Service de chirurgie orthopedique

Sotteville-lès-Rouen, France

Service de chirurgie orthopedique

Sotteville-lès-Rouen, France
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Bone infection is a frequent complication of foot ulcers resulting from diabetic neuropathy. While medical or conservative surgical treatment is relatively standard practice for multi-disciplinary teams familiar with this type of pathology, the condition often remains synonymous with amputation for less experienced practitioners. Conservative treatment offers a definitive diagnosis, eradicating most of the infected tissues and avoiding the transfer of stresses which are a source of new ulcerations. The contribution of revascularisation, including distal revascularisation, and modern dressings, enable conservative treatment to be considered the rule. © 2014 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.

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.

Colin F.,Nantes University Hospital Center | Gaudot F.,Service de Chirurgie Orthopedique | Odri G.,Nantes University Hospital Center | Judet T.,Service de Chirurgie Orthopedique
Orthopaedics and Traumatology: Surgery and Research | Year: 2014

Introduction: Supramalleolar osteotomy is an alternative surgical procedure for the management of asymmetric early arthritis of the ankle. The main goal of this retrospective study was to evaluate the clinical and radiological benefits of supramalleolar osteotomy. The secondary goal was to identify prognostic factors to help decide upon this therapeutic indication. Materials and methods: Eighty-three patients, mean age 45. years old (17-79), presenting with post-traumatic asymmetric early arthritis of the ankle were followed up for a mean 3.5. years (1-14. years). Sixty-two patients presented with a varus deformity (mean: 13°), and 21 with a valgus deformity (mean: 17.5°). The presence of a preoperative clinical 'sidewalk sign' was looked for and it was considered positive if pain improved when the patient walked on a surface slope that was tilted in the opposite direction of their deformity. A functional preoperative evaluation and at the final follow-up were performed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale. The frontal deformity was measured by the Meary angle on a weight-bearing X-ray. Varus deformities were treated by a lateral closing wedge supramalleolar osteotomy or a medial opening wedge supramalleolar osteotomy. Valgus deformities were treated by a lateral opening wedge or a medial closing wedge supramalleolar osteotomy. Results: At last follow-up, the mechanical axis in the varus group was 1.3° and 7.5° in the valgus group. The AOFAS score significantly improved (P< 0.001) by 15 points in patients with a varus deformity and 13 points in patients with a valgus deformity. A positive sidewalk sign (disappearance of pain) was correlated with a good outcome and had a positive predictive value of 0.88 (CI: 0.77-0.95) (P< 0.001). Discussion: The supramalleolar osteotomy is a conservative therapeutic surgical option for the management of arthritis of the ankle associated with varus or valgus deformities. The results are satisfactory for indications of arthritis with varus and valgus deformities and a positive 'sidewalk' sign (pain relief on a slope surface tilted in the opposite direction of the deformity). Level of evidence: Level IV: retrospective case series. © 2014 Elsevier Masson SAS.

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.

Argenson J.-N.A.,Service de Chirurgie Orthopedique | Parratte S.,Service de Chirurgie Orthopedique | Ashour A.,Service de Chirurgie Orthopedique | Saintmard B.,Service de Chirurgie Orthopedique | Aubaniac J.-M.,Service de Chirurgie Orthopedique
Journal of Bone and Joint Surgery - Series A | Year: 2012

Background: Durable, long-term results have been reported for patients managed with first-generation mobile-bearing total knee arthroplasty. Second-generation mobile-bearing total knee arthroplasty has been introduced to enhance instrumentation, to increase flexion, and to improve functional outcome, but, to our knowledge, no long-term results are available. Methods: From May 1999 to June 2000, 116 consecutive rotating-platform total knee arthroplasties were performed by the two senior authors in 112 patients with use of the LPS-Flex Mobile cemented prosthesis, which was implanted with a measured resection technique. The patella was resurfaced in every knee. The average age of the patients at the time of surgery was sixty-nine years (range, thirty-seven to eighty-five years), and seventy-seven patients (eighty knees) were women. The predominant diagnosis was osteoarthritis. The clinical and radiographic evaluation was performed with use of the Knee Society rating system. The level of activity and patient-reported functional outcome were evaluated with use of the University of California at Los Angeles (UCLA) score and the Knee injury and Osteoarthritis Outcome Score (KOOS), respectively. Results: The average duration of follow-up was 10.6 years (range, ten to 11.8 years). Three patients were lost to followup, and five patients died of causes unrelated to knee arthroplasty. Two knees were revised, one because of infection and one because of failure of the medial collateral ligament. Kaplan-Meier survivorship analysis showed an implant survival rate of 98.3% at ten years. For the 104 patients (108 knees) who were evaluated at a minimum of ten years, the average Knee Society knee and function scores improved from 34 to 94 points and from 55 to 88 points, respectively, at the time of the latest follow-up. There was no periprosthetic osteolysis and no evidence of implant loosening on follow-up radiographs. The average knee flexion was 117° preoperatively and 128° at the time of the latest follow-up evaluation. At the time of the latest follow-up, the KOOS quality-of-life score was significantly better for patients with >125° of flexion (p = 0.00034). Conclusions: This study demonstrated durable clinical and radiographic results at a minimum of ten years after total knee replacement with a second-generation, cemented, rotating-platform, posterior-stabilized total knee prosthesis. According to the functional outcome results obtained in this study, we believe that this design is a valuable option for active patients undergoing total knee arthroplasty. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2012 by The Journal of Bone and Joint Surgery, Incorporated.

Argenson J.-N.A.,Service de Chirurgie Orthopedique | Blanc G.,Service de Chirurgie Orthopedique | Aubaniac J.-M.,Service de Chirurgie Orthopedique | Parratte S.,Service de Chirurgie Orthopedique
Journal of Bone and Joint Surgery - Series A | Year: 2013

We previously evaluated the three to ten-year results of 160 consecutive unicompartmental knee arthroplasties that had been performed by two surgeons in 147 patients with use of the cemented metal-backed Miller-Galante prosthesis. The average age of the patients at the time of the index procedure was sixty-six years. The purpose of thepresent study was to report the updated results of this series after a mean duration of follow-up of twenty years. Sixty-two patients (seventy knees) were living, and seven had been lost to follow-up. Eleven knees had undergone conversion tototal knee arthroplasty, three had had an addition of a patellofemoral prosthesis, and five had had polyethylene exchange.Ten knees had had revision since the three to ten-year evaluation. The reasons for revision included progression of osteoarthritis in twelve knees, aseptic loosening (which had been absent at the three to ten-year evaluation) in two knees,and polyethylene wear (which was treated with liner exchange at an average of twelve years) in five knees. The average clinical and functional Knee Society scores were 91 and 88 points, respectively, at the time of the latest follow-up. The average flexion was 127° (range, 80° to 145°). We concluded that modern cemented metal-backed unicompartmental implants, evaluated at a mean of twenty years of follow-up in patients with osteoarthritis that was limited to one tibiofemoral compartment of the knee, provided durable pain relief and long-term restoration of knee function without compromising future conversion to conventional total knee arthroplasty. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright ©2013 by the journal of bone and joint surgery, incorporated.

Jubert P.,Service de chirurgie orthopedique | Lonjon G.,Service de chirurgie orthopedique | Garreau de Loubresse C.,Service de chirurgie orthopedique
Orthopaedics and Traumatology: Surgery and Research | Year: 2013

The frequency of cervical spine trauma in elderly patients is increasing with most injuries occurring in the upper cervical spine. These fractures are associated with a risk of sometimes life-threatening complications, although very few studies have specifically analyzed this. The goal of this study was to identify the incidence of complications in the literature (mortality and morbidity) following upper cervical spine trauma in elderly patients. Methods: A systematic search was performed on the MEDLINE database without limiting the search by language or date to identify all studies reporting the rate of complications after upper cervical spine trauma in patients over the age of 60. Results: Twenty-four observational studies were included, four were comparative. These studies included a total of 857patients, mean age 76. Nearly all traumas were odontoid process fractures, and most were treated surgically (57%). The median mortality rate was 9.2% (Q1-Q3: 2.5-19.6) and the median rate of short-term complications was 15.4% (Q1-Q3: 5.8-26.9). The main late stage complication was nonunion, which developed in a mean 10 to 12% depending on the type of treatment. Conclusion: Complications following cervical spine trauma are frequent in elderly patients whatever the type of treatment. Knowledge of the rate of complications in the literature and the potential risk factors is essential for the clinician to improve the information provided to patients and to prevent complications. Type of Study: Systematic review of the literature. Level of evidence IV. © 2013 Elsevier Masson SAS.

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.

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.

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