Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · May 2007
Comparative Study[Biomechanical evaluation of posterior instrumentation for lumbar burst fracture: comparison of two internal devices].
Burst fractures generally occur due to trauma to the thoracolumbar spine. Surgery is indicated for unstable fractures. Posterior instrumentation with pedicular screws is generally proposed. In certain circumstances, hooks may be preferred due to excessive risk of insertion of the pedicular screw. The purpose of this study was to compare two posterior instrumentations, one using pedicular screws on either side of the fracture each protected by hoods and a second composed of the same pedicular screws inserted under the fracture hooks above. ⋯ This mode simulating burst fractures of the spine appears to be reproducible and more realistic than corporectomy. Attention should be taken concerning the limits of this type of study since fractures can occur for forces as small as 10.6 Nm. Thus we observed that pedicle screw configurations and also fractures produced mean ranges of motion greater than intact segments irrespective of the type of lesion simulated. However, the net increase in motion was observed during rotation movements when hooks were used, even when they were placed only below the fracture. Putting pressure on the hooks does not prevent them from slipping along the lamina. But neither of these two configurations controls the fracture gap. A vertebral reinforcement might be necessary.
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Rev Chir Orthop Reparatrice Appar Mot · May 2007
Comparative Study[Prospective and comparative study of minimally invasive posterior approach versus standard posterior approach in total hip replacement].
There have been few prospective studies comparing minimally invasive approaches for total hip replacement. We wanted to ascertain the contribution of the minimally invasive posterior approach in comparison with the standard posterolateral approach in terms of early outcome. ⋯ The minimally invasive posterior approach does not require an orthopedic table nor specific instrumentation. A minute procedure is required with ligature of the posteromedial circumflex artery of the thigh to improve exposure and limit intraoperative bleeding. It enables satisfactory reproducible implant positioning. Conversion to an open posterolateral approach is possible if needed. The minimally invasive posterior approach enables a reduction in intraoperative bleeding and in postoperative pain while allowing earlier more rapid rehabilitation. Early clinical outcome is better but beyond six weeks, the functional results are comparable for the two approaches. The minimally invasive posterior approach is a reliable reproducible approach with a progressive learning curve.
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Rev Chir Orthop Reparatrice Appar Mot · Apr 2007
[Accuracy measurements of acetabular cup positioning using CT less navigation].
Standard methodology is lacking for evaluating the accuracy of surgical navigation systems. The purpose of the present study was to propose a new approach to error measurements of an image-free navigation system used for total hip arthroplasty. ⋯ The proposed simple clinical end-to-end accuracy evaluation model provides the surgeon with sufficiently accurate information. The evaluation model was able to identify and more importantly to quantify the clinically induced error. This study proves that ameliorating the reference system acquisition would improve the system's overall accuracy.
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Rev Chir Orthop Reparatrice Appar Mot · Feb 2007
[Resurfacing prosthesis for osteoarthritis of the trapeziometacarpal joint: 4.5 year follow-up in 83 implants].
The aim of this study was to present our experience with hemiarthroplasty of the base of the first metacarpal for the treatment of degenerative disease of the trapeziometacarpal joint. We have used this resurfacing implant since 1995 as part of our therapeutic armamentarium together with trapeziectomy, arthrodesis and total arthroplasty. ⋯ This hemiarthroplasty has provided satisfactory results in terms of pain relief, joint motion, and function. There has not been any long-term radiographic problem. If revision is needed for failure, the procedure is simple and trapeziectomy, total arthroplasty or arthrodesis can be performed. The hemi-implant can be inserted after total arthroplasty. Compared with other techniques, this implant avoids the problem of silicone tolerance with the Swanson implant and has provided results superior to those of arthrodesis and trapiezectomy but slightly less satisfactory than with total arthroplasty. The indication for use of this resurfacing implant is osteoarthritis of a centered trapeziometacarpal in the young subject. The implant is contraindicated for advanced-stage disease, stiff joint with retraction of the first commissure and hyperextension of the metacarpophalangeal joint.
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Rev Chir Orthop Reparatrice Appar Mot · Dec 2006
Case Reports[Deep benign fibrous histiocytoma: a case report].
Bening fibrous histiocytoma is one of the most frequent benign tumors. Most tumors are found in the skin, particularly on the limbs. Tumor size is usually small. ⋯ Most deep tumors occur in the subcutaneous tissue. Deep locations in other organs have also been reported. We report a case and discuss the pathological and clinical aspects of this rare tumor.