Iliac crest bone graft harvesting complications: A case of liver herniation

SummaryThe iliac crest is an easily accessible donor site offering a relatively large and safe supply of bone. There are however possible complications; residual pain frequently, and more rarely herniation. This latter's true incidence is unknown in a literature review, which found 15 articles. We report a case of liver herniation in a 64-year-old overweight lady after harvesting bone from her iliac crest. The clinical diagnosis was confirmed by CT scan. Despite an appropriate surgical repair, the hernia recurred. This serious complication of bone harvesting from the iliac crest, and possible other undesirable events described, prompted reconsideration of our harvesting techniques, and the use in our unit of bone substitutes or cell therapy to fill bone defects

Total knee arthroplasty for osteoarthritis secondary to extra-articular malunions

SummaryIntroductionPost-traumatic total knee arthroplasty for extra-articular malunion requires correction of the deformity, either through asymmetrical bone resection (possibly inducing ligaments imbalance) or osteotomy at the time of arthroplasty. We report the results of a continuous multicenter, retrospective series of 78 patients (18 implants with osteotomy) with a mean 4 years of follow-up. The hypothesis is that the selected procedure requires to be based on the deformity's location and severity.PatientsWith a mean age of 63 years (younger in the osteotomy group), 38 patients had femoral malunion, 36 had tibial malunion, and four had a combined malunion. There were 70 frontal deformities (48 varus and 22 valgus) and 10 rotational deformities, often diaphyseal, four of which more than 20°. Twelve patients had a history of infection; eight had frontal laxity greater than 10°, and 15 a limited range of motion in flexion. In 70 cases, semi- or nonconstrained implants were used, and in eight cases more constrained implants, including four hinge prostheses.ResultsWe observed two deep infections, one case of avulsion of the extensor mechanism, and two cases of aseptic loosening with femoral malunion and varus deformity. Two osteotomies resulted in nonunion, one with internal fixation devices mobilization requiring revision using extension rods. The function and pain scores were significantly improved. The mobility improvements were moderate but did not compromise the surgical procedure main objective. The preoperative hip-knee angle was corrected with both techniques. Only the function score gain was greater for the isolated arthroplasty procedures.Discussion and conclusionThe indications for arthroplasty alone were extended to 20° varus and 15° valgus, with no major residual laxity. Beyond 10°, hinge prosthesis should be available. Associated osteotomy can correct rotational deformities that cannot be compensated with bone cuts. In deformities that are close to the joint, osteotomy facilitates implantation of moderately constrained prosthesis. This indication is based on CAT scan rotational deformities measurements because rotational deformities require an osteotomy, and/or the presence of extraligamentous deformity that cannot be reduced with collateral ligaments surgical release.Level of evidenceLevel 4. Non-controlled retrospective study

Hip Fractures: Epidemiology and Risk Factors

International audienceHip fracture represents a major health problem in elderly patients because they are frequent and induce devastating consequences mainly because of associated comorbidities. One third of elderly patients with hip fracture are dead one year later and, in surviving patients, hip fractures have a negative effect on daily life activities and quality of life. One of the main difficulties remains in the complex clinical course following hip fracture, including admission to the emergency department, surgical procedure, anesthesia, acute care during the postoperative period then admission to rehabilitation facilities, each step requiring specific care for these geriatric patients (frailty, multicomorbidities, polypharmacy, frequent postoperative complications). The two main simple objectives to improve outcome are the need for early surgery and the need for a multidisciplinary approach, known as the orthogeriatric concept, although further studies are required to definitely prove its efficacy

Ecoépidémiologie des leishmanioses en Syrie. 1 — Infestation de

Une enquête écoépidémiologique, menée dans le Sud-Ouest de la Syrie, sur les réservoirs de la leishmaniose cutanée zoonotique a permis d’isoler Leishmania major MON-26, chez Psammomys obesus terraesanctae (Rodentia-Gerbillidae). L’abondance du Rongeur, son contact étroit avec les villages contaminés et la haute fréquence d’infestation (62,3 %) en font le réservoir habituel du Bouton d’Orient dans la zone prédésertique de la Syrie

Écoépidémiologie des Leishmanioses en Syrie. 2 — Présence, chez le chien, de

A l’occasion d’une enquête écoépidémiologique dans les foyers syriens de leishmanioses humaines, viscérale (LV) et cutanée (LC), les auteurs mentionnent pour la première fois, l’infestation du Chien domestique par Leishmania infantum MON-1 et L. tropica Mon-76. Dans ce Pays, la LV canine à L. infantum s’étend sur la bordure occidentale, humide et sub-humide, depuis la zone côtière jusqu’aux proches massifs. Dans les sites contaminés, la LV humaine est présente sous forme de cas sporadiques. La LC canine à L. tropica est dépistée, en zone semi-aride, dans un village à forte contamination humaine. Elle s’exprime cliniquement par de petites lésions cutanées, papuleuses ou ulcéro-croûteuses, localisées à la truffe et au chanfrein. Les corollaires prophylactiques sont tirés de ces observations. Dans les foyers de LV humaine, il est recommandé de n’intervenir sur la population canine qu’à la condition d’assurer le jumelage avec d’autres opérations de prévention, telle que la lutte antirabique. La LC du Chien ne saurait être prise en compte dans de telles opérations en raison de la discrétion des lésions, et de la rareté du parasite, arguments qui mettent en doute le rôle de cet animal en tant que « vrai » réservoir. Seul, le dépistage actif de la LC humaine, assorti d’un traitement spécifique, permettrait de freiner la transmission et, par là même, de réduire l’intensité et la durée des épidémies

Iliac Crest Avulsion Fracture in a Young Sprinter

Avulsion fracture of the iliac crest is an uncommon pathology. It usually occurs in teenagers during sport activities, more common in boys. We report a case of 16-year-old male competitive sprinter, who had an avulsion of a part of the iliac crest and the anterior-superior iliac spine during a competition. The traumatism occurred during the period of acceleration phase out of the blocks which corresponds to the maximum traction phase on the tendons. Then a total loss of function of the lower limb appears forcing him to stop the run. X-ray and CT scan confirmed the rare diagnosis of avulsion of the quasitotality of the iliac crest apophysis, corresponding to Salter 2 fracture. We performed an open reduction and internal fixation with two screws, allowing a return to sport after 3 months and his personal best record in the 100 meters at the 6th postoperative month

Instabilité chronique de cheville

ERM

Chronic lateral ankle instability surgical repairs: the long term prospective

ERMAInternational audienceUNLABELLED: The present study sought to assess the clinical and radiological results and long-term joint impact of different techniques of lateral ankle ligament reconstruction. MATERIAL AND METHODS: A multicenter retrospective review was performed on 310 lateral ankle ligament reconstructions, with a mean 13-year-follow-up (minimum FU: 5 years). Male subjects (53%) and sports trauma (78%) predominated. Mean duration of instability was 92 months; mean age at surgery was 28 years. Twenty-eight percent of cases showed subtalar joint involvement. Four classes of surgical technique were distinguished: C1, direct capsular ligamentous complex reattachment; C2, augmented repair; C3, ligamentoplasty using part of the peroneus brevis tendon and C4, ligamentoplasty using the whole peroneus brevis tendon. Clinical and functional assessment used Karlsson and Good-Jones-Livingstone scores; radiologic assessment combined centered AP and lateral views, hindfoot weight-bearing Méary views and dynamic views (manual technique, Telos or self-imposed varus). RESULTS: The majority of results (92%) were satisfactory. The mean Karlsson score of 90 [19-100] (i.e., 87% good and very good results) correlated with the subjective assessment, and did not evolve over time. Postoperative complications (20%), particularly when neurologic, were associated with poorer results. Control X-ray confirmed the very minor progression in degenerative changes, with improved stability; there was, however, no correlation between functional result and residual laxity on X-ray. Unstable and painful ankles showed poorer clinical results and more secondary osteoarthritis. Analysis by class of technique found poorer results in C4-type plasties and poorer control of laxity on X-ray in C1-type tension restoration. DISCUSSION: The present results confirm the interest of lateral ankle ligamentoplasty in the management of instability and protection against secondary osteoarthritis, and of precise lesion assessment (CT-scan/MRI) to adapt surgery to the ligamentary and associated lesions. LEVEL OF EVIDENCE: Level IV. Retrospective therapeutic study