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9 results on '"Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg)"'

1. Total hip arthroplasty with exclusive use of dual-mobility cup after failure of internal fixation in trochanteric fracture

Author

Henri Favreau, Philippe Adam, Matthieu Ehlinger, François Bonnomet, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Reoperation, medicine.medical_specialty, Arthroplasty, Replacement, Hip, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Population, Periprosthetic, Prosthesis Design, 03 medical and health sciences, Fixation (surgical), 0302 clinical medicine, medicine, Humans, Internal fixation, Orthopedics and Sports Medicine, education, Aged, Retrospective Studies, 030222 orthopedics, education.field_of_study, Hip Fractures, business.industry, Retrospective cohort study, 030229 sport sciences, Femoral fracture, medicine.disease, Prosthesis Failure, 3. Good health, Surgery, Harris Hip Score, Female, Hip Prosthesis, Implant, business, Follow-Up Studies
Abstract

Failure of internal fixation in trochanteric fracture (or extracapsular proximal femoral fracture: PFF) is a serious complication often requiring total hip arthroplasty (THA). THA after PPF incurs a higher risk of complications than in intracapsular fracture due to frequent impact on local anatomy, notably with risk of implant dislocation. Recent studies demonstrated a protective effect of dual-mobility (DM) cups against instability in these cases but in a population mixing failure of internal fixation in intra- and extracapsular fractures. We therefore conducted a retrospective study focusing on fixation failure in PFF: 1) to assess surgical complications and notably dislocation rate using DM cups, and 2) to analyse the characteristics of the initial fixation and assess conformity with established standards.DM cups exert a protective effect in PFF fixation failure at high risk of instability.A single-centre retrospective study included 40 cases over a 10-year period: 30 women, 10 men; mean age, 77 years [range, 31-91 years]. All THAs used DM cups. Approaches were transgluteal in 24 cases, posterior in 15 and anterolateral in one. Clinical assessment comprised of: pain on visual analog scale (VAS), Harris Hip Score (HSS), and Postel Merle-d'Aubigné score (PMA). The rate of surgical complications (periprosthetic fracture, infection, non-union, dislocation) was assessed and the primary fixation quality was analysed for fracture complexity and conformity to standards.At a mean 54 months' follow-up [range, 24-122 months], the post-THA complications rate was 22% (9/40), although with no cases of implant dislocation. Pre- to postoperative comparison found significant improvements on VAS (7.9±1.6 versus 1.35±1.5, respectively), HHS (20±11.8 versus 78±12.3) and PMA (4.7±2.9 versus 14.6±2.1) (p0.0001), but non-significant change in Parker-Palmer score (5.5±2 and 4.8±1.9) (p=0.4). Fracture instability rate was 77% and 85% (31 and 34/40) on the AO and Evans-Jensen classifications respectively. Analysis of primary fixation found non-conformity with reduction standards in 68% of cases (27/40): most frequently, cervical screw centering defect (58%, 23/40) and reduction defect (28%, 11/40). The non-conformity rate was 44% (4/9) in AO stable fracture and 74% (23/31) in unstable fracture.The study hypothesis was confirmed, with no dislocations in this high-risk population. This can be attributed to exclusive use of DM cups, which should be systematic in high-risk contexts. The study confirmed the importance of primary fixation quality, although a risk of failure remains, even in stable fractures.IV, retrospective study.

Published
2020

2. Total knee replacement on more than 20° valgus: A case control study

Author

Benjamin Puliero, Bruno Tillie, Gilles Pasquier, Franck Remy, Nassima Ramdane, Sophie Putman, Matthieu Ehlinger, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital privé les Bonnettes [Arras], École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, musculoskeletal diseases, medicine.medical_specialty, Knee Joint, [SDV]Life Sciences [q-bio], Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Survivorship curve, medicine, Deformity, Humans, Orthopedics and Sports Medicine, Arthroplasty, Replacement, Knee, Aged, Retrospective Studies, Valgus deformity, Aged, 80 and over, 030222 orthopedics, biology, business.industry, Case-control study, Retrospective cohort study, 030229 sport sciences, Middle Aged, biology.organism_classification, medicine.disease, 3. Good health, Surgery, Genu Valgum, Radiography, Survival Rate, body regions, Valgus, Case-Control Studies, Female, Implant, medicine.symptom, Complication, business
Abstract

Introduction Lower-limb valgus deformity exceeding 20° is a particular case, with few publications assessing the impact of the severity of the valgus. The present retrospective case control study compared a series of > 20° valgus versus a series of 10–20° valgus, assessing (1) operative data [approach, type of total knee replacement (TKR)], (2) complications and implant survival, and (3) clinical and radiological results. Hypothesis Severe valgus deformity requires TKR with greater constraint, incurring a higher rate of complications and poorer implant survival. Material and method A multicenter retrospective study for the period January 2006 to December 2010 included 53 patients, with a mean age of 72 ± 10 years, presenting > 20° valgus. The study series was matched for age and gender with a series of 53 cases of 10–20° valgus. Convexity laxity was greater in the > 20° group (p = 0.004). Results There was no significant inter-group difference in approach (p = 0.13). Greater constraint was more frequent in the > 20° group (7/53 versus 1/53; p = 0.03), independently of convexity laxity or Krackow grade (p = 0.14). There were 7 complications (13.2%) in the > 20° group and 7 in the 10–20° group (NS). Eight-year survivorship was 95.12% in the > 20° group and 94.9% in the 10–20° group (p = 0.63). There were no significant differences in Oxford score (p = 0.30) or HKA angle (p = 0.78) at last follow-up. Conclusion The study hypothesis was partially confirmed: greater constraint was more frequent in > 20° valgus. The number of complications was low, and survival was identical to that of a control group with less severe deformity. Level of evidence III, retrospectivecase controlstudy.

Published
2019

3. Prospective study of tendon healing and functional gain after arthroscopic repair of isolated supraspinatus tear

Author

Johannes Barth, Isabelle Fatras-Meyer, Ludovic Labattut, David Gallinet, Philippe Collin, Philippe Clavert, Pierre Metais, Nicolas Bonnevialle, Jérôme Garret, Nima Bagheri, Arnaud Godenèche, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), and Francophone Arthroscopy Society

Subjects
medicine.medical_specialty, Rotator Cuff Injuries, Arthroscopy, Rotator Cuff, 03 medical and health sciences, 0302 clinical medicine, medicine, Shoulder function, Humans, Orthopedics and Sports Medicine, Rotator cuff, Prospective Studies, Prospective cohort study, Tendon healing, Wound Healing, 030222 orthopedics, business.industry, Mean age, [PHYS.MECA]Physics [physics]/Mechanics [physics], 030229 sport sciences, Middle Aged, musculoskeletal system, Magnetic Resonance Imaging, Surgery, Tendon, Treatment Outcome, medicine.anatomical_structure, Constant score, business
Abstract

In case of failure of non-operative treatment of isolated supraspinatus tear, tendon surgery can improve shoulder function and alleviate pain. The present study hypothesis was that isolated supraspinatus repair shows good healing, with improved clinical results.A prospective multicentre study followed up 199 patients (mean age, 57 years) for one year. Inclusion criteria comprised: isolated full-thickness supraspinatus tear, retraction grade3, with the same double-row arthroscopic technique. Clinical assessment used Constant score at 6 weeks and 3, 6 and 12 months. Ultrasound control checked tendon repair quality on the Sugaya criteria, types I-II-III being considered as healed.At one year, mean Constant score had increased by 26 points (p0.001). Healing rate was 94% (n=187): Sugaya type I, 46% (n=92); type II, 41% (n=81); type III, 7% (n=14). Mean Constant score was significantly higher in case of healing: 81 vs. 70 points (p=0.002). Constant score progression was identical in both healing groups throughout follow-up. Univariate analysis showed no correlation between epidemiological or tear-related factors and tendon healing.Arthroscopic repair of isolated small supraspinatus tear provided 94% healing. Clinical results were better when healing was achieved.I, prospective cohort study.

Published
2020

4. Safety and efficacy of percutaneous instrumentation combined with antibiotic treatment in spondylodiscitis

Author

Yann Philippe Charles, Arnauld Lambert, Yves Hansmann, Erik Sauleau, Jean-Paul Steib, Nicolas Lefebvre, Yves Ntilikina, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, Male, Spondylodiscitis, medicine.medical_specialty, Discitis, Percutaneous, Nonunion, Kyphosis, Thoracic Vertebrae, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Deformity, medicine, Back pain, Humans, Orthopedics and Sports Medicine, Aged, Retrospective Studies, Aged, 80 and over, 030222 orthopedics, Braces, Lumbar Vertebrae, business.industry, 030229 sport sciences, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Sagittal plane, Anti-Bacterial Agents, Surgery, Spinal Fusion, Treatment Outcome, medicine.anatomical_structure, Back Pain, [INFO.INFO-TI]Computer Science [cs]/Image Processing [eess.IV], Female, medicine.symptom, Tomography, X-Ray Computed, business
Abstract

Background Patients with spondylodiscitis are treated with antibiotics and braces for 6 to 12 weeks. Braces aim to decrease pain and prevent kyphotic deformity due to vertebral body collapse. Percutaneous instrumentation could be an alternative to influence pain and patient's autonomy. Purpose The purpose of this study was to analyze back pain, quality of life, sagittal deformity, and complications after percutaneous instrumentation in spondylodiscitis. Patients and methods VAS for back pain, EQ-5D, radiographic sagittal index were assessed retrospectively for 28 patients who had a standardized follow-up at 5 days, 6 weeks, 3 months, 1 and 2 years. Probabilities > 0.95 indicated significant changes (Bayesian model). Results VAS was 7.0 preoperatively, 3.2 (day 5), 2.2 (6 weeks), 1.9 (3 months), 1.6 (1 year), 1.4 (2 years): probabilities > 0.95 within 6 weeks. EQ-5D was 0.229 preoperatively, 0.563 (6 weeks), 0.687 (3 months), 0.755 (1 year), 0.787 (2 years): probabilities > 0.95 within 1 year. Sagittal index was 15.1° preoperatively, 9.6° postoperatively: probability > 0.95. Inter-body fusion was: complete 60.7%, partial 17.9%, and nonunion 21.4%. Antibiotic treatment was stopped at 6 weeks in 82.1%, at 3 months in 17.9%, without septic complication. Conclusion Percutaneous instrumentation improved pain control, quality of life and prevented kyphosis. Antibiotic treatment was not influenced. Septic complications were not observed. Level of evidence IV.

Published
2019

5. Ethics watch and editorial innovations in Orthopaedics & Traumatology: Surgery & Research

Author

Migaud, Henri, Clavert, Philippe, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Orthopedics, Traumatology, Humans, Orthopedic Procedures, Orthopedics and Sports Medicine, Surgery, [PHYS.MECA]Physics [physics]/Mechanics [physics]
Published
2022

6. Learning a MIPO technique for distal radius fractures: Mentoring versus simple experience versus deliberate practice

Author

Philippe Liverneaux, Sybille Facca, Nicolas Meyer, François Ducournau, Fred Xavier, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
medicine.medical_specialty, media_common.quotation_subject, Teaching method, medicine.medical_treatment, Basic skills, Fracture Fixation, Internal, 03 medical and health sciences, 0302 clinical medicine, Reading (process), medicine, Humans, Minimally Invasive Surgical Procedures, Internal fixation, Orthopedics and Sports Medicine, Medical physics, Technical skills, media_common, 030222 orthopedics, business.industry, Mentoring, [PHYS.MECA]Physics [physics]/Mechanics [physics], 030229 sport sciences, Evidence-based medicine, Surgery, Treatment Outcome, Plate osteosynthesis, Learning curve, Radius Fractures, business, Bone Plates
Abstract

Background Performance skills of a surgeon for a specific surgical technique range from 1 (novice) to 5 (expert). Mentoring can bring the surgeon to level 3. Simple experience rarely allows achievement of level 5, in contrast to deliberate practice, in which performance skills are improved by setting learning goals based on feedback about the trainee's previous performance. Hypothesis When learning a technique for the internal fixation of distal radius fractures, the level of performance skills achieved is higher with deliberate practice than with mentoring or simple experience. Material and methods Four surgeons each performed minimally invasive plate osteosynthesis (MIPO) of 15 distal radius fractures. The procedures were recorded by an HD camera. The first five fractures (step 1) were treated after mentoring, the next 5 fractures after reading an article and viewing a reference video (step 2), and the last 5 fractures after viewing and commenting 20 short videos highlighting possible errors (step 3). Each recording of the procedures performed by the surgeons was scored using the Objective Structured Assessment of Technical Skills (OSATS, 10 items on basic skills [B] and 10 on MIPO-specific skills [S]). Results For the basic skills, the mean OSATS scores (on 50) were 31 for step 1, 31 for step 2, and 43 for step 3. For the specific skills, the mean OSATS scores (on 50) were 25 for step 1, 29 for step 2, and 48 for step 3. For overall skills (B + S), the mean OSATS score (on 100) was 56 for step 1, 60 for step 2, and 91 for step 3. Discussion Our study confirms that the deliberate practice teaching method is more efficient in improving surgeon skills than simple experience. Deliberate practice consists of four essential steps: (i) setting a well-defined goal; (ii) being motivated to improve one's performance; (iii) receiving immediate feedback; and (iv) having multiple opportunities to repeat and gradually perfect one's performance. Our main hypothesis was verified, since the results of learning a MIPO technique, as assessed using the OSATS scale, were significantly better with a video-assisted deliberate practice technique than with mentoring or simple experience. Conclusion Video-assisted deliberate practice deserves to be widely used in order to optimise learning curves and to improve risk management in surgery. Level of evidence III.

Published
2021

7. Treatment of acute perilunate dislocations: ORIF versus proximal row carpectomy

Author

E. Pire, Guillaume Prunières, P.A. Liverneaux, J.J. Hidalgo Diaz, Tomas Muller, Sybille Facca, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Operative Time, Open Fracture Reduction, Joint Dislocations, Osteoarthritis, Fracture Fixation, Internal, Young Adult, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Internal fixation, Orthopedics and Sports Medicine, Lunate Bone, 030212 general & internal medicine, Joint dislocation, Range of Motion, Articular, Carpal Bones, Pain Measurement, Retrospective Studies, 030222 orthopedics, Carpal Joints, Fracture Dislocation, business.industry, Lunate bone, Retrospective cohort study, [PHYS.MECA]Physics [physics]/Mechanics [physics], Middle Aged, medicine.disease, Surgery, Carpal bones, medicine.anatomical_structure, Cohort, Female, business, Follow-Up Studies
Abstract

Purpose Some authors have proposed performing proximal row carpectomy (PRC) as the initial treatment for perilunate dislocations. Hypothesis The goal of this retrospective study was to compare the results of a cohort of perilunate dislocation cases that were operated by open reduction and internal fixation (ORIF) or by PRC between 2006 and 2011. Methods The cohort consisted of 21 men with a mean age of 33 years, who either had an isolated perilunate dislocation (7 cases) or a fracture–dislocation (14 cases). All dislocations were dorsal, with 10 stage I and 12 stage II. Thirteen patients had been treated by ORIF (group 1) a mean of 1.2 days after the injury. Eight patients had been treated by PRC (group 2) a mean of 18.7 days after the injury. Immobilization time was 6–12 weeks in group 1 and 2 weeks in group 2. Results The mean operative time was 95 minutes in group 1 and 65 minutes in group 2. After a mean follow-up of 35 months, the following outcomes were found for groups 1 and 2, respectively: pain 3/10 and 1/10, strength 77% and 73%, strength in supination 79% and 93%, strength in pronation 67% and 95%, QuickDASH 27/100 and 16/100, PRWE 43/150 and 15.5/150, flexion 69% and 57%, extension 84% and 58%, pronation 97% and 103%, supination 98% and 97%. There were four cases of osteoarthritis in both groups. Conclusion Treatment of acute perilunate dislocations by PRC leads to medium-term results that are at least as good as those with ORIF treatment. The surgery duration is shorter with PRC, as is the immobilization period. Type of study Retrospective comparative. Level of evidence III.

Published
2017

8. Prognostic factors for traumatic elbow osteoarthritis after terrible triad surgery, and functional impact

Author

Geoffrey Ginot, Thomas Mereb, Philippe Clavert, Nicolas Meyer, Maxime Antoni, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, Elbow, Joint Dislocations, Physical examination, Osteoarthritis, Cohort Studies, Young Adult, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Elbow Joint, Humans, Medicine, Internal fixation, Orthopedics and Sports Medicine, Range of Motion, Articular, Fisher's exact test, Aged, Retrospective Studies, Aged, 80 and over, Subluxation, 030222 orthopedics, medicine.diagnostic_test, business.industry, Retrospective cohort study, [PHYS.MECA]Physics [physics]/Mechanics [physics], 030229 sport sciences, Middle Aged, Prognosis, medicine.disease, Surgery, Treatment Outcome, medicine.anatomical_structure, symbols, Radius Fractures, business, Range of motion
Abstract

Introduction Terrible triad (TT) of the elbow almost always requires surgery to prevent progression to chronic instability and more or less inevitable osteoarthritis. Progression toward osteoarthritis after well-conducted surgery and associated risk factors have been little reported. We performed a retrospective study: (1) to assess rates of post-traumatic elbow osteoarthritis after surgical treatment of TT; (2) to assess functional impact; and (3) to identify prognostic factors. Hypothesis Prevalence of osteoarthritis after surgical treatment of TT is high, impairing functional results. Material and method A single-center retrospective study included 53 patients, with a mean age of 50 ± 17.8 years (range, 21–84 years), undergoing surgery for acute TT in our department. All received clinical examination with ranges of motion and Mayo Elbow Performance Index (MEPI) and radiographic assessment at a minimum 1 year's follow-up. Osteoarthritis at last follow-up was assessed on elbow X-ray in the humero-ulnar and radio-condylar compartments on the Broberg–Morrey classification. Functional impact on range of motion and MEPI and prognostic factors were assessed on Student test or ANOVA and Chi2 or Fisher test. Results Prevalence of Broberg–Morrey grade 2 or 3 osteoarthritis was 45.3% (24/53) in the humero-ulnar compartment and 50% (25/50) in the radio-condylar compartment. Humero-ulnar osteoarthritis impaired MEPI (76.3 points with versus 88.4 points without; p = 0.003), flexion-extension (102.3° versus 115.2°; p = 0.043) and pronation-supination (138.8° versus 159.3°; p = 0.006). Radio-condylar osteoarthritis had no significant impact on MEPI (81.4 points with and 84.4 points without; p = 0.47), flexion-extension (104.8° and 113°; p = 0.23) or pronation-supination (141.8° and 156.4°; p = 0.2). Humero-ulnar osteoarthritis at last follow-up was associated with dislocation or subluxation on immediate postoperative lateral view (45.8% with versus 10.3% without; p = 0.004) and at last follow-up (20.8% versus 3.4%; p = 0.047) and with postoperative complications (54.2% and 27.6%; p = 0.049). Radio-condylar osteoarthritis at last follow-up was associated with radial head replacement rather than internal fixation (respectively, 92% and 48%; p = 0.0007) and excessively high radial head implant positioning (47.8% versus 0%; p = 0.023). Conclusion Prevalence of traumatic osteoarthritis after TT surgery was high, at 45.3% in the humero-ulnar compartment and 50% in the radio-condylar compartment, with clinical impact in humero-ulnar involvement. Level of evidence IV; cohort study without control group.

Published
2021

9. Critical shoulder angle: Measurement reproducibility and correlation with rotator cuff tendon tears

Author

J.-F. Kempf, L. Cherchi, Julien Godet, J.F. Ciornohac, Philippe Clavert, Laboratoire de Bioimagerie et Pathologies (LBP), Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, Male, medicine.medical_specialty, Population, Glenoid cavity, Rotator Cuff Injuries, 03 medical and health sciences, 0302 clinical medicine, Scapula, medicine, Humans, Orthopedics and Sports Medicine, Rotator cuff, Acromion, education, Aged, Retrospective Studies, Observer Variation, 030222 orthopedics, Reproducibility, education.field_of_study, Arthrometry, Articular, Shoulder Joint, business.industry, Reproducibility of Results, [PHYS.MECA]Physics [physics]/Mechanics [physics], 030229 sport sciences, Anterior shoulder, Middle Aged, medicine.disease, Surgery, Radiography, medicine.anatomical_structure, Bankart lesion, Case-Control Studies, Female, business
Abstract

Background Associations have been reported linking rotator cuff tears (RCTs) to both greater lateral extension of the acromion and greater inclination of the glenoid cavity. These two factors combined can be assessed using a recently introduced parameter, the critical shoulder angle (CSA). The primary objective of this study was to confirm the association linking a high CSA value to RCTs, and the secondary objective was to assess the reproducibility of CSA measurement using a goniometer. Hypothesis The null hypothesis was that the CSA value in a group of patients with RCTs was not significantly different from that in patients with anterior shoulder instability and a Bankart lesion, taken as the general population for this study. Methods After a power estimation, we retrospectively included 28 patients with a mean age of 55.5 years who had surgery for RCTs and 27 patients with a mean age of 27.2 years who underwent anterior labral repair. Two surgeons used a goniometer to measure the CSA in each patient. Reproducibility was assessed based on Bland-Altman plots and Pearson's correlation coefficient. Results The mean CSA was significantly higher ( P = 0.02) in the RCT group (36.4° ± 4.4°; range: 30°–46°) than in the labral-repair group (33.3° ± 3.8°; range: 25°–41°). Intra-observer reproducibility was 96.7% and inter-observer reproducibility was 95.5%. Conclusion Our results support previously published evidence that the CSA is significantly greater in patients with RCTs. Thus, an anatomical difference seems to exist between patients with RCTs and the general population. The CSA measured on a standard radiograph using a goniometer provides a reproducible assessment of this anatomical difference. Level of evidence IV, case-control epidemiological study with a power estimation.

Published
2016

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