RESUMEN
OBJECTIVE: To know the future of appeals against a public establishment of health. MATERIAL AND METHODS: We studied 16 files of dispute having ended in a definitive payment over three years in the service of orthopaedics of the Amiens hospital (2001-2003). RESULTS: The majority of the plaintiffs are people (63%), and the average age is of 45,6 years (24 year/68 years). In 14 cases on 16, an expertise was done (7 on the initiative of the hospital and 8 on the initiative of administrative court). The opinion of the expert was followed in every case, except one. In the final, 5 patients (31%) received a compensation (3 with the administrative court and 2 after a love rule). Eleven patients (69%) were not indemnified (7 after demand with the administrative court 4 after demand of love rule). On the whole, 10 case was treated in the administrative court (62%) and 6 by the legal department of the hospital. Among cases settled by the service of dispute of the hospital, 2 ended in a love rule and 4 were classified. Among those treated by the court, 3 ended in a love rule and 7 were the object of a refusal.
Asunto(s)
Hospitales Públicos , Seguro de Responsabilidad Civil , Mala Praxis , Ortopedia , Adulto , Femenino , Francia , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE OF THE STUDY: Fracture of the radial head associated with elbow instability is infrequent. We report a retrospective series of floating Judet prostheses implanted for comminutive fractures of the radial head associated with elbow laxity caused either by dislocation or rupture of the medial collateral ligaments. MATERIAL AND METHODS: The series included ten patients who underwent surgery from October 1996 to September 2002 at the Amiens University Hospital. The indication for radial head prosthesis was established in the emergency setting for fracture unamendable by osteosyntheis and elbow laxity. Mean age was 48.2 years (25-69). All patients were seen at mean follow-up of 31.7 months (18-48). According to the Mason classification as modified by Johnson, all patients had type 4 fracture. A Judet radial head prosthesis with a floating metallic cup was implanted in all patients. An investigator other than the operators evaluated outcome using the Mayo Clinic criteria. RESULTS: Joint motion as measured by goniometry was: mean flexion 121degrees (90-140 degrees), mean extension deficit 20 degrees (5-60 degrees), mean pronation 45 degrees (0-85 degrees), mean supination 42.5 degrees (0-90 degrees). The Mayo clinic score was excellent in 3, good in 2, fair in 3, and poor in 2 (prosthesis dislocation in one and hung prosthesis requiring removal in one). Four patients developed periarticular ossifications compromising the final result. DISCUSSION: The floating Judet prosthesis allows optimal adaptation of the implant to anatomy and function. For us, these implants are indispensable when the radial head fracture is associated with elbow instability. The indication for prosthesis may be questionable if the non-fixed fracture is free of associated ligament injury, as suggested by the good long-term reported after simple resection. Rigorous operative technique is crucial, with careful restitution of the radial height. The quality of the result is related to the degree of capsule and ligament injury even after optimal implant positioning. Preventive treatment against periarticular ossification should be systematic.
Asunto(s)
Lesiones de Codo , Articulación del Codo/cirugía , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/cirugía , Prótesis Articulares , Fracturas del Radio/complicaciones , Fracturas del Radio/cirugía , Adulto , Anciano , Articulación del Codo/diagnóstico por imagen , Femenino , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Radiografía , Fracturas del Radio/diagnóstico por imagen , Estudios Retrospectivos , Factores de TiempoRESUMEN
PURPOSE OF THE STUDY: Core decompression of the femoral head is a conservative surgical treatment with controversial efficacy. We studied retrospectively a series of 32 cases of femoral head osteonecrosis treated by core decompression between 1988 and 2000 in 25 patients. We examined the epidemiological and clinical features as well as the laboratory findings, comparing cases requiring secondary hip replacement and those who had a favorable outcome. We search for prognostic factors. MATERIAL AND METHODS: The series included 32 hips, one case was lost to follow-up. Mean age at decompression was 41.3 years (22-55). In eight hips, osteonecrosis was favored by corticosteroid treatment, in three by chronic alcoholism, and in one by hypertriglyceridemia. No favoring factors were present for 20 hips. According to the ARCO classification there were 15 stage I hips, 13 stage II, 3 stage III, and one stage IV. Core decompression was centered in 24 hips and mean time to decompression was 6.4 months (14 days to 40 months). We reviewed hips without a total prosthesis using the Postel-Merle-d'Aubigne function score and for the radiological assessment the ARCO stage and the Koo index. RESULTS: Favorable outcome was noted in 12 hips. Total hip arthroplasty was required for 19, one hip was lost to follow-up. Mean follow-up in the success group was 82 months (26-176) and mean "time of participation" in the failure group was 11 months (1-38). Mean survival after core decompression was 14 months. Time between onset of symptoms and decompression did not influence outcome. Lesions which remained asymptomatic before decompression remained stable. The stage I hips did not have more favorable outcome than the stage II hips (p < 0.05). Stage III or IV hips had unfavorable outcome. Hips with a Koo index > 40 had a poor outcome (p < 0.05). DISCUSSION: Epidemiological factors which can worsen outcome after core decompression for osteonecrosis are controversial in the literature. Early stage disease (I or II) is considered as an ideal indication for decompression, but is insufficient alone to guarantee success. As other authors, we consider that ARCO stage III and IV and a Koo index > 40 are contraindications for decompression. Improved outcome after core decompression can only be achieved by limiting indications.
Asunto(s)
Descompresión Quirúrgica/métodos , Necrosis de la Cabeza Femoral/cirugía , Corticoesteroides/efectos adversos , Adulto , Alcoholismo/complicaciones , Femenino , Necrosis de la Cabeza Femoral/epidemiología , Humanos , Hipertrigliceridemia/complicaciones , Incidencia , Masculino , Persona de Mediana Edad , Osteonecrosis/etiología , Pronóstico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
UNLABELLED: We report outcome in eight cases of ankle arthrodesis after failure of a total ankle prosthesis. MATERIAL AND METHODS: This series included eight patients, mean age 57 years (range 36-76) who had initially: post-traumatic talocrural joint degeneration (n=4), rheumatoid polyarthritis (n=3), idiopathic talocrural degeneration (n=1). Three patients had a New Jersey (DePuy) cemented prosthesis, four had a Star (Link) uncemented prosthesis and one, whose implantation was performed in another institution, had a spherical cemented prosthesis. The preoperative Kitaoka score was 19.1 (0-32). Seven patients had subtalar joint degeneration; one patient had a subtalar arthrodesis. The tibial component was cemented alone in two patients, the talar piece in three (two with talar fracture). Failure resulted from loosening, talus fracture or deep infection. Bipolar loosening was observed in two patients. Time to revision was 36 months (range 4-108). Arthrodesis was associated with an iliac graft for seven patients: several tricortical grafts (vertical alignment of the corticals) and cancelous grafts for filling. The height of the graft was adjusted to the substance loss. A bone graft could not be used in one patient who had a deep infection. The arthrodesis was fixed with an anterior plate bridging the talocrural space in six patients, with an external fixator in infected patient, with a conventional centromedullary tibial nail transfixing the talocrural joint and planted in the talus and the calcaneus in one. Outcome was assessed with the Kitaoka score. Mean follow-up was 56 Months (range 10-114). RESULTS: The overall Kitaoka score improved to 54/100 (range 42-70) at last follow-up. The arthrodesis provided improvement in all patients although the final outcome was still considered poor in three patients. Radiographic healing was obtained in seven patients at a mean 3.1 months (range 2.5-6). Wound healing was slow in two patients. One patient developed a deep infection early. DISCUSSION: The rate of fusion was 87%. This is in the general range reported in the literature; use of an iliac graft allows preserving joint height but because of the poor bone quality often encountered, residual bone stock may be insufficient to achieve complete fixation with screwing. Plate fixation appears to be a better way of achieving fixation. This provides a rate of fusion comparable with earlier series where external fixation was generally employed. For us, external fixation should be reserved for infected cases. Use of a conventional anterograde nail can be another solution in the event of poor bone quality. The overall result remains relatively modest although all the patients achieved a functional gain with arthrodesis. The results obtained are less satisfactory than after first-intention ankle arthrodesis.
Asunto(s)
Traumatismos del Tobillo/complicaciones , Articulación del Tobillo , Artritis/cirugía , Artrodesis/métodos , Artroplastia de Reemplazo/efectos adversos , Actividades Cotidianas , Adulto , Anciano , Artritis/diagnóstico por imagen , Artritis/etiología , Artritis/fisiopatología , Artrodesis/instrumentación , Artroplastia de Reemplazo/instrumentación , Artroplastia de Reemplazo/métodos , Clavos Ortopédicos , Placas Óseas , Femenino , Estudios de Seguimiento , Fracturas Óseas/etiología , Humanos , Ilion/trasplante , Masculino , Persona de Mediana Edad , Dolor/diagnóstico , Dolor/etiología , Falla de Prótesis , Radiografía , Rango del Movimiento Articular , Reoperación/métodos , Infección de la Herida Quirúrgica/etiología , Astrágalo/lesiones , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE OF THE STUDY: Dislocation of the proximal tibio-fibular joint is a rare lesion generally described in athletes. In our experience, high-energy trauma in traffic accident victims was a frequent cause. Dislocation of the proximal tibio-fibular joint is generally described as anterolateral, posteromedial, superior, or subluxation. We describe an inferior form of dislocation. MATERIALS AND METHOD: The study population included eight men aged 21-55 years (mean 31 years). One patient had bilateral dislocation. There were four superior, one posterior, and four inferior dislocations. All patients also had an associated fracture of the tibia which was an open fracture in eight cases. Five patients suffered a lesion to the common fibular nerve. Three had tibial nerve involvement in a context of inferior disclocation. The lateral collateral ligament was torn in six cases. The central pivot was involved in four. Two patients had an avulsion of the patellar ligament on the tibial tuberosity. Five patients had vessel damage. Three required emergency amputation. Two patients (one superior and one inferior dislocation) underwent emergency bypass surgery but required below-knee amputation later due to persistent ischemia. All dislocations, excepting the one case of complete fibular avulsion and one emergency above knee amputation were treated by transarticular screw fixation of the proximal tibio-fibular joint. RESULTS: Mean follow-up was 5.8 years (1-9 years). At last follow-up, there were no cases of instability or pain in the proximal tibio-fibular joint. The patient with an initial neurapraxia in territory of the common fibular nerve recovered totally. The five amputated patients had prostheses and walked without crutches. DISCUSSION: Dislocation of the proximal tibio-fibuilar joint is a rare entity, but the frequency is probably underestimated. The dislocation can go unrecognized in patients with multiple injuries. Careful search should nevertheless be undertaken due to the risk of secondary involvement of the common fibular nerve. The Harrisson and Hindenach classification, inspired by the Lyle classification, does not mention inferior dislocation of the proximal tibio-fibular joint, a recently described entity. Our series included dislocations resulting from high-energy trauma associated with numerous ligament, nerve, and vessel injuries. In this context, dislocation of the proximal tibio-fibular joint constitutes an epiphenomenon.
Asunto(s)
Peroné/lesiones , Fracturas Abiertas/complicaciones , Luxación de la Rodilla/etiología , Luxación de la Rodilla/patología , Tibia/lesiones , Adulto , Amputación Quirúrgica , Tornillos Óseos , Peroné/patología , Estudios de Seguimiento , Humanos , Isquemia/etiología , Inestabilidad de la Articulación , Masculino , Persona de Mediana Edad , Dolor/etiología , Nervio Peroneo/lesiones , Factores de Riesgo , Tibia/patología , Nervio Tibial/lesionesRESUMEN
We report three cases of gluteus medius tendon tears discovered fortuitously in patients undergoing total hip arthroplasty. The tears were not suspected from the initial clinical presentation. Sutures were possible in only one patient. Outcome of the hip arthroplasty was very good in all three patients despite lack of tendon repair in two.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Músculo Esquelético/lesiones , Osteoartritis de la Cadera/complicaciones , Osteoartritis de la Cadera/cirugía , Traumatismos de los Tendones , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Factores de Riesgo , Técnicas de Sutura , Resultado del TratamientoRESUMEN
PURPOSE OF THE STUDY: We report outcome at a mean 4.8 years follow-up in 42 patients with hallux rigidus treated by metatarsophalangeal interposition thin prosthesis flat concave with a lateral capsular fixation. MATERIALS AND METHODS: The 42 patients were treated from 1987 to 1997. Sixtine prostheses were implanted for osteoarthritis was grade I (n=2), grade II (n=28), and grade III (n=12). Groulier's clinical criteria and Regnauld's radiologic criteria were used to assess outcome. RESULTS: We observed 22 very good, 12 good, 4 fair, and 4 poor results. There was no significant modification in the forefoot morphology. DISCUSSION: The Sixtine prosthesis provided a global improvement in pain and motion though there was an important difference between patients with grade I and grade II osteoarthritis, who experienced major improvement, and those with grade III disease. A good overall result requires proper prosthetic centering. Subluxation or translation does not appear to be compatible with good results. Among 3 cases with overt dislocation, 1 recovered an acceptable articular space with a good overall result. Two poor results and 3 fair results were observed in patients with condensation of the phalangeal base. These bone condensations appeared in postoperative Egyptian feet. The Sixtine prosthesis may protect the interphalangeal articular space of the great toe, avoiding damage and rearward displacement of sesamoid bones. It ensures primary stability and may be left in place. CONCLUSION: We found that the Sixtine prosthesis is best indicated in hallux rigidus patients with grade II osteoarthritis.
Asunto(s)
Artroplastia de Reemplazo/instrumentación , Artroplastia de Reemplazo/métodos , Hallux Rigidus/cirugía , Prótesis Articulares/normas , Articulación Metatarsofalángica/cirugía , Adulto , Anciano , Artroplastia de Reemplazo/efectos adversos , Femenino , Estudios de Seguimiento , Hallux Rigidus/clasificación , Hallux Rigidus/diagnóstico por imagen , Hallux Rigidus/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Diseño de Prótesis , Radiografía , Rango del Movimiento Articular , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
PURPOSE OF THE STUDY: We reviewed 30 cases of osteochondral lesions of the astragalar vault treated surgically. MATERIAL AND METHODS: Among the 30 patients, 17 participated in sports activities and 24 had a history of trauma. Mean delay to surgery was 10 months. Treatment included osteochondritis curettage and Pridie perforations. Direct access was used in 11 cases, malleolar osteotomy in 13 and arthroscopy in 6. Cancellous bone grafts were used in 6 cases. RESULTS: Mean follow-up was 3 years 7 months (minimum 2 years). All patients had an arthroscan at last follow-up. Evaluation of post-operative outcome was based on clinical assessment and arthroscan findings. Surgical treatment provided very good results in 75 p. 100 of cases with pain relief and improved walking distance. DISCUSSION: Our cases pointed out the important contribution of the FOG (Fracture Osteonecrosis Geode) classification to pathogenic and prognostic analysis. The Berndt and Harty classifications were not found to be useful. CONCLUSION: In case of localized necrosis, we propose arthroscopic perforation curettage. In case of bone loss, a direct cancellous graft may be used.
Asunto(s)
Articulación del Tobillo/cirugía , Osteocondritis/cirugía , Astrágalo/cirugía , Adolescente , Adulto , Traumatismos del Tobillo/cirugía , Articulación del Tobillo/fisiopatología , Artroscopía , Trasplante Óseo , Legrado , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteocondritis/fisiopatología , Osteonecrosis/fisiopatología , Osteonecrosis/cirugía , Osteotomía , Dolor/fisiopatología , Pronóstico , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Caminata/fisiologíaAsunto(s)
Artroplastia de Reemplazo de Cadera , Fémur/cirugía , Prótesis de Cadera , Artroplastia de Reemplazo de Cadera/métodos , Cementación , Fémur/diagnóstico por imagen , Prótesis de Cadera/efectos adversos , Humanos , Complicaciones Intraoperatorias , Falla de Prótesis , Radiografía , Reoperación , Factores de RiesgoAsunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Fracturas del Fémur/cirugía , Fémur/cirugía , Prótesis de Cadera , Factores de Edad , Anciano , Cementación , Fracturas del Fémur/complicaciones , Fracturas del Fémur/etiología , Fijación de Fractura , Humanos , Complicaciones Intraoperatorias , Complicaciones Posoperatorias , Diseño de Prótesis , ReoperaciónRESUMEN
PURPOSE OF THE STUDY: Classicaly Lisfranc fractures dislocations are unusual. Our study is based on 69 observations from January 1974 to January 1992. MATERIAL AND METHODS: Fractures occured during tremendous impacts with a sex ratio of two men for one woman. The authors insist on the diagnostic value of good quality standard x-rays. Using Trillat's classification, we had 19 homolateral spatular fractures dislocations, 22 homolateral columno-spatular, 8 divergent columnar and 19 divergent columno spatular. A dislocation was reduced in emergency before radiography. The treatment consisted in orthopedic reduction and plaster 7 times, percutaneous kwire 2 times, immediate arthrodesis 5 times, open reduction and internal fixation with kwires 55 times. Post-operatively, 8 complications were noticed. 11 secondary arthrodesis were made with reference to failures of previous methods. They have been performed from 9 months to 5 years after the initial traumatism due to a painful ankylosis in bad position or arthrosis. The arthrodesis was total 6 times, partial lateral 2 times, partial medial 3 times. RESULTS: 63 patients were reviewed with a minimum follow-up evaluation of two years and a maximum of 9 years. The results show that we must reduce the tarsometatarsal fracture dislocations even if the displacement is minimal and we must fix them. The most satisfactory means seem to be open reduction if the least anatomical defect exists. Immediate, total arthrodesis reposition is suitable when an important articular comminution exists. If the total secondary arthrodesis reposition gives good results, its realization is sometimes difficult. The lateral partial arthrodesis must be discontinued, because they don't seem logical. The medial partial arthrodesis didn't prove its superiority, compared with total arthrodesis. DISCUSSION: The reduction of Lisfranc's dislocation is essential. The single case not unreduced has given a bad result as shown in the litterature. When the orthopedic treatment is well-made, the result is good. The open reduction followed by an axial fixation has only given 56 per cent of good results. The main reason of these bad results is an important comminution which should have practised an immediate arthrodesis reposition and a bad reduction. We must be aware on the quality of the anatomical reduction. The secondary arthrosis appeared principally in cases where the reduction was defective (13 observations out of 50). The 5 immediate arthrodesis have all given a good result. CONCLUSION: The retrospective study of the series teaches us to reduce the tarsometatarsal fractures dislocations even if the displacement is minimal and to fix them. We must make a wider place to the immediate arthrodesis reposition.
Asunto(s)
Traumatismos de los Pies/terapia , Fracturas Óseas/terapia , Luxaciones Articulares/terapia , Articulaciones Tarsianas , Accidentes de Tránsito , Adolescente , Adulto , Anciano , Artrodesis/métodos , Traumatismos en Atletas/complicaciones , Femenino , Estudios de Seguimiento , Traumatismos de los Pies/etiología , Fijación Interna de Fracturas/métodos , Fracturas Óseas/etiología , Humanos , Luxaciones Articulares/etiología , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Estudios RetrospectivosRESUMEN
Fracture of the navicular bone is rare and sometimes difficult to diagnose. Surgical treatment with direct osteosynthesis gives good results except in the case of fractures of the tubercles. In view of the poor postoperative course of fracture-dislocations, immediate talo-navicular-cuneiform arthrodesis may be proposed.
Asunto(s)
Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Huesos Tarsianos/lesiones , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Complicaciones Posoperatorias , RadiografíaRESUMEN
The sarcoma of Parker and Jackson is a rarely tumor. It is a malign lymphoma primitive of the bone. His diagnostic is difficult. The only treatment is chemotherapy-radiotherapy association.
Asunto(s)
Neoplasias Óseas/diagnóstico , Linfoma de Células B Grandes Difuso/diagnóstico , Adulto , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/terapia , Femenino , Humanos , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/terapia , Persona de Mediana Edad , RadiografíaRESUMEN
Eighty-four articular fractures of the lower end of the tibia were reviewed. One third were compound and three out of four were comminuted. Seventy-three cases were treated by internal fixation. The results were satisfactory in about half of the cases. In eight severe sepsis was found and had to be treated by arthrodesis. In 80 cases reviewed, a satisfactory reduction was obtained in only 52 cases. A classification into three types is proposed.