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Baulot E.,Service de chirurgie orthopedique et traumatologique | Sirveaux F.,Clinique de Traumatologie et dOrthopedie | Boileau P.,Service de chirurgie orthopedique
Clinical Orthopaedics and Related Research | Year: 2011

Background The increased use of the reverse prosthesis over the last 10 years is due to a large series of publications using the reverse prosthesis developed by Paul Grammont. However, there is no article reporting the story of the concepts developed by Grammont. Questions/purposes The purposes of this review are to describe the principles developed by Grammont, the chronology of development, and the biomechanical concepts and studies that led to the current design of the reverse prosthesis. Methods We selectively reviewed literature and provide personal observations. Results From phylogenetic observations, Grammont developed the principle of functional surgery applied to the rotator cuff tears. To increase the deltoid lever arm, he imagined two possibilities: the lateralization of the acromion, which facilitates the action of the rotator cuff, and the medialization of the center of rotation, which has been developed to respond to situations of rotator cuff deficiency. Grammont proposed the use of an acromiohumeral prosthesis, which was quickly abandoned due to problems of acromial loosening. Finally, Grammont used the principle of reverse prosthesis developed in the 1970s, but made a major change by medializing the center of rotation in a nonanatomic location. In 1985, Grammont validated the concept by an experimental study and the first model using a cemented sphere was implanted. Conclusions The development of the modern reverse prosthesis is the result of the intellectual and experimental work conducted by Grammont and his team for 20 years. Knowledge of this history is essential to envision future developments. © 2011 The Association of Bone and Joint Surgeons.

Versier G.,Service de chirurgie orthopedique | Dubrana F.,Brest University Hospital Center
Orthopaedics and Traumatology: Surgery and Research | Year: 2011

Treatment of knee cartilage defect, a true challenge, should not only reconstruct hyaline cartilage on a long-term basis, but also be able to prevent osteoarthritis. Osteochondral knee lesions occur in either traumatic lesions or in osteochondritis dissecans (OCD). These lesions can involve all the articular surfaces of the knee in its three compartments. In principle, this review article covers symptomatic ICRS grade C or D lesions, depth III and IV, excluding management of superficial lesions, asymptomatic lesions that are often discovered unexpectedly, and kissing lesions, which arise prior to or during osteoarthritis. For clarity sake, the international classifications used are reviewed, for both functional assessment (ICRS and functional IKDC for osteochondral fractures, Hughston for osteochondritis) and morphological lesion evaluations (the ICRS macroscopic evaluation for fractures, the Bedouelle or SOFCOT for osteochondritis, and MOCART for MRI). The therapeutic armamentarium to treat these lesions is vast, but accessibility varies greatly depending on the country and the legislation in effect. Many comparative studies have been conducted, but they are rarely of high scientific quality; the center effect is nearly constant because patients are often referred to certain centers for an expert opinion. The indications defined herein use algorithms that take into account the size of the cartilage defect and the patient's functional needs for cases of fracture and the vitality, stability, and size of the fragment for cases of osteochondritis dissecans. Fractures measuring less than 2cm 2 are treated with either microfracturing or mosaic osteochondral grafting, between 2 and 4cm 2 with microfractures covered with a membrane or a culture of second- or third-generation chondrocytes, and beyond this size, giant lesions are subject to an exceptional allografting procedure, harvesting from the posterior condyle, or chondrocyte culture on a 3D matrix to restore volume. Cases of stable osteochondritis dissecans with closed articular cartilage can be simply monitored or treated with perforation in cases of questionable vitality. Cases of open joint cartilage are treated with a PLUS fixation if their vitality is preserved; if not, they are treated comparably to osteochondral fractures, with the type of filling depending on the defect size. © 2011 Elsevier Masson SAS.

Cognet J.M.,SOS mains Champagne Ardenne | Levadoux M.,Service de chirurgie orthopedique | Martinache X.,SOS mains Champagne Ardenne
Journal of Hand Surgery: European Volume | Year: 2011

Seven patients with chronic scapholunate instability (Geissler grade 2-4) were treated by percutaneous placement of screws across the scapholunate joint after arthroscopic debridement of the remnants of the scapholunate ligament. In all seven cases, the screw caused partial destruction of the lunate and/or scaphoid requiring screw removal within 6 months. We no longer perform this procedure. © The Author(s) 2011.

Garreau de Loubresse C.,Service de chirurgie orthopedique
Orthopaedics and Traumatology: Surgery and Research | Year: 2014

Spinal surgery is a high-risk specialty with an ever-increasing patient volume. Results are very largely favorable, but neurologic damage, the most severe complication, may leave major sequelae, some of which can be life-threatening. Neurologic complications may be classified according to onset (per- vs. postoperative) and surgical site (cervical vs. thoracolumbar). The present paper provides quantitative data for the risks involved. Knowledge of these complications and their risk of onset is the best means of guiding prevention strategies. The spine surgeon is part of a multidisciplinary team, with the radiologist and electrophysiologist, which is able to identify risk factors preoperatively and diagnose neurologic complications per- or postoperatively. © 2014.

Allington N.J.,Service de chirurgie orthopedique
Journal of Pediatric Orthopaedics | Year: 2015

BACKGROUND:: Management of developmental dysplasia of the hip (DDH) with a Pavlik harness is a well-known treatment.Follow-up until skeletal maturity is recommended as long-term studies mention late sequelae.The purpose of this study was to determine whether such a follow-up is necessary in patients treated successfully under a strict protocol. METHODS:: A retrospective review of a consecutive series of normal infants treated for DDH between January 1995 and July 2004 was undertaken.Only normal infants with frankly pathologic hips treated successfully with a Pavlik harness were included, and with a normal anteroposterior (AP) pelvis x-ray at the age of 2 years.All infants with any type of neurological disease, syndrome, other form of treatment for DDH, and failure of the Pavlik harness were excluded.At the last follow-up, a clinical examination and a standing AP pelvis x-ray were performed. RESULTS:: A total of 109 hips in 83 children were available for review. The mean follow-up was of 10 years and 2 months. All 109 hips had a normal clinical examination and a normal AP pelvis x-ray: a mean center-edge angle (CEA) of 29.5 degrees, SD±4.1 degrees, a mean acetabular index (AI) of 1457±3.74 degrees, a mean Sharp’s angle of 41.92±3.42 degrees, a Seringe-Severin score of IA, a normal teardrop figure, no signs of avascular necrosis, and Moses circles <2. CONCLUSION:: This study strongly suggests that in a selected group of patients treated for DDH with a Pavlik harness, under a strict protocol, and a normal x-ray at 2 years of age, a long-term follow-up is not necessary. LEVEL OF EVIDENCE:: Level III—therapeutic. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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