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Cipta DA, Andoko D, Theja A, Utama AVE, Hendrik H, William DG, Reina N, Handoko MT, Lumbuun N. Culturally sensitive patient-centered healthcare: a focus on health behavior modification in low and middle-income nations-insights from Indonesia. Front Med (Lausanne) 2024; 11:1353037. [PMID: 38681051 PMCID: PMC11047771 DOI: 10.3389/fmed.2024.1353037] [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] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/18/2024] [Indexed: 05/01/2024] Open
Abstract
Patient-centered, culturally sensitive healthcare acknowledges the profound impact of cultural beliefs on health behaviors and outcomes, particularly vital in low and middle-income countries (LMICs). Within Indonesia, distinct cultural factors are pivotal in empowering patients, necessitating their integration into healthcare practices. For example, the cultural concept of gotong royong, emphasizing communal collaboration, presents an opportunity to foster community support networks among patients. Moreover, honoring familial ties and involving family members in decision-making enhances patient empowerment. Acknowledging and incorporating spiritual and religious beliefs, which are deeply rooted in Indonesian culture, into healthcare interventions further augments patient empowerment and well-being. In LMICs, including Indonesia, achieving patient empowerment demands implementing critical strategies. Community-based interventions harness local resources and engage the community to drive health behavior change. Culturally sensitive communication bridges the gap between healthcare providers and patients, respecting language nuances and cultural norms. Patient education fosters a comprehensive understanding of health conditions, thereby encouraging active involvement in decision-making. Tailored behavior modification techniques, aligned with cultural beliefs and practices, support the adoption of healthier behaviors among patients. This review emphasizes the pivotal role of patient-centered, culturally sensitive healthcare in LMICs, particularly in Indonesia. It delves into strategies to promote health behavior change within these unique contexts, emphasizing the importance of cultural sensitivity and patient-centered care. The discourse also explores the cultural landscape impacting healthcare, acknowledging the challenges faced in delivering comprehensive healthcare services within these diverse cultural contexts. Additionally, it outlines innovative approaches and success stories in implementing patient-centered care, highlighting how cultural factors intersect with healthcare outcomes. By advocating for integrating culture-specific patient empowerment practices into healthcare methodologies, this article underscores the potential for improved health outcomes, heightened patient engagement, and the delivery of culturally relevant services within LMICs.
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Affiliation(s)
- D. A Cipta
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Psychiatry, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - D. Andoko
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - A. Theja
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - A. V. E. Utama
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - H. Hendrik
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - D. G. William
- School of Medicine, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - N. Reina
- School of Medicine, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - M. T. Handoko
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - N. Lumbuun
- Department of Family Medicine and Primary Care, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
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Gracia G, Laumonerie P, Tibbo ME, Cavaignac E, Chiron P, Reina N. Outcomes of acute versus delayed total hip arthroplasty following acetabular fracture. Eur J Orthop Surg Traumatol 2023; 33:51-60. [PMID: 34714391 DOI: 10.1007/s00590-021-03157-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/04/2021] [Accepted: 10/21/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Post-traumatic arthritis is known complication following acetabular fracture. The aim was to compare mid- to long-term outcomes of acute THA (aTHA) for acetabular fracture and delayed THA (dTHA) following failure of ORIF or conservative management. METHODS We retrospectively analysed 60 THA (21 aTHA; 39 dTHA) performed for acetabular fracture between 2004 and 2014 in 60 patients with a mean age of 59 years (20-94). Functional and Radiographic outcomes were assessed at a mean follow-up of 5 years (2-13) utilizing Oxford, Harris Hip (HHS), and Postel Merle d'Aubigné (PMA) scores and Brooker classification. RESULTS The mean HHS (73), Oxford (32) and PMA (12) scores were significantly lower in the aTHA group. Acute THA was significantly associated with lower postoperative Oxford (β = -4.2), HHS (β = -7.8), and PMA (β = -2.2) scores at mean 5 years (2-13). Eleven patients returned to the operating room. There were no significant differences between THA performed in acute or delayed fashion. The two primary reasons for revision were periprosthetic joint infection (n = 5) and aseptic loosening (n = 4). Survivorship free from reoperation at 10 years was 91% and 82% for aTHA and dTHA, respectively (p = 0.24). Increased PMA scores were associated with decreased overall survival of the THA free from reoperation (HR = 0.60). The degree of heterotopic ossification was significantly higher in the aTHA group (p < 0.001). CONCLUSION Acute THA in the setting of acetabular fracture is a technically challenging procedure. However, in the present series, aTHA provided satisfactory immediate stability and good survivorship at 10 years in a medically vulnerable patient population. LEVEL OF EVIDENCE Level 3; Therapeutic study.
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Affiliation(s)
- G Gracia
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France.
- Department of Orthopaedic Surgery, Polyclinique Côte Basque Sud, 7 Rue Leonce Goyetche, 64500, Saint-Jean-de-Luz, France.
| | - P Laumonerie
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - M E Tibbo
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - E Cavaignac
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - P Chiron
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - N Reina
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
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Mourguet M, Lafaurie M, Debard A, Garnier C, Lelièvre L, Grare M, Reina N, Martin-Blondel G, Delobel P. Intérêt des cyclines en association à la rifampicine dans le traitement des infections sur prothèse articulaire à Staphylocoque. Infect Dis Now 2021. [DOI: 10.1016/j.idnow.2021.06.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pedrero AA, Uribe IP, Muñoz R, Reina N, Llorens M, Palacin A, Membrives S, Monreal J, Vidal DP. Evaluation of tava program to improve the quality of life in young adults with autism spectrum disorders (ASD). Eur Psychiatry 2021. [PMCID: PMC9480141 DOI: 10.1192/j.eurpsy.2021.1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Autism spectrum disorders (ASD), is a population that does not usually receive specific treatment. Objectives The main objective of the present study is to evaluate whether specific interventions within the TAVA program (transition program to adult life for patients with ADS), produce significant improvements in the quality of life of young adults with ASD. Methods This is a prospective randomized clinical study of patients with ASD (according to DSM-5 criteria) seen in outpatient of the Parc Tauli University Hospital in Sabadell (Barcelona) since September 2017. We compared the quality of life, functionality, caregiver burden, and comorbidity of patients in TAVA program (beneficiaries of group therapy and specific medical and psychosocial interventions), with that of control patients (treatment as usual), after 2 years of intervention. Results Our sample is composed of 12 patients with ASD. The average age is 18.4 years. 83% of the sample are men (n = 10). 5 of the patients belonged to TAVA and the other 7 were controls. Overall, TAVA patients presented improvement in the ZARIT and BAI scales compared to control patients. The control patients evolved less favorably in the AAA, SRS and RAAS levels compared to TAVA. Conclusions Specific interventions in adults with ASD, improve the caregiver’s feeling of overload and the patients anxiety, compared to the usual interventions. The lack of regulated interventions produces an unfavorable evolution of the core symptoms of autism. More studies are needed to specify efficient interventions to improve the quality of life of adults with ASD. Disclosure No significant relationships.
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Reina J, Reina N. Cáncer de mama y virus, sí pero no. Clínica e Investigación en Ginecología y Obstetricia 2020. [DOI: 10.1016/j.gine.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
AIMS Concurrent hip and spine pathologies can alter the biomechanics of spinopelvic mobility in primary total hip arthroplasty (THA). This study examines how differences in pelvic orientation of patients with spine fusions can increase the risk of dislocation risk after THA. PATIENTS AND METHODS We identified 84 patients (97 THAs) between 1998 and 2015 who had undergone spinal fusion prior to primary THA. Patients were stratified into three groups depending on the length of lumbar fusion and whether or not the sacrum was involved. Mean age was 71 years (40 to 87) and 54 patients (56%) were female. The mean body mass index (BMI) was 30 kg/m2 (19 to 45). Mean follow-up was six years (2 to 17). Patients were 1:2 matched to patients with primary THAs without spine fusion. Hazard ratios (HR) were calculated. RESULTS Dislocation in the fusion group was 5.2% at one year versus 1.7% in controls but this did not reach statistical significance (HR 1.9; p = 0.33). Compared with controls, there was no significant difference in rate of dislocation in patients without a sacral fusion. When the sacrum was involved, the rate of dislocation was significantly higher than in controls (HR 4.5; p = 0.03), with a trend to more dislocations in longer lumbosacral fusions. Patient demographics and surgical characteristics of THA (i.e. surgical approach and femoral head diameter) did not significantly impact risk of dislocation (p > 0.05). Significant radiological differences were measured in mean anterior pelvic tilt between the one-level lumbar fusion group (22°), the multiple-level fusion group (27°), and the sacral fusion group (32°; p < 0.01). Ten-year survival was 93% in the fusion group and 95% in controls (HR 1.2; p = 0.8). CONCLUSION Lumbosacral spinal fusions prior to THA increase the risk of dislocation within the first six months. Fusions involving the sacrum with multiple levels of lumbar involvement notably increased the risk of postoperative dislocation compared with a control group and other lumbar fusions. Surgeons should take care with component positioning and may consider higher stability implants in this high-risk cohort.
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Affiliation(s)
- C G Salib
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - N Reina
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - K I Perry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M J Taunton
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - D J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Reina N, Cognault J, Ollivier M, Dagneaux L, Gauci MO, Pailhé R. The CJOrtho app: A mobile clinical and educational tool for orthopedics. Orthop Traumatol Surg Res 2018; 104:523-527. [PMID: 29654936 DOI: 10.1016/j.otsr.2018.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/05/2017] [Revised: 01/23/2018] [Accepted: 01/30/2018] [Indexed: 02/02/2023]
Abstract
The need for modern patient evaluation tools continues to grow. A dependable and reproducible assessment provides objective follow-up and increases the validity of collected data. This is where mobile apps come into play, as they provide a link between surgeons and patients. They also open the possibility of interacting with other healthcare staff to exchange common scientific reference systems and databases. The CJOrtho app provides fast access to 65 classification systems in orthopedics or trauma surgery, 20 clinical outcome scores and a digital goniometer. The development of free mobile apps is an opportunity for education and better follow-up, while meeting the demands of patients.
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Affiliation(s)
- N Reina
- Collège des jeunes orthopédistes, 56, rue Boissonnade, 75014 Paris, France.
| | - J Cognault
- Collège des jeunes orthopédistes, 56, rue Boissonnade, 75014 Paris, France
| | - M Ollivier
- Collège des jeunes orthopédistes, 56, rue Boissonnade, 75014 Paris, France
| | - L Dagneaux
- Collège des jeunes orthopédistes, 56, rue Boissonnade, 75014 Paris, France
| | - M-O Gauci
- Collège des jeunes orthopédistes, 56, rue Boissonnade, 75014 Paris, France
| | - R Pailhé
- Collège des jeunes orthopédistes, 56, rue Boissonnade, 75014 Paris, France
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Laumonerie P, Lapègue F, Reina N, Tibbo M, Rongières M, Faruch M, Mansat P. Degenerative subtalar joints complicated by medial plantar intraneural cysts : cutting the cystic articular branch prevents recurrence. Bone Joint J 2018; 100-B:183-189. [PMID: 29437060 DOI: 10.1302/0301-620x.100b2.bjj-2017-0990.r1] [Citation(s) in RCA: 3] [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] [Indexed: 11/05/2022]
Abstract
AIMS The pathogenesis of intraneural ganglion cysts is controversial. Recent reports in the literature described medial plantar intraneural ganglion cysts (mIGC) with articular branches to subtalar joints. The aim of the current study was to provide further support for the principles underlying the articular theory, and to explain the successes and failures of treatment of mICGs. PATIENTS AND METHODS Between 2006 and 2017, five patients with five mICGs were retrospectively reviewed. There were five men with a mean age of 50.2 years (33 to 68) and a mean follow-up of 3.8 years (0.8 to 6). Case history, physical examination, imaging, and intraoperative findings were reviewed. The outcomes of interest were ultrasound and/or MRI features of mICG, as well as the clinical outcomes. RESULTS The five intraneural cysts followed the principles of the unifying articular theory. Connection to the posterior subtalar joint (pSTJ) was identified or suspected in four patients. Re-evaluation of preoperative MRI demonstrated a degenerative pSTJ and denervation changes in the abductor hallucis in all patients. Cyst excision with resection of the articular branch (four), cyst incision and drainage (one), and percutaneous aspiration/steroid injection (two) were performed. Removing the connection to the pSTJ prevented recurrence of mIGC, whereas medial plantar nerves remained cystic and symptomatic when resection of the communicating articular branch was not performed. CONCLUSION Our findings support a standardized treatment algorithm for mIGC in the presence of degenerative disease at the pSTJ. By understanding the pathoanatomic mechanism for every cyst, we can improve treatment that must address the articular branch to avoid the recurrence of intraneural ganglion cysts, as well as the degenerative pSTJ to avoid extraneural cyst formation or recurrence. Cite this article: Bone Joint J 2018;100-B:183-9.
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Affiliation(s)
- P Laumonerie
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Allée Jean Dausset, Toulouse 31059, France and Anatomy Laboratory, Toulouse Rangueil Faculty of Medicine, 133 Route de Narbonne, Toulouse 31062, France
| | - F Lapègue
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Allée Jean Dausset, Toulouse, 31059, France
| | - N Reina
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Allée Jean Dausset, Toulouse, 31059, France
| | - M Tibbo
- Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - M Rongières
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Allée Jean Dausset, Toulouse 31059, France and Anatomy Laboratory, Toulouse Rangueil Faculty of Medicine, 133 Route de Narbonne, Toulouse 31062, France
| | - M Faruch
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Allée Jean Dausset, Toulouse, 31059, France
| | - P Mansat
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Allée Jean Dausset, Toulouse, 31059, France
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Laumonerie P, Reina N, Kerezoudis P, Declaux S, Tibbo ME, Bonnevialle N, Mansat P. The minimum follow-up required for radial head arthroplasty: a meta-analysis. Bone Joint J 2017; 99-B:1561-1570. [PMID: 29212677 DOI: 10.1302/0301-620x.99b12.bjj-2017-0543.r2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 05/04/2017] [Accepted: 08/11/2017] [Indexed: 11/05/2022]
Abstract
AIMS The primary aim of this study was to define the standard minimum follow-up required to produce a reliable estimate of the rate of re-operation after radial head arthroplasty (RHA). The secondary objective was to define the leading reasons for re-operation. MATERIALS AND METHODS Four electronic databases, between January 2000 and March 2017 were searched. Articles reporting reasons for re-operation (Group I) and results (Group II) after RHA were included. In Group I, a meta-analysis was performed to obtain the standard minimum follow-up, the mean time to re-operation and the reason for failure. In Group II, the minimum follow-up for each study was compared with the standard minimum follow-up. RESULTS A total of 40 studies were analysed: three were Group I and included 80 implants and 37 were Group II and included 1192 implants. In Group I, the mean time to re-operation was 1.37 years (0 to 11.25), the standard minimum follow-up was 3.25 years; painful loosening was the main indication for re-operation. In Group II, 33 Group II articles (89.2%) reported a minimum follow-up of < 3.25 years. CONCLUSION The literature does not provide a reliable estimate of the rate of re-operation after RHA. The reproducibility of results would be improved by using a minimum follow-up of three years combined with a consensus of the definition of the reasons for failure after RHA. Cite this article: Bone Joint J 2017;99-B:1561-70.
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Affiliation(s)
- P Laumonerie
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - N Reina
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - P Kerezoudis
- Mayo Clinic, 1216 2nd Street SW, Rochester, Minnesota 55905, USA
| | - S Declaux
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - M E Tibbo
- Mayo Clinic, 1216 2nd Street SW, Rochester, Minnesota 55905, USA
| | - N Bonnevialle
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - P Mansat
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
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Chiron P, Demoulin L, Wytrykowski K, Cavaignac E, Reina N, Murgier J. Radiation dose and magnification in pelvic X-ray: EOS™ imaging system versus plain radiographs. Orthop Traumatol Surg Res 2017; 103:1155-1159. [PMID: 28942025 DOI: 10.1016/j.otsr.2017.07.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 04/26/2017] [Revised: 06/29/2017] [Accepted: 07/24/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND In plain pelvic X-ray, magnification makes measurement unreliable. The EOS™ (EOS Imaging, Paris France) imaging system is reputed to reproduce patient anatomy exactly, with a lower radiation dose. This, however, has not been assessed according to patient weight, although both magnification and irradiation are known to vary with weight. We therefore conducted a prospective comparative study, to compare: (1) image magnification and (2) radiation dose between the EOS imaging system and plain X-ray. HYPOTHESIS The EOS imaging system reproduces patient anatomy exactly, regardless of weight, unlike plain X-ray. MATERIAL AND METHOD A single-center comparative study of plain pelvic X-ray and 2D EOS radiography was performed in 183 patients: 186 arthroplasties; 104 male, 81 female; mean age 61.3±13.7years (range, 24-87years). Magnification and radiation dose (dose-area product [DAP]) were compared between the two systems in 186 hips in patients with a mean body-mass index (BMI) of 27.1±5.3kg/m2 (range, 17.6-42.3kg/m2), including 7 with morbid obesity. RESULTS Mean magnification was zero using the EOS system, regardless of patient weight, compared to 1.15±0.05 (range, 1-1.32) on plain X-ray (P<10-5). In patients with BMI<25, mean magnification on plain X-ray was 1.15±0.05 (range, 1-1.25) and, in patients with morbid obesity, 1.22±0.06 (range, 1.18-1.32). The mean radiation dose was 8.19±2.63dGy/cm2 (range, 1.77-14.24) with the EOS system, versus 19.38±12.37dGy/cm2 (range, 4.77-81.75) with plain X-ray (P<10-4). For BMI >40, mean radiation dose was 9.36±2.57dGy/cm2 (range, 7.4-14.2) with the EOS system, versus 44.76±22.21 (range, 25.2-81.7) with plain X-ray. Radiation dose increased by 0.20dGy with each extra BMI point for the EOS system, versus 0.74dGy for plain X-ray. CONCLUSION Magnification did not vary with patient weight using the EOS system, unlike plain X-ray, and radiation dose was 2.5-fold lower. LEVEL OF EVIDENCE 3, prospective case-control study.
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Affiliation(s)
- P Chiron
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - L Demoulin
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - K Wytrykowski
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - E Cavaignac
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - N Reina
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - J Murgier
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
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Laumonerie P, Reina N, Ancelin D, Delclaux S, Tibbo ME, Bonnevialle N, Mansat P. Mid-term outcomes of 77 modular radial head prostheses. Bone Joint J 2017; 99-B:1197-1203. [PMID: 28860400 DOI: 10.1302/0301-620x.99b9.bjj-2016-1043.r2] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 10/18/2016] [Accepted: 04/03/2017] [Indexed: 11/05/2022]
Abstract
AIMS Radial head arthroplasty (RHA) may be used in the treatment of non-reconstructable radial head fractures. The aim of this study was to evaluate the mid-term clinical and radiographic results of RHA. PATIENTS AND METHODS Between 2002 and 2014, 77 RHAs were implanted in 54 men and 23 women with either acute injuries (54) or with traumatic sequelae (23) of a fracture of the radial head. Four designs of RHA were used, including the Guepar (Small Bone Innovations (SBi)/Stryker; 36), Evolutive (Aston Medical; 24), rHead RECON (SBi/Stryker; ten) or rHead STANDARD (SBi/Stryker; 7) prostheses. The mean follow-up was 74.0 months (standard deviation (sd) 38.6; 24 to 141). The indication for further surgery, range of movement, mean Mayo Elbow Performance (MEP) score, quick Disabilities of the Arm, Shoulder and Hand (quickDASH) score, osteolysis and positioning of the implant were also assessed according to the design, and acute or delayed use. RESULTS The mean MEP and quickDASH scores were 90.2 (sd 14; 45 to 100), and 14.0 points (sd 12; 1.2 to 52.5), respectively. There were no significant differences between RHA performed in acute or delayed fashion. There were 30 re-operations (19 with, and 11 without removal of the implant) during the first three post-operative years. Painful loosening was the primary indication for removal in 14 patients. Short-stemmed prostheses (16 mm to 22 mm in length) were also associated with an increased risk of painful loosening (odds ratio 3.54 (1.02 to 12.2), p = 0.045). Radiocapitellar instability was the primary indication for re-operation with retention of the implant (5). The overall survival of the RHA, free from re-operation, was 60.8% (sd 5.7%) at ten years. CONCLUSION Bipolar and press-fit RHA gives unsatisfactory mid-term outcomes in the treatment of acute fractures of the radial head or their sequelae. The outcome may vary according to the design of the implant. The rate of re-operation during the first three years is predictive of the long-term survival in tight-fitting RHAs. Cite this article: Bone Joint J 2017;99-B1197-1203.
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Affiliation(s)
- P Laumonerie
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - N Reina
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - D Ancelin
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - S Delclaux
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - M E Tibbo
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - N Bonnevialle
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - P Mansat
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
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Reina N, Putman S, Desmarchelier R, Sari Ali E, Chiron P, Ollivier M, Jenny JY, Waast D, Mabit C, de Thomasson E, Schwartz C, Oger P, Gayet LE, Migaud H, Ramdane N, Fessy MH. Can a target zone safer than Lewinnek's safe zone be defined to prevent instability of total hip arthroplasties? Case-control study of 56 dislocated THA and 93 matched controls. Orthop Traumatol Surg Res 2017. [PMID: 28629942 DOI: 10.1016/j.otsr.2017.05.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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] [Indexed: 02/02/2023]
Abstract
BACKGROUND Various factors contribute to instability of total hip arthroplasty (THA), with implant orientation being a major contributor. We performed a case-control study with computed tomography (CT) data to determine whether: 1) orientation contributes to THA instability and 2) a safer target zone for stability than Lewinnek's classic safe zone can be defined. MATERIAL AND METHODS We included prospectively 363 cases of THA dislocation that occurred during the calendar 2013 year in 24 participating hospitals. Of the 128 dislocations that occurred in patients who underwent THA at these centers, 56 (24 anterior, 32 posterior) had CT scans, thus were included in the analysis. The control group was matched 4:1 based on implant type, year of implantation, age, sex, bearing types and THA indication. Of the 428 matched control THA cases, 93 had CT scans. In all, the CT scans from 149 cases (56 unstable, 93 stable) were analyzed to determine the acetabular cup's inclination and anteversion, and the femoral stem's anteversion. RESULTS In the unstable THA group, cup inclination was 46.9°±7.4°, cup anteversion was 20.4°±10.8° and stem anteversion was 14.2°±9.9°. In the stable THA group, cup inclination was 44.9°±5.3° (P=0.057), cup anteversion was 22.1°±5.1° (P=0.009) and stem anteversion was 13.4°±4.4° (P=0.362). The optimal total anteversion (cup+stem) of 40-60° was achieved in 16.5% of unstable THA cases and 13.9% of stable THA cases, thus this parameter does not predict stability (odds ratio [OR] of 0.40, P=0.144). The cup was positioned in Lewinnek's safe zone in 44.6% of patients in the unstable group and 68.2% of those in the stable group (OR 3.74, P=0.003). A target zone defined as 40-50° inclination and 15-30° anteversion was better able to distinguish between unstable cases (23.2%) and stable cases (71.6%) resulting in an OR of 13.91 (P<0.001). DISCUSSION Implant positioning was the only risk factor for instability found in this study. Moreover, our findings reinforce the theory put forward by other authors that Lewinnek's safe zone is not specific enough to differentiate between stable and unstable THA implantations. The target zone for acetabular cups proposed here (40-50° inclination and 15°-30° anteversion) is related to a lower risk of instability. This orientation can be used as a guide, but must be combined with other technical elements to optimize stability. By balancing stability and biomechanics, the 40-50° inclination and 15°-30° anteversion target zone redefines the optimal positioning window. LEVEL OF EVIDENCE III case-control study.
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Affiliation(s)
- N Reina
- Institut locomoteur (ILM), hôpital Pierre-Paul-Riquet, CHU de Toulouse, 31059 Toulouse, France.
| | - S Putman
- Hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - R Desmarchelier
- Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, université de Lyon, 69002 Pierre-Bénite, France
| | - E Sari Ali
- Service de chirurgie orthopédique et traumatologique, hôpital la Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Chiron
- Institut locomoteur (ILM), hôpital Pierre-Paul-Riquet, CHU de Toulouse, 31059 Toulouse, France
| | - M Ollivier
- Service de chirurgie orthopédique et traumatologique, hôpital St. Marguerite, 13009 Marseille, France
| | - J Y Jenny
- Service de chirurgie orthopédique et traumatologique, hôpital de Hautepierre, CHU de Strasbourg, 67091 Strasbourg, France
| | - D Waast
- Service de chirurgie orthopédique et traumatologique, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - C Mabit
- Service de chirurgie orthopédique et traumatologique, CHU Dupuytren, avenue M.-Luther-King, CHU de Limoges, 87000 Limoges, France
| | - E de Thomasson
- Institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - C Schwartz
- Centre d'orthopédie clinique des 3-frontières, 68300 Saint-Louis, France
| | - P Oger
- Hopital A.-Mignot, 177, route De-Versailles, 78150 Le Chesnay, France
| | - L E Gayet
- Service de chirurgie orthopédique et traumatologique, CHU de Poitiers, 86021 Poitiers, France
| | - H Migaud
- Hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - N Ramdane
- Unité de biostatistique, pôle de santé publique, CHRU de Lille, 59000 Lille, France
| | - M H Fessy
- Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, université de Lyon, 69002 Pierre-Bénite, France
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Reina J, Reina N. [Favipiravir, a new concept of antiviral drug against influenza viruses]. Rev Esp Quimioter 2017; 30:79-83. [PMID: 28176519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Favipiravir (T-705) is a new antiviral drug with strong inhibitory activity on RNA-dependent RNA polymerase of most RNA virus genome. All the influenza viruses have been shown fully sensitive to this new antiviral, including genetic strains to neuraminidase inhibitors (oseltamivir) resistance. Its mechanism of action lies in blocking viral replication and induction of lethal mutagenesis which determines the loss of infective activity of influenza viruses. Its activity is particularly intense in the respiratory tract, decreasing the viral load to non-infectious levels. Clinical trials in humans have not yet completed but have very favourable results. It seems that the best therapy would be the combination of favipiravir with oseltamivir; both antivirals are synergistic and avoid the emergence of resistance.
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Affiliation(s)
- J Reina
- Jordi Reina, Unidad de Virología, Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
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Reina N, Bonnevialle P, Rubens Duval B, Adam P, Loubignac F, Favier T, Massin P. Internal fixation of intra-capsular proximal femoral fractures in patients older than 80 years: Still relevant? Multivariate analysis of a prospective multicentre cohort. Orthop Traumatol Surg Res 2017; 103:3-7. [PMID: 27919767 DOI: 10.1016/j.otsr.2016.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 07/08/2016] [Revised: 09/21/2016] [Accepted: 10/06/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Arthroplasty is now widely used to treat intra-capsular proximal femoral fractures (PFFs) in older patients, even when there is little or no displacement. However, whether arthroplasty is associated with lower mortality and complication rates in non-displaced or mildly displaced PFFs is unknown. The objectives of this prospective study were: (1) to evaluate early mortality rates with the two treatment methods, (2) to identify risk factors for complications, (3) and to identify predictors of functional decline. HYPOTHESIS Arthroplasty and internal fixation produce similar outcomes in non-displaced fractures of patients older than 80 years with PFFs. MATERIAL AND METHODS This multicentre prospective study included consecutive patients older than 80 years who were managed for intra-capsular PFFs at eight centres in 2014. Biometric data and geriatric assessment scores (Parker Mobility Score, Katz Index of Independence, and Mini-Nutritional Assessment [MNA] score) were collected before and 6 months after surgery. Independent risk factors were sought by multivariate analysis. We included 418 females and 124 males with a mean age of 87±4years. The distribution of Garden stages was stage I, n=56; stage II, n=33; stage III, n=130; and stage IV, n=323. Arthroplasty was performed in 494 patients and internal fixation in 48 patients with non-displaced intra-capsular PFFs. RESULTS Mortality after 6 months was 16.4% overall, with no significant difference between the two groups. By multivariate analysis, two factors were significantly associated with higher mortality, namely, male gender (odds ratio [OR], 3.24; 95% confidence interval [95% CI], 2.0-5.84; P<0.0001) and high ASA score (OR, 1.56; 95% CI, 1.07-2.26; P=0.019). Two factors were independently associated with lower mortality, with 75% predictive value, namely, high haematocrit (OR, 0.8; 95% CI, 0.7-0.9; P=0.001) and better Parker score (OR, 0.5; 95% CI, 0.3-0.8; P=0.01). The cut-off values associated with a significant risk increase were 2 for the Parker score (OR, 1.8; 95% CI, 1.1-2.3; P=0.001) and 37% for the haematocrit (OR, 3.3; 95% CI, 1.9-5.5; P=0.02). Complications occurred in 5.5% of patients. Surgical site infections were seen in 1.4% of patients, all of whom had had arthroplasty. Blood loss was significantly greater with arthroplasty (311±197mL versus 201±165mL, P<0.0002). Dependency worsened in 39% of patients, and 31% of patients lost self-sufficiency. A higher preoperative Parker score was associated with a lower risk of high postoperative dependency (OR, 0.86; 95% CI, 0.76-0.97; P=0.014). DISCUSSION Neither treatment method was associated with decreased mortality or better function after intra-capsular PFFs in patients older than 80 years. Early mortality rates were consistent with previous reports. Among the risk factors identified in this study, age, preoperative self-sufficiency, and gender are not amenable to modification, in contrast to haematocrit and blood loss. CONCLUSION Internal fixation remains warranted in patients older than 80 years with non-displaced intra-capsular PFFs. LEVEL OF EVIDENCE III, prospective case-control study.
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Affiliation(s)
- N Reina
- Hôpital Pierre-Paul-Riquet, CHU de Toulouse, rue Jean-Dausset, 31000 Toulouse, France
| | - P Bonnevialle
- Hôpital Pierre-Paul-Riquet, CHU de Toulouse, rue Jean-Dausset, 31000 Toulouse, France
| | - B Rubens Duval
- Hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
| | - P Adam
- CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - F Loubignac
- Centre hospitalier intercommunal de Toulon, 54, avenue Henri-Sainte-Claire-Deville, La Seyne-sur-Mer, 83100 Toulon, France
| | - T Favier
- Clinique Toutes Aures, 393, avenue des Savels, 04100 Manosque, France
| | - P Massin
- Hôpitaux universitaires Paris Nord Val-de-Seine, 100, boulevard du Général-Leclerc, 92110 Clichy, France; EA 7334 REMES (Recherche Clinique Coordonnée Ville-Hôpital, Méthodologie et Société) Université Paris-Diderot, Sorbonne Paris Cité, 75010 Paris, France.
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Morice A, Reina N, Gracia G, Bonnevialle P, Laffosse JM, Wytrykowski K, Cavaignac E, Bonnevialle N. Proximal femoral fractures in centenarians. A retrospective analysis of 39 patients. Orthop Traumatol Surg Res 2017; 103:9-13. [PMID: 27919768 DOI: 10.1016/j.otsr.2016.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 07/02/2016] [Revised: 09/13/2016] [Accepted: 09/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND A corollary of the current population ageing in France is an increase in proximal femoral fractures (PFFs), particularly among centenarians. The outcomes of PFFs in centenarians in France are unknown. We therefore conducted a retrospective study of centenarians with PFFs both to assess: (1) assess clinical outcomes according to geriatric and trauma scores, (2) and to determine whether routine surgery is warranted. HYPOTHESIS Morbidity and mortality in a single-centre cohort of centenarians with surgically treated PFFs are consistent with previous reports. MATERIAL AND METHOD We retrospectively reviewed the data of 33 women and 6 men aged 100 years or over who were treated surgically for PFFs at a single-centre between 2008 and 2014. Of the 39 patients, 15 were living at home and 24 in an institution at the time of the injury. Mean (range) values were 3.30 (0-7) for the Parker Mobility Score, 5.84 (0-12) for the Katz index, and 7.46 (2-12) for the Mini Nutritional Assessment (MNA). Mean time from injury to surgery was 1.7 days (0-12). The 26 extra-capsular fractures were managed by internal fixation and the 13 intra-capsular fractures by hip arthroplasty (n=12) or screw fixation (n=1). RESULTS After a mean follow-up of 23±14 months (6-60 months), 29 patients had died, including 3 within 48h, 10 within 3 months, and 15 within 1 year. Sequential mortality rates were 33.3% within the first 3 months, 26.9% from months 4 to 9, and 42.2% within the first year. Early dislocation occurred in 3 patients and surgical-site infection in 2 patients. Other complications were heart failure (n=1), confusional state (n=2), pneumonia (n=2), and pyelonephritis (n=2). DISCUSSION A PubMed search identified five studies of PFFs in more than 10 centenarians, of which only 2 provided detailed information on postoperative general and local morbidity related to the surgical treatment. Our hypothesis was confirmed for 3-month and 1-year mortality rates, which were at the lower ends of previously reported ranges. Local complications related directly to surgery were considerably more common in our study. PFFs in centenarians carry a high risk of death. Despite the absence of a control group, our data support surgery as the best treatment option. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- A Morice
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France.
| | - N Reina
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
| | - G Gracia
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
| | - P Bonnevialle
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
| | - J-M Laffosse
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
| | - K Wytrykowski
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
| | - E Cavaignac
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
| | - N Bonnevialle
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
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Ancelin D, Reina N, Cavaignac E, Delclaux S, Chiron P. Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: Case-control study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28-mm replacement. Orthop Traumatol Surg Res 2016; 102:1029-1034. [PMID: 28341264 DOI: 10.1016/j.otsr.2016.08.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 02/07/2016] [Revised: 08/13/2016] [Accepted: 08/18/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total hip arthroplasty is the most widely used procedure to treat avascular necrosis (AVN) of the femoral head. Few studies have compared the outcomes of THA in femoral head AVN and primary hip osteoarthritis. Therefore we performed a case-control study to compare THA for femoral head AVN vs. primary hip osteoarthritis in terms of: (1) prosthesis survival, (2) complication rates, (3) functional outcomes and radiographic outcomes, (4) and to determine whether specific risk factors for THA failure exist in femoral head AVN. HYPOTHESIS THA survival is similar in femoral head AVN and primary hip osteoarthritis. MATERIAL AND METHODS We compared two prospective cohorts of patients who underwent THA before 65 years of age, one composed of cases with femoral head AVN and the other of controls with primary hip osteoarthritis. In both cohorts, a cementless metal-on-metal prosthesis with a 28-mm cup and an anatomical stem was used. Exclusion criteria were THA with other types of prosthesis, posttraumatic AVN, and secondary osteoarthritis. With α set at 5%, to obtain 80% power, 246 patients were required in all. Prosthesis survival was assessed based on time to major revision (defined as replacement of at least one implant fixed to bone) and time to aseptic loosening. The other evaluation criteria were complications, Postel-Merle d'Aubigné (PMA) score, and the Engh and Agora Radiographic Assessment (ARA) scores for implant osseointegration. RESULTS The study included 282 patients, 149 with AVN and 133 with osteoarthritis. Mean age was 47.8±10.2 years (range, 18.5-65) and mean follow-up was 11.4±2.8 years (range, 4.5-18.3 years). The 10-year survival rates were similar in the two groups: for major revision, AVN group, 92.5% (95% confidence interval [95% CI], 90.2-94.8) and osteoarthritis group, 95.3% (95% CI, 92.9-97.7); for aseptic loosening, AVN group, 98.6% (95% CI, 97.6-98.6) and osteoarthritis, 99.2% (95% CI, 98.4-100). The AVN group had higher numbers of revision for any reason (19 vs. 6, P=0.018) and for dislocation (8 vs. 1, P=0.031). Mean PMA scores at last follow-up were comparable in the AVN group (17.65±1.27 [range, 10-18]) and osteoarthritis group (17.59±1.32 [range, 14-18]) (P=0.139). Osseointegration was also similar in the two groups: global Engh score, 26.51±1.81 (range, 14-27) for AVN and 26.84±0.91 (range, 19.5-27) for osteoarthritis (P=0.065); femoral ARA score, 5.83±0.46 (range, 3-6) for AVN and 5.90±0.42 (range, 3-6) for osteoarthritis (P=0.064); and cup ARA score, 5.74±0.67 (range, 3-6) for AVN and 5.78±0.66 (range, 3-6) for osteoarthritis (P=0.344). DISCUSSION Survival in this study was good and consistent with recent data on AVN, with no difference between AVN and osteoarthritis. Revisions for any cause or for dislocation were more common after THA for AVN. Functional outcomes were similar in the AVN and osteoarthritis groups. An anatomical cementless prosthesis combined with metal-on-metal 28-mm bearing provides durable good outcomes. LEVEL OF EVIDENCE III, non-randomized comparison of two prospective cohorts.
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Affiliation(s)
- D Ancelin
- Département de Chirurgie Orthopédique, Traumatologique et Réparatrice, Hôpital Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France.
| | - N Reina
- Département de Chirurgie Orthopédique, Traumatologique et Réparatrice, Hôpital Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - E Cavaignac
- Département de Chirurgie Orthopédique, Traumatologique et Réparatrice, Hôpital Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - S Delclaux
- Département de Chirurgie Orthopédique, Traumatologique et Réparatrice, Hôpital Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - P Chiron
- Département de Chirurgie Orthopédique, Traumatologique et Réparatrice, Hôpital Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
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Chiron P, Murgier J, Cavaignac E, Pailhé R, Reina N. Minimally invasive medial hip approach. Orthop Traumatol Surg Res 2014; 100:687-9. [PMID: 25164350 DOI: 10.1016/j.otsr.2014.06.009] [Citation(s) in RCA: 8] [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: 02/28/2014] [Revised: 06/01/2014] [Accepted: 06/12/2014] [Indexed: 02/02/2023]
Abstract
The medial approach to the hip via the adductors, as described by Ludloff or Ferguson, provides restricted visualization and incurs a risk of neurovascular lesion. We describe a minimally invasive medial hip approach providing broader exposure of extra- and intra-articular elements in a space free of neurovascular structures. With the lower limb in a "frog-leg" position, the skin incision follows the adductor longus for 6cm and then the aponeurosis is incised. A slide plane between all the adductors and the aponeurosis is easily released by blunt dissection, with no interposed neurovascular elements. This gives access to the lesser trochanter, psoas tendon and inferior sides of the femoral neck and head, anterior wall of the acetabulum and labrum. We report a series of 56 cases, with no major complications: this approach allows treatment of iliopsoas muscle lesions and resection or filling of benign tumors of the cervical region and enables intra-articular surgery (arthrolysis, resection of osteophytes or foreign bodies, labral suture).
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Affiliation(s)
- P Chiron
- Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, cinquième étage, hôpital Pierre-Paul-Riquet, 308, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - J Murgier
- Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, cinquième étage, hôpital Pierre-Paul-Riquet, 308, avenue de Grande-Bretagne, 31059 Toulouse, France.
| | - E Cavaignac
- Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, cinquième étage, hôpital Pierre-Paul-Riquet, 308, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - R Pailhé
- Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, cinquième étage, hôpital Pierre-Paul-Riquet, 308, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - N Reina
- Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, cinquième étage, hôpital Pierre-Paul-Riquet, 308, avenue de Grande-Bretagne, 31059 Toulouse, France
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Murgier J, Reina N, Cavaignac E, Espié A, Bayle-Iniguez X, Chiron P. The frequency of sequelae of slipped upper femoral epiphysis in cam-type femoroacetabular impingement. Bone Joint J 2014; 96-B:724-9. [DOI: 10.1302/0301-620x.96b6.33000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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] [Indexed: 01/15/2023]
Abstract
Slipped upper femoral epiphysis (SUFE) is one of the known causes of cam-type femoroacetabular impingement (FAI). The aim of this study was to determine the proportion of FAI cases considered to be secondary to SUFE-like deformities. We performed a case–control study on 96 hips (75 patients: mean age 38 years (15.4 to 63.5)) that had been surgically treated for FAI between July 2005 and May 2011. Three independent observers measured the lateral view head–neck index (LVHNI) to detect any SUFE-like deformity on lateral hip radiographs taken in 45° flexion, 45° abduction and 30° external rotation. A control group of 108 healthy hips in 54 patients was included for comparison (mean age 36.5 years (24.3 to 53.9). The impingement group had a mean LVHNI of 7.6% (16.7% to -2%) versus 3.2% in the control group (10.8% to -3%) (p < 0.001). A total of 42 hips (43.7%) had an index value > 9% in the impingement group versus only six hips (5.5%) in the control group (p < 0.001). The impingement group had a mean α angle of 73.9° (96.2° to 53.4°) versus 48.2° (65° to 37°) in the control group (p < 0.001). Our results suggest that SUFE is one of the primary aetiological factors for cam-type FAI. Cite this article: Bone Joint J 2014; 96-B:724–9.
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Affiliation(s)
- J. Murgier
- Pierre Paul Riquet Hospita, Orthopaedics
and Trauma Surgery, Musculoskeletal Institute, 308
avenue de Grande Bretagne, 31059, Toulouse, France
| | - N. Reina
- Pierre Paul Riquet Hospita, Orthopaedics
and Trauma Surgery, Musculoskeletal Institute, 308
avenue de Grande Bretagne, 31059, Toulouse, France
| | - E. Cavaignac
- Pierre Paul Riquet Hospita, Orthopaedics
and Trauma Surgery, Musculoskeletal Institute, 308
avenue de Grande Bretagne, 31059, Toulouse, France
| | - A. Espié
- Pierre Paul Riquet Hospita, Orthopaedics
and Trauma Surgery, Musculoskeletal Institute, 308
avenue de Grande Bretagne, 31059, Toulouse, France
| | - X. Bayle-Iniguez
- Pierre Paul Riquet Hospita, Orthopaedics
and Trauma Surgery, Musculoskeletal Institute, 308
avenue de Grande Bretagne, 31059, Toulouse, France
| | - P. Chiron
- Pierre Paul Riquet Hospita, Orthopaedics
and Trauma Surgery, Musculoskeletal Institute, 308
avenue de Grande Bretagne, 31059, Toulouse, France
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Vargas Castro J, Reina N, Grau T, Faus G, Sánchez Povedano M. EPA-1458 – Impulsivity and adolescence : evolution and treatment of a teenager with an eating disorder and comorbidity with attention deficit disorder with hyperactivity, in the context of a dysfunctional family. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78651-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Pailhé R, Chiron P, Reina N, Cavaignac E, Lafontan V, Laffosse JM. Pudendal nerve neuralgia after hip arthroscopy: retrospective study and literature review. Orthop Traumatol Surg Res 2013; 99:785-90. [PMID: 24080353 DOI: 10.1016/j.otsr.2013.07.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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: 01/08/2013] [Revised: 06/26/2013] [Accepted: 07/02/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pudendal nerve neurapraxia is a classic complication after traction on the fracture table. Diagnosis, however, is difficult and often overlooked, especially after arthroscopy in traction on fracture table; incidence is therefore not known exactly. HYPOTHESIS The study hypothesis was that incidence of pudendal nerve neuropathy exceeds 1% after hip arthroscopy. MATERIALS AND METHODS Results for 150 patients (79 female, 71 male) undergoing hip arthroscopy between 2000 and 2010 were analyzed retrospectively. The principal assessment criterion was onset of pudendal neuralgia. Secondary criteria were risk factors (history, surgery time, type of anesthesia), associated complications, onset to diagnosis interval and pattern of evolution. RESULTS At a mean 93 months' follow-up, there were 3 cases (2 women, 1 man) (2%) of pure sensory pudendal neuralgia; 2 concerned labral lesion resection and 1 osteochondromatosis. Surgery time ranged from 60 to 120min, under general anesthesia with curarization. Time to diagnosis was 3 weeks. No complementary examinations were performed. Spontaneous resolution occurred at 3 weeks to 6 months. No significant risk factors emerged. CONCLUSION The present study found 2% incidence of pudendal neuralgia, with no risk factors emerging from analysis. Prevention involves limiting traction force and duration by using a large pelvic support (diameter>8-10cm). Patient information and postoperative screening should be systematic. LEVEL OF EVIDENCE Level IV. Retrospective study.
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Affiliation(s)
- R Pailhé
- Service de chirurgie orthopédique, hôpital Rangueil, 1, avenue du Pr-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex, France.
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Cavaignac E, Lafontan V, Reina N, Pailhé R, Wargny M, Warmy M, Laffosse JM, Chiron P. Obesity has no adverse effect on the outcome of unicompartmental knee replacement at a minimum follow-up of seven years. Bone Joint J 2013; 95-B:1064-8. [PMID: 23908421 DOI: 10.1302/0301-620x.95b8.31370] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [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] [Indexed: 12/11/2022]
Abstract
The significance of weight in the indications for unicompartmental knee replacement (UKR) is unclear. Our hypothesis was that weight does not affect the long-term rate of survival of UKRs. We undertook a retrospective study of 212 UKRs at a mean follow-up of 12 years (7 to 22). The patients were distributed according to body mass index (BMI; < vs ≥ 30 kg/m(2)) and weight (< vs ≥ 82 kg). Kaplan-Meier survivorship analysis was performed and ten-year survival rates were compared between the sub-groups. Multimodal regression analysis determined the impact of the various theoretical contraindications on the long-term rate of survival of UKR. The ten-year rates of survival were similar in the two weight subgroups (≥ 82 kg: 93.5% (95% confidence interval (CI) 66.5 to 96.3); < 82 kg: 92.5% (95% CI 82.5 to 94.1)) and also in the two BMI subgroups (≥ 30 kg/m(2): 92% (95% CI 82.5 to 95.3); < 30 kg/m(2): 94% (95% CI 78.4 to 95.9)). Multimodal regression analysis revealed that weight plays a part in reducing the risk of revision with a relative risk of 0.387, although this did not reach statistical significance (p = 0.662). The results relating weight and BMI to the clinical outcome were not statistically significant. Thus, this study confirms that weight does not influence the long-term rate of survival of UKR.
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Affiliation(s)
- E Cavaignac
- CHU Rangueil, Institut de l'Appareil Locomoteur, 1 Avenue Jean Pouilhes, Toulouse, France.
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Gasq D, Molinier F, Reina N, Dupui P, Chiron P, Marque P. Posterior tibial tendon transfer in the spastic brain-damaged adult does not lead to valgus flatfoot. Foot Ankle Surg 2013; 19:182-7. [PMID: 23830167 DOI: 10.1016/j.fas.2013.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 10/06/2012] [Revised: 03/01/2013] [Accepted: 04/12/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND We studied the possible development of valgus flat foot after transfer of the posterior tibial tendon to the lateral cuneiform, used for surgical restoration of dorsiflexion in brain-damaged adult patients with spastic equinovarus foot. METHODS Twenty hemiplegic patients were reviewed with a mean postoperative follow-up of 57.9 months. Weightbearing radiographs, static baropodometry analysis and functional evaluation were used to assess postoperatively outcomes. RESULTS On the operated side, weightbearing radiographs showed an absence of medial arch collapse and a symmetrical and physiological hindfoot valgus; static baropodometric analysis showed a reduced plantar contact surface with a pes cavus appearance. The surgical procedure yielded good functional results. Nineteen patients were satisfied with the outcome of their surgery. CONCLUSIONS Our findings support that transfer of the posterior tibial tendon does not lead to valgus flat foot in the spastic brain-damaged adult, and is still a current surgical alternative for management of spastic equinovarus foot.
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Affiliation(s)
- D Gasq
- Explorations Fonctionnelles Physiologiques, CHU Rangueil, 1 Avenue Jean Poulhes, 31059 Toulouse Cedex 9, France.
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Reina N, Delaunay C, Chiron P, Ramdane N, Hamadouche M. Infection as a cause of primary total hip arthroplasty revision and its predictive factors. Orthop Traumatol Surg Res 2013; 99:555-61. [PMID: 23891660 DOI: 10.1016/j.otsr.2013.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [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: 04/24/2013] [Revised: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Infection is a serious complication of total hip arthroplasty (THA) and is one of the most frequent causes of failure. The goal of this study was to evaluate the importance of infection among the different causes of revision THA and identify any risk factors specifically associated with this cause of revision. MATERIALS AND METHODS All patients who underwent a first revision of THA were included in a prospective multicenter study. Postoperative clinical and radiological evaluation and follow-up of morbidity and mortality were performed at 3 months. RESULTS Two hundred forty out of 2107 revisions (11.4%) were performed for infected THA, which was the third cause after aseptic loosening (42.3%) and peri-prosthetic fractures (11.8%). These patients had a higher BMI associated with co-morbidities and lower clinical scores than patients with other causes of revision. One-stage revision was performed in most cases (66%) with replacement of the complete implant in 86% of cases, resulting in longer surgery compared to that for other causes. Male gender (OR 2.3), avascular necrosis (OR 2.4), arthroplasties with dual mobility cups (OR 2.5) and a Rottinger anterolateral approach (OR 3.4) were all associated with an increased risk of infection. DISCUSSION Some of these risk factors are not or have rarely been reported in the literature. They should be taken into consideration to help in the prevention and continuing battle against THA infection. LEVEL OF EVIDENCE Level IV, prospective cohort study.
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Affiliation(s)
- N Reina
- ILM Institut locomoteur, Clinique Pierre-Paul-Riquet, Hôpital Purpan, CHU de Toulouse, Toulouse, France.
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Abstract
This review describes bone and nerve injury mechanisms during a femoral head fracture-dislocation and outlines a novel classification system that uses computed tomography scanning (CT scan) to help determine how to best treat these fractures in an emergency setting or in chronic cases. A series of 55 cases with CT scan performed in the emergency department (ED) and an average follow-up of 9 years (range 3-13) was used as a basis to develop the classification system; this system takes into account the size of the fragments and any associated acetabular wall or femoral neck fractures. The suggested course of action is based on the CT scan results after the hip joint is reduced. Conservative treatment is indicated every time the head fragments and any potential acetabular wall fragments are properly reduced and there are no foreign bodies (37.7%). Osteochondral head fragments below the fovea must be removed (36.3%). Fragments that are one-third or one-quarter of the head size can either be removed (7.2%) or reduced and fixed (5.4%). A novel medial approach is described that provides minimally invasive access to the anterior-inferior part of the femoral head, which should extend the indications for preservation of one-third head fragments. If the femoral neck is also fractured or a one-half head fragment exists in elderly patients, a total hip replacement should be considered right way (9%). At the latest follow-up, osteoarthritis was present in 43.7% of cases, but was mostly well tolerated - 94% of patients had a WOMAC score between 80 and 100 with signs of osteoarthritis visible on radiographs. Paradoxically, avascular necrosis (9%) is due to small head fractures. The results of our series are compared with the few series that have been published since CT scanning has been systematically used in the ED.
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Affiliation(s)
- P Chiron
- Orthopaedics and Trauma Surgery, Rangueil University Hospital Centre, 1, avenue J.-Poulhès, Toulouse cedex 09, France.
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Laffosse JM, Pourcel A, Reina N, Tricoire JL, Bonnevialle P, Chiron P, Puget J. Primary tumor of the periacetabular region: resection and reconstruction using a segmental ipsilateral femur autograft. Orthop Traumatol Surg Res 2012; 98:309-18. [PMID: 22463866 DOI: 10.1016/j.otsr.2011.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 07/22/2011] [Revised: 11/16/2011] [Accepted: 11/22/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bone reconstruction, after periacetabular tumour removal, is a complex procedure that carries a high morbidity rate and can result in poor clinical outcomes. Among the available options, the Puget pelvic resection-reconstruction procedure uses an autograft from the ipsilateral proximal femur to restore the anatomical and mechanical continuity of the pelvic ring before inserting an acetabular implant. HYPOTHESIS AND GOALS: This reconstruction technique satisfactorily restores the pelvic anatomy such that functional results and morbidity are comparable to alternative reconstruction techniques. PATIENTS AND METHODS This was a retrospective study of 10 patients with an average age of 38.2 years (range 19 to 75) at the surgical procedure (performed between 1986 and 2007). There were five chondrosarcomas, three Ewing tumours, one plasmacytoma and one giant cell tumour. The position of the hip centre of rotation after reconstruction and autograft integration were evaluated on radiographs. Functional results were evaluated through the Musculoskeletal Tumor Society (MSTS) score and the Postel and Merle d'Aubigné (PMA) score. RESULTS At the time of review, one patient was lost to follow-up and four had died. On radiographs, the hip centre of rotation after reconstruction was higher by a median value of 15 mm (range 5 to 35) and more lateral by a median value of 6mm (range -5 to 15). Upon evaluation of radiographs at a median time of 40 months (range 6 to 252 months), the autograft was completely integrated in five patients and partially integrated in three patients (two patients had a local recurrence). There were no cases of autograft fracture or non-union at the junctions of the graft. The median MSTS score was 25 out of 30 (range 20 to 29), or 83% (range 67 to 97%) at the median clinical follow-up of 82 months (range 49 to 264). The median PMA score was 13 out of 18 (range 12 to 18). All living patients were walking without assistance. Five patients required nine surgical revisions. Seven were attributed directly or indirectly to local recurrence; one revision was performed because of instability and one because of early acetabular loosening at 9 months. CONCLUSION This challenging procedure provides satisfactory mechanical and anatomical results, while restoring hip anatomy and function. The primary cause of failure in this series was local recurrence of the tumour, which highlights the need to carefully select the indications and optimize the surgical tumour resection.
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Affiliation(s)
- J-M Laffosse
- Department of Orthopaedic Surgery and Traumatology, Musculoskeletal Institute, Rangueil Teaching Medical Center, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
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Chiron P, Espié A, Reina N, Cavaignac E, Molinier F, Laffosse JM. Surgery for femoroacetabular impingement using a minimally invasive anterolateral approach: analysis of 118 cases at 2.2-year follow-up. Orthop Traumatol Surg Res 2012; 98:30-8. [PMID: 22257764 DOI: 10.1016/j.otsr.2011.08.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [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: 03/29/2011] [Revised: 07/04/2011] [Accepted: 08/17/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Treatment of femoroacetabular impingement (FAI) has progressed over time from using long incisions and dislocation to using arthroscopic surgery. Minimally invasive treatment has rarely been evaluated and a minimally invasive, anterolateral approach has not been used up to now for this indication. A prospective, on-going study was performed to evaluate surgical treatment of FAI with a minimally invasive, anterolateral approach. HYPOTHESIS Femoral neck, acetabulum and labrum abnormalities can be corrected without significant morbidity using a minimally invasive, anterolateral approach without dislocation. PATIENTS AND METHODS Treatment of 120 FAI cases (108 patients, 16 women, 92 men, 12 bilateral cases during one surgical session), average age: 34 years (18.9-63.5 years), was done prospectively and in an uninterrupted series. Two cases were lost to follow-up; 106 patients (118 FAI cases) were evaluated with a follow-up of at least 1 year. Assessments consisted of the Non-Arthritic Hip Score (NAHS), WOMAC, measurement of internal rotation with 90° flexion and the Nötzli alpha angle on an A/P radiograph in 45° of flexion, 45° abduction and 30° external rotation. RESULTS Blood loss averaged 1.2g/dl (range 0.5 to 2.7g/dl) and the average operative time was 44.9 minutes (range 30 to 65). With an average follow-up of 2.2 years (range 12 to 54 months), the NAHS changed by 32.5 points (P<0.0001), internal rotation by 19.0° (P<0.0001) and the alpha angle by -24.9° (P<0.0001). Eight surgical revisions were required (6.8%) (four haematomas, two capsular debridement, two additional procedures on the acetabulum) and these had a good outcome; there were no nerve-related or infection-related complications. Four failures (3.5%) were revised by arthroplasty (two patients experienced residual pain and two patients rapidly progressed to osteoarthritis). Eighteen cases progressed by only one Tönnis stage. Brooker stage II and III ossification were observed in 12 cases (10.2%) but these did not affect the functional score and range of motion improvement. DISCUSSION This approach, which can be learned and performed quickly, does not require any specific materials and yields a reliable surgical procedure without major complications. This short-term study, where the central cartilaginous compartment was not explored and the labrum was not sutured, comprised a consecutive, non-selected series of patients (independent of age, weight, osteoarthritis stage) and had encouraging results. LEVEL OF EVIDENCE Level III, prospective study, no control group.
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Affiliation(s)
- P Chiron
- Orthopaedics Department, Rangueil Teaching Hospital Center, Toulouse cedex 9, France.
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Laffosse JM, Reina N, Tricoire JL, Chiron P, Puget J. Variants of the shoulder side impact syndrome: the posterior sternoclavicular dislocation. Orthop Traumatol Surg Res 2010; 96:816-20. [PMID: 20884312 DOI: 10.1016/j.otsr.2010.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 09/22/2009] [Revised: 04/18/2010] [Accepted: 06/14/2010] [Indexed: 02/02/2023]
Abstract
Side impact syndrome of the shoulder is rare and usually associated with concomitant mid-shaft clavicle, rib and scapular fractures. Visceral complications involve pleural cavity and/or lung injuries. The authors report two rare instances of posterior sternoclavicular dislocations with this entity. This association is rare and diagnosis can be overlooked in multi-trauma patients especially when blunt thoracic lesions can be life threatening. The absence of a fracture of the clavicle after a high-energy side impact to the shoulder should suggest this diagnosis, which can be facilitated by systematic total body CT scan with 3D reconstruction. Management is surgical.
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Affiliation(s)
- J-M Laffosse
- Musculoskeletal Institute, Orthopaedic Surgery Department, Toulouse-Rangueil Teaching Hospital Center, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
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Davidson S, Reina N, Shefi O, Hai-Tov U, Akselrod S. Spectral analysis of heart rate fluctuations and optimum thermal management for low birth weight infants. Med Biol Eng Comput 1997; 35:619-25. [PMID: 9538537 DOI: 10.1007/bf02510969] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Spectral analysis of heart rate variability is studied in 10 healthy growing premature infants to investigate the changes in autonomic balance achieved as a function of changes in skin temperature. Heart rate is obtained from ECG recordings and the power spectrum of beat-to-beat heart rate fluctuations is computed. The infants maintain mean rectal temperature within 36.3-37.2 degrees C, while skin temperature changes. The respiratory rate does not change at the different servocontrol set points. Heart rate is found to increase slightly, but consistently. The low-frequency band (0.02-0.2 Hz), reflecting the interplay of the sympathetic and parasympathetic tone and known to be maximum at the thermoneutral zone, is maximum at 35.5 and 36 degrees C and decreases gradually to a lower level at a servocontrol temperature of 36.5-37 degrees C. The high-frequency band (0.2-2.0 Hz), coinciding with the respiratory peak and reflecting parasympathetic activity, is significantly elevated at 36 degrees C (p < 0.01). The minimum low: high ratio, indicating the minimum sympathetic-parasympathetic balance and possibly reflecting the most comfortable conditions, occurs at 36 degrees C, although the differences are not statistically significant. Servocontrol skin temperature may thus be adapted, and possibly selected at 36 degrees C for growing premature infants in an attempt to achieve thermal comfort and more balanced autonomic activity.
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Affiliation(s)
- S Davidson
- Department of Neonatology, Beilinson Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Ellenberg M, Reina N, Ross M, Chodoroff G, Honet JC, Gross N. Regression of herniated nucleus pulposus: two patients with lumbar radiculopathy. Arch Phys Med Rehabil 1989; 70:842-4. [PMID: 2818158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Thirty percent to 95% of patients with lumbar radiculopathy secondary to a bulging or herniated disc improve to a pain-free and functional level with nonsurgical treatment. What happens to the herniated disc material as this improvement occurs is unclear. We present two patients with lumbar radiculopathy documented by physical examination and electrodiagnostic testing. Both patients had herniated disc material at the L5 to S1 level on computed tomography (CT) scans corresponding to the side and level of their lesion on physical examination and electrodiagnostic testing. In both instances, the radiculopathy resolved with conservative treatment. CT scans were repeated in three months on one patient and four months on the other. The scans showed major resolution of the herniated disc material in both patients. These two cases demonstrate that in some patients with proven radiculopathy secondary to herniated nucleus pulposus, the herniated disc material will no longer be visible on CT scan and is presumed to resorb as the symptoms abate.
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Affiliation(s)
- M Ellenberg
- Department of Rehabilitation Medicine, Sinai Hospital, Detroit, MI 48235
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