How difficult it is to think about uncertainty and perplexity.

The author has covered a range of issues to define concepts in psychoanalytic terms that are missing from psychoanalytic theory: the social, social subjectivity, the pain of the social, unpredictability, and uncertainty. First, she reconsiders social pain and social suffering from the perspective proposed by Freud in 1921 in terms of three psychic spaces - intersubjective, intrasubjective and transsubjective - which she considers to be different from one another, and she proposes that pain is manifested in different modes in each of these spaces.Second, she defines the concept of the social, separating it from the mass and proposing the concept of the collective as truly social.

Dual Site Pudendal Nerve Infiltration: More than Just a Diagnostic Test?

Background: Pudendal neuralgia (PN) is a very painful and often disabling condition in which pudendal nerve blocks play an important role in both the diagnosis and management of PN. Some previous reports have advocated the use of pudendal nerve infiltration (PNI) as a diagnostic test only.

Objective: We aim to assess the outcomes of patients with typical refractory PN who underwent dual site computed tomography (CT)-guided pudendal nerve infiltration.

EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures.

The European League Against Rheumatism (EULAR) and the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) have recognised the importance of optimal acute care for the patients aged 50 years and over with a recent fragility fracture and the prevention of subsequent fractures in high-risk patients, which can be facilitated by close collaboration between orthopaedic surgeons and rheumatologists or other metabolic bone experts. Therefore, the aim was to establish for the first time collaborative recommendations for these patients. According to the EULAR standard operating procedures for the elaboration and implementation of evidence-based recommendations, 7 rheumatologists, a geriatrician and 10 orthopaedic surgeons met twice under the leadership of 2 convenors, a senior advisor, a clinical epidemiologist and 3 research fellows.

Joint analysis of BICEP2/keck array and Planck Data.

We report the results of a joint analysis of data from BICEP2/Keck Array and Planck. BICEP2 and Keck Array have observed the same approximately 400  deg^{2} patch of sky centered on RA 0 h, Dec. -57.

Ethical standards for orthopaedic surgeons.

This paper offers a summary of the ethical guide for the European orthopaedic community; the full report will be published in the EFORT Journal.

Reconstruction of the iliac bone using the homolateral femur after resection for pelvic tumor.

The authors have treated three patients with extensive involvement of the acetabular and peri-acetabular bone by a malignant tumour. One had a metastasis from a carcinoma of the thyroid, one from a carcinoma of the breast and one a plasmacytoma. In all three cases, the upper part of the femur was unaffected.

[Statistical analysis of the factors that increase perioperative bleeding in trochanteric fractures].

Objective: The objective of this study was to determine the major risk factors for bleeding in patients with a pertrochanteric fracture in order to plan the transfusion strategy and to overcome the problem of post-surgical anaemia. Various factors were analysed, including the taking of anticoagulant and/or anti-platelet treatment, the type of fracture, type of anaesthesia, and the type of osteosynthesis used.

Material And Methods: A retrospective study was performed on 307 patients over 75 years old, operated on between the years 2005 and 2009.

Primary tumor of the periacetabular region: resection and reconstruction using a segmental ipsilateral femur autograft.

Introduction: Bone reconstruction, after periacetabular tumour removal, is a complex procedure that carries a high morbidity rate and can result in poor clinical outcomes. Among the available options, the Puget pelvic resection-reconstruction procedure uses an autograft from the ipsilateral proximal femur to restore the anatomical and mechanical continuity of the pelvic ring before inserting an acetabular implant. HYPOTHESIS AND GOALS: This reconstruction technique satisfactorily restores the pelvic anatomy such that functional results and morbidity are comparable to alternative reconstruction techniques.

Variants of the shoulder side impact syndrome: the posterior sternoclavicular dislocation.

Side impact syndrome of the shoulder is rare and usually associated with concomitant mid-shaft clavicle, rib and scapular fractures. Visceral complications involve pleural cavity and/or lung injuries. The authors report two rare instances of posterior sternoclavicular dislocations with this entity.

Tamponade following sternoclavicular dislocation surgical fixation.

The authors report a case of posterior sternoclavicular dislocation surgically reduced and stabilized with tenodesis, according to the Burrows technique completed by temporary wire fixation. The patient presented postoperative pericardiac tamponade appearing progressively from brachiocephalic blood vessels bleeding. Emergency drainage was surgically placed associated with removal of the material, thus curing the patient.

Posterior dislocation of the sternoclavicular joint and epiphyseal disruption of the medial clavicle with posterior displacement in sports participants.

We retrospectively analysed the clinical results of 30 patients with injuries of the sternoclavicular joint at a minimum of 12 months' follow-up. A closed reduction was attempted in 14 cases. It was successful in only five of ten dislocations, and failed in all four epiphyseal disruptions.

Developmental dysplasia of the hip: is acetabular retroversion a crucial factor?

Objective: The objective of this study was to investigate a possible relation between congenital hip dysplasia and acetabular retroversion and to explore the eventual influence of the latter in the surgical decision for periacetabular osteotomy.

Materials And Methods: We assessed the classical morphological characteristics of both hips, with an additional newly described retroversion index. The study was conducted in 174 patients with uni- or bilateral congenital hip dysplasia having undergone unilateral (153 patients) or bilateral (21 patients) periacetabular osteotomy when respectively one or both dysplastic hips remained symptomatic.

[CT guided dual site infiltration in pudendal neuralgia].

Purpose: To assess the value of CT guided dual site infiltration in patients with pudendal neuralgia and determine prognostic factors of efficacy. Materials and methods. Retrospective review of 49 patients with suspected pudendal neuralgia who underwent one or multiple injections of local anesthetics and steroids.

[Osteoporosis and the orthopaedic surgeon in 2007].

Despite advances in the prevention and treatment of fragility fractures, their prevalence continues to grow. The identification and treatment of osteoporosis in these high-risk patients are widely reported to be inadequate. The results of the 2002 and 2006 "Orthopaedic Surgeon Survey" under the auspice of BJD and IOF have shown a better involvement of the orthopaedic surgeon in osteoporosis management during his routine clinical practice.

A case of malignant primary non-Hodgkin's lymphoma in skeletal muscle treated by exclusive chemotherapy.

Malignant non-Hodgkin's lymphoma (MNHL) is a frequent tumour but a primary intra-muscular location is exceptional. Standard treatment combines wide surgical removal with chemotherapy and radiotherapy. The functional consequences of this large excision are sometimes very unsatisfactory.

Cementless modular hip arthroplasty as a salvage operation for failed internal fixation of trochanteric fractures in elderly patients.

Failure of internal fixation of trochanteric fractures requires repeat surgery in order to avoid the risks of complications affecting bedridden patients. This study was conducted to assess the results of hemi- or total hip arthroplasty with a cementless modular femoral stem, as a salvage operation following early mechanical failure of internal fixation. Twenty nine patients with a mean age of 81.

[Anatomic danger of percutaneous section of the inter-metatarsal ligament for the treatment of Morton's neuroma].

Certain authors have proposed percutaneous neurolysis of Morton's neuroma. We conducted a human anatomy study to assess the reliability and the iatrogenic effect of percutaneous section of the ligament. Percutaneous section of the inter-metatarsal ligament was performed on 16 fresh cadaver specimens via a dorsal approach.

Sexual function before and after primary total hip arthroplasty.

Objectives: Chronic hip pain can have an impact on the sexual activity of patients, all the more so if they are young.

Methods: Our department undertook a retrospective study using a questionnaire mailed out to 135 patients (58 women and 77 men) under 65 years of age who had undergone a total hip replacement (THA) with primary implant more than 6 months previously. The mean age of the patients was 51.

Anterolateral mini-invasive versus posterior mini-invasive approach for primary total hip replacement. Comparison of exposure and implant positioning.

Introduction: We conducted a prospective study to compare the exposure and implant positioning in primary total hip replacement through the anterolateral minimally invasive (ALMI) approach versus the posterior minimally invasive (PMI) approach.

Materials And Methods: We applied these techniques to 2 consecutive groups (33 and 43 patients, respectively) comparable preoperatively. All the patients received the same cementless stem and acetabular component.