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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.

RECONSTRUCTIVE SURGERY IN DIFFICULT CIRCUMSTANCES – COVERAGE OF THE KNEE Patrick Knipper

MO n°161 February 2007

Soft tissue defect of the knee is something which is frequently observed in orthopaedic surgery and traumatology. The present article proposes a number of simple but reliable techniques for covering a loss of soft tissue in this region of the anatomy. In addition, these techniques are adapted to surgical management in hazardous conditions i.e. when the working environment is difficult or even precarious such as at some medical centres in developing countries or in some small French hospitals during on-call duty at the weekend and after 6 pm…Please refer to the article on reconstructive surgery under difficult conditions (Maîtrise d’Orthopédie, N° 118 and 122) for the general principles of reconstruction using simple techniques applied in difficult working circumstances. In this article we propose reconstructive surgery of the ... Patrick Knipper

INTRAPROSTHETIC DISLOCATION: A RARE COMPLICATION IN DUAL MOBILITY CUPS M.H. Fessy

MO n°152 March 2006

The main problem with dual mobility cups in the medium term is intraprosthetic dislocation. The head comes out of the polyethylene through wear of the retentive rim. The head then lodges itself in the metalback shell which can be seen by a characteristic view on x.ray. . Alas this type of incident is reported in all the literature on series of dual mobility cups, which is an indicator of this sad reality.We were able to conduct an exhaustive retrospective analysis of all the cases of intraprosthetic dislocation in our departments care between 1991 and 2002. 63 cases were analysed. For each of these 63 cases we had complete medical, surgical and radiological files. Average age at implantation was 51 years. In 30 cases the stem implanted opposite was a PF. This was a screw in stem with a modular monoblock polished stainless steel neck with ... M.H. Fessy

TRIBUTE - GILLES BOUSQUET, Surgeon and technician A. Rambert

MO n°152 March 2006

In 1969 I was running an applied mechanics laboratory at the Ecole Catholique des Arts at Métiers – ECAM - in Lyon. A phone call from one of my suppliers in scientific materials, informed me that one of his cousins, Head of Clinic in Orthopaedics at the Hospices Civils de Lyon, was looking for an engineer to work on an innovative project; making a knee prosthesis. Naturally I hesitated before meeting this surgeon given my lack of knowledge in anatomy, but accepted to meet with him for a first contact a few days later. The surgeon was Gilles Bousquet, he was Head of Clinic in Professor Albert Trillats department, and had just presented a thesis on knee laxities. Professor Albert Trillat had an international reputation and combined with his exceptional surgical qualities a particular liking for mechanics and mathematics. When he was young ... A. Rambert

DUAL MOBILITY: A Stéphanois Concept (St Etienne area, France) M.H. Fessy

MO n°152 March 2006

It was Gilles Bousquet who has the merit of having first defined the original concept of dual mobility. The prosthetic head is mobile within a retentive polyethylene which is free to move within a metalback cup . Figure 1 : The principle of dual mobility The first drafts of the project began in the early 1970s. The first implantations started in 1975. The finalisation of the project was due to the meeting of three men. - Gilles Bousquet, Professor in Orthopaedics at the University Hospital of St Etienne - Jean Rieu, Professor of teaching at the Ecole des Mines in St Etienne, and director of the biomaterials department - André Rambert, engineer and Professor in mechanical engineering at the ECAM school in Lyon Gilles Bousquet proposed the concept, Jean Rieu brought his knowledge in biomaterials and especially in surface finishing and ... M.H. Fessy