RESUMEN

INTRODUCTION: Sickle cell disease is a public health problem. The WHO has recommended that global management be implemented to reduce mortality and morbidity. Since no comprehensive care programme for bone and joint complications exists, the Caribbean Sickle Cell Disease Center added orthopaedic consultation to screen for and monitor these complications in 1992. HYPOTHESIS: Comprehensive medical and surgical care of patients with sickle cell disease will reduce the complications and disability associated with this disease. POPULATIONS AND METHODS: Two populations were compared to evaluate the impact of comprehensive disease management on the occurrence of avascular necrosis (AVN) of the femoral head (femoral head AVN). The case-control series, [E-1994], included 115 patients (58 SS and 57 S) without orthopaedic monitoring and was evaluated retrospectively. The other patient series, [E-2008], included 215 patients (94 SS and 121 SC) with systematic orthopaedic care and was followed prospectively. Age, gender, duration of follow-up, haemoglobin levels, genotype, pain before treatment, associated humerus AVN and leg ulcers were analysed. RESULTS: Femoral head AVN occurred in young adult patients (35.3 ± 4 years for [E-1994] and 29 ± 3.4 years for [E-2008]). Only elevated haemoglobin levels were associated with the occurrence of femoral head AVN, which suggests that increased blood viscosity contributes to the condition ([E-1994], P<0.0001; [E-2008], P=0.001). Treatment in [E-2008] patients reduced the number of femoral head AVN cases from 36.5% in [E-1994] to 14.4% in [E-2008] (P<0.0001). DISCUSSION: The prevention and management of femoral head AVN must include medical treatment of the disease to reduce the occurrence of painful vaso-occlusive crises, which are known to trigger femoral head AVN. The effectiveness of this programme hinged on identifying risk factors and using simple approaches (hydration, pain medication, rest and crutches) to manage painful joint crises before femoral head AVN appeared. These approaches could be implemented in disadvantaged countries where sickle cell disease is prevalent. CONCLUSION: By knowing the risk factors, symptomatic patients who are at risk for femoral head AVN can be identified and additional evaluations can be performed early on in cases of hip pain.

Asunto(s)

Anemia de Células Falciformes/complicaciones , Necrosis de la Cabeza Femoral/epidemiología , Procedimientos Ortopédicos/métodos , Derivación y Consulta , Medición de Riesgo/métodos , Adolescente , Adulto , Distribución por Edad , Anemia de Células Falciformes/diagnóstico , Anemia de Células Falciformes/epidemiología , Región del Caribe/epidemiología , Progresión de la Enfermedad , Femenino , Necrosis de la Cabeza Femoral/etiología , Necrosis de la Cabeza Femoral/prevención & control , Estudios de Seguimiento , Hemoglobinas/metabolismo , Humanos , Incidencia , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Tasa de Supervivencia/tendencias , Factores de Tiempo , Tomografía Computarizada por Rayos X , Adulto Joven

RESUMEN

On the occasion of the thirty years since its inauguration, the Department of Orthopaedics and Traumatology of the University Hospital Erasme reviews the milestones of its development. Various original new techniques have been implemented: monitoring of implants using strain gauges, external fixation of the limbs, external minifixation, miniinvasive anterior approach in hip arthroplasty, knee ligamentoplasties, orthopaedic microsurgery and composite tissue allotransplantation. The care of aged patients takes place in close collaboration with the Department of Geriatrics. Two new clinical units have been created, the Unit of Hand and Peripheral Nerve Surgery, and the Centre for Sports. The Department has organized an efficient Bone Bank. The new day care hospital improves the possibilities of ambulatory surgery. The article details as well the activities of teaching and research of the members of the Department.

Asunto(s)

Departamentos de Hospitales , Hospitales Universitarios , Ortopedia , Traumatología , Bélgica , Investigación Biomédica , Ortopedia/educación , Edición , Traumatología/educación

RESUMEN

The history of the Orthopaedics and Traumatology Research Laboratory (LROT) is summarized during the last thirty years. The approach, initially focused on bone biomechanics and strength of materials, underwent a rapid diversification as expressed by the list of research topics: monitoring of bone healing; bone strains measurements for different level of activities including microgravity and prevention of disuse osteoporosis; biological effects of electromagnetic fields; evolution of the viscoelastic properties of the callus during bone healing; improvement of the osteoinductive properties of bone substitutes produced by the Tissues Bank of the University Hospital Erasme; Kashin-Beck disease; SICOT telediagnostic, and biomechanics of threaded implants. Those topics, event the most fundamental ones, have immediate significant clinical applications allowing a decrease of the morbidity and an acceleration of the rehabilitation of the patients. The results show the need of multidisciplinary collaborations coordinated around one autonomous laboratory, able to handle specific protocols requiring a dedicate environment.

Asunto(s)

Investigación Biomédica/historia , Laboratorios/historia , Ortopedia/historia , Traumatología/historia , Bélgica , Curación de Fractura , Historia del Siglo XX , Humanos , Fenómenos Físicos

RESUMEN

Distraction radio-metacarpal external fixation is an excellent technique for the osteosynthesis of distal radius fractures, in particular of comminuted articular fractures. The alternative is the locked palmar plate, a more demanding technique. The published literature does not allow concluding if one method is better than the other. The other main possible indications of external fixation at the wrist are comminuted fractures of the base of the thumb metacarpal, distal radius osteotomies, and wrist arthrodeses. At the hand, external minifixation is an excellent technique of osteosynthesis. Stable bone fixation is obtained, allowing early active mobilization of the fingers. The technique is especially indicated to treat open lesions or to perform lengthening, but we use also external minifixation to treat closed fractures, to perform arthrodesis or to cure non-unions, and to maintain the length of the thumb after trapeziectomy for osteoarthrosis.

Asunto(s)

Fijación de Fractura/métodos , Fracturas del Radio/cirugía , Traumatismos de la Muñeca/cirugía , Fijadores Externos , Humanos

RESUMEN

INTRODUCTION: The young age of patients, total arthroplasties complications risks, and implant costs justify evaluation of the results of core decompression in the treatment of sickle-cell disease avascular necrosis of the femoral head (ONFH). HYPOTHESIS: In sickle-cell disease necrosis, core decompression offers good relief from pain and delays the use of total arthroplasty in comparison to a conservatively treated control group by a simple non-weight bearing protocol. MATERIALS AND METHODS: From 1994 to 2008, among 215 drepanocytic adults, 42 patients (22 genotype SS, 20 genotype SC; 15 men, 27 women) presented symptomatic ONFH. We report the data from a prospective study of two patients' groups: a non-operated group (16 patients aged 36.5+/-6.5 years, 23 hips) and an operated group (26 patients aged 30.3+/-2.8 years, 42 hips). The results were considered on the basis of change in clinical status according to the numeric evaluation of pain scale, the functional score of Merle d'Aubigné-Postel (MAP), the radiological progression of lesions, and the time delay to total arthroplasty. RESULTS: Twenty-three hips were conservatively treated by discharge (a pair of canes). After a follow-up period of 13.4+/-0.5 years, no pain improvement was noted (p=0.76), and MAP score was unchanged (p=0.27). Out of 23 hips managed by discharge, 9 stage IV hips (degenerative arthritis, 39.1%) underwent arthroplasty after an average delay of 2.6+/-2.4 years. Forty-two hips were treated by core decompression. The duration of follow-up was 11.3+/-1.8 years. Postoperatively, pain reduction and MAP score improvement were significant in 39 out of 42 hips (93%, p<0.0001). Twenty-nine out of these 42 hips had a favorable evolution. Ten hips (23.8%) progressed to total arthroplasty, after a period of 7.4+/-2.7 years, longer than the one of the non-operated group (p=0.0007). By comparing the two groups (operated and non-operated), the benefit of core decompression appeared very significant (p<0.0001). In addition to allocating patients osteonecrosis stages, the Koo and Kim Index estimated the severity and evolution of necrotic lesions in both groups. It indicated decline in the non-operated group (p=0.002) and improvement for operated patients (p=0.0002). DISCUSSION: Core decompression had a favorable clinical and radiological outcome superior to surgical abstention. Stages I and II ONFH remained stable after drilling, necessitating no arthroplasty (considered as a failure of drilling). The Koo and Kim Index above 30 degrees in the non-operated group was a significant indicator of lesions degradation (p=0.002). In addition to the indolence obtained by core decompression, the benefit of drilling was manifested by the prolonging the adjournment before arthroplasty end-point. It was respectively 7.4+/-2.7 years in the operated group versus 2.6+/-2.4 years in the non-operated group (difference of 4.8 years, p<0.01). CONCLUSION: The technique of core decompression remains a valid option place in the treatment sickle-cell disease avascular necrosis of the femoral head (ONFH). It may be especially recommended in under-equipped regions where drepanocytosis and its osteo-articular complications are frequent. LEVEL OF EVIDENCE: Level III case-control therapeutic study.

Asunto(s)

Anemia de Células Falciformes/cirugía , Descompresión Quirúrgica/métodos , Necrosis de la Cabeza Femoral/cirugía , Adulto , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/diagnóstico por imagen , Artroplastia de Reemplazo de Cadera , Bastones , Estudios de Casos y Controles , Descompresión Quirúrgica/instrumentación , Progresión de la Enfermedad , Femenino , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Necrosis de la Cabeza Femoral/etiología , Estudios de Seguimiento , Humanos , Masculino , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/cirugía , Dimensión del Dolor , Satisfacción del Paciente , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Radiografía , Reoperación

Asunto(s)

Diagnóstico por Computador/instrumentación , Prótesis de Cadera , Diseño de Prótesis , Telemetría/instrumentación , Terapia Asistida por Computador/instrumentación , Diagnóstico por Computador/métodos , Humanos , Telemetría/métodos , Terapia Asistida por Computador/métodos , Transductores

RESUMEN

The Department is involved in clinical and research activities. We pioneered the clinical application of "smart of Orthopaedic implants". The monitoring concept, bringing a high added value, helps in assessing fracture healing or implant fixation. The technique, featuring the 21st century, also requires advanced knowledge in biomaterials. Such implants have been used during the ESA Parabolic Flight Campaigns. These measurements are a prerequisite to establish prevention programs of the bone demineralisation during space flights but also in disuse osteoporosis. The Department is deeply involved in external fixation. In vitro studies of the mechanical insertion and holding parameters of external fixation pins have been performed to produce new implants, which efficiency has been proved by a clinical study. We defined original clinical principles of external fixation as its use in upper limb indications, to maintain microsurgery transplant, preserving devascularization and providing adequate fixation. Our biomechanical approach of the upper limb, now confirmed by others research groups, questioned old clinical concepts. The isokinetic evaluation assesses the dynamic function of articulations, i.e. after arthroplasty, and is also used for medico-legal evaluation. The clinical research touches orthopaedic (or systemic) diseases as algodystrophy, Kienböck disease, Kashing Beck. We conducted a multidisciplinary research on the effect of electromagnetic fields (EMF) on cells differentiation. In addition to possible healing properties, it helps as an objective support to analyse the exposure to the environmental EMF.

Asunto(s)

Ortopedia , Servicio de Cirugía en Hospital , Traumatología , Bélgica , Investigación Biomédica , Hospitales Universitarios , Humanos

RESUMEN

Extensive clinical experience has been built up using orthopaedic implants instrumented with strain gauges connected to a Wheatstone bridge by means of percutaneous leads. This research showed the medical relevance of the monitoring of the deformation of implants as a powerful tool to evaluate nursing and rehabilitation exercises, for tracing dangerous overloads and anticipating implant failure and also to observe the healing process. The IMPACT 3500 project focuses on the instrumentation of femoral implants with on board sensors: regular Benoist-Girard implants have been modified, to contain a 'sensing cell', and thoroughly tested in vitro and in vivo. The implant deformations are measured with resistive strain gauges, and the signal is transferred to a personal computer for processing and display, via a hard wired connection, or via a telemetry system. Two fully implantable wireless designs, called Linkstrain and Sealstrain, are powered from the outside by magnetic induction. As Sealstrain contains the whole telemetric system in its cavity, the highest miniaturization was required; this seriously deteriorates the efficiency of the inductive power link.

Asunto(s)

Fracturas del Fémur/cirugía , Prótesis e Implantes , Telemetría/instrumentación , Materiales Biocompatibles , Placas Óseas , Cerámica , Corrosión , Fracturas del Fémur/fisiopatología , Humanos , Ensayo de Materiales , Metales , Microscopía Electrónica de Rastreo , Monitoreo Fisiológico/instrumentación , Diseño de Prótesis , Análisis Espectral , Acero Inoxidable/análisis , Estrés Mecánico , Soporte de Peso/fisiología

RESUMEN

Glues and adhesives attach to a surface principally involving molecular attraction, whereas cements mostly work through mechanical interlocking. The adhesive and its degradation products must be biocompatible: chemical, clinical, legal, physical aspects are considered; the toxicity of even minor components must be extremely reduced. The idea of bone bonding using biological materials has been proposed by Gluck, in Berlin, more than a century ago. Cements and adhesives have been used for the fixation of fractures, the repair of defects and the fixation of prostheses. The cements are initially liquid or plastic and conform with the irregularities in the substratum, producing better bonding on rough surfaces. Developed during the early 1950s, cyanocrylate adhesives attracted the medical community by their bonding strength and ability to bond in wet environments but reports of displacement of the fracture ends were followed by reports of high infection rates, nonunion, and severe local reactions. Polymethylmethacrylate does not form a chemical bond with bone but a mechanical bond, a weak bone-polymer joint. Charnley used self-curing acrylic cement to bond a femoral head prosthesis into a femur. When adhesives are used to bond tissues, the polymer acts as a barrier between the growing edges and delay healing; the adhesive tends to be rapidly isolated from the bone by a fibrotic, non-adhesive capsule. No proof exists concerning the osteogenic potential of fibrin sealing (FS); its beneficial effect on bone formation has been questioned even if there is some evidence that FS should influence the early phases of bone repair and may help to solve the problem of reattachment of small osteocartilagenous fragments following joint trauma.

Asunto(s)

Materiales Biocompatibles , Cementos para Huesos , Adhesivos Tisulares , Animales , Humanos , Procedimientos Ortopédicos

RESUMEN

INTRODUCTION: Chronic hematogenous osteomyelitis (C.H.O.) is still a scourge of the non-industrialized countries. The authors operated on 420 cases of C.H.O. in Algeria between 1968 and 1987. A computerized analysis of the results of the surgical treatment of these 420 cases was made in Brussels, Belgium, by two of the authors. The results of this computerized study are exposed. MATERIAL AND METHODS: 67.1 per cent of the patients were male and 37.9 female. 68 per cent were operated before 16 y. of age. 381 lesions involved tubular bones: femur, tibia and humerus were the most frequent locations. Only 4 per cent of the cases had never presented a suppuration. Cultures of Staphylococcus were positive in 82 per cent of the cases. Surgical procedure was classical--bone window opening, sequestrectomy and saucerisation--in 359 cases. Operation was limited to soft tissues in 22 cases and bone resection was performed in 39 cases. Post-operative antibiotherapy was administered for a period of 10 to 60 days according to the patients. RESULTS: After the first operation with the classical procedure, results were satisfactory in 72 per cent of the cases but "healing" was achieved in 95 per cent of the cases after 2, 3, 4 and up to 6 operations. After bone resection, the rate of permanent healing was of 100 per cent. Follow-up was of more of 1 year (up to 22 y.) in 80 per cent of the cases. DISCUSSION: As far as classical procedure is concerned, a computerized analysis made according to 34 variables, led to the conclusions that the following variables could have a positive influence upon the prognosis: surgical team's experience, young age of the patient at the time of operation, subacute onset of the disease, location on the humerus, diaphysis of long bones, membranous and short bones, small number of sinuses, sclero-geodic radiologic appearance of the lesions, thin perifocal radiologic condensation, periosteal reaction, post-operative administration of two antibiotics. Excellent results of bone resection are pointed out but attention is drawn on the dangers of extending the indications for resection to the tubular bones. CONCLUSION: The authors conclude that improvement in the results of the surgical treatment of C.H.O. may only take place after improvement of the quality and duration of chemotherapy: that is confirmed by the results of a clinical trial they organized on the role of post-operative administration of Amoxicilline + Clavulanic Acid for a period of 60 days after surgery: 44 patients, 2 lost to follow-up, 4 failures and 38 "healings" (90.5 per cent) at 2 years and more.

Asunto(s)

Osteomielitis/cirugía , Infecciones Estafilocócicas , Adolescente , Adulto , Enfermedad Crónica , Interpretación Estadística de Datos , Desbridamiento , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/microbiología , Complicaciones Posoperatorias , Pronóstico , Reoperación , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/cirugía

RESUMEN

One of the factors determining the stability of osteosynthesis is the mechanical strength of the bone fragments required for the anchorage of the implant. The aim is to study the driving of a Thornton nail in the proximal epiphysis of a human femur as a way to measure the strength of the trabecular bone and to predict the stability of the implanted system.

Asunto(s)

Clavos Ortopédicos/normas , Fijación Interna de Fracturas/métodos , Fracturas de Cadera/cirugía , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Humanos , Ensayo de Materiales , Persona de Mediana Edad , Falla de Prótesis

RESUMEN

External minifixators were used in the treatment of 63 closed diaphyseal metacarpal bone fractures. A simple half-frame configuration was applied in all the cases. Open reduction was performed in 26%. The mean duration of external fixation was 30 days. There were no cases of nonunion. Anatomical reduction was obtained in 86.6% of the cases. There were no cases of reflex sympathetic dystrophy. The general functional results were very good or good in 96.6%. Open reduction did not significantly alter the final results. External minifixation is usually accepted as a treatment of open metacarpal fractures. Because of the excellent results obtained in our series, we believe that the indications of external minifixation could be enlarged to closed metacarpal bone fractures.

Asunto(s)

Fijación de Fractura/métodos , Fracturas Cerradas/cirugía , Huesos del Metacarpo/lesiones , Huesos del Metacarpo/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Clavos Ortopédicos , Niño , Femenino , Fracturas Cerradas/fisiopatología , Humanos , Masculino , Huesos del Metacarpo/fisiopatología , Persona de Mediana Edad , Rotación

Asunto(s)

Fijación de Fractura , Fracturas del Radio/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Complicaciones Posoperatorias

RESUMEN

Twenty-four fractures or nonunions of the clavicle were treated by a Hoffmann external fixator, for selected indications. No vascular or pleural complications were observed. All clavicles healed, after a mean duration of 52 days.

Asunto(s)

Clavícula/lesiones , Fijación de Fractura/instrumentación , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

A technique of osteosynthesis of the clavicle with Hoffmann external fixation was used to treat twenty patients for selected indications, including an open fracture, inability of a patient to tolerate prolonged conservative treatment, or a painful non-union. No vascular or pleural complication was observed. The average time that the external fixator was retained was fifty-one days. All of the clavicles united well. Mobility of the shoulder returned to normal in all patients.

Asunto(s)

Clavícula/lesiones , Fracturas Óseas/cirugía , Fracturas no Consolidadas/cirugía , Dispositivos de Fijación Ortopédica , Clavícula/diagnóstico por imagen , Clavícula/cirugía , Fracturas no Consolidadas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Radiografía

RESUMEN

Surgical drilling and pin insertion can lead to mechanical and thermic damage of the bone. A methodology giving reproducible in vitro records of insertion and holding parameters of threaded implants is presented. Both drilling and tapping are related to the cutting technology. To understand the basic principles of the cutting technology some important parameters of drilling and tapping of an external fixation pin are defined. A bone model was selected based on specific mechanical and thermal properties of the bone tissue. In addition, a specific instrumentation was designed in order to compare the insertion characteristics and the anchorage of different pins. Electronic scanning microscopy of the samples was systematically performed to evaluate the quality of the bone thread. The in vitro measurements of the shearing torque and the pull-out force are representative of the immediate holding power of a pin. The different holding parameters were then correlated. Temperature measurements were performed during drilling, smooth part penetration (transfixing pins), tapping, and screwing. The final objective of the study was to develop new threaded implants with better biomechanical characteristics.

Asunto(s)

Tornillos Óseos/normas , Fijación de Fractura/instrumentación , Fenómenos Biomecánicos , Fijación de Fractura/métodos , Humanos

Asunto(s)

Enfermedades Óseas/etiología , Fracturas Óseas/complicaciones , Astrágalo/lesiones , Humanos , Inestabilidad de la Articulación/etiología , Osteítis/etiología , Osteonecrosis/etiología , Seudoartrosis/etiología , Estudios Retrospectivos , Riesgo

RESUMEN

The injuries of the talus are rare. In this retrospective study, complications of 359 talar lesions are studied. Secondary displacement occurred in 8%. Bone infection remained low in spite of frequent primary skin injury (20%). Bone fusion was slow but no case of non-union could be found. Avascular necrosis of the body or of the trochlea occurred in 33% but could be partially prevented by accurate reduction of the fractured bone. Osteoarthritis occurred in 33%.

Asunto(s)

Fracturas Óseas/cirugía , Complicaciones Posoperatorias/etiología , Astrágalo/lesiones , Adulto , Artritis/etiología , Fracturas Abiertas/cirugía , Humanos , Luxaciones Articulares/cirugía , Osteonecrosis/etiología , Riesgo , Infección de la Herida Quirúrgica/etiología , Cicatrización de Heridas

RESUMEN

The MTR can be considered as representative of the quality of the anchorage of a cylindrical implant. We present preliminary investigations in the patients of our "External Fixation Clinic." The quality of the anchorage of the pins may decrease according to the duration of implantation. Appreciation of clinical loosening is valuable and can be used to roughly assess the quality of the anchorage.

RESUMEN

During our experience with external fixation for the fractures of the shaft of the humerus since 1967, the indications have been extended to include complex metaphyseal and epiphyseal fractures of both the proximal and the distal part of the bone. We propose elastic fixation of the fragments using half frame Hoffmann external fixation. Because of anatomical considerations, the two proximal pins must be inserted laterally in the upper third of the humerus, and the two distal pins in the posterior aspect of the lower third above the olecranon fossa. If the mechanical properties of the bone are poor (due to osteoporosis) more than two pins must be used in each fragment. The advantages of the technique include fast and easy application requiring simple materials; versatility of use for fractures at different levels; possible closed reduction, as in conservative treatments; early rehabilitation of joint function; fast periosteal callus formation; and retrieval of the fixator on an outpatient basis.The reduction and the immobilization of the fracture by osteotaxis are done in emergency. Closed reduction is performed as in conservative treatments. In cases of important muscular interposition, open reduction is possible. Associated internal fixation was required in 18.4% (unstable or articular fractures). A secondary transient radial palsy is observed in 5% of the patients. Intolerance to the external fixation appears in 5.6% of cases, usually consisting of drain age and redness around the pin tracts. A general evaluation of the results gives 73.8% very good results and 93.6% satisfactory results after rehabilitation.