Coût social de la traumatologie des sports d'hiver 2010 2011 en orthopédie au CHU Nord de Grenoble

En hiver, l'activité des services hospitaliers comme les urgences et l'orthopédie, augmente de manière importante. Les mesures de prévention contribuent à faire baisser l'incidence des traumatismes liés aux sports de glisse, mais celle-ci reste élevée, et a un retentissement médico-économique conséquent. Ce travail consiste à fournir des données épidémiologiques sur le coût sociétal de la traumatologie des sports d'hiver en comparant l'activité ski / snowboard, et sur les facteurs liés à ce coût. Le coût de séjour du skieur apparait plus élevé, de 742 EUR par séjour, par rapport au snowboardeur, pouvant s'expliquer par une durée de séjour supérieure, des passages en réanimation plus fréquents et un SMUR aérien plus souvent engagé.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Mise au point et évaluation des guides de coupe patient spécifique pour la mise en place des prothèses de genou (étude cadavérique)

L alignement frontal des prothèses totales de genou (PTG) semble être un élément majeur sur la survie des implants et sur la fonction du genou. Les guides de coupe patient spécifique (GPS) ont été introduits afin d améliorer la capacité à atteindre un axe mécanique post opératoire neutre. En comparaison à une pose de PTG avec un ancillaire standard (AS), les GPS permettent d améliorer l alignement des membres inférieurs et de diminuer le temps opératoire. 33 membres inférieurs ont été prélevés sur 17 cadavres. Un scanner pré opératoire de chaque membre inférieur a été effectué permettant, de mesurer les angles HKA, AMF et AMT, et de planifier la PTG afin de modéliser les GPS. 17 PTG ont été réalisées avec un GPS, 16 avec un AS. L alignement frontal des PTG en post opératoire était mesuré avec l aide d un scanner. Pour chaque intervention le temps opératoire était noté. En pré opératoire 66,7% (22/33) des membres inférieurs était en varus, 27,3% (9/33) en valgus et 6% (2/33) normo axé, il n y avait pas de différence significative entre les groupes. En post opératoire : l alignement des PTG était compris entre 177 et 183 pour 81,25% (13/16) dans le groupe AS et 76,47% (13/17) dans le groupe GPS. L HKA moyen pour le groupe AS était à 179,1 (2,45) et pour le groupe GPS à 178 (2,18), sans différence significative entre les deux groupes (p-Value : 0,17). Seul le temps opératoire était significativement plus faible pour le groupe GPS avec une médiane à 43 minutes [35-47] contre 50 minutes [43-62,5] pour le groupe AS. Dans cette étude la pose de PTG avec GPS n est pas supérieure concernant l alignement des PTG mais permet une diminution du temps opératoire.Coronal alignment in total knee arthroplasty (TKA), seems to be a major factor in the survivorship of the components and in the functional outcome. The Patient Specific Guides (PSG), based on 3 D imaging, had been introduced in surgical process in order to improve accuracy in TKA, and to reach post operative neutral mechanical alignment. Compared with standard instrumentation (SI), PSG can improve the coronal alignment of the TKA and decrease the operative time. Thirty-three lower limbs have been taken from seventeen cadavers. A pre operative CT scan of each lower limb has been realized in order to measure: HKA angle, MFA and MTA, and to plan the TKA for shaping the PSG. 17 TKAs have been implanted with PSG, 16 with SI. Post operatively, a further CT scan has been used to make the measures to compare the two groups. Per operatively, operative time and positioning of PSG have been reported. Pre operatively, 66,7% (22/33) of the lower limbs were in varus, 27,3% (9/33) were in valgus and 6% (2/33) were in neutral alignment, there was no significant difference between the groups. Post operatively, the overall mechanical alignment was between 177 and 183 for 81,25% (13/16) in SI group, and 76,47% (13/17) in PSG group. The mean HKA in SI was 179,1 (+-2,45), and 178 (+-2,18) in PSG group, there was no significant difference between the group (p-Value: 0,17). Only the operative time was significantly lower in PSG group with a median of 43 minutes [35-47] for 50 minutes [43-62,5] in SI group. In our study, PSG did not demonstrate a superiority regarding the coronal mechanical alignment comparing with SI in TKA. But the use of PSG process can reduce the operative time.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Fluoroscopy-based navigation system in spine surgery

The variability in width, height, and spatial orientation of a spinal pedicle makes pedicle screw insertion a delicate operation. The aim of the current paper is to describe a computer-assisted surgical navigation system based on fluoroscopic X-ray image calibration and three-dimensional optical localizers in order to reduce radiation exposure while increasing accuracy and reliability of the surgical procedure for pedicle screw insertion. Instrumentation using transpedicular screw fixation was performed: in a first group, a conventional surgical procedure was carried out with 26 patients (138 screws); in a second group, a navigated surgical procedure (virtual fluoroscopy) was performed with 26 patients (140 screws). Evaluation of screw placement in every case was done by using plain X-rays and post-operative computer tomography scan. A 5 per cent cortex penetration (7 of 140 pedicle screws) occurred for the computer-assisted group. A 13 per cent penetration (18 of 138 pedicle screws) occurred for the non computer-assisted group. The radiation running time for each vertebra level (two screws) reached 3.5 s on average in the computer-assisted group and 11.5 s on average in the non computer-assisted group. The operative time for two screws on the same vertebra level reaches 10 min on average in the non computer-assisted group and 11.9 min on average in the computer-assisted group. The fluoroscopy-based (two-dimensional) navigation system for pedicle screw insertion is a safe and reliable procedure for surgery in the lower thoracic and lumbar spine

Assessment of a percutaneous iliosacral screw insertion simulator.

International audienceBACKGROUND: Navigational simulator use for specialized training purposes is rather uncommon in orthopaedic and trauma surgery. However, it reveals providing a valuable tool to train orthopaedic surgeons and help them to plan complex surgical procedures. PURPOSE: This work's objective was to assess educational efficiency of a path simulator under fluoroscopic guidance applied to sacroiliac joint percutaneous screw fixation. MATERIALS AND METHODS: We evaluated 23 surgeons' accuracy inserting a guide-wire in a human cadaver experiment, following a pre-established procedure. These medical trainees were defined in three prospective respects: novice or skilled; with or without theoretical knowledge; with or without surgical procedure familiarity. Analysed criteria for each tested surgeon included the number of intraoperative X-rays taken in order to achieve the surgical procedure as well as an iatrogenic index reflecting the surgeon's ability to detect any hazardous trajectory at the time of performing said procedure. RESULTS: An average number of 13 X-rays was required for wire implantation by the G1 group. G2 group, assisted by the simulator use, required an average of 10 X-rays. A substantial difference was especially observed within the novice sub-group (N), with an average of 12.75 X-rays for the G1 category and an average of 8.5 X-rays for the G2 category. As far as the iatrogenic index is concerned, we were unable to observe any significant difference between the groups

Computer Assisted Navigation in Knee Arthroplasty

Computer assisted surgery (CAS) was used to improve the positioning of implants during total knee arthroplasty (TKA). Most studies have reported that computer assisted navigation reduced the outliers of alignment and component malpositioning. However, additional sophisticated studies are necessary to determine if the improvement of alignment will improve long-term clinical results and increase the survival rate of the implant. Knowledge of CAS-TKA technology and understanding the advantages and limitations of navigation are crucial to the successful application of the CAS technique in TKA. In this article, we review the components of navigation, classification of the system, surgical method, potential error, clinical results, advantages, and disadvantages

Selection of massive bone allografts using shape-matching 3-dimensional registration

Background and purpose Massive bone allografts are used when surgery causes large segmental defects. Shape-matching is the primary criterion for selection of an allograft. The current selection method, based on 2-dimensional template comparison, is inefficient for 3-dimensional complex bones. We have analyzed a 3-dimensional (3-D) registration method to match the anatomy of the allograft with that of the recipient