Patient information in orthopedic and trauma surgery. Fundamental knowledge, legal aspects and practical recommendations.

Providing information to surgery patients is a form of health-care governed by clearly defined therapeutic and medicolegal rules, and in particular in France by the Act of March 4, 2002 and the Code of Good Practice. The patient's right to information is implemented in a face-to-face consultation, which should be fully codified, and in a specific clinical examination, followed by information regarding the affected organ, pathology, treatment options, possible surgery, and the preconditions, risks and results associated with the procedure. Information should be personalized and as complete as possible, communicating the state of knowledge as validated by scientific societies and medical institutions.

New design of a cementless glenoid component in unconstrained shoulder arthroplasty: a prospective medium-term analysis of 143 cases.

The uncemented glenoid implants in total anatomical shoulder arthroplasty are likely to be accused of problems like dissociations, secondary rotator cuff tear, and wear of polyethylene (PE). This work is a clinical and radiological prospective review of 143 cases of anatomical total shoulder arthroplasty using a new metal back uncemented glenoid implant (MB) in order to see if this new implant induces those complications. A total of 143 cases were operated between 2003 and 2011.

Pain management in the rehabilitation of stiff shoulder: prospective multicenter comparative study of 193 cases.

Introduction: The present study investigated the impact of respecting pain threshold on clinical recovery in stiff shoulder.

Patients And Methods: A prospective multicenter comparative study followed up 193 cases of shoulder stiffness for a mean 12-month period (range, 8-31 months) after four different treatment protocols: (1) conventional sub-pain-threshold rehabilitation (58 cases); (2) self-rehabilitation exceeding the pain threshold (59 cases); (3) supervised suprathreshold rehabilitation (31 cases); and (4) capsulotomy with sub-threshold rehabilitation (45 cases). Follow-up was daily for the first 6 weeks then weekly for the next 6; each session included assessment of the painfulness, feasibility and duration of each rehabilitation and self-rehabilitation exercise and of pain status, disability and psychological status.

Management of the stiff shoulder. A prospective multicenter comparative study of the six main techniques in use: 235 cases.

Introduction: Stiffness in the shoulder is a frequent symptom associated with a number of clinical entities whose management remains inadequately defined.

Patients And Methods: This prospective study of 235 cases of stiffness in the shoulder compared six therapeutic techniques with a mean follow-up of 13 months (range, 3-28 months) (T1: 58 cases, conventional rehabilitation under the pain threshold, T2: 59 cases, self-rehabilitation over the pain threshold, T3: 31 cases, T2 + supervision, T4: 11 cases, T1 + capsular distension, T5: 31 cases, T1 + locoregional anesthesia, T6: 45 cases, T1 + T5 + capsulotomy). The therapeutic power of each technique and its impact on the result were assessed at each self-rehabilitation and rehabilitation session during the first 6 weeks and then at 3 months, 6 months, and at the final revision depending on subjective criteria (pain, discomfort, and morale) and objective criteria (Constant score, goniometric measurements).

Comparison and critical evaluation of rehabilitation and home-based exercises for treating shoulder stiffness: prospective, multicenter study with 148 cases.

Introduction: The goal of this study was to evaluate the effectiveness of individual exercises performed as classic rehabilitation or a home program on the clinical progression of patients with shoulder stiffness. Based on this information, the secondary goal was to develop a new rehabilitation protocol.

Patients And Methods: This prospective, comparative series included 148 cases of shoulder stiffness.

Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears.

Two hundred twenty shoulders with a rotator cuff tear repaired by simple tendon-to-bone suture were analyzed to determine whether the severity of presurgical fatty degeneration had an influence on their anatomic and functional outcome. Fatty degeneration was evaluated for each muscle with the 5-stage grading system developed by Goutallier et al. A global fatty degeneration index (GFDI), the mean value of the 3 muscles, was calculated for each shoulder.

[Arthroscopic rotator cuff repair: a multicentric retrospective study of 87 cases with anatomical assessment].

Purpose Of The Study: The aim of this study was to evaluate the anatomical and technical limits of endoscopic rotator cuff repair. Anatomical results were also compared with functional assessment of the shoulder.

Material And Methods: A multicentric serie of 87 patients presenting a full thickness rotator cuff tear repaired endoscopically was retrospectively reviewed at 25.

[Arthroscopic debridement of full-thickness tears of the rotator cuff: a retrospective multicenter study of 283 cases with 3-year follow-up].

Purpose Of The Study: The purpose of this study was to assess clinical and radiological course of full-thickness rotator cuff tears treated by arthroscopic debridement and to discuss surgical indications according to patient demands and anatomical lesions.

Material And Methods: This retrospective and multicentric study included patients with a minimal 3 years follow-up. The coronal extent of the supraspinatus tear was described as distal, intermediate or retracted.

Arthroscopic assessment of full-thickness rotator cuff tears.

To evaluate the reliability of the arthroscopic assessment of full-thickness rotator cuff tears, 117 cases were prospectively investigated by imaging, arthroscopy, and open surgery. The confidence of the surgeon, his accuracy, and the surgeon-dependent character of arthroscopic assessment were evaluated in terms of the description of the main anatomic parameters. The surgeons were confident and accurate in diagnosing a full-thickness tear of the supraspinatus, but they underestimated its coronal and sagittal extent and its reducibility to the greater tuberosity.

[Meningeal metastases of ovarian cancer. Contribution of imaging].

Background: Secondary meningeal localizations are uncommon and may disclose reactivation of a malignant disease. Most meningeal metastases occur in breast cancer, exceptionally in primary ovarian cancer.

Case Report: We report 2 cases of secondary meningeal localizations of ovarian cancer.

Evolution of lesions of the labrum-ligament complex in posttraumatic anterior shoulder instability: a prospective study.

The aim of this study was to evaluate the evolution of intraarticular disease in posttraumatic shoulder instability. Ninety-one patients with posttraumatic shoulder instability were examined arthroscopically. The intraarticular disease was recorded on a special documentation sheet (containing 67 descriptive items).

A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty.

We followed 210 cases of rotator cuff tears treated in four French centers by arthroscopic acromioplasty in 195 cases and by a tenotomy of the Long Head of Biceps (LHB) in 15 cases. All patients were evaluated by means of the Constant score (CS) and radiographic imaging. The mean age was 61 years and the mean follow-up period was 26.

[Interscalenic block and surgery of the shoulder. A prospective study of a continuous series of 167 patients].

Objectives: To determine the relationship between minimal stimulating current and success rate of interscalene brachial plexus block (IBPB), to assess the quality of anaesthesia and postoperative analgesia, and to evaluate the benefits and drawbacks of this technique in shoulder surgery.

Study Design: Prospective study of a continuous series of clinical cases.

Patients: Series of 167 patients undergoing shoulder surgery under IBPB, obtained with Winnie's technique, in 1995.

[Results of surgical treatment of metastases of renal carcinomas in 65 operated cases].

Several reports have assessed that the prognosis of metastatic renal cell carcinoma was better if patient's general condition was good, if primary tumor had been resected, if the time between nephrectomy and metastasis was long, if metastases are only pulmonary and bone marrow was not involved. The bone metastases of renal cell cancer have a bad reputation because of their haemorragic caracteristics and their resistance to radiotherapy.In the Orthopaedic and Traumatologic Department of the University hospital in Strasbourg, the authors had operated on 65 metastatic renal cell cancers.

[Arthroscopic aspects and chronologic outcome of lesions of the labro-ligament complex in post-traumatic antero-inferior instability of the shoulder. A prospective study of 91 cases].

Purpose Of The Study: The authors present a prospective and mono-operator study of 91 gleno-humeral arthroscopies for post-traumatic antero-inferior instability of the shoulder. The aim of the study was to obtain a dynamic understanding of the relationship between the anatomic lesions to allow the integration of all the described lesions into literature and to produce a natural history of lesions in antero-inferior shoulder instability.

Materials: 91 endoscopies for post-traumatic instability of the shoulder were performed by the same surgeon.

[Functional and anatomical results after surgical treatment of ruptures of the rotator cuff. 1: Preoperative functional and anatomical evaluation of ruptures of the rotator cuff].

Purpose Of The Study: In a consecutive series of 98 patients presenting 100 full thickness cuff tears and managed by the same medico-surgical team, the authors studied the correlation between preoperative shoulder function values and the anatomic lesions found at surgery. Predictive factors of tear size were evaluated and any elements that were likely to improve preoperative function were determined so that patients could be best prepared for surgery. The validity of preoperative radiographic assessment of lesions was examined.

[Functional and anatomical results after surgical treatment of ruptures of the rotator cuff. 2: postoperative functional and anatomical evaluation of ruptures of the rotator cuff].

Purpose Of The Study: The authors examined the anatomic condition and the function of the rotator cuff obtained after an average period of four years following surgical repair in a series of 100 full thickness rotator cuff tears. The aim was to assess the validity of Constant's scoring method and to analyse risk factors and the frequency of recurrent tears.

Material And Methods: The series comprised 98 patients, 62 men and 36 women whose average age was 56 years.

Functional and anatomical results after rotator cuff repair.

The anatomic condition of the rotator cuff and the functional results obtained were studied in a homogeneous series of 100 full thickness cuff tears in 98 patients with an average followup of 4 years. Constant's functional score, used by the European Society for Shoulder and Elbow Surgery, was done preoperatively and postoperatively in each patient, in addition to ultrasonography at followup. There was a close correlation between the anatomic condition of the cuff and Constant's functional score before surgery (p = 0.

[Results of endoscopic treatment of non-broken tendinopathies of the rotator cuff. 2. Calcifications of the rotator cuff].

The authors studied the results of the arthroscopic treatment of the chronic calcifying tendinitis within a multi-center study of the French Society of Arthroscopy. 112 patients were available for the study. All shoulders had a preoperative radiographic clinical and radiographic evaluation.

[Results of endoscopic treatment of tendinopathies of the rotator cuff (excluding total ruptures). 1: Non-calcifying tendinopathies].

The authors have studied the result of endoscopic treatment in 129 non ruptured and non calcified tendinitis of the rotator cuff as well as 33 partial thickness tears included in a multicentric study made by the french arthroscopic society. The files included a revision form using Constant's functional evaluation and filled by a physician different from the operator, and a radiological standardized evaluation allowing to appreciate, from A.P.