[Total hip arthroplasty by mini-approach: review of literature and experience of direct anterior approach on orthopaedic table]. / Arthroplastie totale de hanche par mini abord: revue de la littérature et expérience de la voie antérieure directe sur table orthopédique.

In addition to the choice of the surgical approach, the respective place of the mini-incisions and mini-invasive surgery for total hip arthroplasty (THA) remains a controversial topic. The purpose of this study was to specify the advantages and disadvantages of these different approaches by a systematic review of the orthopedic literature and by our experience of the first 100 THA implanted by mini-invasive direct anterior approach (DAA) on orthopedic table. Selecting 15 orthopedic journals, we found 252 articles among which 65 are particularly relevant; 25 correspond to randomized studies. Mini-invasive approaches permit to obtain results at least equivalent to standard approaches with regard to operative time, general complications and adequate component positioning. Contrarily to posterior approach, DAA is associated to a low dislocation rate, even in so-called "at risks patients". Recent randomized studies highlight an earlier functional recovery in patients treated by mini-invasive approaches and particularly by DAA. This advantage seems to persist only the first six weeks but it could be interesting to patients avid to resume quickly their activities. Nevertheless, further studies are mandatory to confirm the observed results and to specify the place of the mini-invasive approaches with regard to early recovery as long-term results.

Single stage reconstruction of a large tibial defect using a free vascularised osteomyocutaneous ulnar transfer.

We present the case of a young man with 13 cm of bone and soft-tissue loss in the tibia and a severe traction injury of the brachial plexus. A free vascularised composite transfer of the bone and soft tissues of the ulnar side of the forearm was undertaken to reconstruct the defect. Bony union was achieved after a year and was followed by complete functional recovery of the lower limb.

Routine reinsertion of the hump in rhinoplasty.

Reinsertion of the hump as a free graft, a technique based on the rhinoplasty described by Skoog, has been performed for more than 10 years in severely deviated noses to hide residual deformities of the septum after rhinoplasty. The results have been so encouraging that this technique is now routinely used in all rhinoplasties requiring a reduction of the profile. Grafting the hump after remodelling gives a natural aspect to the dorsum, especially in patients with thin skin where irregularities of sharp edges of the cut nasal bones are otherwise often seen. The hump is tailored into a thin composite graft (bone + cartilage) 3-4 cm long and 3-5 mm broad. No major complications have been observed. 32 cases have been reviewed after a mean delay of 24 months. 29 show radiographic evidence of bone graft survival although no fusion with the nasal bones is observed. It is suggested that facial bone grafts survive better in the nose than grafts taken from the iliac crest or the ribs.