The purpose of this study was to compare the manifestations of elbow stress due to repetitive val... more The purpose of this study was to compare the manifestations of elbow stress due to repetitive valgus forces between the dominant and the non-dominant elbow in 40 uninjured elite team handball players using plain films, stress radiographs, ultrasound, and MRI examination. On comparative plain films generalized bony hypertrophy manifested by increased humeral diameter, and cortical hypertrophy of the humeral shaft of the dominant extremity was observed in all players. A significantly greater difference in medial joint space opening between stressed and unstressed elbows was measured in the dominant elbow compared with the non-dominant elbow (0.41 +/- 0.59 mm). The ultrasonographic findings showed statistically significant bilateral differences in the thickness of the flexor-pronator tendon (0.90 +/- 0.56 mm), extensor tendon (0.96 +/- 0.50 mm), triceps tendon (0.69 +/- 0.27 mm), and medial collateral ligament (0.47 +/- 0.24 mm): the values were systematically higher on the dominant side. US examination showed intra-articular effusions in 67% and small loose bodies in 33.3% of the players, exclusively in dominant elbows. MRI showed joint effusion in the same subjects as US, but loose bodies were only detected in half of the cases found by ultrasound. This study demonstrates that repetitive stress on the dominant extremities of handball players is responsible for physiologic and pathologic changes in the dominant elbow.
Journal of Bone and Joint Surgery - British Volume, 2008
Several aspects of the management of an orthopaedic surgical patient are not directly related to ... more Several aspects of the management of an orthopaedic surgical patient are not directly related to the surgical technique but are nevertheless essential for a successful outcome. Blood management is one of these. This paper considers the various strategies available for the management of blood loss in patients undergoing orthopaedic and trauma surgery.
The authors present an overview of currently available data relating to acquired dysfunction of t... more The authors present an overview of currently available data relating to acquired dysfunction of the tibialis posterior tendon (TPT).This condition has only gained wide recognition over the past twenty years, although isolated cases had been reported much earlier. They describe the anatomy of the tendon and its complex distal insertions, together with particular features of the vascularisation and histology of the retromalleolar portion of the tendon. They analyse the biomechanical role of the TPT under normal conditions and the mechanism of the foot deformities that occur secondary to acquired dysfunction of the tendon. A number of theories have been suggested to explain the occurrence of acquired TPT dysfunction, such as degenerative tendinosis, chronic inflammation, retromalleolar impingement, hypovascularity. Most cases are not linked to any specific aetiological factor and are therefore termed 'idiopathic. Several classification schemes have been proposed, based on MRI findings or clinical presentation. In the latter classification, stage I is characterised by medial pain without any clinical or radiological deformities; in stage II, with elongation of the TPT, pain is present medially and/or laterally, with a pes planovalgus deformity that remains flexible; the deformity becomes fixed and irreducible in stage III and stage IV is the end stage, with osteoarthritis of the ankle. The diagnosis is essentially clinical, with the too many toes sign, a positive single-heel rise test together with medial pain and swelling and weakness of ankle inversion. Plain radiographs are useful to rule out any concomitant abnormalities; various methods have been proposed to quantify the flatfoot deformities on weight-bearing radiographs. Ultrasound and MRI may be useful to assess tendon pathology. Conservative treatment (rest, orthoses, shoe modifications; NSAIDs) may alleviate symptoms in patients with minimal deformity but is not effective in cases with advanced pathological changes. Surgical treatment is therefore often necessary but controversy persists with regard to which technique or combination of techniques is preferable. Stage I is an indication for synovectomy, possibly combined with repair of the deltoid ligament and augmentation of the TPT with soft tissue transfer from the flexor digitorum longus, the flexor hallucis longus or the anterior tibialis tendon. Treatment of stage II is controversial; the current trend is to combine tendon transfer with a joint-sparing bony operation such as a lateral column lengthening procedure or a medial translational osteotomy of the calcaneus. Subtalar, double or triple arthrodesis are the procedures of choice for stage III TPT dysfunction whereas tibiocalcaneal arthrodesis or pantalar fusion is the only remaining option in stage IV.
This Policy Directive provides a definitive overview of best transfusion practice covering the wh... more This Policy Directive provides a definitive overview of best transfusion practice covering the whole healthcare organisation based transfusion chain of events, i.e. from when a blood product is received from the blood service into a clinical facility, its storage, safe matching to an individual patient, delivery and then the immediate and follow up care of the patient who is administered any blood product. A key change is for the introduction of double independent checking at the administration check.
Stress fracture of the femoral component is a rare complication following total knee arthroplasty... more Stress fracture of the femoral component is a rare complication following total knee arthroplasty. We report one such complication which occurred 6.5 years after primary implantation of an uncemented meniscal Low Contact Stress (LCS) prosthesis. The fracture affected the medial condyle of the femoral component, and a large osteolytic lesion was present in the underlying femoral condyle. The patient underwent revision arthroplasty with a cemented constrained condylar knee, which is still in place with a satisfactory result 12 years later. This complication appears to be very rare, although a number of cases probably go unreported. From data available in literature, it appears that stress fractures of the femoral component have predominantly affected the medial condyle, following uncemented implantation of fixed-bearing as well as mobile-bearing knees. Different mechanisms may be involved: specific design features of the implant, failure of bone ingrowth in uncemented components, and ...
An informed consent document signed by a patient before surgery is supposed to provide evidence t... more An informed consent document signed by a patient before surgery is supposed to provide evidence that he effectively received adequate information to be able to give informed consent. In fact, it only provides limited legal protection to the surgeon. Although the situation may vary from one country to another and, within each country, from one court to another, a standard consent form is usually considered inadequate, and a procedure-specific consent form appears as a minimal requirement. Even this will provide limited protection if a patient has presented a complication not listed. When confronted to a determined lawyer who pleads the absence of informed consent, a surgeon will most often not be able to give evidence for disclosure of some specific items to the patient. This raises a number of questions: - How extensive should the information be? Should compliance with a legal obligation always prevail over common sense? - How much information can the average patient understand, sto...
Conformement aux propositions du Conseil National du Sang, une Commission d'Hemovigilance a e... more Conformement aux propositions du Conseil National du Sang, une Commission d'Hemovigilance a ete mise en place au CHU en 1995. On y discute de facon multidisciplinaire toutes les mesures visant a ameliorer la securite transfusionnelle, ainsi que le suivi de leur application. Le premier dossier traite fut celui de la mise en place d'une documentation detaillee des donnees de tous les actes transfusionnels. Ces donnees sont maintenant enregistrees sur un document unique ou figurent l'identification des intervenants et des produits, mais egalement des incidents eventuels. Ce document a permis l'amelioration de la securite transfusionnelle et de la gestion administrative des mouvements de produits sanguins. La Commission a coordonne deux etudes multicentriques analysant la consommation de produits labiles et l'incidence des reactions transfusionnelles. En matiere d'epargne sanguine, les problemes abordes furent l'autotransfusion differee, ainsi que la limitati...
Bleeding is an inevitable consequence of most surgical interventions. Total blood loss resulting ... more Bleeding is an inevitable consequence of most surgical interventions. Total blood loss resulting from an operation can be calculated from the observed drop in haemoglobin and haematocrit levels, taking into account the amounts of blood transfused. Total blood loss is partly accounted for by the measurable external blood loss, during operation and in the drains, but there is also occult blood loss in the tissues, which is often as much as or even greater than the measurable external blood loss; occult blood loss is often underestimated; it has been found to represent on average 30% of the total blood loss after THR, and 45 to 60% after TKR. Blood loss may be important enough to require compensatory measures. Transfusion of homologous blood has been for a long time the method of choice, but its use has been restricted for a number of reasons, among which the fear of viral transmission, although it has decreased dramatically over the past few years. There are several possible ways to r...
Radiographic evidence of migration of the femoral stem component after THA is the most important ... more Radiographic evidence of migration of the femoral stem component after THA is the most important diagnostic sign of femoral implant loosening. Early detection of stem subsidence may help in deciding to perform revision surgery before severe bone destruction has occurred, at a moment when standard clinical and radiological follow-up may still be reassuring. The aim of this study was to identify the most appropriate bone and prosthetic landmarks to study subsidence and to determine the accuracy of the Imagika® method as compared to the ‘gold standard’ EBRA-FCA® software. 256 THA in 242 patients (102 men, 140 women) with a median age of 63.8 years (range: 36–85) received 4 different cementless or cemented prosthetic stem designs. They were followed for 10.6 years (range: 6–16). CLS® stems were used in 56 patients, MS-30® in 76, Elite® in 50 and Osteal® in 74. 4 specific analysis models were created in the Imagika® software in order to evaluate several possible landmarks on the proximal...
Over the past 100 years, experimental and clinical studies have tried to accelerate fracture heal... more Over the past 100 years, experimental and clinical studies have tried to accelerate fracture healing and to bring ununited fractures to union . Besides advances in surgical management, non-surgical means have been investigated. Mechanical enhancement of fracture healing using controlled micromotion has been used with some success but does not seem to have been applied to nonunions. Electrical stimulation has been found effective in hypertrophic nonunions, but less so in atrophic nonunions and in the presence of a gap; the various devices available have never gained wide acceptance for various reasons. Low-intensity pulsed ultrasound has been found effective to heal non-unions, especially hypertrophic, with a success rate around 85 % . High-energy extracorporeal shock wave therapy (ESWT) has also been found effective in non-union management, but this is still controversial and there is a need for prospective controlled studies. Biological action has also been attempted for a long tim...
The authors present an overview of currently available data relating to acquired dysfunction of t... more The authors present an overview of currently available data relating to acquired dysfunction of the tibialis posterior tendon (TPT).This condition has only gained wide recognition over the past twenty years, although isolated cases had been reported much earlier. They describe the anatomy of the tendon and its complex distal insertions, together with particular features of the vascularisation and histology of the retromalleolar portion of the tendon. They analyse the biomechanical role of the TPT under normal conditions and the mechanism of the foot deformities that occur secondary to acquired dysfunction of the tendon. A number of theories have been suggested to explain the occurrence of acquired TPT dysfunction, such as degenerative tendinosis, chronic inflammation, retromalleolar impingement, hypovascularity. Most cases are not linked to any specific aetiological factor and are therefore termed 'idiopathic. Several classification schemes have been proposed, based on MRI findi...
The purpose of this study was to compare the manifestations of elbow stress due to repetitive val... more The purpose of this study was to compare the manifestations of elbow stress due to repetitive valgus forces between the dominant and the non-dominant elbow in 40 uninjured elite team handball players using plain films, stress radiographs, ultrasound, and MRI examination. On comparative plain films generalized bony hypertrophy manifested by increased humeral diameter, and cortical hypertrophy of the humeral shaft of the dominant extremity was observed in all players. A significantly greater difference in medial joint space opening between stressed and unstressed elbows was measured in the dominant elbow compared with the non-dominant elbow (0.41 +/- 0.59 mm). The ultrasonographic findings showed statistically significant bilateral differences in the thickness of the flexor-pronator tendon (0.90 +/- 0.56 mm), extensor tendon (0.96 +/- 0.50 mm), triceps tendon (0.69 +/- 0.27 mm), and medial collateral ligament (0.47 +/- 0.24 mm): the values were systematically higher on the dominant side. US examination showed intra-articular effusions in 67% and small loose bodies in 33.3% of the players, exclusively in dominant elbows. MRI showed joint effusion in the same subjects as US, but loose bodies were only detected in half of the cases found by ultrasound. This study demonstrates that repetitive stress on the dominant extremities of handball players is responsible for physiologic and pathologic changes in the dominant elbow.
Journal of Bone and Joint Surgery - British Volume, 2008
Several aspects of the management of an orthopaedic surgical patient are not directly related to ... more Several aspects of the management of an orthopaedic surgical patient are not directly related to the surgical technique but are nevertheless essential for a successful outcome. Blood management is one of these. This paper considers the various strategies available for the management of blood loss in patients undergoing orthopaedic and trauma surgery.
The authors present an overview of currently available data relating to acquired dysfunction of t... more The authors present an overview of currently available data relating to acquired dysfunction of the tibialis posterior tendon (TPT).This condition has only gained wide recognition over the past twenty years, although isolated cases had been reported much earlier. They describe the anatomy of the tendon and its complex distal insertions, together with particular features of the vascularisation and histology of the retromalleolar portion of the tendon. They analyse the biomechanical role of the TPT under normal conditions and the mechanism of the foot deformities that occur secondary to acquired dysfunction of the tendon. A number of theories have been suggested to explain the occurrence of acquired TPT dysfunction, such as degenerative tendinosis, chronic inflammation, retromalleolar impingement, hypovascularity. Most cases are not linked to any specific aetiological factor and are therefore termed 'idiopathic. Several classification schemes have been proposed, based on MRI findings or clinical presentation. In the latter classification, stage I is characterised by medial pain without any clinical or radiological deformities; in stage II, with elongation of the TPT, pain is present medially and/or laterally, with a pes planovalgus deformity that remains flexible; the deformity becomes fixed and irreducible in stage III and stage IV is the end stage, with osteoarthritis of the ankle. The diagnosis is essentially clinical, with the too many toes sign, a positive single-heel rise test together with medial pain and swelling and weakness of ankle inversion. Plain radiographs are useful to rule out any concomitant abnormalities; various methods have been proposed to quantify the flatfoot deformities on weight-bearing radiographs. Ultrasound and MRI may be useful to assess tendon pathology. Conservative treatment (rest, orthoses, shoe modifications; NSAIDs) may alleviate symptoms in patients with minimal deformity but is not effective in cases with advanced pathological changes. Surgical treatment is therefore often necessary but controversy persists with regard to which technique or combination of techniques is preferable. Stage I is an indication for synovectomy, possibly combined with repair of the deltoid ligament and augmentation of the TPT with soft tissue transfer from the flexor digitorum longus, the flexor hallucis longus or the anterior tibialis tendon. Treatment of stage II is controversial; the current trend is to combine tendon transfer with a joint-sparing bony operation such as a lateral column lengthening procedure or a medial translational osteotomy of the calcaneus. Subtalar, double or triple arthrodesis are the procedures of choice for stage III TPT dysfunction whereas tibiocalcaneal arthrodesis or pantalar fusion is the only remaining option in stage IV.
This Policy Directive provides a definitive overview of best transfusion practice covering the wh... more This Policy Directive provides a definitive overview of best transfusion practice covering the whole healthcare organisation based transfusion chain of events, i.e. from when a blood product is received from the blood service into a clinical facility, its storage, safe matching to an individual patient, delivery and then the immediate and follow up care of the patient who is administered any blood product. A key change is for the introduction of double independent checking at the administration check.
Stress fracture of the femoral component is a rare complication following total knee arthroplasty... more Stress fracture of the femoral component is a rare complication following total knee arthroplasty. We report one such complication which occurred 6.5 years after primary implantation of an uncemented meniscal Low Contact Stress (LCS) prosthesis. The fracture affected the medial condyle of the femoral component, and a large osteolytic lesion was present in the underlying femoral condyle. The patient underwent revision arthroplasty with a cemented constrained condylar knee, which is still in place with a satisfactory result 12 years later. This complication appears to be very rare, although a number of cases probably go unreported. From data available in literature, it appears that stress fractures of the femoral component have predominantly affected the medial condyle, following uncemented implantation of fixed-bearing as well as mobile-bearing knees. Different mechanisms may be involved: specific design features of the implant, failure of bone ingrowth in uncemented components, and ...
An informed consent document signed by a patient before surgery is supposed to provide evidence t... more An informed consent document signed by a patient before surgery is supposed to provide evidence that he effectively received adequate information to be able to give informed consent. In fact, it only provides limited legal protection to the surgeon. Although the situation may vary from one country to another and, within each country, from one court to another, a standard consent form is usually considered inadequate, and a procedure-specific consent form appears as a minimal requirement. Even this will provide limited protection if a patient has presented a complication not listed. When confronted to a determined lawyer who pleads the absence of informed consent, a surgeon will most often not be able to give evidence for disclosure of some specific items to the patient. This raises a number of questions: - How extensive should the information be? Should compliance with a legal obligation always prevail over common sense? - How much information can the average patient understand, sto...
Conformement aux propositions du Conseil National du Sang, une Commission d'Hemovigilance a e... more Conformement aux propositions du Conseil National du Sang, une Commission d'Hemovigilance a ete mise en place au CHU en 1995. On y discute de facon multidisciplinaire toutes les mesures visant a ameliorer la securite transfusionnelle, ainsi que le suivi de leur application. Le premier dossier traite fut celui de la mise en place d'une documentation detaillee des donnees de tous les actes transfusionnels. Ces donnees sont maintenant enregistrees sur un document unique ou figurent l'identification des intervenants et des produits, mais egalement des incidents eventuels. Ce document a permis l'amelioration de la securite transfusionnelle et de la gestion administrative des mouvements de produits sanguins. La Commission a coordonne deux etudes multicentriques analysant la consommation de produits labiles et l'incidence des reactions transfusionnelles. En matiere d'epargne sanguine, les problemes abordes furent l'autotransfusion differee, ainsi que la limitati...
Bleeding is an inevitable consequence of most surgical interventions. Total blood loss resulting ... more Bleeding is an inevitable consequence of most surgical interventions. Total blood loss resulting from an operation can be calculated from the observed drop in haemoglobin and haematocrit levels, taking into account the amounts of blood transfused. Total blood loss is partly accounted for by the measurable external blood loss, during operation and in the drains, but there is also occult blood loss in the tissues, which is often as much as or even greater than the measurable external blood loss; occult blood loss is often underestimated; it has been found to represent on average 30% of the total blood loss after THR, and 45 to 60% after TKR. Blood loss may be important enough to require compensatory measures. Transfusion of homologous blood has been for a long time the method of choice, but its use has been restricted for a number of reasons, among which the fear of viral transmission, although it has decreased dramatically over the past few years. There are several possible ways to r...
Radiographic evidence of migration of the femoral stem component after THA is the most important ... more Radiographic evidence of migration of the femoral stem component after THA is the most important diagnostic sign of femoral implant loosening. Early detection of stem subsidence may help in deciding to perform revision surgery before severe bone destruction has occurred, at a moment when standard clinical and radiological follow-up may still be reassuring. The aim of this study was to identify the most appropriate bone and prosthetic landmarks to study subsidence and to determine the accuracy of the Imagika® method as compared to the ‘gold standard’ EBRA-FCA® software. 256 THA in 242 patients (102 men, 140 women) with a median age of 63.8 years (range: 36–85) received 4 different cementless or cemented prosthetic stem designs. They were followed for 10.6 years (range: 6–16). CLS® stems were used in 56 patients, MS-30® in 76, Elite® in 50 and Osteal® in 74. 4 specific analysis models were created in the Imagika® software in order to evaluate several possible landmarks on the proximal...
Over the past 100 years, experimental and clinical studies have tried to accelerate fracture heal... more Over the past 100 years, experimental and clinical studies have tried to accelerate fracture healing and to bring ununited fractures to union . Besides advances in surgical management, non-surgical means have been investigated. Mechanical enhancement of fracture healing using controlled micromotion has been used with some success but does not seem to have been applied to nonunions. Electrical stimulation has been found effective in hypertrophic nonunions, but less so in atrophic nonunions and in the presence of a gap; the various devices available have never gained wide acceptance for various reasons. Low-intensity pulsed ultrasound has been found effective to heal non-unions, especially hypertrophic, with a success rate around 85 % . High-energy extracorporeal shock wave therapy (ESWT) has also been found effective in non-union management, but this is still controversial and there is a need for prospective controlled studies. Biological action has also been attempted for a long tim...
The authors present an overview of currently available data relating to acquired dysfunction of t... more The authors present an overview of currently available data relating to acquired dysfunction of the tibialis posterior tendon (TPT).This condition has only gained wide recognition over the past twenty years, although isolated cases had been reported much earlier. They describe the anatomy of the tendon and its complex distal insertions, together with particular features of the vascularisation and histology of the retromalleolar portion of the tendon. They analyse the biomechanical role of the TPT under normal conditions and the mechanism of the foot deformities that occur secondary to acquired dysfunction of the tendon. A number of theories have been suggested to explain the occurrence of acquired TPT dysfunction, such as degenerative tendinosis, chronic inflammation, retromalleolar impingement, hypovascularity. Most cases are not linked to any specific aetiological factor and are therefore termed 'idiopathic. Several classification schemes have been proposed, based on MRI findi...
Henri Pottier a fêté son quatre-vingt-cinquième anniversaire le 4 novembre 2018. Jean-Marc Doyen ... more Henri Pottier a fêté son quatre-vingt-cinquième anniversaire le 4 novembre 2018. Jean-Marc Doyen et Cécile Morrisson ont, à cette occasion, réuni les contributions de vingt et un de ses amis et collègues. Les thèmes en sont variés, allant de l’ouverture de l’atelier monétaire de Byzance par Aurélien (J.-Cl. Thiry) au voyage à Constantinople du peintre anversois Jacob Jacobs (E. Warmenbol), en passant par les tissus byzantins conservés en Europe occidentale (R. de Mûelenaere), ou les origines du nom d’Istanbul (L. Severs). Mais ce sont bien entendu les VIe et VIIe s. qui se taillent la part du lion : jetons en plomb du VIe s. (J.-P.. Blicq), trésors de solidi de Gaza (B. Callegher), monnaies d’argent ostrogothiques en Gaule (J.-M. Doyen). Les périodes plus récentes ne sont certes pas oubliées, comme les imitations latines du XIIIe s. (C. Wolkow). Une place importante a été accordée aux cultures périphériques : monnayages arabo-byzantin (T. Goodwin), des Sassanides (Fr. Gurnet), des Arméniens et de l’Orient (M. Phillips), de Carthage (I. & W. Schulze). J. Elsen décrit le système pondéral égyptien. Plusieurs contributions traitent d’iconographie, comme les représentations de Constantinople à la fin du Moyen Âge (Ph. Pottier), les images de la Vierge sous Isaac II Ange (S. Mansfield) ou les influences byzantines chez les Seldjoukides et les Turcomans (R. Lemaire).
Les monnaies de fouilles ne sont pas oubliées : elles viennent d’Apamée de Syrie (Chr. Lauwers et R. Margos) ou de Sagalassos (F. Stroobants).
C. Morrisson et F. de Callataÿ insistent finalement sur le caractère novateur des travaux d’Henri Pottier et leur enseignement pour les recherches à venir.
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Papers by Roger Lemaire
Les monnaies de fouilles ne sont pas oubliées : elles viennent d’Apamée de Syrie (Chr. Lauwers et R. Margos) ou de Sagalassos (F. Stroobants).
C. Morrisson et F. de Callataÿ insistent finalement sur le caractère novateur des travaux d’Henri Pottier et leur enseignement pour les recherches à venir.