Transverse translunate fracture–dislocation: a rare injury

Perilunate fracture–dislocation is rare. We report the case of a 24-year-old male who fell from his motorcycle and presented with a transverse lunate fracture with perilunate ligament damage. The initial diagnosis based on X-rays was confirmed by CT scan. A dorsal approach was used to obtain good reduction, double screw fixation and ligament reinsertion protected by temporary K-wires. To the best of our knowledge, this is the first case of transverse lunate fracture within perilunate fracture–dislocation. The patient returned to normal activities after 6 months

Le risque et son information en chirurgie

Cette thèse comprend trois parties. La première traite de la notion même de risque. Historiquement associé aux assurances et aux probabilités, le risque est maintenant une construction sociale centrale des sociétés occidentales. Les "risques" entraînent des réactions variables selon les groupes sociaux, mais tous condamnent "la science". Le risque oblige à repenser la démocratie et le rôle des savants au sein des organes de décision. La deuxième partie traite des risques en médecine. Si les risques ne sont pas tous nouveaux, la complexification du système de santé dilue les responsabilités, ce qui limite les possibilités de corrections individuelles. En copiant les modèles industriels, la médecine moderne apprend maintenant à gérer les risques organisationnels et individuels. La dernière partie traite de la relation médecin-patient et de l'information individuelle du risque. En nous appuyant sur nos travaux et sur ceux de la littérature, nous voulons montrer comment et pourquoi les patients ne comprennent pas les risques. Ceci permet d'expliquer que derrière la demande de l'information des risques, ce sont les valeurs de la société que le patient interroge.Our modern society is unable to reach "the zero risk" and must now deal with risks which perception and acceptability have changed over the last decades. All social groups, with variations between groups, condemn "the science". We must now redraw the limit of our democracy and the role of experts. In medical field, risks are not something new. However the complexification of the medical system make evaluation and correction of risks difficult. By copying the industrial models, we now start to manage "the risk". In France, risk information is a legal obligation. Practically, however, patient cannot understand the risks. This is because when asking for risks, patients mainly ask for the real definitions of the values of our society.PARIS5-BU Méd.Cochin (751142101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

VINGT ANS DE CHIRURGIE PLASTIQUE ET RECONSTRUCTRICE DANS UN SERVICE D'ORTHOPEDIE ET TRAUMATOLOGIE (ETUDE DE 444 PATIENTS)

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Bénéfice vasculaire du dégraissage primaire d'un lambeau cutanéo graisseux pris au hasard, par suppression du vol d'irrigation

PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

Trends in Trapeziometacarpal Implant Design: A Systematic Survey Based on Patents and Administrative Databases

International audienc

Modified Masquelet Technique Using Allogeneic Graft for a Gustilo-Anderson Type III-A Open Fracture of the Femur with an 8 cm Bone Defect

The induced membrane technique was initially described by Masquelet et al. in 1986 as a treatment for tibia nonunion; then, it became one of the established methods in the management of bone defects. Several changes have been made to this technique and have been used in different contexts and different methodologies. We present the case of a 16-year-old girl admitted to our department for a polytrauma after a motorcycle accident. She presented a Gustilo III-A open fracture of the right femoral shaft with a large bone defect of 8 centimeters that we treated with a modified Masquelet technique. In the first stage, an Open Reduction and Internal Fixation of the fracture was made using a 4,5 mm Dynamic Compression Plate and a PMMA cement was inserted at the bone defect area. The second stage was done after 11 weeks, and the defect area was filled exclusively with bone allograft from a bone bank. Complete bony union was seen at 60 weeks of follow-up. After the removal of the implants by another surgeon, the patient presented an atraumatic fracture of the neoformed bone that we treated with intramedullary femoral nailing associated with a local autograft using reaming debris. A complete bony union was achieved after 12 weeks with a complete range of motion of the hip and knee. The stability given to the fracture is essential because it influences the quality of the induced membrane and Masquelet has recommended high initial fixation rigidity to promote incorporation of the graft. It is recommended to delay the second stage of this technique after 8 weeks, especially in femoral reconstruction, to optimize the quality of the induced membrane. Several studies used a modified induced membrane technique to recreate a traumatic large bone defect, and all of them used an autologous bone graft alone or an enriched bone graft. In this case, the use of allograft exclusively seems to be as successful as an autologous or enriched bone graft. Now, with the advent of bone banks, it is possible to get an unlimited amount of allograft, so additional research and large studies are necessary before giving recommendations

Questions about Using the Induced Membrane Technique to Manage Cases of Congenital Tibial Pseudarthrosis

International audienceThe induced membrane technique is an innovative approach for repairing critical bone defects and has been applied recently in patients with congenital pseudarthrosis of the tibia (CPT). CPT is frequently associated with neurofibromatosis type 1 (NF1). Here, we briefly describe the clinical results of the induced membrane technique in NF1-deficient patients with CPT and in an animal model of CPT. Furthermore, we discuss the hypotheses used to explain inconsistent outcomes for the induced membrane technique in CPT–especially when associated with NF1

Repeated Induced-Membrane Technique Failure without Infection: A Series of Three Consecutive Procedures Performed for a Single Femur Defect

A 40-year-old male was treated using the induced-membrane technique (IMT) for a noninfected, 9 cm long femoral bone defect complicating a lengthening procedure. The interesting case feature lies in the three consecutive IMT procedures that were necessary to achieve complete bone repair in this unusual clinical situation. The first procedure failed because of the lack of graft revascularization likely related to an induced-membrane (IM) alteration demonstrated by histological observations. The second IMT procedure led to partial graft integration interrupted by the elongation nail breakage. At last, the third procedure fully succeeded after nail exchange and iterative iliac bone grafting. Complete bone union was achieved with a poor functional recovery one year after the last procedure and four years following the first cement spacer implantation. By means of clinical and histological observations, we demonstrated that the first and the second IMT failures had two distinct origins, namely, biological and mechanical causes, respectively. Although simple, a successful IMT procedure is not so easy to complete

The Masquelet technique: Current concepts, animal models, and perspectives

International audienceBone reconstruction within a critical-sized defect remains a real challenge in orthopedic surgery. The Masquelet technique is an innovative, two-step therapeutic approach for bone reconstruction in which the placement of a poly (methylmethacrylate) spacer into the bone defect induces the neo-formation of a tissue called ``induced membrane.'' This surgical technique has many advantages and is often preferred to a vascularized bone flap or Ilizarov's technique. Although the Masquelet technique has achieved high clinical success rates since its development by Alain-Charles Masquelet in the early 2000s, very little is known about how the process works, and few animal models of membrane induction have been developed. Our successful use of this technique in the clinic and our interest in the mechanisms of tissue regeneration (notably bone regeneration) prompted us to develop a surgical model of the Masquelet technique in rats. Here, we provide a comprehensive review of the literature on animal models of membrane induction, encompassing the defect site, the surgical procedure, and the histologic and osteogenic properties of the induced membrane. We also discuss the advantages and disadvantages of those models to facilitate efforts in characterizing the complex biological mechanisms that underlie membrane induction

Induced membrane technique: a critical literature analysis and proposal for a failure classification scheme

International audienceThe reconstruction of long-bone segmental defects remains challenging, with the three common methods of treatment being bone transport, vascularized bone transfer, and the induced membrane technique (IMT). Because of its simplicity, replicability, and reliability, usage of IMT has spread all over the world in the last decade, with more than 300 papers published in the PubMed literature database on this subject so far. Most of the clinical studies have reported high rates of bone union, yet some also include more controversial results with frequent complications and revision surgeries. At the same time, various experimental research efforts have been designed to understand and improve the biological properties of the induced membrane. This literature review aims to provide an overview of IMT clinical results in terms of bone union and complications and to compare them with those of other reconstructive procedures. In light of our findings, we then propose an original classification scheme of IMT failures distinguishing between preventable and nonpreventable failures