SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
Not a member yet
578 research outputs found
Sort by
Digital replantation in forward surgical units: a cases study
No full textIntroduction: Noncombat-related hand injuries are common in current theatres of operations. Crushing is one of the most frequent mechanisms that may cause traumatic amputations of digits. In the military setting, management of these digital amputations is challenging regarding limitation in microsurgical means in medical treatment facilities and aeromedical evacuation delays out of the combat zone.
Methods: Two cases of digital replantation performed in French forward surgical units are described. The first case was a complete distal amputation of the medius which was successfully replanted in the operating theatre of an aircraft carrier. No complication was observed after evacuation. Functional and aesthetic results were excellent. The second case was a ring finger avulsion revascularized in a role 2 facility in Central African Republic. Unfortunately, revascularization failed due to arterial thrombosis during evacuation.
Results: Digital, hand or more proximal upper extremity replantation may be considered for isolated amputations due to work-related accidents within the combat zone. For a surgeon trained to microsurgery, a microsurgical set and magnification loupes enable to attempt such procedures in austere conditions.
Discussion: The authors propose an algorithm of management in the field according to the type and level of amputation
Removal of broken reamer stuck into femoral shaft in implanting PFNA: a case report
No full textFemoral intertrochanteric fracture is very common in elderly population. The usual treatment for these patients is intra-extramedullary fixation. In normal situations, expand medullary cavity is needed, in order to implant various intramedullary implants. On rare occasion, which will in turn lead to the reamer is stuck into the medullary cavity of femoral shaft. Open or closed technique for moving of the broken nails had been reported before. We firstly report a novel technique by using handy tool which included in orthopaedic instrument set to remove the broken reamer stuck into femoral cavity when implanting a PFNA
Extended trochanteric osteotomy: comparison of 3 modes of fixation: metallic wires, cables, plate, about a series of 157 cases
No full textIntroduction: The trans femoral osteotomy was initially described by Wagner in 1987 and the extended trochanteric osteotomy (ETO) was described by Younger et al. in 1995 and is considered to be the gold standard technique for removal of well-fixed femoral stems in revision total hip arthroplasty (THA). The purpose of this report is:
to compare the different types of fixation metallic wires, cables, metallic reinforcement plate (MRP) we have used in revision THA where an ETO was performed
Arthroscopic excision of heterotopic ossification in the rectus femoris muscle causing extra-articular anterior hip impingement
No full textSubspine impingement is an extra-articular hip impingement syndrome that usually occurs when there is abnormal contact between an enlarged or malorientated anterior inferior iliac spine (AIIS) and the distal anterior femoral neck in straight flexion of the hip. We present the case of a 13-year-old boy with a history of left groin pain and loss of range of movement of the hip for over six months following an avulsion fracture of the AIIS during a game of rugby. He was diagnosed with subspine impingement secondary to a large lesion of heterotopic ossification in the rectus femoris; this was dissected and extracted from the muscle in toto arthroscopically. This case highlights the importance of heterotopic ossification after injury as an important cause for subspine impingement in the young adult hip. This is the first report and describes subspine impingement secondary to a large lesion of heterotopic ossification
Similar function and complications for patients with short versus long hip nailing for unstable pertrochanteric fractures
No full textPurpose: To compare short with long intramedullary hip nailing for elderly patients with unstable pertrochanteric fractures.
Methods: We prospectively studied 50 patients (33 women, 17 men; mean age, 80 years; range, 74–93 years) with unstable pertrochanteric fractures admitted and treated with a short (group A) or a long (group B) intramedullary hip nail from January 2013 to 2017. The patients were randomly allocated into each group according to their order of admission. The mean follow-up was 2 years (range, 1–5 years). We evaluated operative time, function, fracture healing, varus/valgus loss of reduction, and distance between the distal line of the fracture and the distal locking screw of the nail.
Results: Operative time was significantly shorter in group A. Function, fracture healing and varus/valgus loss of reduction was similar between the two groups. The mean distance between the distal fracture line and distal locking screw was 7.2 cm (range, 3–10 cm) in patients of group A; in all patients of group B, an appropriate nail length was chosen so that the distal locking screw was inserted at least 3 times the diameter of the bone at the distal fracture line. Complications included periprosthetic fracture (one patient of group A), and z-effect phenomenon (one patient of group B); complications rate was similar between the two groups.
Conclusion: Short intramedullary hip nailing is associated with similar function and complications, but shorter operative time compared to long intramedullary hip nails for patients with unstable pertrochanteric fractures
The cross technique for the positioning of Kerboull plate in acetabular reconstruction surgery
No full textAcetabular reconstruction aims at filling bony defects and positioning the acetabular component in its anatomical place. To this, the use of Kerboull plate would give an automatic optimal positioning while reconstructing the acetabular cavity. We developed a technique, the cross technique, that approaches acetabular reconstruction in a systematic way. It consists of placing the KP following its cross design, in reference to a vertical plane (hook, center, palette) and a horizontal plane (horizontal flanges). The cross technique has three steps; the preparation of the acetabular cavity, the cross technique itself and cementation. We recommend a downsizing of the plate in relation to the size of the acetabular cavity in addition to another downsizing of the acetabular implant in relation to the plate size whenever a dual mobility cup is used
Medium term results of total knee arthroplasty as a primary treatment for knee fractures
No full textIntroduction: Successful treatment of knee comminuted periarticular fractures associated with osteoporosis and pre-existing arthritis is a challenging task.
Methods: This is a prospective study on 27 patients who had comminuted intra and periarticular knee fractures and pre-existing arthritis. Fractures were classified according to Muller's AO classification. Primary knee arthroplasty was performed ± internal fixation following 4 weeks of splinting. A stem was added to the tibial tray and Legacy Constrained Condylar Knee (LCCK) or Rotating Hinge (RH) prosthesis were used depending on the level of ligament damage and bone defects. The Knee Society Score (KSS) and radiological evaluation were performed at 3, 6 and 12 months then annually thereafter.
Results: The average age of this group of patients was 63 years (range 59–74). Sixteen knees received primary femoral component and Posterior Stabilized insert, while 8 had LCCK. RH implants were chosen in 2 and distal femoral replacement was necessary in one knee. Twenty five patients were available for the final review at an average 6 years in whom the KSS was 80 (range 75–89) points. All patients achieved full knee extension and average knee flexion of 110° (range 90–135°). One knee needed re-admission for early Debridement Antibiotic Irrigation and Retention (DAIR) but none of the knees was revised or awaiting revision.
Conclusion: Knee arthroplasty achieves highly successful outcome when performed as a primary treatment for comminuted intra and periarticular knee fractures in elderly patients. Survival of implants and functional range of movement at midterm are excellent
Nail or plate in the management of distal extra-articular tibial fracture, what is better? Valutation of outcomes
No full textIntroduction: Distal tibial fractures are the most common long bone fractures. Several studies focusing on the methods of treatment of displaced distal tibial fractures have been published. To date, locked plates, intramedullary nails and external fixation are the three most used techniques. The aim of our study was to compare intramedullary nail (IMN) and locked plate (LP) for treatment of this kind of fracture.
Materials and methods: We collected data on 81 patients with distal tibial fractures (distance from the joint between 40 and 100 mm) and we divided into two groups: IMN and LP. We compared in the 2 groups the mean operation time, the mean union time, the infection rate the rate of malunion and nonunion, the full weight bearing time.
Results: No patient in the two groups developed a nonunion. None of the patients obtained a fair or poor outcome. Overall 52 patients obtained an excellent result (69.3%) and 23 obtained a good result (30.6%).
Discussion: Our study results indicate a superiority of IMN over LP in terms of lower rates of infections and statistically significant shorter time to full weight bearing. Whereas LP appeared to be advantageous over IMN in terms of leading to a better anatomical and fixed reductions of the fracture and a lower rate of union complications. The two treatments achieved comparable results in terms of operation time, hospital stay, union time and functional outcomes
ACL status in arthroplasty patients, why not to preserve?
No full textIntroduction: Only 70–85% of patients that had total knee arthroplasty (TKA) are satisfied with their knees. The need for a near to normal knee kinematics is crucial and maybe the solution to their needs. Addressing the cruciate ligaments during surgery along with the extent of arthrosis may give a solution to this problem.
Material and methods: One hundred consecutive patients in whom a total knee arthroplasty was indicated and performed were prospectively documented. During the knee replacement surgery, the condition of the anterior and posterior cruciate ligaments and the degree of osteoarthritis (OA) in the medial and lateral compartments as well as in the patello-femoral joint were documented using the Outerbridge classification. The patients’ average age was 72.3 years, with the majority being female. In all patients, a total bi-compartmental knee replacement was indicated.
Results: Our results showed that in 78% of all patients the anterior, and in 98% the posterior cruciate ligament was still intact. Seventy-one percent of cases suffered from grade 4 medial osteoarthritis, 19% from grade 3 and 10% from grade 2. Thirty-six of patients suffered from grade 4 lateral osteoarthritis, 36% from grade 3, 24% from grade 2 and 4% from grade 1. Grade 4 patello-femoral osteoarthritis was present in 32% of all patients, grade 3 in 60% and grade 2 in 8% of all patients.
Discussion: The goal of arthroplasty is to approximate the function of a normal knee. The retention of the anterior cruciate ligament (ACL) allows for better knee, kinematics, improved proprioception, increased flexion and an overall improvement in knee function. The decreased constraint that is possible with retention of both cruciates may decrease implant stresses and improve the implant survivorship. The distribution of OA shows that the medial and patello-femoral compartments of the joint are primarily affected. This could also allow for a more conservative and patient-tailored prosthetic design