Shoulder anatomy : some surgical consequences

Cette thèse s’est d’abord voulue pratique. La chirurgie de l’épaule est en pleine expansion avec le vieillissement croissant de la population et la pratique de plus en plus généralisée du sport. L’épaule est une articulation complexe. Paradoxalement les progrès techniques en chirurgie sont sans cesse grandissants et renouvelés tandis que l’on tientpour acquis des données anatomiques démontrées il y a longtemps et rapportées jusqu’à nos jours. Nous avons voulu confronter l’anatomie avec les techniques diagnostiques actuelles et voir si cela pouvait avoir un impact sur les pratiques chirurgicales. Nous avons également voulu voir si certaines complications chirurgicales pouvaient s’expliquer par des données anatomiques. Ce qui a orienté nos recherches sont les principaux problèmes actuels en pathologie de l’épaule c’est-à-dire la coiffe des rotateurs et le syndrome sous-acromial. Les observations lors des nombreuses dissections de l’épaule nous ont conduit à ces réflexions : comment la glène est-elle vascularisée?, pourquoi est-elle si fragile?, que se passe-t- il dans l’espace sous acromial?, quelle est l’utilité du ligament coraco-acromial?, quels sont ses rapports avec lesuprapinatus?, pourquoi l’insertion du supraspinatus est-elle fragile et difficile à reconstituer ?, la qualité osseuse de la tête humérale a-t-elle un impact sur la géographie des fractures, les échecs des ostéosynthèses, les descellements prothétiques?, qu’est ce que la chape delto-trapézoidienne? Autant de questions que nous nous sommes posées endisséquant cette articulation très complexe qui est l’épaule. Par ailleurs, l’anatomie classique peut maintenant secompléter non seulement de l’histologie, mais aussi de techniques radiologiques modernes comme l’IRM l, le microCT, le synchrotron, la reconstruction 3D, la modélisation en éléments finis.I would like to make a practical thesis. Shoulder surgery is growing and growing as the population is ageing and people is doing more and more sports activities. A lot of technical progress were done but there are still a lot of surgical complications. On the other way some very old anatomical ideas are still alive. I want to see with the actual knowledge, if some surgical complications could be explained by anatomy. Subacromial pathology and bone quality remain the two mainproblems of shoulder surgery and pathology. That’s what had suggested to me this study about the shoulder. I was supposed to analyze glenoid bone first .The aim was to know more about arterial supply of glenoid. That was my firststudy (article 1). Then, I was interested in glenoid bone quality. And the second study had appeared. (article 2). During the shoulder dissection, I was looking for the fascia delto-trapezoidal which I didn’t found as described in books. It was my third study. (article 3). Going on I found the coraco-acromial ligament and I was surprised to see the constant portion under the acromial process. And that gave me the idea for the fourth study. (article 4).As I had discovered the very interesting technique of micro-Ct densitometry, I would like to apply it to the humeral head bone. There was the fifth study. (article 5)But, I want to know more and more about bone quality and I went on with the greater tuberosity and especially the area ofsupraspinatus insertion. The insertion and the sub-chondral bone were analyzed. There’s the last but not least study!(article 6). I was really interested in supraspinatus muscle and tendon and I want to follow the course of the muscle as the zone of conflict. I was the subject of study in life as I went through RMI . The muscle was reconstructed as finite element. Then it was possible to describe the zone of conflict with the supraspinatus. Here’s the seventh article. (article 7

Pièges en orthopédie ambulatoire: rachis (3)

Spine is always a great deal in tramatology. Complete clinical exam associated to plain Xray is the best challenge. CT-scan is preferred when there is osteoarthritis. IRM is used to check ligaments ("coup du lapin") or for medullar contusion

Pièges en orthopédie ambulatoire : le membre inférieur (2)

The lower limb is the seat of many traumatic lesions especially the foot and ankle. To misdiagnose these injuries leads to pain, instability, early arthritis and poor results. Clinical examination is very important and also standard X rays. New imaging techniques such as MRI will help to delineate some difficult to see lesions such as Lisfranc's fracture-dislocations, osteochondral lesions or occult hip fractures

Pièges en orthopédie ambulatoire: le membre supérieur

Trauma to the upper extremity presents difficulties in diagnosis because of the complexity of the anatomy and of the structures involved. These injuries are common, representing more that 45% of all injuries coming to a walk-in emergency center. Commonly missed or misdiagnosed injuries are listed below with clinical examples. Posterior dislocation of the shoulder or perilunar dislocations of the carpus are still commonly missed today in spite of ample information in all medically oriented media. This series of articles is tended to warn emergency room practitioners of the these traps for the unwary

Arterial supply of the glenoid: an anatomic study

Surgery is performed on the glenoid for a variety of pathologic conditions, and an adequate blood supply is required to achieve good healing of soft tissue and bone. The objective of this investigation was to study the arterial supply of the glenoid in 24 fresh human cadaveric specimens. The vascular supply originates from branches of the anterior and posterior circumflex arteries and the suprascapular artery and branches directly from the infraspinatus and teres minor muscles. The antero-superior portion of the glenoid is poorly vascularized, with a specific area that is completely devoid of blood supply. In addition, circumferentially around the glenoid rim, there is an area of approximately 5 mm from the edge that is completely devoid of vascularity. Adequate bone and soft-tissue healing in the glenoid, particularly in its anterosuperior portion, after fracture repair, osteotomy, total shoulder arthroplasty, and capsular procedures may be compromised by the demonstrated hypovascularity

Unstable pelvic ring injury with hemodynamic instability: what seems the best procedure choice and sequence in the initial management?

Most fatalities related to pelvic ring injuries occur early and are caused by massive retroperitoneal bleeding. The objective of our study is to determine the optimal sequence of surgical procedures to restore hemodynamic stability in patients with unstable pelvic ring injuries

Morbidity associated with isolated iliac wing fractures

BACKGROUND: Iliac wing fractures have received little attention in the literature. Commonly occurring after a direct blow, they are rotationally and vertically stable. However, one must be aware of their potential for major morbidity including soft tissue, abdominal organ, and vascular lesions. This study examines the incidence, radiographic findings, soft tissue injuries, and complications associated with isolated iliac wing fractures. METHODS: Retrospective review between 2003 and 2006 of a consecutive series of 450 polytraumatized patients treated in a level-1 University trauma center. Hospital charts and radiographs were reviewed and all patients with an isolated iliac wing fracture were requested to return for a clinical and radiologic examination. RESULTS: One hundred twenty patients had major pelvic trauma. Only 10 sustained a fracture limited to the iliac wing, all after high-energy trauma. Nine of 10 patients sustained a total of 36 additional injuries involving head, thorax, spine, abdomen, urologic, and orthopedic systems. Only two patients underwent internal fixation of their fracture, one because of the fracture compressing the bowel and the other because of a very large rotated iliac wing fragment. Two patients with open fractures were treated with irrigation and debridement and no internal fixation. CONCLUSIONS: An isolated iliac wing fracture not compromising the stability of the pelvic ring may be interpreted as a benign injury. However, serious and potentially life-threatening associated injuries may be present requiring emergency abdominal, vascular, or neurologic surgery. A thorough search for such injuries is critical. Most iliac wing fractures can be managed nonoperatively

Anatomie de l'epaule (implications en chirurgie)

Cette thèse s est d abord voulue pratique. La chirurgie de l épaule est en pleine expansion avec le vieillissement croissant de la population et la pratique de plus en plus généralisée du sport. L épaule est une articulation complexe. Paradoxalement les progrès techniques en chirurgie sont sans cesse grandissants et renouvelés tandis que l on tientpour acquis des données anatomiques démontrées il y a longtemps et rapportées jusqu à nos jours. Nous avons voulu confronter l anatomie avec les techniques diagnostiques actuelles et voir si cela pouvait avoir un impact sur les pratiques chirurgicales. Nous avons également voulu voir si certaines complications chirurgicales pouvaient s expliquer par des données anatomiques. Ce qui a orienté nos recherches sont les principaux problèmes actuels en pathologie de l épaule c est-à-dire la coiffe des rotateurs et le syndrome sous-acromial. Les observations lors des nombreuses dissections de l épaule nous ont conduit à ces réflexions : comment la glène est-elle vascularisée?, pourquoi est-elle si fragile?, que se passe-t- il dans l espace sous acromial?, quelle est l utilité du ligament coraco-acromial?, quels sont ses rapports avec lesuprapinatus?, pourquoi l insertion du supraspinatus est-elle fragile et difficile à reconstituer ?, la qualité osseuse de la tête humérale a-t-elle un impact sur la géographie des fractures, les échecs des ostéosynthèses, les descellements prothétiques?, qu est ce que la chape delto-trapézoidienne? Autant de questions que nous nous sommes posées endisséquant cette articulation très complexe qui est l épaule. Par ailleurs, l anatomie classique peut maintenant secompléter non seulement de l histologie, mais aussi de techniques radiologiques modernes comme l IRM l, le microCT, le synchrotron, la reconstruction 3D, la modélisation en éléments finis.I would like to make a practical thesis. Shoulder surgery is growing and growing as the population is ageing and people is doing more and more sports activities. A lot of technical progress were done but there are still a lot of surgical complications. On the other way some very old anatomical ideas are still alive. I want to see with the actual knowledge, if some surgical complications could be explained by anatomy. Subacromial pathology and bone quality remain the two mainproblems of shoulder surgery and pathology. That s what had suggested to me this study about the shoulder. I was supposed to analyze glenoid bone first .The aim was to know more about arterial supply of glenoid. That was my firststudy (article 1). Then, I was interested in glenoid bone quality. And the second study had appeared. (article 2). During the shoulder dissection, I was looking for the fascia delto-trapezoidal which I didn t found as described in books. It was my third study. (article 3). Going on I found the coraco-acromial ligament and I was surprised to see the constant portion under the acromial process. And that gave me the idea for the fourth study. (article 4).As I had discovered the very interesting technique of micro-Ct densitometry, I would like to apply it to the humeral head bone. There was the fifth study. (article 5)But, I want to know more and more about bone quality and I went on with the greater tuberosity and especially the area ofsupraspinatus insertion. The insertion and the sub-chondral bone were analyzed. There s the last but not least study!(article 6). I was really interested in supraspinatus muscle and tendon and I want to follow the course of the muscle as the zone of conflict. I was the subject of study in life as I went through RMI . The muscle was reconstructed as finite element. Then it was possible to describe the zone of conflict with the supraspinatus. Here s the seventh article. (article 7)PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF