Orthop Traumatol Sur
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Orthop Traumatol Sur · Dec 2009
Multicenter StudyVascular lesions associated with bicruciate and knee dislocation ligamentous injury.
The incidence of associated vascular lesions in biligamentous cruciate injuries of the knee ranges from 16 to 64%, with a mean rate of 30%. Treatment of ischemic vascular lesions associated with ligaments injury is well established, comprising emergency arterial vascular repair, most of the times combined to external fixation. In the absence of clinical symptoms of vascular lesion, some authors recommend systematically performing arteriography, while others advocate selectively prescribing this examination in doubtful clinical situations. The present study analyzed data extracted from the prospective series of the 2008 SOFCOT Symposium (dedicated to management of bicruciate knee lesions) and from an analysis of the literature, with emphasis on developing a diagnostic strategy for vascular lesions associated with bicruciate lesions. ⋯ At initial examination, it is essential to look for the peripheral pulse. In case of ischemic syndrome, the priority is a revascularization procedure associated to intraoperative arteriography. In case of abnormal pulse without obvious ischemia, emergency imaging (usually arteriogram or angioscan) is essential. Where there is no initial clinical vascular abnormality, good practice is less clearly cut. Initially, present pulses are found in a mean 30% (17-55%) of cases of popliteal artery lesion, according to the series. Different authors draw diverging conclusions from this fact. For some, the absence of frank abnormality on clinical examination is sufficient to exclude not any possible anatomic vascular lesion but any vascular lesion requiring surgery. However, even without pulse abnormality, we consider systematic imaging to be justified, partly by the difficulty of ensuring strict monitoring, and partly by the decompensation risk of clinically asymptomatic intimal lesions during the ligament surgery under consideration in most cases. Although many authors cling to the dogma of late emergency arteriography, recent reports argue against this attitude. Angio-MRI has good diagnostic value, but in practice is difficult to obtain in emergency. We would rather advocate angioscanning, which is easily available in emergency and does not incur the risk of local complication associated with arteriography.
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Orthop Traumatol Sur · Dec 2009
Comparative StudyMini-invasive nail versus DHS to fix pertrochanteric fractures: a case-control study.
Fixation devices to treat trochanteric fractures belong to two general categories: dynamic hip screw (DHS) type and intramedullary type implants. In spite of possible pitfalls, both are considered valid options. Comparing a sliding screw-plate system (DHS) along a mini-invasive nailing device (BCM nail) with primary insertion of the cephalic screw, sheds light on the debated management of trochanteric fractures. ⋯ This study has shown the benefits of the BCM nail in terms of stability. But the potential advantages of this mini-invasive technique were limited by ancillary-related difficulties which need to be rectified. These preliminary results are in favour of a further development of this innovating device.
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Orthop Traumatol Sur · Dec 2009
Long-term results of the ABG-1 hydroxyapatite coated total hip arthroplasty: analysis of 111 cases with a minimum follow-up of 10 years.
Medium-term studies of ABG-1 cementless total hip arthroplasty have shown favorable functional results with excellent femoral component fixation but an abnormally high rate of periacetabular component osteolysis, which may require early revision. ⋯ This long-term study confirms the high frequency of retroacetabular osteolysis of ABG-1 prostheses surpassing the osteolysis rate of other uncemented cups with a polyethylene insert. The absence of predictive criteria of osteolysis occurrence and the lack of symptoms warrants periodic follow-up of patients with ABG-1 cups and, if necessary, early repair of bone stock loss with grafts combined with acetabular cup revision. This procedure remains simple as long as performed before the onset of massive bone destruction, confirming the proposed revisions in this series were judicious. This study also confirms the excellent long-term fixation of the ABG-1 femoral stems derived from the osteointegration and proximal seal around the hydroxyapatite coating.
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Orthop Traumatol Sur · Dec 2009
Anterior dislocation of a total hip replacement. Radiographic and CT-scan assessment. Behavior following conservative management.
Hip dislocation is one of the most frequent complications of total hip replacement. The direction of dislocation matters. Most dislocations are posterior; anterior dislocation remains rare and its treatment is controversial. ⋯ Anterior dislocation after total hip replacement is associated with approximately 10 degrees of excessive femoral and acetabular anteversion respectively. Nevertheless, correction of these architectural anomalies is not necessary because immobilisation in the deck chair position for 2 weeks effectively prevents recurrence and results in satisfactory medium-term functional results.
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Historically, anatomic factors have been identified that increase one's risk for episodic lateral patella dislocations. A surgical treatment algorithm has been proposed which utilizes these risk factors. ⋯ Current indications for MPFL reconstructions will be reviewed. The frequency of reconstructing the MPFL alone versus combining it with other realignment schemes in my last 30 patients will be presented.