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Bastard C, Sandman E, Balg F, Patenaude N, Chapleau J, Rouleau D. Validity, reliability and responsiveness of the French translation of the Patient-Rated Wrist Evaluation Questionnaire (PRWE). Orthop Traumatol Surg Res 2024; 110:103549. [PMID: 36642404 DOI: 10.1016/j.otsr.2023.103549] [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: 06/27/2022] [Accepted: 10/12/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The patient-rated wrist evaluation questionnaire (PRWE) is a specific wrist questionnaire, developed in Canada that has been validated and proved reliable and sensitive. It assesses pain and function. Unfortunately, there was no validated French-language version. It is important that a translation should be methodologically rigorous, as both linguistic and cultural factors come into play. OBJECTIVE To produce a French-language version of the PRWE, culturally adapted to the French-speaking populations of Europe and North America. MATERIALS AND METHODS A validated protocol was used to produce a French-language version of the PRWE (PRWE-Fr) that would be culturally acceptable for the French-speaking populations of Europe and North America. Reliability and responsiveness analyses were performed and PRWE-Fr scores were compared to F-QuickDASH-D/S (French translation of short-form Disabilities of the Arm, Shoulder and Hand-Disability/Symptoms) scores to assess validity. RESULTS A French-language version of the PRWE (PRWE-Fr) was accepted by a multinational committee, then validated in 65 French-speaking subjects, divided into 2 groups for analyses. A strong positive correlation was found between PRWE-Fr and F-QuickDASH-D/S scores. Comparison of results between two PRWE-Fr sessions at a 1-week interval found a very strong correlation (ρ=0.93; r2=0.868; p<0.001). The intraclass correlation coefficient for total PRWE-Fr score demonstrated excellent reliability (ICC: 0.93; 95% CI: [0.859; 0.969]; p<0.001). Responsiveness analysis revealed greater sensitivity to change than for the F-QuickDASH-D/S (standardized response mean [SRM], 1.14 versus 1.04 respectively). DISCUSSION A French-language version of the PRWE was produced and validated for use in French-speaking populations. It should facilitate evaluation of results in French-speaking settings, collaboration in multinational studies and comparison between studies performed in different countries. LEVEL OF EVIDENCE II; Multicenter cohort study.
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Affiliation(s)
- Claire Bastard
- CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, C2095-5400, boulevard Gouin O, Montréal, QC, H4J 1C5, Canada; Centre Hospitalier Universitaire Henri Mondor, Créteil, France.
| | - Emilie Sandman
- CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, C2095-5400, boulevard Gouin O, Montréal, QC, H4J 1C5, Canada
| | - Frederic Balg
- CIUSSS-de-l'Estrie-CHUS, 3001, 12e avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Nicolas Patenaude
- CIUSSS-de-l'Estrie-CHUS, 3001, 12e avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Julien Chapleau
- CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, C2095-5400, boulevard Gouin O, Montréal, QC, H4J 1C5, Canada
| | - Dominique Rouleau
- CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, C2095-5400, boulevard Gouin O, Montréal, QC, H4J 1C5, Canada
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Cohen D, Sandman E, Saran N, Petrisor B, Bhandari M, Veljkovic A, Leucht A, Downey EA, Martineau P. Evidence-based treatment of Achilles tendon rupture. Can J Surg 2023; 66:E356-E357. [PMID: 37402560 DOI: 10.1503/cjs.008321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 07/06/2023] Open
Abstract
SummaryThe treatment of Achilles tendon rupture has recently seen a shift toward non-operative management, as supported by the literature, yet many surgeons continue to treat these injuries operatively. The evidence clearly supports non-operative management of these injuries except for Achilles insertional tears and for certain patient groups, such as athletic patients, for whom further research is warranted. This nonadherence to evidence-based treatment may be explained by patient preference, surgeon subspecialty, surgeon era of practice or other variables. Further research to understand the reasons behind this nonadherence would help to promote conformity in the surgical community across all specialties and adherence to evidence-based approaches.
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Affiliation(s)
- Dan Cohen
- From the Division of Orthopaedic Surgery, Hamilton Health Sciences Centre, Hamilton, Ont. (Cohen, Petrisor, Bhandari); Division of Orthopaedic Surgery, University of Montreal, Montréal, Que. (Sandman); Division of Orthopaedic Surgery, McGill University Health Centre, Montréal, Que. (Saran, Martineau); Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, Vancouver, BC (Veljkovic, Leucht, Downey)
| | - Emilie Sandman
- From the Division of Orthopaedic Surgery, Hamilton Health Sciences Centre, Hamilton, Ont. (Cohen, Petrisor, Bhandari); Division of Orthopaedic Surgery, University of Montreal, Montréal, Que. (Sandman); Division of Orthopaedic Surgery, McGill University Health Centre, Montréal, Que. (Saran, Martineau); Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, Vancouver, BC (Veljkovic, Leucht, Downey)
| | - Neil Saran
- From the Division of Orthopaedic Surgery, Hamilton Health Sciences Centre, Hamilton, Ont. (Cohen, Petrisor, Bhandari); Division of Orthopaedic Surgery, University of Montreal, Montréal, Que. (Sandman); Division of Orthopaedic Surgery, McGill University Health Centre, Montréal, Que. (Saran, Martineau); Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, Vancouver, BC (Veljkovic, Leucht, Downey)
| | - Brad Petrisor
- From the Division of Orthopaedic Surgery, Hamilton Health Sciences Centre, Hamilton, Ont. (Cohen, Petrisor, Bhandari); Division of Orthopaedic Surgery, University of Montreal, Montréal, Que. (Sandman); Division of Orthopaedic Surgery, McGill University Health Centre, Montréal, Que. (Saran, Martineau); Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, Vancouver, BC (Veljkovic, Leucht, Downey)
| | - Mohit Bhandari
- From the Division of Orthopaedic Surgery, Hamilton Health Sciences Centre, Hamilton, Ont. (Cohen, Petrisor, Bhandari); Division of Orthopaedic Surgery, University of Montreal, Montréal, Que. (Sandman); Division of Orthopaedic Surgery, McGill University Health Centre, Montréal, Que. (Saran, Martineau); Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, Vancouver, BC (Veljkovic, Leucht, Downey)
| | - Andrea Veljkovic
- From the Division of Orthopaedic Surgery, Hamilton Health Sciences Centre, Hamilton, Ont. (Cohen, Petrisor, Bhandari); Division of Orthopaedic Surgery, University of Montreal, Montréal, Que. (Sandman); Division of Orthopaedic Surgery, McGill University Health Centre, Montréal, Que. (Saran, Martineau); Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, Vancouver, BC (Veljkovic, Leucht, Downey)
| | - Anna Leucht
- From the Division of Orthopaedic Surgery, Hamilton Health Sciences Centre, Hamilton, Ont. (Cohen, Petrisor, Bhandari); Division of Orthopaedic Surgery, University of Montreal, Montréal, Que. (Sandman); Division of Orthopaedic Surgery, McGill University Health Centre, Montréal, Que. (Saran, Martineau); Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, Vancouver, BC (Veljkovic, Leucht, Downey)
| | - Emilie-Ann Downey
- From the Division of Orthopaedic Surgery, Hamilton Health Sciences Centre, Hamilton, Ont. (Cohen, Petrisor, Bhandari); Division of Orthopaedic Surgery, University of Montreal, Montréal, Que. (Sandman); Division of Orthopaedic Surgery, McGill University Health Centre, Montréal, Que. (Saran, Martineau); Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, Vancouver, BC (Veljkovic, Leucht, Downey)
| | - Paul Martineau
- From the Division of Orthopaedic Surgery, Hamilton Health Sciences Centre, Hamilton, Ont. (Cohen, Petrisor, Bhandari); Division of Orthopaedic Surgery, University of Montreal, Montréal, Que. (Sandman); Division of Orthopaedic Surgery, McGill University Health Centre, Montréal, Que. (Saran, Martineau); Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, Vancouver, BC (Veljkovic, Leucht, Downey)
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Orban C, Goetti P, Leduc JM, Sandman E, Balg F, Pelet S, Rouleau DM. The POSI study: gender differences in 94 cases of postoperative shoulder surgery infection: results of a 7-year retrospective multicenter study. J Shoulder Elbow Surg 2023; 32:813-819. [PMID: 36283562 DOI: 10.1016/j.jse.2022.09.023] [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: 02/28/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Contrary to lower limb infection, POstoperative Shoulder surgery Infection (POSI) often involves Cutibacterium acnes. Our aim was to describe patient characteristics and pathogens retrieved in POSI to guide initial empiric antibiotic selection with suspected infection during revision. We also compared microorganisms in infection following trauma, arthroplasty (AP), and arthroscopy (AS). METHODS A multicenter retrospective study from 2010 to 2016 reviewed laboratory databases and medical records to identify patients with a previous shoulder surgery and a confirmed shoulder infection. The following procedures were included: AP, AS, fracture fixation (FF), and another open surgery (OS). A confirmed shoulder infection was defined as 2 positive cultures or more of the same microorganism, or clear clinical infection with 1 positive culture or more. RESULTS Among the 5 hospitals and 28 surgeons involved, 94 POSI cases were identified. Mean age was 59 years at index surgery (range: 22-91) with a majority of men (n = 70, 74%). Among POSI cases, AP was the most common index surgery (n = 41), followed by FF (n = 27), AS (n = 16), and OS (n = 10). The median time between index surgery and the first positive sample was 5 months and the mean was 23 months (minimum 6 days to maximum 27 years), illustrating a positively skewed distribution. Cutibacterium spp were identified in 64 patients (68%), including 59 C acnes patients (63%), which was the most frequent germ in all 4 surgical groups. In 86% of cases, C acnes was identified at the first revision. The other 2 most common germs were Staphylococcus epidermidis and Staphylococcus aureus, with 29% and 17%, respectively. Polymicrobial infection was present in 30% of patients. Gender analysis revealed that C acnes was twice as frequent in men (male = 52 of 70, female = 7 of 24; P < .001). S epidermidis was more prevalent in women (n = 11; 46%) compared with men (n = 16; 21%) (P = .032). C acnes infection was most frequent in arthroscopic surgery (n = 14; 70%, P = .049). S epidermidis was 3 times more prevalent in chronic than in acute cases. CONCLUSION Empiric antimicrobial therapy following POSI, while waiting for culture results, should cover C acnes, S epidermidis, and S aureus. There is a significant gender difference regarding POSI culture results. C acnes is more frequent in men, but should still be covered in women as it was found in 29% of cases.
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Affiliation(s)
| | - Patrick Goetti
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Michel Leduc
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Emilie Sandman
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | | | - Stéphane Pelet
- CHU de Québec-Hôpital de l'Enfant-Jésus, Quebec, Quebec, Canada
| | - Dominique M Rouleau
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.
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Goetti P, Achkar J, Sandman E, Balg F, Rouleau DM. Phone Administration of the Western Ontario Shoulder Instability Index Is More Reliable Than Administration via Email. Clin Orthop Relat Res 2023; 481:84-93. [PMID: 35943525 PMCID: PMC9750603 DOI: 10.1097/corr.0000000000002320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Western Ontario Shoulder Instability (WOSI) questionnaire is a 21-item questionnaire to evaluate quality of life in patients with shoulder instability. Completing the questionnaire is time-consuming because each item is evaluated on a visual analog scale. Telephone or email versions of the score are appealing alternatives to administering it during the standard in-person patient visit; however, their validity and reliability remain unknown. QUESTIONS/PURPOSES (1) Does the numerical scale (NS) version of the WOSI correlate with the original WOSI and Quick-DASH? (2) Do telephone and email administration of the NS-WOSI have good reliability and consistency? (3) Compared with the original WOSI form, does the NS form lead to faster completion for patients and quicker data extraction for researchers? METHODS Between 2014 and 2019, 50 patients with a documented history of shoulder dislocation with persistent symptomatic shoulder instability, whether anterior, posterior, or multidirectional; patients scheduled for surgery; and patients with traumatic or nontraumatic injuries were prospectively recruited from the outpatient clinic of two university hospitals acting as Level 1 trauma centers and sports traumatology tertiary referral centers. The median (IQR) age was 28 years (24 to 36), and 80% (40 of 50) were men. Most (52% [26 of 50]) patients had two to five lifetime shoulder dislocations. Validity of the NS-WOSI was assessed using the Pearson correlation coefficient during an in-person visit; the original WOSI questionnaire (or its previously validated French-language version), NS-WOSI, and Quick-DASH questionnaires were administered in a random order. After a minimum 7-day interval, 78% (39 of 50) of patients completed the phone interview, and 74% (37 of 50) of patients completed the email version of the NS-WOSI score to evaluate NS-WOSI's reliability using the intraclass correlation coefficient (ICC), which was interpreted as poor (< 0.5), moderate (0.50-0.75), strong (0.75-0.90), and very strong (> 0.90). The standard error of measurement (SEM) was used to evaluate variability around the true score, with a low value indicating a high reliability. The 95% minimal detectable change (MDC 95% ) was calculated to evaluate the minimal change in score that was not related to measurement errors. Lastly, the Cronbach alpha was used to assess internal consistency (intercorrelation strength), where a value > 0.70 was considered good. The time needed for the patient to complete the various versions and for researchers to extract data was recorded. RESULTS The NS-WOSI score was very strongly correlated with the original WOSI score (r = 0.96 [95% confidence interval (CI) 0.93 to 0.98]; p < 0.001). Although telephone-acquired and email-acquired data for the NS-WOSI questionnaires were correlated with the NS-WOSI (telephone r = 0.91 [95% CI 0.83 to 0.95]; p < 0.001; email r = 0.84 [95% CI 0.71 to 0.91]; p < 0.001), the ICC was higher for telephone interviews (0.92 [95% CI 0.86 to 0.96] versus email 0.80 [95% CI 0.64 to 0.89]), indicating that although both had good reliability, the phone interview was more suitable. The phone interview was also preferable to email regarding SEM (3% [52 of 2100 points] versus 6% [132 of 2100 points]) and the MDC 95% (7% [144 of 2100 points] versus 17% [366 of 2100 points]). The 95% CI of the MDC acquired by email was superior to the reported minimum clinically important difference for the original WOSI (7% [152 of 2100 points]), meaning that an error of measurement could wrongly be interpreted as a clinically significant change in score. Internal consistency was deemed good, with a Cronbach alpha of 0.96 (95% CI 0.92 to 98) and 0.89 (95% CI 0.79 to 0.94) for NS-WOSI telephone and email, respectively. The time to complete the NS-WOSI was reduced compared with the original WOSI (221 ± 153 seconds versus 266 ± 146 seconds, mean difference -45 seconds [95% CI -72 to -12]; p = 0.009). Lastly, data extraction was faster (62 ± 15 seconds versus 209 ± 52 seconds, mean difference -147 seconds [95% CI -164 to -130]; p < 0.001) with the NS-WOSI than with the original WOSI. CONCLUSION The NS-WOSI in person, by telephone, or by email is a valid, reliable, and timesaving alternative to the original WOSI questionnaire. However, the reliability of data acquisition by telephone interviews was superior to that of email. CLINICAL RELEVANCE Given that there were no important differences in performance for the NS-WOSI, regardless of whether it was administered in person or by phone, we suggest that physicians use both interchangeably based on patient convenience. However, we do not recommend using the email version, especially for research purposes, since it was not as reliable when compared with in-person administration. The responsiveness of the modified NS-WOSI, as well as factors influencing response rates to phone interview, are questions that remain to be explored.
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Affiliation(s)
- Patrick Goetti
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jacquelina Achkar
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Emilie Sandman
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- CIUSSS (Centre Intégré Universitaire de Santé et des Servives Sociaux) du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Frédéric Balg
- Centre Intégré Universitaire de Santé et des Servives Sociaux CIUSSS-de-l’Estrie-Centre Hospitalier Universitaire Sherbrooke, Sherbrooke, Quebec, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Dominique M. Rouleau
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- CIUSSS (Centre Intégré Universitaire de Santé et des Servives Sociaux) du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
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Degen RM, Hiemstra LA, Lobo J, Woodmass JM, Sommerfeldt M, Khan M, Carsen S, Pauyo T, Chahal J, Urquhart N, Grant J, Rousseau-Saine A, Lebel ME, Sheehan B, Sandman E, Tucker A, Kopka M, Wong I. Arthroscopy Association of Canada Position Statement on Intra-articular Injections for Hip Osteoarthritis. Orthop J Sports Med 2022; 10:23259671211066966. [PMID: 35155702 PMCID: PMC8832617 DOI: 10.1177/23259671211066966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ryan M. Degen
- Arthroscopy Association of Canada
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
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Masud S, Sheehan B, Rousseau-Saine A, Tucker A, Sandman E, Wong I, Woodmass J, Chalal J, Lobo J, Grant J, LeBel ME, Sommerfeldt M, Kopka M, Urquhart N, Carsen S, Pauyo T, Khan M. Arthroscopy Association of Canada Position Statement on Exercise for Knee Osteoarthritis: A Systematic Review of Guidelines. Orthop J Sports Med 2021; 9:23259671211016900. [PMID: 34179210 PMCID: PMC8207290 DOI: 10.1177/23259671211016900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Exercise is widely regarded to improve pain and function in patients with knee osteoarthritis (OA) through building supportive muscle mass, facilitating weight loss, and through the other beneficial effects associated with it. PURPOSE To explore literature that presents clinical guidelines for the use of exercise in the treatment of knee OA to inform an evidence-based position statement for the Arthroscopy Association of Canada. STUDY DESIGN Position statement. METHODS PubMed, MEDLINE, Embase, and Cochrane databases were searched for guidelines commenting on the role of exercise for knee OA. The search was limited to guidelines published in the last 10 years. Articles were screened for relevance, focusing on recently published research with clinical guidelines. Inclusion criteria involved all articles providing clinical guidelines for exercise and knee OA. RESULTS Eight guidelines were identified. All eight recommended exercise as an important component of treatment for knee OA, with 6/8 strongly recommending it. CONCLUSION Exercise is an effective and important component of the non-pharmacological management of knee OA. The Arthroscopy Association of Canada strongly recommends the use of exercise in the management of knee OA.
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Affiliation(s)
- Saad Masud
- Wayne State School of Medicine, Detroit, Michigan, USA
| | | | | | | | - Emilie Sandman
- Wayne State School of Medicine, Detroit, Michigan, USA
- Arthroscopy Association of Canada
| | | | | | | | | | | | | | | | | | | | | | | | - Moin Khan
- Arthroscopy Association of Canada
- McMaster University, Hamilton, Ontario, Canada
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Couture A, Lavergne V, Sandman E, Leduc JM, Benoit B, Leduc S, Rouleau DM. Calcium sulphate mixed with antibiotics does not decrease efficacy against Cutibacterium acnes (formerly Propionibacterium acnes), in vitro study. J Orthop 2020; 19:138-142. [PMID: 32025121 DOI: 10.1016/j.jor.2019.11.028] [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: 08/21/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022] Open
Abstract
Background This study explored the in vitro efficacy of antibiotics mixed with calcium sulfate (ACS) against Cutibacterium acnes (C. acnes). Methods C. acnes isolates from orthopaedic infection sites were tested for antimicrobial susceptibility with ACS. Minimal inhibitory concentrations (MIC) were determined with a gradient diffusion method (Etest® strips). Results When tested with Etest®, all 22 isolates were susceptible to penicillin, ceftriaxone, vancomycin, and two were resistant to clindamycin (MICs of 4 and 8 mg/L). Penicillin and rifampin had the largest inhibition zone diameters. Conclusions Antibiotics retained activity against C. acnes when mixed with calcium sulfate.
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Affiliation(s)
- Anne Couture
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Valéry Lavergne
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Hôpital Du Sacré-Cœur, Montréal, 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Emilie Sandman
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Hôpital Du Sacré-Cœur, Montréal, 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Jean-Michel Leduc
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Hôpital Du Sacré-Cœur, Montréal, 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Benoit Benoit
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Hôpital Du Sacré-Cœur, Montréal, 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Stéphane Leduc
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Hôpital Du Sacré-Cœur, Montréal, 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Dominique M Rouleau
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Hôpital Du Sacré-Cœur, Montréal, 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
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Jodoin M, Rouleau DM, Therrien E, Chauny JM, Sandman E, Larson-Dupuis C, Leduc S, Gosselin N, De Beaumont L. Investigating the incidence and magnitude of heterotopic ossification with and without joints involvement in patients with a limb fracture and mild traumatic brain injury. Bone Rep 2019; 11:100222. [PMID: 31463337 PMCID: PMC6706636 DOI: 10.1016/j.bonr.2019.100222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/25/2019] [Accepted: 08/12/2019] [Indexed: 01/01/2023] Open
Abstract
Objectives This study seeks to evaluate the incidence rate of heterotopic ossification (HO) formation in patients afflicted by an isolated limb fracture (ILF) and a concomitant mild traumatic brain injury (mTBI). Methods The current study is an observational study including ILF patients with or without a concomitant mTBI recruited from an orthopedic clinic of a Level 1 Trauma Hospital. Patients were diagnosed with a mTBI according to the American Congress of Rehabilitation Medicine (ACRM) criteria. Radiographs taken on average 3 months post-trauma were analyzed separately by two distinct specialists for the presence of HO proximally to the fracture site (joints or extra joints). Both raters referred to Brooker's and Della's Valle's classification to establish signs of HO. First, analyses were conducted for the full sample. Secondly, a matched cohort was used in order to control for specific factors, namely age, sex, type of injury, and time elapsed between the accident and the analyzed radiograph. Results The full sample included a total of 183 patients with an ILF (94 females; 47.5 years old), of which 50 had a concomitant mTBI and 133 without. Radiographic evidence of HO was significantly higher in patients with an ILF and a mTBI compared to ILF patients (X2 = 6.50; p = 0.01). The matched cohort consisted of 94 participants (i.e.; 47 patients from the ILF + mTBI group and 47 patients from the ILF group). Again, ILF + mTBI patients presented significantly higher rates of HO signs in comparison to ILF patients (X2 = 3.69; p = 0.04). Presence of HO was associated with prolonged delays to return to work (RTW) only in ILF + mTBI patients (F = 4.055; p = 0.05) but not in ILF patients (F = 0.823; p = 0.37). Conclusions Study findings suggest that rates of HO are significantly higher proximally to fracture sites when ILF patients sustain a concomitant mTBI, even after controlling for factors known to influence HO. Moreover, results show that HO is associated with a prolonged RTW only in ILF patients with a concomitant mTBI but not in ILF-only patients. The impact of mTBI on HO formation warrants further attention to detect early signs of HO, to identify shared physiopathological mechanisms and, ultimately, to design targeted therapies. Rates of HO are significantly higher in patients with a fracture and a mTBI compared to patients with a fracture only. Factors such as sex, age, joint involvement, and surgical procedures were unrelated to the detection of signs of HO Presence of HO negatively impacted RTW delays in patients with a concomitant mTBI
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Affiliation(s)
- Marianne Jodoin
- Centre de Recherche de l'Hôpital Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Départment de Psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Dominique M Rouleau
- Centre de Recherche de l'Hôpital Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Départment de Chirurgie, Université de Montréal, Montréal, Québec, Canada
| | - Erik Therrien
- Centre de Recherche de l'Hôpital Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Départment de Chirurgie, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Marc Chauny
- Centre de Recherche de l'Hôpital Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Emilie Sandman
- Centre de Recherche de l'Hôpital Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Départment de Chirurgie, Université de Montréal, Montréal, Québec, Canada
| | - Camille Larson-Dupuis
- Centre de Recherche de l'Hôpital Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Départment de Psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Stephane Leduc
- Centre de Recherche de l'Hôpital Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Départment de Chirurgie, Université de Montréal, Montréal, Québec, Canada
| | - Nadia Gosselin
- Centre de Recherche de l'Hôpital Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Départment de Psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Louis De Beaumont
- Centre de Recherche de l'Hôpital Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Départment de Chirurgie, Université de Montréal, Montréal, Québec, Canada
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9
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Abstract
BACKGROUND Ulnar-sided wrist pain at the dorsal proximal triquetrum, especially during wrist pronation, flexion and radial deviation, is common in athletes, particularly ice hockey players. The purpose of this study was to evaluate in which position the dorsal ulnotriquetral ligament (DUTL) is placed under the greatest strain, the torque to failure and the injury pattern. We hypothesized that the DUTL is maximally strained with wrist flexion, pronation and radial deviation, and that, at failure, the ligament tears off the triquetrum. METHODS We performed a biomechanical study on 7 fresh frozen cadaveric upper extremities, with testing done on a wrist-movement stimulator to identify the position (45° of wrist flexion, 45° of wrist extension or neutral) that generated the highest and earliest strain increases in the DUTL. We performed load-to-failure testing, characterized the ligament's pattern of failure, and repaired and retested the DUTL using the same load-to-failure protocol. RESULTS The DUTL reached 3 N∙m the earliest in 45° of wrist flexion (p = 0.02). The native DUTL failed at 0.35 N∙m (standard deviation [SD] 0.13 N∙m) per degree of angular stiffness, 12.93 N∙m of yield strength and with angular deformation of 57.73° (SD 20.62°). There was no significant difference in these variables between the native and repaired DUTL. Tearing occurred at a mean of 10 mm (SD 2 mm) proximal from the triquetrum's insertion in a transverse midsubstance pattern. CONCLUSION This study showed a reproducible pattern of injury to the DUTL in a cadaveric model. Additional work is needed to further characterize the pathoanatomy of "hockey wrist."
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Affiliation(s)
- Emilie Sandman
- From the Université de Montréal, Montréal, Que. (Sandman); the Department of Orthopaedic Surgery, Hôpital du Sacré-Cœur de Montréal, Montréal, Que. (Sandman); McGill University, Montréal, Que. (Boily, Martineau); and the Departments of Radiology (Boily) and Orthopedic Surgery (Martineau), Montreal University Health Centre, Montréal, Que
| | - Mathieu Boily
- From the Université de Montréal, Montréal, Que. (Sandman); the Department of Orthopaedic Surgery, Hôpital du Sacré-Cœur de Montréal, Montréal, Que. (Sandman); McGill University, Montréal, Que. (Boily, Martineau); and the Departments of Radiology (Boily) and Orthopedic Surgery (Martineau), Montreal University Health Centre, Montréal, Que
| | - Paul A Martineau
- From the Université de Montréal, Montréal, Que. (Sandman); the Department of Orthopaedic Surgery, Hôpital du Sacré-Cœur de Montréal, Montréal, Que. (Sandman); McGill University, Montréal, Que. (Boily, Martineau); and the Departments of Radiology (Boily) and Orthopedic Surgery (Martineau), Montreal University Health Centre, Montréal, Que
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10
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Couture A, Hébert-Davies J, Chapleau J, Laflamme GY, Sandman E, Rouleau DM. Involvement of the proximal radial ulnar joint in partial radial head fractures: a novel three-dimensional computed tomography scan evaluation method. Shoulder Elbow 2019; 11:121-128. [PMID: 30936952 PMCID: PMC6434964 DOI: 10.1177/1758573217728492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/23/2017] [Revised: 07/15/2017] [Accepted: 08/03/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Partial radial head fractures (PRHF) can involve the proximal radioulnar joint (PRUJ) or be restricted to the 'safe zone' (SZ) during forearm rotation. The objective of the present study was to develop an assessment method for PRUJ involvement in radial head fractures using axial computed tomography (CT) scans. METHODS The area of the radial head in contact with the PRUJ zone was identified, and defined on 18 cadaveric elbows CT scans; the quantitative relationship between PRUJ zone and radial tuberosity was established. Then, four evaluators validated it on PRHF CT scan axial views, classifying the fractures as involving the PRUJ or not. RESULTS Using the radial tuberosity as the 0° of a 360° circle, the SZ was within 108° to 212° clockwise for a right elbow and counter clockwise for the left elbow. Fifty-five consecutive (30 men, 25 women, mean age of 49 years) partial radial head fracture CT scans were classified: four in the SZ only, three in the PRUJ zone and 48 in both the PRUJ and SZ. The kappa for the inter- and intra-observer agreement was 0.517 and 0.881, respectively. CONCLUSIONS Ninety-three percent of partial radial head fractures will involve the PRUJ and the geometric model developed allows their classification, potentially helping surgeons decide on optimal treatment. LEVEL OF EVIDENCE Retrospective basic science study. Level III: anatomic study, imaging.
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Affiliation(s)
| | - Jonah Hébert-Davies
- Université de Montréal, Montreal, QC, Canada,Hôpital du Sacré-Cœur, Montreal, Quebec, Canada
| | | | - G. Yves Laflamme
- Université de Montréal, Montreal, QC, Canada,Hôpital du Sacré-Cœur, Montreal, Quebec, Canada
| | - Emilie Sandman
- Université de Montréal, Montreal, QC, Canada,Laboratoire d'imagerie et d'orthopédie, Hôpital du Sacré-Cœur, Research Center, Montreal, Quebec, Canada
| | - Dominique M. Rouleau
- Université de Montréal, Montreal, QC, Canada,Hôpital du Sacré-Cœur, Montreal, Quebec, Canada,Dominique M. Rouleau, C2095-5400 Bouleard Gouin Ouest, Montreal, Quebec H4J 1C5 Canada.
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11
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Rouleau DM, Garant-Saine L, Canet F, Sandman E, Ménard J, Clément J. Measurement of combined glenoid and Hill-Sachs lesions in anterior shoulder instability. Shoulder Elbow 2017; 9:160-168. [PMID: 28588656 PMCID: PMC5444602 DOI: 10.1177/1758573216681208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 06/03/2016] [Accepted: 10/28/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recurrent glenohumeral anterior instability (RGAI) frequently induces combined glenoid and Hill-Sachs bone lesions and is a risk factor for soft tissue repair failure. This cohort study describes a simple preoperative quantification method for bone loss, the Clock method, the first that combines glenoid and humeral lesions. METHODS Computed tomography scans of 34 shoulders with RGAI were twice reviewed by three independent observers, who measured bone lesions using the new Clock method and existing validated methods. Intra- and inter-observer reliability of the Clock method was evaluated (intraclass correlation coefficient). Pearson correlation was used to correlate Clock method with existing methods, and with function (Western Ontario Shoulder Instability, Quick-Disabilities of the Arm, Shoulder and Hand). RESULTS Thirty-two patients met the inclusion criteria: three females and 29 males, mean age 28 years. The intra- and inter-observer reliability was excellent, with intraclass correlation coefficient ranging from 0.817 to 0.938 for the novel Clock method. Humeral Clock and Glenoid Clock strongly correlated with Humeral Ratio (r = 0.882, p < 0.001) and Glenoid Surface Area and Glenoid Ratio (r = 0.793 and 0.717, p < 0.001), respectively. The classic threshold of 25% of the glenoid diameter with the Glenoid Ratio method corresponds to 4 hours with the Glenoid Clock method. CONCLUSIONS The Clock method is quick and reliable, with more studies being needed to investigate whether it is correlated with surgical outcomes.
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Affiliation(s)
- Dominique M. Rouleau
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada,Dominique M. Rouleau, HSCM, 5400 boul. Gouin Ouest, Local K-3035, Montreal, QC H4J 1C5, Canada.
| | | | - Fanny Canet
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Emilie Sandman
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Jérémie Ménard
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Julien Clément
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
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12
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Sandman E, Canet F, Petit Y, Laflamme GY, Athwal GS, Rouleau DM. Effect of elbow position on radiographic measurements of radio-capitellar alignment. World J Orthop 2016; 7:117-122. [PMID: 26925383 PMCID: PMC4757656 DOI: 10.5312/wjo.v7.i2.117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/22/2015] [Accepted: 12/04/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effect of different elbow and forearm positions on radiocapitellar alignment.
METHODS: Fifty-one healthy volunteers were recruited and bilateral elbow radiographs were taken to form a radiologic database. Lateral elbow radiographs were taken with the elbow in five different positions: Maximal extension and forearm in neutral, maximal flexion and forearm in neutral, elbow at 90° and forearm in neutral, elbow at 90° and forearm in supination and elbow at 90° and forearm in pronation. A goniometer was used to verify the accuracy of the elbow’s position for the radiographs at a 90° angle. The radiocapitellar ratio (RCR) measurements were then taken on the collected radiographs using the SliceOmatic software. An orthopedic resident performed the radiographic measurements on the 102 elbows, for a total of 510 lateral elbow radiographic measures. ANOVA paired t-tests and Pearson coefficients were used to assess the differences and correlations between the RCR in each position.
RESULTS: Mean RCR values were -2% ± 7% (maximal extension), -5% ± 9% (maximal flexion), and for elbow at 90° and forearm in neutral -2% ± 5%, supination 1% ± 6% and pronation 1% ± 5%. ANOVA analyses demonstrated significant differences between the RCR in different elbow and forearm positions. Paired t-tests confirmed significant differences between the RCR at maximal flexion and flexion at 90°, and maximal extension and flexion. The Pearson coefficient showed significant correlations between the RCR with the elbow at 90° - maximal flexion; the forearm in neutral-supination; the forearm in neutral-pronation.
CONCLUSION: Overall, 95% of the RCR values are included in the normal range (obtained at 90° of flexion) and a value outside this range, in any position, should raise suspicion for instability.
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13
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Abstract
OBJECTIVES Understanding the anatomy of proximal ulna is important when treating complex injuries, since nonanatomic reconstruction may lead to malunion, arthrosis, and instability. The proximal ulna has a sagittal bow, termed the proximal ulna dorsal angulation (PUDA). The purpose of this study was to evaluate the magnitude of angular malalignment at the PUDA that would lead to radial head subluxation. METHODS This biomechanical study was conducted on 6 fresh frozen upper extremities with an elbow movement simulator. An osteotomy was performed at the PUDA and stabilized with internal fixation at 5 angles. Lateral elbow fluoroscopic images were taken in 4 elbow and 3 forearm positions, with the annular ligament intact and then released. The displacement of the radial head was quantified with the radiocapitellar ratio measurement. RESULTS A significant interaction exists between elbow positions, angles of malalignment, and annular ligament integrity (P < 0.001). The greatest magnitudes of radial head subluxation were with annular ligament tear, ranging from -4% to 88% (P < 0.001). Significant differences were found between the different internal fixation angles (P = 0.002) and elbow positions (P < 0.001). Anterior subluxation increased as malalignment was fixed into extension and with progressive elbow flexion. Posterior subluxation increased as malalignment advanced into flexion and decreased with elbow flexion. CONCLUSIONS Proximal ulna malalignment combined with an annular ligament tear affect the biomechanics of the elbow and can lead to radial head subluxation. This study demonstrates the importance of an anatomic reconstruction, specifically recreation of each individual's unique PUDA. Thus, in the setting of a comminuted proximal ulna fracture with associated annular ligament insufficiency, radiographs of the contralateral elbow may assist with the restoration of the normal anatomy to limit radial head instability.
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Affiliation(s)
- Emilie Sandman
- *Department of Orthopedic Surgery, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada; †Université de Montréal, Montreal, Canada; ‡École de Technologie Supérieure, Montreal, Canada; and §Department of Orthopedic Surgery, Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, Ontario, Canada
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14
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Hebert-Davies J, Laflamme GY, Rouleau D, Canet F, Sandman E, Li A, Petit Y. A biomechanical study comparing polyaxial locking screw mechanisms. Injury 2013; 44:1358-62. [PMID: 23849980 DOI: 10.1016/j.injury.2013.06.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 03/27/2013] [Revised: 06/05/2013] [Accepted: 06/13/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Locking plates have become ubiquitous in modern fracture surgery. Recently, manufacturers have developed locking plates with polyaxial screw capabilities in order to optimise screw placement. It has already been demonstrated that inserting uniaxial locking screws off axis results in weaker loads to failure. Our hypothesis was that even implants specifically designed for polyaxial insertion would experience a drop-off in resistance when using non-perpendicular screws. METHODS Four different types (one monoaxial and three polyaxial locking plates) of readily available small fragment plates were tested. A biomechanical model was developed to test the screws until failure (defined as breakage and rapid loss of >50% force). Screws were inserted at 0, 10 and 15°. RESULTS The standard monoaxial locking mechanism sustained saw a 60% reduction in force (332N vs. 134N) when screws were inserted cross-threaded at 10°. Two polyaxial systems saw similar significant reductions in force of 45% and 34%, respectively at 15°. A third system utilizing an end cap locking mechanism showed highly variable results with large standard deviations. Polyaxial screws showed on average only limited reduction at 10 degrees of insertion angle. CONCLUSION Newer designs of locking plates have attractive properties to allow more surgical options during fixation. However this freedom comes at the price of reduced force. Our results show that the safe zone for inserting these screws is closer to 20°, rather than the 30° indicated by the manufacturers. Also, the various polyaxial locking mechanisms seem to influence the overall resistance of the screws.
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Affiliation(s)
- Jonah Hebert-Davies
- University of Montréal, Hôpital du Sacré Cœur, 5400 Gouin Ouest, Local J-3245, Montréal, Québec, Canada H4J 1C5.
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15
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McCann F, Canet F, Sandman E, Petit Y, Rouleau DM. Does radiographic beam angle affect the radiocapitellar ratio measurement of subluxation in the elbow? Clin Orthop Relat Res 2013; 471:2556-62. [PMID: 23653100 PMCID: PMC3705071 DOI: 10.1007/s11999-013-3027-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/24/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Radial head alignment is the key to determine elbow reduction after treatment of subluxations or Monteggia fractures. The radiocapitellar ratio (RCR) quantifies the degree of subluxation, by evaluating radial head alignment with the capitellum of the humerus; this ratio is reproducible when measured on true lateral radiographs of nonsubluxated elbows. However, the impact of beam angulation on RCR measurement is unknown. QUESTIONS/PURPOSES Our hypotheses were that the RCR of the nonsubluxated elbow would remain in the normal range as the beam angle changed and that the RCR variability would increase for the subluxated elbow with small deviations in the beam angle. METHODS Radiographs were taken of six healthy cadaveric extremities using beam angles ranging from -20° to 20° along the inferosuperior axis and from -20° to 20° along the dorsoventral axis. The same views then were taken of the six arms with anterior radiocapitellum subluxation followed by posterior radiocapitellum subluxation. RCRs were measured by one observer. As a reference value, the RCR was measured in the 0° to 0° position and the difference between each RCR in a nonreference position was subtracted from each RCR reference to obtain the delta-RCR. An ANOVA was performed to assess the main and interactive effects on the RCR measured in each C-arm position compared with the RCR measured on a true lateral radiograph. RESULTS The RCR remained in the normal range even as the beam angle of the C-arm varied between -20° and 20°. The position of the beam did not affect the RCR in anteriorly subluxated elbows (p = 0.777), whereas RCR variation increased especially in the presence of posterior radial head subluxation when the C-arm position was 10° or more out of plane (p = 0.006). The inferosuperior malposition of the C-arm had a greater impact on quantification of radial head alignment measurement. Despite that, the RCR measurement is reliable in reduced and subluxated elbows on lateral radiographs with a C-arm position deviation of as much as 20°. CONCLUSIONS Identification of a subluxated elbow could be made on any lateral radiograph with a beam angulation deviation of as much as 20°. This suggests that the RCR is a useful diagnostic tool for clinical and research purposes, although for subluxated elbows, it is important to pay careful attention to the inferosuperior position of the C-arm.
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Affiliation(s)
| | - Fanny Canet
- Recherche orthopédie C2095, Hôpital du Sacré-Cœur de Montréal, 5400 boul. Gouin ouest, Montréal, QC H4J 1C5 Canada
| | | | - Yvan Petit
- Recherche orthopédie C2095, Hôpital du Sacré-Cœur de Montréal, 5400 boul. Gouin ouest, Montréal, QC H4J 1C5 Canada
| | - Dominique M. Rouleau
- Université de Montréal, Montréal, QC Canada ,Recherche orthopédie C2095, Hôpital du Sacré-Cœur de Montréal, 5400 boul. Gouin ouest, Montréal, QC H4J 1C5 Canada
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16
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Chapleau J, Canet F, Petit Y, Sandman E, Laflamme GY, Rouleau DM. Demographic and anthropometric factors affecting elbow range of motion in healthy adults. J Shoulder Elbow Surg 2013; 22:88-93. [PMID: 22947233 DOI: 10.1016/j.jse.2012.05.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/15/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND To use elbow range of motion routinely as a diagnostic index, it is important to explain the normal variability among the population. Consequently, this study assessed the possible associations between age, sex, laterality, body mass index, joint laxity, level of physical activities, upper limb dimensions, and the elbow range of motion in flexion/extension. MATERIALS AND METHODS Maximal flexion and extension were measured on the lateral radiographs of 102 elbows of 51 volunteers. The difference of range of motion regarding sex and laterality was assessed with Student t tests. The Pearson correlation coefficient was used to evaluate the relationship between elbow mobility and the other factors, and a stepwise multiple regression analysis was performed. RESULTS Among the 51 volunteers, a correlation was found between flexion and body mass index, age, and midbrachial and forearm circumferences (r = -0.234 to -0.594). Age (r = 0.268) and hyperlaxity (r = -0.323) were the only factors associated with a change in elbow extension. No correlation was found between the level of physical activity or with the laterality and changes in elbow mobility. Finally, women presented with more flexion and total elbow range of motion than men. CONCLUSIONS This study confirms the association between various demographic and anthropometric factors and elbow range of motion in healthy adults. Among these, the body mass index and forearm circumference are the most likely responsible for mobility variations among the population.
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Rouleau DM, Canet F, Chapleau J, Petit Y, Sandman E, Faber KJ, Athwal GS. The influence of proximal ulnar morphology on elbow range of motion. J Shoulder Elbow Surg 2012; 21:384-8. [PMID: 22321356 DOI: 10.1016/j.jse.2011.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 09/28/2011] [Accepted: 10/10/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Physiologic dorsal apex angulation of the proximal ulna is present in 96% of the population. We hypothesize that a correlation exists between the physiologic dorsal ulnar angulation and elbow range of motion (ROM). METHODS Fifty healthy adults underwent bilateral lateral elbow radiographs in neutral forearm rotation in the following positions: terminal flexion (TF), 90° of flexion, and terminal extension (TE). The proximal ulna dorsal angulation (PUDA), TF, and TE were measured on the digital lateral radiographs by 2 independent observers. ROM was calculated as the difference between TF and TE measurements. Subjects were divided into 2 groups: those with PUDA measurements less than the median and those with PUDA measurements equal to or greater than the median. The relationship between the PUDA and TE, TF, and ROM was evaluated by use of Pearson correlation coefficients. RESULTS The mean age of the cohort was 31 ± 9 years, and there were 30 women among the 50 volunteers. The sample of 100 elbow radiographs had a mean TF of 150.8° ± 4.5°, a mean TE (ie, flexion contracture) of 11.5° ± 7.3°, and a mean ROM of 139.3° ± 8.4°. The mean PUDA was 5.2° ± 2.8°. Elbows with a greater PUDA had significantly less TE (r = 0.381, P ≤ .001) and ROM (r = -0.351, P ≤ .001). The group of elbows with a lesser PUDA had better TE (9.4° vs 13.6°, P = .004) and ROM (142.0° vs 136.7°, P = .001) than elbows with a greater PUDA. CONCLUSION The increasing magnitude of the PUDA is associated with decreased maximal elbow extension and global elbow ROM.
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Affiliation(s)
- Dominique M Rouleau
- Recherche Orthopedie C2095, Hôpital du Sacré-Cœur, Montréal, Québec, Canada.
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