Mini-Open Latarjet Procedure for Recurrent Anterior Shoulder Instability

Anterior shoulder instability is a common problem. The Latarjet procedure has been advocated as an option for the treatment of anteroinferior shoulder instability. The purpose of this paper is to explain our surgical procedure titled “Mini-open Latarjet Procedure.” We detailed patient positioning, skin incision, subscapularis approach, and coracoid fixation. Then, we reviewed the literature to evaluate the clinical outcomes of this procedure

Computer-assisted osteotomy for valgus knees: Medium-term results of 29 cases

AbstractIntroductionComputer-assisted surgery has been shown to be beneficial for correcting misaligned lower limbs. The purpose of this study was to analyze the medium-term results of computer-assisted osteotomy for 29 valgus knees. The hypothesis was that computer navigation would allow a valgus deformity to be corrected with similar precision as varus deformity.Material and methodsThe series consisted of 27 patients (29 knees); there were 7 men and 20 women with ages ranging from 15 to 63 years (mean: 42.4±14.3 years). Twenty-four varus osteotomies of the femur (14 medial closing and 10 lateral opening) and five double osteotomies (proximal tibia and distal femur) were performed. The pre-operative functional status was evaluated with the Lysholm-Tegner score. The mean score was 64±20.5 points (range: 18–100). According to Ahlbäck's modified classification for knee osteoarthritis, 12 patients were at stage 1, nine were at stage 2, five at stage 3 and one at stage 4. Two of the knees had no radiological signs of osteoarthritis but had a particularly unsightly deformity; one of these was secondary to high tibial valgus osteotomy. The mean pre-operative hip-knee-angle (HKA) angle was 189.3±3.9°; the mean mechanical medial distal femoral angle (mMDFA) was 97.2±2.6° and mechanical medial proximal tibial angle (mMPTA) was 90.1±2.8°. The goal was to achieve an HKA angle of 179±2° and mMPTA of 90±2° to avoid an oblique joint line. Functional outcomes were evaluated with the Lysholm-Tegner, KOOS and IKS scores.ResultsNo complications other than a transient paralysis of the common fibular nerve were observed. Twenty-three patients (25 knees) were reviewed at a mean follow-up of 50.9±38.8 months (range: 6–144). The mean Lysholm-Tegner score was 92.9±4 points (86–100), the mean KOOS was 89.7±9.3 (range: 68–100), the mean IKS “knee” score was 88.7±11.4 points (range: 60–100) and the “function” score was 90.6±13.3 points (range: 55–100). Twenty-two patients were satisfied or very satisfied. The mean HKA angle was 180.1±1.9°, the mean mMDFA 90.7±2.5° and the mean mMPTA 89.1±1.9°. The pre-operative goal was achieved in 86.2% of cases (25/29) for the HKA angle and 100% of cases of the mMPTA angle. At the follow-up, none of the knees had been revised with a prosthesis.ConclusionComputer-assisted osteotomy for cases of osteoarthritis secondary to valgus knee leads to excellent medium-term results. Navigation provides reliable and accurate deformity correction.Level of evidenceIV. Retrospective study

Standardising the clinical assessment of coronal knee laxity

Clinical laxity tests are used for assessing knee ligament injuries and for soft tissue balancing in total knee arthroplasty. This study reports the development and validation of a quantitative technique of assessing collateral knee laxity through accurate measurement of potential variables during routine clinical examination. The hypothesis was that standardisation of a clinical stress test would result in a repeatable range of laxity measurements.Non- invasive infrared tracking technology with kinematic registration of joint centres gave real-time measurement of both coronal and sagittal mechanical tibiofemoral alignment. Knee flexion, moment arm and magnitude of the applied force were all measured and standardised. Three clinicians then performed six knee laxity examinations on a single volunteer using a target moment of 18Nm. Standardised laxity measurements had small standard deviations (within 1.1°) for each clinician and similar mean values between clinicians, with the valgus laxity assessment (mean of 3°) being slightly more consistent than varus (means of 4° or 5°).The manual technique of coronal knee laxity assessment was successfully quantified and standardised, leading to a narrow range of measurements (within the accuracy of the measurement system). Minimising the subjective variables of clinical examination could improve current knowledge of soft tissue knee behaviour

Is unicompartmental-to-unicompartmental revision knee arthroplasty a reliable option? Case-control study

AbstractBackgroundIn selected patients with failed unicompartmental knee arthroplasty (UKA), revision UKA is a reliable option and may even provide lower morbidity rates and better functional outcomes compared to revision total knee arthroplasty.Material and methodsIn a multicentre retrospective study of 425 knees requiring revision surgery after UKA, 36 knees were managed with revision UKA.ResultsOf the 36 knees, 3 (8.33%) required iterative revision surgery, for aseptic loosening. After a mean follow-up of 8.3 years, the mean IKS knee and function scores were high (93.81/100 and 90.77/100, respectively).DiscussionIn carefully selected patients, UKA-to-UKA revision performed according to a rigorous operative technique deserves a role in the surgical strategy for failed UKA.Level of evidenceIII, multicentre retrospective case-control study

Les dynamiques de la végétation et des anthroposystèmes d’altitude cernées par l’anthracologie pastorale et minière à l’échelle d’un haut vallon alpestre (Freissinières, France)

This review paper outlines the reconstruction of vegetation and altitude anthroposystem dynamics, at the scale of the Freissinières high valley, based on the anthracological analysis of mining and (agro-) pastoral carbonised deposits, dating from the Bronze Age to the Renaissance. Archaeological and chronological features of the various deposit contexts, sampling protocol and laboratory methods used, have been outlined. All the obtained data has been summarized in diagrams, and attempts have been made to model vegetation dynamics and areas of firewood supply for mining and pastoral activities. Thus, this study identifies the major subalpine floristic changes that have occurred since the Bronze Age, the development of wood pasture and the lowering of the upper limit of dense forest associated with heathlands and thicket expansion. In addition, this study characterises the evolution of supply practices of fuel wood and the management of uncultivated area -particularly during the Middle Ages- and grasps the leaf-fodder cycle, documented by charcoals at the turn of the Modern era

Traitement de la gonarthrose post traumatique par arthroplastie (à propos de 25 patients revus a moyen terme)

INTRODUCTION : La gonarthrose post traumatique fait suite à une fracture articulaire autour du genou ou à des lésions ligamentaires du pivot central. L arthroplastie est une solution thérapeutique possible. Les résultats fonctionnels sont inférieurs à ceux retrouvés dans la gonarthrose essentielle et le taux de complications est plus élevé. Le but de notre travail était d étudier les résultats fonctionnel, clinique et radiologique de l arthroplastie pour les gonarthroses post traumatique avancées. METHODES : Il s agit d une étude rétrospective et monocentrique. Nous avons inclus 25 patients d âge moyen à la révision de 62 ans +/- 16 (34-89). Il s agissait entre 1996 et 2010 de 5 PUC, 10 PTG standard, 6 PTG postéro stabilisées et 4 PTG à Haute contrainte. Le délai moyen entre le traumatisme initial et la prothèse était de 86 mois +/- 142(6-619). RESULTATS : Vingt -trois patients ont été revus avec un recul moyen de 7,2ans +/- 3,8 (3-16). Neuf patients (36%) ont présenté une complication : 3 patients ont nécessité une réintervention chirurgicale (un sepsis grave, une instabilité patellaire et une fracture de matériel), les autres n ont pas été réopérés (3 raideurs, 3 sepsis). Aucune usure du polyéthyléne ni descellement n ont été retrouvés. Le score IKS global a été amélioré, passant de 67 points +/- 36 à 173 points +/- 23. Le score KOOS global moyen était de 57 points +/- 19. Le gain de flexion moyen était de 12. CONCLUSION : Les arthroplasties dans les gonarthroses post traumatique donnent des résultats fonctionnels inférieurs aux gonarthroses dégénératives. Le taux de complications est plus élevé. Cependant, les patients sont satisfaits de leur intervention.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Primary total knee arthroplasty in the management of epiphyseal fracture around the knee

SummaryIntroductionOver the past few years the use of arthroplasty was broadened to treating complex epiphyseal fractures at the shoulder and elbow joints. Similar trends to treat this type of fractures at the knee are less documented. Based on a multicenter retrospective series study, the aims of this work is to evaluate the short term clinical results of total knee prostheses in the management of comminuted epiphyseal fractures around the knee, to identify the technical issues and fine tune the indications.Material and methodsFollowing the initiative of the French Hip and Knee Society (SFHG) and the Traumatology Study Group (GETRAUM), 26 charts from eight different centers in France were included in this multicenter retrospective series. Inclusion criteria were: primary total knee arthroplasty (TKA) in the management of complex articular fractures involving the proximal end of the tibia or distal end of the femur. Surgical features were identified and complications were analyzed. The assessment protocol at last follow-up was standardized and included patient demographic data, analysis of the Parker and IKS scores.ResultsDuring the immediate postoperative period, six patients (23%) reported a general complication and four patients (15%) a local arthroplasty-related complication. At last follow-up (mean 16.2 months), the overall final Parker score was 6.3 (a mean decrease of 1.7) and the mean IKS knee score was 82 points for a mean function score of 54 points.DiscussionPrimary TKA is a suitable management option for complex fractures in autonomous elderly patients suffering from knee osteoarthritis. The key technical details of this procedure should be respected and meticulously planned to achieve optimal results and limit the risk of complications. This risk in these acute complex fractures remains higher than after conventional TKA but comparable to that observed after TKA for post-traumatic arthritis.Level of evidenceIV; retrospective cohort study

Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years

SummaryIntroductionIn trochanteric fracture, whatever its anatomic type, internal fixation is currently the standard attitude, with arthroplasty as a relatively unusual option.HypothesisHip implants are an excellent alternative to osteosynthesis in unstable trochanteric fracture in patients aged over 75 years.Patients and methodsA non-randomised prospective multicenter study compared osteosynthesis by trochanteric nailing (n=113) to hip arthroplasty (n=134) in unstable trochanteric fracture (AO types 31 A2.2 and 3 and A3.3) in 247 patients over the age of 75 years. The series was recruited during 2007 in seven centres, four of which included only arthroplasties, two only osteosyntheses and one both. The two groups were comparable in age, sex, preoperative Parker score, pre-fracture place of residence, fracture type, time to surgery and preoperative comorbidity. The sole difference was in operators, with more senior surgeons in arthroplasty (62% versus 27%).ResultsThree-month mortality was identical in the two groups (21.2% versus 21%). General complications did not differ, although mechanical complications were more frequent in the nailing group (12.5% versus 2.8%). Functional results (Parker and PMA scores) were better in the implant than in the nail group.DiscussionThe present study validated hip arthroplasty in these indications. Cemented stems associated to a dual-mobility acetabular component gave the best results.Type of studyProspective, level of evidence III

Évolution de la traumatologie des sports d'hiver (comparaison de deux séries à 10 ans d'intervalle à Grenoble (1998-1999 et 2008-2009))

L objectif de notre étude est d établir un recensement de la traumatologie des sports de glisse sur neige (ski alpin, ski de randonnée, snowboard et snowblade) et son évolution entre les saisons 1998/1999 et 2008/2009. Matériel et méthode : Matériel : Nous avons traité 1322 dossiers d accidentés de sports d hiver accueillis aux urgences de l hôpital sud lors des saisons 1998-1999 et 2008-2009, puis nous avons comparé ces 2 séries. On remarque la prédominance du ski (77, 6 % des accidents en 1998-1999 et 71,8% en 2008-2009). Méthode : nous avons réalisé une étude épidémiologique rétrospective, en utilisant le test du chi 2 pour mettre en évidence des évolutions statistiquement significatives. Résultats : De façon globale nous avons mis en évidence une augmentation de la gravité des lésions périphériques. Cette proportion augmente lors de la saison 2008-2009 avec 28,5 % de lésions bénignes contre 71,5% de lésions graves p<0,001. En ce qui concerne le ski: Au niveau des membres : on note une augmentation de la proportion des atteintes du membre supérieur en 10 ans, de 29,1 % en 1998-1999 contre 35,06% en 2008-2009 p=0,054. Les lésions du genou en ski alpin restent majoritaires et se sont stabilisées sur ces 10 dernières années. En ce qui concerne le snowboard : Il s'est produit un glissement des lésions vers le haut avec une augmentation des atteintes du membre supérieur passant de 60,45% du total des lésions en 1998-1999 contre 81,29% du total en 2008-2009 p<0,001. Conclusion : Cette étude révèle que la traumatologie des sports d hiver s est modifiée entre les saisons 1998-1999 et 2008-2009. Les résultats sont en accord avec les données de la littérature. Avec des lésions évoluant vers le haut du corps et vers plus de gravité du fait de l évolution du matériel, et des modifications des conditions de glisses (pistes plus larges, mieux damées, plus fréquentées).GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF