scaphoïdal arthrodesis can be suggested in front of a multi-fragmentary dislocation fracture. CONCLUSION: The scaphoïdal tarsal fracture is unusual and its diagnosis remains sometimes difficult. The treatment is often surgical by direct approach. In consideration of the pejorative post-operative outcome of fracture dislocations, some authors suggest an immediate astragalo-scapho-cuneate arthrodesis.

Adolescent↗
PubMed1996

[Subtalar dislocations. Apropos of 35 cases].

PURPOSE OF THE STUDY: The subtalar dislocation is a rare injury. The authors appreciate the difference of frequency between medial and lateral displacement, the factors likely to increase a classical favorable prognosis and the therapeutic attitude to suggest. MATERIAL AND METHODS: 35 observations were included of which two bilateral, 26 had a medial displacement, 9 a lateral displacement. Treatment was conservative in 21 cases and surgical in 14 cases. The results were analysed using Gay and Evrard's clinical scoring system at which we added radiological results. RESULTS: The average follow-up was 7 years and 7 months. The global results are 11 excellent, 13 good, 9 fair, 2 poor. DISCUSSION: The high frequency of medial displacement is explained by the fact that the subtalar joint is only really unstable in inversion. The lateral displacement is rare. The prognosis is good in pure dislocation. It is only good enough every time a fragmentary talar fracture is associated as a factor of stiffness. The 11 arthrosis cases are secondary to a dislocation associated with a talar dislocation, a scaphoid dislocation or a vascular injury. In the series, there is no syndrome of tarsal sinus, and no post traumatic instability. Talar necrosis are rare: 3 cases in this series. They occur following large dislocations at the limit of enucleation. The reduction is urgent. The treatment is more often conservative. It must be surgical in case of associated injury requiring a surgical procedure or in front of widely open dislocation. CONCLUSION: Subtalar dislocation is a rare injury. In the majority of cases, the displacement is medial. The prognosis is good in pure cases. It's only good enough every time a fragmentary talar fracture is associated as a factor of joint stiffness.

Accidental Falls↗
PubMed1996

Mycobacterium kansasii infection limited to the skin in a patient with AIDS.

We describe a case of cutaneous Mycobacterium kansasii infection in a 56-year-old man with acquired immunodeficiency syndrome, who received treatment with trimethoprim-sulphamethoxazole for Pneumocystis carinii pneumonia. Resolution of the cutaneous lesion was observed without specific treatment.

HIV Infections↗
PubMed1996

["Chevron" basal osteotomy of the middle metatarsal bones for static metatarsalgia. Apropos of 69 cases].

PURPOSE OF THE STUDY: Round or flat forefoot metatarsalgia are frequent and surgical techniques are various. The authors relate a series with chevron basi-metatarsal osteotomy. MATERIAL: 69 operated metatarsalgia were reviewed at a mean follow up of 5 years. METHODS: The surgical approach was dorsal, aligned on metatarsal diaphysis. The basi metatarsal "chevron shape" osteotomy was performed using an oscillatory saw, on 1, 2 or 3 metatarsi inducing lowering and shortening. This osteotomy wasn't fixed. Weight bearing was allowed at the third post-operative day. RESULTS: In 68 per cent of cases, the global result was good or very good, but it persisted 32 per cent of post-operative pain either climatic or continuous, including 29 per cent metatarsalgia. The plantar corns only disappeared one out of twice, but the shoe wearing was improved in 82.6 per cent of cases. DISCUSSION: This study showed that the results improved when 3 median metatarsal osteotomy were performed simultaneously. The forefoot morphology didn't influenced the final result. In fact, this technique includes a good result one out of twice in hollow feet. It seems that three metatarsal osteotomies induce a metatarsal elevation and shortening, once out of twice. CONCLUSION: The advantage of this technique are : a dorsal medio plantar surgical approach, an osteotomy realized in cancellous bone and no need for fixation allowing a more accurate adjustment of the metatarsal height.

Adult↗
PubMed1996

[Labeled leukocyte scintigraphy and total hip prosthesis].

During the last few years, labelled leukocyte scintigraphy has become a decisive tool in the diagnosis of bone infections. However, this test may sometimes be deceptive as far as hip prostheses are concerned. The authors have carried out a retrospective study of 62 labelled leucocyte scintigraphies performed for suspected infection of a hip prosthesis. The comparison of the results with the different clinical, biological and radiological factors and the follow up of the patients allows determination of the sensitivity and specificity of this test which are 41% and 100% respectively. The results reported in the literature and the indications for this examination are discussed.

Adult↗
PubMed1995

Subcutaneous sarcoidosis with dactylitis.

Subcutaneous sarcoidosis appears to be rare and is usually associated with hiliar adenopathy. Finger swelling is well recognized in patients with sarcoidosis and usually results from bony involvement or tenosynovitis. We report a patient with subcutaneous sarcoidosis and dactylitis. Biopsy of a finger and of subcutaneous nodules showed similar features with a granulomatous infiltrate. There were no osseus or tendinous lesions.

Female↗
PubMed1995

[Hallux valgus treated by shortening of the first phalanx with trans-epiphyseal impaction and adductor plasty. Apropos of 49 cases with 5-years follow-up].

PURPOSE OF THE STUDY: 49 cases of hallux-valgus were treated by a shortening of the phalanx with impaction according to the technic described by Regnauld, associated with a plasty of the adductor. Patients were evaluated with a follow-up greater than 5 years. MATERIAL AND METHODS: 32 female and 5 male patients were treated. 63 per cent patients were between 30 and 60 years old. The preoperative average of metatarsus varus was 12 degrees 1. The length of first metatarsal was inferior to the second in 30 cases. The preoperative average of first phalange valgus was 30 degrees. Every operated foot had an Egyptian morphotype. Sesamoids were consistently dislocated. Associated lesion were: 19 flat feet, 10 round fore-feet, 9 clinodactylies treated during the same procedure. RESULTS: They were evaluated according 3 Groulier's criteria: the correction of deformation, static disturbances, and professional activities. The phalangeal valgus was corrected in 37 cases (72 per cent). 33 feet were painless (67 per cent). The dorsal flexion of the first toe was superior to 60 degrees in 38 cases (77 per cent). Metatarsus varus was consistently reduced. 2 permanent metatarsalgia and 4 plantar corns persisted. 76 per cent of operated patients were able to wear shoes normally with a normal perimeter of walking. At X-ray examination, the head of first metatarsal was unchanged in all cases. The joint space was normal in 39 cases (79 per cent). The base of first phalanx was normal in 25 cases (51 per cent). 37 feet had centered sesamoïds. In total, we noticed: 37 very good and good results (72 per cent), 8 moderate results (17 per cent), bad results (9 per cent). DISCUSSION: The operative technic gives a stable shortening of the first phalanx without material and allows the early weight bearing. The abductor of the great toe is a stronger muscle than adductor, allows rotational correction and the alignment of the first phalanx on the first metatarsal. We agree with criteria of bad prognosis proposed by Groulier: age, valgus flat foot, the duration and the importance of deformation, the presence of osteoarthritis. CONCLUSION: The abductor plasty and soft tissue operation contributes to the durable correction of hallux valgus. Shortening must preserve the vascularization of the proximal end of the phalangeal. This operation should be reserved for young patients, without signs of articular cartilage degeneration and having an Egyptian foot.

Adult↗
PubMed1995

[Treatment of Morton neuroma by neurectomy. Apropos of 43 cases].

PURPOSE OF THE STUDY: Morton's neuroma is a frequent cause of metatarsalgia. Its diagnosis is clinical but progress in medical imaging: ultrasound, evoked potentials and above all MRI allows an improvement of para-clinical diagnosis. MATERIAL AND METHODS: 48 neuromas were treated surgically between 1979 and 1990. That represents 46 feet in 43 patients. Female predominance was clear with an average age of 53 years. The follow-up period was 6 years and 10 months. 3 patients had multiple injuries. Medical treatment had been prescribed prior to surgery in 24 patients (15 had injections, 9 orthopedic shoe inserts and 5 both injections and inserts). The interval between the first symptoms and surgery was long since it was on average of 3 years and 6 months. The neuroma was located 36 times in the third interdigital space. The initial incision was plantar 11 times dorsal 32 times. Only neurectomies were performed. The neuroma was very large 9 times. 10 patients had treatment for other affections in the same operative time. RESULTS: At review, 41 feet were completely painless. Shoe wear was normal for 32 patients. 12 pulpar hypoesthesia and 7 commissural and pulpary hypoesthesia were noted. 3 of 11 patients operated by the plantar approach had a painful hyperkeratosic scar. DISCUSSION: None of our cases had preoperative MRI because our most recent case has 4 years of evaluation. At the present time the MRI could contribute to diagnosis owing to good tissular differentiation. The neurectomy led to a total disappearance of pain but hypoesthesia was frequent. The dorsal approach induces cutaneous complication. Neurolysis induces a sensitive postoperative deficit but recurrence occurs in 77 per cent of cases after neurolysis. CONCLUSION: Morton's neuroma is located essentially in the third interdigital space. Neurectomy is a simple operation that often leads to recovery.

Adult↗
PubMed1995

[Bipolar dislocation of the first metatarsal bone].

Simultaneous dislocation of the first cuneometatarsal joint and metatarsophalangeal joint is a rare injury. The case of a 22-year-old man is reported, but no previous cases have been reported in the literature. The treatment by closed reduction and pinning was very classical. Occasionally the reducibility of the metatarsophalangeal joint may be made more difficult by the interposition of a sesamoid bone. The simultaneous dislocation occurred because the injury was very severe. After 2 years, the function and mobility of the toe were normal, but radiographs revealed modifications of the Lisfranc joint.

Adult↗
PubMed1995

[Value of a direct approach to the calcaneum].

The authors describe an approach to the calcaneus: the incision follows the Achilles tendon and curves anteriorly between the lateral and plantar skin of the foot. The subtalar joint is opened using a Müller distractor, with one pin in the tibia and the other in the calcaneus. Sixty-one crush fractures of the thalamus were treated using this approach. There were 6 cases with skin problems; in 4 cases the skin necrosis was limited. This approach is useful in all cases: it provides excellent exposure of the subtalar joint, making a precise reduction of the fracture possible. When a distractor is used, varus of the calcaneus should first be reduced.

Ankle Injuries↗
PubMed1995

[Removal through the coronal approach of the upper wisdom teeth. Apropos of a case of bilateral migration into the temporal fossa].

This report presents a case of double migration of third maxillary molar in temporal fossa and their removal by a coronal approach. A 15 years of old boy, was seen for major trismus. 2 months before, he underwent under general anaesthesy impacted third maxillary molar removal. The radiologic examination showed that superior third molar has been pushed and left into the temporal fossa in both sides. After computed tomography examination, teeth were removed by a coronal approach. This was the only approach in order to preserve facial nerve and to allow with good chances to remove the teeth. Intervention was successful. Postoperative course was uneventful. The buccal apperture was normalized three months after surgery.

Adolescent↗
PubMed1995

[Lisfranc's fracture-dislocations].

PURPOSE OF THE STUDY: Classicaly Lisfranc fractures dislocations are unusual. Our study is based on 69 observations from January 1974 to January 1992. MATERIAL AND METHODS: Fractures occured during tremendous impacts with a sex ratio of two men for one woman. The authors insist on the diagnostic value of good quality standard x-rays. Using Trillat's classification, we had 19 homolateral spatular fractures dislocations, 22 homolateral columno-spatular, 8 divergent columnar and 19 divergent columno spatular. A dislocation was reduced in emergency before radiography. The treatment consisted in orthopedic reduction and plaster 7 times, percutaneous kwire 2 times, immediate arthrodesis 5 times, open reduction and internal fixation with kwires 55 times. Post-operatively, 8 complications were noticed. 11 secondary arthrodesis were made with reference to failures of previous methods. They have been performed from 9 months to 5 years after the initial traumatism due to a painful ankylosis in bad position or arthrosis. The arthrodesis was total 6 times, partial lateral 2 times, partial medial 3 times. RESULTS: 63 patients were reviewed with a minimum follow-up evaluation of two years and a maximum of 9 years. The results show that we must reduce the tarsometatarsal fracture dislocations even if the displacement is minimal and we must fix them. The most satisfactory means seem to be open reduction if the least anatomical defect exists. Immediate, total arthrodesis reposition is suitable when an important articular comminution exists. If the total secondary arthrodesis reposition gives good results, its realization is sometimes difficult. The lateral partial arthrodesis must be discontinued, because they don't seem logical. The medial partial arthrodesis didn't prove its superiority, compared with total arthrodesis. DISCUSSION: The reduction of Lisfranc's dislocation is essential. The single case not unreduced has given a bad result as shown in the litterature. When the orthopedic treatment is well-made, the result is good. The open reduction followed by an axial fixation has only given 56 per cent of good results. The main reason of these bad results is an important comminution which should have practised an immediate arthrodesis reposition and a bad reduction. We must be aware on the quality of the anatomical reduction. The secondary arthrosis appeared principally in cases where the reduction was defective (13 observations out of 50). The 5 immediate arthrodesis have all given a good result. CONCLUSION: The retrospective study of the series teaches us to reduce the tarsometatarsal fractures dislocations even if the displacement is minimal and to fix them. We must make a wider place to the immediate arthrodesis reposition.

Accidents, Traffic↗
PubMed1994

[Subtalar arthrodesis for sequelae of calcaneal fractures. Apropos of 57 cases].

PURPOSE OF THE STUDY: 57 subtalar arthrodesis for sequelae of calcaneal fractures were reviewed with a minimum follow up of 6 years 11 months. MATERIAL AND METHODS: Bone resection and interposition of bone grafts, stabilized by screws were used in 36 cases. Iliac crest grafts were used in 20 cases, cryopreserved grafts 15 times and local graft taken on the anterior tibial epiphysis once. No surgery was performed on the mid foot. RESULTS: Results were evaluated using the grading system described by Mestdagh with 33 good global results, 18 fair results and 6 poor results for a total of only 58 per cent of good global results. Of the 57 cases reviewed, 18 remained painful with a limited range of motion for inversion and eversion of the foot. In 18 patients monopodal weight-bearing was unstable. Residual oedema persisted in 5 patients. 16 patients continued to limp and 3 required the use of a crutch. 7 valgus and 3 varus deviations of the hindfoot were noted at follow up with poor tolerance of the varus when compared to exaggerated valgus. Podoscopic examination revealed increase anterior pressure zones responsible for metatarsalgia which was relieved by corrective shoe inserts in 10 patients. Radiographic evidence of fusion could be demonstrated in 55 cases. There was little or no repercussion on the tibio-talar joint. In the Chopart joint we noted 4 cases of osteoarthritis; there were 6 lesions in the talo-navicular joint and no repercussion in Lisfranc's joint. 16 complications of varying severity were noted with 2 nonunions following use of cryopreserved grafts. DISCUSSION: Subtalar arthrodesis for sequelae of traumatic lesion in the hindfoot gives good results in 2 cases out of 3. In our series, 26 per cent of the patients showed degenerative changes in the mid foot unlike the series published by Kempf. As Meary and Mestdagh noted, we found that residual varus or valgus deformity > 10 degrees was poorly tolerated as well as modifications > 20-30 degrees in the vertical ratio between the talus and the calcaneum in the horizontal plane. CONCLUSION: Subtalar arthrodesis is a useful technique giving good results in 2 out of 3 cases of traumatic sequelae in the hindfoot. Triple arthrodesis does not seem indicated when the talus and the calcaneus can be realigned before fusion. Talo-navicular arthrodesis, though more easily realized, requires blocking a normal joint in order to immobilize a painful joint.

Arthrodesis↗
PubMed1994

[The Sixtine metatarsophalangeal prosthesis at first glance. Preliminary results in 74 cases].

The Sixtine prosthesis is a metallic, hemiconical, flat concave, metatarsophalangeal interposition prosthesis, with a rim on the phalangeal end, with a lateral capsular fixation or a temporary fixation by axial pinning. Seventy-four cases using a Sixtine prosthesis were reviewed with a minimum follow-up of 2 years. The range of motion was improved (+12.4 degrees), as was the phalangeal valgus (18.2 degrees for 30.2 degrees), but weight bearing on the ventral side of the first toe was very often lost in spite of the complete preservation of the flexor hallucis brevis. The complication rate was 9.5% with 8% subluxations, which do not influence the final result. The comparison of patients who kept the prosthesis, and of patients in whom the prosthesis was systematically retrieved after one year, shows that the prosthesis may be left in place and that retrieval is only indicated in cases of complications or subluxation.

Adult↗
PubMed1994

[10-year radiologic results of a cemented stem in close contact with the bone].

The femoral stem "Contact", conceived in 1981, provides an excellent contact with metaphyseal-diaphyseal bone, on the medial and lateral cortices. The stress on the cement is not high; the cement fills the medulla in the anteroposterior direction. Five-year results in 92 prostheses were published at the annual meeting of the SO.F.C.O.T. in 1986. The follow-up after 10 years of 76 prostheses with a complete radiological evaluation showed neither loosening, nor space between cortex and prosthesis. The calcar remained unchanged after 5 years in 60 cases; in 11 patients the density was diminished and in 5 hips, a cavitation was seen. Around the top of the stem, 11 partial or total "wall-forming" deposits were seen. On 42 lateral x rays the bone cement interface was satisfactory. Cortical resorption, which was not seen before, is now apparent on the most recent controls. The cortical index (Hoffman), measured on 49 prostheses, was unchanged in 15 cases (30%). The narrowing of the cortex increases with age, being more frequent and significant and occurring earlier in women. This process was seen from the age of 65 years in females and about 75 in males. This natural increase in the size of the medulla induces a loosening of the stem. Loosening may be limited by the use of a snugly fitting cemented stem, with limited stress on the cement.

Age Factors↗