Dynamiser et diversifier les prestations actuelles et futures de l’Ecole Suisse de Ski de Vercorin

L’ESS Vercorin subit une baisse de sa clientèle depuis 3 ans malgré des prestations de qualité et une clientèle fidèle. Cette baisse est principalement due à des facteurs externes sur lesquels l’ESS a peu d’influence. Ainsi, ce travail a pour objectif d’amener des propositions concrètes susceptibles d’augmenter sa fréquentation

Are there clinical variables determining antibiotic prophylaxis-susceptible versus resistant infection in open fractures?

Purpose: In Gustilo grade III open fractures, it remains unknown which demographic or clinical features may be associated with an infection resistant to the administered prophylactic agent, compared to one that is susceptible. Methods: This was a retrospective case-control study on patients hospitalized from 2004 to 2009. Results: We identified 310 patients with Gustilo-III open fractures, 36 (12%) of which became infected after a median of tendays. In 26 (72%) of the episodes the pathogen was susceptible to the prophylactic antibiotic agent prescribed upon admission, while in the other ten it was resistant. All antibiotic prophylaxis was intravenous; the median duration of treatment was threedays and the median delay between trauma and surgery was oneday. In multivariate analysis adjusting for case-mix, only Gustilo-grade-IIIc fractures (vascular lesions) showed tendency to be infected with resistant pathogens (odds ratio 10; 95% confidence interval 1.0-10; p = 0.058). There were no significant differences between cases caused by antibiotic resistant and susceptible pathogen cases in patient's sex, presence of immune suppression, duration and choice of antibiotic prophylaxis, choice of surgical technique or materials, time delay until surgery, use of bone reaming, fracture localization, or presence of compartment syndrome. Conclusion: We were unable to identify any specific clinical parameters associated with infection with antibiotic resistant pathogens in Gustilo-grade III open fractures, other than the severity of the fracture itself. More research is needed to identify patients who might benefit from a broader-spectrum antibiotic prophylaxis

Type of mRNA COVID-19 vaccine and immunomodulatory treatment influence humoral immunogenicity in patients with inflammatory rheumatic diseases

Patients with inflammatory rheumatic diseases (IRD) are at increased risk for worse COVID-19 outcomes. Identifying whether mRNA vaccines differ in immunogenicity and examining the effects of immunomodulatory treatments may support COVID-19 vaccination strategies. We aimed to conduct a long-term, model-based comparison of the humoral immunogenicity following BNT162b2 and mRNA-1273 vaccination in a cohort of IRD patients. Patients from the Swiss IRD cohort (SCQM), who assented to mRNA COVID-19 vaccination were recruited between 3/2021-9/2021. Blood samples at baseline, 4, 12, and 24 weeks post second vaccine dose were tested for anti-SARS-CoV-2 spike IgG (anti-S1). We examined differences in antibody levels depending on the vaccine and treatment at baseline while adjusting for age, disease, and past SARS-CoV-2 infection. 565 IRD patients provided eligible samples. Among monotherapies, rituximab, abatacept, JAKi, and TNFi had the highest odds of reduced anti-S1 responses compared to no medication. Patients on specific combination therapies showed significantly lower antibody responses than those on monotherapy. Irrespective of the disease, treatment, and past SARS-CoV-2 infection, the odds of higher antibody levels at 4, 12, and 24 weeks post second vaccine dose were, respectively, 3.4, 3.8, and 3.8 times higher with mRNA-1273 versus BNT162b2 (p < 0.0001). With every year of age, the odds ratio of higher peak humoral immunogenicity following mRNA-1273 versus BNT162b2 increased by 5% (p < 0.001), indicating a particular benefit for elderly patients. Our results suggest that in IRD patients, two-dose vaccination with mRNA-1273 versus BNT162b2 results in higher anti-S1 levels, even more so in elderly patients

Type of mRNA COVID-19 vaccine and immunomodulatory treatment influence humoral immunogenicity in patients with inflammatory rheumatic diseases.

Patients with inflammatory rheumatic diseases (IRD) are at increased risk for worse COVID-19 outcomes. Identifying whether mRNA vaccines differ in immunogenicity and examining the effects of immunomodulatory treatments may support COVID-19 vaccination strategies. We aimed to conduct a long-term, model-based comparison of the humoral immunogenicity following BNT162b2 and mRNA-1273 vaccination in a cohort of IRD patients. Patients from the Swiss IRD cohort (SCQM), who assented to mRNA COVID-19 vaccination were recruited between 3/2021-9/2021. Blood samples at baseline, 4, 12, and 24 weeks post second vaccine dose were tested for anti-SARS-CoV-2 spike IgG (anti-S1). We examined differences in antibody levels depending on the vaccine and treatment at baseline while adjusting for age, disease, and past SARS-CoV-2 infection. 565 IRD patients provided eligible samples. Among monotherapies, rituximab, abatacept, JAKi, and TNFi had the highest odds of reduced anti-S1 responses compared to no medication. Patients on specific combination therapies showed significantly lower antibody responses than those on monotherapy. Irrespective of the disease, treatment, and past SARS-CoV-2 infection, the odds of higher antibody levels at 4, 12, and 24 weeks post second vaccine dose were, respectively, 3.4, 3.8, and 3.8 times higher with mRNA-1273 versus BNT162b2 (p < 0.0001). With every year of age, the odds ratio of higher peak humoral immunogenicity following mRNA-1273 versus BNT162b2 increased by 5% (p < 0.001), indicating a particular benefit for elderly patients. Our results suggest that in IRD patients, two-dose vaccination with mRNA-1273 versus BNT162b2 results in higher anti-S1 levels, even more so in elderly patients

Effect of surgical experience and spine subspecialty on the reliability of the {AO} Spine Upper Cervical Injury Classification System

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (&lt; 5 years, 5–10 years, 10–20 years, and &gt; 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (&lt; 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs &gt; 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (&lt; 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs &gt; 20 years: 0.62), and only surgeons with &gt; 20 years of experience did not have substantial reliability on assessment 2 (&lt; 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs &gt; 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system

La monoarthrite septique primaire doit-elle être considérée comme une urgence chirurgicale immédiate ?

Les arthrites septiques sont habituellement considérées comme des urgences chirurgicales nécessitant un traitement quasi immédiat, même au milieu de la nuit. Cependant, il n’existe que peu d’évidence dans la littérature justifiant un tel traitement. Nous avons donc revu les dossiers de tous les patients adultes ayant été traités aux Hôpitaux Universitaires de Genève pour une arthrite septique entre 1997 et 2015 et analysé l’association possible entre le délai de prise en charge chirurgicale et la survenue d’éventuelles séquelles. 204 épisodes d’arthrite septiques ont été inclus, touchant en majorité le genou. Tous les patients ont bénéficié d’un drainage chirurgical et d’une antibiothérapie. Sur un suivi minimum de 3 mois, nous avons relevé des séquelles chez 83 patients (arthrose secondaire, récidive d’infection, raideur articulaire ou autres). Après analyse statistique, nous n’avons pu mettre en évidence aucune influence du délai de prise en charge sur l’incidence d’éventuelles séquelles

Fractures de la région du genou chez la personne âgée: prise en charge et évolution

From the age of 50 the risk of fracture during the remaining years of life is estimated to be 40% in women and 20% men. The management of a fracture in the elderly is complex for several reasons, including decreased bone strength, a frequent association with previous joint replacement surgery or another orthopaedic implant, a high risk for anesthesia, difficulty in following postoperative recommendations, and an increased postoperative mortality. This article offers a review of fractures around the knee: distal femur, proximal tibia, patella and periprosthetic fractures. The vast majority of these fractures are treated surgically. When surgery is indicated, treatment should be initiated as soon as possible according to the patient's general condition in order to minimize the risk of complications and deconditioning

Chirurgie lombaire endoscopique

L’endoscopie spinale est le résultat d’une évolution des techniques et des technologies au service d’une chirurgie toujours moins invasive. Elle permet de traiter un bon nombre de pathologies telles que la hernie discale ou la sténose canalaire et ce nombre continue d’augmenter. Elle a déjà prouvé sa non-infériorité et son rapport coûts-bénéfices avantageux par rapport à la microchirurgie, et ce, bien que sa courbe d’apprentissage ne soit pas toujours aisée. Elle a le potentiel de remplacer le « gold standard » microscopique car elle permet une récupération plus rapide pour le patient et une hospitalisation plus courte.Spinal endoscopy is the result of an evolution of techniques and technologies in the service of an ever less invasive surgery. It allows the treatment of a large range of pathologies such as disc herniation or spinal stenosis and this range continues to increase. It has already proven its non-inferiority and cost-effectiveness compared to microsurgery despite a difficult learning curve. It has the potential to replace the microscopic «gold standard» as it allows a faster recovery for the patient and a shorter hospital stay

The SWING test: A more reliable test than passive clinical tests for assessing sagittal plane hip mobility

Background: Clinical assessment of sagittal plane hip mobility is usually performed using the Modified Thomas Test (for extension) and the Straight-Leg-Raise (for flexion) with a goniometer. These tests have limited reliability, however. An active swinging leg movement test (the SWING test), assessed using 3D motion analysis, could provide an alternative to these passive clinical tests.Research question: Is the SWING test a more reliable alternative to evaluate hip mobility, in comparison to the clinical extension and flexion tests?Methods: Ten asymptomatic adult participants were evaluated by two investigators over three sessions. Participants performed 10 maximal hip extensions and flexions, with both legs straight and no trunk movement (the SWING test). Hip kinematics was assessed using a 3D motion analysis system. Maximal and minimal hip angles were calculated for each swing and represented maximal hip flexion (SWING flexion) and extension (SWING extension), respectively. The Modified Thomas Test and Straight-Leg-Raise were repeated 3 times for each leg. On the first day, both investigators performed all the tests (SWING + Modified Thomas Test + Straight-Leg-Raise). A week later, a single investigator repeated all the tests. Inter-rater, intra-rater, within-day and between-day reliability were evaluated using intra-class correlation.Results: Intra-class correlation coefficients for all the tests were superior to 0.8, except for the Modified Thomas Test's intra-rater, between-day (intra-class correlation 0.673) and the Straight-Leg-Raise's inter-rater, within-day (intra-class correlation 0.294). The SWING test always showed a higher intra-class correlation coefficient than the passive clinical tests. The only significant correlation found was for the Straight-Leg-Raise and SWING flexion (r = 0.48; P Significance: The SWING test seems to be an alternative to existing passive clinical tests, offering better reliability for assessing sagittal plane hip mobility.</p