PubMed Health⌕ Search

Biomedical subjects

T Dubert

Publications and source records attributed to T Dubert.

At least 19 recordsLinked to original sources
PubMed2006

Long-term review of five leg replantations: emergency strategy and examples of lengthening of the leg on nerve regeneration.

The success rate for leg replantation has improved with the development of shortening-lengthening protocols. We checked whether this success was maintained long term in five cases of emergency reimplantation. The significant initial shortening of 93 mm, on average, enabled direct internal osteosynthesis, secondary lengthening was initiated swiftly, in the proximal metaphyseal area, and average lengthening was 85 mm. Consolidation was achieved in all cases within normal time periods, with an average inequality in residual length of 8mm. The speed of nerve regeneration was on average 1.926 mm/day, twice faster than usual after simple nerve suturing. At average follow-up of more than 11 years, all patients were walking. We conclude that nerve lengthening stimulates nerve regeneration, and that the results of this protocol, involving extensive initial debridement compensated by secondary lengthening, have enabled the limitations on unilateral leg replantation to be reduced.

Adult↗
PubMed2006

[Schwannomas of the peripheral nerve in the hand and the upper limb: Analysis of 14 cases].

The Schwannomas are usually considered as enucleable lesions of which the excision under microscope doesn't entail a post-operative deficit. Having frequently observed the inclusion of fascicle in the tumor, we wanted to verify the absence of deficit in a retrospective survey. Our survey is composed of 14 patients operated of schwannoma of the superior member and whose mean age is 53 years old. All patients presented an average of nine months old palpable mass; the pain was present in four cases; paresthesiae in seven cases; irritatif syndrome in ten cases. A preoperative sensory deficit was present in two patients but without any case of preoperative motor deficit. The schwannoma was localized in eight cases in the hand, one case in the forearm, two cases in the elbow, two cases in the arm and one case in the armpit. The affected nerves were the digital ones in six cases, the main trunk of the median nerve in four cases, the trunk of the ulnaire nerve in three cases and the sensory branch of the radial nerve in one case. All tumors have been operated under a microscope. The enucleation was possible without fascicle lesion in six cases. In the eight other cases we have proceeded to a resection of indissociable fascicles. The diagnosis is confirmed by the histologycal examination in all cases. In postoperative, the two patients that presented a preoperative sensory deficit no longer presented it. On the contrary, three patients that didn't have any preoperative deficit presented each a post-operative sensory deficit with in addition a motor trouble in one of cases. We conclude from this survey that there is a risk of peroperative fascicle lesion even when using the microscope. This information is important to consider in the setting of deciding how to proceed before the excision of this benign lesion.

Adult↗
PubMed2005

Extensor tendon impingement in a gymnast.

Wrist injuries in the gymnast are due to the transformation of the upper extremity into a weight bearing entity. Gymnast wrist pain presents a difficult diagnostic and therapeutic challenge. Here, we present a new case of extensor tendon impingement in an elite gymnast. To our knowledge, there is no similar report in the literature.

Adult↗
PubMed2005

The safest location for steroid injection in the treatment of carpal tunnel syndrome.

Steroid injections are routinely performed for carpal tunnel syndrome. Direct needle injury of the median nerve is the major complication of these injections. The safest location of the injection remains controversial. The purpose of this study is to define safe guidelines to avoid nerve injury. The distances between the Median nerve, Palmaris Longus, Flexor Carpi Ulnaris and Flexor Carpi Radialis tendons were measured pre-operatively, 1cm proximal to the distal wrist crease in 93 endoscopic carpal tunnel releases. We found that the median nerve extended ulnarly beyond the Palmaris Longus tendon in 82 hands (88%). It is concluded that the median nerve is at risk if the injection is performed within 1cm on either the ulnar or radial side of the Palmaris Longus tendon. More ulnarly, there is risk to the ulnar pedicle. The safest location is to inject through the FCR tendon.

Adrenal Cortex Hormones↗
PubMed2005

[Acute PIP joint fractures].

Recent PIP fractures are challenging trauma in terms of diagnosis as well as treatment. It must be remembered that the final outcome will have a considerable impact on the global finger and hand function. Immediate mobilization and rehabilitation are mandatory, and may justify a surgical approach and fixation in selected cases. A good understanding of the fracture type is essential and relies in good part on precise, focused and standardized radiographs. Non-displaced fractures are generally treated conservatively. In the proximal phalanx, the orientation of the fracture line dictates the stability of the fracture. Thus non-displaced fractures can occasionally be preventively stabilized, in order to allow early mobilization. Displaced fractures should always be anatomically reduced and surgically fixed. A temporary joint stabilization is optional. In the middle phalanx, one must consider palmar and dorsal fractures differently. Palmar fractures include a distal palmar plate avulsion. The degree of impaction will dictate the stability of the joint towards dorsal subluxation. Dorsal fractures include central slip avulsion of the extensor tendon. An antomical reduction and surgical fixation is mandatory to avoid a progressive boutonniere deformity. Prognosis of all the middle fractures is closely dependent on the degree of impaction. When direct osteosynthesis is not possible, distraction devices, bone graft or palmar plate reconstruction may be useful alternatives. In complex fractures, bone fixation and joint stabilization must be combined in order to prevent secondary displacement and joint instability.

Fracture Fixation↗
PubMed2005

[Sifting through the results, a proposal for a new concept of outcome measurement. In connection with a series of 72 carpal tunnel endoscopic releases].

We present a new concept in outcome measurement namely "sifting", which we demonstrate in a series of endoscopic carpal tunnel releases on 72 patients. Each patient is evaluated by considering three groups of criteria. The criteria in the first group are evaluated by the patients themselves (self-evaluation), those in the second group are evaluated by a medical observer (clinical examination) and those in the third group are evaluated by the community (socio-professional aspects). We consider that the global outcome result is good only if it is good at the same time from the point of view of the patient himself, from the point of view of the medical observer and from the point of view of the community. The originality of this "sifting" concept consists in sorting the global outcomes according to a principle of elimination. When the global outcome of each patient is passed through the sieve, this total result is considered as "poor" if only one of the three groups is noted as having a bad result. By applying this original principle to our series, we obtained 11 bad self-evaluated results (reduction in the preoperative DASH lower than 10), 6 bad clinical results (persistence of awkward paraesthesiae) and 1 bad socio-professional result (absence of return to work). After sifting all the patients the poor results represented 14 patients (19 %). It seems to us that this sifting principle represents an advance compared to existing evaluation forms, which do not independently consider these three points of view, and which provide a total score by means of arithmetic operations with arbitrary coefficients.

Adult↗
PubMed2003

[Eight days of hand emergencies. Report of the audit carried out at the FESUM centers from June 3 to June 9, 2002].

All the FESUM centers in France, Belgium and Switzerland were invited to participate in this prospective audit, during 1 week in June 2002. In these FESUM centers, the patients are operated by senior hand surgeons or trainees graduated with a microsurgical and a hand surgery University degrees. All acute hand disorders, requiring surgery or not, were to be included. For every case, a standardized form was to be filled. This form included 22 fields concerning the specificities of the patient, the circumstances of the accident, the lesions and initial treatment up to exit of the patient out of the Hand Center. Out of the 43 French centers, 38 (90%) participated in this study, but only 30% in the other French speaking countries. A total of 2360 forms were completed and analyzed, representing a mean of 8 forms per day center (6-147). The population was predominantly active men with a mean age of 31. Manual workers represented 41%, scholars 33%. Most of them came to the Hand Center with a non-specilized vehicle (86%). Emergency medical transportation was required in 130 cases (5.8%). A majority of the patients were treated on an outdoor basis. A 1-day admission concerned 29% of the patients, and 4.6% have been admitted on an indoor basis during several days. Work accident represented 28% of all the cases, while the majority was daily living (62%) or sport (15%) accidents. Closed trauma represented 50% of the cases. Amongst open trauma (974 cases), 862 were simple skin lacerations, 156 skin loss, 140 extensor tendon lacerations, 70 flexor tendon lacerations. A preliminary wound exploration had been performed in a non-specialized center in 124 cases (12%). Complete amputation of some part was observed in 33 cases. In 32%, the initial severity of the lesion led to expect some degree of definitive consequences. Some kind of anesthesia was required in 43% of the cases (local in 41%, troncular in 19%, plexical in 28% and general in 9%). A surgical procedure was performed in 45% of the patients. Microsurgery was necessary in 15%, six of which were replantations. The period between presentation to the Hand Center and treatment was less than 1 day in 95% of the cases. Time of treatment was considered to be delayed in 113 cases (5%). Following this audit, it is considered that the FESUM centers make provision for the care of 120,000 cases per year, 54,000 of which needing a surgical procedure. This may be a small part of the total load of emergency hand surgery throughout the country (generally estimated over 1.4 million), but compares quite favorably with other European studies. We believe that improvement relies essentially on a better orientation of the patients whether they need a simple skill or specialist skill treatment. An information leaflet about orientation of hand trauma has been distributed to non-specialized emergency centers. Hand surgery training must be reevaluated inside the universitary system to avoid a dramatic lack of hand surgeons within a few years. A new audit will be presented next year.

Adolescent↗
PubMed2003

[Patient-rated wrist questionnaire: preliminary report on a proposed French version of a North American questionnaire designed to assess wrist pain and function].

We present a French translation of a North American self-assessment questionnaire (Patient Rated Wrist Questionnaire or PRWE). This questionnaire was developed by Joy MacDermid and members of the IWI (International Wrist Investigators). Three years were needed to establish the specific items and questions to get a valid and reliable questionnaire. It includes 5 questions on pain and 10 questions on function. All the questions were rated on a 0-10 scale. The questionnaire provides several scoring options with a total of 100. MacDermid assessed the responsiveness of three questionnaires (DASH, SF-36 and PRWE) in 59 patients after distal radius fractures. Standardised response means (SRM) were calculated to indicate responsiveness. The PRWE was the most responsive. The French version was evaluated on 20 patients. All the questions were understood. The mean writing time was 5 minutes (3 min - 7 min).

Adult↗
PubMed2002

[The VB system: a new modular osteosynthesis material involving both screws and wires].

VB is an osteosynthesis system for the stabilisation of small fragments, which combines the benefits of both wires and screws. It is a modular system comprising a threaded pin and a ring. The threaded pin is first positioned. Then a ring is grasped and opened by the progressive angulation of a screwdriver. Still anchored on the screwdriver, the ring slides easily on the pin. It is clamped on the pin by simply removing the screwdriver and the pin is then cut. This modular system includes 1.8 and 1.1 mm pins and different types of rings (threaded or non threaded, with or without collars). The system is easy to handle and can be introduced using an open or percutaneous technique, allowing compression or distraction. Our preliminary series, performed in accordance with National clinical trial protocol (Huriet) consisted of 50 cases in 24 patients (five women and 19 men) with an average age of 48 years, and a follow-up of more than six months. Fourteen cases of fractures (28 implants) were treated as emergencies (two radial heads, one capitellum, one trochlea of the humerus, seven distal radius fractures, one trapezium, two metacarpals) and 12 cases (22 implants) were elective cases: arthrodesis (one trapezo-metacarpal, one intermetacarpal, two interphalangeal, two carpal), non-union (six scaphoids, one phalangeal) and one phalangeal malunion. Hardware removal was performed in 16 cases. No implant failure has been detected. One case, a DIP arthrodesis, had a suspicion of sepsis which led to the removal of the implants at six weeks. The results of this study have convinced us of the merits of the system, which combines the advantages of both wires and screws. The system allows the user to perform either distraction or compression, and to adjust the force by hand. Compared to the fixed amount of compression produced by lag screws, this feature seems to be a real step forward.

Adult↗
PubMed2002

[Current techniques for primary flexor tendon repair].

Flexor tendon lacerations still represent a challenging problem to hand surgeons, particularly in zone 2. There has been a considerable improvement in therapeutic modalities during the past 30 years, following a better understanding of the tendon healing process. It is now universally accepted that flexor tendon repair must be performed in emergency, by mean of a direct primary suture, and followed by a immediate rehabilitation protocol. More recently, the benefits of early active motion has been demonstrated. Early axial loading of the repair enhances intrinsic callus formation, reduces peritendinous adhesion, and could attenuate the fragilization of the callus during the first three weeks. However, active motion generates a heavier stress on the repair. The initial resistance of the repair thus appeared to be the critical point. This has motivated a large number of investigations about the suture technique itself, with in vitro and in vivo evaluations. The results of these studies did precise the concept of "locking" and "grasping" sutures, and demonstrated the superiority of four strands sutures. These experimental results cannot be ignored by surgeons dealing with flexor tendon repairs.

Bony Callus↗
PubMed2001

[The DASH questionnaire. French translation of a trans-cultural adaptation].

The DASH (Disability of Arm-Shoulder-Hand) is a self-administered questionnaire developed in 1994 by representatives of the Institute for Work & Health (IWH) and the American Academy of Orthopaedic Surgeons (AAOS). It measures the physical disability and symptoms for all upper limb disorders in a heterogeneous population and for acute as well as chronic disorders. The original american version has been already tested for reliability and validity. Interest in the DASH was raised by several European publications. It appeared that the DASH could provide a common measure for upper extremity physical disability in Northern America and European countries. For this cross-cultural adaptation, we followed the guidelines developed by the Institute for Work & Health and American Academy of Orthopaedic Surgeons. Five translations and two "back-translations" were compared, aiming to semantic, idiomatic, experimental and conceptual equivalence. The final version has been tested in 223 patients presenting a variety of traumatic or non traumatic disorders. 208 questionnaires (93%) were valid because there was less than 4 missing answers. This final version has been proposed to American Academy of Orthopaedic Surgeons in order to be endorsed as an official translation. This could improve assessment for international studies by establishing standard measures.

Arm Injuries↗
PubMed2001

Closed traumatic rupture of the flexor pulleys of a long finger associated with avulsion of the flexor digitorum superficialis.

We report a closed rupture of the second, third and fourth annular pulleys associated with avulsion of the flexor digitorum superficialis tendon in the ring finger of a healthy, 48-year-old patient. It was caused by sudden and violent flexion of the finger and led to a serious impairment of the proximal interphalangeal joint motion, despite physiotherapy and dynamic splinting. The patient was treated surgically, 3 months after the injury, with reconstruction of the second (A2) and fourth (A4) annular pulleys and excision of the distal portion of the superficialis tendon. The final functional result was satisfactory.

Finger Injuries↗
PubMed2001

[Imaging of the wrist and of the hand: what is the best modality?].

The authors describe the indications for radiologic explorations in case of traumatic as well as non-traumatic conditions. In case of trauma of the wrist, the radiologic exploration looks for a fracture, a dislocation or a ligament injury. Initially, postero-antérior and lateral views must be completed with an antero-posterior view, a scaphoid incidence and an oblique view. This initial examination can be completed secondarily by specific views for the carpal bones, dynamic X-Rays, CT scan or arthro CT scan. In non-traumatic cases, radiologic explorations look for osteo-articular or soft tissue abnormalities specific of a inflammatory or degenerative disease. The initial incidence is a postero-anterior view of both hands. It can be completed secondarly by other explorations (other X-Rays, Ultra-sound, CT scan or MRI).

Arthrography↗
PubMed2000

[Classification of finger deformities due to muscle-tendon imbalance].

We have developed a 4 stages classification comprising: purely dynamic imbalance (Stage 1); tenodesis effect (Stage 2); articular rigidity without cartilage lesion (Stage 3); articular rigidity with bone and cartilage destruction (Stage 4). This classification is easy to remember and general enough to be used for most deformities due to musculo-tendinous imbalance, whatever their type or etiology. We believe that this assessment will help to clarify the therapeutic indications and allow better interpretation of the results.

Biomechanical Phenomena↗
PubMed2000

An experimental study of ring avulsion injuries and two preventive devices.

We have performed biomechanical experiments on fresh cadaveric fingers to test two modifications to normal rings which may prevent ring avulsion injuries. One of these modifications produced reliable protection against ring avulsion accidents and was undetectable. It thus does not reduce the symbolic value of a wedding ring.

Aged↗
PubMed2000

[Partial replantation following proximal limb injury].

PURPOSE OF THE STUDY: Proximal replantation is a technically feasible but life-threatening procedure. Indications must be restricted to patients in good condition with a good functional prognosis. The goal of replantation must be focused not only on reimplanting the amputated limb but also on achieving a good functional outcome. For the lower limb, simple terminalization remains the best choice in many cases. When a proximal amputation is not suitable for replantation, the main aim of the surgical procedure must be to reconstruct a stump long enough to permit fitting a prosthesis preserving the function of the adjacent joint. If the proximal stump beyond the last joint is very short, it may be possible to restore some length by partial replantation of spared tissues from the amputated part. We present here the results we obtained following this policy. MATERIALS AND METHODS: This series included 16 cases of partial replantations, 14 involving the lower limb and 2 the upper limb. All were osteocutaneous microsurgical transfers. For the lower limb, all transfers recovered protective sensitivity following tibial nerve repair. The functional calcaeoplantar unit was used in 13 cases. The transfer of this specialized weight bearing tissue provided a stable distal surface making higher support unnecessary. In one case, we raised a 13-cm vascularized tibial segment covered with foot skin for additional length. For the upper limb, the osteocutaneous transfer, based on the radial artery, was not reinnervated, but this lack of sensitivity did not impair prosthesis fitting. RESULTS: One vascular failure was finally amputated. This was the only unsuccessful result. For all other patients, the surgical procedure facilitated prosthesis fitting and preserved the proximal joint function despite an initially very proximal amputation. DISCUSSION: The advantages of partial replantation are obvious compared with simple terminalization or secondary reconstruction. There is no secondary donor site and, because there is no major muscle mass in the distal fragment, the overall risk is very low compared with the risk of total proximal leg replantation.

Adolescent↗
PubMed1999

[Lower limb stump reconstruction with a functional calcaneo-plantar unit free flap. A series of 16 cases].

The main objective of surgery, once amputation is inevitable, is to preserve a functional stump. This report describes the immediate reconstruction of 16 leg stumps in children by transfer of a functional calcaneo-plantar unit. Of these, 3 were thigh and 13 were lower leg reconstructions. Amputation was performed for tumor in 4 cases, and was due to accidents in the remaining twelve. The main technical features of flap preparation are preservation of the calcaneum branch and attachment of the heel skin to the greater tuberosity of the calcaneum. One case resulted in failure due to vascular thrombosis. The other 15 cases resulted in bone consolidation after an average of 45 days, sensitive protection by 70 days, and very good trophic and protective results. The provision of good distal pressure area encourages overall development of the child. There was no morbidity at the donor site, and because there is no major muscle mass in the distal fragment, the overall risk is very low compared to that of total proximal leg replantation. The transfer of functional calcaneo-plantar tissue as a single unit is the best strategy for one-step restoration of good distal support area for the stump. All surgeons liable to perform leg amputations should be aware of this technical approach.

Adolescent↗