Epidemiology of distal femur fractures in France in 2011–12

AbstractIntroductionEpidemiological study of femoral fractures has been dominated by proximal fractures. Distal fracture requires equal attention for correct management.Patients and methodsA prospective study in 12 French hospital centres between June 1st, 2011 and May 31st, 2012 recruited cases of non-pathologic distal femoral fracture in patients over 15 years of age without ipsilateral knee prosthesis.ResultsThere were 183 fractures in 177 patients. Mean age was 63.5 years. Female patients (60.5%) were significantly older than males (mean age, respectively 73 versus 48.4 years). Walking was unrestricted in only 83 patients (46.89%). On the AO/OTA (Orthopaedic Trauma Association) classification, there were 86 type A fractures (47%), 29 type B (15.8%) and 68 type C (37.2%). Fractures were open in 32 cases (17.5%), most frequently in male, young patients and type C fracture. Causal trauma was low-energy (fall from own height) in 108 cases, most frequently in female patients and type A fracture. Forty-five patients were proximal femoral implant bearers.ConclusionDistal femoral fracture shows highly variable epidemiology. AO/OTA type A fracture mainly involves elderly, relatively dependent female subjects. Outcome study requires radiographic data and assessment of functional capacity.Level of evidence IVProspective cohort study

Blade-plate fixation for distal femoral fractures: A case-control study

AbstractBackgroundThe blade-plate is the earliest of the contemporary internal fixation devices introduced for distal femoral fractures. The recent development of dedicated, fixation devices has considerably limited its use. The objective of this study was to evaluate outcomes after blade-plate fixation and after fixation using other devices.HypothesisOutcomes after blade-plate fixation are similar to those after condylar screw-plate, distal femoral nail, or locking condylar plate fixation.Material and methodsWe reviewed outcomes after 62 patients managed with blade-plate fixation and included in a multicentre retrospective study (n=57) or a multicentre prospective study (n=5) and we compared them to outcomes after fixation using condylar screw-plates (n=82), distal femoral nail (n=219), or locking condylar plates (n=301). The four groups were comparable for age, gender distribution, occupational status, prevalence of skin wounds, patient-related factors, type of accident, and type of fracture. The evaluation relied on the clinical International Knee Society (IKS) score and on radiographs.ResultsNo significant differences existed across the four groups for operative time, blood transfusion use, complications, need for bone grafting, non-union rate, or IKS score values. The early surgical revision rate for removal of the fixation material was 4% with the blade-plate and 16% with the other three fixation devices (P=0.02). Post-operative fracture deformity was similar in the four groups with, however, a higher proportion of residual malalignment in the screw-fixation group. The final anatomic axis was 3.3±1.4° with the blade-plate versus 2.3±3.7° with the other three fixation devices. The blade-plate group had few patients with axial malalignment, and the degree of malalignment was limited to 3° of varus and 10° of valgus at the most, compared to 10° and 18° respectively, with the other three fixation devices.ConclusionDespite the now extremely limited use and teaching of blade-plate fixation, as well as the undeniable technical challenges raised by the implantation of this device, the blade-plate is a simple, strong, and inexpensive fixation method. It remains reliable for the fixation of distal femoral fractures. The disfavour into which the blade-plate is currently falling is not warranted.Level of evidenceIII, case-control study

Avancées de la conservation des greffons destinés à la transplantation

National audienceLa conservation d’organes peut être définie comme l’ensemble des procédés qui s’attachent à protéger le greffon des méfaits de l’anoxie entre le moment de sa déafférentation vasculaire chez le donneur et celui de sa revascularisation chez le receveur. Elle s’est appuyée longtemps sur le principe selon lequel l’hypothermie, distribuée par la perfusion initiale de solutions de conservations dans les vaisseaux du greffon, atténuait les méfaits de l’ischémie. Le manque de greffons a poussé à élargir les critères de sélection des greffons. Ces greffons, plus sensibles à l’ischémie, ont incité à rechercher de nouveaux modes de conservations basés sur le maintien du métabolisme cellulaire. Ainsi ont été développées des conservations oxygénées, utilisant des machines dites de perfusion. D’abord en hypothermie à l’aide de solutions spécifiques, la conservation par perfusion oxygénée se fait maintenant au sang et en normothermie. Plus qu’améliorer et allonger la conservation, ces machines permettent de tester et sélectionner les greffons avant l’implantation. Elles permettront dans un avenir proche de réparer ou même transformer le greffon pour améliorer sa fonction initiale et sa survie au long cours

Association between Intraventricular Position of Inflow Cannula and Clinical Outcomes in LVAD Recipients

International audience83

Virtual positioning of ventricular assist device for implantation planning

International audienceThe use of Ventricular Assist Devices (VAD) is increasing in the context of refractory heart failure. Nevertheless, there is still a high rate of complications. This preliminary work analyzes more precisely the clinical needs and proposes a first solution for preoperative planning of device implantation. The proposed approach consists in representing within a common space the 3D mesh describing the device and the patient CT image, in order to interactively simulate the device positioning and detect collisions between the VAD and different kinds of surrounding anatomical structures (bones and right ventricle). CT scans from 3 adult patients who have previously received a VAD, were used for the experiments. We analyzed the influence of mesh precision on computation time and accuracy of collision detection. Results show that the proposed approach is compatible with fast and interactive simulation of virtual device positioning, in order to preoperatively plan its implantation. Such a solution could also facilitate the decision-making about the choice of the device taking into consideration the feasibility of implantatio