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Y Tropet

Publications and source records attributed to Y Tropet.

At least 19 recordsLinked to original sources
PubMed2006

[Bone and soft tissue loss of the proximal interphalangeal joint of the long fingers: emergency treatment with a Swanson implant: prospective study of ten patients with mean 2.7 year follow-up].

PURPOSE OF THE STUDY: Injury of the proximal interphalangeal joint (PIP) with loss of bone and soft tissue (joint surface, tendon, skin cover) can compromise finger vascularization. Fusion or amputation is often proposed. We report our experience with another solution, emergency implantation of the Swanson implant. MATERIAL AND METHODS: Thirteen patients, mean age 47.4 years (range 18-76) underwent emergency surgery between 1997 and 2003. In twelve patients, the finger injury occurred when working with wood. For ten of the thirteen patients, the injury occurred during recreational activity. The index was involved when only one ray was injured. The thumb was spared in all patients. Joint tissue was lost in all patients. The head of P1 was injured in all cases creating a situation incompatible with fusion without loss of finger length. All patients underwent an emergency surgery for complete reconstruction of the PIP joint with Swanson implant, tendon reconstruction or suture, and skin cover performed during the same procedure. RESULTS: Ten patients, 16 implants, were reviewed at mean 2.7 years (range 1-6 years). Mean flexion reached 41.8 degrees (range 20-80 degrees). Maximal amplitude of flexion was achieved at one year and remained unchanged thereafter. There were no cases of infection, or secondary amputation. Two implant fractures were noted with no functional impact at six years. There were four cases of instability. DISCUSSION: Most reports in the literature concern composite blast or firearm injuries. Ours appears to be the first series involving injuries occurring while working with wood. Most of the lesions caused by the circular saw were tangential, damaging the dorsal aspect of several PIP joints. Classically, it would be logical to propose arthrodesis if the bone and cartilage loss is not excessive, but with the loss of joint motion provided by implants. Like Nagle, we propose emergency implantation of a Swanson prosthesis if soft tissue and tendon reconstruction can be achieved, avoiding amputation. Although the technique is relatively simple, implantation of a Swanson prosthesis implies certain prerequisites, particularly ligament repair and correct alignment. Oversized implants appear to be better. We did not have to perform any secondary arthrodesis.

Adolescent↗
PubMed2006

[Functional and sonographic shoulder assessment after Seidel nailing: a retrospective study of 29 cases].

PURPOSE OF THE STUDY: Centromedullary nailing with a Seidel nail is a validated treatment for humeral shaft fractures which some teams have abandoned due to the injury caused to the rotator muscles. The purpose of this study is to assess shoulder function (Constant and DASH) after nailing procedures and to analyze sonographic findings. MATERIAL AND METHODS: Twenty-nine patients who underwent Seidel nailing between 1996 and 2002 were reviewed by an independent operator at 36 months follow-up on average (range 11-84 months). The sex-ratio was 1.64. Mean age at surgery was 41.5 years (range 17-81 years). The dominant side was involved in 17 cases. Fracture was caused by a traffic accident in 13 cases, a fall in 12, and a blunt injury in 4. The fracture was situated in the mid third of the shaft in 19 cases, the upper third in 3, the mid and lower third in 3 and mid and upper third in 3. Mean delay before surgery was 2.4 days. Initial complications were medioulnar palsy (n=1), complete brachial palsy (n=1), partial brachial palsy (n=1). There was one open Cauchoix I fracture. RESULTS: Bone healing was achieved in 27/29 patients at 3.5 months on average. Revision was required in nine patients. The Constant score was 69.1 (86.9% contralateral). The weighted Constant score was 81.7 and the DASH was 25. The Constant score was significantly better in patients aged less than 50 years and with transverse fractures. Sub-acromial space narrowing was observed in six patients at follow-up and only 9/28 sonographic examinations (32%) were normal; most shoulders presented transient healing lesions. DISCUSSION: This series was comparable with others regarding patient satisfaction, bone healing and complications, but was less satisfactory for the Constant score and time to healing. We have found that using a subjective function score (DASH) with an objective score (Constant) enables a better assessment of shoulder function. Like Gaullier, we consider that after cuff healing, anterograde nailing does not compromise shoulder function despite the injuries observed sonographically.

Adolescent↗
PubMed2005

[Unreconstructible radial head fracture: resection, implant of Swanson or prosthesis? Retrospective comparative study].

Treatment of unreconstructible comminuted fractures of the radial head remains a therapeutic challenge. Thirty two patients sustained unreconstructible radial head fracture between 1969 and 1999 and have been treated by resection (16 patients), by Swanson implant (8 patients), or by Judet prosthesis (8 patients). The three groups of patients were reviewed clinically and radiologically by two surgeons not involved in their treatment. Functional outcomes of the elbow (Morrey scoring-SOO scoring system, instability, cubitus valgus) and involvement of the wrist (pain, grasp, RUD instability) were evaluated with a mean follow up of 15 years (6-27.7). Elbow or wrist arthritis, ulnar variance, and evolution of Swanson implants were evaluated on standard radiographs. The Judet prosthesis group was evaluated with DASH scoring. Half of the patients were male and 1/3 had a work-related injury. Regarding the following criteria, there was no significant difference between the resection and the Swanson group: Morrey scoring 77/100, SOO scoring 7.4/11, mean flexion was 130 degrees, mean deficient extension was 18 degrees, mean pronation 60 degrees, mean supination 67 degrees, grasp reached 90% of the controlateral side. Arthritis was noted with the same frequency at the elbow (87%), and wrist levels (66%) in each group. Ninety four percent (94%) of patients in the resection group and 89% in the Swanson group were satisfied. Excellent and good results were reported more frequently in the Swanson group (37% resection group, 51% Swanson group). In the resection group the following complications were significantly more frequent: ulnar nerve irritation (2 x), ulnar head dislocation (2 x), ulnar head instability (3 x), para articular ossification (5 x), ulnar variance positive in all cases (mean value 3.20 mm). In the Swanson group only two implants were found to be destroyed at follow-up. In the prosthesis group function and satisfaction were higher than the two other groups but with a shorter follow up. Excellent and good results were reported in 62.5% cases with a DASH scoring between 0 and 16.7. Comminuted fractures of the radial head treated by resection or Swanson implant are both followed by fair results (same functional scoring). Only the level of complications differs between groups: at elbow level for Swanson group, at wrist level for the resection group. Patients in the Swanson group were most frequently satisfied. Metal radial head implant is an attractive solution yielding good functional outcomes in recent reported limited series and in our personal experience, but with a very short follow-up.

Accidents, Occupational↗
PubMed2005

[Osteocartilaginous autograft after proximal resection of the scaphoid for radioscaphoid osteoarthritis].

PURPOSE OF THE STUDY: Radioscaphoid osteoarthritis is usually a complication of scaphoid pseudarthrosis or chronic scapholunate disjunction. As an alternative to the classical surgical techniques used for this lesion, we propose a novel reconstruction method consisting In partial proximal resection of the scaphoid associated with interposition of a biological spacer composed of a osteocartilaginous rib graft. The purpose of this study was to present the technical aspects of this procedure and to report preliminary results in ten patients with radioscapular osteoarthritis treated between 1994 and 2001. MATERIAL AND METHODS: We performed a retrospective analysis of the ten patients who underwent surgery from 1994 to 2001 for early-stage radioscaphoid osteoarthritis associated with scaphoid osteoarthritis in eight and chronic scapholunate disjunction in two. The procedure consisted in partial resection of the proximal portion of the scaphoid and insertion of an osteocartilaginous autograft harvested from a rib. Outcome was based on the clinical results (pain, motion, grip force, activity) and patient satisfaction. Bone healing was measured with plain x-rays and vitality of the osteocartilaginous graft with MRI. RESULTS: Mean follow-up was 4.6 years. Clinical outcome was considered excellent or good in eight patients, fair in one and poor in one (graft dislocation). All patients were satisfied or very satisfied except one (one failure). Radiological healing was achieved at three months in nine patients. Four patients underwent an MRI examination at thirteen months which demonstrated, in all patients: no sign of necrosis, healing of the graft-scaphoid interface, and no bony metaplasia in the cartilage. DISCUSSION: Compared with partial carpal arthrodesis and resection of the first row of the carpus, this palliative technique can be used to reconstruct the proximal portion of the carpal scaphoid in young patients with early-stage radioscaphoid osteoarthritis. As for arthroplasty or scaphoid implants, our goal was to achieve a satisfactory scaphoid height using a biological spacer after resection of the proximal 3/4 of the bone. The results of this technique are encouraging but must be examined with precaution due to the small number of patients and the short follow-up to date.

Adult↗
PubMed2005

[Centromedullary nailing of the femur for bone metastasis: clinical and radiological evaluation using the Tokuhashi score in 24 patients].

PURPOSE OF THE STUDY: Pluridisciplinary management of patients with metastasis to the femur is well defined, but the choice between palliative surgery or abstention must be decided on the basis of a few evaluated prognostic criteria. We report a series of 24 cases of metastasis to the weakened or fractured femur which was evaluated with the Tokuhashi score and treated by surgery. MATERIAL AND METHODS: Sixteen women and eight men, mean age 71 years (58-89) underwent centromedullary nailing of the femur. These patients had metastases from breast cancer (n = 13 of the 16 women). Twenty of the 24 patients also had other metastases. The Tokuhasi score was > 6 in 16/24 patients. Fourteen patients had pain which did not respond to morphine. Thirteen had fractures and eleven weakened femurs. Time to surgery was six days (1-15). A full nail was inserted in four patients and a reconstruction nail in twenty. RESULTS: Operative time was 93 minutes (57-123). Blood loss was 200 ml (150-350). There were no intraoperative complications (fat embolism) excepting increased comminution. Hospital stay was 23 days (8-55). Survival was 148 days (8-510) for patients with fractures and 272 days (12-730) for patients with weakened femurs. Eight patients with a fractured femur died (six within the first three postoperative weeks), two among those with preventive nailing. On average, weight bearing among the surviving patients with nailing for fracture was achieved on the 57th postoperative day (30-90). Only six patients required morphine early after surgery. Centromedullary nailing successfully relieved pain in all patients with an isolated metastasis. Mean survival in patients with a Tokuhashi score < 3 was 2.1 months. It was 17 months in those whose score was > 6. CONCLUSION: Centromedullary nailing for fractured or weakened femur due to metastasis is a useful therapeutic solution for patients with short life expectancy. With this technique, antalgesics can be reduced while preserving independence as long as possible. The Tokuhashi score is easy to establish. If it is less than 3, centromedullary nailing should not be attempted due to the short expected survival.

Aged↗
PubMed2004

[Should we divide Osborn's ligament during epicondylectomy and in situ decompression of the ulnar nerve?].

INTRODUCTION: Two groups of patients with cubital tunnel syndrome were treated by neurolysis and medial epicondylectomy. In the first group, the operative procedure consisted solely of dividing Osborn's ligament and fascia but in the second group Osborn's ligament was reinserted after epicondylectomy to avoid dislocation of the nerve. The aim of this retrospective study was to compare the level of complete recovery after surgery and the frequency of dislocation of the nerve. MATERIAL AND METHOD: Group one: Nineteen patients, with a mean age of 47.7 (15-65), and 52% female, with the dominant hand involved in 63% cases, were treated. According to Mac Gowan's criteria, 32% of the elbows were classified preoperatively as grade I, 52% as grade II and 16% as grade III. Sensory nerve conduction velocity across the elbow was less than 40 m/s in 40% of cases. The mean duration of the disease was longer than 3 years in 16% of cases. Group two: Twenty three patients, with a mean age of 54.1 (33-75), and 56% female, with the dominant hand involved in 56% cases, were treated. According to Mac Gowan's criteria, three 17% of the elbows were classified preoperatively as grade I, 47% as grade II and 34% as grade III. Sensory nerve conduction velocity across the elbow was less than 40 m/s in 60% of cases. The mean duration of the disease was longer than 3 years in 4% of cases. Both groups were evaluated by a surgeon not involved in the treatment by clinical examination and DASH scoring. RESULTS: DASH scoring is correlated with functional recovery, grip strength and Mac Gowan preoperative scoring. In group one, (divided and reinserted ligament) with younger patients, half the incidence of Mac Gowan stage II and a shorter follow up, there were no dislocations, but less complete resolution of preoperative symptoms (68%/82%) and a higher DASH scoring (30.6/24.9). In group two (resected ligament), dislocation of the nerve was noted in 17% of cases. In both groups, pain at the epicondylectomy site was noted in 20% of cases. The chance of complete recovery was inversely related to the age (>50), and to the duration of the disease (>1 year). DISCUSSION: Surgical treatment of ulnar nerve entrapment at the elbow remains controversial. None of the presently advocated procedures (simple decompression of the ulnar nerve, medial epicondylectomy or transposition of the ulnar nerve) has proven optimal regarding long-term results. In both groups in this study, neurolysis of ulnar nerve by section of Osborn's ligament and fascia together with medial epicondylectomy proved to be an effective surgical procedure for treating grade I to II ulnar neuropathy. Section of Osborn's ligament without its reattachment is followed by more cases of complete recovery as well as more dislocation of the nerve although the latter elicited no subjective complaints from the patients. DASH scoring is effective in evaluating the recovery.

Adolescent↗
PubMed2004

[Contribution of quantitative radio-scintigraphy to diagnosis of wrist injuries undetected on plain films: a prospective study of 154 cases].

PURPOSE OF THE STUDY: Fractures of the scaphoid must be diagnosed quickly to avoid persistent nonunion and the risk of osteoarthritis. Despite meticulous physical examination and adequate x-ray detection, numerous occult fractures still go unrecognized. The aim of this prospective study was to analyze the pertinence of quantitative radio-scintigraphy (QRS) presently used for the diagnosis of occult wrist fractures. MATERIAL AND METHODS: Quantitative radio-scintigraphy (QRS) is a new imaging technique associating quantitative bone scan and numerical fusion between bone scan images and x-ray images. We conducted a prospective study between November 1994 and March 1999 to evaluate the pertinence of this examination technique for the diagnosis of occult wrist fractures in patients presenting clinical symptoms suggestive of wrist fracture but whose plain x-rays were initially considered normal. Further some patients had several series of plain x-rays performed at several week intervals in order to search for fractures becoming progressively visible on plain x-rays. After the QRS data was acquired, these patients' x-rays were reviewed again. We also compared the cost of QRS, repeated x-rays, bone scan and MRI at the Besançon University Hospital. RESULTS: QRS was performed in all 154 patients and revealed 61 fractures (56 single-line and 5 multiple-line fractures). Thus 43.5% of these patients had occult wrist fractures (41% of which involved the carpal scaphoid). DISCUSSION: Occult fracture of the wrist, particularly the carpal scaphoid, is frequent. Repeated x-ray examination does not increase the rate of detection of these fractures. Bone scans may also fail to reveal occult fractures. MRI is a key examination in the assessment of wrist fracture symptoms, but is presently not available in all institutions. Bone scan is classically insufficiently precise. QRS is a rapidly available low-cost examination which we have found to be indispensable for the diagnosis of occult wrist fractures. With early QRS diagnosis, the risk of neglected carpal scaphoid fracture and subsequent nonunion and osteoarthritis together with the personal, social, and medicolegal consequences can be avoided.

Adolescent↗
PubMed2004

[Fractures of the distal radius treated by osteosynthesis and injectable bone substitute: a prospective study of 39 patients].

PURPOSE OF THE STUDY: Comminution is often neglected in patients presenting fractures of the distal radius. Use of injectable bone substitutes can fill the gap left by comminution, avoiding radial shortening and loss of prono-supination. MATERIAL AND METHODS: Forty-eight patients with a distal fracture of the radius were treated by osteosynthesis and injectable cement between 1998 and 2001. These patients were reviewed at mean follow-up of 46 months (36-56). Dorsal displacement was present in all cases and the AO classification was A (n=26), B (n=15), C (n=7). Fixation was achieved with pins (n=32), posterior plate (n=14), and external fixator (n=2) before injection of the bone substitute. Outcome was evaluated with the Herzberg score, the Gartland and Werley score and DASH by an independent operator. RESULTS: Four patients were lost to follow-up and five who developed a deformed callus after the initial osteosynthesis were excluded from the analysis. The Herzberg functional score reached 84 (range 54-100) and the Gartland and Werley radioclinical score was 4.6 (0-11) with 89% excellent and good outcomes. DASH was 23.6 (5.8-62.7). Ulnar variance was unchanged or changed less than 2 mm between the immediate postoperative period and last follow-up in 88% of patients. There was one carpal tunnel syndrome related to anterior cement leakage. Three biopsies were performed and revealed a "humid sand" aspect six months after injection as well as presence of osteoblasts within the bone substitute. There was no or very little resorption. DISCUSSION: Several authors have demonstrated the biomechanical and functional effects of filling the comminution gap to avoid radial shortening. The first reported cases, then later prospective series, favored the use of injectable cements for patients with comminution. Cement used in our patients allowed preservation enables preservation of normal ulnar variance in addition to filling the gap. Like any bone substitute, it is an attractive alternative to other filling methods (ceramic graft) offering two advantages: adaptation to the bone defect and primary stability. This easy-to-use cement is resorbed slowly. Because of high cost, it may be reserved for patients with important functional needs.

Adult↗
PubMed2003

[Reinsertion of the flexor tendon using a suture anchor: prospective study using early active motion].

INTRODUCTION: The aim of this study was to evaluate subjective and functional results of a prospective continuous series of immediate tendon-to-bone repair of the F.D.L. using a miniaturized anchor. METHOD: Seven patients have been operated by the same surgeon in emergency for a section of the FDL in zone one. Distal tendon-to-bone re-attachment has been realized using a mini-G II Mitek anchor suture. Five of the patient were male, four of them being manual workers. Only one had a work accident. According to Leddy and Packer's classification one patient had a stage 1 lesion and the six others had stage two lesions. The injured fingers showed associated lesions in four cases. Rehabilitation consisted of early active mobilization protected by a Duran-type splint. All the patients had been examined by an independent surgeon at 10 months follow-up. Mean age at that time was 32 years. RESULTS: One patient was very satisfied with his results while the six others were satisfied. Two minor complications were encountered, one of them being directly in relation to the implant. Total Active Motion (TAM) summed up to 92% of the arch of motion of the normal controlateral finger. Pinch-force reached 81% compared to that of the controlateral finger. Two patients described no pain. Mean eviction from work was 70 days. DISCUSSION: Tendon-to-bone repair of the FDL using an anchor seems to give good results on pain, TAM and on force. The only complication due to the implant did not have any functional incidence. The series of Marin Braun on 77 cases of such repairs using a barb-wire show similar results compared to the implant used in our series. However, anchor sutures have several advantages compared to a transcutaneous device: they reduce the risk of infection, of nail dystrophy and they offer a better comfort to the patient.

Adolescent↗
PubMed2003

[Isolated traumatic luxation of the radial head in adults: report of a case and review of the literature].

One case of isolated traumatic dislocation of the radial head in a 59-years-old female secondary to an injury in pronation and extension of the non dominant left elbow is reported. Treatment consisted of immediate closed reduction followed by immobilisation in a plaster cast with the elbow flexed at 110 degrees, for 10 days. An MRI scan 2 months after the injury showed the lesion of annular ligament which did not have any clinical consequences. At 5 years follow-up, functional outcome is excellent compared to the normal contralateral elbow with no difference between both sides. Only 20 cases of isolated traumatic dislocation of the radial head in the adult have been reported in the last 30 years, and there are no guidelines for treatment. Thirteen were treated conservatively with no recurrence. Typical clinical presentation is a maintenance of flexion and extension following the injury, but complete loss of pronation and supination. This case is the first case reported in the french literature treated conservatively and with a 5-years follow-up.

Elbow Joint↗
PubMed2002

[Aseptic bone necrosis following reimplantation of a degloving finger].

We report a case of microsurgical replantation of a degloved finger in a manual worker. Four months following replantation, avascular necrosis of the middle and distal phalanges was apparent. Amputation at the level of the proximal phalanx was performed. Re-plantation is the solution of choice for such degloving injuries, but a different flap can be used if replantation is not possible. Avascular necrosis of bone is an unfrequent complication, but surgeons should be aware of it.

Accidents, Occupational↗
PubMed2002

[Hand injuries resulting from high-pressure injection: lesions specific to industrial oil].

Nineteen cases of high pressure injection injuries in the hand were treated between 1973 and 1998. Same surgical treatment plan was followed in all cases: excision of the penetration point, irrigation, debridement and synovectomy if opening of the flexor sheath was noted, and skin closure to allow early mobilisation. All cases concerned men, work injuries, and volar aspect of the hand. The elapsed time between injection and initial surgery ranged from 1 hour to 1 month with a mean of 6.5 days. Eighteen patients out of 19 were reviewed with a mean follow up of 12 years. In 11/19 cases, (58%) oil was injected. The results of oil injection cases have been analysed: the quantity of oil and the preoperative delay (if more ten hours) are associated with poor functional results or complications. Two amputations, two cases of skin necrosis at the injection point, and one case of infection are reported. One case of oleoma of the thumb is described. The specificity of injuries by industrial oil under pressure must be known: paint or white spirit are more toxic than oil which was in all cases injected in the dominant hand (no high pressure injection tool but a defect in the pipe). An important inflammatory reaction with functional sequelae is caused by foreign bodies in oil. Extraction of oil off the injured tissues is difficult because oil is not visible. A specific information is necessary for farmers and truck driver, very exposed population.

Accidents, Occupational↗
PubMed2001

[Use of distally based intermetacarpal flaps to cover dorsal traumatic defects of the middle fingers].

INTRODUCTION: The presence of distal intermetacarpal anastomoses between dorsal and palmar vascular networks makes it possible to dissect and isolate Distally Based Dorsal Hand (DBDH) flaps. Quaba and Davidson first described this possibility. The purpose of this paper is to report our experience using the DBDH flap to reconstruct complicated defects of the long fingers. MATERIAL AND METHOD: We are reporting our experience in eight cases (seven performed in emergency) where such a flap was used to cover dorsal traumatic skin defects of the long fingers. The average age was 40.3 years, ranging from 25 to 67 years. All the patients were males, seven of them had a job at the time of injury and the last one had already retired when injured. RESULTS: All the eight flaps survived, sometimes with minor complications. Only one case developed a whole-thickness distal necrosis treated successfully by regular dressings. In one case, a Z-plasty was performed to correct a retraction in the 2nd web-space two months after surgery. DISCUSSION: Many flaps have been described to cover dorsal skin defects in the fingers. All of them display some advantages and some disadvantages. The use of this flap allows coverage of vast skin defects and thereby early finger mobilisation. The surgical technique is rather easy, and it does not require microsurgical experience. Skin grafting to cover donor site is not always necessary.

Accidents, Occupational↗
PubMed2001

[Osteosynthesis of distal radius fractures by doral plate: advantages and disadvantages].

Distal radius fractures remain a challenge. No one osteosynthesis procedure can solve all the problems. A method of analysis is necessary in order to choose the best tools. Open treatment of the fracture is logical but rarely performed. A review of the literature and the experience of the authors are reported in order to analyse the correct place of dorsal plating in distal radius fracture with dorsal displacement. The learning curve of the operative procedure and the design of the implants can explain the occurrence of several complications. The dorsal plate is effective against secondary dorsal displacement. This demanding procedure must be compared with other reported procedures (pining and external fixator) to define the advantages and disadvantages.

Bone Nails↗
PubMed2001

One-stage emergency treatment of open grade IIIB tibial shaft fractures with bone loss.

The purpose of this study was to report the authors' experience with emergency reconstruction of severe tibial shaft fractures. Five male patients were admitted to the emergency room with a grade IIIB open tibial shaft fracture with bone loss (average age, 33 years; age range, 18-65 years). Injuries were the result of motorcycle accidents (N = 2), pedestrian accidents (N = 1), gunshot wound (N = 1), and paragliding fall (N = 1). Primary emergent one-stage management for all patients consisted of administration of antibiotics, debridement, stabilization by locked intramedullary nailing, bone grafting from the iliac crest, and coverage using free muscle flaps (four latissimus dorsi and one gracilis). The average follow-up was 21 months (range, 8 months-3.5 years). Partial weight bearing with no immobilization was started at 3 months, and full weight bearing began 5 months after trauma. No angular complications and no nonunions were observed. There was one case of superficial infection without osteitis. All fractures healed within 6 months in 4 patients and within 10 months in 1 patient. At the last follow-up examination, ankle and knee motion was normal and no pain was noted, except for 1 patient who had associated lesions (ankle motion reduced by 50%). Aggressive emergency management of severe open tibial fractures provides good results. It improves end results markedly, not only by reducing tissue loss from infection, but also reducing healing and rehabilitation times.

Adolescent↗
PubMed2001

[Occult fractures of the carpal navicular. Detection by quantitative radioscintigraphy. Social and medico-legal repercussions].

Fractures of the scaphoid of the wrist are not easily diagnosed and when they are eventually recognized due to late complications, the prognosis is much poorer than it would have been at injury. Medical negligence and poorly-performed or interpreted x-rays are frequently cited as reasons for non-diagnosis. Often these fractures are trabecular, so-called occult, and they cannot be seen on a conventional exam, even if well-performed. Tomography and tomodensitometry have yielded poor results. Quantitative radioscintigraphy (QRS), the exam we are proposing, is a modification of scintigraphy, which is a very sensitive exam (100%) but has little specificity. The first step in QRS is to quantify the fixation of the tracer on the injured side and compare it to that of the uninjured side. If the injured side fixation is double that of the uninjured side, a fracture (often scaphoid) is present. MRI is our reference. In the second step in QRS, a computer-assisted fusion is made of the scintigraphic image and the x-ray (quantitative scintigraphy has the same diagnostic value as MRI). The center of the fracture is localized, thus yielding a specificity of nearly 100% for this exam. Out of a prospective series of 154 patients who had a conventional examination: 41% were diagnosed to have a scaphoid fracture using QSR, therefore a number higher than supposed. Rare carpal fractures were also detected. The cost of this exam is low. The exam climinates non-diagnosed fractures which can lead to non-union and arthrosis. Due to the frequency of carpal trauma, this exam should have a significant effect on the individual, on social security costs and litigations.

Adolescent↗
PubMed2000

[One-stage emergency treatment of open tibial shaft fractures with bone loss. Specifics and indications].

OBJECTIVES: The purpose of this study was to report our experience in the reconstruction of severe tibial shaft fractures in emergency treatment. PATIENTS: Five male patients were admitted to the emergency room with a grade IIIB open tibial shaft fracture with bone loss, one patient with a grade IIIA open tibial fracture with massive articular bone loss and one patient with a grade IIIC open tibial fracture. INTERVENTION: Primary one-stage management was the same for the five patients with a grade IIIB: debridement, stabilization by locked intramedullary nailing, bone grafting from iliac crest. Skin loss was covered in the same operative time using free muscle flaps (four latissimus dorsi, one gracilis). For the patient with massive articular and diaphyseal bone loss, a vascularized fibula transfer with arthrodesis was performed one day after the trauma. For the patient with grade IIIC open tibial fracture, a shortening was performed in emergency treatment. RESULTS: The average follow-up was 21 months (range: eight months to 3.5 years). Partial weight-bearing was started at three months and the time of full weight-bearing was five months after the trauma. No angular complication and no non-union were observed. We noted one superficial infection without osteitis. All fractures healed within five to ten months (mean: 8.5 months). At the last follow-up, ankle and knee motion was normal and no pain was noted, except for the patient who had an arthrodesis and another who had associated lesions. CONCLUSION: We think that "aggressive" emergency management for severe open tibial fractures gives good results. It significantly reduces tissue loss from infection and improves healing and rehabilitation times.

Adolescent↗