Orthop Traumatol Sur
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Pectus excavatum (PE) is a congenital deformity essentially responsible for an unattractive aspect, much more rarely for compression problems. The classical treatments consist either in filling the excavation or in open thoracic reconstruction (the Ravitch technique). Alternatively, the treatment described by Nuss raises the sternum with a retrosternal metallic bar placed under thoracoscopic guidance. We present the preliminary results of a series of 25 children operated on using this technique. ⋯ Level IV. Therapeutic Study.
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Orthop Traumatol Sur · Apr 2009
Comparative StudySickle-cell hip necrosis and intraosseous pressure.
Osteonecrosis of the femoral head (ONFH) is a frequent complication of sickle-cell disease. Numerous studies have demonstrated increased intraosseous pressure (IOP) in idiopathic necrosis and necrosis secondary to corticotherapy or alcohol poisoning. Several reports have testified to the clinical interest of decompression by drilling which, when performed in the early course of the pathology, can arrest or slow evolution. To the best of our knowledge, no studies have reported IOP increase in sickle-cell ONFH. The present study sought to show that intraosseous hyperpressure plays a role in the physiopathology of sickle-cell, like idiopathic, ONFH. ⋯ Measuring pressure is of diagnostic interest in sickle-cell disease patients with symptomatic hips. Manometry can be performed independently of surgery, under local anesthesia, and provides early confirmation of ONFH in geographic regions in which MRI is not readily available. It can be carried out very straightforwardly, without pressure sensor, using a simple water column (physiological saline) and three-way tap. Peroperative comparison of IOP-1 and IOP-3 is a means of assessing the effectiveness of decompression drilling.
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Orthop Traumatol Sur · Apr 2009
A newly designed locked intramedullary nail for trochanteric hip fractures fixation: results of the first 100 Trochanteric implantations.
Internal fixation continues to be the surgical treatment of choice for trochanteric region hip fractures. Intramedullary nailing is the updated version of the Küntscher Y nail and provides stable osteosynthesis of trochanteric hip fractures, classically achieved by closed reduction. ⋯ This original intramedullary nailing system provides reliable internal fixation means for intertrochanteric fractures since it combines the advantage of a closed reduction procedure with a more stable biomechanical construct.
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Orthop Traumatol Sur · Apr 2009
ReviewIliac bone-block autograft for posterior shoulder instability.
Posterior shoulder instability is a rare condition, representing only 4% of all shoulder-joint instabilities. Numerous surgical techniques are used to treat it when conservative functional treatment proves to be insufficient. This retrospective study relates to 8 patients, presenting recurrent posterior shoulder instability, all treated with a posterior iliac bone-block procedure. The results were assessed both clinically and with contemporary imaging techniques. ⋯ The iliac posterior shoulder bone-block is effective in managing instances of involuntary posterior shoulder instability. A review of the literature confirmed these satisfactory results in terms of non-recurrence, pain relief and function recovery with this technique; the main difficulties of this technique remains in the correct positioning of the bone-block and the proper orientation of the fixation screws.
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Orthop Traumatol Sur · Apr 2009
Femoral deficiency reconstruction using a hydroxyapatite-coated locked modular stem. A series of 43 total hip revisions.
We report a continuous prospective series of patients operated on for total hip prosthesis femoral component loosening involving a bone defect. Reconstruction was performed using a hydroxyapatite-coated locked modular stem. The study's objective was to assess medium term clinical and X-ray results obtained with this original concept. ⋯ The complications rate was low, and results were comparable with those reported in the literature. The study confirmed the interest of the extended trochanteric osteotomy exposure and the effectiveness of the hydroxyapatite-coated interlocked modular stem concept in the treatment of hip prosthesis loosening with femoral bone loss (involving or not the cortex). On analysis, the one case of failure does not prescribe the surgical technique employed. Implant osseointegration was difficult to analyze. The extent of the surgical approach and of its corresponding sequels, combined with the complexity of adjusting the implant, however, restrict this surgical option indications to level III and IV cases of femoral loosening.