Intramedullary nailing for humeral shaft fractures: Is distal locking necessary?

Introduction: Intramedullary (IM) nailing of humeral shaft fractures is a reliable means to achieve bone union while allowing early motion. The hypothesis was that distal locking is unnecessary due to good primary stability of the impacted nail in the distal, truncated cone portion of the medullary canal. The primary objective of this study was to confirm the success of the procedure without distal locking by identifying failure criteria.

Identification and treatment of potentially destabilizing Vancouver B-lesser trochanter periprosthetic fracture ("New B2"): A 33-case series.

Introduction: A new type of periprosthetic fracture, between Vancouver-SoFCOT types A and B, was recently described and labeled "new B2". It occurs intraoperatively or in the early postoperative period, on cementless implants, and features a posteromedial cortical fragment around the lesser trochanter. The main aim of the present study was to report clinical and radiological results in a series of 33 cases of what is better called Vancouver B-lesser trochanter (VB-LT) fracture.

Subperitoneal approach in revision arthroplasty for acetabular component protrusion: Analysis of practices within the French Hip and Knee Society (SFHG).

Introduction: The complications related to revision for acetabular component protrusion with material migrating into the intrapelvic region remain rare but potentially serious. Today, the literature reports no epidemiological data on the subperitoneal approach (SPA) in revision total hip arthroplasty (RTHA) for protrusion. Therefore we conducted a retrospective study on a large revision arthroplasty database to answer the following questions: (1) What is the frequency of this approach in this population? (2) What are the factors related to this procedure? (3) Is morbidity and mortality of the SPA higher than for an isolated conventional approach?

Hypothesis: Major protrusions with material in the superomedial quadrant (SMQ) have a higher probability of being operated using a SPA.

Femoral revision with a primary cementless stem.

Introduction: The use of a primary cementless component is a tempting option for revision total hip arthrosplasty (reTHA), however, the results of this type of revision have not been clearly determined. The goal of this retrospective study was to determine: if revision with a primary anatomical cementless femoral stem gives adequate bone fixation; the rate of secondary subsidence or recurrent loosening; the survival rate with this device.

Hypothesis: Revision with a primary anatomical cementless femoral stem results in a low rate of subsidence and recurrent loosening.

Outcomes and prognostic factors in revision hip arthroplasty for severe intra-pelvic cup protrusion: 246 cases.

Background: The outcome of revision total hip arthroplasty (THA) for intra-pelvic cup protrusion is unclear. Hence, we conducted a large retrospective study to clarify the surgical strategy (hip lever arm and cup mechanical fixation) and the outcomes of reconstruction for severe intra-pelvic cup protrusion.

Hypothesis: We hypothesized that restoration of the anatomic hip centre in such acetabular revisions decreased the risk of recurrent loosening.

Prosthetic joint infection: A pluridisciplinary multi-center audit bridging quality of care and outcome.

Background: Care to patients with prosthetic joint infections (PJI) is provided after pluridisciplinary collaboration, in particular for complex presentations. Therefore, to carry out an audit in PJI justifies using pluridisciplinary criteria. We report an audit for hip or knee PJI, with emphasis on care homogeneity, length of hospital stay (LOS) and mortality.

Antibiotic addition to cement - is it beneficial.

Antibiotic loaded acrylic cement (ALAC) is widely employed in primary as well as revision hip arthroplasties. There are prerequisites in relation to antibiotic choice and mixing techniques. The 2007 French Consensus Conference delivered recommendations for ALAC in primary arthroplasty.

Tibial tubercule osteotomy during medial approach to difficult knee arthroplasties.

Introduction: Osteotomy of the anterior tibial tubercle (TT) is well known as the approach to difficult knees, in particular those with a low patella, but it has a poor reputation.

Patients And Methods: This technique was used 21 times in 20 patients (10 males and 10 females) with a mean age of 71 years (range, 42-90 years) for 14 prosthesis revisions (three for septic loosening, 11 for aseptic loosening) and seven knees that had not anteriorly received prior implants (three osteotomies, one synovectomy). The surgical technique included a long (7 cm), thick (>1 cm) fragment retaining its lateral muscle hinge with compression fixation using two screws.

Distal locking stem for revision femoral loosening and peri-prosthetic fractures.

Revision total hip arthroplasty in the setting of a large proximal femoral deficiency or a peri-prosthetic fracture remains a challenging problem. We describe the development, surgical technique and the use of cementless revision stems with distal inter-locking screws to provide immediate stability of the femoral implant. Results were assessed in a large multicentre French study conducted with the french hip and knee surgery society (SFHG).

Hip arthroplasty up to the age of 30 and considerations in relation to subsequent revision.

We reviewed a series of 17 hip arthroplasties in 16 patients performed when the patients were 30 years old or younger who presented to us for consideration of revision. The mean age was 23.1 years (14 to 30) at the initial arthroplasty.

[Femoral neck fractures in patients over 50 years old].

Introduction: Despite many papers and instructional course lectures, therapeutic guidelines are not clearly defined about treatment of femoral neck fractures. The aim of this multicentric French symposium was to prospectively study the results of current therapeutic options in order to propose scientifically proven options.

Material And Methods: Three prospective studies were carried out in order to answer to these questions: (1) is it possible with anatomical reduction and stable fixation to lower the non union and osteonecrosis rate? (2) is functional treatment of Garden 1 fractures successful in more than 65 years patients? (3) what criteria are useful to choose the kind of arthroplasty for more than 65 years patients?

Results: For the 64 patients between 50 and 65 years old included in the first study, 44 ORIF and 17 prostheses were performed.

[Tibial diaphysis fractures below a total knee prosthesis].

The fractures of the tibial diaphysis below a total knee prosthesis are a surgical challenge and intra medullary nailing seems impossible. For the SOFCOT 2005 symposium on peri prosthetic fractures we reviewed our files: six cases were found and analysed. These fractures are rare: 5 cases from the symposium (out of 96 periprosthetic fractures at the knee) are reported plus a more recent one.

[Fence grafting for acetabular reconstruction with a cementless cup].

Acetabular reconstruction is difficult after loss of bone stock and socket remodeling. Several techniques have been proposed ranging from a metal backing to allografting. We propose fence grafting.

[Computer-assisted positioning of the acetabular cup for total hip arthroplasty based on joint kinematics without prior imaging: preliminary results with computed tomographic assessment].

Purpose Of The Study: Most navigation systems for computer-assisted total hip arthroplasty (THA) require prior computed tomography (CT) or acquisition of multiple bone landmarks on the pelvis. In order to avoid these problems, we developed a computer-assisted navigation system without CT based on a kinematic approach to the hip joint. The principle is to orient the cup in relation to the cone describing the hip joint range of motion.

Should we resurface the patella in total knee replacement? Experience with the Nex Gen prothesis.

Patellar resurfacing is a controversial issue in primary total knee replacement. So, we took advantage of a large study to try and answer this question. An open prospective multicentric study was conducted about the outcome of the Nex Gen Total Knee prosthesis with clinical and radiological follow-up at regular intervals (1, 2 and 5 years).

[Progressive intra-acetabular dislocation of bipolar hip prostheses: four cases].

Certain complications, such as acetabular erosion or cup dissociation, are specific to bipolar prostheses. Progressive intra-acetabular dislocation has not been reported to date. We report 4 cases.

[Osseous reconstruction of the patella with screwed autologous graft in the course of repeat prosthesis of the knee].

Purpose Of The Study: The aim of this study was to propose an original way of solving the infrequent but difficult problem of a thin patellar remnant. After removal of the loose patellar button of a knee prosthesis, several options are available: patellectomy should be avoided because of unpredictable results; patelloplasty may be the solution if bone quality is too poor and can allow for its improvement with time; recementing a new implant needs the remaining patella to be thick enough (more than 10 millimeters).

Material And Methods: We advised reconstruction with an autologous monocortical iliac bone graft, harvested from the medial cortex of the anterior iliac wing, and shaped to accommodate for the patellar remnant.

[Prosthetic replacement of the anterior cruciate ligament in dogs by carbon fibres (author's transl)].

Division of the anterior cruciate ligament in dogs usually leads to degenerative arthrosis of the knee after a few weeks. The authors have replaced the anterior cruciate ligament in 7 dogs by an artificial ligament made of carbon fibre. The results were analysed after seven months.