Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Nov 2008
Case Reports[Paraplegia after interlaminar epidural steroid injection: a case report].
We report the first case of paraplegia observed after epidural steroid injection in the upper spine. The patient was a 42-year-old male who underwent surgery two years earlier for stenosis of the lumbar spine from L2 to the sacrum leading to early manifestations of an equina cauda syndrome. This first operation provided satisfactory function with complete resolution of the objective neurological symptoms. ⋯ The patient's neurological status remained unchanged and four days later the T2 MRI sequence revealed a high-intensity intramedullar signal in the cone. The diagnosis of ischemia of the medullary cone was retained, hypothetically by injury to the dominant radiculomedullary artery via an undetermined mechanism. This complication has been previously described after upper foraminal steroid injections but not after intralaminar epidural steroid injection.
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Rev Chir Orthop Reparatrice Appar Mot · Nov 2008
[Dynamic stabilisation and compression without fusion using Dynesys for the treatment of degenerative lumbar spondylolisthesis: a prospective series of 25 cases].
We used the Dynesys stabilization to treat degenerative lumber spondylolysis by decompression without fusion with the objective of decreasing the morbidity related to instrumented arthrodesis in older patients yet preventing progression of the displacement. ⋯ The most logical indication for this instrumentation is the older subject aged at least 65 years with degenerative lumber spondylolysis and a predominantly self-reducible angular displacement and satisfactory disc height. This context (group 3 in our series) occurs in patients with a weak sacral slope and incidence, as well as minimal lordosis adapted to the pelvic parameters. The Dynesys instrumentation can be a palliative alternative to fusion for more advanced degenerative lumber spondylolysis occurring on spines with anterior imbalance where fusion would be technically difficult in terms of correction of the kyphosis or because of the general risk factors.
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Rev Chir Orthop Reparatrice Appar Mot · Oct 2008
Comparative Study[Distal femoral torsion: comparison of CT scan and intra operative navigation measurements during total knee arthroplasty. A report of 70 cases].
Proper positioning of the prosthesis components in total knee arthroplasty is an important factor for satisfactory outcomes such as mobility, pain and wear. If an independent cutting technique is performed, rotational alignment of the femoral component should adapt patient's specific anatomy. The distal epiphyseal femoral torsion (DEFT) is adjusted in order to align the prosthetic posterior condylar axis along the bone transepicondylar axis. The DEFT presents a high rate of interindividual variations. Computed tomography scanning produces reliable and reproducible measurement of the epiphyseal torsion, but this requires additional procedure. We therefore used intraoperative computed navigation for DEFT measurement, thus accurately adapting each patient's epiphyseal torsion during the procedure, without resorting to the preoperative CT scan. ⋯ Our results report a large variability in distal epiphyseal femoral torsion measured with CT scan. Moreover, computed navigation does not provide a reliable and reproducible evaluation of the epiphyseal torsion. Due to inaccurate identification of femoral epicondyles, the related navigated measurement is not considered to be reliable and reproducible. Navigated HKA at 90 degrees of knee flexion is not a fair indirect reflection of epiphyseal torsion. Computer-assisted navigation fails to provide direct or indirect, reliable and reproducible intraoperative measurement of distal epiphyseal femoral torsion. Preoperative CT scan is the only reliable method to produce accurate measurement of distal epiphyseal femoral torsion.
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Rev Chir Orthop Reparatrice Appar Mot · Oct 2008
[Total knee arthroplasty with bicruciate preservation: Comparison versus the same posterostabilized design at eight years follow-up].
The purpose of this study was to determine the functional, clinical and radiographic results obtained with total knee arthroplasty (TKA) preserving both cruciate ligaments using the Hermès prosthesis with a fixed plateau. Mid-term results at eight years mean follow-up were compared with the outcome achieved at the same follow-up with posterior-stabilized (PS) Hermès TKA with a fixed bearing. ⋯ The risk of prosthetic loosening is not greater with TKA bicruciate sparing designs than with PS knees when the postoperative frontal laxity and the frontal realignment are satisfactory. They enabled better function but greater operative precision is required to achieve pain-free knees with a good range of motion.
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Rev Chir Orthop Reparatrice Appar Mot · Oct 2008
Multicenter Study Comparative Study Clinical Trial[Femoral neck fractures in patients over 50 years old].
Despite many papers and instructional course lectures, therapeutic guidelines are not clearly defined about treatment of femoral neck fractures. The aim of this multicentric French symposium was to prospectively study the results of current therapeutic options in order to propose scientifically proven options. ⋯ For young patients, ORIF should be the treatment of choice: the initial displacement and its effects on the femoral head vascularisation, the quality of reduction and fixation are the two most significant factors for good outcome. For Garden 1, fractures in patients 65 years old or more, it is proposed to performed an internal fixation despite in two thirds of the cases, it should be unnecessary because non identification of predictive factors of failure. For patients over 65 years old, the type of arthroplasty to perform in displaced fractures is to be chosen according to the preoperative mobility and comorbidities. Because of acetabular erosion with long-term follow-up, it is clearly indicated to perform total hip replacement for patients with life expectancy of 10 years or more. For frail patients, unipolar arthroplasty is the best option. The place for bipolar or uncemented implants is not yet well-defined and more prospective trials are needed. In this multicentric study, results appear quite different in terms of mortality, or functional status. These differences seem to be related to technical choice, geriatric care, nutritional consideration or surgical organisation, all factors that may be of major importance for prognostic.