1
|
Saad M, Tonetti J, Kerschbaumer G, Boudissa M. Navigated pedicle screw insertion with the Surgivisio system: malposition rate and risk factors - about 648 screws. Orthop Traumatol Surg Res 2024:103899. [PMID: 38677474 DOI: 10.1016/j.otsr.2024.103899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/05/2023] [Revised: 02/06/2024] [Accepted: 04/23/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Pedicle screw malposition rates vary greatly in scientific literature depending on the chosen criteria. Different techniques have been developed to lower the risk of screw malposition. Our primary objective is to evaluate the malposition rate associated with the use of the Surgivisio navigation system and to identify risk factors for screw malposition. The secondary objectives are to assess operating time and radiation data. MATERIALS AND METHODS We performed a monocentric retrospective consecutive case series. All patients operated for pedicle screw implantation using the Surgivisio system between September 2017 and June 2020 were included. Screw positioning was evaluated on post-operative CT scans using Heary and Gertzbein classifications. Thirteen potential risk factors for screw malposition were hypothesized and tested with a univariate and multivariate analysis. RESULTS 648 screws could be evaluated in 97 patients. Our study reported a 92.4% satisfactory screw implantation rate with a mean operative time per screw of 14,5 ± 6,7 minutes and a patient effective dose of 0,47 ± 0,31 mSv per screw. One screw was neurotoxic and required an early revision (0,15%). Three risk factors for screw malposition have been identified in a multivariate analysis : female gender (OR 2,13 [1,11 ; 4], p = 0,0219), an implantation level above D10 (OR 2,17 [1,13 ; 4,16], p = 0,0197), and an "open" surgery (as opposed to percutaneous) (OR 3,47 [1,83 ; 6,56], p = 0,0002). CONCLUSION Pedicle screw malposition rate and operative time with the Surgivisio navigation system are comparable with those reported in scientific literature. We theorized that intraoperative patient reference displacement could be a major cause of navigation failure. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Maxime Saad
- Service de chirurgie orthopédique et traumatologique, CHU Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble Alpes, Grenoble, France.
| | - Jérôme Tonetti
- Service de chirurgie orthopédique et traumatologique, CHU Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble Alpes, Grenoble, France; CNRS UMR 5525, laboratoire TIMC-IMAG, université Grenoble Alpes, Pavillon Taillefer, 38700 La Tronche, France
| | - Gaël Kerschbaumer
- Service de chirurgie orthopédique et traumatologique, CHU Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble Alpes, Grenoble, France
| | - Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologique, CHU Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble Alpes, Grenoble, France; CNRS UMR 5525, laboratoire TIMC-IMAG, université Grenoble Alpes, Pavillon Taillefer, 38700 La Tronche, France
| |
Collapse
|
2
|
Tolosano L, Rieussec C, Sauzeat B, Caillard G, Drevet S, Kerschbaumer G, Porcheron G, Wagner D, Rommens PM, Tonetti J, Boudissa M. Fragility fractures of the pelvis: First 48 cases of surgical treatment at a level 1 trauma center in France. Orthop Traumatol Surg Res 2024:103855. [PMID: 38438109 DOI: 10.1016/j.otsr.2024.103855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/19/2021] [Revised: 06/30/2023] [Accepted: 01/04/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Longer life expectancy is accompanied by a higher incidence of fragility fractures of the pelvis (FFP), which has repercussions on mortality and nursing home admissions. Given the paucity of data at French healthcare facilities, we carried out a retrospective study to (1) evaluate how surgical treatment of FFP with posterior displacement (type III and IV according to Rommens and Hofmann) affects a patient's pain, functional status and ability to stay at home and (2) evaluate the postoperative complications and mortality rate. HYPOTHESIS Surgery for posteriorly displaced FFP will relieve pain and preserve the patient's independence. METHODS All the patients over 65 years of age who were operated on for a posterior FFP between January 2015 and August 2020 were included in this prospective, single-center study. The demographics, fracture type, details of the surgical treatment, complications and mortality were analyzed. Pain (visual analog scale, VAS), functional status (Activity of Daily Living [ADL] and Instrumental Activity of Daily Living [IADL]), mobility (Parker score) and rates of nursing home admissions were compared before the fracture, after surgery and at a mean follow-up of 28 months (minimum follow-up of 1 year). RESULTS Forty-eight patients with a mean age of 75 years were included. Twenty-four of these patients (50%) had at least two comorbidities. The FFPs were either type IV (31/48; 65%) or type III (17/48; 35%). The mean VAS for pain was significantly lower on the first day postoperative (3.5 versus 4.8; p=0.02). This significant reduction continued upon discharge from the hospital (1.95; p=0.003) and persisted at the mean follow-up of 28 months (2.2; p=0.64). The complication rate was 15% (7/48) and the mortality rate at the final review was 15% (7/48). Among the surviving patients, 81% (29/36) returned to living at home. The ADL (5.1 versus 5.8; p=0.09), IADL (5.9 versus 6.9; p=0.15) and Parker score (6.8 versus 8.2; p=0.08) at the final review were not significantly different from the values before the fracture. CONCLUSION This is the first French study of patients operated on for an FPP. Fixation of posteriorly displaced fractures allows surviving patients to retain their mobility. Pain relief is achieved quickly and maintained during the follow-up period. Thus, our initial hypothesis is affirmed. The complication rate is not insignificant; given the complexity of this surgery, percutaneous treatment is preferable. LEVEL OF EVIDENCE IV; retrospective study.
Collapse
Affiliation(s)
- Luca Tolosano
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France
| | - Clementine Rieussec
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France
| | - Bérengère Sauzeat
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France
| | - Gauthier Caillard
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France
| | - Sabine Drevet
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France
| | - Gael Kerschbaumer
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France
| | - Geoffrey Porcheron
- Orthopedic and Trauma Surgery Department, Mayence University Hospital, Langenbeckstrasse 1, 55131 Mayence, Germany
| | - Daniel Wagner
- Orthopedic and Trauma Surgery Department, Mayence University Hospital, Langenbeckstrasse 1, 55131 Mayence, Germany
| | - Pol Maria Rommens
- Orthopedic and Trauma Surgery Department, Mayence University Hospital, Langenbeckstrasse 1, 55131 Mayence, Germany
| | - Jérôme Tonetti
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France; TIMC-IMAG lab, CNRS UMR 5525, Grenoble Alpes University, 38700 La Tronche, France
| | - Mehdi Boudissa
- Orthopedic and Trauma Surgery Department, University Hospital, Grenoble Alpes University, 38700 La Tronche, France; TIMC-IMAG lab, CNRS UMR 5525, Grenoble Alpes University, 38700 La Tronche, France.
| |
Collapse
|
3
|
Caudron M, Gerset V, Tronc C, Tonetti J, Boudissa M. Anterior approaches in acetabular fractures: a true learning curve analysis. Acta Orthop Belg 2024; 90:17-25. [PMID: 38669644 DOI: 10.52628/90.1.10974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Today, acetabular surgeons in training have to learn ilioinguinal and anterior intrapelvic approaches (AIP). The aim of this study was to describe the 5-years learning curve of a surgeon. Objective was to assess clinical and radiological results; and to assess factors which could influence this learning curve. Between November 2015 and May 2020, patients with an acetabular fracture operated by the surgeon during the 5-years learning curve with an anterior approach were included in this single-center retrospective study based on a prospective database. Epidemiological, operative, clinical, radiological and complications data's were collected. To assess learning-curve effect the series was divided into two groups: first 2.5-years and last 2-years. Subgroup analysis were performed according to the surgical approach, to the reduction quality and the prognostic factors. In total, 46 patients were included, 23 in period 1 and 23 in period 2. 16 patients (35%) had ilioinguinal approach and 30 patients (65%) had modified Stoppa-Cole approach. At mean follow-up of 24 months, 38 patients (83%) were reviewed. Anatomical reduction (< 1 mm) was achieved in 28 patients (60.9%) with a 9% rate of perioperative complications and 37% rate of post-operative complications. In conclusion, this study gives a realistic overview of the learning curve of anterior approaches in acetabular fractures surgery. Our results should encourage surgeons, while keeping in mind how much this surgery can be challenging, with high rate of complications and difficulty to obtain a systematic anatomical reduction.
Collapse
|
4
|
Boudissa M, Sauzeat B, Noblet B, Tonetti J, Chabanas M. Simulation Software to Plan the Treatment of Acetabular Fractures: The Patient-Specific Biomechanical Model. J Orthop Trauma 2023; 37:S18-S22. [PMID: 37828697 DOI: 10.1097/bot.0000000000002689] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES The objective of this study was to assess the impact of using simulation software for preoperative planning: a patient-specific biomechanical model (PSBM) in acetabular surgery. The secondary objectives were to assess operating time, intraoperative bleeding, and peroperative complications. DESIGN This is a prospective control study. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS Between January 2019 and December 2022, patients with operative acetabular fracture treated by the first author were prospectively enrolled. INTERVENTION Patients were divided into 2 groups according to the use or not of PSBM for preoperative planning. When PSBM was used, data were extracted from the preoperative high-resolution computed tomography scans to build a biomechanical model implemented in a custom software [simulation (SIM group)]. When computed tomography scans were not performed in our hospital, PSBM was not feasible (non-SIM group). MAIN OUTCOME MEASUREMENTS Radiological results, surgery duration, blood loss, and peroperative complications were recorded. RESULTS Sixty-six patients were included; 26 in the PSBM group and 40 in the standard group. The 2 groups were comparable regarding fracture patterns and epidemiological data. After simulation, in the SIM group, a poor reduction (>3 mm) was found in 2 of 26 patients (7.7%) versus 11 of 40 patients (27.5%) in the non-SIM group, P = 0.048. The mean operative time was shorter after simulation (110 minutes vs. 155 minutes, P = 0.01), and the mean blood loss was reduced (420 vs. 670 mL, P = 0.01). CONCLUSIONS By reducing the peroperative trials for reduction, PSBM allows better reduction in a shorter operative time and with less blood loss. LEVEL OF EVIDENCE Level II: prospective study.
Collapse
Affiliation(s)
- Mehdi Boudissa
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Grenoble Alpes University, La Tronche, France; and
- TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS UMR 5525, La Tronche, France
| | - Bérengère Sauzeat
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Grenoble Alpes University, La Tronche, France; and
| | - Baptiste Noblet
- TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS UMR 5525, La Tronche, France
| | - Jérôme Tonetti
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Grenoble Alpes University, La Tronche, France; and
- TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS UMR 5525, La Tronche, France
| | - Matthieu Chabanas
- TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS UMR 5525, La Tronche, France
| |
Collapse
|
5
|
Tonetti J, Martz P, Riouallon G, Boudissa M. New trends in hip and pelvic-acetabular fixation. Orthop Traumatol Surg Res 2023; 109:103698. [PMID: 37797806 DOI: 10.1016/j.otsr.2023.103698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Jerome Tonetti
- Clinique universitaire de chirurgie orthopédique et traumatologie, hôpital A. Michallon, CS 10217, 38043 Grenoble cedex 9, France.
| | - Pierre Martz
- Service de chirurgie orthopédique et traumatologique, hôpital F. Mitterrand, BP 77908, 14, rue Paul-Gaffarel, 21079 Dijon, France
| | - Guillaume Riouallon
- Service de chirurgie orthopédique et traumatologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris, France
| | - Mehdi Boudissa
- Clinique universitaire de chirurgie orthopédique et traumatologie, hôpital A. Michallon, CS 10217, 38043 Grenoble cedex 9, France
| |
Collapse
|
6
|
Corbet C, Boudissa M, Dao Lena S, Ruatti S, Corcella D, Tonetti J. Surgical treatment of terrible triad of the elbow: Retrospective continuous 50-patient series at 2 years' follow-up. Orthop Traumatol Surg Res 2023; 109:103057. [PMID: 34536597 DOI: 10.1016/j.otsr.2021.103057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/26/2019] [Revised: 10/02/2020] [Accepted: 12/31/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Terrible triad (TT) of the elbow is an association at high risk of instability. Treatment aims to restore joint stability. Lateral collateral ligament (LCL) repair is systematic, whereas medial collateral ligament (MCL) repair is only exceptionally necessary. The main aim of the present study was to assess clinical results in TT surgery. The secondary objective was to compare clinical progression with versus without MCL repair. MATERIAL AND METHODS A retrospective study included 50 TTs operated on via an isolated lateral or combined medial-lateral approach. Clinical assessment comprised MEPS, QuickDASH, VAS, flexion-extension and pronation-supination, and return to work and sport. Subgroup analysis was made according to associated MCL repair. RESULTS Fifty patients (19 female, 31 male) were operated on between January 2006 and January 2017. Mean follow-up was 24 months. At last follow-up, mean MEPS was 89.1, VAS 0.7, QuickDASH 16, flexion-extension 114°, and pronation-supination 137°. Only MEPS was significantly improved by MCL repair (p=0.02), with no significant difference in complications. DISCUSSION TT surgery with immediate mobilization gave good long-term functional results, not significantly improved by MCL repair. The lateral approach should be adopted in first line, with the medial approach in second line in case of persistent instability after lateral osteo-ligamentous repair. LEVEL OF EVIDENCE IV; retrospective study.
Collapse
Affiliation(s)
- Clémentine Corbet
- Service Orthopédie et Traumatologie, CHU Grenoble Alpes, Boulevard de la Chantourne, 38700 La Tronche, France.
| | - Mehdi Boudissa
- Service Orthopédie et Traumatologie, CHU Grenoble Alpes, Boulevard de la Chantourne, 38700 La Tronche, France
| | | | - Sébastien Ruatti
- Service Orthopédie et Traumatologie, CHU Grenoble Alpes, Boulevard de la Chantourne, 38700 La Tronche, France
| | - Denis Corcella
- Service de Chirurgie de la Main et des Brûlés, CHU Grenoble Alpes, Boulevard de la Chantourne, 38700 La Tronche, France
| | - Jérôme Tonetti
- Service Orthopédie et Traumatologie, CHU Grenoble Alpes, Boulevard de la Chantourne, 38700 La Tronche, France
| |
Collapse
|
7
|
de Ridder VA, Pape HC, Chana-Rodríguez F, Boudissa M, Claudia G, Fabian S, Steven H, Tina H, Konstantinos T, Zoe D. Managing periprosthetic fractures: perspectives on periprosthetic pelvic fractures. OTA Int 2023; 6:e266. [PMID: 37006450 PMCID: PMC10064643 DOI: 10.1097/oi9.0000000000000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 03/30/2023]
Abstract
Periacetabular periprosthetic fractures are rare but potentially disastrous for the longevity of the adjacent implants, leading to multiple revision surgeries. It is of paramount importance to identify and treat intraoperative fractures, which will lead to satisfactory results. Postoperative fractures may be managed operatively or nonoperatively depending on the patient's pain and function, the fracture pattern, and the stability of the acetabular component.
Collapse
|
8
|
Caudron M, Boudissa M, Tonetti J. Succession of failures in surgical management of fragility fracture of the pelvis. Trauma Case Rep 2022; 42:100731. [PMID: 36386428 PMCID: PMC9649390 DOI: 10.1016/j.tcr.2022.100731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Case We report a case of a 79-years old man who sustained a Fragility Fracture of the Pelvis (FFP) classified type IVb according to Rommens and Hofmann. After a delayed diagnosis with persistence of pain and loss of mobility, a bilateral sacroplasty was performed. Although pain relief was achieved, a fracture progression (FP) occurred with bilateral neurologic compression of L5 and S1 nerve roots with pain recurrence. A percutaneous ilio-lumbar reduction was attempted with cemented augmentation and bilateral ilio-sacral screwing. Reduction was not achieved and screws finally pulled-out. The patient died one year after institutionalization with a significant loss of mobility and autonomy. Conclusions Misunderstanding in management of FFP according to Rommens and Hofmann recommendations can lead to bad results with fracture progression, implants failure, pain recurrence, loss of function, loss of autonomy and finally death of the patient.
Collapse
|
9
|
Prod'homme M, Tonetti J, Boscherini D, Cavalié G, Kerschbaumer G, Grasset D, Boudissa M. Navigated Cementoplasty With O-Arm and Surgivisio: An Ambispective Comparison With Radiation Exposure. Int J Spine Surg 2022; 16:944-952. [PMID: 36113951 PMCID: PMC10151395 DOI: 10.14444/8348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Vertebral compression fractures (VCF) are usually treated by cementoplasty. Computerized navigation allows more accurate surgery without additional imaging acquisition for guidance and related radiation exposure. New technologies trend to optimize the irradiation for patients and surgeons. The objective was to investigate the radiological results and radiation exposure of O-arm navigation compared with the all-in-one 2-dimensional/3-dimensional (2D/3D) Surgivisio device in navigated cementoplasty procedures. METHODS Patients in the O-arm group comprised an O-arm prospective cohort as well as previous patients. Operations for VCF by navigated cementoplasty took place over 18 months. Patients in the Surgivisio group were the first patients operated on using Surgivisio and were prospectively recruited. Demographic, operative, and irradiation data were collected, as well as the image quality subjectively evaluated by the surgeon. The vertebal filling was evaluated using the Garnier classification and quoted as satisfactory, acceptable, or poor. The effective dose in millisievert (mSv) was calculated for radiation exposure estimation, and the absolute risk of cancer (AR) in percent equivalent to a whole-body irradiation was also calculated. RESULTS A total of 123 patients were included: 62 in the O-arm group and 61 in the Surgivisio group. A total of 166 vertebrae were analyzed. Compared with the Surgivisio group, the effective dose was significantly higher in the O-arm group, with a mean of 11.47 vs 1.14 mSv, respectively (P < 0.001). The 2D part of the effective dose received by the surgeon was significantly higher in the O-arm group, with an average of 2.25 vs 0.47 mSv, respectively (P < 0.001). Overall AR followed the same trend, with a mean of 4.9 × 10-4% in the O-arm group and 5.7 × 10-5% in the Surgivisio group (P < 0.001). Operative time was significantly higher in the O-arm group (34.52 vs 30.12 minutes respectively, P = 0.03). Image quality was similarly sufficient in 3D, but in 2D, image quality was significantly better in the O-arm group (P = 0.01). Vertebral filling was significantly better in the O-arm group, with 100% of results reported as satisfactory and acceptable versus 85% in the Surgivisio group (P < 0.001). CONCLUSIONS The O-arm delivered a 10-times higher effective dose during navigated cementoplasty in comparison with the Surgivisio device. The O-arm also had a longer operative time, but it had better image quality and radiological results. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Marc Prod'homme
- Clinic La Source, Neuro Orthopedic Center, Lausanne, Switzerland
| | - Jérôme Tonetti
- Orthopedic Surgery Department, University Hospital of Grenoble, La Tronche, France
| | | | - Guillaume Cavalié
- Orthopedic Surgery Department, University Hospital of Grenoble, La Tronche, France
| | - Gael Kerschbaumer
- Orthopedic Surgery Department, University Hospital of Grenoble, La Tronche, France
| | - Didier Grasset
- Clinic La Source, Neuro Orthopedic Center, Lausanne, Switzerland
| | - Mehdi Boudissa
- Orthopedic Surgery Department, University Hospital of Grenoble, La Tronche, France
| |
Collapse
|
10
|
Cavalié G, Boudissa M, Kerschbaumer G, Seurat O, Ruatti S, Tonetti J. Clinical and radiological outcomes of antegrade posterior column screw fixation of the acetabulum. Orthop Traumatol Surg Res 2022; 108:103288. [PMID: 35470116 DOI: 10.1016/j.otsr.2022.103288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/19/2021] [Revised: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Antegrade posterior column screw fixation (APCS) provides stable fixation while reducing the complications related to dual acetabular approaches. The objective of this study was to present the radiological and clinical outcomes of fixation of the posterior column of the acetabulum through a single anterior approach. HYPOTHESIS APCS will produce better clinical and radiological outcomes relative to not placing any screws in the posterior column. PATIENTS AND METHODS This was a retrospective single-center study of 69 patients operated through a single anterior approach for a both-column fracture of the acetabulum between 2014 and 2018. Patients were divided into two groups (APCS+, n=24 and APCS-, n=45) depending on whether the posterior column was fixed with an antegrade lag screw or not. The radiological outcomes were defined by the quality of the reduction according to Matta. The clinical outcomes were evaluated using the Harris Hip score and Merle Postel D'Aubigné (MDP) score at the final assessment. A sequential hierarchical analysis was done with a Chi2 test for the radiological criterion and Student's t test for the clinical outcomes. RESULTS In the APCS+ group, the reduction was anatomical in 71% (17/24) of patients, imperfect in 12% (3/24) and poor in 17% (4/24). In the APCS- group, the reduction was anatomical in 33% (15/45) of patients, imperfect in 31% (14/45) and poor in 35% (16/45). This difference between groups was statistically significant (p=.012). The differences between groups in the Harris (p=.201) and MDP (p>.05) scores were not significant. Mean irradiation in the APCS+ group was significantly higher (114.8 cGy.cm-2) relative to the APCS- group (39.8 cGy.cm-2) (p<.001). None of the patients in the APCS+ group underwent a subsequent total hip arthroplasty, while 8 patients from the APCS- group did (p=.031). The differences in the postoperative complications were not statistically significant. DISCUSSION APCS yields satisfactory radiological and clinical outcomes without increasing the complication rate; this must be balanced out against the additional irradiation. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Guillaume Cavalié
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble-Alpes, Laboratoire d'Anatomie des Alpes Françaises (LADAF), Faculté de médecine, Domaine de la Merci, 38700 La Tronche, France.
| | - Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - Gaël Kerschbaumer
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - Olivier Seurat
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - Sébastien Ruatti
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - Jérôme Tonetti
- Service de chirurgie orthopédique et traumatologie Nord, CHU Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France; Université Grenoble-Alpes, Laboratoire TIMC-IMAG, CNRS UMR 5525, 38000 Grenoble, France
| |
Collapse
|
11
|
Boudissa M, Carmagnac D, Kerschbaumer G, Ruatti S, Tonetti J. Screw misplacement in percutaneous posterior pelvic iliosacral screwing with and without navigation: A prospective clinical study of 174 screws in 127 patients. Orthop Traumatol Surg Res 2022; 108:103213. [PMID: 35081456 DOI: 10.1016/j.otsr.2022.103213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/11/2020] [Revised: 03/22/2021] [Accepted: 04/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Recent studies of iliosacral screw fixation performed using intraoperative navigation systems have shown promising results. The Surgivisio Platform is a new-generation three-dimensional intraoperative navigation tool that has been used at our institution for 2years. The aim of this prospective study was to assess the contribution of navigation in terms of iliosacral screw positioning accuracy and of radiation exposure, by comparing outcomes with vs. without navigation. HYPOTHESIS Navigation allows more accurate percutaneous iliosacral screw positioning regardless of the type of screw fixation (with sacral dysmorphism and/or cemented screw fixation and/or multiple screw fixation). MATERIALS AND METHODS Between January 2018 and December 2019, consecutive patients who underwent percutaneous iliosacral screw fixation of pelvic ring fractures without vertical instability were included in this single-centre prospective study. Screw position accuracy was evaluated by postoperative high-resolution computed tomography (HRCT). Operative time, radiation dose, and complications were recorded. RESULTS We included 127 patients with 174 iliosacral screws, of which 129 were positioned under fluoroscopic guidance and 45 using navigation. According to the modified Gras classification, 7% (12/174) of the screws were incorrectly positioned and 2% (4/174) required repositioning. The frequency of screw malposition was not significantly different between the fluoroscopy and navigation groups (8.5%, 11/129 vs. 2.2%, 1/45, respectively; p=0.19). However, screw position in dysmorphic sacra was significantly better with navigation (p=0.04), whereas no significant difference in final screw position was found for cemented or multiple screw implantations. In the navigation group, the operative time was significantly longer (28.2min vs. 21.6min, p=0.003), and the mean dose-area product significantly greater (6.6Gy·cm2 vs. 4.9Gy·cm2, p=0.02). The complication rates were not different between the two groups. CONCLUSION In patients who have pelvic ring fractures without vertical instability, navigation of percutaneous iliosacral screw placement using the Surgivisio Platform improves screw positioning in dysmorphic sacra, at the cost of a longer operative time and greater radiation exposure of the patient. LEVEL OF EVIDENCE II, prospective study.
Collapse
Affiliation(s)
- Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Grenoble, université Grenoble Alpes, 38700 La Tronche, France; TIMC-IMAG lab, Université. Grenoble Alpes, CNRS UMR 5525, 38700 La Tronche, France.
| | - Delphine Carmagnac
- Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Grenoble, université Grenoble Alpes, 38700 La Tronche, France
| | - Gaël Kerschbaumer
- Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Grenoble, université Grenoble Alpes, 38700 La Tronche, France
| | - Sébastien Ruatti
- Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Grenoble, université Grenoble Alpes, 38700 La Tronche, France
| | - Jérôme Tonetti
- Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Grenoble, université Grenoble Alpes, 38700 La Tronche, France; TIMC-IMAG lab, Université. Grenoble Alpes, CNRS UMR 5525, 38700 La Tronche, France
| |
Collapse
|
12
|
Rommens PM, Hopf JC, Arand C, Handrich K, Boudissa M, Wagner D. Prospective assessment of key factors influencing treatment strategy and outcome of fragility fractures of the pelvis (FFP). Eur J Trauma Emerg Surg 2022; 48:3243-3256. [PMID: 35122506 PMCID: PMC9360063 DOI: 10.1007/s00068-022-01887-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Fragility fractures of the pelvis (FFP) are a clinical entity with an increasing significance in clinical practice. Little is known about the conditions, which influence decision making and outcome. SETTING Level I trauma center. MATERIAL AND METHODS Prospective assessment of selected parameters of patients, who were admitted with a FFP in a 2-year period. Fractures were classified in accordance with the Rommens and Hofmann classification. Living environment, level of autonomy (independent walking), type of treatment (conservative versus operative), type of surgical technique, European Quality of Life-5 Dimensions-5 Levels (EQ-5D-5L), Short Form-8 Physical Component Score (SF-8 PCS) and Short Form-8 Mental Component Score (SF-8 MCS), Barthel Index, Parker Mobility Score (PMS) and Numeric Rating Scale (NRS) were collected at primary presentation (t1), at discharge (t2) and after 3 (t3) and 12 months (t4). Length of hospital stay, in-hospital complications, surgery-related complications, new osteoporotic fractures and mortality rate within the first year were also registered. The key factors influencing the choice of therapy and outcome were looked for. RESULTS 110 patients, 99 women (90%) and 11 men (10%), were included in the study. Their mean age was 79.2 years (SD 10 years). Fourteen patients had FFP type I (12.7%), 59 FFP type II (53.6%), 11 FFP type III (10%) and 26 FFP type IV fractures (23.6%). All patients with FFP type I were treated conservatively. 48 patients with FFP types II-IV were treated conservatively and 48 operatively. Patients, who got a conservative outpatient treatment first and were hospitalized later, had higher FFP fracture types at admission. Operatively treated patients were hospitalized at a median of 33.5 days after the beginning of complaints, whereas the median day of admission of the conservative group was the day of trauma (p < 0.001). The operatively treated patients were hospitalized in a worse clinical condition (SF-8 PCS, EQ-5D-5L, autonomy). Length of stay (LoS) of operatively treated patients was significantly longer than of conservatively treated (p < 0.001). There was a tendency to more in-hospital complications in the operative group (p = 0.059). The rate of surgery-related complications (8.3%) was low with only one revision needed. Selected outcome parameters improved during the observation period nearly reaching the level before FFP after 1 year. SF-8 PCS, Barthel index and rate of patients living home were higher in the operative group at t4. The improvement of autonomy (independent walking) between t1 and t4 was significant in the operated group (p = 0.04) but not in the conservative group (p = 0.96). One-year mortality rate was 11.7% with no difference between the fracture types. One-year mortality rate of conservatively treated patients with FFP type II-IV was 13.5% versus 6.9% in the operative group (p = 0.38). CONCLUSION Conservative treatment is appropriate in patients with FFP type I as well as in patients with FFP type II, provided that the last ones are hospitalized immediately after the traumatic event. Surgical treatment is recommended in patients with higher fracture types, with delayed presentation or after unsuccessful conservative treatment. In the conservative and operative group, all selected parameters considerably improved between t1 and t4 with a steeper increase in the operative group. The rate of postoperative complications is low. The 1-year mortality rate is the lowest in the operative group. Surgical stabilization of FFP is safe and reliable provided it is performed with care and in the appropriate target group.
Collapse
Affiliation(s)
- Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Johannes Christoph Hopf
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Charlotte Arand
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Kristin Handrich
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Mehdi Boudissa
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Daniel Wagner
- Department of Orthopaedics and Traumatology, University Medical Center, Langenbeckstrasse 1, 55131 Mainz, Germany
| |
Collapse
|
13
|
Jalbert R, Blain H, Boudissa M, Bioteau C, Parent T, Arnaud M, Tonetti J, Gavazzi G, Drevet S. Zoledronic Acid Contraindications Prevalence among Hip-Fractured Patients Aged 75 Years or Over Hospitalized in an Orthogeriatric Unit. Gerontology 2022; 68:1224-1232. [PMID: 35066496 DOI: 10.1159/000520999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/02/2021] [Accepted: 11/17/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Zoledronic acid (ZA) is an antiosteoporotic drug that has been proven to reduce mortality after a hip fracture (HF). ZA is however underused with older HF patients. One possible cause may be the high prevalence of severe renal failure and hypocalcemia which contraindicate ZA administration. The aim of this study was to assess the prevalence of these 2 contraindications in patients aged 75 years or older admitted into an orthogeriatric (OG) unit after a low-energy HF. The secondary objective was to assess the prevalence of situations in which ZA must be used with caution. METHODS Our retrospective descriptive monocentric study was performed in an OG unit on a cohort of elderly patients hospitalized for HF from August 2015 to August 2017. Prevalence of hypocalcemia lower than 2 mmol/L and Cockcroft creatinine clearance lower than 35 mL/min was recorded. RESULTS Among the 194 patients admitted for HF, 136 patients (mean age 86 ± 5.6 years; 101 women) were included. The mean length of hospital stay was 15 ± 9 days. 111 (81.5%) had no contraindications to ZA administration. More than 80% presented situations in which ZA had to be used with caution, including 25(OH)D deficiency (20%). CONCLUSION The majority of subjects aged 75 years or older admitted to hospital after an HF seem to have no contraindication for ZA administration during their immediate postoperative hospital stay. The hospitalization period after HF repair gives the opportunity to give most of them this treatment to improve their prognosis, taking into account situations in which ZA must be used with caution.
Collapse
Affiliation(s)
- Robin Jalbert
- Centre Hospitalier Métropole Savoie, Service de gériatrie, Chambéry, France
| | - Hubert Blain
- CHU de Montpellier, université Montpellier 1, Centre Antonin-Balmes, unité de soins aigus gériatriques, Montpellier, France
| | - Mehdi Boudissa
- Service hospitalo-universitaire de chirurgie orthopédique et traumatologique, hôpital Nord, CHU Grenoble Alpes, La Tronche, France.,Université Grenoble Alpes, Faculté de Médecine et Pharmacie, La Tronche, France
| | - Catherine Bioteau
- Service hospitalo-universitaire de médecine gériatrique, CHU Grenoble Alpes, La Tronche, France
| | - Thibault Parent
- Hôpital universitaire de Genève, Service de médecine interne général (SMIG), Geneva, Switzerland
| | - Mélanie Arnaud
- Service hospitalo-universitaire de médecine gériatrique, CHU Grenoble Alpes, La Tronche, France
| | - Jérôme Tonetti
- Service hospitalo-universitaire de chirurgie orthopédique et traumatologique, hôpital Nord, CHU Grenoble Alpes, La Tronche, France.,Université Grenoble Alpes, Faculté de Médecine et Pharmacie, La Tronche, France
| | - Gaëtan Gavazzi
- Université Grenoble Alpes, Faculté de Médecine et Pharmacie, La Tronche, France.,Service hospitalo-universitaire de médecine gériatrique, CHU Grenoble Alpes, La Tronche, France
| | - Sabine Drevet
- Université Grenoble Alpes, Faculté de Médecine et Pharmacie, La Tronche, France.,Service hospitalo-universitaire de médecine gériatrique, CHU Grenoble Alpes, La Tronche, France
| |
Collapse
|
14
|
Boudissa M, Girard P, Kerschbaumer G, Ruatti S, Tonetti J. Does intraoperative 3D navigation improve SpineJack vertebral augmentation in thoracic and lumbar compression fracture? Orthop Traumatol Surg Res 2021; 107:103028. [PMID: 34329760 DOI: 10.1016/j.otsr.2021.103028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/11/2020] [Revised: 01/12/2021] [Accepted: 02/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of this retrospective study was to evaluate the effect of navigation on the positioning of the SpineJack implant in the treatment of thoracic and lumbar compression fractures. METHODS Between January 2018 and December 2019, all patients operated on for thoracic or lumbar fracture using the SpineJack device in stand-alone were included in this single-center study. The positioning of the SpineJack implant was analyzed on axial CT views by measuring the angle between the axis of the pedicle and the axis of the final implant. The relationships between implant positioning and the use of navigation or fluoroscopy, pedicle dimensions and levels of injury were analyzed. Surgical time, radiation exposure, radiological findings and complications were assessed. RESULTS One hundred patients were included, for 103 fractured vertebrae and a total of 205 implants, 148 placed under standard fluoroscopy and 57 with the Surgivisio navigation system. For pedicle diameters≥5mm (165 implants), the positioning of the implant relative to the axis of the pedicle was significantly better in the navigation group: 2°±1.4° (range, 0-7°) in the fluoroscopy group versus 1.2°±1.1° (range, 0-5°) in the navigation group (p=0.04). There were no significant differences in reduction of vertebral kyphosis angle or mean operating time. Dose area product (DAP) was significantly higher with navigation: 4.43Gy.cm2 versus 0.47Gy.cm2 (p<0.001) and dose to the surgeon significantly lower: 0.5 versus 1.6μSv (p<0.001). No difference was found regarding complications. Subgroup analysis showed significantly greater operative time and patient irradiation in the fluoroscopy group when pedicle diameter was less than 5mm. CONCLUSION This study demonstrates the interest of navigation for positioning the SpineJack implant with respect to the pedicle axis in vertebrae with pedicle diameter≥5mm. This study also confirmed the reliability of navigation and lower radiation dose to the surgeon, regardless of the fracture level. Navigation reduced operating time and patient irradiation for vertebrae with pedicle diameter<5mm. LEVEL OF EVIDENCE IV; retrospective study.
Collapse
Affiliation(s)
- Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologique, université Grenoble Alpes, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France; CNRS UMR 5525, TIMC-IMAG Lab, university Grenoble Alpes, 38700 La Tronche, France.
| | - Pierre Girard
- Service de chirurgie orthopédique et traumatologique, université Grenoble Alpes, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France
| | - Gaël Kerschbaumer
- Service de chirurgie orthopédique et traumatologique, université Grenoble Alpes, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France
| | - Sébastien Ruatti
- Service de chirurgie orthopédique et traumatologique, université Grenoble Alpes, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France
| | - Jérôme Tonetti
- Service de chirurgie orthopédique et traumatologique, université Grenoble Alpes, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France; CNRS UMR 5525, TIMC-IMAG Lab, university Grenoble Alpes, 38700 La Tronche, France
| |
Collapse
|
15
|
Ruel M, Boussat B, Boudissa M, Garnier V, Bioteau C, Tonetti J, Pailhe R, Gavazzi G, Drevet S. Management of preoperative pain in elderly patients with moderate to severe cognitive deficits and hip fracture: a retrospective, monocentric study in an orthogeriatric unit. BMC Geriatr 2021; 21:575. [PMID: 34666691 PMCID: PMC8524930 DOI: 10.1186/s12877-021-02500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background Patients with cognitive deficits are 3 times more likely to suffer a hip fracture than geriatric patients of the same age group without cognitive deficits. The persistence of perioperative pain following hip fracture is a risk factor for the occurrence of delirium, poor functional prognosis, and the development of secondary chronic pain. Patients with cognitive deficits receive 20 to 60% less analgesics than those without cognitive deficits. Our retrospective descriptive monocentric study was performed in an orthogeriatric unit on a cohort of elderly patients hospitalized for hip fracture. The aim of the study was to compare the quantity of strong opioids delivered in a morphine sulfate equivalent daily during the preoperative period after a hip fracture between cognitively intact patients and those with cognitive deficits. Results Our total population of 69 patients had a median age of 90 years old, and 46% of these patients had moderate or severe cognitive deficits. During the preoperative period, the same quantity of strong opioids was administered to both groups of patients (13.1 mg/d versus 10.8 mg/d (p = 0.38)). Patients with moderate to severe cognitive deficits more often experienced delirium during their hospitalization (p < 0.01) and received more psychotropic drugs in the first 3 postoperative days (p = 0.025). Conclusions We reported that with standardized pain management in an orthogeriatric unit, patients aged 75 years and older received the same daily average quantity of strong opioids during the preoperative period regardless of the presence of cognitive deficits.
Collapse
Affiliation(s)
- Mathilde Ruel
- Orthogeriatric Unit, University Hospital Grenoble Alpes, Grenoble, France.
| | - Bastien Boussat
- Public Health Department, University Hospital Grenoble Alpes, Grenoble, France
| | - Mehdi Boudissa
- Orthopaedic and Traumatology Surgery Department, University Hospital Grenoble Alpes, Grenoble, France
| | - Virginie Garnier
- Geriatric Department, University Hospital Grenoble Alpes, Grenoble, France
| | | | - Jérôme Tonetti
- Orthopaedic and Traumatology Surgery Department, University Hospital Grenoble Alpes, Grenoble, France
| | - Régis Pailhe
- Orthopaedic and Traumatology Surgery Department, University Hospital Grenoble Alpes, Grenoble, France
| | - Gaëtan Gavazzi
- Orthogeriatric Unit, University Hospital Grenoble Alpes, Grenoble, France
| | - Sabine Drevet
- Orthogeriatric Unit, University Hospital Grenoble Alpes, Grenoble, France
| |
Collapse
|
16
|
Rommens PM, Hofmann A, Kraemer S, Kisilak M, Boudissa M, Wagner D. Operative treatment of fragility fractures of the pelvis: a critical analysis of 140 patients. Eur J Trauma Emerg Surg 2021; 48:2881-2896. [PMID: 34635938 PMCID: PMC9360165 DOI: 10.1007/s00068-021-01799-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/26/2021] [Indexed: 12/29/2022]
Abstract
Background Fragility fractures of the pelvis (FFP) are a clinical entity with an increasing frequency. Indications for and type of surgical treatment are still a matter of debate. Purpose This retrospective study presents and critically analyses the results of operative treatment of 140 patients with FFP. Setting Level-I trauma center. Materials and methods Demographic data, comorbidities, FFP-classification, type of surgical stabilization (percutaneous (P-group) versus open procedure (O-group)), length of hospital stay (LoS), general in-hospital complications, surgery-related complications, living environment before admission, mobility and destination at discharge were retracted from the medical and radiographic records. Patients were asked participating in a survey by telephone call about their quality of life. SF-8 Physical Component Score (PCS) and SF-8 Mental Component Score (MCS) were calculated as well as the Parker Mobility Score (PMS) and the Numeric Rating Scale (NRS). Results Mean age was 77.4 years and 89.3% of patients were female. 92.1% presented with one comorbidity, 49.3% with two or more comorbidities. Median length of hospital stay was 18 days, postoperative length of hospital stay was 12 days. 99 patients (70.7%) received a percutaneous operative procedure, 41 (29.3%) an open. Patients of the O-group had a significantly longer LoS than patients of the P-group (p = 0.009). There was no in-hospital mortality. There were significantly more surgery-related complications in the O-group (43.9%) than in the P-group (19.2%) (p = 0.006). Patients of the O-group needed more often surgical revisions (29.3%) than patients of the P-group (13.1%) (p = 0.02). Whereas 85.4% of all patients lived at home before admission, only 28.6% returned home at discharge (p < 0.001). The loss of mobility at discharge was not influenced by the FFP-classes (p = 0.47) or type of treatment (p = 0.13). One-year mortality was 9.7%. Mortality was not influenced by the FFP-classes (p = 0.428) or type of treatment (p = 0.831). Median follow-up was 40 months. SF-8 PCS and SF-8 MCS were moderate (32.43 resp. 54.42). PMS was 5 and NRS 4. Follow-up scores were not influenced by FFP-classes or type of treatment. Conclusion Patients with FFP, who were treated operatively, suffered from a high rate of non-lethal general, in-hospital complications. Open surgical procedures induced more surgery-related complications and surgical revisions. Mental and physical follow-up scores are low to moderate. Condition at follow-up is not influenced by FFP-classes or type of treatment. Indications for operative treatment of FFP must be critically examined. Surgical fixation should obtain adequate stability, yet be as less invasive as possible. The advantages and limitations of different surgical techniques have to be critically evaluated in prospective studies.
Collapse
Affiliation(s)
- Pol Maria Rommens
- Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Alexander Hofmann
- Department of Orthopedics and Traumatology, Westpfalz Clinics Kaiserslautern, Helmut-Hartert-Strasse 1, 67655, Kaiserslautern, Germany
| | - Sven Kraemer
- Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Miha Kisilak
- Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Mehdi Boudissa
- Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Daniel Wagner
- Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany
| |
Collapse
|
17
|
Cech A, Rieussec C, Kerschbaumer G, Seurat O, Corbet C, Vibert B, Tronc C, Ruatti S, Bouzat P, Tonetti J, Boudissa M. Complications and outcomes in 69 consecutive patients with floating hip. Orthop Traumatol Surg Res 2021; 107:102998. [PMID: 34214653 DOI: 10.1016/j.otsr.2021.102998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/14/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Floating hip is a rare and potentially serious injury. The objective of this study was to evaluate our management strategy for patients with floating hip. HYPOTHESIS A standardized strategy with specialised multidisciplinary management is associated with a low mortality rate. METHODS Consecutive patients who had surgery to treat floating hip between January 2010 and December 2019 were included in this single-centre retrospective study. Epidemiological, clinical, and radiological data were collected and analysed. Patients were managed according to a standardised strategy adapted to the haemodynamic status and type of floating hip (type A, femoral and pelvic ring fractures; type B, femoral and acetabular fractures; and type C, femoral, acetabular, and pelvic ring fractures). The clinical outcome at last follow-up was determined by a telephone interview, based on the Majeed and Oxford scores, sports resumption, and work resumption. To assess the radiological outcomes, we applied Matta's criteria for the acetabulum and Tornetta's criteria for the pelvic ring. RESULTS We included 69 patients with a mean age of 38.5 years. Among them, 39 (57%) had haemodynamic instability requiring embolisation (n=15, 22%) or multiple blood transfusions (n=24, 35%). Type A injuries predominated (n=57, 83%). The need for multiple blood transfusions was significantly associated with type C floating hip, underlining the risk of heavy bleeding with this injury. Two (3%) patients died. When management was complete, the reduction was anatomical or satisfactory for 76% (13/17) of the acetabula according to Matta's criteria (maximum residual displacement <3mm) and for 85% (56/66) of the pelvic rings according to Tornetta's criteria (maximum residual displacement <10mm). One or more complications occurred in 45 (65%) patients. After a mean follow-up of 5 years, the mean Oxford Hip Score in patients with acetabular fractures was 35.5 and the mean Majeed score in patients with pelvic ring fractures was 71.5. Only 30% of patients were able to resume physical activities at the former level and to return to their former professional activities. CONCLUSION Type C floating hip, which combines fractures of the pelvic ring and acetabulum, carries a high risk of bleeding. Special attention should be directed to the reduction of pelvic ring fractures, to avoid malunion. Acetabular fractures that are complex in the Letournel classification carry a risk of imperfect reduction. The results of this study confirm the severity of these rare injuries and the need for specialised multidisciplinary management according to a standardised strategy that is appropriate for the haemodynamic status and type of floating hip (A, B, or C). LEVEL OF EVIDENCE IV; retrospective study.
Collapse
Affiliation(s)
- Alexandre Cech
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Clémentine Rieussec
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Gaël Kerschbaumer
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Olivier Seurat
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Clémentine Corbet
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Benoît Vibert
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Camille Tronc
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Sébastien Ruatti
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Pierre Bouzat
- Service de réanimation et déchocage, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Jérôme Tonetti
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France; TIMC-IMAG lab, University Grenoble Alpes, CNRS UMR 5525, 38700 La Tronche, France
| | - Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France; TIMC-IMAG lab, University Grenoble Alpes, CNRS UMR 5525, 38700 La Tronche, France.
| |
Collapse
|
18
|
Rommens PM, Boudissa M, Krämer S, Kisilak M, Hofmann A, Wagner D. Correction: Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience. PLoS One 2021; 16:e0258076. [PMID: 34570808 PMCID: PMC8476023 DOI: 10.1371/journal.pone.0258076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
19
|
Rommens PM, Boudissa M, Krämer S, Kisilak M, Hofmann A, Wagner D. Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience. PLoS One 2021; 16:e0253408. [PMID: 34242230 PMCID: PMC8270175 DOI: 10.1371/journal.pone.0253408] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/05/2021] [Indexed: 11/27/2022] Open
Abstract
Background Fragility fractures of the pelvis (FFP) represent an increasing clinical entity. Until today, there are no guidelines for treatment of FFP. In our center, recommendation for operative treatment was given to all patients, who suffered an FFP type III and IV and to patients with an FFP type IIwith unsuccessful non-operative treatment. We performed a retrospective observational study and investigated differences between fracture classes and management alternatives. We hypothetized that operative treatment may reduce mortality. Materials and methods The medical charts and radiographs of 362 patients were analysed. Patient demographics, FFP-classification, length of hospital stay (LoS), type of treatment, general and surgery-related complications, mortality, Short Form-8 physical component score (SF-8 PCS) and mental component score (SF-8 MCS), Parker Mobility Score (PMS) and Numeric Rating Scale (NRS) were documented. Results 238 patients had FFP type II and 124 FFP type III and IV. 52 patients with FFP type II (21.8%) and 86 patients with FFP type III and IV (69.4%) were treated operatively (p<0.001). Overall mortality did not differ between the fracture classes (p = 0.127) but was significantly lower in the operative group (p<0.001). Median LoS was significantly higher in FFP type III and IV (p<0.001) and in operated patients (p<0.001). There were more in-hospital complications in patients with FFP type III and IV (p = 0.001) and in the operative group (p = 0.006). More patients of the non-operative group were mobile (p<0.001) and independent (p<0.001) at discharge. Half of the patients could not return in their living environment.203 of the 235 surviving patients (86%) answered the questionnaires after a mean follow-up time of 38 months. SF-8 PCS, SF-8 MCS and PMS did not differ between the fracture classes and treatment groups. Pain perception was higher in the operated group (p = 0.013). Conclusion In our study, we observed that operative treatment of FFP provides low mortality rates, although LoS and in-hospital complications were higher in the operative group. At discharge, the non-operative group was more mobile and independent. At follow up, quality of life and mobility were comparable between the groups. Further prospective studies are needed to clarify the impact of operative treatment of FFP on mortality and functional outcome.
Collapse
Affiliation(s)
- Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany
- * E-mail:
| | - Mehdi Boudissa
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany
| | - Sven Krämer
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany
| | - Miha Kisilak
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany
| | - Alexander Hofmann
- Department of Orthopaedics and Traumatology, Westpfalz Clinics Kaiserslautern, Kaiserslautern, Germany
| | - Daniel Wagner
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany
| |
Collapse
|
20
|
Boudissa M, Porcheron G, Nowak T, Hofmann A, Wagner D, Rommens PM. Quadrilateral Surface Restoration by Medial Buttressing Before Revision in Periprosthetic Acetabular Fracture: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00033. [PMID: 33861728 DOI: 10.2106/jbjs.cc.20.00927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a case of periprosthetic acetabular fracture with pelvic discontinuity (PAFPD) classified Paprosky IIIb around an infected hip resurfacing prosthesis. A 3-stage revision was performed with (1) implants removal and surgical debridement to treat the infection; (2) open reduction and internal fixation using a medial buttress plate to treat pelvic discontinuity; and (3) custom-made total hip replacement with acetabular-ring reinforcement. The patient recovered with excellent clinical and radiographic results at 4-year follow-up. CONCLUSIONS In complex cases of PAFPD, a collaboration between pelvic trauma surgeons and orthopaedic hip surgeons allows to provide stability for revision surgeries with good outcomes.
Collapse
Affiliation(s)
- Mehdi Boudissa
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstrasse, Mainz, Germany
| | | | | | | | | | | |
Collapse
|
21
|
Orfeuvre B, Tonetti J, Kerschbaumer G, Barthelemy R, Moreau-Gaudry A, Boudissa M. EOS stereographic assessment of femoral shaft malunion after intramedullary nailing. A prospective series of 48 patients at 9 months' follow-up. Orthop Traumatol Surg Res 2021; 107:102805. [PMID: 33434691 DOI: 10.1016/j.otsr.2021.102805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/09/2018] [Revised: 03/14/2020] [Accepted: 07/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of the present study was to assess femoral shaft malunion following anterograde intramedullary nailing, using low-dose EOS stereoradiography. The study hypothesis was that our surgical technique is associated with radiological rotation disorder rates equivalent to those reported in the literature. METHODS All patients with unilateral femoral shaft fracture treated by anterograde nailing between January 2014 and December 2016 and followed up in our structure were included in a single-center prospective study. The main endpoint was≥15° transverse malrotation compared to the contralateral side as measured on EOS stereoradiography. Correlations between malrotation and Harris Hip and SF12 functional scores were assessed, as were risk factors for onset of shaft malunion in rotation. Forty-eight patients with a mean age of 31.4 years were analyzed at a mean 9.3 months' follow-up. RESULTS Stereoradiographic malrotation was found in 29.2% of patients. Mean anteversion was 18.5±13.8°. In 2.1% of patients, symptomatic rotation disorder required revision surgery. No correlations emerged between transverse malrotation and functional scores (p>0.05). Risk factors for malrotation comprised multi-site fracture (p=0.04), surgeon's inexperience (p=0.04), and open reduction (p=0.01). CONCLUSION The present radiologic malrotation rate was comparable to those reported in the literature, using the EOS stereoradiographic system, which provides precise assessment of rotation disorder following closed nailing of femoral shaft fracture. LEVEL OF EVIDENCE III; prospective study without control group.
Collapse
Affiliation(s)
- Benoît Orfeuvre
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, université Grenoble-Alpes, Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France.
| | - Jérôme Tonetti
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, université Grenoble-Alpes, Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France
| | - Gaël Kerschbaumer
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, université Grenoble-Alpes, Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France
| | - Renaud Barthelemy
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, université Grenoble-Alpes, Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France
| | - Alexandre Moreau-Gaudry
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, université Grenoble-Alpes, Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France
| | - Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, université Grenoble-Alpes, Grenoble, hôpital Nord, boulevard de la Chantourne, 38700 La Tronche, France
| |
Collapse
|
22
|
Boudissa M, Noblet B, Bahl G, Oliveri H, Herteleer M, Tonetti J, Chabanas M. Planning acetabular fracture reduction using a patient-specific biomechanical model: a prospective and comparative clinical study. Int J Comput Assist Radiol Surg 2021; 16:1305-1317. [PMID: 33763792 DOI: 10.1007/s11548-021-02352-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/13/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE A simple, patient-specific biomechanical model (PSBM) is proposed in which the main surgical tools and actions can be simulated, which enables clinicians to evaluate different strategies for an optimal surgical planning. A prospective and comparative clinical study was performed to assess early clinical and radiological results. METHODS From January 2019 to July 2019, a PSBM was created for every operated acetabular fracture (simulation group). DICOM data were extracted from the pre-operative high-resolution CT scans to build a 3D model of the fracture using segmentation methods. A PSBM was implemented in a custom software allowing a biomechanical simulation of the surgery in terms of reduction sequences. From July 2019 to December 2019, every patient with an operated for acetabular fracture without PSBM was included in the standard group. Surgery duration, blood loss, radiological results and per-operative complications were recorded and compared between the two groups. RESULTS Twenty-two patients were included, 10 in the simulation group and 12 in the standard group. The two groups were comparable regarding age, time to surgery, fracture pattern distribution and surgical approaches. The mean operative time was significantly lower in the simulation group: 113 min ± 33 (60-180) versus 184 ± 58 (90-260), p = 0.04. The mean blood loss was significantly lower in the simulation group, p = 0.01. No statistical significant differences were found regarding radiological results (p = 0.16). No per-operative complications were recorded. CONCLUSION This study confirms that pre-operative planning in acetabular surgery based on a PSBM results in a shorter operative time and a reduction of blood loss during surgery. This study also confirms the feasibility of PSBM planning in daily clinical routine. LEVEL OF EVIDENCE II: prospective study.
Collapse
Affiliation(s)
- Mehdi Boudissa
- Department of Orthopaedics and Traumatology, Grenoble University Hospital, Grenoble Alpes University, 38700, La Tronche, France. .,TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS UMR 5525, La Tronche, France.
| | - Baptiste Noblet
- TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS UMR 5525, La Tronche, France
| | - Gaétan Bahl
- TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS UMR 5525, La Tronche, France
| | - Hadrien Oliveri
- TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS UMR 5525, La Tronche, France
| | | | - Jérôme Tonetti
- Department of Orthopaedics and Traumatology, Grenoble University Hospital, Grenoble Alpes University, 38700, La Tronche, France.,TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS UMR 5525, La Tronche, France
| | - Matthieu Chabanas
- TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS UMR 5525, La Tronche, France
| |
Collapse
|
23
|
Herteleer M, Boudissa M, Hofmann A, Wagner D, Rommens PM. Plate fixation of the anterior pelvic ring in patients with fragility fractures of the pelvis. Eur J Trauma Emerg Surg 2021; 48:3711-3719. [PMID: 33693977 PMCID: PMC9532279 DOI: 10.1007/s00068-021-01625-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/16/2021] [Indexed: 11/24/2022]
Abstract
Introduction In fragility fractures of the pelvis (FFP), fractures of the posterior pelvic ring are nearly always combined with fractures of the anterior pelvic ring. When a surgical stabilization of the posterior pelvis is performed, a stabilization of the anterior pelvis is recommended as well. In this study, we aim at finding out whether conventional plate osteosynthesis is a valid option in patients with osteoporotic bone. Materials and methods We retrospectively reviewed medical charts and radiographs of all patients with a FFP, who underwent a plate osteosynthesis of the anterior pelvic ring between 2009 and 2019. Patient demographics, fracture characteristics, properties of the osteosynthesis, complications and revision surgeries were documented. Single plate osteosynthesis (SPO) at the pelvic brim was compared with double plate osteosynthesis (DPO) with one plate at the pelvic brim and one plate anteriorly. We hypothesized that the number and severity of screw loosening (SL) or plate breakage in DPO are lower than in SPO. Results 48 patients with a mean age of 76.8 years were reviewed. In 37 cases, SPO was performed, in 11 cases DPO. Eight out of 11 DPO were performed in patients with FFP type III or FFP type IV. We performed significantly more DPO when the instability was located at the level of the pubic symphysis (p = 0.025). More patients with a chronic FFP (surgery more than one month after diagnosis) were treated with DPO (p = 0.07). Infra-acetabular screws were more often inserted in DPO (p = 0.056). Screw loosening (SL) was seen in the superior plate in 45% of patients. There was no SL in the anterior plate. There was SL in 19 of 37 patients with SPO and in 3 of 11 patients with DPO (p = 0.16). SL was localized near to the pubic symphysis in 19 of 22 patients after SPO and in all three patients after DPO. There was no SL in DPO within the first month postoperatively. We performed revision osteosynthesis in six patients (6/48), all belonged to the SPO group (6/37). The presence of a bone defect, unilateral or bilateral anterior pelvic ring fracture, post-operative weight-bearing restrictions, osteosynthesis of the posterior pelvic ring, and the presence of infra- or supra-acetabular screws did not significantly influence screw loosening in SPO or DPO. Conclusion There is a high rate of SL in plate fixation of the anterior pelvic ring in FFP. In the vast majority, SL is located near to the pubic symphysis. DPO is associated with a lower rate of SL, less severe SL and a later onset of SL. Revision surgery is less likely in DPO. In FFP, we recommend DPO instead of SPO for fixation of fractures of the anterior pelvic ring, which are located in or near to the pubic symphysis.
Collapse
Affiliation(s)
- Michiel Herteleer
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany.
| | - Mehdi Boudissa
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany
| | - Alexander Hofmann
- Department of Traumatology and Orthopaedics, Westpfalz-Clinics Kaiserslautern, Kaiserslautern, Germany
| | - Daniel Wagner
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany
| | - Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Mainz, Germany
| |
Collapse
|
24
|
Rommens PM, Herteleer M, Handrich K, Boudissa M, Wagner D, Hopf JC. Medial buttressing of the quadrilateral surface in acetabular and periprosthetic acetabular fractures. PLoS One 2020; 15:e0243592. [PMID: 33284841 PMCID: PMC7721143 DOI: 10.1371/journal.pone.0243592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/24/2020] [Indexed: 11/19/2022] Open
Abstract
Background In geriatric acetabular fractures, the quadrilateral plate is often involved in the fracture pattern and medially displaced. Open reduction and internal fixation (ORIF) includes reduction of the quadrilateral plate and securing its position. In this study, the concept of medial buttressing in acute and periprosthetic acetabular fractures is evaluated. Materials and methods Patients, who sustained an acetabular fracture between 2012 and 2018, in whom ORIF with a specific implant for medial buttressing was performed, were included in the study. Patients were divided in two groups; acute acetabular fractures (group 1) and periprosthetic acetabular fractures (group 2). Demographics, type of fracture, surgical approach, type of implant for medial buttressing, comorbidities, general and surgical in-hospital complications and length of hospital stay were recorded retrospectively. The following data were collected from the surviving patients by telephone interview: EQ-5D-5L, SF-8 physical and SF-8 mental before trauma and at follow-up, UCLA activity scale, Parker Mobility Score and Numeric Rating Scale. Results Forty-six patients were included in this study, 30 males (65.2%) and 16 females (34.8%). Forty patients were included group 1 and six patients in group 2. The median age of patients of group 1 was 78 years. Among them, 82.5% presented with comorbidities. Their median length of in-hospital stay was 20.5 days. 57.5% of patients suffered from in-hospital complications. The concept of medial buttressing was successful in all but one patient. ORIF together with primary total hip arthroplasty (THA) was carried out as a single stage procedure in 3 patients. Secondary THA was performed in 5 additional patients (5/37 = 13.5%) within the observation period. Among surviving patients, 79.2% were evaluated after 3 years of follow-up. Quality of life, activity level and mobility dropped importantly and were lower than the values of a German reference population. SF-8 mental did not change. The median age of patients of group 2 was 79.5 years, all of them presented with one or several comorbidities. The median length of in-hospital stay was 18.5 days. 50% of patients suffered from in-hospital complications. The concept of medial buttressing was successful in all patients. 5 of 6 patients (83.3%) could be evaluated after a median of 136 weeks. In none of these patients, secondary surgery was necessary. Quality of life, activity level and mobility importantly dropped as well in this group. SF-8 mental remained unchanged. Conclusion In geriatric acetabular fractures with involvement and medial displacement of the quadrilateral plate, medial buttressing as part of ORIF proved to be reliable. Only 13.5% of patients of group 1 needed a secondary THA within 3 years of follow-up, which is lower than in comparable studies. Despite successful surgery, quality of life, activity level and mobility dropped importantly in all patients. The loss of independence did however not influence SF-8 mental values.
Collapse
Affiliation(s)
- Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
- * E-mail:
| | - Michiel Herteleer
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Kristin Handrich
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Mehdi Boudissa
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Daniel Wagner
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Johannes Christof Hopf
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| |
Collapse
|
25
|
Boudissa M, Roudet A, Fumat V, Ruatti S, Kerschbaumer G, Milaire M, Merloz P, Tonetti J. Part 1: Outcome of Posterior Pelvic Ring Injuries and Associated Prognostic Factors - A Five-Year Retrospective Study of One Hundred and Sixty Five Operated Cases with Closed Reduction and Percutaneous Fixation. Int Orthop 2020; 44:1209-1215. [PMID: 32328739 DOI: 10.1007/s00264-020-04574-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022]
Abstract
PURPOSES The aim of this study was to evaluate: 1. the outcome of pelvic ring fractures treated by closed reduction and percutaneous fixation, 2. the prognostic factors associated with a poor quality reduction, 3. the prognostic factors associated with ilio-sacral screws misplacement and 4. the prognostic factors associated with nonunion. METHODS Data from medical charts for all patients admitted with unstable posterior pelvic ring injuries from 2009 to 2013 were extracted. A total of 165 patients with a mean age of 40 years were included. One hundred and five patients were reviewed at a mean of 32 months of follow-up. The prognostic factors analyzed were clinical and radiological factors. Tile B and Tile C pelvic ring fractures were compared and analyzed separately. Then specific statistical analysis was performed using a logistic regression model to eliminate confusion factors. RESULTS An excellent or good clinical result was achieved for 94 patients (90%). An excellent or good reduction was achieved for 141 patients (85%). Nonunion rate, smoking patients, bad reductions, age of patients and ISS score were significantly higher in Tile C group. To eliminate confusion factors we used a multivariate analysis logistic regression model. Only unstable vertical bilateral posterior injuries (Tile C2 and C3) were independent prognostic factors for unsatisfactory reduction (p = 0.001; OR = 4.72; CI 95% [2.08-16.72]). Screw misplacement was recorded for 30 patients (16%) and sacral dysmorphia was an associated prognostic factor (p = 0.0001; OR = 15.6; CI95% [3.41-98.11]). Nonunion was recorded for ten patients (6%) and smoking was an associated prognostic factor (p = 0.01, OR = 5.12; CI95% [1.1-24.1]). CONCLUSIONS Posterior pelvic ring fractures treated by closed reduction and percutaneous fixation are associated with excellent/good clinical results if excellent/good reduction and bone healing are achieved without screw misplacement. Bilateral unstable vertical posterior pelvic ring injuries, and sacral dysmorphia are risk factors for bad quality reduction and screw misplacement respectively.
Collapse
Affiliation(s)
- Mehdi Boudissa
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France. .,Grenoble Alpes University, Grenoble, France. .,TIMC-IMAG lab, Univ. Grenoble Alpes, CNRS UMR, 5525, Saint-Martin-d'Hères, France.
| | - A Roudet
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - V Fumat
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - S Ruatti
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - G Kerschbaumer
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - M Milaire
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - P Merloz
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - J Tonetti
- Orthopedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Grenoble Alpes University, 38700 La Tronche, Grenoble, France.,Grenoble Alpes University, Grenoble, France.,TIMC-IMAG lab, Univ. Grenoble Alpes, CNRS UMR, 5525, Saint-Martin-d'Hères, France
| |
Collapse
|
26
|
Grobost P, Boudissa M, Kerschbaumer G, Ruatti S, Tonetti J. Early versus delayed corpectomy in thoracic and lumbar spine trauma. A long-term clinical and radiological retrospective study. Orthop Traumatol Surg Res 2020; 106:261-267. [PMID: 30765308 DOI: 10.1016/j.otsr.2018.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/19/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 02/03/2023]
Abstract
AND BACKGROUND DATA Many authors have demonstrated the necessity of reconstruction of the anterior column in spinal trauma with vertebral body collapse or nonunion. There is no publication comparing the result depending on the time between trauma and anterior reconstruction of the vertebral body. OBJECTIVE To compare long-term clinical and radiological results between early and late anterior vertebral body reconstruction with expandable cages in patients with thoracic and lumbar spine trauma. HYPOTHESIS An early anterior reconstruction of thoracolumbar fractures provides better clinical and radiological outcomes than a delayed one. MATERIALS AND METHODS A retrospective clinical study was carried out with 44 consecutive patients with injuries of the thoracic and lumbar spine treated operatively with combined posterior stabilization and anterior reconstruction with an expandable implant for vertebral body replacement. All patients were evaluated with EOS full-spine radiograph and CT-scan. The mean follow-up was 5.1 years. Clinical result was evaluated with ODI, SF12, VAS back pain, return to work and sport. Radiological result was evaluated with regional kyphosis angle (RKA) evolution, fusion rate and sagittal alignment. In Group A, twenty-nine patients underwent an early anterior reconstruction within 3 weeks after trauma. The indication of vertebral body reconstruction was placed after post-operative CT-scan for a Mc Cormack score≥7. In Group B, fifteen patients underwent a late anterior reconstruction after diagnosis of nonunion by the combination of pain and CT-scan after 1 year. RESULTS Clinical scores and scales were significantly better for patients operated early in Group A. Return to work and activities were significantly more important in Group A too. The mean RKA correction with posterior reduction was 9.3°. The secondary anterior approach permit to reduce 2.9° more. At last follow-up, the loss of reduction was 4.3°. There was no significant difference between groups for those results. No difference in fusion rate was observed between groups. There was no significant difference between groups in the sagittal alignment excepted for SVA that was higher for Group B while remaining under a normal value of 50mm. CONCLUSION Early anterior vertebral body reconstruction for fractures gives better clinical results than delayed reconstruction for patients with diagnosis of nonunion in patients with thoracic and lumbar spine trauma. Moreover, the shorter the time from trauma to operation, the better the sagittal reduction of kyphosis. The use of expandable titanium cage is a good way to perform and maintain this reduction. LEVEL OF EVIDENCE IV, retrospective study.
Collapse
Affiliation(s)
- Pierre Grobost
- Orthopedic and trauma unit, Grenoble-Alpes University Hospital, 38000 Grenoble, France; Orthopedic spine unit, CMCR des Massues, 92, rue Edmond-Locard, 65005 Lyon, France.
| | - Mehdi Boudissa
- Orthopedic and trauma unit, Grenoble-Alpes University Hospital, 38000 Grenoble, France
| | - Gaël Kerschbaumer
- Orthopedic and trauma unit, Grenoble-Alpes University Hospital, 38000 Grenoble, France
| | - Sébastien Ruatti
- Orthopedic and trauma unit, Grenoble-Alpes University Hospital, 38000 Grenoble, France
| | - Jérôme Tonetti
- Orthopedic and trauma unit, Grenoble-Alpes University Hospital, 38000 Grenoble, France
| |
Collapse
|
27
|
Boudissa M, Francony F, Drevet S, Kerschbaumer G, Ruatti S, Milaire M, Merloz P, Tonetti J. Operative versus non-operative treatment of displaced acetabular fractures in elderly patients. Aging Clin Exp Res 2020; 32:571-577. [PMID: 31183749 DOI: 10.1007/s40520-019-01231-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/23/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acetabular fracture treatments in elderly patients are not well codified. PURPOSE The aim of the study was to determine if, for active elderly patients, the clinical results after surgical treatment of displaced acetabular fractures are better than for non-operative treatment. METHODS All active patients over 60 years with a Parker score higher than 6, managed for displaced acetabular fracture between 2005 and 2014, were included in this single-center retrospective study. Clinical outcomes were compared according to the therapeutic option (operative or non-operative) and the fracture pattern (anterior fracture that requires open reduction and internal fixation or posterior fracture that requires total hip arthroplasty). RESULTS Among the 82 patients with Parker score higher than 6, 44 were treated non-operatively and 38 were operated. Forty-seven had anterior fracture (AF) and 35 had posterior fracture (PF). In the AF group, the autonomy scores were better for operative than non-operative patients (p < 0.05) with a PARKER score 7.8 (7-8) versus 5.4 (1-9); ADL score 5.7 (4-6) versus 4.4 (1-6) and IADL score 7.6 (6-8) versus 4.2 (0-8). In the PF group, the autonomy scores were better for operative than non-operative patients (p < 0.05) with a PARKER score 7.3 (4-9) versus 5.6 (2-9), ADL score 5.3 (2-6) versus 4.4 (1-6) and IADL score 5.6 (2-8) versus 4.1 (1-7). Regarding clinical outcomes, the HARRIS and PMA scores were better for operative patients (p < 0.05). CONCLUSION Surgical treatment in elderly patients with displaced acetabular fractures is associated with better clinical outcomes than non-operative treatment when the autonomy level is comparable.
Collapse
Affiliation(s)
- Mehdi Boudissa
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Boulevard de la Chantourne, 38700, La Tronche, France.
- Joseph Fourier University, Grenoble, France.
- TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS, UMR 5525, Pavillon Taillefer, 38700, La Tronche, France.
| | - Florent Francony
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Boulevard de la Chantourne, 38700, La Tronche, France
- Joseph Fourier University, Grenoble, France
| | - Sabine Drevet
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Boulevard de la Chantourne, 38700, La Tronche, France
- Joseph Fourier University, Grenoble, France
| | - Gael Kerschbaumer
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Boulevard de la Chantourne, 38700, La Tronche, France
- Joseph Fourier University, Grenoble, France
| | - Sebastien Ruatti
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Boulevard de la Chantourne, 38700, La Tronche, France
- Joseph Fourier University, Grenoble, France
| | - Michel Milaire
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Boulevard de la Chantourne, 38700, La Tronche, France
- Joseph Fourier University, Grenoble, France
| | - Philippe Merloz
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Boulevard de la Chantourne, 38700, La Tronche, France
- Joseph Fourier University, Grenoble, France
- TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS, UMR 5525, Pavillon Taillefer, 38700, La Tronche, France
| | - Jérôme Tonetti
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Northern Hospital, Boulevard de la Chantourne, 38700, La Tronche, France
- Joseph Fourier University, Grenoble, France
- TIMC-IMAG Lab, Univ. Grenoble Alpes, CNRS, UMR 5525, Pavillon Taillefer, 38700, La Tronche, France
| |
Collapse
|
28
|
Tonetti J, Boudissa M, Kerschbaumer G, Seurat O. Role of 3D intraoperative imaging in orthopedic and trauma surgery. Orthop Traumatol Surg Res 2020; 106:S19-S25. [PMID: 31734181 DOI: 10.1016/j.otsr.2019.05.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 01/29/2019] [Revised: 05/03/2019] [Accepted: 05/09/2019] [Indexed: 02/02/2023]
Abstract
Intraoperative three-dimensional (3D) imaging is now feasible because of recent technological advances such as 3D cone-beam CT (CBCT) and flat-panel X-ray detectors (FPDs). These technologies reduce the radiation dose to the patient and surgical team. The aim of this study is to review the advantages of 3D intraoperative imaging in orthopedic and trauma surgery by answering the following 5 questions: What are its technical principles? CBCT with a FPD produces non-distorted digital images and frees up the surgical field. The high quality of these 3D intraoperative images allows them to be integrated into surgical navigation systems. Human-robot comanipulation will likely follow soon after. Conventional multislice CT technology has also improved to the point where it can be used in the operating room. What can we expect from 3D intraoperative imaging and which applications have been validated clinically? We reviewed the literature on this topic for the past 10 years. The expected benefits were determined during the implantation of pedicular screws: more accurate implantation, fewer surgical revisions and time savings. There are few studies in trauma or arthroplasty cases, as robotic comanipulation is a more recent development. What is the tolerance for irradiation to the patient and surgical team? The health drawbacks are the harmful radiation-induced effects. The deterministic effects that we will develop are correlated to the absorbed dose in Gray units (Gy). The stochastic and carcinogenic effects are related to the effective dose in milliSievert (mSv) of linear evolution without threshold. The International Commission on Radiological Protection (ICRP) states that irradiation for medical purposes with risk of detriment is acceptable if it is justified by an optimization attempt. The radioprotection limits must be known but do not constitute opposable restrictions. The superiority of intraoperative 3D imaging over fluoroscopy has been demonstrated for spine surgery and sacroiliac screw fixation. How does the environment need to be adapted? The volume, access, wall protection and floor strength of the operating room must take into account the features of each machine. The instrumentation implants and need for specialized staff result in additional costs. Not every system can track movements during the CBCT acquisition thus transient suspension of assisted ventilation may be required. Is it financially viable? This needs to be calculated based on the expected clinical benefits, which mainly correspond to the elimination of expenses tied to surgical revisions. Our society's search for safety has driven the investments in this technology. LEVEL OF EVIDENCE: V, Expert opinion.
Collapse
Affiliation(s)
- Jérôme Tonetti
- Clinique universitaire de chirurgie orthopédique et traumatologie, hôpital Michallon, CS 10217, 38043 Grenoble cedex 09, France.
| | - Mehdi Boudissa
- Clinique universitaire de chirurgie orthopédique et traumatologie, hôpital Michallon, CS 10217, 38043 Grenoble cedex 09, France
| | - Gael Kerschbaumer
- Clinique universitaire de chirurgie orthopédique et traumatologie, hôpital Michallon, CS 10217, 38043 Grenoble cedex 09, France
| | - Olivier Seurat
- Clinique universitaire de chirurgie orthopédique et traumatologie, hôpital Michallon, CS 10217, 38043 Grenoble cedex 09, France
| |
Collapse
|
29
|
Kerschbaumer G, Gaulin B, Ruatti S, Tonetti J, Boudissa M. Clinical and radiological outcomes in thoracolumbar fractures using the SpineJack device. A prospective study of seventy-four patients with a two point three year mean of follow-up. International Orthopaedics (SICOT) 2019; 43:2773-2779. [DOI: 10.1007/s00264-019-04391-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/07/2019] [Indexed: 12/31/2022]
|
30
|
Ruatti S, Boudissa M, Grobost P, Kerschbaumer G, Tonetti J. Radius' Giant Cell Tumor: Allograft with Conservation of Distal Radioulnar Joint. J Wrist Surg 2019; 8:215-220. [PMID: 31192043 PMCID: PMC6546493 DOI: 10.1055/s-0039-1683364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/03/2018] [Accepted: 01/28/2019] [Indexed: 01/03/2023]
Abstract
Purpose Giant cell tumor of the distal radius are frequent lesions, and different types of surgeries have been described. Functional results, after conservative treatment or arthrodesis, often find a decreased strength and range of motion. The sacrifice of the distal radioulnar joint could be one of the causes. We report the case of a 26-year-old patient who presented with a Campanacci Grade III giant cell tumor of the distal radius. We managed his case by the association of en bloc resection and allograft reconstruction with the preservation of distal radioulnar joint. Hypothesis This procedure could improve functional results, without increasing the risk of recurrence at 2 years follow-up. Case Report The originality of our technique was the possibility of distal radioulnar joint conservation. We preserved a long portion of cortex bone all through the ulnar side of the distal radius. We then used an allograft of distal radius, fixed by a reconstruction anatomical plate. Results At 2 years follow-up, the range of motion was 100° with 60° of palmar flexion, 40° of extension, 75° of pronation, and 70° of supination. Radial and ulnar inclination were 10 and 15°, respectively. MTS (Musculoskeletal Tumor Society Score) 1993 was 88% and DASH score was 6. Concerning grip strength, it was measured at 85% in comparison with the other side. Pronation and supination strengths were 80 and 73%, respectively, in comparison with the other side. At follow-up, standard X-rays showed no recurrence. The allograft was well integrated. Conclusion Conservative treatment of the distal radioulnar joint allowed an almost ad integrum recovery, concerning strengths and range of motion. It allows a better functional recovery, without increasing the risk of recurrence.
Collapse
Affiliation(s)
- S. Ruatti
- Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble Cedex, France
| | - M. Boudissa
- Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble Cedex, France
| | - P. Grobost
- Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble Cedex, France
| | - G. Kerschbaumer
- Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble Cedex, France
| | - J. Tonetti
- Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble Cedex, France
| |
Collapse
|
31
|
Giunta JC, Tronc C, Kerschbaumer G, Milaire M, Ruatti S, Tonetti J, Boudissa M. Outcomes of acetabular fractures in the elderly: a five year retrospective study of twenty seven patients with primary total hip replacement. Int Orthop 2018; 43:2383-2389. [PMID: 30338339 DOI: 10.1007/s00264-018-4204-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 10/11/2018] [Indexed: 11/29/2022]
Abstract
PURPOSES Open reduction and internal fixation (ORIF) in osteoporotic acetabular fractures is quite difficult with high risk of implant failure. Total hip arthroplasty (THA) may be an effective option for treating acetabular fractures in appropriately selected patients, with immediate full weightbearing. The aim of the study was to evaluate the functional outcomes of primary THA for acetabular fractures in elderly patients. METHODS Between 2010 and 2015, 27 elderly patients operated for acetabular fractures by primary THA were included. The surgical technique associated plate stabilization of both acetabular columns with THA using an acetabular reinforcement cross-plate. Mean age was 68.5 years (57-84) and mean ASA was 2 (1-3). The mean follow-up was four years. RESULTS The mean Harris score was 70.4 ± 23 (24-90), and the mean Postel-Merle Aubigné (PMA) score was 14.3 ± 4 (7-18). For 17 patients with rank of pre-operative Devane 4, the post-operative rank was unchanged (p < 0.05). Twenty patients (74%) were satisfied by the surgical treatment. Twenty post-operative complications (74%) were found. Two patients died during follow-up (7%). CONCLUSIONS Primary THA for acetabular fracture in the elderly population might be a good therapeutic option that allows return to the previous daily life activity. Three patients (11%) became bedridden, and four patient's skiers (15%) returned to skiing. However, this surgery is difficult and selection of elderly patients, i.e., with acetabular fractures who are expected to get a poor result with ORIF, i.e., fracture patterns with posterior wall lesion and marginal impaction, for primary THA in an experienced centre provides satisfactory clinical results.
Collapse
Affiliation(s)
- Jean-Charles Giunta
- Centre Hospitalier Universitaire Grenoble Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France.
| | - Camille Tronc
- Centre Hospitalier Universitaire Grenoble Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Gael Kerschbaumer
- Centre Hospitalier Universitaire Grenoble Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Michel Milaire
- Centre Hospitalier Universitaire Grenoble Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Sébastien Ruatti
- Centre Hospitalier Universitaire Grenoble Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Jerôme Tonetti
- Centre Hospitalier Universitaire Grenoble Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Mehdi Boudissa
- Centre Hospitalier Universitaire Grenoble Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| |
Collapse
|
32
|
Boudissa M, Oliveri H, Chabanas M, Tonetti J. Computer-assisted surgery in acetabular fractures: Virtual reduction of acetabular fracture using the first patient-specific biomechanical model simulator. Orthop Traumatol Surg Res 2018; 104:359-362. [PMID: 29458201 DOI: 10.1016/j.otsr.2018.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 08/16/2017] [Revised: 12/28/2017] [Accepted: 01/04/2018] [Indexed: 02/02/2023]
Abstract
UNLABELLED Preoperative planning for the management of acetabular fracture is founded on geometric models allowing virtual repositioning of the bone fragments, but not taking account of soft tissue and the realities of the surgical procedure. The present technical note reports results using the first simulator to be based on a patient-specific biomechanical model, simulating the action of forces on the fragments and also the interactions between soft issue and bone: muscles, capsules, ligaments, and bone contacts. In all 14 cases, biomechanical simulation faithfully reproduced the intraoperative behavior of the various bone fragments and reduction quality. On Matta's criteria, anatomic reduction was achieved in 12 of the 14 patients (86%; 0.25mm±0.45 [range: 0-1]) and in the 12 corresponding simulations (86%; 0.42mm±0.51 [range: 0-1]). Mean semi-automatic segmentation time was 156min±37.9 [range: 120-180]. Mean simulation time was 23min±9 [range: 16-38]. The model needs larger-scale prospective validation, but offers a new tool suitable for teaching purposes and for assessment of surgical results in acetabular fracture. LEVEL OF EVIDENCE IV: retrospective study.
Collapse
Affiliation(s)
- M Boudissa
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; Laboratoire TIMC-IMAG, université Grenoble Alpes, CNRS UMR 5525, pavillon Taillefer, 38700 La Tronche, France.
| | - H Oliveri
- Laboratoire TIMC-IMAG, université Grenoble Alpes, CNRS UMR 5525, pavillon Taillefer, 38700 La Tronche, France
| | - M Chabanas
- Laboratoire TIMC-IMAG, université Grenoble Alpes, CNRS UMR 5525, pavillon Taillefer, 38700 La Tronche, France
| | - J Tonetti
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| |
Collapse
|
33
|
Boudissa M, Courvoisier A, Chabanas M, Tonetti J. Computer assisted surgery in preoperative planning of acetabular fracture surgery: state of the art. Expert Rev Med Devices 2017; 15:81-89. [PMID: 29206497 DOI: 10.1080/17434440.2017.1413347] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The development of imaging modalities and computer technology provides a new approach in acetabular surgery. AREAS COVERED This review describes the role of computer-assisted surgery (CAS) in understanding of the fracture patterns, in the virtual preoperative planning of the surgery and in the use of custom-made plates in acetabular fractures with or without 3D printing technologies. A Pubmed internet research of the English literature of the last 20 years was carried out about studies concerning computer-assisted surgery in acetabular fractures. The several steps for CAS in acetabular fracture surgery are presented and commented by the main author regarding to his personal experience. EXPERT COMMENTARY Computer-assisted surgery in acetabular fractures is still initial experiences with promising results. Patient-specific biomechanical models considering soft tissues should be developed to allow a more realistic planning.
Collapse
Affiliation(s)
- Mehdi Boudissa
- b Grenoble Alpes University , Grenoble , France.,c TIMC-IMAG Lab , Univ. Grenoble Alpes, CNRS UMR , Grenoble , France.,d Orthopedic and Traumatology Surgery Department , Grenoble University Hospitals, Northern Hospital, Joseph Fourier University , Grenoble , France
| | - Aurélien Courvoisier
- a Pediatric Orthopedics , Grenoble University Hospitals, Northern Hospital, Joseph Fourier University , Grenoble , France.,b Grenoble Alpes University , Grenoble , France.,c TIMC-IMAG Lab , Univ. Grenoble Alpes, CNRS UMR , Grenoble , France
| | - Matthieu Chabanas
- b Grenoble Alpes University , Grenoble , France.,c TIMC-IMAG Lab , Univ. Grenoble Alpes, CNRS UMR , Grenoble , France.,d Orthopedic and Traumatology Surgery Department , Grenoble University Hospitals, Northern Hospital, Joseph Fourier University , Grenoble , France
| | - Jérôme Tonetti
- b Grenoble Alpes University , Grenoble , France.,c TIMC-IMAG Lab , Univ. Grenoble Alpes, CNRS UMR , Grenoble , France.,d Orthopedic and Traumatology Surgery Department , Grenoble University Hospitals, Northern Hospital, Joseph Fourier University , Grenoble , France
| |
Collapse
|
34
|
Boudissa M, Orfeuvre B, Chabanas M, Tonetti J. Does semi-automatic bone-fragment segmentation improve the reproducibility of the Letournel acetabular fracture classification? Orthop Traumatol Surg Res 2017; 103:633-638. [PMID: 28428032 DOI: 10.1016/j.otsr.2017.03.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 11/04/2016] [Revised: 03/12/2017] [Accepted: 03/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Letournel classification of acetabular fracture shows poor reproducibility in inexperienced observers, despite the introduction of 3D imaging. We therefore developed a method of semi-automatic segmentation based on CT data. The present prospective study aimed to assess: (1) whether semi-automatic bone-fragment segmentation increased the rate of correct classification; (2) if so, in which fracture types; and (3) feasibility using the open-source itksnap 3.0 software package without incurring extra cost for users. HYPOTHESIS Semi-automatic segmentation of acetabular fractures significantly increases the rate of correct classification by orthopedic surgery residents. METHODS Twelve orthopedic surgery residents classified 23 acetabular fractures. Six used conventional 3D reconstructions provided by the center's radiology department (conventional group) and 6 others used reconstructions obtained by semi-automatic segmentation using the open-source itksnap 3.0 software package (segmentation group). Bone fragments were identified by specific colors. Correct classification rates were compared between groups on Chi2 test. Assessment was repeated 2 weeks later, to determine intra-observer reproducibility. RESULTS Correct classification rates were significantly higher in the "segmentation" group: 114/138 (83%) versus 71/138 (52%); P<0.0001. The difference was greater for simple (36/36 (100%) versus 17/36 (47%); P<0.0001) than complex fractures (79/102 (77%) versus 54/102 (53%); P=0.0004). Mean segmentation time per fracture was 27±3min [range, 21-35min]. The segmentation group showed excellent intra-observer correlation coefficients, overall (ICC=0.88), and for simple (ICC=0.92) and complex fractures (ICC=0.84). CONCLUSION Semi-automatic segmentation, identifying the various bone fragments, was effective in increasing the rate of correct acetabular fracture classification on the Letournel system by orthopedic surgery residents. It may be considered for routine use in education and training. LEVEL OF EVIDENCE III: prospective case-control study of a diagnostic procedure.
Collapse
Affiliation(s)
- M Boudissa
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; CNRS UMR 5525, laboratoire TIMC-IMAG, pavillon Taillefer, université Grenoble Alpes, 38700 La Tronche, France.
| | - B Orfeuvre
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - M Chabanas
- CNRS UMR 5525, laboratoire TIMC-IMAG, pavillon Taillefer, université Grenoble Alpes, 38700 La Tronche, France
| | - J Tonetti
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; CNRS UMR 5525, laboratoire TIMC-IMAG, pavillon Taillefer, université Grenoble Alpes, 38700 La Tronche, France
| |
Collapse
|
35
|
Lateur G, Pailhé R, Refaie R, Rubens-Duval B, Morin V, Boudissa M, Saragaglia D. Ganglion cysts of the proximal tibiofibular articulation: the role of arthrodesis and combined partial fibula excision. International Orthopaedics (SICOT) 2017; 42:1233-1239. [DOI: 10.1007/s00264-017-3542-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/14/2017] [Indexed: 11/30/2022]
|
36
|
Abstract
Dislocation of the talus is a serious and extremely rare injury, with 86 cases reported in the published data in 20 years. The reference standard for case management involves replacement of the dislocated talus to restore the height and function of the tibiotalar joint. The risk of avascular necrosis remains very high, and the standard treatment in such cases is tibiotalar arthrodesis. We report the case of total dislocation of the talus, which was treated with the insertion of a custom total talar prosthesis affixed directly to the tibial cartilage at 6 months after injury. At the 2-year follow-up point, the preliminary results were rather encouraging, with well-functioning activity and an improved American Orthopaedic Foot and Ankle Society foot function scale score increasing from 11 to 77 of 100 and a Short-Form 36-item Health Survey score increasing from 17 to 82. Much longer follow-up periods are necessary to evaluate longer term trends.
Collapse
Affiliation(s)
- Sébastien Ruatti
- Orthopaedic Surgeon, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France.
| | - Clémentine Corbet
- Resident, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France
| | - Mehdi Boudissa
- Assistant Professor, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France
| | - Gael Kerschbaumer
- Orthopaedic Surgeon, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France
| | - Michel Milaire
- Orthopaedic Surgeon, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France
| | - Philippe Merloz
- Professor, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France
| | - Jérôme Tonetti
- Professor, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France
| |
Collapse
|
37
|
Boudissa M, Eid A, Bourgeois E, Griffet J, Courvoisier A. Early outcomes of spinal growth tethering for idiopathic scoliosis with a novel device: a prospective study with 2 years of follow-up. Childs Nerv Syst 2017; 33:813-818. [PMID: 28324184 DOI: 10.1007/s00381-017-3367-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 02/22/2017] [Indexed: 11/26/2022]
Abstract
QUESTIONS/PURPOSES Adolescent idiopathic scoliosis is a 3D spine deformity that worsens during the whole growth. New methods for spinal growth modulation with flexible spinal implants have been described to avoid progression of the deformity during growth spurt. The main limitations are that no specific ancillaries and devices are available, which makes the surgery technically demanding. METHODS We have developed a new method of spinal growth tethering using minimal invasive videothoracoscopic approach. Fixation is performed with staples and synthetic ligament on the lateral aspect of vertebral bodies on main curvature convexity. Patients with progressive thoracic idiopathic scoliosis despite the brace treatment were included. The clinical and radiological examinations were compared before and 2 years after surgery. RESULTS Six patients with flexible thoracic curves with a mean age 11.2 ± 1.2 years and a mean Cobb angle 45° ± 10° (35-60) were operated. All were skeletally immature. At last follow-up, the Cobb angle was stable. None of the patient underwent fusion. CONCLUSIONS The procedure allowed a stabilization of the deformity during growth spurt. Validated devices and further studies with longer term follow-up are needed to confirm the efficiency of this technique. This small cohort of patients is a source of reflection for further medical devices developments. LEVEL OF EVIDENCE Level 4 case series comparing to not randomized studies.
Collapse
Affiliation(s)
- M Boudissa
- Orthopedic Pediatric Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble, France.
- Orthopedic and Traumatology Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble, France.
| | - A Eid
- Orthopedic Pediatric Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble, France
| | - E Bourgeois
- Orthopedic Pediatric Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble, France
| | - J Griffet
- Orthopedic Pediatric Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble, France
| | - A Courvoisier
- Orthopedic Pediatric Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble, France
| |
Collapse
|
38
|
Boudissa M, Francony F, Kerschbaumer G, Ruatti S, Milaire M, Merloz P, Tonetti J. Epidemiology and treatment of acetabular fractures in a level-1 trauma centre: Retrospective study of 414 patients over 10 years. Orthop Traumatol Surg Res 2017; 103:335-339. [PMID: 28235575 DOI: 10.1016/j.otsr.2017.01.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/25/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Epidemiological studies of acetabular fractures (AFs) are scarce and, to our knowledge, the most recent one from France, by Letournel and Judet, dates back to 1993. Studies have suggested a decrease in high-energy AFs contrasting with an increase in low-energy AFs due to the longer life expectancy. However, a French case-series study failed to confirm these data. We therefore conducted a 10-year retrospective study in a level-1 trauma centre to: (1) characterise the epidemiological profile of AF; (2) and to describe the treatment strategy. HYPOTHESIS The epidemiological profile of AF in France is consonant with data from European case-series studies. METHOD All patients managed for AF between 2005 and 2014 were included in this single-centre retrospective study. All patients were re-evaluated at our centre or another facility 6 months after the fracture. The epidemiological data were compared in the three treatment groups: non-operative, open reduction and internal fixation (ORIF), and total hip arthroplasty (THA). RESULTS Between 2005 and 2014, 414 patients were admitted for AF. Mean age was 49.4 years (range: 15-101 years). Treatment was non-operative in 231 (56%) older patients, most of whom had low-energy fractures involving the anterior wall. THA with or without acetabular reinforcement and screw-plate fixation was performed in 27 (7%) older patients, most of whom had posterior-wall fractures and experienced postoperative complications (26/27 patients, 96%). ORIF was used in 156 (38%) younger patients, most of whom had high-energy fractures of greater complexity. CONCLUSION Our results reflect the current indications in AF management. The epidemiological characteristics in our population are comparable to those reported in the few recent European epidemiological studies. To our knowledge, this is the largest French epidemiological study since the landmark work by Letournel and Judet. LEVEL OF EVIDENCE Level IV, retrospective study.
Collapse
Affiliation(s)
- M Boudissa
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; CNRS UMR 5525, laboratoire TIMC-IMAG, université Grenoble Alpes, Pavillon Taillefer, 38700 La Tronche, France.
| | - F Francony
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - G Kerschbaumer
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - S Ruatti
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - M Milaire
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - P Merloz
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; CNRS UMR 5525, laboratoire TIMC-IMAG, université Grenoble Alpes, Pavillon Taillefer, 38700 La Tronche, France
| | - J Tonetti
- Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France; CNRS UMR 5525, laboratoire TIMC-IMAG, université Grenoble Alpes, Pavillon Taillefer, 38700 La Tronche, France
| |
Collapse
|
39
|
Lateur G, Boudissa M, Rubens-Duval B, Mader R, Rouchy RC, Pailhé R, Saragaglia D. Long-term outcomes of tension band wiring with a single K-wire in Rockwood type IV/V acute acromio-clavicular dislocations: 25 cases. Orthop Traumatol Surg Res 2016; 102:589-93. [PMID: 27424096 DOI: 10.1016/j.otsr.2016.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 09/07/2015] [Revised: 01/24/2016] [Accepted: 02/24/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our objective was to evaluate the long-term functional and radiological outcomes of tension band wiring with a single K-wire for acute Rockwood types IV and V acromio-clavicular dislocation (ACD). METHODS Single-centre cross-sectional non-randomised observational cohort study of 25 shoulders treated surgically between January 2002 and December 2004, in 25 patients, 23 males and 2 females, with a mean age of 35±11years (24-46). The evaluation criteria were the absolute and weighted Constant scores, QuickDASH score, subjective shoulder value (SSV), visual analogue scale (VAS) pain score at rest and during activities, and radiographic features in clinically symptomatic patients. RESULTS Mean values were as follows: follow-up, 150±17months (133-167); absolute Constant score, 88±17 (71-105); weighted Constant score, 92.5±12.5 (80-105); QuickDASH, 15.5±7 (8.5-22.5); SSV, 88±17% (71-105); VAS pain score at rest, 0.2±0.7 (0-0.9); and VAS pain score while active, 1.4±2.3 (0-3.7). The weighted Constant score was less than 70% in only 8% of patients. Of the 17 patients for whom radiographs were obtained, 8 had acromio-clavicular osteoarthritis. Mean coraco-clavicular distance was 12.3±4.3mm (8-16.6) and mean acromio-clavicular distance was 5±5mm (0-10). The recurrence rate was 8%. CONCLUSION Tension band wiring with a single K-wire for acute acromio-clavicular dislocation reliably provides good long-term functional outcomes. Recurrences are uncommon and few patients experience symptoms (8%). LEVEL OF EVIDENCE IV, retrospective study.
Collapse
Affiliation(s)
- G Lateur
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France.
| | - M Boudissa
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - B Rubens-Duval
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - R Mader
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - R C Rouchy
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - R Pailhé
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| | - D Saragaglia
- Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, 38130 Échirolles, France
| |
Collapse
|
40
|
Boudissa M, Lebecque J, Boissière L, Gille O, Pointillart V, Obeid I, Vital JM. Early reintervention after anterior cervical spine surgery: Epidemiology and risk factors: A case-control study. Orthop Traumatol Surg Res 2016; 102:485-8. [PMID: 27108258 DOI: 10.1016/j.otsr.2016.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 06/20/2015] [Revised: 01/04/2016] [Accepted: 02/01/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Anterior cervical spine surgery is a frequent and effective procedure; complications are rare, but potentially fatal. The objective of the present study was to assess epidemiology and risk factors for early reintervention in anterior cervical spine surgery. METHODS A retrospective case-control study recruited 2319 patients operated on in our department, with 7 years' follow-up. Incidence and prevalence of causes of early reintervention were analyzed. Each case was matched to 2 controls from the same source population. Risk factors were identified and odds ratios (OR) were calculated. RESULTS Thirteen patients (0.6%: 3 female, 10 male; mean age, 59±12 years) underwent surgical reintervention within 72hours. Causes comprised: retropharyngeal hematoma (0.2%), epidural hematoma (0.3%) and dural breach (0.04%). As risk factor for early reintervention, only ASA score≥3 proved significant (OR: 5.5; 95% confidence interval: 1.1-29.85). As risk factor for epidural hematoma, only smoking proved significant (OR: 14.67; 95% confidence interval: 1.16-185.29). No risk factors emerged for onset of retropharyngeal hematoma. CONCLUSION ASA score≥3 and smoking entail risk of epidural hematoma and early reintervention. Postoperative pain, neurologic deficit, dysphagia, dysphonia, dyspnea and agitation suggest onset of complications, requiring necessary measures to be taken. Implementation of drainage fails to prevent such complications.
Collapse
Affiliation(s)
- M Boudissa
- Service de Chirurgie Orthopédique et Traumatologique, CHU Grenoble, 38700 La Tronche, France; Université Joseph-Fourier, Grenoble, France; Service de Chirurgie Orthopédique, Unité Rachis, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux 1, Bordeaux, France.
| | - J Lebecque
- Service de Chirurgie Orthopédique, Unité Rachis, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux 1, Bordeaux, France
| | - L Boissière
- Service de Chirurgie Orthopédique, Unité Rachis, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux 1, Bordeaux, France
| | - O Gille
- Service de Chirurgie Orthopédique, Unité Rachis, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux 1, Bordeaux, France
| | - V Pointillart
- Service de Chirurgie Orthopédique, Unité Rachis, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux 1, Bordeaux, France
| | - I Obeid
- Service de Chirurgie Orthopédique, Unité Rachis, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux 1, Bordeaux, France
| | - J-M Vital
- Service de Chirurgie Orthopédique, Unité Rachis, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux 1, Bordeaux, France
| |
Collapse
|
41
|
Boudissa M, Ruatti S, Kerschbaumer G, Milaire M, Merloz P, Tonetti J. Part 2: outcome of acetabular fractures and associated prognostic factors-a ten-year retrospective study of one hundred and fifty six operated cases with open reduction and internal fixation. Int Orthop 2015; 40:2151-2156. [PMID: 26686672 DOI: 10.1007/s00264-015-3070-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 12/07/2015] [Indexed: 11/26/2022]
Abstract
QUESTIONS/PURPOSES The aim of this study was to identify prognostic factors associated with a poor quality of reduction and their relationships. METHODS Data from medical charts for all patients admitted with acetabular fractures operated by open reduction and internal fixation (ORIF) from 2005 to 2014 were extracted. A total of 156 patients with a mean age of 40.3 years were included. All patients were reviewed at six months of follow-up. The prognostic factors analyzed were clinical and radiological factors. A new radiological parameter was also studied: the scanographic roof-arc angle. Specific statistical analysis was performed using a logistic regression model. RESULTS Using a multivariate analysis logistic regression model: roof impaction (p = 0.001; OR = 6.59; CI 95% [2.01-20.97]), transverse + posterior wall (p = 0.03, OR = 2.52; CI 95% [1.46-13.65]) and surgeons in training (p = 0.02; OR = 1.24; CI 95% [1.07-3.32]) were three independent prognostic factors. Lower values of medial and posterior scanographic roof-arc angle were associated with unsatisfactory reduction. A significant association between unsatisfactory reduction and posterior roof arc angle < 61° was found. CONCLUSIONS Three independent prognostic factors associated with a risk of unsatisfactory reduction in ORIF for acetabular fractures were identified: roof impaction, transverse + posterior wall fracture and surgeons in training. Scanographic roof-arc angle seems to be a new prognostic factor. Level of Evidence Level 4 retrospective study.
Collapse
Affiliation(s)
- Mehdi Boudissa
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Boulevard de la Chantourne, 38700, La Tronche, France.
- Joseph Fourier University, Grenoble, France.
| | - Sébastien Ruatti
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Boulevard de la Chantourne, 38700, La Tronche, France
- Joseph Fourier University, Grenoble, France
| | - Gael Kerschbaumer
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Boulevard de la Chantourne, 38700, La Tronche, France
- Joseph Fourier University, Grenoble, France
| | - Michel Milaire
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Boulevard de la Chantourne, 38700, La Tronche, France
- Joseph Fourier University, Grenoble, France
| | - Philippe Merloz
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Boulevard de la Chantourne, 38700, La Tronche, France
- Joseph Fourier University, Grenoble, France
| | - Jérôme Tonetti
- Orthopaedic and Traumatology Surgery Department, Grenoble University Hospitals, Boulevard de la Chantourne, 38700, La Tronche, France
- Joseph Fourier University, Grenoble, France
| |
Collapse
|
42
|
Boudissa M, Chabanas M, Oliveri H, Tonetti J. Virtual fracture reduction of the acetabulum using a rigid body biomechanical model. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rcot.2015.09.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
43
|
Vital JM, Boudissa M, Campana M. [Surgery for chronic low back pain: good option? Better than conservative treatment?]. Bull Acad Natl Med 2015; 199:1367-1382. [PMID: 29874425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The goal of this article is to assess, using the literature and our own experience, whether surgery is a reasonable option in the management of non-specific or degenerative chronic low back pain. The usual starting points for low back pain are without doubt the intervertebral disc and the facet joints, but the actual etiology is often difficult to determine. Moreover, psychogenic factors may amplify clinical symptoms. In our experience, thorough clinical, psychological, and socioprofessional assessment along with relevant imaging studies, parti- cularly MRI to look for inflammatory disc disease and EOS system to evaluate sagittal balance, leads to surgical indication in only 5 % of the patients with chronic low back pain. In these cases, surgery is aimed at short-circuiting ideally one, but sometimes two, interver- tebral segment by a conventional rigid fixation (arthrodesis), or by more recent non-rigid fixation techniques (disc replacement or interspinous dynamic stabilization). Their preven- tive effect on accelerated degeneration of adjacent segment appears to be moderate at best. The problem is to compare the results of surgical and conservative treatment: The analysis of publications concerning comparative randomized studies and personal studies shows that surgery is useful in only a small proportion of well selected patients with chronic low back pain, compared with physical and cognitive-behavioral management techniques.
Collapse
|
44
|
Boudissa M, Castelain JE, Boissière L, Mariey R, Pointillart V, Vital JM. Conversion paralysis after cervical spine arthroplasty: a case report and literature review. Orthop Traumatol Surg Res 2015; 101:637-41. [PMID: 26194210 DOI: 10.1016/j.otsr.2015.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 10/14/2014] [Revised: 05/11/2015] [Accepted: 06/03/2015] [Indexed: 02/02/2023]
Abstract
We report a case of conversion paralysis after cervical spine arthroplasty performed in a 45-year-old woman to treat cervico-brachial neuralgia due to a left-sided C6-C7 disc herniation. Upon awakening from the anaesthesia, she had left hemiplegia sparing the face, with normal sensory function. Magnetic resonance imaging (MRI) of the brain ruled out a stroke. MRI of the spinal cord showed artefacts from the cobalt-chrome prosthesis that precluded confident elimination of mechanical spinal cord compression. Surgery performed on the same day to substitute a cage for the prosthesis ruled out spinal cord compression, while eliminating the source of MRI artefacts. Findings were normal from follow-up MRI scans 1 and 15days later, as well as from neurophysiological testing (electromyogram and motor evoked potentials). The deficit resolved fully within the next 4days. A psychological assessment revealed emotional distress related to an ongoing divorce. The most likely diagnosis was conversion paralysis. Surgeons should be aware that conversion disorder might develop after a procedure on the spine, although the risk of litigation requires re-operation. Familiarity with specific MRI sequences that minimise artefacts can be valuable. A preoperative psychological assessment might improve the detection of patients at high risk for conversion disorder.
Collapse
Affiliation(s)
- M Boudissa
- Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - J E Castelain
- Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - L Boissière
- Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - R Mariey
- Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - V Pointillart
- Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - J M Vital
- Unité rachidienne, département de chirurgie orthopédique, hôpital universitaire de Bordeaux, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| |
Collapse
|
45
|
Roudet A, Boudissa M, Chaussard C, Rubens-Duval B, Saragaglia D. Acute traumatic patellar tendon rupture: Early and late results of surgical treatment of 38 cases. Orthop Traumatol Surg Res 2015; 101:307-11. [PMID: 25771528 DOI: 10.1016/j.otsr.2014.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 08/22/2014] [Revised: 12/06/2014] [Accepted: 12/23/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Acute patellar tendon rupture is easy to diagnose but is still often overlooked. The aim of this study was to assess early and late results of surgical treatment of acute patellar tendon rupture. Our hypothesis was that functional outcome is satisfactory. METHODS A retrospective study included 38 knees in 37 patients (4 female, 33 male). Mean age was 42.6 ± 9.9 years (range, 23-81 years). Lesions comprised 15 tendon body ruptures, 20 avulsions from the tip of the patella and 3 avulsions from the anterior tibial tuberosity. Tendon repair was protected in more than 95% of cases by a reinforcement frame: hamstring (21 cases), synthetic ligament (12 cases) or metallic wire (3 cases). Results were evaluated in 2 steps: on patient files at a mean follow-up of 7.1 months (range, 3-24 months) to assess complications and early functional and radiological results; and by phone at a mean follow-up of 9.3 years (range, 19-229 months) in order to assess long-term functional outcome on Lysholm score and patient satisfaction. RESULTS Thirty-one knees were assessed at a mean 7.1 months. Mean knee flexion was 128.5° ± 7.5° (range, 85°-150°), extension -1° (range, -15° to 0°) and Caton-Deschamps index 0.96 (range, 0.57-1.29). Twenty-three knees were further assessed at a mean 9.3 years. Mean Lysholm score was 93.7 points (range, 61-100). Ninety-six percent of patients were satisfied or very satisfied with the result. All had returned to their previous job, and 20 had returned to sports activities, including 8 at pretrauma level. CONCLUSION Patellar tendon rupture has good prognosis if diagnosis and surgical treatment is early.
Collapse
Affiliation(s)
- A Roudet
- Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, avenue de Kimberley, BP 338, 38130 Echirolles, France
| | - M Boudissa
- Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, avenue de Kimberley, BP 338, 38130 Echirolles, France
| | - C Chaussard
- Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, avenue de Kimberley, BP 338, 38130 Echirolles, France
| | - B Rubens-Duval
- Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, avenue de Kimberley, BP 338, 38130 Echirolles, France
| | - D Saragaglia
- Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, avenue de Kimberley, BP 338, 38130 Echirolles, France.
| |
Collapse
|
46
|
Boudissa M, Roudet A, Rubens-Duval B, Chaussard C, Saragaglia D. Acute quadriceps tendon ruptures: a series of 50 knees with an average follow-up of more than 6 years. Orthop Traumatol Surg Res 2014; 100:213-6. [PMID: 24529850 DOI: 10.1016/j.otsr.2013.09.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 07/16/2013] [Revised: 09/08/2013] [Accepted: 09/27/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Quadriceps tendon ruptures are rare and mainly affect patients over 40 years of age who have a systemic disease. The aim of this study was to evaluate the functional and radiological outcomes following surgical repair of acute quadriceps tendon ruptures. METHODS This retrospective study included 68 knees in 65 patients (three women, 62 men), having an average age of 55.2 ± 13.9 years. The Lysholm and Tegner scores, patient satisfaction, range of motion and X-rays were evaluated. RESULTS Fifty knees were evaluated with a mean follow-up of 76±67 months (12-253 months). The average Lysholm score was 93.7±10 (range 56-100, median 99) and 49 of 50 knees (98%) had good or very good subjective results. The average Tegner score was 3.4±1.6 (range 1-9, median 4). At the last follow-up, the average active flexion was 133°±10.8° (range 110°-150°, median 130°). Minor or moderate patellofemoral osteoarthritis was found in 24% of knees, but this was attributed to the surgery or initial injury in only 8% of cases. For 97% of active patients, the surgical repair allowed them to return to work in their pre-injury occupations. CONCLUSION Quadriceps tendon ruptures have a good prognosis if they are diagnosed quickly. Treatment consists of surgery and postoperative immobilization for at least 6 weeks. An intensive rehabilitation protocol is also needed to recover good knee function. LEVEL OF EVIDENCE Level IV. Retrospective study.
Collapse
Affiliation(s)
- M Boudissa
- Clinique universitaire de chirurgie orthopedique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France.
| | - A Roudet
- Clinique universitaire de chirurgie orthopedique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
| | - B Rubens-Duval
- Clinique universitaire de chirurgie orthopedique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
| | - C Chaussard
- Clinique universitaire de chirurgie orthopedique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
| | - D Saragaglia
- Clinique universitaire de chirurgie orthopedique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
| |
Collapse
|