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Kuczewski E, Munier-Marion E, Bénet T, Rongieras F, Monneuse O, Vanhems P. Surveillance of surgical site infections cases in prosthetic orthopedics in a French University Hospital, from 2013 to 2016. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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2
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Zapata E, Rongieras F, Pialat JB, Follet H, Mitton D. An ex vivo experiment to reproduce a forward fall leading to fractured and non-fractured radii. J Biomech 2017; 63:174-178. [PMID: 28859857 DOI: 10.1016/j.jbiomech.2017.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/24/2017] [Accepted: 08/11/2017] [Indexed: 10/19/2022]
Abstract
Forward falls represent a risk of injury for the elderly. The risk is increased in elderly persons with bone diseases, such as osteoporosis. However, half of the patients with fracture were not considered at risk based on bone density measurement (current clinical technique). We assume that loading conditions are of high importance and should be considered. Real loading conditions in a fall can reach a loading speed of 2m/s on average. The current study aimed to apply more realistic loading conditions that simulate a forward fall on the radius ex vivo. Thirty radii from elderly donors (79y.o.±12y.o., 15 males, 15 females) were loaded at 2m/s using a servo-hydraulic testing machine to mimic impact that corresponds to a fall. Among the 30 radii, 14 had a fracture after the impact, leading to two groups (fractured and non-fractured). Surfacic strain fields were measured using stereovision and allow for visualization of fracture patterns. The average maximum load was 2963±1274N. These experimental data will be useful for assessing the predictive capability of fracture risk prediction methods such as finite element models.
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Affiliation(s)
- E Zapata
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, INSERM, Lyos UMR1033, F69622 Lyon, France
| | - F Rongieras
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France; Service de chirurgie orthopédique et traumatologique - Hôpital d'instruction des armées Desgenettes, 69003 Lyon, France
| | - J-B Pialat
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, Lyos UMR1033, F69622 Lyon, France; Service de Radiologie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - H Follet
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, Lyos UMR1033, F69622 Lyon, France
| | - D Mitton
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France.
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Abstract
Wounds due to gunshot and explosions, while usually observed during battlefield combat, are no longer an exceptional occurrence in civilian practice in France. The principles of wound ballistics are based on the interaction between the projectile and the human body as well as the transfer of energy from the projectile to tissues. The treatment of ballistic wounds relies on several principles: extremity wound debridement and absence of initial closure, complementary medical treatment, routine immobilization, revision surgery and secondary closure. Victims of explosions usually present with a complex clinical picture since injuries are directly or indirectly related to the shock wave (blast) originating from the explosion. These injuries depend on the type of explosive device, the environment and the situation of the victim at the time of the explosion, and are classed as primary, secondary, tertiary or quaternary. Secondary injuries due to flying debris and bomb fragments are generally the predominant presenting symptoms while isolated primary injuries (blast) are rare. The resulting complexity of the clinical picture explains why triage of these victims is particularly difficult. Certain myths, such as inevitable necrosis of the soft tissues that are displaced by the formation of the temporary cavitation by the projectile, or sterilization of the wounds by heat generated by the projectile should be forgotten. Ballistic-protective body armor and helmets are not infallible, even when they are not perforated, and can even be at the origin of injuries, either due to missile impact, or to the blast.
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Affiliation(s)
- N J Prat
- Unité thérapie tissulaire et traumatologie de guerre, département soutien médico-chirurgical des forces, institut de recherche biomédicale des armées, 1, place Valérie-André, 91220 Brétigny-sur-Orge, France.
| | - J-L Daban
- Service d'anesthésie et réanimation, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
| | - E J Voiglio
- UMR T 9405, unité de chirurgie d'urgence, faculté de médecine Lyon-Est, université Claude-Bernard Lyon 1, centre hospitalier de Lyon-Sud, 69495 Pierre-Bénite cedex, France
| | - F Rongieras
- Service de chirurgie orthopédique et traumatologique, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France; École du Val-de-Grâce, 1, place Alphonse-Laveran, 75230 Paris cedex 05, France
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Zhu Y, Bermond F, Payen de la Garanderie J, Pialat JB, Sandoz B, Brizard D, Pracros JP, Rongieras F, Skalli W, Mitton D. In Vivo Assessment of Elasticity of Child Rib Cortical Bone Using Quantitative Computed Tomography. Appl Bionics Biomech 2017; 2017:2471368. [PMID: 28835733 PMCID: PMC5556606 DOI: 10.1155/2017/2471368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/23/2017] [Accepted: 03/12/2017] [Indexed: 11/17/2022] Open
Abstract
Elasticity of the child rib cortical bone is poorly known due to the difficulties in obtaining specimens to perform conventional tests. It was shown on the femoral cortical bone that elasticity is strongly correlated with density for both children and adults through a unique relationship. Thus, it is assumed that the relationships between the elasticity and density of adult rib cortical bones could be expanded to include that of children. This study estimated in vivo the elasticity of the child rib cortical bone using quantitative computed tomography (QCT). Twenty-eight children (from 1 to 18 y.o.) were considered. Calibrated QCT images were prescribed for various thoracic pathologies. The Hounsfield units were converted to bone mineral density (BMD). A relationship between the BMD and the elasticity of the rib cortical bone was applied to estimate the elasticity of children's ribs in vivo. The estimated elasticity increases with growth (7.1 ± 2.5 GPa at 1 y.o. up to 11.6 ± 1.9 GPa at 18 y.o.). This data is in agreement with the few previous values obtained using direct measurements. This methodology paves the way for in vivo assessment of the elasticity of the child cortical bone based on calibrated QCT images.
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Affiliation(s)
- Y. Zhu
- Université de Lyon, Université Claude Bernard Lyon 1, Ifsttar, LBMC UMR_T9406, 69622 Lyon, France
- School of Automotive Studies, Tongji University, Shanghai 201804, China
| | - F. Bermond
- Université de Lyon, Université Claude Bernard Lyon 1, Ifsttar, LBMC UMR_T9406, 69622 Lyon, France
| | | | - J.-B. Pialat
- Service de Radiologie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - B. Sandoz
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 Bd de l'Hopital, 75013 Paris, France
| | - D. Brizard
- Université de Lyon, Université Claude Bernard Lyon 1, Ifsttar, LBMC UMR_T9406, 69622 Lyon, France
| | - J.-P. Pracros
- Service de Radiologie, Hôpital Femme Mère Enfant, Lyon, France
| | - F. Rongieras
- Université de Lyon, Université Claude Bernard Lyon 1, Ifsttar, LBMC UMR_T9406, 69622 Lyon, France
- Service de Chirurgie Orthopédique et Traumatologique-Hôpital d'Instruction des Armées Desgenettes, 69003 Lyon, France
| | - W. Skalli
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 Bd de l'Hopital, 75013 Paris, France
| | - D. Mitton
- Université de Lyon, Université Claude Bernard Lyon 1, Ifsttar, LBMC UMR_T9406, 69622 Lyon, France
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Cantin O, Lustig S, Rongieras F, Saragaglia D, Lefèvre N, Graveleau N, Hulet C. Outcome of cartilage at 12years of follow-up after anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 2016; 102:857-861. [PMID: 27544885 DOI: 10.1016/j.otsr.2016.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/05/2016] [Accepted: 06/09/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In cases of chronic anterior laxity, reconstruction of the anterior cruciate ligament (ACL) can slow the development of osteoarthritis. This study was conducted to determine the overall prevalence of osteoarthritis and to identify the risk factors after ACL reconstruction. HYPOTHESIS Meniscus tears, time from injury to surgery, body mass index (BMI), residual laxity, and cartilage lesions influence the progression towards osteoarthritis. MATERIALS AND METHODS This multicenter, retrospective study on the outcome of cruciate ligaments at 12 years of follow-up was conducted within the 2014 SOFCOT Symposium. The cohort included 675 arthroscopic reconstructions of the ACL from January 2002 to December 2003. The clinical evaluation included the objective and subjective IKDC score. Osteoarthritis was analyzed on 589 knee X-rays according to the IKDC classification. The predictive factors of osteoarthritis development studied were age, gender, BMI, time from injury to surgery, activity level, medial or lateral meniscectomy, type of graft, medial or lateral chondropathy, tunnel positioning, and residual laxity. Univariate and multivariate analyses with logistic regression were performed. RESULTS The mean follow-up was 11.9±0.8 years. The subjective IKDC score was 83.7±13. At 12 years, the rate of moderate to severe osteoarthritis l (IKDCC or D) was 19% (16% medial tibiofemoral osteoarthritis, 4% lateral tibiofemoral osteoarthritis, and 2% patellofemoral osteoarthritis). The prognostic factors were age at surgery greater than 34 years (P<0.05), cartilage lesions at surgery (P<0.05), medial or lateral meniscectomy (P<0.05), and residual laxity (P<0.05). CONCLUSIONS This large-scale study identified risk factors for osteoarthritis that should improve the information provided to patients on long-term progression after ACL reconstruction. LEVEL OF EVIDENCE Retrospective cohort study, level IV.
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Affiliation(s)
- O Cantin
- Service de chirurgie orthopédique, centre Albert-Trillat, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - S Lustig
- Service de chirurgie orthopédique, centre Albert-Trillat, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - F Rongieras
- Service de chirurgie orthopédique, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - D Saragaglia
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
| | - N Lefèvre
- Institut de l'appareil locomoteur Nollet, 75017 Paris, France; Clinique du sport Paris V, 75005 Paris, France
| | - N Graveleau
- Centre de consultation orthopédique et sportive, clinique du sport de Bordeaux-Mérignac, 2, rue Negrevergne, 33700 Mérignac, France
| | - C Hulet
- Département d'orthopédie-traumatologie, Unité Inserm COMETE, UMR U1075, CHU de Caen, avenue Côte-de-Nacre, 14000 Caen, France
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- SoFCOT, 56, rue Boissonade, 75014 Paris, France
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Duclos A, Peix JL, Piriou V, Occelli P, Denis A, Bourdy S, Carty MJ, Gawande AA, Debouck F, Vacca C, Lifante JC, Colin C, Aegerter P, Aouifi A, Arickx D, Aubart F, Baudrin D, Berry WR, Beuvry C, Bonnet F, Bouveret L, Cabarrot P, Cames E, Carty MJ, Caton J, Chenitz MC, Clergues F, Colin C, Coudray JM, Damiens M, Dauzac C, Debono B, Debouck F, De Germay B, Deleforterie AC, Denis A, Desrousseaux JF, Didelot MP, Doat B, Domingo-Saidji NY, Duclos A, Durieux P, Fessy M, Hardy P, Cariven P, Fontas N, Ganansia P, Gawande AA, Giraud F, Gostiaux G, Habi S, Haga S, Houlgatte A, Jaffe M, Jourdan J, Kaczmarek N, Lamblin S, Level C, Liaras E, Lifante JC, Lipsitz SR, Majchrzak C, Malavaud B, Serres TM, Martin X, Martinet C, Maupetit B, Michel P, Movondo A, Naamani B, Nacry R, Occelli P, Olousouzian S, Papin P, Paquet JC, Parfaite A, Pattou F, Paugam C, Pavy E, Peix JL, Petit H, Pierre S, Piriou V, Poupon Bourdy S, Pradere B, Quesne M, Radola Y, Raould A, Rongieras F, Rouquette I, Sanders V, Sanz F, Sens F, Surmont S, Sicre C, Tabur D, Targosz P, Thery D, Toppan N, Usandizaga G, Vacca C, Verheyde I, Zadegan F. Cluster randomized trial to evaluate the impact of team training on surgical outcomes. Br J Surg 2016; 103:1804-1814. [DOI: 10.1002/bjs.10295] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/07/2016] [Accepted: 07/15/2016] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The application of safety principles from the aviation industry to the operating room has offered hope in reducing surgical complications. This study aimed to assess the impact on major surgical complications of adding an aviation-based team training programme after checklist implementation.
Methods
A prospective parallel-group cluster trial was undertaken between September 2011 and March 2013. Operating room teams from 31 hospitals were assigned randomly to participate in a team training programme focused on major concepts of crew resource management and checklist utilization. The primary outcome measure was the occurrence of any major adverse event, including death, during the hospital stay within the first 30 days after surgery. Using a difference-in-difference approach, the ratio of the odds ratios (ROR) was estimated to compare changes in surgical outcomes between intervention and control hospitals.
Results
Some 22 779 patients were enrolled, including 5934 before and 16 845 after team training implementation. The risk of major adverse events fell from 8·8 to 5·5 per cent in 16 intervention hospitals (adjusted odds ratio 0·57, 95 per cent c.i. 0·48 to 0·68; P < 0·001) and from 7·9 to 5·4 per cent in 15 control hospitals (odds ratio 0·64, 0·50 to 0·81; P < 0·001), resulting in the absence of difference between arms (ROR 0·90, 95 per cent c.i. 0·67 to 1·21; P = 0·474). Outcome trends revealed significant improvements among ten institutions, equally distributed across intervention and control hospitals.
Conclusion
Surgical outcomes improved substantially, with no difference between trial arms. Successful implementation of an aviation-based team training programme appears to require modification and adaptation of its principles in the context of the the surgical milieu. Registration number: NCT01384474 (http://www.clinicaltrials.gov).
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Affiliation(s)
- A Duclos
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
| | - J L Peix
- Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, France
| | - V Piriou
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Service d'Anesthésie Réanimation Médicale et Chirurgicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - P Occelli
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
| | - A Denis
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - S Bourdy
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - M J Carty
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
| | - A A Gawande
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
- Ariadne Labs and Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - F Debouck
- Air France Consulting, AFM42, Chambourcy, France
| | - C Vacca
- Coordination pour l'Evaluation des Pratiques Professionnelles en Santé en Rhône-Alpes, Lyon, France
| | - J C Lifante
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, France
| | - C Colin
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
| | | | | | | | | | - D Baudrin
- Agence Régional de Santé de Toulouse
| | | | | | - F Bonnet
- Assistance Publique-Hôpitaux de Paris
| | | | | | - E Cames
- Centre Hospitalier Universitaire de Toulouse
| | - M J Carty
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J Caton
- Clinique Emile Vialar de Lyon
| | | | | | | | | | | | - C Dauzac
- Assistance Publique-Hôpitaux de Paris
| | - B Debono
- Clinique des Cèdres de Cornebarrieu
| | | | | | | | | | | | | | | | | | | | - P Durieux
- Assistance Publique-Hôpitaux de Paris
| | | | - P Hardy
- Assistance Publique-Hôpitaux de Paris
| | | | - N Fontas
- Centre Hospitalier Universitaire de Toulouse
| | | | - A A Gawande
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - S Habi
- Centre Hospitalier de Vienne
| | - S Haga
- Infirmerie Protestante de Lyon
| | - A Houlgatte
- Hôpital d'Instruction des Armées du Val de Grâce
| | - M Jaffe
- Clinique Ambroise Paré de Toulouse
| | | | | | | | - C Level
- Assistance Publique-Hôpitaux de Paris
| | - E Liaras
- Hôpital Privé de Natécia de Lyon
| | | | - S R Lipsitz
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - B Malavaud
- Centre Hospitalier Régional Universitaire de Toulouse
| | | | | | | | | | | | | | | | | | | | | | - P Papin
- Centre Hospitalier de Villefranche sur Saône
| | | | | | - F Pattou
- Centre Hospitalier Régional Universitaire de Lille
| | - C Paugam
- Assistance Publique-Hôpitaux de Paris
| | - E Pavy
- Hôpital Simone Veil d'Eaubonne
| | | | | | - S Pierre
- Institut Claudius Régaud de Toulouse
| | | | | | - B Pradere
- Centre Hospitalier Régional Universitaire de Lille
| | | | - Y Radola
- Centre Hospitalier Régional Universitaire de Lille
| | - A Raould
- Assistance Publique-Hôpitaux de Paris
| | - F Rongieras
- Hôpital d'Instruction des Armées Desgenettes de Lyon
| | | | - V Sanders
- Centre Hospitalier Régional Universitaire de Lille
| | - F Sanz
- Centre Hospitalier Régional Universitaire de Lille
| | | | | | | | | | | | - D Thery
- Institut Catholique de Lille
| | - N Toppan
- Clinique de l'Union de Saint Jean
| | | | - C Vacca
- Coordination pour l'Evaluation des Pratiques Professionnelles en Santé en Rhône-Alpes de Lyon
| | | | - F Zadegan
- Assistance Publique-Hôpitaux de Paris
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Bonnet S, Gonzalez F, Mathieu L, Boddaert G, Hornez E, Bertani A, Avaro JP, Durand X, Rongieras F, Balandraud P, Rigal S, Pons F. The French Advanced Course for Deployment Surgery (ACDS) calledCours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX): history of its development and future prospects. J ROY ARMY MED CORPS 2015; 162:343-347. [DOI: 10.1136/jramc-2015-000528] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/15/2015] [Indexed: 11/04/2022]
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8
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Tondeur G, Havé L, Bertani A, Mathieu L, Chaudier P, Rongieras F, Goldet R. Interest of postural control evaluation after ACL hamstring tendon reconstruction: A prospective monocentric study. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tondeur G, Havé L, Bertani A, Mathieu L, Chaudier P, Rongieras F, Goldet R. Intérêt de l’évaluation du contrôle postural après ligamentoplastie du LCA par transplant DIDT : étude prospective monocentrique contrôlée. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zhu Y, Fang Y, Bermond F, Bruyère-Garnier K, Ellouz R, Rongieras F, Mitton D. Relationship between human rib mechanical properties and cortical bone density measured by high-resolution quantitative computed tomography. Comput Methods Biomech Biomed Engin 2013; 16 Suppl 1:191-2. [DOI: 10.1080/10255842.2013.815888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Beillas P, Helfenstein C, Rongieras F, Gennisson JL, Tanter M. A new method to assess the deformations of internal organs of the abdomen during impact. Comput Methods Biomech Biomed Engin 2013; 16 Suppl 1:202-3. [DOI: 10.1080/10255842.2013.815913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bertani A, Launay F, Candoni P, Mathieu L, Rongieras F, Chauvin F. Teleconsultation in paediatric orthopaedics in Djibouti: evaluation of response performance. Orthop Traumatol Surg Res 2012; 98:803-7. [PMID: 23040542 DOI: 10.1016/j.otsr.2012.03.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 02/20/2012] [Accepted: 03/12/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Djibouti has no paediatric orthopaedics department and three options are available for difficult cases: transfer of the patient to another country; overseas mission transfer to Djibouti by a specialised surgical team; and management by a local orthopaedic surgeon receiving guidance from an expert. The extreme poverty of part of the population of Djibouti often precludes the first two options. Telemedecine can allow the local orthopaedic surgeon to receive expert advice. HYPOTHESES AND STUDY DESIGN: We prospectively recorded all the paediatric orthopaedics teleconsultations that occurred between November 2009 and November 2011. Our objective was to assess the performance of the teleconsultations. We hypothetized that this option was influential in decision making. MATERIALS AND METHODS We assessed the influence of the teleconsultation on patient management (i.e., change in the surgical indication and/or procedure). We then used the electronic patient records to compare the actual management to that recommended retrospectively by two independent orthopaedic surgeon consultants who had experience working overseas. Finally, we assessed the clinical outcomes in the patients. RESULTS Of 48 teleconsultations for 39 patients, 13 dealt with diagnostic problems and 35 with therapeutic problems. The teleconsultation resolved the diagnostic uncertainties in 90% of cases. Advice from the expert modified the management in 37 (77%) teleconsultations; the change was related to the surgical indication in 18 cases, the surgical technique in 13 cases, and both in six cases. Agreement between the advice from the independent consultants and the treatment delivered by the local surgeon was 2.2/3. Clinical outcomes were good or very good in 31 (81%) of the 38 treated patients. CONCLUSIONS This study establishes the feasibility and usefulness of paediatric orthopaedics teleconsultations in Djibouti. The introduction of telemedicine has changed our approach to challenges raised by patients in remote locations or precarious situations. Input from experts considerably benefits patient management. LEVEL OF EVIDENCE III, prospective comparative study.
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Affiliation(s)
- A Bertani
- Service de chirurgie orthopédique et traumatologique, 108, boulevard Pinel, 69005 Lyon, France.
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13
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Prat N, Rongieras F, Sarron JC, Miras A, Voiglio E. Contemporary body armor: technical data, injuries, and limits. Eur J Trauma Emerg Surg 2012; 38:95-105. [DOI: 10.1007/s00068-012-0175-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 01/08/2012] [Indexed: 10/14/2022]
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14
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Pichon-Jagou M, Estival JL, Rabar D, Rongieras F. Prise en charge chirurgicale d’un syndrome des grosses mains. Ann Dermatol Venereol 2011. [DOI: 10.1016/j.annder.2011.10.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Mathieu L, Rongieras F, Fascia P, Ollat D, Chauvin F, Versier G. Disjonctions acromio-claviculaires traitées par ligamentoplastie synthétique coraco-claviculaire. ACTA ACUST UNITED AC 2007; 93:116-25. [PMID: 17401284 DOI: 10.1016/s0035-1040(07)90214-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE OF THE STUDY The aim of this study was to evaluate results of coraco-clavicular ligamentoplasty using a synthetic material, dacrylene, for the treatment of recent and neglected acromio-clavicular dislocation. MATERIAL AND METHODS The series initially included 104 patients who underwent surgery from 1981 to 2001. Among these, 75 were reviewed with a mean follow-up of 85 months (72% review rate). A complete set of clinical (Constant score/100 points) and radiographic (coraco-clavicular distance) data was available for 39 patients. Thirty-six answered a questionnaire with measurement of a partial Constant score (65 points). RESULTS Seventy-seven percent of patients were satisfied or very satisfied and 98% presented good or very good functional outcome as assessed by the partial Constant score. Reduction of the coraco-clavicular distance was satisfactory for 54% of patients evaluated. For the vast majority, insufficient reduction was reducible and had no impact on the functional outcome. The time to treatment (recent or neglected dislocation) had no effect on patient satisfaction or functional outcome. The coraco-clavicular distance was greater for dislocations operated on late (p<0.05). The grade of the injury, the type of assembly used, and use or not of lateral clavicular resection had no effect on clinical or radiological outcomes. Dacrylene was tolerated poorly by 14 patients (18.7%). The functional outcome was very good for all after removal of the ligament. DISCUSSION Functional results are good with this technique which enables a well sustained stable reduction of recent and neglected dislocations, irrespective of the grade of the lesion or the type of assembly used. Reducing the mechanical stress on the ligament and prudent rehabilitation exercises should be helpful in preventing intolerance reactions.
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Affiliation(s)
- L Mathieu
- Service d'Orthopédie et Traumatologie, Hôpital d'Instruction des Armées Bégin, 69 avenue de Paris, 94160 Saint-Mandé.
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Caillot JL, Rongieras F, Voiglio E, Isaac S, Neidhardt JP. A new case of congenital cyst of the pancreas. Hepatogastroenterology 2000; 47:916-8. [PMID: 11020847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A new case of congenital cyst of the pancreas is reported. A 34-year-old woman was admitted with a painless, large, epigastric mass. Ultrasonography revealed an anechogenic retrogastric tumor. Computed tomography scan described a liquid cyst of the pancreas which was 15 cm in diameter. During surgery, a well-delimited translucent cyst was found and no local malignancy was observed. Extensive distal pancreatic resection with preservation of the spleen was performed and a thin part of cephalic pancreas was preserved. The liquid of the cyst did not contain any mucus. Microscopic study of the cyst wall described normal cuboidal cells and congenital cyst of the pancreas was diagnosed. Several diagnoses including hydatid cyst, pseudocyst and cystic tumors of the pancreas are discussed. Before surgery, lack of acute pancreatitis in recent medical history rules out pseudocyst and hydatid cyst. During the operation, if cystadenocarcinoma is easily ruled out, macrocystic serous cystadenoma is more difficult to exclude. Only histological examination of the cystic wall confirms the difference between cystadenoma and congenital cyst which remains an exceptional entity.
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Affiliation(s)
- J L Caillot
- Department of Surgical Emergency, Lyon-Sud University Hospital, Pierre-Bénite, France.
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