Thierry Dubert - Academia.edu (original) (raw)

Papers by Thierry Dubert

Hand surgery and rehabilitation, Jun 1, 2023

EMC - Techniques chirurgicales - Orthopédie - Traumatologie, 2006

Orthopaedics & Traumatology: Surgery & Research, 2020

BACKGROUND Intra-articular fractures and fracture-dislocations of the ulnar-sided carpometacarpal... more BACKGROUND Intra-articular fractures and fracture-dislocations of the ulnar-sided carpometacarpal joints (US-CMC) are common and under-reported. Their diagnosis is often delayed or incomplete, and there is no consensus as to the best treatment. The aim of this systematic literature review was to focus on the quality of existing data and to describe in detail the available evidence on the diagnosis and treatment of these lesions. Based on our findings, we will propose guidelines for improving the design of future studies on these lesions. METHODS This systematic literature review looked at all articles published between 1918 and 2019 on US-CMC fractures and fracture-dislocations. The quality of the articles was evaluated using the Quality Appraisal Tool devised by Moga et al. Information on the diagnostic and therapeutic methods were extracted along with epidemiological data, classifications, and clinical and radiological outcomes. RESULTS Of the 500 articles identified, 13 were included. According to the Quality Appraisal Tool, three of these articles had acceptable quality. While either radiographs or CT scans were used for the diagnosis, the radiographs were insufficient to precisely describe the lesions and guide the treatment. Conservative treatment or percutaneous surgical treatment was preferred for acute stable lesions without extensive fractures or comminution, while open surgical treatment was used most often in cases of unstable or sub-acute fractures and fracture-dislocations. DISCUSSION The current literature on this topic is made up of case series with a low level of evidence. CT is needed to assess and classify these lesions and select between conservative and surgical treatment. Unstable cases or those with delayed presentation should be treated with an open surgical approach. Based on our findings, we propose reporting guidelines for future studies on the treatment of US-CMC fractures and fracture-dislocations. LEVEL OF EVIDENCE III.

La Revue du praticien, 2013

Purpose of the study: We reviewed traumatic distal leg amputations managed in our unit between 19... more Purpose of the study: We reviewed traumatic distal leg amputations managed in our unit between 1990 and 1993. Reimplantation or unilateral emergency revascularization were undertaken in five cases. Material and methods: The initial loss of length was considerable (range 8.5–12 cm) allowing direct internal fixation, protected with an external fixator bridging the ankle, and direct vasculonervous suture. Secondary lengthening was undertaken early in the proximal metaphyseal zone before sensorial recovery was complete. Results: Healing was achieved within a normal delay in all cases. Nerve regeneration was monitored from the site of the microsuture by following the progression of the Tinel sign along the repaired nerve trunks; this defined the rate of regeneration. Our observations showed that nerve lengthening above the site of the microsurgical suture did not hinder nerve regeneration and even appear to stimulate it. Conclusion: This strategy of extensive initial debridement compensa...

The invention concerns a device adaptable to any ring, wedding ring or band, said band (wedding r... more The invention concerns a device adaptable to any ring, wedding ring or band, said band (wedding ring or the like) is bored with at least a hole right through the whole cross-section. The hole(s) is (are) bored such that the remaining thickness is slight whatever the direction of the hole(s) relative to the band cross-section. The invention is applicable in all cases where the calibration of the breaking strength on a band (wedding ring or the like) is useful.

Dupuytren’s disease (DD) is a benign, progressive and irreversible fibro-proliferative disorder o... more Dupuytren’s disease (DD) is a benign, progressive and irreversible fibro-proliferative disorder of unknown origin affecting the palmar surface of the hand and fingers, leading to the formation of nodules and cords and ultimately to disabling extension deficits of the finger joints. It is most prevalent in Northern European Caucasian and males are more affected than females [1-4]. In 1979 the first black patient with Dupuytren’s contracture who had no evidence of Caucasoid mixture in their genetic make-up was reported on in Miami [5,6]. In 1986, 5 other black patients were reported in USA [7]. Only ten cases of DD in Africa have been reported so far. Understanding the epidemiology of DD in Africa is important in order to provide clues to its etiology and pathogenesis. Many etiologic factors associated to DD have been mentioned: hand injury, manual labor, alcohol consumption, smoking, epilepsy drugs, and diabetes mellitus but apart from smoking none has made its sufficient evidence [8...

Hand Surgery and Rehabilitation

Revue de Chirurgie Orthopédique et Traumatologique

The Journal of Bone and Joint Surgery

BACKGROUND Upper-limb injuries and musculoskeletal disorders represent a major economic burden fo... more BACKGROUND Upper-limb injuries and musculoskeletal disorders represent a major economic burden for both patients and society, largely due to limitations in returning to work. We hypothesized that a positive patient-surgeon relationship may facilitate patients' recovery and lead to a faster return to work. METHODS This longitudinal observational study comprised 219 patients, from 8 French hand trauma centers, who were 18 to 55 years of age and were on sick leave from work because of an injury or musculoskeletal disorder of the upper limb. In addition to instruments measuring patients' functional scores and quality of life, the quality of the patient-surgeon relationship was assessed at enrollment using a specific questionnaire (Q-PASREL [Quality of PAtient-Surgeon RELationship]). Six months after enrollment, the return-to-work status was assessed. Logistic and Cox regression models were developed to identify predictors of return to work (yes/no) and the time off from work in days. RESULTS Overall, 74% of the patients who returned to work within 6 months after enrollment had a high or medium-high Q-PASREL score, whereas 64% of the patients who were still on sick leave had a low or medium-low Q-PASREL score. The odds of patients with a low or medium-low Q-PASREL score returning to work were, respectively, 95% and 71% lower than the odds of patients with a high score doing so, with a percent difference of 56% (95% confidence interval [CI] = 40% to 71%) for low versus high (odds ratio [OR] = 0.05 [95% CI = 0.02 to 0.13]) and 25% (95% CI = 6% to 44%) for medium-low versus high (OR = 0.29 [95% CI = 0.11 to 0.76]). All Q-PASREL items and scores were significantly associated with return to work. CONCLUSIONS Patients with a lower Q-PASREL score and more severe disability were less likely to return to work within 6 months and had a longer time off from work. Efforts to improve the quality of patient-surgeon relationships may minimize the duration of sick leaves and accelerate patient recovery. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Annales de Chirurgie de la Main et du Membre Supérieur

Annales de Chirurgie de la Main et du Membre Supérieur

ABSTRACT

Journal of Market Access & Health Policy

Hand surgery & rehabilitation, 2016

Recent studies seem to show that ligament reconstruction with tendon interposition (LRTI) does no... more Recent studies seem to show that ligament reconstruction with tendon interposition (LRTI) does not provide any benefit over trapezium excision alone; however dorsal subluxation was not measured in these studies. We believe it is logical to perform ligamentoplasty in order to obtain long-term stability and therefore treat dorsal subluxation. Our aim is to verify this hypothesis in an observational prospective study of LRTI using the entire flexor carpi radialis (FCR) tendon. Patients who had failed to respond to nonoperative treatment for advanced thumb basal joint arthritis were recruited prospectively between 2007 and 2011. They all received the same surgical treatment, which consisted of LRTI using the entire FCR tendon. Pre- and postoperative pain, range of motion, strength, stability of the base of the first metacarpal and DASH scores were evaluated. Forty-three patients (49 thumbs) were included with a mean follow-up of 37months (range: 29-72months). Patients showed significant...

Journal de Radiologie

ABSTRACT

Hand surgery and rehabilitation, Jun 1, 2023

EMC - Techniques chirurgicales - Orthopédie - Traumatologie, 2006

Orthopaedics & Traumatology: Surgery & Research, 2020

BACKGROUND Intra-articular fractures and fracture-dislocations of the ulnar-sided carpometacarpal... more BACKGROUND Intra-articular fractures and fracture-dislocations of the ulnar-sided carpometacarpal joints (US-CMC) are common and under-reported. Their diagnosis is often delayed or incomplete, and there is no consensus as to the best treatment. The aim of this systematic literature review was to focus on the quality of existing data and to describe in detail the available evidence on the diagnosis and treatment of these lesions. Based on our findings, we will propose guidelines for improving the design of future studies on these lesions. METHODS This systematic literature review looked at all articles published between 1918 and 2019 on US-CMC fractures and fracture-dislocations. The quality of the articles was evaluated using the Quality Appraisal Tool devised by Moga et al. Information on the diagnostic and therapeutic methods were extracted along with epidemiological data, classifications, and clinical and radiological outcomes. RESULTS Of the 500 articles identified, 13 were included. According to the Quality Appraisal Tool, three of these articles had acceptable quality. While either radiographs or CT scans were used for the diagnosis, the radiographs were insufficient to precisely describe the lesions and guide the treatment. Conservative treatment or percutaneous surgical treatment was preferred for acute stable lesions without extensive fractures or comminution, while open surgical treatment was used most often in cases of unstable or sub-acute fractures and fracture-dislocations. DISCUSSION The current literature on this topic is made up of case series with a low level of evidence. CT is needed to assess and classify these lesions and select between conservative and surgical treatment. Unstable cases or those with delayed presentation should be treated with an open surgical approach. Based on our findings, we propose reporting guidelines for future studies on the treatment of US-CMC fractures and fracture-dislocations. LEVEL OF EVIDENCE III.

La Revue du praticien, 2013

Purpose of the study: We reviewed traumatic distal leg amputations managed in our unit between 19... more Purpose of the study: We reviewed traumatic distal leg amputations managed in our unit between 1990 and 1993. Reimplantation or unilateral emergency revascularization were undertaken in five cases. Material and methods: The initial loss of length was considerable (range 8.5–12 cm) allowing direct internal fixation, protected with an external fixator bridging the ankle, and direct vasculonervous suture. Secondary lengthening was undertaken early in the proximal metaphyseal zone before sensorial recovery was complete. Results: Healing was achieved within a normal delay in all cases. Nerve regeneration was monitored from the site of the microsuture by following the progression of the Tinel sign along the repaired nerve trunks; this defined the rate of regeneration. Our observations showed that nerve lengthening above the site of the microsurgical suture did not hinder nerve regeneration and even appear to stimulate it. Conclusion: This strategy of extensive initial debridement compensa...

The invention concerns a device adaptable to any ring, wedding ring or band, said band (wedding r... more The invention concerns a device adaptable to any ring, wedding ring or band, said band (wedding ring or the like) is bored with at least a hole right through the whole cross-section. The hole(s) is (are) bored such that the remaining thickness is slight whatever the direction of the hole(s) relative to the band cross-section. The invention is applicable in all cases where the calibration of the breaking strength on a band (wedding ring or the like) is useful.

Dupuytren’s disease (DD) is a benign, progressive and irreversible fibro-proliferative disorder o... more Dupuytren’s disease (DD) is a benign, progressive and irreversible fibro-proliferative disorder of unknown origin affecting the palmar surface of the hand and fingers, leading to the formation of nodules and cords and ultimately to disabling extension deficits of the finger joints. It is most prevalent in Northern European Caucasian and males are more affected than females [1-4]. In 1979 the first black patient with Dupuytren’s contracture who had no evidence of Caucasoid mixture in their genetic make-up was reported on in Miami [5,6]. In 1986, 5 other black patients were reported in USA [7]. Only ten cases of DD in Africa have been reported so far. Understanding the epidemiology of DD in Africa is important in order to provide clues to its etiology and pathogenesis. Many etiologic factors associated to DD have been mentioned: hand injury, manual labor, alcohol consumption, smoking, epilepsy drugs, and diabetes mellitus but apart from smoking none has made its sufficient evidence [8...

Hand Surgery and Rehabilitation

Revue de Chirurgie Orthopédique et Traumatologique

The Journal of Bone and Joint Surgery

BACKGROUND Upper-limb injuries and musculoskeletal disorders represent a major economic burden fo... more BACKGROUND Upper-limb injuries and musculoskeletal disorders represent a major economic burden for both patients and society, largely due to limitations in returning to work. We hypothesized that a positive patient-surgeon relationship may facilitate patients' recovery and lead to a faster return to work. METHODS This longitudinal observational study comprised 219 patients, from 8 French hand trauma centers, who were 18 to 55 years of age and were on sick leave from work because of an injury or musculoskeletal disorder of the upper limb. In addition to instruments measuring patients' functional scores and quality of life, the quality of the patient-surgeon relationship was assessed at enrollment using a specific questionnaire (Q-PASREL [Quality of PAtient-Surgeon RELationship]). Six months after enrollment, the return-to-work status was assessed. Logistic and Cox regression models were developed to identify predictors of return to work (yes/no) and the time off from work in days. RESULTS Overall, 74% of the patients who returned to work within 6 months after enrollment had a high or medium-high Q-PASREL score, whereas 64% of the patients who were still on sick leave had a low or medium-low Q-PASREL score. The odds of patients with a low or medium-low Q-PASREL score returning to work were, respectively, 95% and 71% lower than the odds of patients with a high score doing so, with a percent difference of 56% (95% confidence interval [CI] = 40% to 71%) for low versus high (odds ratio [OR] = 0.05 [95% CI = 0.02 to 0.13]) and 25% (95% CI = 6% to 44%) for medium-low versus high (OR = 0.29 [95% CI = 0.11 to 0.76]). All Q-PASREL items and scores were significantly associated with return to work. CONCLUSIONS Patients with a lower Q-PASREL score and more severe disability were less likely to return to work within 6 months and had a longer time off from work. Efforts to improve the quality of patient-surgeon relationships may minimize the duration of sick leaves and accelerate patient recovery. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Annales de Chirurgie de la Main et du Membre Supérieur

Annales de Chirurgie de la Main et du Membre Supérieur

ABSTRACT

Journal of Market Access & Health Policy

Hand surgery & rehabilitation, 2016

Recent studies seem to show that ligament reconstruction with tendon interposition (LRTI) does no... more Recent studies seem to show that ligament reconstruction with tendon interposition (LRTI) does not provide any benefit over trapezium excision alone; however dorsal subluxation was not measured in these studies. We believe it is logical to perform ligamentoplasty in order to obtain long-term stability and therefore treat dorsal subluxation. Our aim is to verify this hypothesis in an observational prospective study of LRTI using the entire flexor carpi radialis (FCR) tendon. Patients who had failed to respond to nonoperative treatment for advanced thumb basal joint arthritis were recruited prospectively between 2007 and 2011. They all received the same surgical treatment, which consisted of LRTI using the entire FCR tendon. Pre- and postoperative pain, range of motion, strength, stability of the base of the first metacarpal and DASH scores were evaluated. Forty-three patients (49 thumbs) were included with a mean follow-up of 37months (range: 29-72months). Patients showed significant...

Journal de Radiologie

ABSTRACT