Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Jun 2008
Comparative Study[Confrontation of the radiographic preoperative planning with the postoperative data for uncemented total hip arthroplasty].
For hip prosthesis surgery, the challenge is to obtain optimal function of the instrumented hip but also to eliminate any limb length discrepancy, correct the femur offset and guarantee the center of rotation of the hip joint. Preoperative planning for total hip arthroplasty (THA) enables determination of the appropriate length for the prosthetic neck and the size and eventually the type of implants to use. From a prospective series of 86 patients who underwent first-intention THA for implantation of a noncemented prosthesis, we studied the precision of the outcome as function of the preoperative planning. We also ascertained whether the preoperative planning was sufficient to provide the measurements necessary for correct implant position. ⋯ Preoperative planning reliably predicts the final offset of the implanted femoral stem. It is more difficult to predict the size of a press fit cup but in our experience the difference does not greatly affect restitution of the hip anatomy. We readily changed the length of the neck during the operation if necessary and have found that the leg length has been better with this approach. This leads to the observation that all of the planning parameters are not fully accurate because of the magnification effect, anatomic conditions, or possible defective execution. While the overall rate of conformity was low, looking at the results for each element separately provided a useful element for each phase of the operation. We recommend planning a medium length neck so it can be easily changed during the operation. The availability of offset measurements is particularly important to control hip lateralization and leg length. Current advances in computer-assisted surgery should be helpful in improving the imperfections of preoperative planning.
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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.