Anatomical and morphological study of the subcoracoacromial canal

International audienceIntroduction Many clinical anatomy studies have looked into how variations in the acromion, coracoacromial ligament (CAL) and subacromial space are associated with rotator cuff injuries. However, no study up to now had defined anatomically the fibro-osseous canal that confines the supraspinatus muscle in the subcoracoacromial space. Through an anatomical study of the scapula, we defined the bone-related parameters of this canal and its anatomical variations. Materials and methods This study on dry bones involved 71 scapulas. With standardised photographs in two orthogonal views (superior and lateral), the surface area of the subcoracoacromial canal and the anatomical parameters making up this canal were defined and measured using image analysis software. The primary analysis evaluated the anatomical parameters of the canal as a function of three canal surface area groups; the secondary analysis looked into how variations in the canal surface area were related to the type of acromion according to the Bigliani classification. Results Relative to glenoid width, the group with a large canal surface area (L) had significantly less lateral overhang of the acromion than the group with a small canal surface area (S), with ratios of 0.41 ± 0.23 and 0.58 ± 0.3, respectively (P = 0.04). The mean length of the CAL was 46 ± 8 mm in the L group and 39 ± 9 mm in the S group (P = 0.003). The coracoacromial arch angle was 38° ± 11° in the L group and 34° ± 9° in the S group; the canal surface area was smaller in specimens with a smaller coracoacromial arch angle (P = 0.20). Conclusion Apart from acromial morphology, there could be innate anatomical features of the scapula that predispose people to extrinsic lesions to the supraspinatus tendon (lateral overhang, coracoacromial arch angle) by reducing the subcoracoacromial canal's surface area. Level of evidence Anatomical descriptive study. © 2016 Elsevier Masson SA

Existe-t-il un syndrome canalaire sous-acromiocoracoïdien ? Étude anatomique du canal sous-acromiocoracoïdien [Anatomical and morphological study of the subcoracoacromial canal]

National audienceRefers To O. Le Reun, J. Lebhar, F. Mateos, J.L. Voisin, H. Thomazeau, M. Ropars Anatomical and morphological study of the subcoracoacromial canal Orthopaedics & Traumatology: Surgery & Research, Volume 102, Issue 8, Supplement, December 2016, Pages S295-S29

Withholding and withdrawing treatment in pediatric intensive care. Update of the GFRUP recommendations

International audienceIn 2005, the French-speaking task force on pediatric critical and emergency care [Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP)] issued recommendations on withholding and withdrawing treatments in pediatric critical care. Since then, the French Public Health Code, modified by the laws passed in 2005 and 2016 and by their enactment decrees, has established a legal framework for practice. Now, 15 years later, an update of these recommendations was needed to factor in the experience acquired by healthcare teams, new questions raised by practice surveys, the recommendations issued in the interval, the changes in legislation, and a few legal precedents. The objective of this article is to help pediatric critical care teams find the closest possible compromise between the ethical principles guiding the care offered to the child and the family and compliance with current regulations and laws

Limitations et arrêts des traitements (LAT) en réanimation pédiatrique. Actualisation des recommandations du GFRUP

International audienc