Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
4S36 82 e RÉUNION ANNUELLE DE LA SO.F.C.O.T. dement extensif de tout tissu dégénératif et inflamm... more 4S36 82 e RÉUNION ANNUELLE DE LA SO.F.C.O.T. dement extensif de tout tissu dégénératif et inflammatoire ont été réalisés, soit sous arthroscopie, soit à ciel ouvert.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
ABSTRACT Introduction La prothèse totale inversée est un des traitements proposé dans l’omarthros... more ABSTRACT Introduction La prothèse totale inversée est un des traitements proposé dans l’omarthrose excentrée. Son indication reste prudente à ce jour du fait de l’apparition quasi systématique d’une encoche, en quelques mois, au bord inférieur de la glène, responsable d’une rupture de la courbe de survie de l’implant vers la 7e année. Gerber a montré que le positionnement bas de l’implant glénoïdien permet de limiter la survenue de l’encoche. Cette fixation basse est limitée par le faible stock osseux à cet endroit. Matériel et Méthodes Depuis Mars 2003, nous avons réalisé 122 prothèses totales inversées d’épaule. L’âge moyen est de 70 ans, le recul moyen est de 18 mois. La voie d’abord a été 59 fois antéro-supérieure, et 63 fois deltopectorale. Résultats Nous constatons une seule encoche (0,01 %). Celle-ci est survenue sur une prothèse inversée vers le 3e mois, est évolutive, avec une dégradation clinique sur 12 mois. Aucun descellement n’est manifeste, cette encoche concerne le 1/3 inférieur de la glène et n’est pas associée à un éperon osseux. Par contre, nous constatons un éperon osseux, de volume variable, dans 71 cas. Dans les 50 autres cas, aucune image d’addition ou de soustraction osseuse n’est visible. Cet éperon n’est pas spécifique des prothèses inversées, puisqu’on le retrouve également 1 fois sur 2 dans les prothèses totales anatomiques. Discussion Nous expliquons mal notre seul cas d’encoche évolutive. Peut-être s’agit-il d’un sepsis latent. Les éperons surviennent très tôt, vers le 3e mois, puis se stabilisent. Ils n’ont pas été responsables de complications. Conclusion Le dessin de l’implant glénoïdien et huméral semble tout aussi important que son positionnement bas pour éviter la survenue de l’encoche.
European Journal of Orthopaedic Surgery & Traumatology, 2012
The optimal choice for the treatment of end-stage primary glenohumeral osteoarthritis remains con... more The optimal choice for the treatment of end-stage primary glenohumeral osteoarthritis remains controversial, with alternatives including total shoulder replacement (TSR) and humeral head replacement (HHR). The objective of this review is to analyze the effect of TSR compared with HHR on rates of pain relief, range of motion, patient satisfaction and revision surgery in patients with primary glenohumeral osteoarthritis. Compared with HHR, TSR provided significantly greater pain relief, gain in forward elevation, and gain in external rotation and patient satisfaction. Furthermore, TSR required significantly less revision surgery glenoid component loosening than patients undergoing HHR (progression of osteoarthritis changes with subchondral sclerosis, joint space narrowing and glenoid subsidence). A convex-back pegged glenoid component with a modern instrumented cement pressurization technique achieves risk of loosening. For 10 years, a high interest regarding new designs of uncemented metal back glenoid components has developed with promising results, because they allow glenoid bone graft in case of glenoid erosion or dysplasia and a one-stage glenoid bone reconstruction in case of revision surgery.
RÉSULTATS. Une simple arthroscopie exploratrice a été réalisée pour se familiariser avec cette no... more RÉSULTATS. Une simple arthroscopie exploratrice a été réalisée pour se familiariser avec cette nouvelle anatomie dans les 4 premiers cas. Dans les 2 autres cas suivants, la pénétration de l'optique de 2,7 mm n'a pas été possible du fait de la petite taille de l'articulation, du manque de sensation tactile précise dans ces épaules cartilagineuses, et probablement du fait des déformations articulaires avec des surfaces ovoïdes. Dans les 4 derniers cas, l'expérience aidant, l'arthrolyse arthroscopique a été possible. Nous avons utilisé une électrode monopolaire à 35 watt pour libérer par voie gléno-humérale le ligament coraco-huméral et le ligament gléno-huméral moyen à la face profonde du sous scapulaire. Ce geste a suffi pour libérer totalement la rotation externe RE1 (+ 60°de gain) et seul a été réalisé en complément un transfert du grand dorsal sur le sus épineux.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
Purpose of the studyThe vascularized fibular graft is a widely used technique for the reconstruct... more Purpose of the studyThe vascularized fibular graft is a widely used technique for the reconstruction of long bone defects after tumor resection. Complications are not uncommon despite the presence of a good vascular supply. We report our experience with long bone reconstructions in children and adolescents after resection of primary malignant bone tumors.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur
The vascularized fibular graft is a widely used technique for the reconstruction of long bone def... more The vascularized fibular graft is a widely used technique for the reconstruction of long bone defects after tumor resection. Complications are not uncommon despite the presence of a good vascular supply. We report our experience with long bone reconstructions in children and adolescents after resection of primary malignant bone tumors. This retrospective analysis included thirteen patients aged 4-17 years (mean age 12 years). Preoperatively, the pathological diagnosis was Ewing tumor (n=7), osteogenic sarcoma (n=5), neuroepithelioma (n=1). All patients except one were given chemotherapy preoperatively and postoperatively and four received adjuvant radiotherapy. Tumor resection created a gap (n=8) or involved resection-arthrodesis (n=5, three knees, one ankle, one elbow). All reconstructions used a vascularized fibular flap with a complementary corticocancellous autograft for seven. Complete carcinological resection was achieved in all cases. Mean follow-up was 50 months (range 12-14...
European journal of orthopaedic surgery & traumatology : orthopédie traumatologie, 2013
Although TSA has been shown to significantly yield better outcomes than hemiarthroplasty, glenoid... more Although TSA has been shown to significantly yield better outcomes than hemiarthroplasty, glenoid prosthesis loosening remains the most common complication. Inadequate primary fixation enables the glenoid component to move. In primary glenohumeral osteoarthritis (GHOA), glenoid involvement and proper morphology vary considerably. Postero-inferior glenoid hypoplasia could be associated with some degree of osteoarthritis. According to Walch, 24 % of glenoids in GHOA are type B2 or C (excessive posterior retroversion), which increases the challenge for the glenoid component fixation. A total of 30 cases of TSR with glenoid type B2 (20 cases) and type C (10 cases) were reviewed. Mean follow-up was 11.2 months. A metal-backed (MB) glenoid component was implanted, with a posterior bone graft reconstruction. Pre- and post-operative clinical evaluation was done using the Constant-Murley score and the SST from Matsen. There is no glenoid loosening, no joint narrowing and no radiolucent line....
Orthopaedics & Traumatology: Surgery & Research, 2015
In some clinical situations such as when the Long Head of the Biceps (LHB) is unstable or with an... more In some clinical situations such as when the Long Head of the Biceps (LHB) is unstable or with an "hourglass biceps", treatment is required. Tenodesis is an alternative to tenotomy to prevent the Popeye sign. Although sutures, anchors or interference screws may be used, they all have complications and drawbacks. Moreover, the number of failures is underestimated because it only considers the visible deformities of the arm. MRI provides more accurate assessment, but is more expensive. We hypothesized that Froimson's "keyhole technique" which has been described in open surgery could be performed arthroscopically with similar clinical outcomes to conventional techniques and without the complications or drawbacks. We also propose an objective and less expensive assessment of treatment failure. This 12-month prospective study was performed by a single surgeon. All patients requiring LHB tenodesis underwent arthroscopic "keyhole technique" surgery performed at the upper edge of the Pectoralis major in the bicipital groove. The LHB was externalised, pulled back on itself and the intra-articular portion was resected. A metal marker was placed in the tendon. The latter was introduced into the keyhole and hangs spontaneously. The follow-up evaluation was performed during the third month with a clinical examination and a plain X-ray. Distal migration of the metal marker was the sign of the failure of tenodesis. Between January 1st and December 31st, 2013, 123 patients were included. There were 87 men (70.7%) and 36 women (29.3%) and mean age was 52.2 (27-71). Eighty-eight patients underwent arthroscopic rotator cuff repair. Twenty-three patients (18.5%) had tenodesis failure shown by distal migration of the metal marker on plain X-rays. There were 21 men and 2 women. Only 13 had a visible Popeye sign and 1 was severe. None of the patients felt any discomfort, fatigue or painful cramping. There was no difference in flexion and supination strength from the healthy side. No complications were noted. We confirm the hypothesis that this arthroscopic technique is feasible and reproducible with clinical outcomes similar to conventional techniques but without the complications. The metal marker implanted in the LHB confirms the exact number of failures, which is a significant element in this study. IV.
Revue de Chirurgie Orthopédique et Traumatologique, 2014
ABSTRACT Dans certaines situations cliniques comme les biceps instables, les biceps en prérupture... more ABSTRACT Dans certaines situations cliniques comme les biceps instables, les biceps en prérupture à l’entrée de la gouttière ou les biceps en sabliers, un geste thérapeutique s’impose. La ténodèse est une alternative à la ténotomie pour éviter le signe de Popeye. Sutures simples, ancres ou vis d’interférences sont proposées, mais des complications et des inconvénients existent. Par ailleurs l’analyse des échecs de la ténodèse dans la littérature est sous-évaluée car elle ne tient compte que de la déformation visible du bras. L’IRM a été utilisée pour affiner cette analyse, mais son coût est élevé.
We present an original technique for reconstruction of the distal fibula after tumor resection. T... more We present an original technique for reconstruction of the distal fibula after tumor resection. The case report was of a 13-year old boy suffering from an osteogenic sarcoma of the distal fibula. Pedicled vascularized epiphyseal transfer using the ipsilateral proximal fibula was performed. Results were assessed at 2 years and 6 months and provided good stability and normal functional outcome of the ankle.
The aim of the study was to evaluate the advantages of magnetic resonance imaging (MRI) in determ... more The aim of the study was to evaluate the advantages of magnetic resonance imaging (MRI) in determining subluxation in Legg-Calvé-Perthes (LCPD) disease. Twenty-six patients with unilateral LCPD received 33 MRI and plain radiographs. For each patient, acetabulum head index (AHI) was measured on both hips (affected and unaffected) in a blinded fashion. Measurements were made from the cortical bone margin on the plain radiograph and from the cartilaginous surfaces on MRI. On the unaffected side AHI was 92.8% on the plain radiograph and 85% on MRI. On the affected side, AHI was 87% on the plain radiograph and 77% on MRI. These differences were statistically significant. With regard to the unaffected side, the femoral head should be considered subluxated if AHI is less than 86% on the plain radiograph and less than 77% on MRI. On the affected side, in 14 cases the femoral head was well-contained on both the plain radiograph and MRI. In 11 patients the femoral head was subluxated both on the plain radiograph and on MRI. In 8 patients the femoral head was well-contained on the plain radiograph but subluxated on MRI. This was due to thickening of the cartilaginous portion of the femoral head, which was clearly seen on MRI. MRI appeared to be more sensitive in determining the subluxation of the femoral head during the active phase of LCPD.
The purpose of this study was to evaluate a minimally invasive subscapularis-preserving arthrosco... more The purpose of this study was to evaluate a minimally invasive subscapularis-preserving arthroscopic release of capsule in the treatment of internal rotation contracture of the shoulder due to Erb's palsy. We performed our procedure (subscapularis-preserving arthroscopic release of capsule) in 10 paediatric shoulders with an average age of 20.2 months and followed them for an average period of 41.5 months. All the patients were assessed clinically and radiologically preoperatively and postoperatively at regular intervals. The Mallet scoring system was used for analysing the results. The average gain in passive external rotation was 508. The active internal rotation was preserved in all the cases. With the mid-term follow-up, there was no loss of the gained external rotation or the recurrence of internal rotation contracture of the shoulder. Our hypothesis has achieved its goal in preserving subscapularis, active internal rotation and treatment of internal rotation contracture of the shoulder. The success of this procedure lies in the early identification of starting of internal rotation contracture and early surgical intervention to prevent progressive permanent glenohumeral osseocartilaginous deformity.
Ulnar styloid fractures are frequently ignored in the treatment of wrist fractures in children. F... more Ulnar styloid fractures are frequently ignored in the treatment of wrist fractures in children. Forty-six untreated ulnar styloid fractures (40 tip and six base fractures) associated with radial injuries (45 patients) were retrospectively analysed. At the removal of the cast, we recorded that 80% had a nonunion of the styloid fracture. Thirty-five patients were reviewed at an average of 19 months after treatment. Thirty tip fractures and five base avulsions were found. We recorded 28 patients with a good clinical result despite 21 cases of nonunion, whereas seven patients (all nonunions) had a fair result. All the fair results suffered from intermittent pain during sports and movement, radioulnar joint instability and tears of the triangular fibrocartilage complex. It can be concluded that both distal radius and ulnar styloid fractures should be taken into account in the initial treatment and pain associated with a nonunion of the ulnar styloid in a child may be due to a tear of the triangular fibrocartilage complex.
A case of bilateral forearm localization of multiple hereditary osteochondromata and unilateral K... more A case of bilateral forearm localization of multiple hereditary osteochondromata and unilateral Kienböck's disease is reported. Ulnar minus variance is frequent in both diseases. Carpal slip is often found in multiple hereditary osteochondromata. In this case, the extremity having both multiple hereditary osteochondromata and Kienböck's disease had no carpal slip. This might have produced an excess load on the lunate, which might have provoked Kienböck's disease.
Journal of hand surgery (Edinburgh, Scotland), 2002
Thirty obstetrical brachial plexus palsies involving the upper roots were retrospectively reviewe... more Thirty obstetrical brachial plexus palsies involving the upper roots were retrospectively reviewed. There were 20 C5-C6 palsies and ten C5-C6-C7 palsies in which recovery of C7 occurred by the end of the first month. Recovery of elbow flexion at 3 months, C7 involvement and high birthweight were the best early predictors of outcome, but all were unreliable when used separately. In combination, recovery of elbow flexion and birthweight predicted the final outcome reasonably satisfactorily, particularly when elbow flexion at 9 months, and not 3 months was considered (risk of error = 13%). Brachial plexus reconstruction may therefore be justified when there was initial C7 involvement associated with increased birthweight and poor elbow flexion at 6-9 months.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2015
ABSTRACT The main complication of radial head fracture is elbow stiffness consequence of ligament... more ABSTRACT The main complication of radial head fracture is elbow stiffness consequence of ligament injuries due to the trauma and those due to the surgery The aim of this study is to use an arthroscopic procedure for reduction and internal fixation:– enabling a complete diagnosis of ligament impairments (medial, volar, lateral);– sparing the collateral lateral and annular ligaments during the reduction and fixation.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
4S36 82 e RÉUNION ANNUELLE DE LA SO.F.C.O.T. dement extensif de tout tissu dégénératif et inflamm... more 4S36 82 e RÉUNION ANNUELLE DE LA SO.F.C.O.T. dement extensif de tout tissu dégénératif et inflammatoire ont été réalisés, soit sous arthroscopie, soit à ciel ouvert.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
ABSTRACT Introduction La prothèse totale inversée est un des traitements proposé dans l’omarthros... more ABSTRACT Introduction La prothèse totale inversée est un des traitements proposé dans l’omarthrose excentrée. Son indication reste prudente à ce jour du fait de l’apparition quasi systématique d’une encoche, en quelques mois, au bord inférieur de la glène, responsable d’une rupture de la courbe de survie de l’implant vers la 7e année. Gerber a montré que le positionnement bas de l’implant glénoïdien permet de limiter la survenue de l’encoche. Cette fixation basse est limitée par le faible stock osseux à cet endroit. Matériel et Méthodes Depuis Mars 2003, nous avons réalisé 122 prothèses totales inversées d’épaule. L’âge moyen est de 70 ans, le recul moyen est de 18 mois. La voie d’abord a été 59 fois antéro-supérieure, et 63 fois deltopectorale. Résultats Nous constatons une seule encoche (0,01 %). Celle-ci est survenue sur une prothèse inversée vers le 3e mois, est évolutive, avec une dégradation clinique sur 12 mois. Aucun descellement n’est manifeste, cette encoche concerne le 1/3 inférieur de la glène et n’est pas associée à un éperon osseux. Par contre, nous constatons un éperon osseux, de volume variable, dans 71 cas. Dans les 50 autres cas, aucune image d’addition ou de soustraction osseuse n’est visible. Cet éperon n’est pas spécifique des prothèses inversées, puisqu’on le retrouve également 1 fois sur 2 dans les prothèses totales anatomiques. Discussion Nous expliquons mal notre seul cas d’encoche évolutive. Peut-être s’agit-il d’un sepsis latent. Les éperons surviennent très tôt, vers le 3e mois, puis se stabilisent. Ils n’ont pas été responsables de complications. Conclusion Le dessin de l’implant glénoïdien et huméral semble tout aussi important que son positionnement bas pour éviter la survenue de l’encoche.
European Journal of Orthopaedic Surgery & Traumatology, 2012
The optimal choice for the treatment of end-stage primary glenohumeral osteoarthritis remains con... more The optimal choice for the treatment of end-stage primary glenohumeral osteoarthritis remains controversial, with alternatives including total shoulder replacement (TSR) and humeral head replacement (HHR). The objective of this review is to analyze the effect of TSR compared with HHR on rates of pain relief, range of motion, patient satisfaction and revision surgery in patients with primary glenohumeral osteoarthritis. Compared with HHR, TSR provided significantly greater pain relief, gain in forward elevation, and gain in external rotation and patient satisfaction. Furthermore, TSR required significantly less revision surgery glenoid component loosening than patients undergoing HHR (progression of osteoarthritis changes with subchondral sclerosis, joint space narrowing and glenoid subsidence). A convex-back pegged glenoid component with a modern instrumented cement pressurization technique achieves risk of loosening. For 10 years, a high interest regarding new designs of uncemented metal back glenoid components has developed with promising results, because they allow glenoid bone graft in case of glenoid erosion or dysplasia and a one-stage glenoid bone reconstruction in case of revision surgery.
RÉSULTATS. Une simple arthroscopie exploratrice a été réalisée pour se familiariser avec cette no... more RÉSULTATS. Une simple arthroscopie exploratrice a été réalisée pour se familiariser avec cette nouvelle anatomie dans les 4 premiers cas. Dans les 2 autres cas suivants, la pénétration de l'optique de 2,7 mm n'a pas été possible du fait de la petite taille de l'articulation, du manque de sensation tactile précise dans ces épaules cartilagineuses, et probablement du fait des déformations articulaires avec des surfaces ovoïdes. Dans les 4 derniers cas, l'expérience aidant, l'arthrolyse arthroscopique a été possible. Nous avons utilisé une électrode monopolaire à 35 watt pour libérer par voie gléno-humérale le ligament coraco-huméral et le ligament gléno-huméral moyen à la face profonde du sous scapulaire. Ce geste a suffi pour libérer totalement la rotation externe RE1 (+ 60°de gain) et seul a été réalisé en complément un transfert du grand dorsal sur le sus épineux.
Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur, 2007
Purpose of the studyThe vascularized fibular graft is a widely used technique for the reconstruct... more Purpose of the studyThe vascularized fibular graft is a widely used technique for the reconstruction of long bone defects after tumor resection. Complications are not uncommon despite the presence of a good vascular supply. We report our experience with long bone reconstructions in children and adolescents after resection of primary malignant bone tumors.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur
The vascularized fibular graft is a widely used technique for the reconstruction of long bone def... more The vascularized fibular graft is a widely used technique for the reconstruction of long bone defects after tumor resection. Complications are not uncommon despite the presence of a good vascular supply. We report our experience with long bone reconstructions in children and adolescents after resection of primary malignant bone tumors. This retrospective analysis included thirteen patients aged 4-17 years (mean age 12 years). Preoperatively, the pathological diagnosis was Ewing tumor (n=7), osteogenic sarcoma (n=5), neuroepithelioma (n=1). All patients except one were given chemotherapy preoperatively and postoperatively and four received adjuvant radiotherapy. Tumor resection created a gap (n=8) or involved resection-arthrodesis (n=5, three knees, one ankle, one elbow). All reconstructions used a vascularized fibular flap with a complementary corticocancellous autograft for seven. Complete carcinological resection was achieved in all cases. Mean follow-up was 50 months (range 12-14...
European journal of orthopaedic surgery & traumatology : orthopédie traumatologie, 2013
Although TSA has been shown to significantly yield better outcomes than hemiarthroplasty, glenoid... more Although TSA has been shown to significantly yield better outcomes than hemiarthroplasty, glenoid prosthesis loosening remains the most common complication. Inadequate primary fixation enables the glenoid component to move. In primary glenohumeral osteoarthritis (GHOA), glenoid involvement and proper morphology vary considerably. Postero-inferior glenoid hypoplasia could be associated with some degree of osteoarthritis. According to Walch, 24 % of glenoids in GHOA are type B2 or C (excessive posterior retroversion), which increases the challenge for the glenoid component fixation. A total of 30 cases of TSR with glenoid type B2 (20 cases) and type C (10 cases) were reviewed. Mean follow-up was 11.2 months. A metal-backed (MB) glenoid component was implanted, with a posterior bone graft reconstruction. Pre- and post-operative clinical evaluation was done using the Constant-Murley score and the SST from Matsen. There is no glenoid loosening, no joint narrowing and no radiolucent line....
Orthopaedics & Traumatology: Surgery & Research, 2015
In some clinical situations such as when the Long Head of the Biceps (LHB) is unstable or with an... more In some clinical situations such as when the Long Head of the Biceps (LHB) is unstable or with an "hourglass biceps", treatment is required. Tenodesis is an alternative to tenotomy to prevent the Popeye sign. Although sutures, anchors or interference screws may be used, they all have complications and drawbacks. Moreover, the number of failures is underestimated because it only considers the visible deformities of the arm. MRI provides more accurate assessment, but is more expensive. We hypothesized that Froimson's "keyhole technique" which has been described in open surgery could be performed arthroscopically with similar clinical outcomes to conventional techniques and without the complications or drawbacks. We also propose an objective and less expensive assessment of treatment failure. This 12-month prospective study was performed by a single surgeon. All patients requiring LHB tenodesis underwent arthroscopic "keyhole technique" surgery performed at the upper edge of the Pectoralis major in the bicipital groove. The LHB was externalised, pulled back on itself and the intra-articular portion was resected. A metal marker was placed in the tendon. The latter was introduced into the keyhole and hangs spontaneously. The follow-up evaluation was performed during the third month with a clinical examination and a plain X-ray. Distal migration of the metal marker was the sign of the failure of tenodesis. Between January 1st and December 31st, 2013, 123 patients were included. There were 87 men (70.7%) and 36 women (29.3%) and mean age was 52.2 (27-71). Eighty-eight patients underwent arthroscopic rotator cuff repair. Twenty-three patients (18.5%) had tenodesis failure shown by distal migration of the metal marker on plain X-rays. There were 21 men and 2 women. Only 13 had a visible Popeye sign and 1 was severe. None of the patients felt any discomfort, fatigue or painful cramping. There was no difference in flexion and supination strength from the healthy side. No complications were noted. We confirm the hypothesis that this arthroscopic technique is feasible and reproducible with clinical outcomes similar to conventional techniques but without the complications. The metal marker implanted in the LHB confirms the exact number of failures, which is a significant element in this study. IV.
Revue de Chirurgie Orthopédique et Traumatologique, 2014
ABSTRACT Dans certaines situations cliniques comme les biceps instables, les biceps en prérupture... more ABSTRACT Dans certaines situations cliniques comme les biceps instables, les biceps en prérupture à l’entrée de la gouttière ou les biceps en sabliers, un geste thérapeutique s’impose. La ténodèse est une alternative à la ténotomie pour éviter le signe de Popeye. Sutures simples, ancres ou vis d’interférences sont proposées, mais des complications et des inconvénients existent. Par ailleurs l’analyse des échecs de la ténodèse dans la littérature est sous-évaluée car elle ne tient compte que de la déformation visible du bras. L’IRM a été utilisée pour affiner cette analyse, mais son coût est élevé.
We present an original technique for reconstruction of the distal fibula after tumor resection. T... more We present an original technique for reconstruction of the distal fibula after tumor resection. The case report was of a 13-year old boy suffering from an osteogenic sarcoma of the distal fibula. Pedicled vascularized epiphyseal transfer using the ipsilateral proximal fibula was performed. Results were assessed at 2 years and 6 months and provided good stability and normal functional outcome of the ankle.
The aim of the study was to evaluate the advantages of magnetic resonance imaging (MRI) in determ... more The aim of the study was to evaluate the advantages of magnetic resonance imaging (MRI) in determining subluxation in Legg-Calvé-Perthes (LCPD) disease. Twenty-six patients with unilateral LCPD received 33 MRI and plain radiographs. For each patient, acetabulum head index (AHI) was measured on both hips (affected and unaffected) in a blinded fashion. Measurements were made from the cortical bone margin on the plain radiograph and from the cartilaginous surfaces on MRI. On the unaffected side AHI was 92.8% on the plain radiograph and 85% on MRI. On the affected side, AHI was 87% on the plain radiograph and 77% on MRI. These differences were statistically significant. With regard to the unaffected side, the femoral head should be considered subluxated if AHI is less than 86% on the plain radiograph and less than 77% on MRI. On the affected side, in 14 cases the femoral head was well-contained on both the plain radiograph and MRI. In 11 patients the femoral head was subluxated both on the plain radiograph and on MRI. In 8 patients the femoral head was well-contained on the plain radiograph but subluxated on MRI. This was due to thickening of the cartilaginous portion of the femoral head, which was clearly seen on MRI. MRI appeared to be more sensitive in determining the subluxation of the femoral head during the active phase of LCPD.
The purpose of this study was to evaluate a minimally invasive subscapularis-preserving arthrosco... more The purpose of this study was to evaluate a minimally invasive subscapularis-preserving arthroscopic release of capsule in the treatment of internal rotation contracture of the shoulder due to Erb's palsy. We performed our procedure (subscapularis-preserving arthroscopic release of capsule) in 10 paediatric shoulders with an average age of 20.2 months and followed them for an average period of 41.5 months. All the patients were assessed clinically and radiologically preoperatively and postoperatively at regular intervals. The Mallet scoring system was used for analysing the results. The average gain in passive external rotation was 508. The active internal rotation was preserved in all the cases. With the mid-term follow-up, there was no loss of the gained external rotation or the recurrence of internal rotation contracture of the shoulder. Our hypothesis has achieved its goal in preserving subscapularis, active internal rotation and treatment of internal rotation contracture of the shoulder. The success of this procedure lies in the early identification of starting of internal rotation contracture and early surgical intervention to prevent progressive permanent glenohumeral osseocartilaginous deformity.
Ulnar styloid fractures are frequently ignored in the treatment of wrist fractures in children. F... more Ulnar styloid fractures are frequently ignored in the treatment of wrist fractures in children. Forty-six untreated ulnar styloid fractures (40 tip and six base fractures) associated with radial injuries (45 patients) were retrospectively analysed. At the removal of the cast, we recorded that 80% had a nonunion of the styloid fracture. Thirty-five patients were reviewed at an average of 19 months after treatment. Thirty tip fractures and five base avulsions were found. We recorded 28 patients with a good clinical result despite 21 cases of nonunion, whereas seven patients (all nonunions) had a fair result. All the fair results suffered from intermittent pain during sports and movement, radioulnar joint instability and tears of the triangular fibrocartilage complex. It can be concluded that both distal radius and ulnar styloid fractures should be taken into account in the initial treatment and pain associated with a nonunion of the ulnar styloid in a child may be due to a tear of the triangular fibrocartilage complex.
A case of bilateral forearm localization of multiple hereditary osteochondromata and unilateral K... more A case of bilateral forearm localization of multiple hereditary osteochondromata and unilateral Kienböck's disease is reported. Ulnar minus variance is frequent in both diseases. Carpal slip is often found in multiple hereditary osteochondromata. In this case, the extremity having both multiple hereditary osteochondromata and Kienböck's disease had no carpal slip. This might have produced an excess load on the lunate, which might have provoked Kienböck's disease.
Journal of hand surgery (Edinburgh, Scotland), 2002
Thirty obstetrical brachial plexus palsies involving the upper roots were retrospectively reviewe... more Thirty obstetrical brachial plexus palsies involving the upper roots were retrospectively reviewed. There were 20 C5-C6 palsies and ten C5-C6-C7 palsies in which recovery of C7 occurred by the end of the first month. Recovery of elbow flexion at 3 months, C7 involvement and high birthweight were the best early predictors of outcome, but all were unreliable when used separately. In combination, recovery of elbow flexion and birthweight predicted the final outcome reasonably satisfactorily, particularly when elbow flexion at 9 months, and not 3 months was considered (risk of error = 13%). Brachial plexus reconstruction may therefore be justified when there was initial C7 involvement associated with increased birthweight and poor elbow flexion at 6-9 months.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2015
ABSTRACT The main complication of radial head fracture is elbow stiffness consequence of ligament... more ABSTRACT The main complication of radial head fracture is elbow stiffness consequence of ligament injuries due to the trauma and those due to the surgery The aim of this study is to use an arthroscopic procedure for reduction and internal fixation:– enabling a complete diagnosis of ligament impairments (medial, volar, lateral);– sparing the collateral lateral and annular ligaments during the reduction and fixation.
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Papers by Jean Kany