Ahmed Zemirline - Academia.edu (original) (raw)
Papers by Ahmed Zemirline
Chirurgie de la Main, 2012
Chirurgie de la main, 2014
The intravascular stent technique (IVaS) was developed to simplify the anastomosis of submillimet... more The intravascular stent technique (IVaS) was developed to simplify the anastomosis of submillimeter blood vessels. One variation of the IVaS called the "clip stent", improved the patency of anastomosed vessels. The goal of this study was to analyze a subsequent technical variation called the "pull out stent", which aims to reduce trauma to the vessel. Our experimental study comprised 4 groups of 10 rats. Anastomosis of the tail artery was performed with 10-0 nylon suture using either interrupted sutures (group I), IVaS (group II), "clip stent" (group III), or "pull out stent" (group IV). The "pull out stent" technique consisted of 3 steps: introduction of the stent (intraluminal and then transluminal introduction of a 4-0 nylon monofilament followed by introduction of the other end into the opposite lumen), anastomosis, and then removal of the stent. The anastomosis procedure time was longer in group III than in group IV. The number ...
European journal of orthopaedic surgery & traumatology : orthopédie traumatologie, 2014
The aim of this study was to determine the feasibility of a mini-approach for distal radius volar... more The aim of this study was to determine the feasibility of a mini-approach for distal radius volar plating. A 15-mm incision was made in 11 cadaver wrists. A 41 mm length and 24 mm width plate was placed deep to the pronator quadratus then fixed using 2 K-wires. The 2 central epiphyseal screws were placed before pin removal, the lateral screws followed and finally the proximal ones. The number of control views needed was on average 1.9 mm, and the position of the plate was good in 10 cases and average in 1 case. The size of the incision after the operation was on average 16.3 mm. No complications were found. Our results show that volar plate fixation of distal radius fracture is feasible through a 15 mm approach. This approach is esthetic, respects noble structures and facilitates reduction due to ligamentotaxis.
Chirurgie de la Main, 2013
HAND, 2012
Introduction It is usual to stop the intake of oral anticoagulants (anti-vitamin K) before surger... more Introduction It is usual to stop the intake of oral anticoagulants (anti-vitamin K) before surgery. Some authors have shown that during minimal surgery, the relay with low molecular weight heparin (LMWH) may lead to more thromboembolic complications. We present a prospective comparative study while evaluating the results of stopping or continuing anticoagulants in the surgery for carpal tunnel syndrome. Material and methods Our series included 21 patients (24 hands) taking anticoagulants on a long-term basis. For the first nine patients (group I), treatment with anticoagulants was stopped before the surgery. For the following 12 patients (group II), treatment with anticoagulants was not interrupted. The evaluation was based on the measurement of pain (VAS), functional score of the Quick D.A.S.H. and grip strength (Jamar®) and search for a haematoma or thromboembolism). Results The pain decreased by 3.5 points in both groups. The Quick D.A.S.H. decreased by 19.9 and 27.7 points in groups I and II, respectively. The average grip strength decreased by 2.5 kg in group I and increased by 3.8 kg in group II. A subcutaneous haematoma that got healed by itself was observed in group II. We did not observe any thromboembolic complications.
Chirurgie de la Main, 2011
Chirurgie de la Main, 2013
Prospective continuous study comparing intrafocal cross-pinning HK2 1 with a locking plate in dis... more Prospective continuous study comparing intrafocal cross-pinning HK2 1 with a locking plate in distal radius fracture fixation Étude prospective continue comparant brochage intrafocal bloqué HK2 1 versus plaque à vis bloquées dans la fixation des fractures du radius distal
Journal of Wrist Surgery, 2013
One of the main problems in endoscopic surgery is positioning and placing both the optical device... more One of the main problems in endoscopic surgery is positioning and placing both the optical device and the surgical instruments within the operative field. Triangulation of the instruments is only mastered after years of training. To smooth the learning curve, computer-assisted solutions have been developed in some disciplines such as in abdominal laparoscopy, 1 arthroscopy of the temporomandibular joint, 2 and hip arthroscopy. 3
European Journal of Orthopaedic Surgery & Traumatology, 2014
Fracture dislocations of the fifth carpometacarpal are usually treated by percutaneous K-wires de... more Fracture dislocations of the fifth carpometacarpal are usually treated by percutaneous K-wires despite occasional complications: displacement, stiffness, malunions, and arthritis. Our aims were to evaluate the use of locked K-wire fixation for these fracture dislocations. Our series includes 31 fracture dislocations, five extra-articular and 26 articular, 21 of which were at the base of the metacarpal, four at the hamate, and one involving both the hamate and the metacarpal. Mean tourniquet time was 22 min and irradiation 2 mGy. After reduction, an M4 M5 K-wire and a carpometacarpal wire were connected using an MetaHUS (®) connector. Immediate immobilization was allowed. Return to normal activity was resumed at 6.5 weeks. At around 15 months follow-up, mean pain score was 8.5, Quick DASH was 6.36, and overall grip strength was 92 %, TAM of the fifth ray was 96 % of the contralateral side. There were two displacements that were re-operated with good result, three superficial infections, and one case of stiffness. All fractures healed without arthritis. Overall, percutaneous K-wire and splinting of fracture dislocations of the fifth carpometacarpal joint is unstable, and internal fixation can cause adhesions and stiffness. Our results show that the percutaneous locked K-wire technique is a good alternative as it associates closed reduction with K-wire fixation and a solid fixation using an external connector. This technique allows immediate mobilization of the hand and removal of hardware in clinic.
Hand Surgery, 2014
Several techniques are used for fixation of Bennett's fractures. ... more Several techniques are used for fixation of Bennett's fractures. The aim of this study was to assess a technique of arthroscopic-assisted reduction and percutaneous cannulated screw fixation of Bennett's fractures. Seven patients (mean age 29 years) with three fractures Type I and four fractures Type II according to Gedda were operated under arthroscopic lavage, fluoroscopic screw fixation, and arthroscopic control of the joint reduction. Arthroscopy, showed satisfactory joint reduction in all cases. At 4.5 months, the mean pain score was 1 (0-4), QuickDASH 15 (0-61), and Kapandji score 9 (5-10). Compared to the contralateral side, first web opening was 86% (58-100), key pinch 73% (45-89), grip strength, and 85% (40-100). Four secondary displacements were noted, two of which had a step of more than 1 mm. Our results showed that the use of arthroscopy for percutaneous screw fixation of Bennett's fractures facilitates joint reduction but does not guarantee stability of fixation.
Hand Surgery, 2014
We report the case of a traumatic amputation by circular saw of the ring and small fingers, assoc... more We report the case of a traumatic amputation by circular saw of the ring and small fingers, associated with middle finger nail matrix loss and tendon, bone and joint exposure. The replantation was not attempted with patient's consent. Since the nail unit from the ring finger was intact, we decided to harvest the ring finger nail unit for major finger reconstruction. Although the principle of vascularized transfer from a severely damaged finger is widely recognized and the vascularized nail transfer from toe is a relatively common procedure, there is no description of a vascularized nail transfer from a non-replantable digit in the literature.
Surgical and Radiologic Anatomy, 2010
Background Following the example of the anterior cruciate ligament reconstruction, the success of... more Background Following the example of the anterior cruciate ligament reconstruction, the success of meniscus allograft transplantation relies on good position of the graft and Wrm anchorage. The anatomy of the intercondylar region and the connections between the cruciate ligament and the meniscal horns have been the subject of many surveys. However, as far as we know, there is only one description of meniscoligamentous band between the posterior horn of the lateral meniscus (PHLM) and the anterior cruciate ligament (ACL) (Lahlaïdi in Rev Chir Orthop Reparatrice Appar Mot 57(8):593-600, 1971).
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2013
We report a case of a Type Vb flexor digitorum profundus tendon avulsion in a patient for whom su... more We report a case of a Type Vb flexor digitorum profundus tendon avulsion in a patient for whom surgery was contraindicated because of a high risk of stroke if anticoagulant treatment was to be stopped. After a 6-week conservative treatment and a 3-week selfphysiotherapy programme, the patient achieved a nearly full active range of motion and an excellent functional result. A radiograph demonstrated a good fracture healing.
Surgical and Radiologic Anatomy, 2013
Background The dorsal approach to the wrist is the exposure of choice for most of the surgical pr... more Background The dorsal approach to the wrist is the exposure of choice for most of the surgical procedures on the radiocarpal and intercarpal joints. Contrary to the volar approach, it encounters neither the main arteries nor the motor nerve branch. However, the dorsal approach goes necessarily through the extensor retinaculum. We describe two transseptal dorsal approaches that pass through the extensor retinaculum in the thickness of a septum between two compartments. A virtual space was developed beneath the infratendinous retinaculum (which is a deep layer covering the floor of the extensor compartments) to expose the periosteum, the ligaments and the joint capsule without opening the extensor compartments. Methods Twenty cadaveric wrists have been dissected to study the feasibility of the two transseptal approaches. Ten wrists were exposed through a 3-4 transseptal approach, passing through the extensor retinaculum in the thickness of the septum between the third and fourth compartments. Ten wrists were exposed through a 4-5 transseptal approach, passing through the extensor retinaculum in the thickness of the septum between the fourth and fifth compartments. The extent of violations of extensor compartments and joint capsule, and the exposed anatomical structures were noted. At the end of each dissection, the whole extensor system was outrightly removed for histological study. Results The feasibility of the transseptal approaches was demonstrated for all the dissected wrists. The dissection plane beneath the infratendinous retinaculum was macroscopically and microscopically highlighted. Conclusions The transseptal approaches provide a good exposure to the dorsal side of the wrist joint, without opening the extensor tendon compartments.
Chirurgie de la Main, 2012
Chirurgie de la main, 2014
The intravascular stent technique (IVaS) was developed to simplify the anastomosis of submillimet... more The intravascular stent technique (IVaS) was developed to simplify the anastomosis of submillimeter blood vessels. One variation of the IVaS called the "clip stent", improved the patency of anastomosed vessels. The goal of this study was to analyze a subsequent technical variation called the "pull out stent", which aims to reduce trauma to the vessel. Our experimental study comprised 4 groups of 10 rats. Anastomosis of the tail artery was performed with 10-0 nylon suture using either interrupted sutures (group I), IVaS (group II), "clip stent" (group III), or "pull out stent" (group IV). The "pull out stent" technique consisted of 3 steps: introduction of the stent (intraluminal and then transluminal introduction of a 4-0 nylon monofilament followed by introduction of the other end into the opposite lumen), anastomosis, and then removal of the stent. The anastomosis procedure time was longer in group III than in group IV. The number ...
European journal of orthopaedic surgery & traumatology : orthopédie traumatologie, 2014
The aim of this study was to determine the feasibility of a mini-approach for distal radius volar... more The aim of this study was to determine the feasibility of a mini-approach for distal radius volar plating. A 15-mm incision was made in 11 cadaver wrists. A 41 mm length and 24 mm width plate was placed deep to the pronator quadratus then fixed using 2 K-wires. The 2 central epiphyseal screws were placed before pin removal, the lateral screws followed and finally the proximal ones. The number of control views needed was on average 1.9 mm, and the position of the plate was good in 10 cases and average in 1 case. The size of the incision after the operation was on average 16.3 mm. No complications were found. Our results show that volar plate fixation of distal radius fracture is feasible through a 15 mm approach. This approach is esthetic, respects noble structures and facilitates reduction due to ligamentotaxis.
Chirurgie de la Main, 2013
HAND, 2012
Introduction It is usual to stop the intake of oral anticoagulants (anti-vitamin K) before surger... more Introduction It is usual to stop the intake of oral anticoagulants (anti-vitamin K) before surgery. Some authors have shown that during minimal surgery, the relay with low molecular weight heparin (LMWH) may lead to more thromboembolic complications. We present a prospective comparative study while evaluating the results of stopping or continuing anticoagulants in the surgery for carpal tunnel syndrome. Material and methods Our series included 21 patients (24 hands) taking anticoagulants on a long-term basis. For the first nine patients (group I), treatment with anticoagulants was stopped before the surgery. For the following 12 patients (group II), treatment with anticoagulants was not interrupted. The evaluation was based on the measurement of pain (VAS), functional score of the Quick D.A.S.H. and grip strength (Jamar®) and search for a haematoma or thromboembolism). Results The pain decreased by 3.5 points in both groups. The Quick D.A.S.H. decreased by 19.9 and 27.7 points in groups I and II, respectively. The average grip strength decreased by 2.5 kg in group I and increased by 3.8 kg in group II. A subcutaneous haematoma that got healed by itself was observed in group II. We did not observe any thromboembolic complications.
Chirurgie de la Main, 2011
Chirurgie de la Main, 2013
Prospective continuous study comparing intrafocal cross-pinning HK2 1 with a locking plate in dis... more Prospective continuous study comparing intrafocal cross-pinning HK2 1 with a locking plate in distal radius fracture fixation Étude prospective continue comparant brochage intrafocal bloqué HK2 1 versus plaque à vis bloquées dans la fixation des fractures du radius distal
Journal of Wrist Surgery, 2013
One of the main problems in endoscopic surgery is positioning and placing both the optical device... more One of the main problems in endoscopic surgery is positioning and placing both the optical device and the surgical instruments within the operative field. Triangulation of the instruments is only mastered after years of training. To smooth the learning curve, computer-assisted solutions have been developed in some disciplines such as in abdominal laparoscopy, 1 arthroscopy of the temporomandibular joint, 2 and hip arthroscopy. 3
European Journal of Orthopaedic Surgery & Traumatology, 2014
Fracture dislocations of the fifth carpometacarpal are usually treated by percutaneous K-wires de... more Fracture dislocations of the fifth carpometacarpal are usually treated by percutaneous K-wires despite occasional complications: displacement, stiffness, malunions, and arthritis. Our aims were to evaluate the use of locked K-wire fixation for these fracture dislocations. Our series includes 31 fracture dislocations, five extra-articular and 26 articular, 21 of which were at the base of the metacarpal, four at the hamate, and one involving both the hamate and the metacarpal. Mean tourniquet time was 22 min and irradiation 2 mGy. After reduction, an M4 M5 K-wire and a carpometacarpal wire were connected using an MetaHUS (®) connector. Immediate immobilization was allowed. Return to normal activity was resumed at 6.5 weeks. At around 15 months follow-up, mean pain score was 8.5, Quick DASH was 6.36, and overall grip strength was 92 %, TAM of the fifth ray was 96 % of the contralateral side. There were two displacements that were re-operated with good result, three superficial infections, and one case of stiffness. All fractures healed without arthritis. Overall, percutaneous K-wire and splinting of fracture dislocations of the fifth carpometacarpal joint is unstable, and internal fixation can cause adhesions and stiffness. Our results show that the percutaneous locked K-wire technique is a good alternative as it associates closed reduction with K-wire fixation and a solid fixation using an external connector. This technique allows immediate mobilization of the hand and removal of hardware in clinic.
Hand Surgery, 2014
Several techniques are used for fixation of Bennett's fractures. ... more Several techniques are used for fixation of Bennett's fractures. The aim of this study was to assess a technique of arthroscopic-assisted reduction and percutaneous cannulated screw fixation of Bennett's fractures. Seven patients (mean age 29 years) with three fractures Type I and four fractures Type II according to Gedda were operated under arthroscopic lavage, fluoroscopic screw fixation, and arthroscopic control of the joint reduction. Arthroscopy, showed satisfactory joint reduction in all cases. At 4.5 months, the mean pain score was 1 (0-4), QuickDASH 15 (0-61), and Kapandji score 9 (5-10). Compared to the contralateral side, first web opening was 86% (58-100), key pinch 73% (45-89), grip strength, and 85% (40-100). Four secondary displacements were noted, two of which had a step of more than 1 mm. Our results showed that the use of arthroscopy for percutaneous screw fixation of Bennett's fractures facilitates joint reduction but does not guarantee stability of fixation.
Hand Surgery, 2014
We report the case of a traumatic amputation by circular saw of the ring and small fingers, assoc... more We report the case of a traumatic amputation by circular saw of the ring and small fingers, associated with middle finger nail matrix loss and tendon, bone and joint exposure. The replantation was not attempted with patient's consent. Since the nail unit from the ring finger was intact, we decided to harvest the ring finger nail unit for major finger reconstruction. Although the principle of vascularized transfer from a severely damaged finger is widely recognized and the vascularized nail transfer from toe is a relatively common procedure, there is no description of a vascularized nail transfer from a non-replantable digit in the literature.
Surgical and Radiologic Anatomy, 2010
Background Following the example of the anterior cruciate ligament reconstruction, the success of... more Background Following the example of the anterior cruciate ligament reconstruction, the success of meniscus allograft transplantation relies on good position of the graft and Wrm anchorage. The anatomy of the intercondylar region and the connections between the cruciate ligament and the meniscal horns have been the subject of many surveys. However, as far as we know, there is only one description of meniscoligamentous band between the posterior horn of the lateral meniscus (PHLM) and the anterior cruciate ligament (ACL) (Lahlaïdi in Rev Chir Orthop Reparatrice Appar Mot 57(8):593-600, 1971).
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2013
We report a case of a Type Vb flexor digitorum profundus tendon avulsion in a patient for whom su... more We report a case of a Type Vb flexor digitorum profundus tendon avulsion in a patient for whom surgery was contraindicated because of a high risk of stroke if anticoagulant treatment was to be stopped. After a 6-week conservative treatment and a 3-week selfphysiotherapy programme, the patient achieved a nearly full active range of motion and an excellent functional result. A radiograph demonstrated a good fracture healing.
Surgical and Radiologic Anatomy, 2013
Background The dorsal approach to the wrist is the exposure of choice for most of the surgical pr... more Background The dorsal approach to the wrist is the exposure of choice for most of the surgical procedures on the radiocarpal and intercarpal joints. Contrary to the volar approach, it encounters neither the main arteries nor the motor nerve branch. However, the dorsal approach goes necessarily through the extensor retinaculum. We describe two transseptal dorsal approaches that pass through the extensor retinaculum in the thickness of a septum between two compartments. A virtual space was developed beneath the infratendinous retinaculum (which is a deep layer covering the floor of the extensor compartments) to expose the periosteum, the ligaments and the joint capsule without opening the extensor compartments. Methods Twenty cadaveric wrists have been dissected to study the feasibility of the two transseptal approaches. Ten wrists were exposed through a 3-4 transseptal approach, passing through the extensor retinaculum in the thickness of the septum between the third and fourth compartments. Ten wrists were exposed through a 4-5 transseptal approach, passing through the extensor retinaculum in the thickness of the septum between the fourth and fifth compartments. The extent of violations of extensor compartments and joint capsule, and the exposed anatomical structures were noted. At the end of each dissection, the whole extensor system was outrightly removed for histological study. Results The feasibility of the transseptal approaches was demonstrated for all the dissected wrists. The dissection plane beneath the infratendinous retinaculum was macroscopically and microscopically highlighted. Conclusions The transseptal approaches provide a good exposure to the dorsal side of the wrist joint, without opening the extensor tendon compartments.