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Saab M, Beldame J, Charpail C, Kaba A, Mainard D, Caubère A, Maynou C, Bredicianu R, Ghorbani A, Giunta JC, Coursier R, Thoreux P, Laboute E. Clinical and functional outcomes of 405 Achilles tendon ruptures after a minimum follow-up of 1 year. Orthop Traumatol Surg Res 2024:103886. [PMID: 38615885 DOI: 10.1016/j.otsr.2024.103886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/28/2023] [Accepted: 02/02/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE The results of surgical versus conservative treatment of acute Achilles tendon ruptures are still controversial. The objective of this study was to compare surgical and conservative treatment at a minimum follow-up of 1 year in terms of the complications, functional outcomes and clinical results. HYPOTHESES There is no difference in the complications, clinical results and functional outcomes between the two treatment groups. There is no difference in the occurrence of complications or the clinical results due to the immobilization or rehabilitation protocols. METHODS This was a retrospective comparative, multicenter, non-randomized study of acute Achilles tendon ruptures treated between 01/01/2018 and 31/12/2019 at 21 study sites in France. All patients who received surgical or conservative treatment were included. The demographics, sports participation, nature of treatment, immobilization parameters (type, duration, position) and rehabilitation protocol were collected. Rerupture, general and specific complications, clinical results (heel-rise test, single-leg hop, calf circumference, ankle dorsiflexion) and the functional outcomes (ATRS, VISA-A, EFAS, SF-12) were collected at the final review. RESULTS Four hundred five patients were reviewed at a mean follow-up of 24 (±7) months. Surgical treatment was done in 372 patients (92%) and conservative treatment in 33 patients (8%), with these two sets of patients having comparable preoperative characteristics. There was a similar number of reruptures in the conservative group (3 cases, 9%) as in the surgical group (15 cases, 4%) (p=0.176). There were more general complications in the conservative group (24%) than in the surgical group (11%) (p=0.04). There was a 9% rate of surgery-related complications (infection, nerve damage, anesthesia after-effects). The ATRS (p=0.017), EFAS Total (p=0.013), EFAS daily living (p=0.008), and SF-12 physical (p=0.01) were better in the surgical group. Strict then relative immobilization provided the best balance between functional recovery (EFAS total of 33, p<0.01) and tendon lengthening (0°, p=0.01) without increasing the occurrence of rerupture (2%, p=0.18). Early weightbearing accompanied by immobilization and rehabilitation within 30 days did not lead to more reruptures than if it was started beyond 30 days (p=0.082 and p=0.07). CONCLUSIONS This study found no differences in the number of reruptures between surgical treatment and conservative treatment of acute Achilles tendon ruptures. Surgical treatment led to better clinical results but had a variable effect on improving the functional scores. No matter which treatment is used, in the ideal case, 3 weeks of strict immobilization in equinus should be followed by progressive reduction over the next 3 weeks. Early weightbearing and mobilization within 30 days did not increase the risk of rerupture; it actually optimized the clinical and functional outcomes. LEVEL OF EVIDENCE III; retrospective comparative, non-randomized.
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Affiliation(s)
- Marc Saab
- Service d'orthopédie 1-traumatologie, CHU de Lille, 59000 Lille, France.
| | - Julien Beldame
- Institut de la cheville et du pied, clinique Blomet, 75015 Paris, France; Clinique Megival, 76550 Saint-Aubin-sur-Scie, France
| | - Christel Charpail
- SOS pied-cheville, clinique du sport, 33700 Merignac, France; Centre Achille, 34070 Montpellier, France
| | - Arnaud Kaba
- Centre hospitalier de Dunkerque, 130, avenue Louis-Herbeaux, 59240 Dunkerque, France
| | - Didier Mainard
- CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Alexandre Caubère
- Hôpital d'instruction des armées Saint-Anne, 2, boulevard Saint-Anne, 83000 Toulon, France
| | - Carlos Maynou
- Service d'orthopédie 1-traumatologie, CHU de Lille, 59000 Lille, France
| | - Rares Bredicianu
- Centre hospitalier de Sarrebourg, 25, avenue General-de-Gaulle, 57400 Sarrebourg, France
| | - Ali Ghorbani
- Medipole Garonne, 45, rue de Gironis, 31036 Toulouse, France
| | | | - Raphaël Coursier
- Hôpital Saint-Vincent, boulevard de Belfort, 59000 Lille, France
| | - Patricia Thoreux
- Hôpital Hôtel-Dieu-APHP-université Sorbonne Paris Nord, 75004 Paris, France
| | - Eric Laboute
- CERS, groupe Ramsay Santé, 83, avenue du Maréchal-de-Lattre-de-Tassigny, 40130 Capbreton, France
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de Geofroy B, Caubère A, Peras M, Bilichtin E, Pessey LM, Barbier O, Choufani C. Comments on: "Open and arthroscopic posterior bone block with iliac crest autograft for posterior shoulder instability - Systematic review of clinical and radiological outcomes" by Abu Z. Saeed, Nikhil Pandit, Robert W. Jordan, Hubert Laprus, Peter D'Alessandro, Ian K. Y. Lo, Shanhbaz S. Malik, published in Orthop Traumatol Surg Res. 2023;4:103424. Orthop Traumatol Surg Res 2024; 110:103828. [PMID: 38316268 DOI: 10.1016/j.otsr.2024.103828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Bernard de Geofroy
- Department of Orthopaedic Surgery and Traumatology, Military Teaching Hospital Sainte-Anne, 2, boulevard Sainte-Anne, BP600, 83000 Toulon, France.
| | - Alexandre Caubère
- Department of Orthopaedic Surgery and Traumatology, Military Teaching Hospital Sainte-Anne, 2, boulevard Sainte-Anne, BP600, 83000 Toulon, France
| | - Matthieu Peras
- Department of Orthopaedic Surgery and Traumatology, Military Teaching Hospital Sainte-Anne, 2, boulevard Sainte-Anne, BP600, 83000 Toulon, France
| | - Emilie Bilichtin
- Department of Orthopaedic Surgery and Traumatology, Military Teaching Hospital Sainte-Anne, 2, boulevard Sainte-Anne, BP600, 83000 Toulon, France
| | - Louis-Marie Pessey
- Department of Orthopaedic Surgery and Traumatology, Military Teaching Hospital Sainte-Anne, 2, boulevard Sainte-Anne, BP600, 83000 Toulon, France
| | - Olivier Barbier
- Department of Orthopaedic Surgery and Traumatology, Military Teaching Hospital Sainte-Anne, 2, boulevard Sainte-Anne, BP600, 83000 Toulon, France
| | - Camille Choufani
- Department of Orthopaedic Surgery and Traumatology, Military Teaching Hospital Sainte-Anne, 2, boulevard Sainte-Anne, BP600, 83000 Toulon, France
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Barbier O, Rassat R, Caubère A, Dubreuil S, Estour G. Short-stem total hip arthroplasty is equivalent to a standard-length stem procedure in an unselected population at mid-term follow-up. Int Orthop 2024; 48:1017-1022. [PMID: 37934276 DOI: 10.1007/s00264-023-06020-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Limitations of standard-length femoral stems persist, including proximal-distal mismatch, non-ideal load transfer, loss of bone tissue, and perioperative fracture. Symbol® (Dedienne Santé, France) is a metaphyseal-engaging short-stem implant designed to address these issues in total hip arthroplasty (THA). While short stems have been well studied in selected and younger patients, it is unclear whether they offer advantages in an unselected population. We hypothesized that short femoral stems offer similar mid-term survivorship at five year minimum follow-up and function score to standard-length femoral stems, in an unselected patient population. METHODS We retrospectively reviewed a continuous unselected cohort of patients who undergone THA by one surgeon with a standard-length stem between November 2013 and October 2015, and a short stem between November 2015 and March 2017. We compared modified Harris Hip Score and Oxford Scores with a minimum follow-up of five years and procedural factors that could be associated with worse results with a short stem design. RESULTS There was no difference in survival rate between the two groups. Average Harris Hip Score and Oxford Scores at the last follow-up were comparable. A multivariate linear regression was performed to assess the relationship between modified Harrys Hip Score at five years post-operatively and the explanatory variables: age, body mass index, physical status score ASA (American Society of Anesthesiologists), and HHS pre-op. None was associated with the standard-length stem but for the short stem. CONCLUSION Short-stem implants provide good survival rate at mid-term; nevertheless, a steep learning curve is necessary to optimize the metaphyseal filling of the implant, especially for osteoporotic bone.
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Affiliation(s)
- Olivier Barbier
- Service de chirurgie orthopédique, HIA Sainte Anne, 2 boulevard Sainte Anne, 83000, Toulon, France.
| | - Robin Rassat
- Service de chirurgie orthopédique, HIA Sainte Anne, 2 boulevard Sainte Anne, 83000, Toulon, France
| | - Alexandre Caubère
- Service de chirurgie orthopédique, HIA Sainte Anne, 2 boulevard Sainte Anne, 83000, Toulon, France
| | - Sonia Dubreuil
- MEDI'CONSULTING, 4 rue du Couvent, 73240, Saint-Genix-sur-Guier, France
| | - Gilles Estour
- Médipôle de Savoie, 300 Av. des Massettes, 73190, Challes-les-Eaux, France
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Peras M, Caubère A, Choufani C, Passuti N, Versier G, Barbier O. Does AMIC® provide improvements at least two years after surgery for knee osteochondral lesions? A multicentre retrospective study of 101 patients. Orthop Traumatol Surg Res 2024; 110:103774. [PMID: 38008249 DOI: 10.1016/j.otsr.2023.103774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/03/2023] [Accepted: 08/24/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Osteochondral defects of the knee due to trauma or osteochondritis are associated with osteoarthritis in the medium term. Defects 2 to 8cm2 in size can be managed by autologous matrix-induced chondrogenesis (AMIC®), in which sub-chondral micro-fractures are created within the lesion and the defect is then covered by a matrix of type I and type III collagen to induce de novo cartilage formation. Although promising outcomes have been observed in small single-centre cohorts, the medium-term clinical and radiological effectiveness of AMIC® remains to be demonstrated in larger populations. The objective of this study was to evaluate outcomes of patients at least 2 years after AMIC® for knee osteochondral defects. HYPOTHESIS AMIC® is associated with clinical and radiological improvements after at least 2 years. MATERIAL AND METHOD This multicentre (16 centres), multisurgeon (18 senior orthopaedic surgeons), retrospective study included consecutive patients who underwent AMIC® with Chondro-Gide® membrane implantation between September 2011 and January 2020. The 36-item Short Form quality-of-life (SF-36) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) score were determined before the procedure and during follow-up. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was assessed by magnetic resonance imaging 2 years after the procedure. RESULTS In total, 101 patients aged 12 to 60 years were included. Mean follow-up was 30 months. Mean defect size was 3.44cm2 (range, 2-8cm2). Significant improvements were documented in the SF-36 score, KOOS, and IKDC score. The mean MOCART score at 2 years was 75% (range, 20-100). DISCUSSION The AMIC® procedure was associated with significant improvements at 2.5 years in patients treated for knee osteochondral defects measuring 2 to 8cm2. This method seems to provide similar outcomes to those of other available methods with the advantages of single-step surgery and elimination of osteochondral graft donor-site complications. LEVEL OF EVIDENCE IV, retrospective observational cohort study.
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Affiliation(s)
- Matthieu Peras
- Hôpital d'instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France.
| | - Alexandre Caubère
- Hôpital d'instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - Camille Choufani
- Hôpital d'instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - Norbert Passuti
- CHU de Nantes, 5, allée de l'île Gloriette, 44000 Nantes, France
| | - Gilbert Versier
- Clinique Drouot-Lafitte, 20, rue Lafitte, 75009 Paris, France
| | - Olivier Barbier
- Hôpital d'instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
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Petitjean M, de La Villéon B, Lefort H, de Martène H, Caubère A. [Caregiving in an exceptional environment: the military operating theater nurse in a tropical zone]. Rev Infirm 2023; 72:35-38. [PMID: 38071016 DOI: 10.1016/j.revinf.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The profession of operating theater nurse in the French Armed Forces Medical Corps is often little-known. Called upon to serve in mainland France, but also deployed on overseas operations, they provide medical and surgical support to the French armed forces. Personal qualities - human, physical and technical - are essential to adapt to the environmental constraints of this isolated post.
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Affiliation(s)
- Mélodie Petitjean
- Service du bloc opératoire, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - Bruno de La Villéon
- Service de chirurgie viscérale, Hôpital d'instruction des armées Lavéran, 34, boulevard Lavéran, 13013 Marseille, France
| | - Hugues Lefort
- Service de médecine d'accueil et d'urgences, Hôpital d'instruction des armées Lavéran, 34, boulevard Lavéran, 13013 Marseille, France.
| | - Hugues de Martène
- Centre médico-chirurgical interarmées, Forces françaises stationnées à Djibouti, Base aérienne 188, Djibouti
| | - Alexandre Caubère
- Service de chirurgie orthopédique et traumatologie, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
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Caubère A, Lefort H, Petitjean M, Rabuteau F, Choufani C. [Orthopedic ballistic injury, a five-beat waltz]. Rev Infirm 2023; 72:26-28. [PMID: 37952990 DOI: 10.1016/j.revinf.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Two-thirds of ballistic injuries result in severe limb damage. Damage Control Orthopaedic is a surgical strategy that makes it possible to save life, limb and function using simple mnemonic markers: 5minutes, 6hours, 7 days, 8 weeks and 9 months. The many players involved in this coherent care pathway, with its multiple surgical challenges, help to meet the challenge of comprehensive rehabilitation for orthopaedic ballistic injuries.
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Affiliation(s)
- Alexandre Caubère
- Service de chirurgie orthopédique et traumatologie, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France.
| | - Hugues Lefort
- Structure des urgences, Hôpital d'instruction des armées Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Mélodie Petitjean
- Service du bloc opératoire, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - Fabienne Rabuteau
- Centre médico-chirurgical interarmées, Forces françaises stationnées à Djibouti, Base aérienne 188, Djibouti
| | - Camille Choufani
- Service de chirurgie orthopédique et traumatologie, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
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Caubère A, Roseren F, Aullo-Rasser G, Pithioux M, Ollivier M, Chabrand P. Osteochondral autograft transplantation (mosaicplasty): What is the impact of plug diameter in cartilage repair? Int Orthop 2023; 47:623-630. [PMID: 36637461 DOI: 10.1007/s00264-022-05686-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/29/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To compare the mechanical stress applied to our grafted defect area according to the diameter of the plugs used in the treatment of osteochondral lesion with osteochondral autograft transplantation (OAT) procedure. METHODS A biomechanical study was conducted on eight cadaveric knees. A 20-mm defect was created in the weight-bearing zone on the medial femoral condyle then filled either with three plugs of 8 mm, or with four plugs of 6 mm, or with 6 plugs of 4 mm diameter. After the preparation of the specimens, each knee was installed on a mechanical test bench (Instron 5566A). A continuous axial compression of 700 N at 10 mm.min-1 was exerted on the joint. A K-scan 4000-type pressure sheet was used to record the contact area (mm2), the mean pressure (MPa), and the maximum pressure (MPa) on the area of interest. RESULTS The differences found between the conditions were not statistically significant but showed tendencies. Filling the defect with six plugs of 4 mm restores a larger contact surface compared with the other plugs. The use of 8- and 6-mm grafts lead to a respective increase of 12% and 52% of the mean pressure compared with the 4 mm grafts. This difference was also found for the maximum pressure (36% and 129%). Regardless of the diameter of the plugs used, filling the lesion reduces the mean pressure exerted on the healthy cartilage by 19%. DISCUSSION A trend emerged towards a better restoration of the cartilage surface and a more harmonious distribution of the pressures exerted in favour of the grafts of smaller diameter. A larger study is needed to obtain a statistically significant result.
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Affiliation(s)
- Alexandre Caubère
- Department of Orthopaedic Surgery and Traumatology, Military Hospital Sainte-Anne, 2, Bd Sainte Anne, BP600 83800, Toulon, France.
| | - Flavy Roseren
- Aix Marseille Univ, APHM, CNRS, ISM, Mecabio Platform, Anatomy laboratory, Marseille, France
- Mecabio Platform, ISM, Aix Marseille University, 13009, Marseille, France
- Department of Orthopaedic Surgery and Traumatology, Institute of Locomotion, Sainte-Marguerite Hospital, Hospitalo-University Center of Marseille, APHM, Aix-Marseille University, 270, Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - Gaëtan Aullo-Rasser
- Aix Marseille Univ, APHM, CNRS, ISM, Mecabio Platform, Anatomy laboratory, Marseille, France
- RLC Systems & Research, 13008, Marseille, France
- Department of Orthopaedic Surgery and Traumatology, Institute of Locomotion, Sainte-Marguerite Hospital, Hospitalo-University Center of Marseille, APHM, Aix-Marseille University, 270, Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - Martine Pithioux
- Aix Marseille Univ, APHM, CNRS, ISM, Mecabio Platform, Anatomy laboratory, Marseille, France
- Department of Orthopaedic Surgery and Traumatology, Institute of Locomotion, Sainte-Marguerite Hospital, Hospitalo-University Center of Marseille, APHM, Aix-Marseille University, 270, Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - Matthieu Ollivier
- Aix Marseille Univ, APHM, CNRS, ISM, Mecabio Platform, Anatomy laboratory, Marseille, France
- RLC Systems & Research, 13008, Marseille, France
| | - Patrick Chabrand
- Aix Marseille Univ, APHM, CNRS, ISM, Mecabio Platform, Anatomy laboratory, Marseille, France
- Department of Orthopaedic Surgery and Traumatology, Institute of Locomotion, Sainte-Marguerite Hospital, Hospitalo-University Center of Marseille, APHM, Aix-Marseille University, 270, Boulevard de Sainte-Marguerite, 13009, Marseille, France
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Caubère A, Barbier O, Kley K, Hanak L, Jacquet C, Ollivier M. Double level osteotomy for genu varum: Is a return to sport possible? Orthop Traumatol Surg Res 2022; 109:103397. [PMID: 36087834 DOI: 10.1016/j.otsr.2022.103397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION A double level osteotomy (DLO) may be indicated in patients with genu varum when the deformity involves both the tibia and femur. These patients, who are often young and active, have a high functional demand and hope for a rapid return to sport. The purpose of our study was to assess return to sport and functional outcomes following DLO for symptomatic genu varum. MATERIALS AND METHODS A total of 40 patients (mean age 45.5±2 years) who underwent a DLO between 2018 and 2020, performed in 2 different hospitals, were reviewed after a minimum follow-up of 1-year. The mean initial varus was 11±2°. The type of sport and frequency of participation (UCLA activity score) as well as time to return to sport and level of activity recovered were defined as the primary endpoints. Functional scores were also assessed with the knee injury and osteoarthritis outcome score (KOOS). RESULTS At the last follow-up, 87.5% (n=35) of patients reported that they had returned to sport. The mean time to return to sport was 6±1 months with a significant difference (p<0.001) between the pre- and postoperative UCLA activity scores. There was a strong correlation between the presence of a joint line obliquity >3° and decreased functional outcomes (p<0.0001). The overall KOOS score improved (p<0.001) by a mean of 38.6 points after the correction. The 8 lateral cortical fractures (Takeuchi type I and II) and the 2 medial cortical fractures (Nakayama type 1) that were found had no impact on functional outcomes (p>0.05). CONCLUSION Our findings demonstrated that DLO provided rapid return to sport, thus making it possible to meet the functional demands and expectations of patients. LEVEL OF EVIDENCE IV; Retrospective study.
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Affiliation(s)
- Alexandre Caubère
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital d'Instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon, France.
| | - Olivier Barbier
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital d'Instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon, France
| | - Kristian Kley
- Harley Street Specialist Hospital, 18-22, Queen Anne Street, London, W1G8HU, United Kingdom
| | | | - Christophe Jacquet
- Service de Chirurgie Orthopédique et Traumatologie, Université Aix-Marseille, APHM, CNRS, ISM, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Marseille, France; Service de Chirurgie Orthopédique et Traumatologie, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Matthieu Ollivier
- Service de Chirurgie Orthopédique et Traumatologie, Université Aix-Marseille, APHM, CNRS, ISM, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Marseille, France; Service de Chirurgie Orthopédique et Traumatologie, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
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Zaiz S, Caubère A, Hugues L, Barbier O, Choufani C. [Post-operative monitoring of a patient with severe limb trauma]. Rev Infirm 2020; 70:24-25. [PMID: 33455675 DOI: 10.1016/j.revinf.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the postoperative monitoring of a patient with severe limb trauma, the nurse's objectives are multiple: prevention and screening of complications, follow-up care, compliance with postoperative instructions. Presentation of the key elements of this monitoring, which must be systematised and personalised.
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Affiliation(s)
- Samir Zaiz
- Service de chirurgie orthopédique, Hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - Alexandre Caubère
- Service de chirurgie orthopédique, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - Lefort Hugues
- Service des urgences, Hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57070 Metz, France
| | - Olivier Barbier
- Service de chirurgie orthopédique, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - Camille Choufani
- Service de chirurgie orthopédique, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France.
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Caubère A, de Landevoisin ES, Schlienger G, Demoures T, Romanat P. Tactical tourniquet: Surgical management must be within 3 hours. Trauma Case Rep 2019; 22:100217. [PMID: 31338408 PMCID: PMC6611996 DOI: 10.1016/j.tcr.2019.100217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 11/30/2022] Open
Abstract
Despite longstanding controversy, tourniquets are widely used in tactical combat casualty care, with undisputed benefits for recent conflicts in Iraq and Afghanistan. Increased time delays are a particular issue in large areas, such as the Sahel-Saharan band. Complications associated with tourniquet use are predominantly related to acute ischemia with risk of amputation and ischaemia-reperfusion injury, as shown in the first clinical case. Often stated but poorly described, misuse of tourniquet and subsequent failure to interrupt arterial blood flow is also a clinical scenario that should be recognized. In the case of misuse of the tourniquet, more significant blood loss may be expected because of venous compression (« venous tourniquet », second clinical case). Early medical re-evaluation of the tourniquet is an essential component in prolonged field care. This includes reassessment of the tourniquet's ability to achieve hemostasis, abolish the downstream pulse and the relevance of the tourniquet altogether. This combat tool requires training to be successful and complications are time dependent. Tourniquet use requires appropriate application, re-evaluation and triage of wounded personnel within 3 h towards more structured surgical management.
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Affiliation(s)
- A. Caubère
- 6 Antenne Chirurgicale Aerotransportable, Department of Orthopaedic and Trauma surgery, Bégin Military Hospital, 69 Avenue de Paris, 94160 Saint-Mandé, France
- Corresponding author.
| | - E. Soucanye de Landevoisin
- Department of Orthopedic and Trauma Surgery, Laveran Military Hospital, 34 Bd Laveran, 13013 Marseille, France
| | - G. Schlienger
- 6 Antenne Chirurgicale Aerotransportable, Department of Visceral and Vascular Surgery, Sainte-Anne Military Hospital, 2 Bd Sainte-Anne, 83000 Toulon, France
| | - T. Demoures
- Department of Orthopaedic and Trauma Surgery, Bégin Military Hospital, 69 Avenue de Paris, 94160 Saint-Mandé, France
| | - P. Romanat
- 6 Antenne Chirurgicale Aerotransportable, Department of Anesthesiology and Intensive Care Unit, Laveran Military Hospital, 34 Bd Laveran, 13013 Marseille, France
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Abstract
Foot wounds are frequent and not usually serious. The first caregiver to provide treatment must decide on the most appropriate action to take, sometimes in inadequate places. We present an analysis of the management of these traumas to highlight the key stages of the evaluation and initial treatment of the wound while placing the patient on a coherent and efficient clinical pathway.
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Affiliation(s)
- Camille Choufani
- Service de chirurgie orthopédique-traumatologique, Hôpital d'instruction des armées Bégin, 69 avenue de Paris, 94160 Saint-Mandé, France
| | - Alexandre Caubère
- Service de chirurgie orthopédique-traumatologique, Hôpital d'instruction des armées Bégin, 69 avenue de Paris, 94160 Saint-Mandé, France
| | - Olivier Barbier
- Service de chirurgie orthopédique-traumatologique, Hôpital d'instruction des armées Bégin, 69 avenue de Paris, 94160 Saint-Mandé, France
| | - Hugues Lefort
- Service d'accueil des urgences, Hôpital d'instruction des armées Legouest, 27 rue de Plantières, 57000 Metz, France.
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Caubère A, Harrosch S, Fioravanti M, Curvale G, Rochwerger A, Mattei JC. Does curettage-cement packing for treating giant cell tumors at the knee lead to osteoarthritis? Orthop Traumatol Surg Res 2017; 103:1075-1079. [PMID: 28782699 DOI: 10.1016/j.otsr.2017.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/20/2017] [Accepted: 06/06/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Giant cell tumors (GCTs) make up 15 to 20% of bone-related tumors in adults. They are often found around the knee in the metaphysis and epiphysis area, contacting the joint cartilage. The aims of our study were to evaluate the presence of early knee osteoarthritis (OA) in patients with GCTs in the knee area treated by curettage-cement packing, and to evaluate whether replacing subchondral bone with acrylic cement has an effect on the functional outcomes and quality of life. MATERIAL AND METHODS This was a retrospective study of all patients operated between 2000 and 2010 by the same specialized surgical team. Functional outcomes and quality of life were evaluated in each patient using the Knee Injury and Osteoarthritis Outcome (KOOS), the Musculoskeletal Tumor Society Score (MSTS) and the Short Form-36 (SF-36). The presence of OA was evaluated in a full radiological work-up comparing the operated knee with the healthy contralateral knee. Knee OA was defined as grade 3 or grade 4 radiographic findings based on the Kellgren and Lawrence classification, and a significant difference between the operated and contralateral knee. RESULTS Nineteen patients were included in this study. The average follow-up was 120 months (range 60-180). Four patients (21%) had radiographic KL-3 and one patient (5%) had KL-4. Eight patients (42%) had recurrence of the GCT. The distance between the tumor and cartilage, and the area of the subchondral bone invaded by the tumor appeared to contribute to OA progression. DISCUSSION Resection of GCTs around the knee by curettage-cement packing did not have an effect on development of OA. In the four patients who developed knee OA, the tumor was located less than 3mm from the joint cartilage and took up more than 90% of the epiphysis. Based on these observations, there seems to be a strong correlation between the development of knee OA and the small quantity of subchondral bone left after curettage. The functional outcomes and quality of life were similar no matter the knee OA grade in patients. Replacing subchondral bone by cement had no effect on quality of life in this study. LEVEL OF EVIDENCE IV (retrospective study).
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Affiliation(s)
- A Caubère
- Service de chirurgie orthopédique, traumatologique et des tumeurs musculo-squelettiques, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France; HIA Sainte-Anne, 26, impasse des Coquelicots, 83210 La Farlède, France.
| | - S Harrosch
- Service de chirurgie orthopédique, traumatologique et des tumeurs musculo-squelettiques, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - M Fioravanti
- Service de chirurgie orthopédique, traumatologique et des tumeurs musculo-squelettiques, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - G Curvale
- Service de chirurgie orthopédique, traumatologique et des tumeurs musculo-squelettiques, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - A Rochwerger
- Service de chirurgie orthopédique, traumatologique et des tumeurs musculo-squelettiques, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - J-C Mattei
- Service de chirurgie orthopédique, traumatologique et des tumeurs musculo-squelettiques, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
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Caubère A, Butin C, Guilhem K, Levadoux M, Legré R, Nguyen MK. [Is there pisotriquetral instability after carpal tunnel release? Retrospective study of 55 cases]. ACTA ACUST UNITED AC 2014; 33:286-90. [PMID: 24996695 DOI: 10.1016/j.main.2014.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 02/16/2014] [Accepted: 05/28/2014] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine if pisotriquetral instability is present after neurolysis of the median nerve in the wrist. Fifty-five patients who underwent carpal tunnel release between December 2005 and March 2009 were included in this retrospective study. The surgical procedure consisted of cutting the transverse carpal ligament under local anesthesia through an anterior approach. Instability was evaluated clinically and radiologically by measuring the pisometacarpal angle. The mean patient age was 61years and the mean follow-up 42months. Only 9% of patients complained of pain on the ulnar side of wrist. The pisometacarpal angle in all the operated wrists was the same as in the non-operated wrists. Our findings suggest there is no pisotriquetral instability after median nerve neurolysis.
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Affiliation(s)
- A Caubère
- Service de chirurgie orthopédique et traumatologique, HIA Sainte-Anne, BP 600, 83800 Toulon Naval, France.
| | - C Butin
- Service de chirurgie orthopédique et traumatologique, HIA Sainte-Anne, BP 600, 83800 Toulon Naval, France
| | - K Guilhem
- Service de chirurgie orthopédique et traumatologique, HIA Sainte-Anne, BP 600, 83800 Toulon Naval, France
| | - M Levadoux
- Service de chirurgie orthopédique et traumatologique, HIA Sainte-Anne, BP 600, 83800 Toulon Naval, France
| | - R Legré
- Service de chirurgie réparatrice et chirurgie de la main, hôpital de la Conception, Marseille, France
| | - M-K Nguyen
- Service de chirurgie orthopédique et traumatologique, HIA Sainte-Anne, BP 600, 83800 Toulon Naval, France.
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