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Bauer T.,Hopitaux Universitaires Paris Ile Of France Ouest
Orthopaedics and Traumatology: Surgery and Research | Year: 2014

Percutaneous methods can be used to perform many surgical procedures on the soft tissues and bones of the forefoot, thereby providing treatment options for all the disorders and deformities seen at this site. Theoretical advantages of percutaneous surgery include lower morbidity rates and faster recovery with immediate weight bearing. Disadvantages are the requirement for specific equipment, specific requirements for post-operative management, and lengthy learning curve. At present, percutaneous hallux valgus correction is mainly achieved with chevron osteotomy of the first metatarsal, for which internal fixation and a minimally invasive approach (2. cm incision) seem reliable and reproducible. This procedure is currently the focus of research and evaluation. Percutaneous surgery for hallux rigidus is simple and provides similar outcomes to those of open surgery. Lateral metatarsal malalignment and toe deformities are good indications for percutaneous treatment, which produces results similar to those of conventional surgery with lower morbidity rates. Finally, fifth ray abnormalities are currently the ideal indication for percutaneous surgery, given the simplicity of the procedure and post-operative course, high reliability, and very low rate of iatrogenic complications. The most commonly performed percutaneous techniques are described herein, with their current indications, main outcomes, and recent developments. © 2013 Elsevier Masson SAS. Source

Merle C.S.,London School of Hygiene and Tropical Medicine | Fielding K.,London School of Hygiene and Tropical Medicine | Sow O.B.,Service de pneumo phtisiologie | Gninafon M.,Center National Hospitalier Of Pneumophtisiologie | And 15 more authors.
New England Journal of Medicine | Year: 2014

Methods We conducted a noninferiority, randomized, open-label, controlled trial involving patients 18 to 65 years of age with smear-positive, rifampin-sensitive, newly diagnosed pulmonary tuberculosis in five sub-Saharan African countries. A standard 6-month regimen that included ethambutol during the 2-month intensive phase was compared with a 4-month regimen in which gatifloxacin (400 mg per day) was substituted for ethambutol during the intensive phase and was continued, along with rifampin and isoniazid, during the continuation phase. The primary efficacy end point was an unfavorable outcome (treatment failure, recurrence, or death or study dropout during treatment) measured 24 months after the end of treatment, with a noninferiority margin of 6 percentage points, adjusted for country.Results A total of 1836 patients were assigned to the 4-month regimen (experimental group) or the standard regimen (control group). Baseline characteristics were well balanced between the groups. At 24 months after the end of treatment, the adjusted difference in the risk of an unfavorable outcome (experimental group [21.0%] minus control group [17.2%]) in the modified intention-to-treat population (1356 patients) was 3.5 percentage points (95% confidence interval, -0.7 to 7.7). There was heterogeneity across countries (P = 0.02 for interaction, with differences in the rate of an unfavorable outcome ranging from -5.4 percentage points in Guinea to 12.3 percentage points in Senegal) and in baseline cavitary status (P = 0.04 for interaction) and body-mass index (P = 0.10 for interaction). The standard regimen, as compared with the 4-month regimen, was associated with a higher dropout rate during treatment (5.0% vs. 2.7%) and more treatment failures (2.4% vs. 1.7%) but fewer recurrences (7.1% vs. 14.6%). There was no evidence of increased risks of prolongation of the QT interval or dysglycemia with the 4-month regimen.Conclusions Noninferiority of the 4-month regimen to the standard regimen with respect to the primary efficacy end point was not shown. (Funded by the Special Program for Research and Training in Tropical Diseases and others; ClinicalTrials.gov number, NCT00216385.).Background Shortening the course of treatment for tuberculosis would be a major improvement for case management and disease control. This phase 3 trial assessed the efficacy and safety of a 4-month gatifloxacin-containing regimen for treating rifampinsensitive pulmonary tuberculosis. Copyright © 2014 Massachusetts Medical Society. All rights reserved. Source

Sommaire C.,CCOM UF 9406 | Penz C.,CCOM UF 9406 | Clavert P.,CCOM UF 9406 | Klouche S.,Hopitaux Universitaires Paris Ile Of France Ouest | And 3 more authors.
Orthopaedics and Traumatology: Surgery and Research | Year: 2012

Introduction: Bone defects in the humeral head or antero-inferior edge of the glenoid cavity increase recurrence risk following arthroscopic Bankart repair. The present study sought to quantify such preoperative defects using a simple radiological technique and to determine a threshold for elevated risk of recurrence. Materials and methods: A retrospective study conducted in two centers enrolled patients undergoing primary arthroscopic Bankart repair for isolated anterior shoulder instability in 2005. The principle assessment criterion was revision for recurrent instability. Quantitative radiology comprised: the ratio of notch depth to humeral head radius (D/R) on AP view in internal rotation; Gerber's X ratio between antero-inferior glenoid cavity edge defect length and maximum anteroposterior glenoid cavity diameter on arthro-CT scan; and the D1/D2 ratio between the glenoid joint surface diameters of the pathologic (D1) and healthy (D2) shoulders on Bernageau glenoid profile views. Seventy-seven patients were included, with a mean follow-up of 44 months (range, 36-54). Results: Overall recurrence rate was 15.6%. Recurrence risk was significantly greater when the humeral notch length was more or equal to 20% of the humeral head diameter and the Gerber ratio more or equal to 40%. On Bernageau views, mean D1/D2 ratio was 4.2% (range, 0-23%) in patients without recurrence, versus 5.1% (range, 0-19) in those with recurrence (P=0.003). Discussion: Beyond the above thresholds, bone defect as such contraindicates isolated arthroscopic stabilization. The D/R and Gerber ratios are simple and reproducible quantitative measurements can be taken in routine practice, enabling preoperative planning of complementary bone surgery as needed. Level of evidence: Level IV; retrospective cohort study. © 2012 Elsevier Masson SAS. Source

Pansard E.,Center for Sport Medicine and Orthopaedic Surgery | Klouche S.,Hopitaux Universitaires Paris Ile Of France Ouest | Vardi G.,Center for Sport Medicine and Orthopaedic Surgery | Greeff E.,Center for Sport Medicine and Orthopaedic Surgery | And 2 more authors.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association | Year: 2015

PURPOSE: To assess the ability of 2 independent surgical techniques, an inside-out technique and an outside-in technique, using bony landmarks on the femoral wall, to place the anterior cruciate ligament graft anatomically.METHODS: A retrospective single-center study was conducted in 2012 and included patients who underwent anterior cruciate ligament reconstruction. Two techniques were used: The lateral condylar wall was visualized from the anterolateral portal and tunnels were drilled "outside-in" in one group, whereas viewing was performed from the anteromedial portal and retrograde drilling ("inside-out") was performed in the other group. The primary outcome measure was the placement of the tunnel center point on postoperative computed tomography scans with 3-dimensional reconstruction, according to the radiographic quadrant method of Bernard and Hertel. The measurements were compared with optimal placements according to Bird et al. Their reliability was assessed with Spearman (rho) and intraclass correlation coefficients.RESULTS: Forty patients were included, with 20 in each group; the mean age was 29.8 ± 9.6 years, and there were 33 men and 7 women. The interobserver reliability and intraobserver reliability of measurements were good, with a Spearman ρ between 0.46 (P = .002) and 0.93 (P < .001) and an intraclass correlation coefficient between 0.44 (P = .001) and 0.86 (P < .001). The femoral tunnel positions of both techniques were close to the previously published anatomic placements, but there was a significant difference between our results and the theoretical position in proximal-distal measurements (P = .01). There was no difference in the anteroposterior measurements. There was no statistical difference in the accuracy of placement of the femoral tunnel center point between these 2 independent techniques.CONCLUSIONS: The direct arthroscopic visualization of bony landmarks seems sufficient for accurate positioning of the femoral tunnel whatever the drilling technique. This finding is clinically relevant because the routine use of direct measurement techniques or intraoperative radiographs may not be necessary to obtain anatomic tunnel placement.LEVEL OF EVIDENCE: Level IV, case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved. Source

Cournapeau J.,Hopitaux Universitaires Paris Ile Of France Ouest | Klouche S.,Hopitaux Universitaires Paris Ile Of France Ouest | Hardy P.,Hopitaux Universitaires Paris Ile Of France Ouest | Hardy P.,University of Versailles
Orthopaedics and Traumatology: Surgery and Research | Year: 2013

Introduction: In France, approximately 36,000 anterior cruciate ligament (ACL) reconstruction surgical procedures are performed every year. Technical progress, in particular arthroscopy, has made surgery more precise, but more expensive. In a context of healthcare cost containment, the increase in the cost of technology must be compared to the improved outcome for the patients. The main aim of this study was to determine all material costs related to ACL reconstruction using hamstring tendons. This study also compared the material costs between the two arthroscopic techniques: standard or "all-inside". Materials and methods: A retrospective study of material costs was performed in 2011. With the standard technique, the tibial tunnel was drilled from outside to inside, while with the all-inside technique two tunnels were drilled from inside to outside. All of the material used from the first swab to the final bandage was reported. It was classified into three categories: reusable arthroscopy material, disposable arthroscopic material, and disposable surgical supplies. The costs were those of our supplier in 2011 (Arthrex™) and based on Public Hospitals of Paris (AP-HP) public contract tariffs. Results: Standard ligament reconstruction was less expensive than the all-inside technique: 791.59. € versus 931.06. € excluding taxes (hors taxes [HT]), respectively. The largest percentage of expenses was allocated to disposable material use (81 and 84%). Discussion: Possible avenues of savings are limited: all the material used was necessary. To control costs, correct use and good maintenance of instruments are the most important elements. Level of evidence: Level IV. Economic and decision analyses, retrospective study. © 2013 Elsevier Masson SAS. Source

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