Orthop Traumatol Sur
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Orthop Traumatol Sur · May 2011
Comparative StudyIs patella eversion during total knee arthroplasty crucial for gap adjustment and soft-tissue balancing?
Assessment of soft-tissue balance by the gap technique in Total Knee Arthroplasty (TKA) impacts femoral component rotation positioning. Proper femoral component rotation is a critical factor in TKA, both for adequate patellar tracking and in achieving a symmetrical flexion gap. Soft tissue balance assessment and gap measurements are performed at 90° flexion and with the patella everted in conventional TKA; during MIS-TKA, this step is performed with the patella in situ. We therefore investigated intraoperative joint gap parameters at 90° flexion with and without patellar eversion during conventional TKA, so as to better understand the influence of this intraoperative patellar position factor on final ligament balance. ⋯ The flexion gap inclination obtained without patellar eversion was steeper than with patellar eversion. This induced more externally rotated femoral positioning in absence of patellar eversion. These results ought to be taken into account by surgeons considering switching from conventional to MIS-TKA.
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Orthop Traumatol Sur · May 2011
Comparative StudyPain after shoulder arthroscopy: a prospective study on 231 cases.
Shoulder arthroscopy is reputed to be painful, but progression of postoperative pain after this type of surgery has never been described and analyzed. This study had a triple objective: the description, search for risk factors, and analysis of the long-term impact of postoperative pain. ⋯ Pain after shoulder arthroscopy is relatively low and the efficacy of the intervention is long-lasting in terms of pain symptom. A pain bounce appears on D1, which must be taken into account, notably in the context of outpatient surgery. The use of local anesthesia is therefore advantageous. Despite the efficacy of postoperative pain relief protocols, their effect on longer term perspective was not demonstrated.
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Atlanto-occipital dislocation is a devastating ligamentous injury that most often turns fatal. However, because of on-site resuscitation improvements, the emergency teams are increasingly dealing with this condition. We report a rare case of atlanto-occipital dislocation (AOD) in a surviving patient with more than one-year follow-up. ⋯ Surgical treatment should be combined with cardiorespiratory management. The emergency teams should get familiar with this injury since they will be increasingly confronted to it. Early recognition and standard appropriate management is essential to avoid delayed treatment and complications.
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Orthop Traumatol Sur · May 2011
Case ReportsCranial nerves neuropraxia after shoulder arthroscopy in beach chair position.
We report a case of neuropraxia of the 9th, 10th and 12th cranial nerve pairs after arthroscopic rotator cuff repair in the beach chair position. The elements in the medical file seem to exclude an intracranial cause of the lesions and support a mechanical, extracranial cause due to intubation and/or the beach chair position. This clinical case report shows the neurological risks of the beach chair position during arthroscopic shoulder surgery and presents the essential safety measures to prevent these risks.
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Orthop Traumatol Sur · May 2011
Proximal clavicle physeal fracture-separation mimicking an anterior sterno-clavicular dislocation.
Proximal physeal fracture-separation of the clavicle is a very rare injury occurring in the adolescent and in the young adult which involves a contact loss with fracture between the clavicle and its cartilaginous ossification center similar in appearance to a sternoclavicular dislocation. The authors report an unusual case of a proximal physeal fracture-separation of the clavicle with avulsion of sternoclavicular periosteal and ligamentous structures without vasculonervous injury in a 16-year-old young person. ⋯ Surgical management consisted in costoclavicular ligament and periosteum reattachment associated with reduction of the fracture-separation and pin fixation. This repair demonstrated a successful outcome at 8-month follow-up.