Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Dec 2007
[Total hip arthroplasty after hip arthrodesis performed for septic arthritis].
Revision total hip arthroplasty (THA) after hip arthrodesis is an uncommon and challenging operation. The task would appear to be even more difficult if the arthrodesis was performed because of septic arthritis due to the theoretical risk of recurrent infection. We report our fifteen-year experience. ⋯ An earlier history of infection does not appear to be a contraindication for implantation of a total hip arthroplasty after hip arthrodesis. Despite the long recovery period and the modest gain in joint motion, 80% of patients were satisfied after having had a blocked hip for 36 years on average.
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Rev Chir Orthop Reparatrice Appar Mot · Dec 2007
Comparative Study[Mini-invasive double-incision for patellar tendon harvesting in anterior cruciate ligament reconstruction].
Injury to infrapatellar branches of the medial saphenous nerve are incriminated in disorders of the anterior aspect of the knee, particularly following bone-tendon-bone reconstruction. We demonstrated in prior anatomic work the usefulness of using a double-incision minimal approach for harvesting the patellar transplant in order to spare the nerve branches. ⋯ Our technique has enabled a significant decrease in the surface area of sensorial disorders (7.4 cm2 versus 17.4 cm2) and problems kneeling compared with the conventional method.
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Rev Chir Orthop Reparatrice Appar Mot · Dec 2007
[Correction of stiff thoracic idiopathic adult scoliosis. Prediction from the traction radiograph].
The aim of this study was to determine the predictive value of the traction radiograph in adults with stiff curve (preoperative Cobb angle>60 degrees and reduction of less than 35% with traction) thoracic scoliosis. We wanted to compare this predictive value with that observed in reducible scoliosis. ⋯ The standard traction radiographs were highly predictive of postoperative reduction of stiff thoracic and thoracolumbar curves treated by segmental instrumentation. The postoperative result can thus be estimated with a margin of error of +/-7 degrees . For the stiff curves, the postoperative Cobb angle was 17.5 degrees on average less than predicted on the traction radiograph (on average 20% supplementary gain in reduction). This angle gain, which was greater for stiff than reducible curves, corresponds to the determining effect of release occurring with stiff curves. Finally, because of the stronger correlation between the traction Cobb angle and the postoperative Cobb angle for stiff curves, the predictive value of the traction radiograph is greater for stiff curves than for reducible curves. In conclusion, one of the contributions of the traction radiograph, which results from the predictability of the postoperative angle with a small margin of error, is to enable adequate prediction of the postoperative outcome for a given patient or a specific sub-group of patients, e.g. with or without anterior release.
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Rev Chir Orthop Reparatrice Appar Mot · Dec 2007
[Total hip arthroplasty for treatment of acute acetabular fracture in elderly patients].
The standard treatment of displaced acetabular fractures is open reduction and internal fixation (ORIF). In elderly patients, ORIF may not be the best option because of osteoporotic bone and the necessary period of bed rest. Primary total hip arthroplasty (THA) for displaced acetabular fractures was initiated by Westerborn in 1954. Since then, several authors described their experience and since 1986 many studies have reported good results with this type of treatment. This study assessed outcome obtained in patients treated by primary THA for acetabular fracture in the orthopedic department of the Dupuytren Teaching Hospital in Limoges. ⋯ In selected patients with a displaced acetabular fracture, we believe that an acute THA may provide several advantages including only one procedure and quick weight bearing with a lower rate of decubitus complications. In this small series, functional outcome was good for most of the patients who recovered their initial activity level.
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Rev Chir Orthop Reparatrice Appar Mot · Dec 2007
[Infection on continuous bone of lower limb: 127 cases].
Infection on continuous bone is a specific diagnostic and therapeutic entity. Treatment requires debridement of infected and necrotic soft tissue and bone, dead space management, effective antibiotic therapy in the bone and good skin coverage with well-vascularized tissues. Results of treatment of infection on continuous bone of the lower limb are presented in this series. ⋯ Infection on continuous bone is a characteristic entity, rarely clearly separated from other bone infections in reported series that combine these infection with septic nonunions and infected arthroplasties. Surgery is essential and is based on quality debridement. The use of flaps (for both dead space management and skin coverage) improves the results for the treatment of such infections but long-term follow-up is needed for a more accurate assessment of success rate.