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Adult hip dysplasia: classification, surgical indications, shelf arthroplasty by a minimally invasive approach Ph. Chiron

MO n°213 April 2012

Hip dysplasia due to insufficient coverage of the femoral head is a structural deformity that affects 4% of the Caucasian population and is the cause of 48% of cases of osteoarthritis requiring hip replacement . The option of preventive surgery carries its own risks; meticulous examination of each patient’s individual case is necessary before deciding whether it is indicated. We consider that shelf arthroplasty by a minimally invasive approach is the simplest surgical procedure, has no major complications and has been the best assessed . It does not close the door on good quality primary arthroplasty, nor does it compete with Chiari osteotomy for acetabular enlargement or with triple periacetabular osteotomy, which has its own indications . Varus femoral osteotomywhich deforms the upper extremity of the femur and shortens the leg ... Ph. Chiron

ORTHOPEDIC MAN Heldé, E. Revue	MO n°200 January 2011
... Heldé, E. Revue

CobbMeter: The Cobb angle on iPhone F. Jacquot, R. Rigal

MO n°196 August 2010

Use of a consumer electronic handheld device (iPhone™) to measure the Cobb angle in acquired localized kyphoses: A reliability study. Handheld computers combined with cell phones have spread rapidly through the market to the point that virtually everybody has provided himself with a powerful pocket computer with connecting capabilities and more. The positioning sensor embedded in some of these devices makes them useful measuring stations, combined with real-time computing capabilities that may be used in daily clinical activities for a variety of tasks. John Cobb described the angle and measurement named after his name in 1948 in the American JBJS. Dr Cobb, an adult and children spine surgeon, spent a part of his life advocating evaluation and measurements in clinical situations as a way to understand and improve outcomes. Since his ... F. Jacquot, R. Rigal

Gardens of the Embassy F. Jacquot

MO n°193 April 2010

Dr Frederic Jacquot, an orthopedic surgeon from Hôpital Saint Antoine, Paris, took part in the SAMU/EPRUS mission that landed in Port au Prince on January 29th 2010. He worked for 12 days at the Adventist Hospital in Diquini, Haiti. The mission was housed in the gardens of the mangled French ambassador’s mansion. Six hundred. We are six hundred fellows Frenchmen – and women, some say six hundred and fifty, but certainly not more than seven hundred says the security guard. This is a giant summer camp settled in the gardens of the French Ambassador’s house in Haiti. Tents are randomly built everywhere from the swimming pool to the mansion, one against each other, in a delicate disorder. Logos blossom on the fabric city, identifying their inhabitants: Civil Security, Firemen from France and elsewhere, National Guards (wearing ... F. Jacquot

Performing the Latarjet procedure with dedicated instruments L. Doursounian, A. Debet-Mejean

MO n°182 March 2009

Recurrence of dislocation after a first episode requires surgical treatment in one out of four cases.1 Many different procedures have been described so far, which can be broken down into two main categories: surgical procedures on soft tissue are considered more anatomical (e.g. Bankart procedure, the gold standard); those using a bone block were pioneered by Latarjet. Although the Latarjet procedure (in which a coracoid bone block is positioned flush with the anterior-inferior border of the glenoid) was questioned because of the many complications reported,2-8 and in spite of the boom of arthroscopic techniques, it is still extensively used in Europe as primary surgery or after a failed Bankart repair. The bone block can be positioned either horizontally or vertically.9-13 As regards exposure, horizontal sectioning of the subscapularis has ... L. Doursounian, A. Debet-Mejean

USE OF THE BILBOQUET IN COMPLEX PROXIMAL HUMERAL FRACTURES G. Griffet, J. Berhouet, Ch. Le Du, Luc Favard

MO n°181 February 2009

Treatment of complex displaced fractures of the proximal humerus is challenging. Management of a comminuted fracture in poor quality bone with a conventional fixation device is difficult,13 not to mention the potential risk of post-traumatic necrosis of the humeral head,10 nonunion or malunion of the tuberosities.2 In such situations, Neer advocated the use of hemiarthroplasty11. But what was a success in Neer's hands was not in others' hands and many surgeons were disappointed by a high rate of nonunion of the tuberosities.2 Percutaneous fixation devices do not allow early mobilization and often have poor holding power in osteoporotic bone. The ideal solution would be a device that allows anatomical reconstruction, provides good stability at the fracture site, allows early mobilization, and preserves bone stock. Actually, intramedullary systems ... G. Griffet, J. Berhouet, Ch. Le Du, Luc Favard

DEEPENING TROCHLEOPLASTY FOR TREATMENT OF RECURRENT DISLOCATION OF THE PATELLA : Indications, Surgical Technique, Results D. Dejour

MO n°176 August 2008

By nature, the patellofemoral joint has low congruity. Passive stability is provided both by the bony structures (congruity between the patella and the trochlear groove) and by the medial and lateral ligaments. Active stability depends on correct tension of the quadriceps muscles on the one hand, and on passive medial-lateral soft-tissue balance on the other hand. The patella needs both passive and active stability to transmit the quadriceps muscle force during flexion and extension movements, whether it be during normal gait cycle or high energy sports activities. In 1987, Henri Dejour's team developed a classification of patellofemoral disorders including three categories : 1) patellar pain syndrome, 2) potential instability (lateral tracking patella), 3) objective patellar instability.6 It did not take into account a possible history of ... D. Dejour

CLINICAL EXAMINATION OF THE SHOULDER IN DISORDERS OF THE ROTATOR CUFF Ch. Dumontier, L. Doursounian

MO n°168 November 2007

Disorders of the rotator cuff are the main source of pain in the shoulder and despite recent progress in shoulder imaging, clinical examination remains a fundamental stage in evaluating pain in the region of the scapula. The rotator cuff of the shoulder consists of the tendons of insertion of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles in the humerus, combined with the intra articular portion along the biceps. In this article, we will deal with lesions which are part of the blurred notion of impingement syndrome between the cuff and the coracoacromial arch. There are in fact two types of impingement (Dumontier et al., 1999): anterointernal impingement and superoexternal impingement.• Anterointernal impingement is rare and occurs in the coracohumeral space at the junction between the supraspinatus and subscapularis ... Ch. Dumontier, L. Doursounian

MANAGING PARALYSIS OF INTRINSIC MUSCLES OF THE THUMB F. Chaise 1.2.3, Ph. Bellemere 1.2, B. Chabaud 3.4.

MO n°165 June 2007

Paralysis of the intrinsic muscles of the thumb will change the opposition function which is the result of a movement made up of three components: extension, adduction and pronation. The full movement of opposition is only possible if all the local anatomic structures are functional. A thumb with paralysis of the intrinsic muscles will be dependent on the extrinsic muscles which will progressively lead to major functional imbalance with the final result being a thumb stiffened in adduction and retroposition with an interphalangeal joint fixed in flexion. Early medical care must be undertaken before these complications arise because their treatment is difficult, the results uncertain and often disappointing. Re-education, fitting of prosthesis and physiotherapy must all be an essential part of this protocol prior to any surgical reconstruction. ... F. Chaise 1.2.3, Ph. Bellemere 1.2, B. Chabaud 3.4.

PALLIATIVE TREATMENT FOR PARALYSIS OF INTRINSIC MUSCLES OF THE FINGERS Ph. Bellemere 1.2, F. Chaise 1.2.3, B. Chabaud 2.4.

MO n°165 June 2007

Paralyses of the intrinsic muscles of the fingers are the result of nerve damage, infectious nerve diseases (leprosy, polio) or degenerative diseases affecting at least the ulnar nerve. These paralyses cause deformity of the fingers and functional disability due to imbalance between the intrinsic and extrinsic muscle apparatus of the fingers. The deformity is a clawing of the fingers which is typically seen during active extension of the fingers with hyperextension of the first phalanx because the metacarpophalangeal joints are not stabilised while the 2nd and 3rd phalanges remain in flexion . This attitude only concerns the 4th and little finger in the case of isolated ulnar nerve paralysis because the lumbrical muscles of the 2nd and 3rd fingers, innervated by the median nerve, can suffice to prevent deformation in these fingers. The claw ... Ph. Bellemere 1.2, F. Chaise 1.2.3, B. Chabaud 2.4.