Rétroversion de la cavité glénoïdale de la scapula, scanner et prothèse d'épaule (comparaison des méthodes de mesure, à propos de 50 cas d'omarthrose)

Résumé françaisDIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Is distal locking screw necessary for intramedullary nailing in the treatment of humeral shaft fractures? A comparative cohort study

International audiencePURPOSE: The gold standard for intramedullary nailing (IMN) in humeral shaft fracture treatment is bipolar interlocking. The aim of this study was to compare clinical and radiographic outcomes in two cohorts of patients treated with IMN with or without distal interlocking. We hypothesized that there was no significant difference between isolated proximal interlocking and bipolar interlocking in terms of consolidation and clinical results.METHODS: One hundred twenty-one acute humeral shaft fractures were retrospectively included in group WDI (without distal interlocking screw, n=74) or in group DI (with distal interlocking screw, n=47). One hundred six patients (87.60%) could be verified by an X-ray, and 63 (52.07%) could be examined clinically. Fracture union at 6months was the primary outcome, and the second was the final clinical outcome for shoulder and elbow after at least 6months of follow-up. Pain, operating time, and radiation time were also analyzed.RESULTS: The two groups were not significantly different for population, fractures, or immobilization duration. No significant difference was found for bone union (WDI 89.06% vs DI 83.33%, p=0.51), shoulder or elbow functional outcomes, or pain. However, there were significant differences in advantage to the WDI group for operating time (WDI 63.09±21.30min vs DI 87.96±30.11min, p<0.01) and fluoroscopy time (WDI 59.06±30.30s vs DI 100.36±48.98s, p<0.01).CONCLUSIONS: Thus, it seems that there were no significant differences between proximal unipolar and bipolar interlocking for humeral shaft fractures in terms of consolidation and clinical outcomes. WDI avoided the additional operating time and fluoroscopy time and risks linked to DI

Total hip arthroplasty with dual mobility cup in osteonecrosis of the femoral head in young patients: over ten years of follow-up

International audienceOsteonecrosis of the femoral head affects mainly young patients with high functional needs this increases the risk of dislocation. Dual mobility cups known for low rate of dislocation and high mobility range seems indicated. We evaluate functional efficiency, survival and dislocation rate of dual mobility cup for total hip arthroplasty for osteonecrosis in young patients. Monocentric retrospective clinical study, from 2000 to 2008. With a clinical analysis in pre-operative and over ten years of follow-up of one cohort of patients under 55 years old with an indication of THA for ONFH. The judgement criteria was: clinical scores at the maximal follow-up, the dislocation rate, and the cumulate survival rate over ten years follow-up. Forty THA in 31 patients, nine bilateral cases, 23 males and eight females with average age of 44 (+/- 4) years old. In pre-operative: PMA 11 (+/- 3.3), HHS 50,8 (+/- 15.5). At the final follow-up of 129.8 (+/- 33.8) months: PMA (17.4 +/- 1.12), HHS (95.7 +/- 6.9), no dislocation. We had 11 deaths on average at 95.2 +/- 47.3 months. The cumulate survival rate over ten years follow-up is 100% without revisions or long-term dislocation. Analysis concludes to very significant functional improvement without any dislocation despite the young population with high level of activity. Thus, dual mobility cups is a reliable choice preventing dislocation with a very good survival rate without premature wear, preserving mobility and activity

Linear relationship between lateralization of the bicipital groove and humeral retroversion and its link with the biepicondylar humeral line. Anatomical study of seventy cadaveric humerus scans

International audienceIntroduction Morphological studies of the humerus have shown that the position of the bicipital groove varies with the individual and the retroversion of the humeral head. Depending on the authors, these two parameters are independent or associated. This study evaluated the relationship between the humeral head axis and its retroversion and the bicipital groove relative to the humeral biepicondylar line.Materials and methods Seventy cadaveric humeri were scanned to obtain 3D reconstructions. Views of the 3D reconstruction from above showed the bicondylar line, the bicipital groove and the humeral head on a single image. After measuring the humeral retroversion angle and the bicipital groove angle relative to the bicondylar line, we assessed the relationship between these two angles with Pearson's correlation coefficient.Results Pearson's correlation coefficient indicated a significant linear correlation between the angle of the groove and the angle of humeral retroversion based on the 70 cadaveric humeral bones (the p-value was 7.5(10) (7), the correlation coefficient was -0.5515, and the 95% confidence interval was (-0.6962; -0.3636)). Our study thus demonstrates that the less lateralized the bicipital groove is, the greater the humeral retroversion will be.Conclusion We demonstrated a linear relationship between humeral head retroversion and bicipital groove lateralization. Within our reliability interval, this relationship can be used in clinical practice to evaluate retroversion without resorting to CT of the entire humerus

Determination of a new computed tomography method for measuring the glenoid version and comparing with a reference method. Radio-anatomical and retrospective study

International audiencePurpose In the literature, there are several techniques for measuring the glenoidal version of the scapula. The superiority of the scannographic measurement over the standard radiologic measures seems evident. The main problems are the evaluation and the reproducibility of these methods, which are dependent on the quality of the CT scan and the orientation of its sections. We pinpoint a simple method of the "scapular triangle", the reliability of which deserves special consideration. The aim of this study is to report a simple and reproducible computed tomography method to measure the glenoidal version.Methods Thrity-one shoulder CT scans, performed on patients attending the emergency department of the University Hospital of Dijon between January 2012 and April 2013 for shoulder trauma, were evaluated retrospectively. The CT scan must include the entire body of scapula to allow measurements to be made with both methods: the conventional method of Friedman and our new method of the "scapular triangle". Two independent operators performed inter-observer and intra-observer reproducibility. We compared both techniques with Pearson's test.Result Pearson's test showed a trend line according to a linear correlation between the two methods with a p value of 7.791(-10) and a correlation coefficient of 0.85 with the 95 % confidence interval (0.7213; 0.929).Conclusion The method of the "scapular triangle" is easily applicable on most sections of the CT scan of scapula whether or not it takes the whole body. It is more reliable and reproducible and could be used by any radiologist