Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Feb 2001
Randomized Controlled Trial Comparative Study Clinical Trial[A prospective randomized study of wound drainage versus non-drainage in primary total hip or knee arthroplasty].
Drainage of the operative wound following total hip or knee replacement (THR, TKR) is usually performed to avoid hematoma formation. A certain amount of blood is lost through the drain. The necessity of wound drainage has been questioned, with a view towards blood saving, although most surgeons have not abandoned drainage for fear of local complications. A prospective randomized study was undertaken to compare drainage and non-drainage following THR/TKR in terms of blood-saving and local complications. ⋯ Following primary hip or knee arthroplasty, the use of wound drainage did not lead to increased blood loss, and non-drainage did not lead to significant wound healing problems but did not reduce blood loss and transfusion requirements. It was even associated, following TKR, with greater blood loss and transfusion. Such data may therefore be used to support drainage as well as non-drainage following THR or TKR. Avoiding drainage may be interesting in terms of cost, but the benefit is marginal; it also eliminates one possible source of retrograde wound infection. Systematic wound drainage following THR or TKR is essentially a tradition. This study shows that it can safely be dispensed with in a number of cases.
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Rev Chir Orthop Reparatrice Appar Mot · Nov 2000
[Sacral chordoma: retrospective review of 11 surgically treated cases].
Chordoma is a malignant neoplasm believed to arise from notochord remnants. It accounts for approximately 3 to 4 p. 100 of primary bone tumors and is localized along the axial skeleton, 50 p. 100 being sacrococcygeal. Clinical, radiographical and histological findings have been well established since the first description by Ribbert in 1894. Sacral chordomas are however difficult to manage and remain a challenge for surgeons and radiotherapists alike. The purpose of this study was to evaluate the long-term results of surgical treatment and patterns of failure in patients treated for chordoma of the sacrum in our department. ⋯ Chordoma is a slow-growing tumor allowing survival for several years despite recurrent disease. However, only 10 to 20 p. 100 of the patients survive free of disease at 5 years. Recurrences are frequent (45 to 80 p. 100) and often multiple. Chordoma inevitably recurs and eventually leads to death after intralesional removal or marginal resection. Radical surgery should be attempted whenever technically feasible. When performed early, particularly for smaller lesions, it offers the best chance for cure. However, tumoral recurrence can occur postoperatively despite a macroscopically complete resection. Because radiation therapy seems to be more successful in controlling microscopic disease, it should be considered as a pre- or postoperative adjuvant to a macroscopically complete resection.
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Rev Chir Orthop Reparatrice Appar Mot · Nov 2000
[Simple screw fixation for calcaneal fractures: 60 cases with preoperative computed tomography analysis].
In accordance with the conclusions established at the SOFCOT symposium in 1988, we propose surgical treatment of displaced fractures of the calcaneus with screw fixation after reduction. We developed an original classification system of 3D computed tomography images which allows a precise description of the fractures and guides joint and calcaneal body reconstructions. The purpose of this work was to provide a precise analysis of operated fractures in order to identify prognostic factors and validate use of exclusive screw fixation for calcaneal fractures. ⋯ Measurement of the medial Böhler angle improves the sensitivity of revision criteria for articular fractures of the calcaneus. Screw fixation has proven its reliability.
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Rev Chir Orthop Reparatrice Appar Mot · Oct 2000
Comparative Study[Long-term influence of associated arthrodesis on adjacent segments in the treatment of lumbar stenosis: a series of 127 cases with 9-year follow-up].
Little is known about the impact of posterolateral arthrodesis on adjacent levels. In order to examine this question, we analyzed the radiological evolution of the lumbar spine in patients treated for lumbar stenosis, comparing cases where posterolateral arthrodesis was used with the other cases. Our aim was to determine whether the long-term radiographical modifications were affected by the arthrodesis. ⋯ Our findings allow the conclusion that, despite the effect of physiological aging, the observed long-term degenerative lesions in patients undergoing treatment of lumbar stenosis are related to the associated arthrodesis which increases their frequency and severity, deteriorating the functional outcome.
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Rev Chir Orthop Reparatrice Appar Mot · Oct 2000
[Risks and results after simultaneous intramedullary nailing in bilateral femoral fractures: a retrospective study of 40 cases].
A retrospective series of 40 patients who underwent simultaneous intramedullary nailings for bilateral femoral shaft fractures was analyzed. The aim of our study was to verify that simultaneous nailing without reaming does not increased risk of fat embolism and to assess clinical and radiological outcome. ⋯ Simultaneous nailing of bilateral femoral shaft fractures can be performed if blood gases remain acceptable and minimal reaming is used.