[Role of radiotherapy in heterotopic ossification]. / Rôle de la radiothérapie dans l'ossification hétérotopique.

PURPOSE: To evaluate the use of radiation therapy for the prevention of heterotopic ossification. PATIENTS AND METHODS: Twenty-two patients, 20 to 76 years old were irradiated for the prevention of heterotopic ossification. All patients received a postoperative irradiation consisting of 700 cGy delivered by 18 MV photons using a linear accelerator. The delay between surgery and irradiation was 24 hours for 20 patients, 48 hours for three patients, 72 hours for two patients and 96 hours for one patient. The follow-up of all patients was based on radiologic findings (Brooker score) as well as the clinical status of the articulation before and after surgery. Of the 14 cases for which follow-up data was available, seven received primary prophylaxis and seven received secondary prophylaxis. RESULTS: Heterotopic ossification prophylaxis using radiation therapy was radiologically successful in 71.5% of patients: 85.7% success for patients receiving primary prophylaxis and 57.1% success for patients receiving secondary prophylaxis. No functional failure was reported. No patient developed radiation related side effects. CONCLUSION: Radiation therapy is proven to be effective in preventing heterotopic ossification. A larger study group is needed in order to compare our results with those seen in the literature.

[Computer-assisted surgery in total knee replacement. Preliminary results: report of 60 cases]. / Prothèse totale du genou assistée par ordinateur Résultats préliminaires: à propos de 60 cas.

PURPOSE OF THE STUDY: Conventional techniques proposed for total knee arthroplasty (TKA), necessarily require an acceptable alignment of the lower limb. Computer-assisted surgery is becoming increasingly popular in order to improve the precision of the component alignment, an essential element for good long-term results. The purpose of this prospective study was to present our preliminary results with computer-assisted implantation of TKA. MATERIAL AND METHODS: This was a prospective study of 55 patients (60 knees) included at random for computer-assisted TKA between April 2004 and September 2005. Mean age was 70.5 years. The preoperative assessment noted genu varum in 56 knees and genu valgum in four knees. Three knees with unilateral degenerative disease presented a post traumatic tibia malunion. The same surgeon performed all of the operations using the same prosthesis and navigation system (P.F.C. Sigma). Lower limb alignment and orientation of the prosthetic implants were assessed with standard pre- and postoperative gonometry. Sagittal alignment was measured on the standard X-rays (lateral and anteroposterior view). RESULTS: Knee alignment improved from 8.1+/-4.5 degrees varus (10 degrees valgus to 18 degrees varus) preoperatively, to 0.4+/-0.6 degrees varus (1 degrees valgus to 2 degrees varus) postoperatively. In the frontal plane, the mean angle of the femoral component on the anteroposterior (ap) view was 89.7+/-0.7 degrees (88-91 degrees). The mean angle of the tibial component on the ap view was 89.9+/-0.7 degrees (88.5-91 degrees). The femorotibial mechanical axis was within +/-2 degrees for all prostheses. In the sagittal plane, the mean angle of the femoral component on the lateral view was 4.8 degrees (3-6.5 degrees). The mean tibial slope was 2.7 degrees (1-4 degrees) for the prostheses with a fixed tibial plateau and 0.2 degrees (-1 degrees to +1 degrees) for those with a rotating plateau. The mean operative time was 135 min (110-180 min) and was inversely proportional to experience. There was one conversion to conventional surgery due to software dysfunction. There were no complications related to the operative technique. DISCUSSION: The best outcome, particularly in terms of aseptic loosening, is reported for knees with a valgus or varus angle within 3 degrees . The improved accuracy of computer-assisted implantation has enabled better orientation of the components in the frontal, sagittal and horizontal planes with implantations well within this range.

[Adolescent bicipitoradial bursitis: a rare disease that can simulate a malignant tumor]. / Bursite bicipitoradiale de l'adolescent: une entité rare pouvant simuler une tumeur maligne.

Bicipitoradial bursitis is a rare condition: we found 36 cases reported in the literature, none in children. The main manifestation is a painful tumefaction. We report a case observed in an adolescent whose magnetic resonance imaging findings were compatible with a malignant tumor. Surgical biopsy enabled the correct diagnosis of inflammatory synovium without signs of malignancy compatible with bicipitoradial bursitis. Complete cure was achieved without resection.

[Mirror hand deformity: a new phenotype with literature review]. / Main en miroir: une nouvelle forme avec revue de la littérature.

We report the case of a child who presented polydactyly with eight triphalangeal fingers, no thumb or radius and ulnar dimelia. Hand, wrist, forearm and elbow function was compromised, particularly due to wrist stiffness in flexion, the absence of forearm pronation supination and severe limitation of elbow motion. In addition, the child underwent surgery for pyloric hypertrophy and also presented a multicystic kidney. We present the clinical, anatomic, electromyographic, genetic and therapeutic aspects of this rare deformity and discuss data presented in the literature.

[Fibrodysplasia ossificans progressiva: orthopedic pitfalls and controversies]. / Fibrodysplasie ossifiante progressive: écueils orthopédiques et controverses.

Fibrodysplasia ossificans progressiva (FOP) is a rare disorder of the connective tissue associating malformation of the great toes and progressive heterotopic ossifications. Diagnosis is mostly clinical and currently no treatment is available. We report on the case of an 8 year old boy having an unusual form of FOP. We discuss clinical aspects of the disease and insist on the importance of early diagnosis, avoiding harmful events and therapeutic pitfalls.

[Linear scleroderma and foot deformity in children]. / Sclérodermie linéaire et déformation du pied chez l'enfant.

Linear scleroderma is a subtype of localized scleroderma generally observed in children, and may produce secondary bone and joint deformities. Its localization at the foot or ankle is rarely reported. A complete review of the literature reveals 21 cases of foot or ankle deformity due to linear scleroderma to which we add one case. The clinical and radiological aspects of the deformity, its pathogenesis, histological findings as well as orthopaedic management are presented and discussed.

A controlled sequential evaluation of open donor nephrectomy versus classical and modified laparoscopic donor nephrectomy: an update.

This study sought to determine the procedure of choice for kidney retrieval for transplantation by comparing open donor nephrectomy to laparoscopic donor nephrectomy and modified laparoscopic donor nephrectomy and by analyzing intraoperative donor and recipient graft function parameters. In this single-center, controlled, sequential analysis, 100 consecutive donor-recipient pairs were recruited, grouped according to surgical procedure, and operated upon between 1997 to 2004, as follows: group 1, open donor nephrectomy (n = 30), performed from 1997 to 2000; group 2, laparoscopic donor nephrectomy (n = 28), performed from 2000 to 2002; and group 3, modified laparoscopic donor nephrectomy (n = 42), performed from 2002 to 2004. Data were analyzed by type of operative procedure, graft function, length of hospital stay, and donor recovery time. Operative time was similar for all three surgical approaches. Warm ischemia times for open donor nephrectomy and modified laparoscopic donor nephrectomy were similar. Acute tubular necrosis occurred in 7% of patients in all groups. Donor recovery and lengths of hospital stay were significantly shorter for laparoscopic approaches. Donor complications were similar in numbers, differing only in complication type. Graft function and survival were similar for all three surgical approaches. We conclude that modified laparoscopic donor nephrectomy is the procedure of choice for living kidney retrieval.

A controlled sequential evaluation of laparoscopic donor nephrectomy versus open donor nephrectomy: an update.

INTRODUCTION: In this study, we compared laparoscopic (lap Nx) to open donor nephrectomy (open Nx) with specific emphasis on outcomes in the donor and recipient. METHODS: This single-center sequential analysis recruited 100 consecutive donor-recipient pairs operated on from 1997 until 2003. The open Nx (n = 30), were performed between 1997 and 2000; the lap Nx (n = 70) were performed between 2000 and 2003. Prospective records included operative data, anatomic details of the graft, hospital stay, and donor recovery. RESULTS: Donor characteristics and renal function were similar for open Nx and lap Nx. Operative parameters were similar except for the longer warm ischemia time in lap Nx versus open Nx (3.14 +/- 2.10 vs 1.5 +/- 0.5 minute, P < .001). Donor complications were equivalent in number, but differed in spectrum with a trend toward more intraoperative complications with lap Nx versus more postoperative complications for open Nx. Donor recovery, hospital stay, and return to work were improved in lap Nx versus open Nx (P < .001). Renal function of grafts after lap Nx were similar to open Nx: 2-year serum creatinine values of 1.26 +/- 0.21 versus 1.31 +/- 0.40, respectively. Graft survivals were similar. CONCLUSION: Compared to open Nx lap Nx offers major advantages to the donor, and yields similarly favorable results in graft outcomes. However, it is more surgically demanding. Consequently, lap Nx should be adopted as the procedure of choice for living kidney retrieval.

[Percutaneous computed tomography-guided thermal ablation of osteoid osteoma]. / Thermocoagulation percutanée scannoguidée de l'ostéome ostéoïde.

PURPOSE OF THE STUDY: Progress in medical imaging has improved recognition and management of osteoid osteoma. The purpose of this study was to assess the efficacy of computed tomography (CT)-guided percutaneous thermal ablation and discuss the advantages and disadvantages. MATERIAL AND METHODS: We reviewed retrospectively 33 consecutive patients with osteoid osteoma who had undergone CT-guided radiofrequency ablation. The diagnosis was established on the basis of the clinical presentation and pathognomonic radiographic findings (CT and bone scintigram) without histological proof. We recorded patient age and gender, tumor location, clinical signs and duration, imaging findings, duration of the ablation procedure, type of anesthesia, hospital stay, and complications. We evaluated their effect on final outcome. RESULTS: Weight-bearing was possible in all patients with a lesion of the lower limb a few hours after surgery. Patients resumed their normal activities in 24-48 hours. Pain resolved immediately after radiofrequency ablation in 26 patients and limping, when present, disappeared within 24 hours. At mean follow-up of 34 months (minimum 12 months) there was one case of recurrent pain. Clinical cure was confirmed by CT and bone scintigraphy in twelve patients. DISCUSSION AND CONCLUSION: This precise and minimally invasive method is an effective and safe way to reduce healthcare expenditures. It can be recommended as the primary treatment for osteoid osteoma.

[Bernese periacetabular osteotomy for the treatment of the degenerative dysplasic hip]. / L'ostéotomie péri-acétabulaire bernoise dans le traitement des coxarthroses sur dysplasie de hanche.

PURPOSE OF THE STUDY: Appropriate management of degenerative joint disease in patients with dysplasic hips is a controversial issue. Non-surgical treatment is generally insufficient to achieve good long-term results and, in young patients, indications for total hip replacement, arthrodesis, or salvage procedures (Chiari, bone block) are limited. The most physiological option is to re-orient the acetabulum to cover the femoral head with a sufficient amount of joint cartilage. Several types of redirection osteotomy have been described. In the present work, we assess the clinical and radiological outcome after Ganz periacetabular osteotomy in patients with dysplastic hips who developed degenerative joints. We searched for factors influencing outcome. MATERIAL AND METHODS: This retrospective analysis was conducted in 57 patients with hip dysplasia who had undergone 64 peri-acetabular osteotomies for joint degeneration. Mean age at surgery was 31 years. The preoperative diagnosis was primary osteochondritis of the hip in 9 patients. The Merle d'Aubigné scores and VCE, VCA, HTE angles on standard x-rays were obtained before surgery and at last follow-up. The Tönnis grade for the severity of the joint degeneration was determined. In 19 patients, inter-trochanteric femoral osteotomy was performed to improve joint congruency in addition to peri-acetabular osteotomy. Clinical and radiological results were assessed at a mean follow-up of 3.5 years (range 2-6 years). The effects of age, cause of dysplasia, surgical history of the hip, severity of joint degeneration, association with femoral osteotomy, and learning curve were studied. Complications were recorded. RESULTS: On the average, the Merle d'Aubigné score improved from 13 points preoperatively to 16.5 points at last follow-up. Limping was observed for a longer period after surgery in patients who had an associated inter-trochanteric osteotomy. At last follow-up, the overall score was lower in grade 3 hips than in grade 1 and 2 hips. Serious complications were observed in the first 15 patients. There was no statistical relationship between age at surgery or surgical history of the hip and final outcome. Comparing the preoperative x-rays with those obtained at last follow-up demonstrated an improvement in the mean value for VCE (2 degrees preoperatively to 25 degrees at last follow-up), VCA (- 6 degrees to 39.5 degrees ), and HTE (25 degrees to 15 degrees ). Radiologically, the severity of joints degeneration was improved or remained unchanged in 83% of the hips (especially for grade 1 and 2 hips). DISCUSSION: In our hands, peri-acetabular osteotomy has provided good results, especially in terms of improved function and control of joint degeneration. Although this procedure is basically indicated for young patients with hip dysplasia free of joint degeneration, it would also be a useful alternative for those who have developed only moderately extensive joint degeneration (Tönnis grades 1 and 2) and a moderately excentric femoral head. Success in these patients depends on surgical experience, correct indications, and careful attention to technical details. Nevertheless, complications are not exceptional and the learning curve may be long. In our series, the main factor predictive of outcome was the Tönnis grade of joint degeneration.

Influence of rotational speed, torque and operator proficiency on failure of Greater Taper files.

AIM: The purpose of this study was to evaluate the influence of rotational speed. torque, and operator experience on the incidence of locking, deformation, and separation of instruments when using a specific Ni-Ti rotary instrumentation technique in extracted human teeth. METHODOLOGY: Greater Taper Ni-Ti rotary instruments (GT) were used in a crown-down technique. In one group (rotational speed evaluation) of canals (n = 300) speeds of 150, 2 50 and 350 r.p.m. (subgroups 1, 2 and 3) were used. Each one of the subgroups included 100 canals. In a second group (evaluation of torque) (n = 300) torque was set at 20, 30 and 55 Ncm (subgroups 4, 5 and 6). In the third group (evaluation of operator proficiency) (n = 300 three operators with varying experience (subgroups 7, 8 and 9) were also compared. Each subgroup included the use of 10 sets of GT rotary instruments and 100 canals of extracted human molars. Each set of instruments was used in up to 10 canals and sterilized before each case. NaOCl 2.5% was used as an irrigant. The number of locked, deformed, and separated instruments was recorded for each group. Statistical analysis was carried out with pairwise comparisons using Fisher's exact tests for each of the failure type. RESULTS: When the influence of rotational speed was evaluated, instrument deformation and separation did not occur in subgroups 1 (150) r.p.m.), 2 (250 r.p.m.), and 3 (350) r.p.m.). Instrument locking occurred in subgroup 3 only. Statistical analysis demonstrated a significant difference between the 150 and 350 r.p.m. groups and between the 250 and 350 r.p.m. groups with respect to instrument locking. In torque evaluation, neither separation, deformation nor locking occurred during the use of the instruments, at 150 r.p.m., and at the different torque values. When the operators were compared, although two instruments were separated in canals prepared by the least experienced operator. Fisher's exact tests did not demonstrate a significant difference between the three subgroups. Instrument locking, deformation, and separation did not occur with the most experienced operator. None of the instruments separated with the trained operator. CONCLUSIONS: Preclinical training in the use of the GT rotary instruments when used with a crown-down technique at 150 r.p.m. was crucial in avoiding instrument separation and reducing the incidence of instrument locking and deformation.

Failure of ProFile instruments used with high and low torque motors.

AIM: The purpose of this study was to evaluate the failure incidence of ProFile nickel-titanium rotary instruments when used in conjunction with different motors and a specific instrumentation technique. METHODOLOGY: ProFile Ni-Ti rotary instruments (PRI) with 0.06 taper were used in a crown-down technique. In groups 1, 2 and 3, an air, a high torque and a low torque motor were used, respectively. Each group included 30 canals in extracted human molars. One set of PRI sizes 40-15 was used for each canal; they were sterilized before each case. A 2.5% NaOCl solution was used as an irrigant. The number of deformed and separated instruments was recorded for the various experimental groups. RESULTS: Instrument separation did not occur in any of the three groups. One and two instruments were deformed when using the air and high torque motors, respectively. CONCLUSIONS: The results indicated no difference between the three motors with respect to the incidence of instrument failure. The results suggest that the use of PRI in a crown-down manner with air control motors was safe.

Influence of rotational speed, torque and operator's proficiency on ProFile failures.

AIM: The purpose of this study was to evaluate the influence of rotational speed, torque, and operator experience with a specific Ni-Ti rotary instrumentation technique on the incidence of locking, deformation and separation of instruments. METHODOLOGY: ProFile Ni-Ti rotary instruments (PRI) sizes 40-15 with a 6% taper were used in a crown-down technique. In one group of canals (n = 300) speeds of 150, 250 and 350 rpm (subgroups 1, 2 and 3) were used. Each one of the subgroups included 100 canals. In a second group (n = 300) torque was set at 20, 30 and 55 Ncm (subgroups 4, 5 and 6). In the third group (n = 300) three operators with varying experience (subgroups 7, 8 and 9) were also compared. Each subgroup included the use of 10 sets of PRI and 100 canals of extracted human molars. Each set of PRI was used in up to 10 canals and then sterilized before each case. NaOCl 2.5% was used as an irrigant. The number of locked, deformed, and separated instruments for the different groups, and within each part of the study was analysed statistically for significance with chi-squared tests. RESULTS: In group 1 only one instrument was deformed in the 150-rpm group and no instruments separated or locked. In the 250-rpm group instrument separation did not occur, however, a high incidence of locking, deformation and separation was noted in the 350-rpm group. In general, instrument sizes 30-15 locked, deformed and separated. Chi-squared statistics showed a significant difference between the 150 and 350 rpm groups but no difference between the 150 and 250 rpm groups with regard to instrument separation. Overall, there was a trend toward a higher incidence of instrument deformation and separation in smaller instruments. Locking and separation occurred during the final passage of the instruments, in the last (tenth) canal in each subgroup. In the second group, neither separation nor deformation and locking occurred during the use of the ProFile instruments, at 150 rpm, and at the different torque values. In the third group, chi-squared analysis demonstrated that significantly more instruments separated with the least experienced operator. Instrument locking, deformation, and separation did not occur with the most experienced operator. CONCLUSIONS: Preclinical training in the use of the PRI technique with crown-down at 150 rpm were crucial in avoiding instrument separation and reducing the incidence of instrument locking and deformation.

Popliteal cyst in a patient with total knee arthroplasty: a case report and review of the literature.

We report a case of total knee arthroplasty (TKA) failure presenting initially as a large popliteal cyst without bony destruction in a 66-year-old woman. A foreign body gigantocellular inflammatory reaction against polyethylene wear particles was found on histology. The size of the cyst and the absence of bony destruction can be due to an exclusive early intramuscular granulomatous reaction. Progressive loosening of the femoral component and narrowing of the joint space heralded the TKA failure.

Cyclic fatigue of ProFile rotary instruments after clinical use.

AIM: The purpose of this study was to evaluate cyclic fatigue of .06 ProFile Ni-Ti rotary instruments after clinical use in molar teeth. METHODOLOGY: In group 1, instruments size 40-15 were used in a crown-down technique using 2.5% NaOCl as an irrigant. Fifty-two molars were included and 13 sets of Profile Ni-Ti rotary instruments were used. Each set of instruments was used in four molars, and was steam autoclaved before each use. Group 2 (10 sets of new ProFile Ni-Ti rotary instruments) was the control group. Cyclic fatigue was tested by rotating the instruments in a 90 degrees metallic tube until they broke. RESULTS: One-way analysis of variance did not show any statistically significant differences amongst the files from both groups regarding cyclic fatigue. CONCLUSIONS: It was concluded that sterilization and clinical use in the presence of NaOCl did not lead to a decrease in the number of rotations to breakage of the files.

Cyclic fatigue of Profile rotary instruments after simulated clinical use.

AIM: The purpose of this study was to evaluate cyclic fatigue of Profile Ni-Ti rotary instruments (PRIs) after dry heat sterilization and up to 10 times simulated clinical use. METHODOLOGY: Instruments of size 40-15 were used in a crown-down technique. Three groups were included in this study. In groups 1 and 2, each set of instruments was used in five and 10 canals, respectively. Group 3 was the control group. NaOCl at a concentration of 2.5% was used as an irrigant. Each set of instruments was sterilized before each use. RESULTS: The PRI size 40 demonstrated the lowest incidence of rotations to breakage. One-way analysis of variance and Turkey's HSD test showed statistically significant differences among different file sizes within each group. CONCLUSIONS: The results showed that dry heat sterilization and simulated clinical use in the presence of NaOCl did not lead to a decrease in the number of rotations to breakage of the files.

Microleakage of a new and an old Kerr root canal sealers.

This study sought to evaluate the microleakage of two Kerr root canal sealers (old and new formulas of the Pulp Canal Sealer). Sixty anterior teeth were used. After cleaning and shaping to a size 30 file, the teeth were obturated with the vertical condensation of gutta-percha with either the old or the new root canal sealer. Apical microleakage was determined using pressurized fluid filtration at 90 min, 1 day, and 1, 4, 12, 18, and 24 wk after root canal obturation. The results showed that leakage tended to increase over time for the two groups. Also, no significant difference was found in microleakage between the old and the new formulas of the root canal sealer.