Orthop Traumatol Sur
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Orthop Traumatol Sur · Feb 2009
Multicenter StudyProximal humerus fractures treated by percutaneous locking plate internal fixation.
There is no consensually accepted recommendation for optimum surgical treatment of unstable fractures of the proximal humerus. ⋯ Our study suggests that percutaneous plating with angular screw fixation of proximal humeral fractures is a safe and effective method, which produces good functional and radiologic outcomes. These minimally-invasive techniques allowing a better preservation of soft-tissues help promote early functional recovery. This more friendly approach combined to upgraded implants and instruments will also improve early and long-term outcomes of these fractures.
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Orthop Traumatol Sur · Feb 2009
Comparative StudyThree or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases.
As population ages, the number of fractures of the proximal humerus in still-active patients is increasing. For three- or four-parts displaced fractures in which replacement is indicated, hemiarthroplasty with tuberosity reattachment remains the reference treatment; this technique, however, can lead to catastrophic functional results due to nonunion or tuberosity migration. The present study compared short-term functional results for reverse prosthesis and hemiarthroplasty in complex fractures of the proximal humerus. ⋯ In three- or four-part displaced proximal humerus fracture, arthroplasty does not ensure recovery of pretrauma shoulder function. Management is therefore to be decided in terms of outcome predictability and rapid recovery of daily comfort for elderly patients. Hemiarthroplasty can provide good functional results, but depends on tuberosity union quality and this often necessitates a prolonged immobilization. Reverse prostheses provide reliable, rapid and predictable results in terms of abduction, anterior elevation and pain relief, but impaired rotation; this impacts quality of life and long-term implant durability (glenoid notching). Reverse prostheses should thus prove advantageous in the treatment of complex fractures of the proximal humerus if these two drawbacks can be resolved and at present seem indicated on condition that the patient is no younger than 70 years of age.
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Orthop Traumatol Sur · Feb 2009
Skeletal landmarks for TKR implantations: evaluation of their accuracy using EOS imaging acquisition system.
Lower extremity alignment remains one essential objective during total knee replacement. Implants positioning analysis requires selecting reliable skeletal landmarks. Our objective was to in vivo evaluate the precision of the implemented skeletal landmarks. This evaluation was based on multiple three-dimensional (3D) computer reconstructions of the lower extremity derived from an EOS biplanar low-dose X-ray system acquisition. A 3D angle measurement protocol was used. ⋯ The lower extremity skeletal landmarks precision relates to the quality of the corresponding 3D reconstructions. Except for tibial rotation, all the translation and rotation parameters were estimated within a mean error margin inferior to 1.2 mm and 1.3 degrees, respectively. Making the reconstruction algorithms more robust would render certain anatomic zones even more precise. Biplanar low-dose EOS X-ray system is a tool of the future to generate 3D knee X-rays that can improve the evaluation and follow-up of total knee arthroplasty patients.
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Orthop Traumatol Sur · Feb 2009
Cemented all polyethylene tibial insert unicompartimental knee arthroplasty: a long term follow-up study.
Unicompartimental knee arthroplasty outcome is sometimes compared to total knee arthroplasty but various implant parameters might greatly influence this outcome. The objectives of this study were to report the results of a consecutive series of 172 all-polyethylene unicompartmental knee arthroplasties (UKAs) and to detail possible factors of success and failure. ⋯ The option of an all-polyethylene tibial implant, with minimal bone cuts (femoral resurfacing), makes excellent long-term results possible.