Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Sep 2002
[Reconstruction-arthrodesis of the first metatarsophalangeal joint iatrogenic bone defects].
Arthrodesis-reconstruction for metatarsophanlangeal bone defects of the great toe after hallux valgus or hallux rigidus is rarely performed and only a few series are found in the literature. In these series, retarded bone fusion, skin rupture, and interphalangeal intolerance (both clinically and radiologically) have been frequent. The purpose of this work was to determine what parameters contribute to minimizing these postoperative risks. ⋯ Correct position of the arthrodesis is essential to alleviate transfer metatarsalgia. A moderate lengthening of the great toe can minimize the risk of skin rupture. In order to preserve the interphalangeal joint, the position of the arthrodesis must be precise both in the sagittal and horizontal plane, leaving sufficient valgus and avoiding the need for temporary interphalangeal pinning.
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Rev Chir Orthop Reparatrice Appar Mot · Sep 2002
[Systematic circumferential (360 degree) decompression treatment of major arthrotic cervical stenosis].
Worsening and irreducible evolution of neural involvement in cervical stenosis requires cord decompression. Different techniques have been proposed. We associated a dual posterior then anterior approach to achieve 360 degrees decompression. We evaluated results on the basis of neurological and mechanical outcome. ⋯ 360 degrees arthrodesis for severe cervical canal stenosis provides a satisfactory solution to mechanical problems and substantial neurological improvement. Fusion is regularly obtained without complementary anterior instrumentation. Neurological improvement is correlated with disease duration and the degree of deficit at onset. Anteroposterior decompression and 360 degrees fusion provide cure for all the components of stenotic disease. The dual approach is indicated in severe cases with cord involvement as recognized by myleopathic clinical manifestations and on the MRI.
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Rev Chir Orthop Reparatrice Appar Mot · Sep 2002
[Total hip arthroplasty and femoral head osteonecrosis in renal transplant recipients].
Osteonecrosis of the femoral head is reported in a very variable proportion of renal transplant recipients. When these patients require total hip arthroplasty (THA), immunosuppression and poor bone quality increase the risk of aseptic loosening and infection. In the literature, functional outcome has been satisfactory although rates of early and late complications have varied greatly. The purpose of our work was to determine the long-term outcome in a series of renal graft recipients who underwent THA for osteonecrosis of the femoral head. ⋯ THA enables good functional outcome for renal transplant recipients suffering from osteonecrosis of the femoral head, but at the cost of a high risk of early and long-term complications not always reported in the literature.
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Rev Chir Orthop Reparatrice Appar Mot · Jun 2002
[Kudo non-constrained elbow prosthesis for inflammatory and hemophilic joint disease: analysis in 30 cases].
We analyzed retrospectively 30 Kudo non-constrained elbow prostheses to determine: 1) functional outcome and mobility, 2) frequency of loosening and any complications. ⋯ Elbow arthroplasty can restore a painless joint and maintain or improve elbow motion. The procedure is indicated when the joint disease impair daily life activities. Final mobility basically depends on the preoperative mobility. The bone stock remains the greatest problem with these resurfaced prostheses. The GUEPAR elbow prosthesis would appear to be more adapted due to the reconstruction of the trochlea. Resection of the radial head is a source of instability for elbow prostheses and should lead to the design of three-compartment prostheses.
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Rev Chir Orthop Reparatrice Appar Mot · Jun 2002
[Reposition flap techniques in fingertip amputations: 6 cases].
The purpose of this study was to evaluate an alternative procedure for amputations distal to the distal interphalangeal joint: the reposition flap. ⋯ Fingertip amputations have been widely reported. Methods have varied from directed scarring to partial toe transfer. These situations present two types of challenge: insensitivity of the volar aspect or an overly sensitive pulp; cosmetic presentation and function of the dorsal aspect due to the complex role of the nail. Distal reimplantation remains the best technique, but the reposition flap offers an interesting alternative in case of failure or for patients who do not accept finger shortening. The advantage of the reposition flap is that it preserves finger length and the nail. Work stoppage and intolerance to cold can be an inconvenience due to the long time required for wound healing.