Traité EM Consulte podologie : Anomalie de torsion du squelette

Définition : la torsion du squelette se définit comme une déformation de l'os autour de son axe longitudinal ; ceci est à opposer à la rotation qui représente le mouvement possible de cet os autour de cet axe. Au niveau du squelette du membre inférieur, ces anomalies se situent généralement sur le fémur (antétorsion fémorale-[ATF] ou rétrotorsion fémorale [RTF]) ou sur le tibia (torsion tibiale externe [TTE] ou torsion tibiale interne [TTI]) plus rarement au niveau du pied pouvant réaliser la triple déformation décrite par Jean Judet . Ces torsions vont évoluer avec la croissance, modelant l'os sous l'influence d'un certain nombre de facteurs génétiques, mécaniques (poids, musculature, etc) et dynamiques. Étiologie : on parlera d'anomalies de torsion lorsque les valeurs mesurées s'écarteront de façon significative des valeurs moyennes ou lorsqu'un facteur intercurrent viendra modifier de façon anormale la croissance du membre, ceci de façon symétrique ou asymétrique

Synthèses, études physico-chimiques et biologiques de nouveaux tensioactifs hybrides hydrofluorocarbonés

Les travaux décrits ici traitent de la synthèse, des études physico-chimiques et biologiques de tensioactifs hybrides hydrofluorés destinés à maintenir des protéines membranaires en solution aqueuse sous leur forme native et active. La synthèse de tensioactifs hybrides combinant les avantages des amphiphiles hydro et perfluorés fait l'objet du premier chapitre. Malgré les difficultés rencontrées lors des synthèses, nous avons préparé une famille de tensioactifs hydrofluorés portant des têtes polaires non-ioniques (télomère, sucre, oxyde d'amine) ou ioniques (carboxylate, sulfonate, sulfate, phosphate, ammonium). Le deuxième chapitre décrit les études physico-chimiques effectuées sur nos composés. La première caractéristique mise en avant est que les valeurs de leur concentration micellaire critique sont anormalement élevées. Ce comportement particulier peut être imputé aux interactions défavorables entre les chaînes hybrides au sein de la micelle. L'incapacité qu'ont ces composés à former des films noirs de Newton est aussi évoquée et confirme l'hypothèse précédente. Certains amphiphiles hybrides forment même des arrangements de type vésiculaire (visualisés en MET et en FFEM), comportement atypique pour des tensioactifs monocaténaires fluorés. Le chapitre suivant traite de l'étude de deux systèmes mixtes en RMN du 19F (composés chacun d'un mélange de tensioactif hydrocarboné et perfluoré). Les études montrent un retard à la micellisation et une certaine miscibilité de deux types de surfactants, résultant de l'incompatibilité partielle des deux types de chaînes (sensibles également aux interactions entre têtes polaires). Les tests biologiques décrits dans le dernier chapitre sont très encourageants. La majorité des tensioactifs hybrides permet un maintien du cytochrome "b6f", choisi comme protéine membranaire modèle, en solution sous sa forme native. Les meilleurs résultats sont obtenus avec un composé portant une tête polaire de type oxyde d'amineAVIGNON-BU Centrale (840072102) / SudocSudocFranceF

Letter to the Editor: Is Isolated Mobile Component Exchange an Option in the Management of Intraprosthetic Dislocation of a Dual Mobility Cup?

The main goal of the article was to define the surgical strategy for the cup in patients with intraprosthetic dislocation. The article also provided a descriptive analysis of intraprosthetic dislocation in this population. This is in fact the paradox of the dual-mobility system. We believe that it is the best option for preventing dislocation, such as may occur with conventional THA implants

Wartime paediatric extremity injuries: experience from the Kabul International Airport Combat support hospital

Since the beginning of Operation Enduring Freedom, management of Afghan military or civilian casualties including children is a priority of the battlefield medical support. The aim of this study is to describe the features of paediatric wartime extremities injuries and to analyse their management in the Kabul International Airport Combat Support Hospital. A retrospective review was carried out using the French surgical database OPEX (Service de Santé des Armées) from June 2009 to January 2013. Paediatric patients were defined as those younger than 16 years old. Of the 220 injured children operated on, 155 (70%) sustained an extremity injury and were included. The mean age of the children was 9.1 ± 3.8 years. Among these children, 77 sustained combat-related injuries (CRIs) and 78 sustained noncombat-related injuries (NCRIs), with a total of 212 extremities injuries analysed. All CRIs were open injuries, whereas NCRIs were dominated by blunt injuries. Multiple extremities injuries and associated injuries were significantly more frequent in children with CRIs, whose median Injury Severity Score was higher than those with NCRIs. Debridement and irrigation was significantly predominant in the CRIs group, as well as internal fracture fixation in the NCRIs group. There were four deaths, yielding a global mortality rate of 2.6%. This study is the first to analyse specifically paediatric extremities trauma and their management at level 3 of battlefield medical facilities in recent conflicts. Except for severe burns and polytrauma, treatment of paediatric extremities injuries can be readily performed in Combat Support Hospitals by orthopaedic surgeons trained in paediatric trauma

Similar levels of pain are reported in forefoot surgery after management as a day case and admission for 48 hours: A continuous prospective study of 317 patients

While many forefoot procedures may be performed as a day case, there are no specific guidelines as to which procedures are suitable. This study assessed the early post-operative pain after forefoot surgery performed a day case, compared with conventional inpatient management. A total of 317 consecutive operations performed by a single surgeon were included in the study. Those eligible according to the criteria of the French Society of Anaesthesia (SFAR) were managed as day cases (127; 40%), while the remainder were managed as inpatients. The groups were comparable in terms of gender, body mass index and smoking status, although the mean age of the inpatients was higher (p < 0.001) and they had higher mean American Society of Anaesthesiologists scores (p = 0.002). The most severe daily pain was on the first post-operative day, but the levels of pain were similar in the two groups; (4.2/10, SD 2.5 for day cases, 4.4/10, SD 2.4 for inpatients; p = 0.53). Overall, 28 (9%) of patients who had their surgery as a day case and 34 (11%) of inpatients reported extreme pain (e 8/10). There were more day case patients rather than inpatients that declared their pain disappeared seven days after the surgery (p = 0.02). One day-case patient with excessive bleeding was admitted post-operatively. Apart from the most complicated cases, forefoot surgery can safely be performed as a day case without an increased risk of pain, or complications compared with management as an inpatient

Pain After Forefoot Surgery Comparing Day-Surgery and Conventional Hospitalization

Category: Midfoot/Forefoot Introduction/Purpose: At present, there are no guidelines for foot-surgery procedures that can be performed in day-surgery. The aim of our study was to evaluate early postoperative pain after forefoot day-surgery compared to a conventional hospitalization. The hypothesis was that patients operated in day-surgery showed as much pain as those hospitalized, without more complications. Methods: All patients operated for forefoot surgery by one senior surgeon (JLB) were included; those eligible for day-surgery according to SFAR (French Society of Anesthesia and Reanimation) recommendations were operated in day-surgery. Patients were distributed into 4 groups according to surgical procedure: 1.minor procedure (isolated lesser ray) – 2.light (isolated first ray) – 3.intermediate (first ray plus one or two lesser rays) – 4.complex (all forefoot). Patients living alone, further than 50 kilometres from our hospital, or in group 4 were hospitalized for 48 hours. The study included 317 patients; 40% were operated on in day-surgery. Those hospitalized were significantly older (60±3.8 versus 55±3.9, p=0.0006) and with higher ASA scores (p=0.0024) without difference in comorbidity. Main etiology was hallux valgus (70% in both groups); revision surgery counted for 9% of etiologies in the day-surgery versus 14% in the hospitalization group. Results: The highest daily pain rate was on day 1 (4.2/10±2.5 in day-surgery versus 4.4/10±2.4 in hospitalization, p=0.53) without significant difference between groups. Pain was evaluated as extreme (≥8/10) by 9% of patients in day-surgery versus 11% of those hospitalized. We found a statistically significant difference at day 0 for the light surgical procedures (category 2), with higher pain in day-surgery (4.4± 2.4 versus 3.3± 2.5, p=0.02). Concerning anaesthesia, time to recovery of sensitivity after nerve block was comparable regardless of the type of hospitalization or surgical procedure (6.0 hours ± 3.7 in day-surgery versus 5.8 hours ± 5.4, p=0.9). One patient in the day-surgery group had crossover for bleeding. Concerning the self-assessment questionnaire, patients operated in day-surgery described significantly more alertness and attention disturbances following surgery (p=0.01), and more frequent disappearance of pain after day 7 (p=0.02). Conclusion: There was no significant difference in pain or complications between groups. All patients were very satisfied. We can then reasonably recommend performing forefoot day-surgery in good collaboration with the anaesthetist and patient, without exposing the latter to greater pain and further complications

Outcomes and survival of a modern dual mobility cup and uncemented collared stem in displaced femoral neck fractures at a minimum 5-year follow-up

IntroductionThe choice of implant type for total hip replacement in the treatment of femoral neck fractures remains debated. Some authors advocate for the systematic use of cemented stems, while others do not use dual mobility first-line. We therefore conducted a retrospective study using a dual mobility cup (DMC) and an uncemented collared stem (UCS) in order to: (1) confirm the low dislocation rate in this indication, (2) assess other surgical complications, in particular periprosthetic fractures, (3) ensure that these benefits are maintained over time, at a minimum follow-up of 5 years and, (4) assess the rate of revision of the implants.HypothesisOur hypothesis was that the dual mobility dislocation rate for the treatment of femoral neck fractures was lower than for bipolar hemiarthroplasties or single mobility hip prostheses.Patients and methodsA retrospective study of 244 femoral neck fractures (242 patients) treated with DMC and UCS was conducted, between 2013 and 2014. The mean age was 83±10 years (60-104). The occurrence of dislocation, periprosthetic fracture, infection of the surgical site, loosening, reoperation and revision were investigated. The HOOS Joint Replacement (JR) score was collected. The cumulative incidence with mortality was used as a competing risk.ResultsThe mean follow-up was 6 years±0.5 (5-7). At the last follow-up, 108 patients (50%) had died. Twenty-three patients (9.5%) were lost to follow-up. One case of symptomatic aseptic loosening of DMC was observed. The cumulative incidence of dislocations and periprosthetic fractures at 5 years were 2% (95% CI: 0.9-5.4) and 3% (95% CI: 1.2-6), respectively. The 5-year cumulative incidence of surgical site infections was 3.5% (95% CI: 1.8-7). The cumulative incidence of reoperations at 5 years was 7% (95% CI: 4.5-11). The causes of reoperation were periprosthetic fracture (n=6), infection (n=8), postoperative hematoma (n=2) and cup malposition (n=2). The cumulative incidence of a revision at 5 years was 2.7% (95% CI: 1.2-6). The cumulative incidence of a surgical complication from any cause at 5 years was 9% (95% CI: 6.7-14.8). The mean HOOS JR score was 79±5 (52-92).DiscussionThe cumulative incidence of dislocation at 5 years is low and other surgical complications (including periprosthetic fractures) do not increase during this period for DMC associated with UCS, in femoral neck fractures. The use of this type of implant is reliable in the treatment of femoral neck fractures.Level of evidenceIV; retrospective study without control group

Numerical Simulation of Metastatic Bone Strength

3ème Journée Scientifique MSDAVENIR, PARIS, FRANCE, 19-/11/2019 - 19/11/2019Therefore, the aim of our study is to quantify the impact of the tumor tissues and location of the metastasis on the whole bone strength using a subject-specific FE simulation