1
|
Abane C, Gominard P, Hardy J, Alain A, Marcheix PS. Should recommended laboratory-test cut-offs allowing surgery be followed for proximal femoral fractures in patients on direct oral anticoagulant therapy? Orthop Traumatol Surg Res 2024; 110:103819. [PMID: 38278346 DOI: 10.1016/j.otsr.2024.103819] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/10/2023] [Accepted: 10/11/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Proximal femoral fractures (PFFs) in elderly patients must receive prompt surgical treatment. Optimal PFF-surgery timing in patients on direct oral anticoagulant (DOA) therapy is a specific but common clinical issue. Recommendations exist about the anti-Xa or anti-IIa levels and creatinine clearance values required to allow surgery. The objectives of this study in patients older than 75 years who required PFF surgery were to evaluate bleeding when the recommendations were versus were not applied and to assess concordance between DOA-activity-assay results and creatinine clearance used to help determine the wait to surgery. HYPOTHESIS Peri-operative bleeding is more marked when surgery is performed while the DOA is still active. PATIENTS AND METHODS This single-centre, retrospective, comparative, observational study included 87 patients older than 75 years who required arthroplasty or intra-medullary nailing for PFF and were taking DOA therapy. Surgery was performed after versus before the laboratory-test results fell below the recommended cut-offs in 68 patients (Rec+ group) versus 19 patients (Rec- group), respectively. The study outcomes were blood loss estimated using the Mercuriali's formula and the proportion of patients requiring post-operative blood transfusions. RESULTS Mean blood loss was 287.1mL in the Rec+ group and 411.7mL in the Rec- group (p=0.12). Blood transfusions were required by a post-operative haemoglobin level below 0.8g/dL in 11 (16.2%) Rec+ patients and 6 (31.6%) Rec- patients (p=0.2). Concordance was poor between DOA activity and creatinine clearance (Cohen's κ, 0.16; p=0.146). DISCUSSION Peri-operative bleeding was not significantly more severe when PFF surgery was performed while DOA therapy was still active. These data suggest that PFF surgery within 48h may be appropriate in patients older than 75 years on DOA therapy. LEVEL OF EVIDENCE IV; retrospective single-centre study.
Collapse
Affiliation(s)
- Cynthia Abane
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Pierre Gominard
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Jérémy Hardy
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Armand Alain
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Pierre-Sylvain Marcheix
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
| |
Collapse
|
2
|
Villatte G, Soleilhavoup M, Antoni M, Marcheix PS, Pereira B, Boisgard S, Descamps S, Erivan R. Assessment and trends in the methodological quality of the top 50 most cited articles in shoulder arthroplasty. Orthop Traumatol Surg Res 2023; 109:103702. [PMID: 37827452 DOI: 10.1016/j.otsr.2023.103702] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/24/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Shoulder arthroplasty is increasingly frequent, and the associated literature is abundant. Citation rate is often considered a good means of assessing impact and scientific value. However, analysis of methodological quality is also essential in evidence-based medicine. OBJECTIVES (1) To identify the 50 most cited articles on shoulder arthroplasty, and (2) to assess the correlation between citation rate and methodological quality. The study hypothesis was that there is no correlation between citation rate and methodological quality. METHOD Articles were retrieved from PubMed and Google Scholar, identifying the 50 most cited articles on shoulder arthroplasty via the keywords "shoulder joint replacement", "shoulder arthroplasty", "anatomic shoulder prothesis", "reverse shoulder prothesis", and "glenohumeral arthritis". Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-Randomized Studies (MINORS) were calculated. RESULTS Mean citation rate for the 50 articles was 312.4±169.5 (range, 151-841.5), with a mean citation density of 18.8±10.6 (range, 4.7-46.7). 56% of the studies (28/50) were retrospective case series with level of evidence IV. There was no correlation between citation rate and methodological quality. DISCUSSION The 50 most cited articles on shoulder arthroplasty mostly showed low levels of methodological quality. There was no correlation between citation rate and methodological quality: the literature needs to be read with a critical eye. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Guillaume Villatte
- CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, 63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie. CHU de Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - Marion Soleilhavoup
- Service d'orthopédie-traumatologie. CHU de Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Maxime Antoni
- Centre orthopédique de l'orangerie, clinique de l'orangerie, 29, allée de la Robertsau, 67000 Strasbourg, France
| | - Pierre-Sylvain Marcheix
- Service de chirurgie orthopédique et traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Bruno Pereira
- Department of Clinical Research and Innovation (DRCI), CHU de Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, 63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie. CHU de Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Descamps
- CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, 63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie. CHU de Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Roger Erivan
- CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, 63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie. CHU de Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| |
Collapse
|
3
|
Alain A, Cunique T, Abane C, Hardy J, Mabit C, Marcheix PS. Can the prognostic score proposed by Elliot serve as an educational tool to shorten the time to surgery for hip fractures in geriatric patients? Orthop Traumatol Surg Res 2023; 109:103707. [PMID: 37838023 DOI: 10.1016/j.otsr.2023.103707] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 04/11/2023] [Accepted: 05/31/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Hip fractures require surgical treatment within 48hours to decrease the risk of postoperative complications. Elliott proposed a prognostic score to identify which patients should be prioritized for surgery. This study was designed to answer the following questions: 1- Does using this score shorten the time to surgery? 2- Does shortening the time to surgery reduce mortality at 6 months and 1 year? 3- What factors delay the surgical procedure? We hypothesized that using this score as an educational tool would reduce the time to surgery in patients over 75 years of age who have a hip fracture. MATERIAL AND METHODS This single-center study involved two populations: 244 patients were included prospectively who had the score applied with the aim of optimizing the time to surgery; 476 patients were included from a historical cohort to serve as a reference group. RESULTS The mean time to surgery was 2.5 days±1.9 [95% CI: 2.41-2.77] and the median was 2 days (minimum 0, maximum 18 days) in the reference group; the mean was 1.4 days±1.0 [95% CI: 1.46-1.67] and the median was 1 day (min. 0, max 6 days) in the prospective cohort, which was a significant reduction (p<0.001). At 6 months, the mortality rate was 22.5% in the reference population and 23% in the prospective cohort. At 1 year, the mortality rate was 47% and 46%, respectively, with no significant difference. Surgical delays were attributed to lack of OR availability, management of anticoagulants, request for cardiac ultrasound and administrative reasons. DISCUSSION/CONCLUSION Elliot's prognostic at-risk score for hip fracture can shorten the time to surgery when used an educational tool to raise the medical staff's awareness of the benefits of rapid surgical care. LEVEL OF EVIDENCE IV; retrospective study without control group.
Collapse
Affiliation(s)
- Armand Alain
- Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France
| | - Thibault Cunique
- Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France
| | - Cynthia Abane
- Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France
| | - Jeremy Hardy
- Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France
| | - Christian Mabit
- Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France
| | - Pierre-Sylvain Marcheix
- Service d'orthopédie-traumatologie, CHU de Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France.
| |
Collapse
|
4
|
Boscher J, Alain A, Vergnenegre G, Hummel V, Charissoux JL, Marcheix PS. Femoral shaft fractures treated by antegrade locked intramedullary nailing: EOS stereoradiographic imaging evaluation of rotational malalignment having a functional impact. Orthop Traumatol Surg Res 2022; 108:103235. [PMID: 35172212 DOI: 10.1016/j.otsr.2022.103235] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/27/2020] [Revised: 02/02/2021] [Accepted: 03/16/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The standard treatment of femoral shaft fractures is intramedullary nailing. One of the most frequent complications is femoral malrotation. Our study sought to: 1) use EOS imaging to determine the amount of rotational malalignment after intramedullary nailing that has an impact on 6-month functional results; 2) determine the incidence of femoral malrotation based on EOS imaging; 3) determine the risk factors for postoperative femoral malrotation that impacts the 6-month functional results. The hypothesis was that EOS imaging can be used to determine the amount of femoral malrotation that has a functional impact in patients treated by percutaneous femoral intramedullary nailing. MATERIAL AND METHODS We performed a prospective, single-center study between September 2017 and February 2020. Patients who had suffered a femoral shaft fracture treated with antegrade intramedullary nailing were included in this study. Femoral anteversion was measured at 6 months with an EOS stereoradiographic imaging system. Patients were assessed at 6 months with the WOMAC, Oxford, Harris and MDP functional scores. The SF-12 quality of life score was also determined. RESULTS Thirty patients were evaluated at 6 months postoperatively, 15 women (50%) and 15 men (50%) who were 47 years old on average [16; 94]. The average anteversion was 19.9°C [-23°; 75°]. The functional scores (Oxford and Harris) were altered when there was 14° or more difference in femoral torsion between the operated side and the healthy side with a sensitivity of 0.88 and a specificity of 0.77. The risk factors for femoral malrotation were age under 35 years (p=0.01), urgent surgical management (p=0.008), location in middle third of femoral shaft (p=0.05), and short spiral fracture (p=0.02). CONCLUSION The use of EOS imaging allowed us to demonstrate that functional hip outcomes are altered at 6 months postoperatively when greater than 14° femoral malrotation is present compared to the contralateral side after femoral intramedullary nailing. The risk factors that contributed to intraoperative rotational malalignment were age less than 35 years, urgent surgical management, mid-shaft femoral fracture and short spiroid fractures. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Julien Boscher
- Service de chirurgie orthopédique et traumatologique, CHU de Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Armand Alain
- Service de chirurgie orthopédique et traumatologique, CHU de Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Guillaume Vergnenegre
- Service de chirurgie orthopédique et traumatologique, CHU de Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Vincent Hummel
- Service de radiologie IMRO, polyclinique de Limoges, 18, du Général-Catroux, 87039 Limoges cedex 1, France
| | - Jean-Louis Charissoux
- Service de chirurgie orthopédique et traumatologique, CHU de Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Pierre-Sylvain Marcheix
- Service de chirurgie orthopédique et traumatologique, CHU de Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
| |
Collapse
|
5
|
Desclée de Maredsous R, Huet S, Brichoux S, Charissoux JL, Marcheix PS. User satisfaction with single-use instruments versus reusable instruments for treating distal radius fractures with locking volar plates. Orthop Traumatol Surg Res 2022; 108:103217. [PMID: 35093567 DOI: 10.1016/j.otsr.2022.103217] [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: 09/25/2020] [Revised: 10/25/2020] [Accepted: 12/07/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The adoption of single-use instruments (SUI) in orthopedic and trauma surgery continues at a rapid pace. Economics studies on this topic have come to contradictory conclusions about whether these SUI have a cost advantage. The aims of our study were to (1) compare the satisfaction of operating room staff between SUI and reusable instruments (RUI) in the context of distal radius fracture fixation with locking volar plates; (2) compare the immediate postoperative and medium-term radiological outcomes of patients operated these two types of instrument sets. We hypothesized that users will be more satisfied with SUI in the context of distal radius fracture fixation with locking volar plates. MATERIALS AND METHODS This was a prospective, single-center study performed between April 2019 and July 2020. The inclusion criteria were patients more than 18 years of age who had a distal radius fracture with indication for fixation with volar locking plate, and whose initial treatment and follow-up were completed in our surgery department. Two groups of patients were created: SUI and RUI. The satisfaction of the surgeons and scrub nurses was determined using a 10-item questionnaire. RESULTS The analysis was done on 91 procedures for which a satisfaction questionnaire was completed by the primary surgeon and the scrub nurse. The satisfaction scores were always significantly better in the RUI group than in the SUI group (p<0.05). DISCUSSION This study found that surgeons and scrub nurses in our surgery department liked the RUI better than the SUI. At a time when SUI kits become more popular in orthopedic and trauma surgery, based on cost arguments that still need to be confirmed, taking into account the operating room staff's opinion is an important criterion for improving RUI kits. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Romain Desclée de Maredsous
- Service de chirurgie orthopédique et traumatologique, CHU Dupuytren, 2, avenue Martin Luther King, 87042 Limoges, France
| | - Soline Huet
- Service de pharmacie centrale, CHU Dupuytren, 2, avenue Martin Luther King, 87042 Limoges, France
| | - Sonia Brichoux
- Service de pharmacie centrale, CHU Dupuytren, 2, avenue Martin Luther King, 87042 Limoges, France
| | - Jean-Louis Charissoux
- Service de chirurgie orthopédique et traumatologique, CHU Dupuytren, 2, avenue Martin Luther King, 87042 Limoges, France
| | - Pierre-Sylvain Marcheix
- Service de chirurgie orthopédique et traumatologique, CHU Dupuytren, 2, avenue Martin Luther King, 87042 Limoges, France.
| |
Collapse
|
6
|
Villatte G, Erivan R, Nourissat G, Marcheix PS, Pereira B, Aubret S, Boisgard S, Descamps S. Allograft and autograft provide similar retear rates for the management of large and massive rotator cuff tears: a review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2039-2059. [PMID: 34586436 DOI: 10.1007/s00167-021-06745-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/12/2021] [Accepted: 09/08/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Currently, autografts and allografts are largely used to treat large or massive rotator cuff tear (RCT), without any evidence in favour of one graft or the other. The purpose of this study was to determine the rate of retear of autograft and allograft in the treatment of large or massive posterosuperior RCT. METHOD The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature as well as the presentation of results. A search of the literature was performed in the electronic databases MEDLINE, Scopus, Embase, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) score. Inclusion criteria were studies in English evaluating clinical and radiological results of surgical treatment with autograft or allograft for large or massive RCT since 2008. The main criterion was the retear rate of the graft assessed on MRI or US scan at 1-year minimum follow-up. Partial tear were classified as "tear". RESULTS The overall retear rate was 23.6% (15.5-32.7) at a mean follow-up of 18.4 ± 7.8 (12-36) months. There was no significant difference between the two kinds of graft, with a retear rate of 27.0% (15.4-40.2) and 20.9% (9.9-34.2) with autograft and allograft respectively (n.s.). Similar improvements of functional scores (+ 28.8 to 38.4 points for the Constant score, + 33.6 to 38.4 points for the ASES, and - 4.0 to - 4.1 points for pain-VAS) were reported in the two groups after at 27.2 ± 11.1 (12-48) months. The rate of complications except retear was 1.8% (0.2, 3.7) with autograft and 0.5% (0.8, 1.8) with allograft (n.s.). CONCLUSION The use of autograft and allograft for the treatment of large or massive RCT leads to similar retear rate and clinical outcomes at short to medium terms. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Guillaume Villatte
- Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France.
- Service d'orthopédie-Traumatologie. CHU Montpied Clermont-Ferrand, 63000, Clermont-Ferrand, France.
| | - Roger Erivan
- Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France
- Service d'orthopédie-Traumatologie. CHU Montpied Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Geoffroy Nourissat
- Clinique Maussins-Nollet, Ramsay Générale de Santé, 78000, Paris, France
| | - Pierre-Sylvain Marcheix
- Service de Chirurgie Orthopédique et Traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042, Limoges cedex, France
| | - Bruno Pereira
- DRCI, CHU de Clermont Ferrand, BP 69, 63003 Cedex 01, Clermont Ferrand, France
| | - Sylvain Aubret
- Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France
- Service d'orthopédie-Traumatologie. CHU Montpied Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Stéphane Descamps
- Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France
- Service d'orthopédie-Traumatologie. CHU Montpied Clermont-Ferrand, 63000, Clermont-Ferrand, France
| |
Collapse
|
7
|
Huet S, Desclée de Maredsous R, Almeida M, Brischoux S, Marcheix PS. The use of single-use ancillaries does not increase the cost of osteosynthesis in orthopaedic surgery: A case study of plate osteosynthesis for distal radius fractures. Injury 2022; 53:2095-2101. [PMID: 35489821 DOI: 10.1016/j.injury.2022.04.016] [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: 11/08/2021] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the cost of using single-use instruments (SUIs) and conventional ancillary instruments (CAIs) during osteosynthesis for distal radius fracture (DRF). MATERIAL AND METHODS We conducted a prospective, monocentric study of ancillary instruments, including a cost minimisation analysis by micro-costing. DRF reduction and postoperative complications were monitored for 3 months. RESULTS In 103 procedures, the overall cost and operating times were similar between the two groups. The costs of using unit screws, sterilisation, and operating room and pharmacy staff were superior when using SUIs, compared with CAIs. The postoperative outcomes were comparable between groups. CONCLUSION In our centre, SUI use was associated with logistical advantages, but it was not associated with increased costs. However, the SUI kit should be optimised in the future.
Collapse
Affiliation(s)
- Soline Huet
- Service de pharmacie centrale, CHU Dupuytren. 2, Avenue Martin Luther King, 87042 LIMOGES cedex
| | - Romain Desclée de Maredsous
- Service de chirurgie orthopédique et traumatologique, CHU Dupuytren. 2, Avenue Martin Luther King, 87042 LIMOGES cedex
| | - Martine Almeida
- Service de pharmacie centrale, CHU Dupuytren. 2, Avenue Martin Luther King, 87042 LIMOGES cedex
| | - Sonia Brischoux
- Service de pharmacie centrale, CHU Dupuytren. 2, Avenue Martin Luther King, 87042 LIMOGES cedex
| | - Pierre-Sylvain Marcheix
- Service de chirurgie orthopédique et traumatologique, CHU Dupuytren. 2, Avenue Martin Luther King, 87042 LIMOGES cedex.
| |
Collapse
|
8
|
Cunique T, Desclee de Maredsous R, Hardy J, Vergnenegre G, Marcheix PS. Évaluation médicale et paramédicale de l’utilisation des ancillaires à usage unique et des ancillaires réutilisables pour le traitement par plaques verrouillées antérieures des fractures du radius distal - Enquête de satisfaction. Hand Surgery and Rehabilitation 2021. [DOI: 10.1016/j.hansur.2021.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
9
|
Marcheix PS, Cuenca C, Vergnenegre G, Mabit C, Hardy J, Charissoux JL. Factors influencing the mid-term radiological and functional outcomes of 41 post-fracture bipolar radial head arthroplasty cases at a mean follow-up of 87 months. Orthop Traumatol Surg Res 2021; 107:102818. [PMID: 33484903 DOI: 10.1016/j.otsr.2021.102818] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/31/2020] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION When treating comminuted radial head fractures that cannot be adequately fixed, the next option is arthroplasty (radial head replacement). We hypothesized that the radiological and functional outcomes of bipolar mobile cup radial head arthroplasty is not influenced by the length of follow-up but instead by the correct positioning of the implant intraoperatively and by the presence of associated bone or ligament injuries. PATIENTS AND METHODS Between May 1998 and December 2016, 82 cases of radial head arthroplasty were performed at our hospital. The mean age of patients at the time of arthroplasty was 53 years (22-81). Ligament or bone injuries complicated the radial head fractures in 70% of patients. RESULTS For the final assessment, 41 patients were reviewed and included in the statistical analysis with a mean of 82 months (12-228). The mean MEPS at the final assessment was 88.7 (61-100). There were 23 excellent, 9 good, 9 average and 0 poor results. The average DASH score was 18.7 (0-55). The average VAS for pain was 1.0 (0-5). Five patients (12%) required surgical revision, including one implant change. Our statistical analysis found no relationship between follow-up time and functional outcomes. The appearance of periprosthetic radiolucent lines was not affected by the length of follow-up. Associated bone or ligament injuries significantly increased the probability of periprosthetic radiolucent lines, humeroulnar joint degeneration and decentering of the implanted cup. Radiological evidence of a suspended implant was associated with significantly worse functional outcomes. CONCLUSION This study confirms the long-term stability of the clinical outcomes of radial head arthroplasty. There was no relationship between worsening radiological appearance of the implant and the clinical outcomes. It is critical that this implant not be oversized or suspended, as this can trigger premature capitellar erosion and painful stiffness of the operated elbow. LEVEL OF EVIDENCE IV; systematic retrospective analysis.
Collapse
Affiliation(s)
- Pierre-Sylvain Marcheix
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin Luther-King, 87042 Limoges, France.
| | - Céline Cuenca
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin Luther-King, 87042 Limoges, France
| | - Guillaume Vergnenegre
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin Luther-King, 87042 Limoges, France
| | - Christian Mabit
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin Luther-King, 87042 Limoges, France
| | - Jérémy Hardy
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin Luther-King, 87042 Limoges, France
| | - Jean-Louis Charissoux
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin Luther-King, 87042 Limoges, France
| |
Collapse
|
10
|
Villatte G, Marcheix PS, Antoni M, Devos P, Descamps S, Boisgard S, Erivan R. Do bibliometric findings differ between Medline, Google Scholar and Web of Science? Bibliometry of publications after oral presentation to the 2013 and 2014 French Society of Arthroscopy (SFA) Congresses. Orthop Traumatol Surg Res 2020; 106:1469-1473. [PMID: 33153959 DOI: 10.1016/j.otsr.2020.09.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Bibliometrics consists in quantitative and qualitative analysis of an individual's or group's communication (volume, visibility), and impacts research funding. There are a number of bibliometric data sources, functioning in different ways and liable to give rise to differing statistics. This point has not been investigated in relation to publication following presentation to a French congress. We therefore conducted a study comparing the main bibliometric instruments, aiming to assess: (1) publication rates following oral presentation to the 2013 and 2014 French Society of Arthroscopy (SFA) Congresses according to the database used, and (2) citation rates for these publications according to database. HYPOTHESIS Publication and citation rates differ according to database. Material and method All 199 Abstracts of oral presentations to the 2013 and 2014 SFA Congresses were included. Based on author names and key-words, manual search was conducted in the Medline, Web of Science and Google Scholar databases. Publication characteristics (citation rate) were studied using the 3 databases and the French SIGAPS (Système d'Interrogation, de Gestion et d'Analyse des Publications Scientifiques: Scientific Publication Search, Management and Analysis System) website. RESULTS Publication rates according to Medline and Google Scholar were the same (48.2%: 96 articles for 199 presentations), but significantly lower on Web of Science (44.7%: 89/199; p=0.002). Citation rates differed significantly (p<0.001) between sources, with Google Scholar listing a mean 1.5-3.4-fold more citations per article than the other 2 databases. Citation rates between the 3 databases correlated strongly (r=0.93). DISCUSSION The example presented in this study illustrates the differences in bibliometrics found between different databases. There was a 4% difference (7/199 articles) in publication rates following oral presentation to an SFA Congress, and even greater differences in citation rates per article, with 1.5-3.4-fold more citations according to Google Scholar. Bibliometric studies need to acknowledge the database(s) being used, which should be as many as possible to enhance exhaustiveness. LEVEL OF EVIDENCE IV; descriptive epidemiologic study.
Collapse
Affiliation(s)
- Guillaume Villatte
- CNRS, SIGMA Clermont, ICCF, université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie, CHU Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - Pierre-Sylvain Marcheix
- Service de chirurgie orthopédique et traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Maxime Antoni
- Service de chirurgie du membre supérieur, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - Patrick Devos
- ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, université de Lille, CHU Lille, 59000 Lille, France
| | - Stéphane Descamps
- CNRS, SIGMA Clermont, ICCF, université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie, CHU Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- CNRS, SIGMA Clermont, ICCF, université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie, CHU Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Roger Erivan
- CNRS, SIGMA Clermont, ICCF, université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie, CHU Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| |
Collapse
|
11
|
Hardy J, Chrosciany S, Bernard JP, Mabit C, Marcheix PS. The human costal cartilage: Anatomical and radiological study of macro-vascularization and micro-vascularization and its clinical relevance regarding vascularized chondrocostal free flap surgery. Ann Anat 2020; 232:151581. [DOI: 10.1016/j.aanat.2020.151581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 01/09/2023]
|
12
|
Collin C, Bimou C, Mabit C, Tchalla A, Charissoux JL, Marcheix PS. Orthogeriatric assessment of patients over 75 years of age with a proximal femur fracture: Predictors of 6-month mortality. Orthop Traumatol Surg Res 2020; 106:1441-1447. [PMID: 33060014 DOI: 10.1016/j.otsr.2020.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/27/2019] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Proximal femur fractures are common and dangerous in older adults, given the high short-term mortality rate. While surgical treatment is vital, medical orthogeriatric care may reduce the 6-month mortality rate; however, this has not been determined on a broad scale in France. This led us to conduct a retrospective study to answer the following questions: (1) Does delayed surgical treatment impact the 6-month mortality rate? (2) Are there correctable medical factors that impact the 6-month mortality? HYPOTHESIS Delayed surgical treatment is not an isolated risk factor for higher 6-month mortality after proximal femur fracture. METHODS We included all patients 75 years or older who had suffered a proximal femur fracture requiring surgical treatment. This allowed us to analyze the medical records of 476 patients retrospectively. We documented their comorbidities and pre-, intra- and postoperative characteristics. A univariate then multivariate analysis was done to identify risk factors for mortality at 6 months. RESULTS In the univariate analysis, time to surgery of more than 48hours increased the risk of dying at 6 months by 1.5 fold (Odds ratio (OR)=1.57/95% CI: 1-2.48/p=0.04). However, this risk factor was not significant in the multivariate analysis since it is not an independent risk factor. In the multivariate analysis, anticoagulants (OR=2/95% CI: 1.13-3.50/p=0.02), dementia (OR=2.2/95% CI: 1.32-3.59/p=0.002), peripheral artery disease (OR=2.9/95% CI: 1.10-7.70/p=0.03), 2-point drop in hemoglobin count from preoperative to postoperative (OR=1.9/95% CI: 1.05-3.12/p=0.04), male sex (OR=1.82/95% CI: 1.05-3.12/p=0.04), age above 85 years (OR=5.26/95% CI: 1.49-5.26/p=0.002) and Charlson comorbidity index≥7 (OR=2.13/95% CI: 1.29-3.52/p=0.003) were statistically associated with mortality at 6 months. DISCUSSION/CONCLUSION Our study found that the patients most at risk for dying within 6 months of a hip fracture were males, older than 85 and have associated medical conditions (Charlson index≥7). Prior anticoagulant treatment increases the time to surgery in our study and therefore increases the risk of these patients dying within 6 months. Treatment of these at-risk patients should ensure that their underlying medical conditions are not made worse, while providing treatment within 48hours. Patients taking anticoagulants must be monitored carefully to ensure surgical treatment is not delayed. LEVEL OF EVIDENCE IV, retrospective study without control group.
Collapse
Affiliation(s)
- Camille Collin
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - Charlotte Bimou
- EA 6310 HAVAE handicap activité vieillissement autonomie environnement, université de Limoges, 33, rue François-Mitterrand, 87032 Limoges, France
| | - Christian Mabit
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - Achille Tchalla
- Service de médecine gériatrique, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - Jean-Louis Charissoux
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - Pierre-Sylvain Marcheix
- Service d'orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France.
| |
Collapse
|
13
|
Picouleau A, Orsoni N, Hardy J, Mabit C, Charissoux JL, Marcheix PS. Analysis of the effects of arthrodesis of the hallux metatarsophalangeal joint on gait cycle: results of a GAITRite ® treadmill test. Int Orthop 2020; 44:2167-2176. [PMID: 32683459 DOI: 10.1007/s00264-020-04716-5] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Approximately 80% of patients are satisfied with the outcome of arthrodesis of the hallux metatarsophalangeal (MTP) joint. The hypothesis of this study was that MTP arthrodesis does not influence the walking cycle. The aim of this study was to evaluate the effect of MTP arthrodesis on gait cycle and to measure the functional outcome of MTP arthrodesis after a minimum of two year follow-up. METHOD This was an observational prospective cohort study performed at a single centre that included 26 patients (32 ft) who underwent unilateral or bilateral MTP arthrodesis during the period 2004-2014. An X-ray assessment based on the American Orthopaedic Foot and Ankle Society score was performed pre-operatively and at the last follow-up (average follow-up duration 8.3 years). The walking cycle was analysed at the final follow-up using a GAITRite® treadmill test. RESULTS Twenty unilateral and six bilateral MTP arthrodeses were included in this study. The average age of the patients was 70 years. No significant difference was found in the walking cycle between the operated and non-operated sides for unilaterally MTP arthrodesis. However, we observed a non-significant increase in the percentage of contact time after MTP arthrodesis (65% on the operated side vs. 63% on the non-operated side). We also observed a significant decrease in the average walking rate, and a decrease in walking speed, in cases of bilateral MTP arthrodesis compared with normal walking cycle data from a laboratory study. CONCLUSIONS MTP joint arthrodesis does not appear to have any effect on the walking cycle, but reduced patient pain and increased the walking distance. The patients reported satisfaction with the surgical outcomes and would recommend it to a relative with the same pathology.
Collapse
Affiliation(s)
- Alexandre Picouleau
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Nathlaie Orsoni
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Jeremy Hardy
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Christian Mabit
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Jean-Louis Charissoux
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Pierre-Sylvain Marcheix
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France.
| |
Collapse
|
14
|
Bonnevialle P, Marcheix PS, Nicolau X, Arboucalot M, Lebaron M, Chantelot C, Mainard D, Ehlinger M. Interprosthetic femoral fractures: Morbidity and mortality in a retrospective, multicenter study. Orthop Traumatol Surg Res 2019; 105:579-585. [PMID: 30514624 DOI: 10.1016/j.otsr.2018.07.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/26/2018] [Accepted: 07/02/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Interprosthetic femoral fractures (IFF) are becoming more frequent; however they have not been the subject of many publications and the largest study on this topic includes only 30 cases. The complication rate and clinical outcomes have only been evaluated in small case series. This led us to conduct a retrospective, multicenter, observational study in IFF patients with at least 12 months' follow-up to (1) determine the mortality and morbidity (2) determine the clinical and radiological outcomes and (3) identify elements of the treatment indications. HYPOTHESIS The morbidity and mortality rates will be comparable to those in recent studies on this topic. MATERIALS AND METHODS The study included 51 patients (49 women, 2 men) with a mean age of 82.8±9.2 years [55-97], a mean Parker score of 4.9±2.4 and a mean Katz score of 4.4±1.4 who had suffered an IFF between 2009 and 2015. According to the SoFCOT modifications of the Vancouver classification, 30 fractures were interprosthetic in the shaft segment where there were no implants (19 double C and 11 type D (corresponding to a type C with less than two diaphysis widths between the extension stems of the hip and knee implants)) while 21 were periprosthetic, with 12 around the THA (11 B1 and 1 B3) and 9 around the TKA (8 B1 and 1 B3). One patient was treated conservatively with an external fixator but died the next day, 2 patients received a new total hip arthroplasty and 47 underwent plate fixation of their fracture (one patient was treated non-operatively because of poor medical condition). RESULTS One patient was lost to follow-up, and nine died during the first 6 months. Six early surgical site complications occurred and 13 general ones. Within 1 year of the IFF, there were six mechanical complications, two surgical site infections and two cases of loosening. The mean follow-up was 27.6±17.2 months. The mean time to union was 19.25±8.8 weeks. The mean final Parker score was 3.37±2.6 and the mean Katz score was 2.98±1.8; both were significantly lower than the initial scores. Six patients died between months 12 and 50. The overall mortality at the final review was 31% (16/51) with a median survival of 3.45 years. DISCUSSION Our hypothesis was not confirmed because the mortality and morbidity in our study were higher than in other published studies. In the six relevant studies identified, the surgical site infection rate was 12.3%, the major revision rate was 11.6% and the mortality rate was 6.5%. In our study, these values were 24%, 24% and 31%, respectively. These worse results may be explained by the very fragile nature of the studied population and the surgeons not following appropriate technical rules for fracture fixation. LEVEL OF EVIDENCE IV, Retrospective study.
Collapse
Affiliation(s)
- Paul Bonnevialle
- Département universitaire d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, place Baylac, 31052 Toulouse, France.
| | - Pierre-Sylvain Marcheix
- Service de chirurgie orthopédique et de traumatologie, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Xavier Nicolau
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - Marine Arboucalot
- Département universitaire d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, place Baylac, 31052 Toulouse, France
| | - Marie Lebaron
- Service de chirurgie orthopédique et de traumatologie, hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - Christophe Chantelot
- Service de chirurgie orthopédique et de traumatologie, place de Verdun, 59037 Lille, France
| | - Didier Mainard
- Service de chirurgie orthopédique et de traumatologie, hôpital central, CHU de Nancy, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | -
- Groupe d'étude en traumatologie [French Orthopedic Trauma Society], 56, rue Boissonade, 75014 Paris, France
| |
Collapse
|
15
|
Hardy J, Collin C, Mathieu PA, Vergnenègre G, Charissoux JL, Marcheix PS. Is non-operative treatment still relevant for Garden Type I fractures in elderly patients? The femoral neck impaction angle as a new CT parameter for determining the indications of non-operative treatment. Orthop Traumatol Surg Res 2019; 105:479-483. [PMID: 30858044 DOI: 10.1016/j.otsr.2018.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/25/2018] [Accepted: 12/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The indications of non-operative treatment of undisplaced femoral neck fractures are controversial. The objective of this study was to assess whether two computed tomography (CT) parameters, the femoral neck impaction angle (IA) and the femoral neck posterior tilt angle (PTA), were effective in predicting the risk of secondary displacement after non-operative treatment of Garden I femoral neck fractures in patients aged 65 years or over. HYPOTHESIS The working hypotheses were that the IA in the coronal plane and PTA in the axial plane predicted secondary displacement after non-operative treatment of Garden I femoral neck fractures, could be reproducibly and reliably measured on CT scans, and could serve to identify Garden I fractures at risk for secondary displacement after non-operative treatment. METHODS Forty-nine patients aged 65 years or over with Garden I fractures treated non-operatively were included in a prospective single-centre study. CT images were used to measure the IA as the position of the fracture line relative to the femoral head in the coronal plane and the PTA as the position of the femoral head centre relative to the femoral neck axis in the axial plane. RESULTS After non-operative treatment, secondary displacement occurred in 22 (45%) patients. The PTA was not significantly different between the groups with vs. without secondary displacement (p=0.62). IA values≤135° were significantly associated with secondary displacement (odds ratio, 11.73; 95% confidence interval [95%CI], 3.04-45.28; p=0.004). An IA≤135° was 72.73% sensitive and 81.48% specific for predicting secondary displacement. IA measurement was reproducible, with intra-class and inter-class Cohen's kappa values of 0.94 (95%CI, 0.90-0.97) and 0.9011 (95%CI, 0.83-0.94), respectively. DISCUSSION The IA measured on CT images may hold promise for identifying Garden I hip fractures at high risk for secondary displacement after non-operative treatment. IA measurement is reproducible and reliable and may help to determine the indications of non-operative treatment. LEVEL OF EVIDENCE II, prospective cohort study.
Collapse
Affiliation(s)
- Jérémy Hardy
- Service de chirurgie orthopédique, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France.
| | - Camille Collin
- Service de chirurgie orthopédique, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Pierre-Alain Mathieu
- Service de chirurgie orthopédique, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Guillaume Vergnenègre
- Service de chirurgie orthopédique, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Jean-Louis Charissoux
- Service de chirurgie orthopédique, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Pierre-Sylvain Marcheix
- Service de chirurgie orthopédique, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| |
Collapse
|
16
|
Cuenca C, Mention PJ, Vergnenegre G, Matthieu PA, Charissoux JL, Marcheix PS. Are orthopedic surgeons exposed to excessive eye irradiation? A prospective study of lens irradiation in orthopedics and traumatology. Orthop Traumatol Surg Res 2019; 105:569-572. [PMID: 30898557 DOI: 10.1016/j.otsr.2019.01.013] [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: 07/08/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Numerous studies in recent years highlighted an increased risk of pathologies related to ionizing radiation in caregivers. A new French decree was adopted on June 4, 2018, dividing by 7.5 the radiation dose authorized in the lens for exposed workers. HYPOTHESIS The hypothesis of the present study was that ocular irradiation in orthopedic surgeons was below the new legal threshold. METHOD The equivalent dose (mSv) received by the lens was prospectively assessed in 10 orthopedic surgeons (5 senior, 5 residents), using 3 passive dosimeters placed at the forehead and either temple. Each intervention of each operator was recorded, with dose per area in the operating room at each use of the fluoroscope. RESULTS All equivalent doses to the lens at the end of the 4 month study period were well below threshold. Doses were not significantly different between forehead and either temple (p=0.7, p=0.6 for the 2 temples). There was no difference according to side of the head (p=0.3). The dose received in the lens correlated with the dose delivered in the room (p=0.004). There were no significant differences in irradiation according to the surgeon's experience (p=0.2) or trauma activity rate (p=0.4). DISCUSSION No studies have reported equivalent doses to the lens exceeding the authorized limit. But none previously measured equivalent dose to the lens according to the axis of irradiation in the eyes. The present study showed that orthopedic surgeons received as much eye radiation laterally as frontally. Ocular radiation protection needs therefore to be as effective laterally as frontally. The surgeon's experience did not emerge as a protective factor against ocular irradiation.
Collapse
Affiliation(s)
- Céline Cuenca
- Service de chirurgie orthopédique et traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
| | - Pierre-Jean Mention
- Service de médecine nucléaire, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Guillaume Vergnenegre
- Service de chirurgie orthopédique et traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Pierre-Alain Matthieu
- Service de chirurgie orthopédique et traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Jean-Louis Charissoux
- Service de chirurgie orthopédique et traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Pierre-Sylvain Marcheix
- Service de chirurgie orthopédique et traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| |
Collapse
|
17
|
Bazin I, Armendariz M, Marcheix PS, Pichon M, Fredon F, Mabit C, Mathieu PA. A computed tomography study of the fibula: morphology, morphometry, intramedullary anatomy, application prospects on intramedullary nailing. Surg Radiol Anat 2019; 41:681-687. [PMID: 30993418 DOI: 10.1007/s00276-019-02213-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/13/2018] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The intramedullary percutaneous pinning in fractures of the lateral malleolus is a technique of osteosynthesis that can reduce complications of ORIF. Our study describes the morphology and the morphometry of the fibula, in particular intramedullary, so as to specify the best fibular nail features. METHODS We conducted a retrospective study on CT acquisitions of fibulae in vivo. We studied total length, and the distal malleolar angle. Regarding intramedullary morphology, six axial study levels were defined. Each level was assigned a morphometric classification (oval, triangular, quadrangular or irregular), and a measure of the diameter of the cavity. The distance between the smaller diameter and the malleolar tip was investigated. RESULTS We included 50 patients for 97 fibulae. The average age was 66.5 years. The irregular morphology type was the most frequently found. The average length was 370.5 mm (SD = 18.1; CI 95% [366.9; 374.1]), the average distal malleolar angle was 163.5° (SD = 3.7; CI 95% [162.7; 164.2]). The average minimal intramedullary diameter at malleolus level was 3.2 mm (SD = 1.2; CI 95% [3.0; 3.5]), with a minimum size reaching 95.8 mm (SD = 13.8; CI 95% [93.0; 98.5]) of the malleolar tip. CONCLUSIONS The analysis of morphological parameters of the fibula, in particular the lateral malleolus and intramedullary morphology is necessary for the design of a morpho-adapted nail. Interpersonal variability must be taken into account by the implant industry to offer nails of suited lengths and diameters.
Collapse
Affiliation(s)
- I Bazin
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France.
| | - M Armendariz
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - P S Marcheix
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - M Pichon
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - F Fredon
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - C Mabit
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - P A Mathieu
- Centre Hospitalier Universitaire de Limoges Dupuytren, 2 Avenue Martin Luther King, 87000, Limoges, France
| |
Collapse
|
18
|
Cambon-Binder A, Walch A, Marcheix PS, Belkheyar Z. Bipolar transfer of the pectoralis major muscle for restoration of elbow flexion in 29 cases. J Shoulder Elbow Surg 2018; 27:e330-e336. [PMID: 30195620 DOI: 10.1016/j.jse.2018.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/16/2017] [Revised: 06/18/2018] [Accepted: 06/23/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study evaluated the functional outcomes of bipolar pedicled pectoralis major (PM) transfer to restore elbow flexion. METHODS We retrospectively reviewed 29 transfers in 28 patients with a mean age of 31.2 years (range, 5-65 years). The loss of elbow flexion was due to brachial plexus palsy in 24 patients, elbow flexors necrosis in 4, and poliomyelitis in 1. The entire PM muscle was mobilized and fixed proximally to the coracoid process. Intraoperative positioning and postoperative immobilization of the shoulder and the elbow flexed at 60° and 120°, respectively, allowed direct distal fixation of the muscle to the biceps brachii tendon. RESULTS At the last follow-up (mean, 13 months; range, 4-37 months), 41% of the transfers (n = 12) recovered grade 4 elbow flexion strength and were able to lift 2.2 kg on average (range, 0.5-5 kg), 52% (n = 15) recovered grade 3 strength, and 7% (n = 2) had a poor result (ie, grade 2 elbow flexion). The mean active elbow flexion was 100° (ranging, 30°-150°), and the patients had 0° to 10° elbow flexion contracture. CONCLUSIONS Our results indicate that bipolar PM transfer is a reliable and effective procedure to restore elbow flexion. Flexion of the shoulder and elbow allowed the transfer to reach the elbow fold and avoided an interposition graft between the distal PM and the biceps brachii tendon.
Collapse
Affiliation(s)
- Adeline Cambon-Binder
- Department of Orthopaedic and Hand Surgery, Saint-Antoine Hospital, Sorbonne Université, Paris, France.
| | - Arnaud Walch
- Hand and Upper Limb Surgery Department, Edouard Herriot Hospital, Lyon, France
| | - Pierre-Sylvain Marcheix
- Orthopaedic and Trauma Department, Centre Hospitalier Universitaire Dupuytren, Limoges, France
| | | |
Collapse
|
19
|
Cambon-Binder A, Preure L, Dubert-Khalifa H, Marcheix PS, Belkheyar Z. Spinal accessory nerve repair using a direct nerve transfer from the upper trunk: results with 2 years follow-up. J Hand Surg Eur Vol 2018; 43:589-595. [PMID: 29433411 DOI: 10.1177/1753193418755618] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Indexed: 02/03/2023]
Abstract
UNLABELLED Spinal accessory nerve grafting requires identification of both nerve stumps in the scar tissue, which is sometimes difficult. We propose a direct nerve transfer using a fascicle from the posterior division of the upper trunk. We retrospectively reviewed 11 patients with trapezius palsy due to an iatrogenic injury of the spinal accessory nerve in nine cases. The mean age was 38 years (range 21-59). Preoperatively, patients showed shoulder weakness and limited range of motion. At a mean follow-up of 25 months, active shoulder abduction improvement averaged 57°. Trapezius muscle strength graded M4 or M5 in 10 cases and M3 in one case. No deltoid or triceps impairment was reported. Scapula kinematics was considered normal in seven patients. This technique gave satisfactory functional results and may be an alternative to spinal accessory nerve grafting for the management of trapezius palsies if direct repair is not feasible. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Adeline Cambon-Binder
- 1 Orthopedic and Hand Surgery Department, Saint-Antoine Hospital, Paris, Sorbonne Université, France
| | - Lynda Preure
- 2 Groupement hospitalier Eaubonne Montmorency, Hôpital Simone Veil, Eaubonne, France
| | | | | | | |
Collapse
|
20
|
Abstract
Background In elderly patients, distal radius fractures frequently occur in osteoporotic bone and may be nonreconstructable. It is our hypothesis that a hemiarthroplasty replacment of the articular surface can provide satisfactory results in terms of range of motion, pain, and function for immediate salvage of a fracture that is not amenable to internal fixation. Methods Between July 2009 and January 2012, eight elderly patients were treated with insertion of a Sophia distal radius implant (Biotech, Paris, France). Inclusion criteria consisted of an isolated AO type C2 distal radius fracture in patients over 70 years old. All patients were reviewed by an independent surgeon. Results The mean follow-up was 25 months (range, 17-36 months). Mean wrist range of motion (ROM) was 45° (40-50°) of flexion, 44° (40-50°) of extension, and a mean pronation-supination arc of 160°. Mean grip force was 18 kgf. The mean QuickDASH (Disabilities of the Arm, Shoulder and Hand) was 18.2/100 (6.82-29.55), and the mean visual analog scale (VAS) was 2.33 (0-4). X-ray images did not demonstrate implant loosening or ulnar translation of the carpus. Conclusions The Sophia hemiarthroplasty provided rapid recovery of independence in elderly patients with a nonreconstructable comminuted distal radius fracture.
Collapse
Affiliation(s)
| | - Jérémy Hardy
- Orthopedics and Traumatology Unit, CHRU Limoges, Limoges, France
| | - Christian Mabit
- Orthopedics and Traumatology Unit, CHRU Limoges, Limoges, France
| | | | | |
Collapse
|
21
|
Mathieu PA, Marcheix PS, Hummel V, Valleix D, Mabit C. Anatomical study of the clavicle: endomedullary morphology. Surg Radiol Anat 2013; 36:11-5. [PMID: 23728517 DOI: 10.1007/s00276-013-1140-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 05/16/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The treatment of clavicle fractures remains controversial. The objective of this study was to investigate the possibility of clavicular intramedullary fixation by nailing through an anatomic study combined with CT scan studies. METHODS For the anatomic study, 20 clavicles of donated bodies to science (10 men, 10 women, 10 right, 10 left) were used. We measured the length of the clavicle, lateral epiphysis diameter, mean diaphysis diameter, medial epiphysis diameter, lateral width, lateral radius of curvature, medial width and medial radius of curvature. Intramedullary cavity diameter (anteroposterior and superoinferior) and calibration were measured by CT scan study on 20 clavicles. RESULTS Average length was 152 mm for men and 140 mm for women. The anteroposterior curvature was most pronounced. The medullary canal had a gradually decreasing size from the distal portion to the middle segment, but never disappeared. CONCLUSION Evaluation of morphological data can clarify the specifications of an intramedullary nail: flexibility of the nail to match clavicle curvature and a locking system to ensure primary stability. Intramedullary fixation by nailing in displaced fractures of the middle portion of the clavicle is a minimally invasive surgical technique, with excellent functional and cosmetic results.
Collapse
Affiliation(s)
- Pierre-Alain Mathieu
- Department of Human Anatomy, Laboratoire d'Anatomie, Faculty of Medicine, University of Limoges, 2, Rue Dr Marcland, 87025, Limoges, France
| | | | | | | | | |
Collapse
|
22
|
Coste C, Asloum Y, Marcheix PS, Dijoux P, Charissoux JL, Mabit C. Percutaneous iliosacral screw fixation in unstable pelvic ring lesions: the interest of O-ARM CT-guided navigation. Orthop Traumatol Surg Res 2013; 99:S273-8. [PMID: 23639760 DOI: 10.1016/j.otsr.2013.03.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The reference surgical treatment for unstable posterior pelvic fracture is percutaneous iliosacral screw fixation, isolated or in association with other techniques. As there is a risk of passage outside the bone when performing screw fixation under fluoroscopy, new image-guidance techniques have been developed: fluoronavigation, peroperative 3D navigation, CT-linked navigation, etc. Since September 2011, our department has performed iliosacral screw fixation under CT control linked to navigation so as to optimize screw positioning. This innovative technology has been used in neurosurgery in our center since 2007, for disc implants, spinal fracture, vertebral arthrodesis and intracerebral localization. MATERIAL AND METHODS Six patients were treated by iliosacral screw fixation for posterior pelvic ring fracture lesion. The O-ARM (Medtronic(®)) computer-assisted surgical navigation system was used, combining surgical navigation and peroperative 3D imaging. This kind of osteosynthesis is suitable for non-displaced or prereduced fracture. A radiation dose report is drawn up at end of surgery. DISCUSSION Postoperative course does not differ from other percutaneous osteosynthesis techniques, combing the advantages of a percutaneous approach (reduced infection and blood-loss rates, etc.) while optimizing iliosacral screw positioning. To date, no radiation overexposure has been found. CONCLUSION The precision and safety of iliosacral screw fixation are now unequalled, meeting the basic computer-assisted surgery principles of reduced morbidity without overexposure to ionizing radiation. Indications for computer-assisted surgery should therefore be extended to iliosacral pathologies (arthritic, tumoral and inflammatory), non-displaced acetabular fracture, etc.
Collapse
Affiliation(s)
- C Coste
- Dupuytren University Hospital, Orthopedic-Traumatology Department, 2 Avenue Martin-Luther-King, Limoges cedex, France
| | | | | | | | | | | |
Collapse
|