Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations

AbstractIntroductionTreatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable.MethodsThis article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays.ResultsBased on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients’ mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p=0.00002); the subjective QuickDASH score decreased from 41 to 9 (p=0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p<10−3) and the horizontal plane (p=0.022).ConclusionIn this study, the favorable prognostic factors found were: time to surgery less than 3 months (p=0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result.Level of proofLevel II prospective non-randomized comparative study

Beware of using cumulated variables in growth and development models

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Formation à la statistique. FPSTAT2. Analyse multidimensionnelle des données

* INRA Département de biométrie, Domaine de Vilvert, 78350 Jouy en Josas cedex Diffusion du document : INRA Département de biométrie, Domaine de Vilvert, 78350 Jouy en Josas cedexNational audienc

Carbon allocation in fruit trees: from theory to modelling

International audienceCarbon allocation within a plant depends on complex rules linking source organs (mainly shoots) and sink organs (mainly roots and fruits). The complexity of these rules comes from both regulations and interactions between various plant processes involving carbon. This paper presents these regulations and interactions, and analyses how agricultural management can influence them. Ecophysiological models of carbon production and allocation are good tools for such analyses. The fundamental bases of these models are first presented, focusing on their underlying processes and concepts. Different approaches are used for modelling carbon economy. They are classified as empirical, teleonomic, driven by source–sink relationships, or based on transport and chemical/biochemical conversion concepts. These four approaches are presented with a particular emphasis on the regulations and interactions between organs and between processes. The role of plant architecture in carbon partitioning is also discussed and the interest of coupling plant architecture models with carbon allocatio