Ostéonécrose aseptique de tête fémorale : résultats des traitements de première intention (à propos de 116 cas )

DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Fracture du col du fémur (voie de Röttinger versus voir de Hardinge pour prothèse totale de hanche)

Résumé françaisDIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Mortalité à 1 an des fractures de l extrémité proximale du fémur (étude épidémiologique et comparative)

Introduction : La fracture de l extrémité proximale du fémur est une pathologie fréquente du sujet âgé, lourde de conséquences en termes de morbi-mortalité. Les objectifs de notre étude étaient de comparer deux techniques chirurgicales : arthroplastie et ostéosynthèse en terme de mortalité et de récupération fonctionnelle à 1 an et d identifier des facteurs de risque de mortalité dans l année suivant l intervention. Matériel et méthode : Etude rétrospective, consécutive, monocentrique, comparative portant sur 2 groupes de 100 patients l un pris en charge pour une fracture pertrochantérienne (ostéosynthèse) et l autre pour une fracture intracapsulaire déplacée du col fémoral (arthroplastie). Nous avons effectué un relevé des critères épidémiologiques préopératoires et un contrôle téléphonique à 1 an. Résultats : Age moyen 83,4 ans. La mortalité à 1 an était de 22,5% (2 perdus de vue) sans différence entre les fractures pertrochantériennes et fractures du col fémoral. La récupération fonctionnelle à la marche à 1 an était significativement meilleure après l arthroplastie pour fracture du col fémoral. L institutionnalisation était significativement plus importante à 1 an après une ostéosynthèse pour une fracture pertrochantérienne. En analyse multivariée, l âge et les comorbidités cardiaques étaient des facteurs prédictifs de mortalité à 1 an. Conclusion : Ces fractures du sujet âgé restent de mauvais pronostic. La mortalité n est pas influencée par la technique opératoire, ceci s explique par une meilleure récupération fonctionnelle avec l arthroplastie. Elle est liée au terrain. L identification et la prise en charge des facteurs de risque de mortalité pourraient permettre d améliorer le pronostic vital de ces fractures.DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Total hip arthroplasty with dual mobility cup in osteonecrosis of the femoral head in young patients: over ten years of follow-up

International audienceOsteonecrosis of the femoral head affects mainly young patients with high functional needs this increases the risk of dislocation. Dual mobility cups known for low rate of dislocation and high mobility range seems indicated. We evaluate functional efficiency, survival and dislocation rate of dual mobility cup for total hip arthroplasty for osteonecrosis in young patients. Monocentric retrospective clinical study, from 2000 to 2008. With a clinical analysis in pre-operative and over ten years of follow-up of one cohort of patients under 55 years old with an indication of THA for ONFH. The judgement criteria was: clinical scores at the maximal follow-up, the dislocation rate, and the cumulate survival rate over ten years follow-up. Forty THA in 31 patients, nine bilateral cases, 23 males and eight females with average age of 44 (+/- 4) years old. In pre-operative: PMA 11 (+/- 3.3), HHS 50,8 (+/- 15.5). At the final follow-up of 129.8 (+/- 33.8) months: PMA (17.4 +/- 1.12), HHS (95.7 +/- 6.9), no dislocation. We had 11 deaths on average at 95.2 +/- 47.3 months. The cumulate survival rate over ten years follow-up is 100% without revisions or long-term dislocation. Analysis concludes to very significant functional improvement without any dislocation despite the young population with high level of activity. Thus, dual mobility cups is a reliable choice preventing dislocation with a very good survival rate without premature wear, preserving mobility and activity

Is distal locking screw necessary for intramedullary nailing in the treatment of humeral shaft fractures? A comparative cohort study

International audiencePURPOSE: The gold standard for intramedullary nailing (IMN) in humeral shaft fracture treatment is bipolar interlocking. The aim of this study was to compare clinical and radiographic outcomes in two cohorts of patients treated with IMN with or without distal interlocking. We hypothesized that there was no significant difference between isolated proximal interlocking and bipolar interlocking in terms of consolidation and clinical results.METHODS: One hundred twenty-one acute humeral shaft fractures were retrospectively included in group WDI (without distal interlocking screw, n=74) or in group DI (with distal interlocking screw, n=47). One hundred six patients (87.60%) could be verified by an X-ray, and 63 (52.07%) could be examined clinically. Fracture union at 6months was the primary outcome, and the second was the final clinical outcome for shoulder and elbow after at least 6months of follow-up. Pain, operating time, and radiation time were also analyzed.RESULTS: The two groups were not significantly different for population, fractures, or immobilization duration. No significant difference was found for bone union (WDI 89.06% vs DI 83.33%, p=0.51), shoulder or elbow functional outcomes, or pain. However, there were significant differences in advantage to the WDI group for operating time (WDI 63.09±21.30min vs DI 87.96±30.11min, p<0.01) and fluoroscopy time (WDI 59.06±30.30s vs DI 100.36±48.98s, p<0.01).CONCLUSIONS: Thus, it seems that there were no significant differences between proximal unipolar and bipolar interlocking for humeral shaft fractures in terms of consolidation and clinical outcomes. WDI avoided the additional operating time and fluoroscopy time and risks linked to DI

Röttinger approach with dual-mobility cup to improve functional recovery in hip osteoarthritis patients: biomechanical and clinical follow-up

International audiencePURPOSE: We assumed that the combination of dual-mobility total hip arthroplasty (THA) using the minimally-invasive Röttinger anterolateral approach could guarantee hip stability with faster functional recovery. We objectively analyzed functional improvement after dual-mobility THA by quantitative gait analysis.METHODS: We compared the results achieved following two different surgical approaches: Röttinger's versus Moore's approach (posterolateral approach). We included 70 patients in an open prospective single-centre study: 38 by Rottinger's approach (age = 67yo) and 32 by Moores's approach (age = 68yo). Clinical and biomechanical analysis (kinematic and kinetic parameters of the hip) were conducted at the pre-operative period and at six months post-op RESULTS: We found a significant improvement in all clinical scores and all biomechanical parameters but no difference was found between the two approaches. However, the study showed marked clinical, biomechanical and functional improvements for patients treated with dual-mobility THA for osteoarthritis without complete hip recovery compared with a control group.CONCLUSIONS: The combination of the Röttinger approach with a dual-mobility cup remains a valid choice for primary THA without functional advantage at midterm