[Etiology of pseudarthrosis of the leg with loss of bony substance].
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Biomedical subjects
Publications and source records attributed to T Judet.
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The authors present their experience of bone-loss reconstruction by a free vasculized fibular transfer. 62 cases were operated, with an average follow-up of 6 years (between 24 to 13 years). Studied were 15 upper limbs (10 humerus, 3 ulna, 2 radius), 28 femurs and 19 tibias. We found a male predominance: 46 cases and the average age was 33 years old. The etiology was often due to trauma: serious road traffic accidents (37 cases). 44 cases were septic and the average bone-loss was of 10 cm (between 4 cm to 30). The most frequent complications were due to fractures of the graft (10 cases) and stiffness (15 cases). Consolidation rate was of 87%: 8 were failures (3 upper limbs: 20% at femur level, 10% at tibia level). The average consolidation rate of the septic cases was of 81%, and the non-septic cases over 97.5%. It seems to be a good technique and in particular for septic cases using a basic orthopedic technique and microsurgical suture.
The authors present the results of 101 osteo-periostal decortications. This technique was used in 72 cases of aseptic non-union, 15 cases of infected non-union and 14 cases with malunion. Stable fixation was carried out using a plate or an external Judet fixator. An autologous cancellous or cortico-cancellous bone graft was added in 12 cases. Union was achieved in 98 of 101 patients after an average of 45 days to 4 months, depending on the localisation and the etiology involved. The 3 failures were due to technical errors or presence of an unfilled bone defect. Osteoperiostal decortication is a reliable and reproductible solution to many problems of malunion or non-union. We consider bone grafting to be necessary only in patients with a major bone defect.
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In a prospective randomised trial, two groups of 20 patients each were compared. The first group received low dose heparin (t.i.d.) and the second group received low dose heparin (t.i.d.) combined with aspirin. The incidence of deep vein thrombosis (DVT) were determined using both radioactive fibrinogen uptake test and venography. The correlation between the two methods of diagnosis was better than 90%. There was no significant difference in the incidence of DVT between the two prophylactic regimen. A significant tendancy towards increased bleeding in observed with the combination of low dose heparin and aspirin.
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The authors report five cases of malignant fibrous histiocytoma of the soft tissues, some of them with atypical presentation (necrotizing tumor, hypereosinophilic syndrome, dermatomyositis). This is the first case of polymyositis associated with malignant fibrous histiocytoma. The tumor occurs between the fifth and the seventh decade, principally as a mass on the proximal lower limb. Local recurrence and metastasis occurs in 50% of patients. Prognosis is dependent on both the surgical possibilities and the characteristics of the tumor (site, size, histologic grade). Surgery alone is inadequate. Adjuvant chemotherapy improves the 5-year survival.
The authors describe a hinge distraction apparatus which allows physiological movement of joints following surgical procedures such as arthrolysis or arthroplasty. The apparatus maintains some space between the bone ends and provides lateral stability. It is based on the principles of external fixation. The apparatus has been used for ankles, knees, and elbows. Thirty-eight patients were operated on. The technique is fully described. The results on experimental work in the dog are given. At the ankle, the authors have shown that the use of the apparatus allows the formation of fibrous tissue between the bone ends. The indications and results obtained at the level of the knee and elbow are discussed.
The authors report their experience concerning eleven cases of that original and frequent association of fractures. The ligamentous lesions associated with those fractures are considered, justifying the necessary dynamic X rays. The eleven cases are reviewed and a classification supported by an iconography is given, according to the unstability of the odontoid or of the pedicles. The complications after orthopaedic or surgical treatment are analysed and the authors give their conclusions. The proposed treatment is conservative when the fractures are neither displaced nor unstable, and surgical when one of the two fractures is unstable. The best procedure is bi-pedicular screwing associated with C1/C2 wiring.
Although total hip arthroplasty stabilized by cement has been a great step forward, loosening is becoming more and more frequent and constitutes a significant problem. This is a report of the design of a non-cemented prosthesis in which fixation of the prosthesis is secured by the in-growth of newly-formed bone into the irregularities of the metal. In more than 2000 cases with a follow-up of 5 1/2 years, this fixation design proves to be sound. The complications are relatively rare and the results are generally good.