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1.
Orthop Traumatol Surg Res ; 100(7): 835-7, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25257754

ABSTRACT

During total knee replacement, hinged total knee implants are used in cases where ligament balancing cannot be achieved with less-constrained implants. The case of a patient who experienced two episodes of intraprosthetic dislocation of his rotating-hinge total knee prosthesis is described. There are very few reports of this type of dislocation with these implants. The implant's design, particularly of the hinge, plays an important role in stability. The balance between the flexion and extension spaces is very important even when using a hinged total knee implant. The role of the extensor mechanism in anteroposterior stability is reviewed, along with simple ways to augment it.


Subject(s)
Arthroplasty, Replacement, Knee , Knee Dislocation/surgery , Knee Prosthesis/adverse effects , Osteoarthritis, Knee/surgery , Aged, 80 and over , Humans , Knee Dislocation/etiology , Male , Prosthesis Design , Prosthesis Failure , Range of Motion, Articular , Reoperation
3.
Rev Esp Cir Ortop Traumatol ; 56(1): 11-6, 2012.
Article in Spanish | MEDLINE | ID: mdl-23177937

ABSTRACT

OBJECTIVE: The objective of this study was to determine the major risk factors for bleeding in patients with a pertrochanteric fracture in order to plan the transfusion strategy and to overcome the problem of post-surgical anaemia. Various factors were analysed, including the taking of anticoagulant and/or anti-platelet treatment, the type of fracture, type of anaesthesia, and the type of osteosynthesis used. MATERIAL AND METHODS: A retrospective study was performed on 307 patients over 75 years old, operated on between the years 2005 and 2009. RESULTS: Bleeding was less in simple, non-comminuted fractures, in patients operated on using a mini-invasive screw-plate, in women, and in patients who did not take any anticoagulant or antiplatelet treatment.The only statistically independent factor associated with bleeding was fracture comminution. DISCUSSION: In this study we have seen that patients operated on using a Gamma(®) and DHS(®) nail are transfused more than in those operated on using PPCP(®) and Traumax(®) plate. Evans fractures 1 or 2, A 2.2, or A 2.3, cervical-trochanteric or simple pertrochanteric fractures bled less than Evans 4 or 5, the rest of the type AO fractures, and the complex pertrochanteric fractures. CONCLUSIONS: The precise analysis of the type of fracture is important, particularly in older and fragile patients, to be able to anticipate the need for transfusion. Thus useless and costly, and sometimes dangerous transfusions may be avoided.


Subject(s)
Blood Loss, Surgical , Hip Fractures/surgery , Aged , Aged, 80 and over , Analysis of Variance , Anesthesia/adverse effects , Anesthesia/methods , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Bone Nails/adverse effects , Female , Fracture Fixation/methods , Fractures, Comminuted/surgery , Hip Fractures/classification , Humans , Male , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/adverse effects , Retrospective Studies , Risk Factors , Sex Factors
4.
Orthop Traumatol Surg Res ; 98(3): 346-51, 2012 May.
Article in English | MEDLINE | ID: mdl-22483630

ABSTRACT

When dealing with severe bone loss during acetabular revision of a total hip arthroplasty, it can be difficult to find a reliable anatomical structure to ensure high-quality primary fixation of the cup. Since 2003, we have been using an implant with a long peg that is anchored into the iliac isthmus. This structure is usually intact, even in the most severe situations of bone loss. The use of this specially designed component provides satisfactory mechanical reconstruction in cases that can be quite challenging (Paprosky and SOFCOT stage 3). The length and postoperative care for the procedure remain the same and early weight bearing is possible. The specific principles applying to this procedure, along with the anatomical features of the iliac isthmus, the implantation technique and our initial results are described in detail.


Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Bone Diseases, Metabolic/surgery , Hip Prosthesis , Pelvic Bones/surgery , Aged , Aged, 80 and over , Bone Diseases, Metabolic/diagnostic imaging , Equipment Design , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pelvic Bones/diagnostic imaging , Prosthesis Design , Severity of Illness Index , Time Factors , Tomography, X-Ray Computed , Treatment Outcome
5.
Orthop Traumatol Surg Res ; 98(3): 309-18, 2012 May.
Article in English | MEDLINE | ID: mdl-22463866

ABSTRACT

INTRODUCTION: Bone reconstruction, after periacetabular tumour removal, is a complex procedure that carries a high morbidity rate and can result in poor clinical outcomes. Among the available options, the Puget pelvic resection-reconstruction procedure uses an autograft from the ipsilateral proximal femur to restore the anatomical and mechanical continuity of the pelvic ring before inserting an acetabular implant. HYPOTHESIS AND GOALS: This reconstruction technique satisfactorily restores the pelvic anatomy such that functional results and morbidity are comparable to alternative reconstruction techniques. PATIENTS AND METHODS: This was a retrospective study of 10 patients with an average age of 38.2 years (range 19 to 75) at the surgical procedure (performed between 1986 and 2007). There were five chondrosarcomas, three Ewing tumours, one plasmacytoma and one giant cell tumour. The position of the hip centre of rotation after reconstruction and autograft integration were evaluated on radiographs. Functional results were evaluated through the Musculoskeletal Tumor Society (MSTS) score and the Postel and Merle d'Aubigné (PMA) score. RESULTS: At the time of review, one patient was lost to follow-up and four had died. On radiographs, the hip centre of rotation after reconstruction was higher by a median value of 15 mm (range 5 to 35) and more lateral by a median value of 6mm (range -5 to 15). Upon evaluation of radiographs at a median time of 40 months (range 6 to 252 months), the autograft was completely integrated in five patients and partially integrated in three patients (two patients had a local recurrence). There were no cases of autograft fracture or non-union at the junctions of the graft. The median MSTS score was 25 out of 30 (range 20 to 29), or 83% (range 67 to 97%) at the median clinical follow-up of 82 months (range 49 to 264). The median PMA score was 13 out of 18 (range 12 to 18). All living patients were walking without assistance. Five patients required nine surgical revisions. Seven were attributed directly or indirectly to local recurrence; one revision was performed because of instability and one because of early acetabular loosening at 9 months. CONCLUSION: This challenging procedure provides satisfactory mechanical and anatomical results, while restoring hip anatomy and function. The primary cause of failure in this series was local recurrence of the tumour, which highlights the need to carefully select the indications and optimize the surgical tumour resection.


Subject(s)
Bone Neoplasms/surgery , Bone Transplantation/methods , Femur/transplantation , Pelvic Bones/surgery , Plastic Surgery Procedures , Acetabulum/diagnostic imaging , Acetabulum/pathology , Acetabulum/surgery , Adult , Aged , Bone Neoplasms/diagnosis , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Pelvic Bones/diagnostic imaging , Pelvic Bones/pathology , Retrospective Studies , Time Factors , Tomography, X-Ray Computed , Transplantation, Autologous , Treatment Outcome , Young Adult
6.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 56(1): 11-16, ene.-feb. 2012.
Article in Spanish | IBECS | ID: ibc-96529

ABSTRACT

Objetivo. El objetivo de este estudio era buscar los factores de riesgo de sangrado mayor en pacientes con una fractura pertrocantérica para planificar la estrategia transfusional y luchar contra la anemia posquirúrgica. Se analizaron diferentes factores como: la ingesta de tratamiento anticoagulante y/o antiagregante, el tipo de fractura, el tipo de anestesia y el tipo de osteosíntesis empleada. Material y métodos. Se realizó un estudio retrospectivo sobre 307 pacientes intervenidos con más de 75 años de edad entre el 2005 y el 2009. Resultados. El sangrado fue menor en las fracturas simples no conminutas, en los pacientes intervenidos mediante un tornillo-placa miniinvasivo, en las mujeres y en los pacientes que no tomaban ningún anticoagulante o antiagregante. El único factor estadísticamente independiente relacionado con el sangrado era la conminución fracturaria. Discusión. En este estudio hemos visto que los pacientes intervenidos con clavo Gamma® y DHS® se transfunden más que en los intervenidos con PPCP® y placa Traumax®. Las fracturas Evans 1 o 2, A 2.2. o A 2.3, las cervicotrocantéricas o pertrocantéricas simples sangraban menos que las Evans 4 o 5, el resto de los tipo AO y las fracturas pertrocantéricas complejas. Conclusiones. El análisis preciso del tipo de fractura es importante, especialmente en los pacientes mayores y frágiles, para poder anticiparse a la necesidad de transfusión. Así se podrían evitar las transfusiones inútiles, costosas y a veces peligrosas (AU)


Objective. The objective of this study was to determine the major risk factors for bleeding in patients with a pertrochanteric fracture in order to plan the transfusion strategy and to overcome the problem of post-surgical anaemia. Various factors were analysed, including the taking of anticoagulant and/or anti-platelet treatment, the type of fracture, type of anaesthesia, and the type of osteosynthesis used. Material and methods. A retrospective study was performed on 307 patients over 75 years old, operated on between the years 2005 and 2009. Results. Bleeding was less in simple, non-comminuted fractures, in patients operated on using a mini-invasive screw-plate, in women, and in patients who did not take any anticoagulant or antiplatelet treatment.The only statistically independent factor associated with bleeding was fracture comminution. Discussion. In this study we have seen that patients operated on using a Gamma® and DHS® nail are transfused more than in those operated on using PPCP® and Traumax® plate. Evans fractures 1 or 2, A 2.2, or A 2.3, cervical-trochanteric or simple pertrochanteric fractures bled less than Evans 4 or 5, the rest of the type AO fractures, and the complex pertrochanteric fractures. Conclusions. The precise analysis of the type of fracture is important, particularly in older and fragile patients, to be able to anticipate the need for transfusion. Thus useless and costly, and sometimes dangerous transfusions may be avoided (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Risk Factors , Hip Fractures/complications , Hip Fractures/diagnosis , Hip Fractures/therapy , Anemia/complications , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Retrospective Studies , Hip Fractures/economics
7.
Orthop Traumatol Surg Res ; 96(7): 816-20, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20884312

ABSTRACT

Side impact syndrome of the shoulder is rare and usually associated with concomitant mid-shaft clavicle, rib and scapular fractures. Visceral complications involve pleural cavity and/or lung injuries. The authors report two rare instances of posterior sternoclavicular dislocations with this entity. This association is rare and diagnosis can be overlooked in multi-trauma patients especially when blunt thoracic lesions can be life threatening. The absence of a fracture of the clavicle after a high-energy side impact to the shoulder should suggest this diagnosis, which can be facilitated by systematic total body CT scan with 3D reconstruction. Management is surgical.


Subject(s)
Joint Dislocations/diagnosis , Joint Dislocations/etiology , Sternoclavicular Joint/injuries , Adult , Humans , Joint Dislocations/therapy , Male , Middle Aged
8.
J Bone Joint Surg Br ; 92(1): 103-9, 2010 Jan.
Article in English | MEDLINE | ID: mdl-20044687

ABSTRACT

We retrospectively analysed the clinical results of 30 patients with injuries of the sternoclavicular joint at a minimum of 12 months' follow-up. A closed reduction was attempted in 14 cases. It was successful in only five of ten dislocations, and failed in all four epiphyseal disruptions. A total of 25 patients underwent surgical reduction, in 18 cases in conjunction with a stabilisation procedure. At a mean follow-up of 60 months, four patients were lost to follow-up. The functional results in the remainder were satisfactory, and 18 patients were able to resume their usual sports activity at the same level. There was no statistically significant difference between epiphyseal disruption and sternoclavicular dislocation (p > 0.05), but the functional scores (Simple Shoulder Test, Disability of Arm, Shoulder, Hand, and Constant scores) were better when an associated stabilisation procedure had been performed rather than reduction alone (p = 0.05, p = 0.04 and p = 0.07, respectively). We recommend meticulous pre-operative clinical assessment with CT scans. In sternoclavicular dislocation managed within the first 48 hours and with no sign of mediastinal complication, a closed reduction can be attempted, although this was unsuccessful in half of our cases. A control CT scan is mandatory. In all other cases, and particularly if epiphyseal disruption is suspected, we recommend open reduction with a stabilisation procedure by costaclavicular cerclage or tenodesis. The use of a Kirschner wire should be avoided.


Subject(s)
Athletic Injuries/etiology , Clavicle/injuries , Joint Dislocations/etiology , Sternoclavicular Joint/injuries , Adolescent , Adult , Athletic Injuries/surgery , Clavicle/surgery , Epiphyses/injuries , Epiphyses/surgery , Female , Follow-Up Studies , Humans , Joint Dislocations/diagnostic imaging , Joint Dislocations/surgery , Male , Retrospective Studies , Sternoclavicular Joint/physiopathology , Sternoclavicular Joint/surgery , Tomography, X-Ray Computed , Young Adult
12.
Rev Chir Orthop Reparatrice Appar Mot ; 93(7): 720-4, 2007 Nov.
Article in French | MEDLINE | ID: mdl-18065883

ABSTRACT

Certain authors have proposed percutaneous neurolysis of Morton's neuroma. We conducted a human anatomy study to assess the reliability and the iatrogenic effect of percutaneous section of the ligament. Percutaneous section of the inter-metatarsal ligament was performed on 16 fresh cadaver specimens via a dorsal approach. The plantar dissection demonstrated that the section was not complete, without associated lesion, in only six cases. Analyzing these failures, we determined the necessary procedure for correct section.


Subject(s)
Foot Diseases/surgery , Ligaments, Articular/pathology , Metatarsal Bones/pathology , Metatarsophalangeal Joint/pathology , Neuroma/surgery , Cadaver , Dissection , Foot Diseases/pathology , Humans , Joint Capsule/pathology , Metatarsal Bones/blood supply , Metatarsal Bones/innervation , Metatarsophalangeal Joint/blood supply , Metatarsophalangeal Joint/innervation , Neoplasm, Residual/pathology , Neuroma/pathology
13.
Rev Chir Orthop Reparatrice Appar Mot ; 93(3): 228-37, 2007 May.
Article in French | MEDLINE | ID: mdl-17534205

ABSTRACT

PURPOSE OF THE STUDY: There have been few prospective studies comparing minimally invasive approaches for total hip replacement. We wanted to ascertain the contribution of the minimally invasive posterior approach in comparison with the standard posterolateral approach in terms of early outcome. MATERIALS AND METHODS: This was prospective comparative consecutive series of patients. Patients with major architectural problems or undergoing revision arthroplasty were excluded. One hundred ten patients (116 hips) were divided into two groups which were comparable for number of patients, gender, age, body mass index, indication for surgery, and preoperative function scores. The preoperative ASA score was lower in the minimally invasive group (p=0.04). The patients were in the lateral reclining position for the two approaches and classical instrumentation using the same implants (stems and cemented or non-cemented cups) were used. We noted operative time and blood loss (using the Brecher method based on the hematocrit at day 1 and 5 and the number of blood transfusions), postoperative pain, and implant position. Functional outcome was assessed with the modified Harris score and the WOMAC index (at 6 weeks and 3 and 6 months). Statview(R) was used to search for statistical significance considering p<0.05 as significant. RESULTS: Mean length of incision was 8.5 cm versus 15.1 cm. Mean blood loss was significantly less in the minimally invasive group (p=0.027) as was the level of postoperative pain as confirmed by the lesser consumption of morphine analgesics (p=0.006). Other operative variables as well as implant position were comparable. There were no major complications in the minimally invasive group. In the standard group, there was one case of common peroneal nerve palsy, two dislocations, and two fractures related to falls after prosthesis implantation. The WOMAC index was better after the minimally invasive approach at six weeks and at three months (p<0.05). The modified Harris score was better only at six weeks. Functional outcome and pain became comparable thereafter. DISCUSSION AND CONCLUSION: The minimally invasive posterior approach does not require an orthopedic table nor specific instrumentation. A minute procedure is required with ligature of the posteromedial circumflex artery of the thigh to improve exposure and limit intraoperative bleeding. It enables satisfactory reproducible implant positioning. Conversion to an open posterolateral approach is possible if needed. The minimally invasive posterior approach enables a reduction in intraoperative bleeding and in postoperative pain while allowing earlier more rapid rehabilitation. Early clinical outcome is better but beyond six weeks, the functional results are comparable for the two approaches. The minimally invasive posterior approach is a reliable reproducible approach with a progressive learning curve.


Subject(s)
Arthroplasty, Replacement, Hip/methods , Accidental Falls , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/instrumentation , Blood Loss, Surgical , Body Mass Index , Case-Control Studies , Female , Follow-Up Studies , Hip Dislocation/etiology , Hip Fractures/etiology , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Morphine/therapeutic use , Narcotics/therapeutic use , Pain, Postoperative/etiology , Peroneal Neuropathies/etiology , Postoperative Complications , Prospective Studies , Range of Motion, Articular/physiology , Time Factors , Treatment Outcome
14.
Article in French | MEDLINE | ID: mdl-17389827

ABSTRACT

Chronic osteitis and squamous-cell carcinoma is a rare but classically described association. We report three cases of chronic tibial osteitis which developed open leg trauma. During the surveillance, after a latency period of several years, local signs developed leading to biopsy which provided the diagnosis of degenerative carcinomatosis. Search for locoregional extension or metastatic dissemination was negative. All three patients underwent amputation with good results. This small series, together with a review of the literature, enabled us to describe the principle epidemiological and diagnostic features, focusing on early signs. The appropriate management scheme remains to be determined although amputation, which some may consider as a failure, should not be postponed indefinitely.


Subject(s)
Bone Neoplasms/etiology , Carcinoma, Squamous Cell/etiology , Osteomyelitis/complications , Tibia/pathology , Accidents, Occupational , Aged , Amputation, Surgical , Anti-Bacterial Agents/therapeutic use , Bone Neoplasms/pathology , Carcinoma, Squamous Cell/pathology , Cell Transformation, Neoplastic/pathology , Chronic Disease , Cutaneous Fistula/etiology , Follow-Up Studies , Humans , Male , Middle Aged , Tibial Fractures/complications , Wounds, Gunshot/complications
15.
Arch Pediatr ; 14(2): 138-43, 2007 Feb.
Article in French | MEDLINE | ID: mdl-17140778

ABSTRACT

UNLABELLED: Thyroid hormones are essential for foetus and newborn development. Preterm newborns present low levels for thyroid hormones. These low levels are related with disorder in psychomotor and neurological development. In the literature, several studies concerning newborns treated with thyroid hormone have been realized in different conditions; however, there is no consensus about preterm newborn supplementation benefit. OBJECTIVE: The aim of the study was to defined hormonal values used for normal and preterm newborns. MATERIAL AND METHODS: We reported TSH, T3T and T4L levels for 195 normal or preterm newborns, eutrophic or small for gestational age (SGA). RESULTS: A positive correlation was found between hormonal level and gestational age. This work allowed us to define a threshold for preterm newborn according to their gestational age. CONCLUSION: Owing to lack of consensus, those values are useful for clinical and biological follow-up of thyroid function for newborns at risk (SGA and preterm before 32 weeks) during the first year of life. Finally, it would be interesting to study systematic supplementation of thyroid hormone for those infants in a prospective study.


Subject(s)
Infant, Newborn/blood , Infant, Premature/physiology , Thyrotropin/blood , Thyroxine/blood , Triiodothyronine/blood , Gestational Age , Hospitalization/statistics & numerical data , Humans , Infant, Small for Gestational Age/physiology , Reference Values
19.
Rev Chir Orthop Reparatrice Appar Mot ; 90(3): 256-64, 2004 May.
Article in French | MEDLINE | ID: mdl-15211275

ABSTRACT

We describe a new technique for reduction and percutaneous osteosynthesis of displaced posterior facet fractures of the calcaneus which appears to overcome the problems encountered with other percutaneous methods described for this type of surgery. The method relies on the use of traction which allows automatic reduction of the greater tubersosity. The patient is installed on an orthopedic traction table. Pin traction provides anatomic reduction of the posterior articular surface and restitution of Böhler's angle under fluoroscopic and arthroscopic control. We used this technique in thirteen patients with fifteen displaced posterior facet fractures of the calcaneum. Mean patient age was 50.4 Years. Mean follow-up was twenty Months. We did not have any cutaneous or infectious complications in this short series. In the majority of the cases, the overall functional and physical results were excellent or good. The mean Böhler's angle was 27 degrees, corresponding to 83% correction compared with the healthy side. These preliminary results are encouraging. We were able to restitute calcaneum anatomy, shorten hospital stay, and avoid all skin complications. Indications for this percutaneous technique could be widened. It is a valid alternative to open treatment of posterior facet fractures of the calcaneum.


Subject(s)
Arthroscopy , Bone Screws , Calcaneus/injuries , Calcaneus/surgery , Fractures, Bone/surgery , Adult , Aged , Calcaneus/diagnostic imaging , Female , Fluoroscopy , Fractures, Bone/diagnostic imaging , Humans , Male , Middle Aged , Prospective Studies
20.
Eur J Vasc Endovasc Surg ; 27(4): 438-44, 2004 Apr.
Article in English | MEDLINE | ID: mdl-15015197

ABSTRACT

OBJECTIVE: To assess the performance of extended lower limb venous ultrasound (US) for the diagnosis of asymptomatic deep vein thrombosis (DVT) and to estimate a 3-month DVT incidence on repeated US after total hip replacement. DESIGN: Diagnostic performance study and prospective cohort study. MATERIALS AND METHODS: US was compared to phlebography in 70 consecutive patients and interobserver agreement was assessed in the last 48 patients at day 8. US was repeated in these 48 patients at day 13 and day 90. RESULTS: Phlebography demonstrated a DVT in 18/70 (26%) patients, with five proximal and 13 distal and US in 23/70 (33%) patients, with eight proximal and 15 distal. Sensitivity and specificity of US with 95% CI were 94% (73-100) and 89% (76-96), respectively. Sensitivity in isolated distal vein thrombosis was 92% (67-99). The Kappa coefficient for agreement between observers was 0.84 (0.66-1.00). Follow-up showed a DVT in 15/48 (31%) patients on day 8, in 20/48 patients (42%) on day 13. DVT recurred in two patients during follow-up. CONCLUSIONS: The incidence of asymptomatic DVT is still significant despite prophylaxis but most DVTs remain distal and occur in the first 2 weeks. Extended US could replace phlebography for systematic screening in clinical trials using surrogate endpoints in view of its high accuracy and reliability.


Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Leg/blood supply , Venous Thrombosis/diagnostic imaging , Humans , Leg/diagnostic imaging , Phlebography , Reproducibility of Results , Ultrasonography , Venous Thrombosis/etiology
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