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Saint-Antoine-de-Breuilh, France

Bernard de Dompsure R.,Nice Teaching Hospital Center | Peter R.,Geneva Academic Hospitals | Hoffmeyer P.,Geneva Academic Hospitals
Orthopaedics and Traumatology: Surgery and Research | Year: 2010

Introduction: Controversy continues around selecting the best strategy for managing nonunions of the humeral diaphysis. The objective of this retrospective study was to analyse the results of management of this complication using a uniform surgical technique. Hypothesis: The rate of union obtained in the present series is comparable to the results reported in the literature. Patients and methods: Twenty-one patients were surgically treated at the Geneva University Hospital for nonunion of the humeral diaphysis between 1995 and 2005 with a mean follow-up of 50 months. Open reduction and internal fixation in compression using plates and screws with autologous bone graft enhancement was used. Eight cases were revisions of nonunions following a closed orthopaedic treatment and 13 cases were revisions following a failed surgical treatment. Results: All the patients obtained union within a mean 4.5 months. The functional scores for the shoulder (Constant) and the elbow (Mayo) were 77 and 97 points (mean), respectively. Two patients developed transient paresis related to radial nerve and musculocutaneous nerve injuries and one had a recurring fracture. A single patient required a second intervention for delayed union. Discussion: Of the surgical techniques for managing nonunion of the humerus, plate osteosynthesis is the most widely used. This simultaneously allows anatomic reduction, fracture compression, and osteogenesis stimulation. However, it can lead to infectious complications (although absent in our series) and neurological complications (10% transitory paresis in our patients). We report 95% rapid union in our series. Other techniques such as intramedullary nailing and external fixation do not provide equivalent results, and this is in agreement with the data found in the literature. We therefore recommend using compression plate fixation associated with autologous bone graft for the treatment of established nonunion of the humeral shaft. Level of evidence: Level IV. Retrospective study. © 2010 Elsevier Masson SAS. All rights reserved. Source

Roux A.,Nice Teaching Hospital Center | Decroocq L.,Nice Teaching Hospital Center | El Batti S.,Nice Teaching Hospital Center | Bonnevialle N.,Toulouse Teaching Hospital Center | And 4 more authors.
Orthopaedics and Traumatology: Surgery and Research | Year: 2012

Proximal humerus fractures (PHF) are osteoporotic fractures that affect women over 70 years of age. Like fractures of the femoral neck they have become a public health concern. As the population ages there is an increase in the number of people in poor general condition with an increased risk of falls on fragile bones. The incidence of these fractures has increased by 15% per year. All patients managed for PHF in our center in the past year were included in this prospective study (prospective cohort study; level 2). Three hundred and twenty-five patients were included with 329 fractures. There was a ratio of two women to one man. At the final follow-up 50 patients had died (15%) and 25 patients were lost to follow-up. The mean age was 70 years old. There were two types of risk factors. The first was fragile bones, and the second was patient specific risk of falls. The severity of the fracture increased with the age of the population. In the study by Charles S. Neer in 1970, 85% of PHF were not or were only slightly displaced, while this category percentage was only 42% in our study. Hospitalization was necessary in 43% of the cases in our study. Surgical management was necessary in 21%. This lack of relationship between the percentage of displaced fractures (58%) and the percentage of surgically treated fractures is a sign of the difficulties of managing this population, which is usually in poor general condition. © 2012 Elsevier Masson SAS. Source

Jenny J.-Y.,University of Strasbourg | Trojani C.,Nice Teaching Hospital Center | Prudhon J.-L.,MEDICEDRES | Vielpeau C.,Cote Of Nacre Teaching Hospital Center | And 6 more authors.
Orthopaedics and Traumatology: Surgery and Research | Year: 2013

Introduction: The value and risk of simultaneous total knee arthroplasty (TKA) in patients with bilateral knee arthritis is a subject of debate. Hypotheses: The risk of complications following simultaneous bilateral TKA will be increased compared to the rates published in the literature for unilateral TKA, and the clinical and functional outcomes will be poorer in this particular group. Materials and methods: One hundred and twenty-three patients who underwent simultaneous bilateral TKA between 2005 and 2011 in five specialized, high volume centers were evaluated. The files were analyzed retrospectively after a mean 33. months of follow-up. Results: The mean hospital stay was 11. days. Mean blood loss was 4.1. g/dL. A postoperative transfusion was performed in 68 patients (55%), with a mean 3.1 units of blood. The mean global IKS score increased from 90 to 150 points. Eighty patients would agree to undergo simultaneous bilateral TKA again (65%), and 70 would recommend this procedure to others (57%). Discussion: The hypothesis was not confirmed: the risk of complications was not increased compared to the generally accepted risk of a unilateral procedure. The risk of complications in this study was very similar to that published in the literature for the same therapeutic strategy. Therefore, there is no solid medical evidence to prevent recommending this strategy. The results of the participating centers suggest that this therapeutic approach should be continued in selected indications. Level of evidence: IV, retrospective study. © 2013 Elsevier Masson SAS. Source

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