Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Dec 2008
Multicenter Study Clinical TrialResults of the Evora dual-mobility socket after a minimum follow-up of five years.
Dislocation is a well-known complication of total hip arthroplasty. The risk can be reduced to one or two cases per thousand using a dual-mobility cup. The survival rate achieved with the Bousquet implant is 95% at 10 years. The complications with this implant are early mobilization and inguinal pain. An overly-large cup and insufficient primary and secondary fixation can be implicated. The design of the original implant was later modified to limit these early complications. The purpose of this study was to check the validity of these design changes. ⋯ Changing the design of the implant to modify its volume, material and primary fixation has eliminated the early mobilizations and inguinal pain described for the original Bousquet cup. These options have not had any deleterious effect on prosthesis stability. The question of long-term wear remains an important problem and requires optimization: a neck as thin as possible, optimized surfacing, elimination of laser marks, extraction leads and head skirts.
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Rev Chir Orthop Reparatrice Appar Mot · Dec 2008
Multicenter Study[Shoulder calcifying tendinitis].
Calcifying tendinitis is a frequent shoulder disease but the surgical treatment is still debatable. The authors of this symposium reviewed retrospectively 450 patients treated by arthroscopal excision for calcifying tendinitis. Imaging were used to assess the cuff status in every case. ⋯ The arthroscopic treatment obtained good results independently from the calcification location but the surgical approach should be adapted. Functional results were lower after removing a type C calcification. Acromioplasty improved the results when the calcification was associated with an aggressive acromion or a partial cuff tear.
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Rev Chir Orthop Reparatrice Appar Mot · Oct 2008
Multicenter Study Comparative Study Clinical Trial[Femoral neck fractures in patients over 50 years old].
Despite many papers and instructional course lectures, therapeutic guidelines are not clearly defined about treatment of femoral neck fractures. The aim of this multicentric French symposium was to prospectively study the results of current therapeutic options in order to propose scientifically proven options. ⋯ For young patients, ORIF should be the treatment of choice: the initial displacement and its effects on the femoral head vascularisation, the quality of reduction and fixation are the two most significant factors for good outcome. For Garden 1, fractures in patients 65 years old or more, it is proposed to performed an internal fixation despite in two thirds of the cases, it should be unnecessary because non identification of predictive factors of failure. For patients over 65 years old, the type of arthroplasty to perform in displaced fractures is to be chosen according to the preoperative mobility and comorbidities. Because of acetabular erosion with long-term follow-up, it is clearly indicated to perform total hip replacement for patients with life expectancy of 10 years or more. For frail patients, unipolar arthroplasty is the best option. The place for bipolar or uncemented implants is not yet well-defined and more prospective trials are needed. In this multicentric study, results appear quite different in terms of mortality, or functional status. These differences seem to be related to technical choice, geriatric care, nutritional consideration or surgical organisation, all factors that may be of major importance for prognostic.
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Rev Chir Orthop Reparatrice Appar Mot · Jun 2008
Multicenter Study Comparative Study[Comminuted intra-articular fractures of the distal humerus in elderly patients].
Treatment of comminuted intra-articular fractures of the distal humerus in elderly patients remains a challenge in trauma surgery. These fractures are rare, but their frequency increases. Our multicenter studies collected 238 cases of comminuted intra-articular fractures of the distal humerus in patients older than 65: two hundred and five cases for the retrospective study, 33 for the prospective study with a minimum follow-up of six months. ⋯ Treatment of these fractures must be discussed according to the physiological status of the patient and the fracture patterns (scan evaluation). In conclusion, osteosynthesis remains the standard treatment when stable fixation is feasible. However, prosthetic reconstruction should be discussed for dependant patients or with comorbidity factors, bad bone quality leading to poor osteosynthesis or complex fracture.
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Rev Chir Orthop Reparatrice Appar Mot · Oct 2007
Multicenter Study[The floating knee: a retrospective analysis of 172 cases].
A retrospective multicentric observational study of 172 floating knee injuries is reviewed. According Fraser's classification 71.5% of the cases are type I and the repartition of the type II in the 3 subgroups is as follow: II A 8.2%, II B 11.6%, et II C 8.7%. At least one of the fractures was open in 69.2% of the patients. ⋯ According the functional score of Karlström and Olerud, 23 patients were rated as excellent, 38 as good, 35 as fair and 20 as bad. The contributing factors influencing bad functional outcome are the age, a type II lesion, a femoral fracture located at the distal third, and an open fracture. The IM using a single knee incision does not show in this series better results but the shortening of the operating time was highly significant.