Intérêt de l'utilisation d'un dispositif d'optimisation de la longueur et de l'offset lors de la pose d'une prothèse totale de hanche

Le succès d une prothèse de hanche impose le bon positionnement des implants et la restauration de longueur du membre et d offset fémoral. Nous rapportons une série prospective de 58 patients opérés d une prothèse totale de hanche non cimentée à cône modulaire, par voie postéro externe, pour coxarthrose. Trente deux patients ont été opérés en utilisant un Dispositif d Optimisation de la Longueur et de l Offset (DOLO) fixé sur le bassin, et vingt six sans. L inégalité de longueur moyenne post opératoire était de 2.20 mm chez les patients opérés avec le DOLO contre 6.89 mm sans (p=O. La modification de l offset était de 6.60 mm avec le DOLO contre 10.24 mm sans (p0.005). Le DOLO permet un contrôle satisfaisant de la longueur des membres et de l offset. Elle confirme les données de la littérature. Les points clés sont le respect de la position du membre lors des mesures et la fixation de l ancillaire au plus près du cotyle et dans l axe du fémur pour limiter les biais de mesures.The success of hip arthroplasty requires the good positioning of implants and the restoration of limb length and femoral offset.We report a prospective series of 58 patients who underwent a total hip replacement for osteoarthritis with uncemented prosthesis and modular taper, by poster lateral approach. Thirty-two patients were operated using a Device for the Optimization of the Length of the Offset (DOLO) attached to the pelvis, and twenty six without. The average leg length ineguality after surgery was 2.20 mm in patients operated with the DOLO versus 6.89 mm without (p = 0.00 13). Modification of the offset was 6.60 mm with DOLO versus 10.24 mm without (p = 0.005). The DOLO allows adequate control of limb length and offset. It confirms the literature data. The key point are the respect of the position of the limb during measurement and the positioning of the ancillary doser to the acetabulum and in axis ofthe femoral shaft to limit errors.PARIS13-BU Serge Lebovici (930082101) / SudocPARIS-Bib. Serv.Santé Armées (751055204) / SudocSudocFranceF

Greffes ostéo-chondrales autologues en MOSAICPLASTY:application aux lésions du dôme de l'astragale avec ostéotomie malléolaire(à propos de 36 cas revus avec un recul de 6 mois à 4 ans)

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Could the orthopaedic surgeon deployed in austere setting perform flaps on the leg?

The orthopaedic military surgeons deployed in operations are led to perform soft tissue coverage on the lower limb. The purpose of this study was to evaluate if flaps performed by surgeons’ non-specialist in reconstructive surgery are associated with good outcome. All patients operated for a flap on the leg in French Forward Surgical Team deployed in theatre of operations between 2003 and 2013 were retrospectively reviewed. Forty-nine patients were included, for a total of 54 flaps’ procedures.  Indications were open fractures in 25 cases and osseous infections in 29 cases. No flap was performed on French soldiers. All the flaps were pedicle. Outcome was favourable for more than 90% of flaps with no statistical difference between muscular and fasciocutaneous flap and with regard to the indication. In conclusion, an orthopaedic surgeon deployed in austere setting with significant good outcome can perform reconstructive surgery with legs’ flaps

Wartime paediatric extremity injuries: experience from the Kabul International Airport Combat support hospital

Since the beginning of Operation Enduring Freedom, management of Afghan military or civilian casualties including children is a priority of the battlefield medical support. The aim of this study is to describe the features of paediatric wartime extremities injuries and to analyse their management in the Kabul International Airport Combat Support Hospital. A retrospective review was carried out using the French surgical database OPEX (Service de Santé des Armées) from June 2009 to January 2013. Paediatric patients were defined as those younger than 16 years old. Of the 220 injured children operated on, 155 (70%) sustained an extremity injury and were included. The mean age of the children was 9.1 ± 3.8 years. Among these children, 77 sustained combat-related injuries (CRIs) and 78 sustained noncombat-related injuries (NCRIs), with a total of 212 extremities injuries analysed. All CRIs were open injuries, whereas NCRIs were dominated by blunt injuries. Multiple extremities injuries and associated injuries were significantly more frequent in children with CRIs, whose median Injury Severity Score was higher than those with NCRIs. Debridement and irrigation was significantly predominant in the CRIs group, as well as internal fracture fixation in the NCRIs group. There were four deaths, yielding a global mortality rate of 2.6%. This study is the first to analyse specifically paediatric extremities trauma and their management at level 3 of battlefield medical facilities in recent conflicts. Except for severe burns and polytrauma, treatment of paediatric extremities injuries can be readily performed in Combat Support Hospitals by orthopaedic surgeons trained in paediatric trauma

Bicruciate ligament lesions and dislocation of the knee: Mechanisms and classification

Knowledge of the mechanisms of bicruciate lesions and dislocation of the knee enables analysis and classification in terms of injuries’ location and type, guiding surgery and facilitating assessment. Careful history taking and clinical examination shed light on the mechanism involved, but exact identification of the lesion further requires examination under anesthesia and static and dynamic X-rays and MRI, which together enable precise determination of lesion type and location. There are two types of mechanism: gaping, causing ligament tear; and translation, causing detachment. When a single mechanism is involved, the lesion is said to be “simple”. Simple gaping causes bicruciate lesions without medial, lateral or posterior dislocation. Simple translation causes pure anterior or posterior dislocation. Gaping and translation may also occur in combination, causing dislocation with peripheral tearing. There are two types of classification: descriptive, based on X-ray findings – i.e., static classification; and physiopathological, based on clinical and dynamic X-ray findings. MRI further explores ligament detachment and bone lesions that are inaccessible to clinical and conventional X-ray examination. Physiopathological assessment-based techniques enable surgical procedure to be refined, defining the surgical approach according to lesion location and differentiating between lesions requiring repair (tears) and those with a good likelihood of spontaneous healing (capsuloperiosteal detachment). The classification advocated here is largely inspired by that of Neyret and Rongieras, extended to include dislocation with single bicruciate ligament lesion. It covers peripheral lesions completely, specifying type (tear or detachment) and including all bicruciate lesions as well as dislocations