[An «all around¼ version of the Mac Gregor free flap]. / Cas clinique. Lambeau Mac Gregor libre en version «all around¼.

Given the appearance of a good number of cover flaps in recent decades, the Mac Gregor flap in its free form is used less and less but still finds its place today in certain complex cases with extensive loss of substance. This report describes an unusual case of wide tissue coverage by «all around¼ flap by Mac Gregor technique in a victim of an extensive burn of the left upper limb which occurred on 08/08/1997 and was responsible for a progressive flessum of the wrist and a hyperextension of the fingers with a complete loss of their mobility. The intervention is done in one step with a wide release of the scarred areas of the wrist and hand and the realization of the free inguinal flap in «all around¼. Here we discuss the type of flap, the surgical approach, the different advantages and disadvantages compared to other known flaps and the possible complications of the Mac Gregor free inguinal flap.

Suite à l'apparition de nombreux lambeaux de couverture au cours des dernières décennies, le lambeau de Mac Gregor sous sa forme libre est de moins en moins utilisé mais trouve encore sa place aujourd'hui dans certains cas complexes avec des pertes de substance étendues. Ce rapport décrit un cas inhabituel de large couverture tissulaire par un lambeau libre de type Mac Gregor en «all around flap¼ chez une victime d'une brûlure étendue du membre supérieur gauche survenue le 08/08/1997 et responsable d'un flessum progressif du poignet et d'une hyperextension des doigts avec une perte complète de leur mobilité. L'intervention se fait en un temps avec une large libération des zones cicatricielles du poignet et de la main et la réalisation du lambeau inguinal libre en «all around flap¼. Nous discutons ici du type de lambeau, de l'approche chirurgicale, des différents avantages et inconvénients par rapport à d'autres lambeaux connus et des possibles complications du lambeau inguinal libre de Mac Gregor.

[Efficacy comparison of conservative and surgical treatment in proximal humerus fractures : a monocentric retrospective study]. / Étude comparative du traitement chirurgical et conservateur des fractures de l'humérus proximal : une étude monocentrique rétrospective.

Proximal humerus fractures (PHF) are common, they represent 4 to 6 % of all fractures. They usually affect the elderly (above 60 years) and most the time, women (M/F ratio = 3/7). In general, they are not or slightly displaced and their treatment is thus commonly conservative (75 to 90 % of cases). A displaced PHF can be challenging for the orthopaedic surgeons because of the actual lack of consensus concerning the gold standard treatment for these fractures. This monocentric retrospective study compares the outcomes of both conservative and surgical treatment in PHF at minimum one year follow-up.

Les fractures de l'humérus proximal (FHPs) sont fréquentes, elles représentent 4 à 6 % de toutes les fractures. Elles touchent préférentiellement le sujet âgé, de plus de 60 ans, qui est le plus souvent une femme (Ratio M/F = 3/7). Elles ne sont généralement pas ou peu déplacées. Dès lors, leur traitement est conservateur dans 75 à 90 % des cas. S'il s'agit d'une FHP déplacée, le traitement représente un challenge pour le chirurgien car il n'existe actuellement aucun consensus scientifique quant à la façon idéale de traiter ces fractures. L'objectif de cette étude monocentrique rétrospective est de comparer les résultats fonctionnels du traitement conservateur versus chirurgical dans le cadre de FHPs après minimum 1 an de suivi.

Preoperative planning of Total Hip Arthroplasty. Must this essential part of the procedure be necessarily performed by the orthopedic surgeon? A prospective study about 100 Corail ® Hip System.

Currently, patients who undergo total hip arthroplasty want a complete restoration of their hip function and not only pain relief. Templating in THA is essential for accurately predicting the optimal size of the implants required. It also reduces the risk of potential complications. To check the reproducibility of our preoperative planning, to compare the accuracy of templating between orthopedic surgeon (OS), orthopedic resident (OR) and data manager (DM), to determine the learning curve between the different planners and to evaluate the effect of body mass index impact on digital templating for THA. One hundred uncemented Corail ® Hip System using a ceramic on ceramic bearing surface were included into the study. The software used for templating was IMPAX-Orthopaedic-Tools. A calibration marker (28-mm ball) was used for calibration. All the anteroposterior pelvis radiographs were planned by three participants (OS, OR, DM). We systematically collected the precisely planned size measurements as well as the variation by 1 or 2 sizes of prostheses. At +/- 1 size, we did not find any significant difference between the participants with respectively 94%, 96% and 93% concordance for the cup, 88%, 90% and 90% for the stem and 85%, 84% and 83% for the neck. Our preoperative templating was accurate in predicting the required implant size and results were similar to those available in the literature. We did not find any difference between the planners and we were unable to objectivate a learning curve period. We conclude that this essential part of the planning procedure can be performed by the surgeon himself or an orthopedic resident or a data manager who has anatomical knowledge if the surgeon is unable to perform templating himself.

A comparative study of Osteal ® stem subsidence using EBRA-FCA ® method and a specific and original analysis model developed with the Imagika ® software.

The radiological follow-up is an essential element of evaluation of total hip arthroplasty. This is a retrospective study based on 71 THA using a cemented Ceraver-Osteal ® stem. They were systematically associated with RM ® cups in all cases with a ceramic on polyethylene bearing surface. The mean age of patients was 74.4 +/-10.2 years and the mean follow-up was 7.9 +/- 0,9 years. Aetiologies were 61 osteoarthritis, 4 osteonecrosis and 6 femoral neck fractures. The main purpose of this work is to verify if a subsidence of femoral implants and radiological changes can be recognized in a comparable pattern using EBRA-FCA ® method and Imagika ® software. The measured subsidence is 0.05 +/- 0.005 mm / year with EBRA-FCA ® and 0.06 +/- 0.004 mm / year with Imagika ® (p = 0.74). We did not show significant migration whatever the method used. The precision of the Imagika ® method, thanks to the automatic detection of contours and the use of a correction factor, makes it possible to objectify sub- millimeter migrations of femoral stems. The absence of a significant difference between the two methods makes it possible to validate the Imagika ® method.

Clinical and radiological results with a 36-mm cobalt-chrome prosthetic head, cross-linked Durasul liners associated with Allofit cups: a more than 10-year follow-up period.

BACKGROUND: Highly cross-linked polyethylene is currently a common articulation surface used for total hip arthroplasty (THA). AIM: The aim of the present study is in vivo assessment of highly cross-linked Durasul polyethylene linear and volumetric wear when associated with a 36-mm prosthetic femoral head. METHODS: We retrospectively reviewed clinical and radiographic data of 78 patients (81 hips) having primary THAs using Durasul liner combined with a 36-mm CoCr prosthetic head. All of them were followed for more than 10 years. Patient outcome was assessed with the Harris Hip Score (HHS) preoperatively and at last follow-up. 2-D prosthetic head penetration into polyethylene, 3D wear rates and cup migration were evaluated. RESULTS: The preoperative and last follow-up HHS were 50.43 +/- 10.42 and 97.44 +/- 5.51 respectively. The annual penetration of the prosthetic head into Durasul® liner was 0.029 +/- 0.003 mm. The annual linear penetration and volumetric wear extrapolation rates using Charnley and Ilchmann formulas were 37.84% and 57.76% respectively of that seen with conventional polyethylene liner. At last follow-up, the total loss of material in Durasul represents only 0.15% of the initial polyethylene mass. We did not observe any significant cup migration in the study group. CONCLUSIONS: Results are promising, and we believe that these data authorise the continued use of highly cross-linked polyethylene liner associated with a 36-mm prosthetic head for total hip arthroplasties in older patients. More long-term follow-up studies are mandatory before we feel comfortable with the project of using cross-linked polyethylene in young and active patients instead of ceramic-on-ceramic bearings.

Total joint replacement improves pain, functional quality of life, and health utilities in patients with late-stage knee and hip osteoarthritis for up to 5 years.

OBJECTIVES: To study and identify the determinants of the impact on pain, function, and quality of life of a prosthetic replacement surgery after 5 years of survival in patients with osteoarthritis (OA) of the lower limb. METHOD: In total, 626 osteoarthritic patients from a University Hospital, divided in 2 groups (according to surgical site), were prospectively followed for 5 years after hip (n = 346) or knee (n = 280) replacement. Validated specific Western Ontario and McMaster Universities Arthritis Index (WOMAC) and generic (SF-36 and EQ) instruments assessing quality of life were used prior to surgery and yearly, thereafter. We defined a good outcome as a clinically relevant improvement in WOMAC greater than or equal to the minimally important difference (MID). Regressions showed the relationships among preoperative, perioperative, and postoperative measures and the evolution of WOMAC scores after 5 years (percent change). We also examined any predictors of good outcomes. RESULTS: The beneficial effect on quality of life observed during the first year after hip and knee arthroplasty (HA and KA) was maintained for up to 5 years. More than 3/4 of the patients in our study experienced a good outcome (86.04% in HA group and 79.91% in KA group). Both the good outcome and the 5-year change in WOMAC are predicted by preoperative (i.e., radiological severity, comorbidities, disability, and level of education), perioperative (i.e., length of hospital stay and place of discharge), and postoperative (i.e., complications) variables in the two groups. CONCLUSIONS: Joint arthroplasty is a highly valuable therapeutic strategy for hip or knee OA patients who do not respond to pharmacological management. These results represent a step towards the collection of robust, scientifically sound data that will facilitate the completion of health economic analyses in the field of OA. KEY POINTS: • This study reports the long term outcomes of hip and knee replacement surgery in late-stage OA.• We identified pre-, per-, and post-operative determinants which contribute to a greater improvement in pain and function, hence increasing patients' satisfaction.• These results could contribute to select an OA population which has a high probability to get an optimal benefit from total joint replacement.

Early Clinically Relevant Improvement in Quality of Life and Clinical Outcomes 1 Year Postsurgery in Patients with Knee and Hip Joint Arthroplasties.

Objective To measure and identify the determinants of the outcomes after hip/knee arthroplasty (HA/KA) in patients with osteoarthritis during the first postsurgical year. Design In this prospective observational study, we evaluated the preoperative and postoperative (3, 6, and 12 months) outcomes of 626 patients who underwent HA (346 with median age 65 years, 59% female) or KA (280 with median age 66.5 years, 54% female) between 2008 and 2013. Generic and specific tools were used to measure health-related quality of life (HRQoL) and utility. Good outcome was defined as an improvement in WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) greater than or equal to the minimal important difference (MID). Regressions were performed to evaluate the relationship between preoperative and postoperative measures and evolution of WOMAC/good outcome. Results We observed an almost systematic improvement of all parameters for up to 12 months, but especially at the 3-month follow-up. The low number of comorbidities and the absence of postoperative complications were the common determinants of improvement of WOMAC total score after 12 months. Other parameters (background of the joint, preoperative function and length of hospital stay in KA group; place of discharge in HA group) affected the evolution of WOMAC scores. 87.09% of HA and 73.06% of KA patients experienced a good outcome. A small number of comorbidities, a worse preoperative function, a shortened hospital stay (KA only), and an absence of early postoperative complications (HA only) significantly predicted a good outcome. Conclusions Intermediate HRQoL following HA or KA improved quickly from preoperative levels for all instruments. More than 70% of patients achieved a good outcome defined as improved pain, stiffness and disability and the predictors are slightly close.

Migration and wear of the Duraloc "1200 series" cup associated with Enduron UHWMPE using the EBRA method and the Imagika software.

We report a retrospective study on 122 THA using Duraloc "1200 series" cups. All patients received a 28-mm head (107 Al2O3, 15 CoCr). The mean age of the patients at surgery was 56.3 years and the mean follow-up was 137 months.Mean migration at two years using the EBRA method was 0.18 mm cranially and 0.16 mm medially. Mean polyethylene wear was 0.03 mm/year using the Imagika software and 0.06 mm/year using EBRA. Only one patient presented with abnormal polyethylene wear of 1.7 mm at 90 months with Imagika and 2.4 mm with EBRA. The Duraloc cup seems to be a reliable implant in respect of bone fixation and resistance to wear.