Positive impacts of Patient Blood Management in total hip arthroplasty. Retrospective and prospective studies (N=700)

The study aimed to determine the impact of implementing a patient blood management (PBM) policy during total hip arthroplasty. Firstly, the authors collected retrospective data concerning blood consumption for all patients (N= 577) having undergone total hip arthroplasty between 2009 and 2011, other than for post-traumatic indications. During this period, no coherent blood management rules were in place. Based on the results obtained, a blood transfusion strategy called Patient Blood Management (PBM) was defined and implemented in our department for this type of surgical procedure beginning 2012. The impact of PBM was then analyzed after a 6-month prospective study during 2013/2014 on a cohort of 123 patients. These prospective data demonstrate that PBM significantly improved patient care and reduced the need for allogeneic labile blood transfusions

Patellar fracture following combined proximal and distal patella realignment

The authors present a case of a proximal avulsion fracture of the patella two months after a combined proximal and distal realignment operation. Devascularisation of the patella due to the combined technique was considered the main pathogenic factor. Treatment with open reduction and transosseous fixation was successful

Intérêt d'une banque de tissus en chirurgie orthopédique

Les pertes de substances tissulaires osseuses, cartilagineuses ou tendineuses peuvent faire l’objet de reconstructions chirurgicales afin de restaurer la fonction déficitaire des membres. Si la transplantation d’un greffon autologue reste le premier choix pour beaucoup de chirurgiens orthopédistes, le prélèvement de ce type de greffon n’est pas dénué de conséquences et de risques de complications pour le patient

Innovations 2018 en chirurgie orthopédique et traumatologie : Prothèse totale de hanche bilaterale : fait-on courir un risque supplémentaire aux patients ?

Le recours à l’arthroplastie s’est imposé depuis de nombreuses années pour le remplacement de l’articulation de la hanche, cette intervention étant même décrite comme l’intervention du siècle dans le Lancet. Le souci d’optimiser les soins a conduit à de nombreuses améliorations, particulièrement dans la chirurgie mini-invasive, permettant une récupération fonctionnelle plus rapide. Ces progrès permettent actuellement d’envisager la réalisation d’une arthroplastie bilatérale, chez les patients qui le nécessitent, dans la même séance opératoire, sans impacter le résultat final des deux arthroplasties et à un moindre coût. Le concept d’arthroplastie s’étend par ailleurs aux structures qui contribuent aux mouvements des articulations sus- et sousjacente. C’est ainsi que nous voyons se développer des arthroplasties qui permettent de rétablir les mouvements de pronosupination de l’avant-bras. La découverte d’une masse des tissus mous est souvent banalisée. Pourtant, dès que son volume dépasse 5 centimètres et qu’elle se localise sous le fascia, un caractère malin ne peut être écarté et une prise en charge multidisciplinaire s’impose. En effet, là où jusqu’à présent la chirurgie semblait seule s’imposer, la prise en charge conjointe avec les radiothérapeutes offre de meilleures chances de succès, particulièrement si elle peut précéder la chirurgie. Des stratégies combinant les techniques de pointe de radiothérapie en faveur d’une épargne cutanée par les rayons et les techniques de prise en charge chirurgicale avec une approche très conservatrice de la gestion des tissus mous et recourant à une thérapie à pression négative de la plaie permettent d'améliorer sensiblement le contrôle de la tumeur.[2018 Innovations in orthopedic surgery and traumatology] Arthroplasty has become the standard approach for hip replacement and has even been described as “The operation of the century” in The Lancet. The drive to optimize care has led to many improvements, particularly regarding minimally invasive surgery, thereby enabling faster functional recovery. Thanks to these advances, it is now possible to consider performing a bilateral arthroplasty, when required, in the same operating session, without impacting the final result of both arthroplasties and at a lower cost. The concept of arthroplasty also extends to the structures involved in the movements of the over- and underlying joints, notably with arthroplasties able to restore the pronation-supination movements of the forearm. The discovery of a soft tissue mass is often trivialized. Yet, when its volume exceeds 5 centimeters and it is located under the fascia, a malignant tumor must be considered, and multidisciplinary care is required. While surgery has long been regarded as the standard therapeutic option, it is now well established that the co-management with radiation therapists offers a better chance of success, especially if it can precede surgery. Strategies combining state-of-the-art radiotherapy techniques to achieve skin saving and surgical management techniques with a very conservative approach to soft tissue management and negative pressure wound therapy significantly improve the tumor control

Effect of Radial Nerve Release on Lateral Epicondylitis Outcomes: A Prospective, Randomized, Double-Blinded Trial

Purpose The purpose of our study was to examine the result of lateral epicondylitis surgery with and without posterior interosseous nerve release. Methods We conducted a prospective, randomized, double-blind single-center clinical trial in 54 patients treated surgically for lateral epicondylitis, without any EMG or imaging sign of compression of the posterior interosseous nerve at the arcade of Frohse. The patients were equally divided into intervention (supplemental radial nerve release) and control groups (no radial nerve release). Clinical symptoms and disability related to the upper extremity were assessed by a blinded assessor prior to surgery, using both the Quick Disabilities of the Arm, Shoulder, and hand (QuickDASH) and Mayo Elbow Performance Score (MEPS) and again at 1-, 3-, and 6-month intervals after surgery. Results Significant improvement was observed in both groups from the first month after surgery and for the whole evaluation period for both the MEPS and the QuickDASH scores. Conclusions Radial nerve release, in association with surgical treatment for lateral epicondylitis, was not associated with greater improvemen

Are bone autografts still necessary in 2006? A three-year retrospective study of bone grafting.

Autograft is considered as the gold standard in bone grafting. However, the development of tissue banks has allowed for a wider use of bone allografts, with good results. Demineralised Bone Matrix (DBM) and recombinant human Bone Morphogenetic Proteins (rh-BMP's) were also introduced to replace the time-honoured autograft. Is there currently still a place for bone autograft? The authors reviewed the orthopaedic surgical activity in their institution during the period 2003-2005, and traced all the surgical procedures in which bone grafting was performed. Tracking forms from the tissue bank were reviewed to assess the surgical indications. Between 2003 and 2005, the use of autografts decreased from 1.3% to 0.9% of all surgical interventions, particularly owing to their decreased use in primary fusions, while the use of allografts increased from 10.7% to 12.7%. Indications for allografts covered all fields of orthopaedic surgery, including nonunions. Processed allografts represented 90% of all grafts used. DBM and rh-BMP were used on an exceptional basis. There is currently a trend for surgeons to use allografts as substitutes for autografts, as processing of the allografts increases their safety while preserving most of their biological and mechanical properties. Autografting is now limited to revision operations after failed fusions, and to combined use at the junction with massive allografts. DBM and rh-BMP are still controversial but they might replace autografts, even in their currently remaining indications, if their cost effectiveness and efficiency are established

Zweistufige Revision. Infizierter Hüftendoprothese mit massiven allotransplantat und distal verriegeltem schaft

Das Management einer Knochen- und Gelenkinfektion stellt eine schwierige Herausforderung dar. Die Verwendung eines massiven Allotransplantates und eines zementfreien Schaftes in einen infizierten Knochen wurde kaum untersucht. In unserer Abteilung haben wir Erfahrung mit beidem: massive Allotransplantate mit einem langen zementierten Schaft in aseptischer sowie septischer Lockerung und distal verriegeltem unzementiertem Schaft bei Femurschaftfraktur und Implantatlockerung oder Revision mit transfemoralem Zugan

Cartographier sans détruire : l’apport des prospections aériennes et géophysiques

International audienceIn the heart of central-western France, the Bellevue site at Chenommet (Charente) was the subject of archaeological excavations between 2008 and 2011. Overlooking the Charente valley and facing the megalithic necropolis of Chenon, this causewayed enclosure has numerous hollow features revealed by aerial and geophysical surveys and then excavated during extensive stripping. The very abundant archaeological remains collected attest to a habitat site occupied for several centuries. The succession of two occupations during the second half of the 4th millennium B.C., referring to the Matignons and then Seuil du Poitou cultural groups, is unprecedented for this area, known until now only through its funerary deposits in a megalithic context. This book presents the results of the multidisciplinary study of the Bellevue site and questions the relationship between the world of the living and the world of the dead during the Neolithic.Au cœur du Centre-Ouest de la France, le site de Bellevue à Chenommet (Charente) a fait l’objet de fouilles archéologiques programmées entre 2008 et 2011. Dominant la vallée de la Charente et faisant face à la nécropole mégalithique de Chenon, cette vaste enceinte fossoyée présente de nombreuses structures en creux révélées par prospection aérienne et géophysique puis fouillés au cours de décapages extensifs. Les très abondants vestiges archéologiques recueillis attestent d’un habitat occupé pendant plusieurs siècles. La succession de deux occupations au cours de la seconde moitié du IVe millénaire avant notre ère, renvoyant aux groupes culturels Matignons puis Seuil du Poitou, est inédite pour ce secteur, connu jusqu’alors uniquement au travers de ses dépôts funéraires en contexte mégalithique. Cet ouvrage présente les résultats de l’étude pluridisciplinaire du site de Bellevue et questionne les relations entre monde des vivants et monde des morts au cours du Néolithique

<i>Quid</i> du port romain estuarien de Barzan (Charente-Maritime) ?

International audienceThe antique town of Barzan is located on the southwestern margins of the civitas Santonum, near the right bank of the Gironde estuary. Because of its location and the already known remains, this settlement has long been assumed to be a major harbour facility. However, previous excavation were not able to confirm this hypothesis. In an initial stage, several geophysical survey methods were used in this area, which encompasses several hectares. The methodology adopted first made it possible to map evidence of buildings set up along the coastline. In order to interpret some anomalies in the survey, several hypotheses are advanced such as the presence of buildings, a quay or navigation markers. The results obtained reveal the archaeological potential of this area, as regards both the study of port structures and the analysis of the evolution of the environmental context.L’agglomération antique de Barzan est située en limite sud-ouest de la cité des Santons, à proximité de la rive droite de l’estuaire de la Gironde. En raison de sa localisation et des vestiges déjà connus, on suppose depuis longtemps qu’il s’agit d’un site portuaire majeur. Cependant, aucune fouille n’a permis d’étayer cette hypothèse. Différentes méthodes de prospection géophysique ont été mises en oeuvre pour débuter l’étude d’un secteur étendu sur plusieurs hectares. La méthodologie adoptée a permis, dans un premier temps, de localiser le rivage ancien. Ensuite, il a été possible de cartographier les traces de constructions en bordure de côte. Des interprétations sont proposées pour expliquer certaines anomalies, comme des bâtiments, un quai, des repères pour la navigation. Les résultats dévoilent le potentiel archéologique de ce secteur, tant pour l’étude des structures portuaires que pour l’analyse de l’évolution du contexte environnemental