1
|
Marty-Diloy T, Rougereau G, Mary P, Vialle R, Fitoussi F, Pietton R, Langlais T. Induced-membrane technique for lower limb reconstruction after malignant bone tumour resection in paediatric patients: Complication and re-operation rates. Orthop Traumatol Surg Res 2024:103875. [PMID: 38556207 DOI: 10.1016/j.otsr.2024.103875] [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: 04/28/2022] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 04/02/2024]
Abstract
BACKGROUND The objective of this study was to assess the complication and re-operation rates, evaluate the risk of non-union, and describe the functional outcomes at last follow-up in children and adolescents after lower-limb malignant tumour resection and reconstruction using the induced-membrane technique. HYPOTHESIS Weight-bearing resumption 6 weeks after the second stage of the induced-membrane procedure promotes bone healing. MATERIAL AND METHODS The study included 13 patients (9 with osteosarcoma, 3 with Ewing's sarcomas, and 1 with alveolar sarcoma) managed between 2000 and 2020 by oncological femoral or tibial resection followed, at a distance from adjuvant chemotherapy, by reconstruction using the induced-membrane technique. Non-union was the primary outcome measure and the MusculoSkeletal Tumor Society (MSTS) lower-limb functional score was the secondary outcome measure. Mean follow-up was 6.1 years (range, 2.0-12.7). At last follow-up, mean age was 18.1 years (range, 11.0-26.0) and the mean MSTS score was 66.6% (37.0-93.0%). RESULTS After the second reconstruction stage, 8 complications developed in 6 patients (46%). Either a complication or limb-length inequality required 12 re-operations in 8 patients (61.5%). Non-union occurred after reconstruction in 5 (38.5%) patients. Early resumption of 50% weight-bearing 6 weeks after reconstruction was associated with bone healing (p=0.02). CONCLUSION The non-union rate was 38.5%. Partial, 50% weight-bearing with two elbow crutches and an orthosis, if allowed by construct stability, may promote bone healing. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Thibault Marty-Diloy
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Grégoire Rougereau
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Service de chirurgie orthopédique et traumatologique, hôpital Pitié Salpêtrière, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Pierre Mary
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Raphael Vialle
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département hospitalo-universitaire MAMUTH pour les thérapies innovantes dans les maladies musculo-squelettiques, université de la Sorbonne, Paris, France
| | - Franck Fitoussi
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Raphael Pietton
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Service de chirurgie orthopédique et traumatologique, hôpital Pitié Salpêtrière, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Tristan Langlais
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département d'orthopédie pédiatrique, hôpital des enfants, Purpan, université de Toulouse, Toulouse, France.
| |
Collapse
|
2
|
Rougereau G, Marty-Diloy T, Vigan M, Donadieu K, Vialle R, Langlais T, Hardy A. Biomechanical evaluation of the anterior talo-fibular and calcaneo-fibular ligaments using shear wave elastography in young healthy adults. Orthop Traumatol Surg Res 2024; 110:103647. [PMID: 37356798 DOI: 10.1016/j.otsr.2023.103647] [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: 10/06/2021] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the stiffness of the anterior talo-fibular ligament (ATFL) and calcaneo-fibular ligament (CFL) using shear wave elastography (SWE) with the ankle in the neutral position and in varus, in young healthy adult volunteers. We also evaluated the reliability and reproducibility of the SWE measurements. HYPOTHESIS The stiffness of both ligaments increases with increasing ankle varus. SWE may be a reliable tool for evaluating the lateral collateral ligament complex of the ankle. MATERIAL AND METHODS We used SWE to evaluate both ankles of each of 20 healthy volunteers (10 females and 10 males). For each test, the foot was placed on a hinged plate and tested in the neutral position and in 15° and 30° of varus. Stiffness was evaluated based on shear wave velocity (SWV). RESULTS Stiffness of both the ATFL and CFL was minimal in the neutral position (2.06m/s and 3.43m/s, respectively). Stiffness increased significantly for both ligaments in 15° of varus (2.48m/s and 4.11m/s, respectively; p<0.0001) and was greatest in 30° of varus (3.15m/s and 4.57m/s, respectively; p<0.0001). ATFL stiffness was greater in males than in females in 15° (p=0.04) and 30° (p=0.02) of varus. For the CFL, in contrast, stiffness was not different between males and females. Stiffness of the ATFL and CFL was not associated with age, dominant side, height, or foot morphology. No correlations were found between stiffness of the two ligaments in any of the positions. Repeating each measurement three times produced excellent concordance for both ligaments in all three positions. CONCLUSION The ATFL and CFL are the main lateral stabilisers of the ankle, and each exerts a specific function. Their stiffness increases with the degree of varus. This study describes a protocol for evaluating ATFL and CFL density by SWE, which is a reliable and reproducible technique that provides a normal range. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Grégoire Rougereau
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département de chirurgie orthopédique adulte, hôpital de la Pitié-Salpêtrière, université de la Sorbonne, AP-HP, 75571 Paris, France.
| | - Thibault Marty-Diloy
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Marie Vigan
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Unité de recherche clinique, hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 92100 Boulogne-Billancourt, France
| | - Kalinka Donadieu
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Raphaël Vialle
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département hospitalo-universitaire MAMUTH pour les thérapies innovantes dans les maladies musculosquelettiques, université de la Sorbonne, Paris, France
| | - Tristan Langlais
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département de chirurgie orthopédique pédiatrique, hôpital des enfants, université de Toulouse, Purpan, Toulouse, France
| | - Alexandre Hardy
- Département de chirurgie orthopédique, clinique du sport, 75005 Paris, France
| |
Collapse
|
3
|
Rougereau G, Marty-Diloy T, Vigan M, Donadieu K, Vialle R, Langlais T, Hardy A. Biomechanical evaluation of the spring ligament and the posterior tibial tendon by shear-waves elastography: validation of a reliable and reproducible measurement protocol. J Exp Orthop 2023; 10:121. [PMID: 38006458 PMCID: PMC10676337 DOI: 10.1186/s40634-023-00678-w] [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: 03/13/2023] [Accepted: 10/19/2023] [Indexed: 11/27/2023] Open
Abstract
PURPOSE The anatomy of the spring ligament complex, as well as its pathology, is not well known in daily clinical practice. The purpose of this study was to evaluate the shear-wave elastography properties of the spring ligament and the posterior tibial tendon in healthy adults, and to assess the reliability and reproducibility of these measurements. METHODS Shear-wave elastography was used to evaluate both ankles in 20 healthy patients (10 females/10 males) resting on a hinge support with their ankles in neutral, valgus 20° and varus 30° positions. The stiffness of the spring ligament and posterior tibial tendon was assessed by measuring the speed of shear wave propagation through each structure. RESULTS Posterior tibial tendon and spring ligament reach a maximum estimated stiffness in valgus 20° position (7.43 m/s vs 5.73 m/s, respectively). Flat feet were associated with greater spring ligament stiffness in the 20° valgus position (p = 0.01), but not for the posterior tibial tendon (p = 0.71). The physiologic weightbearing hindfoot attitude had no impact on the stiffness of the posterior tibial tendon or the spring ligament, regardless of the analysis position. Intra- and inter-observer agreements were all excellent for spring ligament stiffness, regardless of ankle position, and were good or excellent for posterior tibial tendon. CONCLUSIONS This study describes a protocol to assess the stiffness of tibialis posterior and the spring ligament by shear-wave elastography, which is reliable, reproducible, and defines a corridor of normality. Further studies should be conducted to define the role of elastography for diagnosis/ evaluation of pathology, follow-up, or surgical strategies.
Collapse
Affiliation(s)
- Grégoire Rougereau
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, 75571, Paris, France.
- Department of Adult Orthopedic Surgery, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75571, Paris, France.
| | - Thibault Marty-Diloy
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, 75571, Paris, France
| | - Marie Vigan
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, 75571, Paris, France
- Unité de Recherche Clinique Hôpitaux Universitaires Paris Ile-de-France Ouest, APHP, 92100, Boulogne-Billancourt, France
| | - Kalinka Donadieu
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, 75571, Paris, France
| | - Raphaël Vialle
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, 75571, Paris, France
- Department for Innovative Therapies, Musculoskeletal Disease Sorbonne University, The MAMUTH Hospital University, Paris, France
| | - Tristan Langlais
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, 75571, Paris, France
- Department of Pediatric Orthopedic Surgery, Toulouse University, Children's Hospital, Purpan, Toulouse, France
| | - Alexandre Hardy
- Department of Orthopedic Surgery, Clinique du Sport, 75005, Paris, France
| |
Collapse
|
4
|
Rougereau G, Marty-Diloy T, Bonaccorsi R, Vialle R, Boisrenoult P, Pascal-Moussellard H, Langlais T. Malpractice litigation after spinal surgery: A review of allegations in France in 1990-2020. Orthop Traumatol Surg Res 2023; 109:103510. [PMID: 36509364 DOI: 10.1016/j.otsr.2022.103510] [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: 03/05/2021] [Revised: 06/05/2021] [Accepted: 07/05/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Spinal surgery is among the specialities with the highest rates of complications and of peri-operative morbidity and mortality. The number of spinal surgeries performed is rising year on year in France. The objectives of this study were to identify the main reasons for malpractice claims after spinal surgery in France, to evaluate the impact of avoidable errors, and to examine differences between civil lawsuits (private institutions) and administrative lawsuits (public institutions). HYPOTHESIS The leading reasons for malpractice litigation are avoidable errors such as inadequate patient information, errors in indications, and inadequate post-operative monitoring. MATERIAL AND METHODS We reviewed malpractice claims related to spinal surgery and recorded in two French databases (Legifrance and Doctrine) in 1990-2020. We combined the indexing term "surgery" with any of the following terms: "disc", "spine", "cervical", "vertebral", "lumbar", "scoliosis", "disc replacement", and "fusion". The search was performed by three orthopaedic surgeons who were blind to patient data and recorded the allegations, verdicts, and pay-outs. RESULTS We included 275 claims. The main plaintiff allegations were inadequate information (34.5%), infection (22%), spinal-cord injury (17%), and errors in indication (13%). Among these reasons, 56.7% may have been partly avoidable. In private institutions, claims for infection and for erroneous indication were significantly more common than in public institutions (p=0.02 for both), whereas the opposite was true for spinal-cord injury (p<0.001). CONCLUSION After spinal surgery in France, the most common malpractice allegation was inadequate information. Over half the claims were related to potentially avoidable factors. Among allegations, errors in indication were significantly more common in civil than in administrative lawsuits. LEVEL OF PROOF IV, retrospective observational database study.
Collapse
Affiliation(s)
- Grégoire Rougereau
- Département d'orthopédie et traumatologie, CHU Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | | | - Raphaël Bonaccorsi
- Département d'orthopédie et traumatologie, CHU Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Raphaël Vialle
- Département de Maladies Musculo-Squelettiques et Innovations Thérapeutiques (MAMUTH), Sorbonne Université, Paris, France; Département d'orthopédie pédiatrique, CHU Trousseau, AP-HP, Sorbonne Université, Paris, France
| | - Philippe Boisrenoult
- Département d'orthopédie et traumatologie, CH Versailles A. Mignot, Le Chesnay, France
| | - Hugues Pascal-Moussellard
- Département d'orthopédie et traumatologie, CHU Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Tristan Langlais
- Département d'orthopédie pédiatrique, CHU Trousseau, AP-HP, Sorbonne Université, Paris, France; Département d'orthopédie pédiatrique, CHU Purpan, Toulouse Université, Toulouse, France.
| |
Collapse
|
5
|
Rougereau G, Langlais T, Vigan M, Hardy A, Vialle R, Marty-Diloy T, Cambon-Binder A. Ankle syndesmosis biomechanical evaluation by shear-waves elastography in healthy young adults: Assessment of the reliability and accuracy of the measurements and definition of a corridor of normality. Foot Ankle Surg 2022; 28:1279-1285. [PMID: 35717494 DOI: 10.1016/j.fas.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Aims of this study were: 1/ to evaluate the shear wave speed (SWS) properties of the anteroinferior tibiofibular ligament (AITFL) and the distal interosseous membrane (DIOM) in neutral, dorsal flexion and plantar flexion positions in a cohort of healthy adult volunteers; 2/ to assess the reliability and reproducibility of these measurements. METHODS Both ankles were analyzed by shear wave elastography (SWE) in 20 healthy patients (10 females/10 males) standing on a hinge support with their ankles in neutral, 20° dorsal flexion and 30° plantar flexion positions. Stiffness of AITFL and DIOM was evaluated by SWS measurement. RESULTS The SWS of AITFL and DIOM were minimal in the plantar flexion position (4.28 m/s [2.65-5.11] and 3.35 m/s [1.69-4.55], respectively). It increased significantly for both ligaments in neutral position (4.69 m/s [3.53-5.71] and 3.81 m/s [1.91-4.74], respectively; p < 0.0001), and reached their maximum values in dorsal flexion (6.58 m/s [5.23-8.34] and 4.79 m/s [3.07-6.19], respectively; p < 0.0001). There was no correlation between each ligament regardless the positions. SWS of AITFL was independent of demographic characteristics analyzed. SWS of DIOM was negatively correlated with height in dorsal flexion (ρ = -0.35; p = 0.03) and in plantar flexion (ρ = -0.37; p = 0.02). Female gender was associated with increased DIOM SWS in neutral (p = 0.005), dorsal flexion (p = 0.003), and plantar flexion (p = 0.001) positions. Moreover, foot morphology (foot arch, hind foot frontal deviation) did not impact AITFL nor DIOM SWS. Inter- and intra-observer measurements were all good or excellent. CONCLUSION The AITFL and DIOM, stabilizers of the distal tibiofibular syndesmosis, increase in stiffness while dorsal flexion increases. This study describes a reliable and reproducible protocol to assess their stiffness by SWE, and defines a corridor of normality.
Collapse
Affiliation(s)
- Grégoire Rougereau
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Sorbonne University, Department of Adult Orthopedic Surgery, Pitié-Salpêtrière Hospital, APHP, 75571 Paris, France.
| | - Tristan Langlais
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Toulouse University, Department of Pediatric Orthopedic Surgery, Children's Hospital, Purpan, Toulouse, France
| | - Marie Vigan
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Department of Adult Orthopedic surgery, Hospital Ambroise Paré, APHP, 92100 Boulogne-Billancourt, France
| | - Alexandre Hardy
- Clinique du sport, Department of Orthopedic Surgery, 75005 Paris, France
| | - Raphaël Vialle
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France
| | - Thibault Marty-Diloy
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France
| | - Adeline Cambon-Binder
- Sorbonne University, Department of Adult Orthopedic Surgery, Saint Antoine Hospital, APHP, 75571 Paris, France
| |
Collapse
|
6
|
Rougereau G, Marty-Diloy T, Vigan M, Vialle R, Soubeyrand M, Langlais T. Biomechanical assessment of the central band of the interosseous membrane using shear wave elastography: reliability and reproducibility. J Hand Surg Eur Vol 2022; 47:1134-1141. [PMID: 35953882 DOI: 10.1177/17531934221114301] [Citation(s) in RCA: 2] [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] [Indexed: 02/03/2023]
Abstract
The interosseous membrane of the forearm is an essential structure for the stability of the forearm skeleton, the most important part being the central band. The purpose of this study was to determine if shear wave elastography, a non-invasive ultrasound technique, can be used to measure shear wave speed in the central band and quantify stiffness. Fifteen healthy adult subjects were included (30 forearms). The participants forearms were positioned on an articulated plate, with their hand in neutral, pronated and then supinated positions of 30°, 60° and 90°. The shear wave speed was highest in 90° pronation (4.4 m/s (SD 0.3)) and 90° supination (4.4 m/s (SD 0.27)) indicating maximum stiffness in these positions. Its minimum value was in the neutral position, and either in 30° pronation or supination (3.5 m/s (SD 0.3)). Intra- and interobserver agreement was excellent, regardless of probe positioning or forearm mobilization. This study presents a reliable shear wave elastography measurement protocol to describe the physiological function of the central band of the interosseous membrane in healthy adults.Level of evidence: IV.
Collapse
Affiliation(s)
- Grégoire Rougereau
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, Paris, France.,Department of Adult Orthopedic Surgery, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Thibault Marty-Diloy
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, Paris, France
| | - Marie Vigan
- Unité de Recherche Clinique Hôpitaux Universitaires Paris Ile-de-France Ouest, APHP, Boulogne-Billancourt, France
| | - Raphaël Vialle
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, Paris, France.,MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris
| | - Marc Soubeyrand
- Department of Orthopedics and Traumatology, Clinique Saint Jean l'Ermitage, Melun, France
| | - Tristan Langlais
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, Paris, France.,Department of Pediatric Orthopedic Surgery, Toulouse University, Children's hospital, Purpan, Toulouse, France
| |
Collapse
|
7
|
Rougereau G, Marty-Diloy T, Pietton R, Vialle R, Langlais T, Mary P. Induced-Membrane Reconstruction After Calcaneum's Ewing Sarcoma in Children: A Report of 3 Cases. J Foot Ankle Surg 2022; 61:e5-e8. [PMID: 34657808 DOI: 10.1053/j.jfas.2021.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/08/2020] [Accepted: 09/07/2021] [Indexed: 02/03/2023]
Abstract
Calcaneus's Ewing sarcoma is a rare location with a poor prognosis and remains challenging for tumor surgery. We present 3 cases of calcaneus resection for Ewing sarcoma in children and its reconstruction managed by induced-membrane technique. To our knowledge, this technique has never been published for hindfoot's tumor management. Three children (aged from 9 to 14 years) had partial or total resection of calcaneus initially replaced by a cement spacer. The second step consisted of removing the cement and filling the membrane cavity with autograft taken from the ipsilateral iliac crest, potentially combined with bone substitute. In the meantime, children received chemotherapy and possibly radiotherapy according to the Euro E.W.I.N.G. 99 protocol. It was possible to optimize bone formation as we carried out the bone grafting procedure sometime after the treatments. In one case, the evolution was marked by local septic complication, 9 months after resection, and by tumor recurrence in presacral soft tissues treated with radiotherapy and chemotherapy. Partial weightbearing was allowed after 6 weeks of cast, under the protection of a splint. Graft consolidation was achieved at a median of 3.2 months (3-3.5) for all. After a median follow-up of 9 years (5-13), all preserved their limb and were considered in remission. The 3 children reached adulthood, with a median age of 21 years (19-24.8). At last follow-up, median Musculoskeletal Tumor Score was 73% (63-87), and median American Orthopaedic Foot and Ankle Society hind foot score was 78 (72-87).
Collapse
Affiliation(s)
- Gregoire Rougereau
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France.
| | - Thibault Marty-Diloy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Raphaël Pietton
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Raphaël Vialle
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France; Department for Innovative Therapies in Musculoskeletal Disease, The MAMUTH Hospital University, Sorbonne University, Paris, France
| | - Tristan Langlais
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France; Department of Pediatric Orthopedics, Purpan Hospital, Toulouse, France
| | - Pierre Mary
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| |
Collapse
|
8
|
Rougereau G, Marty-Diloy T, Vigan M, Donadieu K, Hardy A, Vialle R, Langlais T. A Preliminary Study to Assess the Relevance of Shear-Wave Elastography in Characterizing Biomechanical Changes in the Deltoid Ligament Complex in Relation to Ankle Position. Foot Ankle Int 2022; 43:840-849. [PMID: 35373593 DOI: 10.1177/10711007221079829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was (1) to evaluate the biomechanical properties of the different bundles of the deltoid ligament in various ankle positions in a cohort of healthy adult volunteers; (2) describe the impact of demographic and hindfoot morphology characteristics on their stiffness; (3) to assess the reliability and reproducibility of these measurements. METHODS Deltoid ligament complex of both ankles were assessed by shear-wave elastography (SWE) in 20 healthy patients resting on hinge support. The propagation shear-wave speed (SWS) in ligaments was measured, which is related to the tissue's elastic modulus. The following ligaments were analyzed in a neutral position and then in varus, valgus, dorsal, and plantar flexions: tibionavicular ligament (TNL), tibiocalcaneal ligament (TCL), the superficial posterior tibiotalar ligament (SPTL), the anterior tibiotalar ligament (ATTL), and the deep posterior tibiotalar ligament (DPTTL). RESULTS The mean SWS increased between neutral and 20 degrees valgus position for TCL (4.08 ± 0.78 m/s vs 5.56 ± 0.62 m/s, respectively; P < .0001) and for DPTTL (2.58 ± 0.52 m/s vs 3.59 ± 0.87 m/s, respectively; P < .0001). The mean SWS increased between neutral and 30 degrees plantarflexion for ATTL (2.11 ± 0.44 m/s vs 3.1 ± 0.5 m/s, respectively; P < .0001) and TNL (2.96 ± 0.66 m/s vs 4.99 ± 0.69 m/s, respectively; P < .0001). The mean SWS increased between neutral and 20 degrees dorsal flexion for SPTL (4.2 ± 1 m/s vs 5.45 ± 0.65 m/s, respectively; P < .0001).Women had less DPTTL SWS than men in the neutral position (2.37 ± 0.35 m/s vs 2.71 ± 0.49 m/s, respectively; P = .007). Other demographics had no impact on the SWS value of other ligaments. All inter- and intraobserver agreements were good to excellent. CONCLUSION This study presents a reliable and reproducible SWE measurement protocol to describe the physiological function of all bundles of the medial collateral ligament in healthy adults. CLINICAL RELEVANCE This examination technique can be available to orthopaedic surgeons, allowing reliable and reproducible monitoring of the SWS of the various ligaments constituting the medial collateral plane. The biomechanical values described in this study may give insight into in what position medial ankle ligament reconstruction should be tensioned.
Collapse
Affiliation(s)
- Grégoire Rougereau
- Department of Pediatric Orthopedic surgery, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
- Department of Adult Orthopedic surgery, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
| | - Thibault Marty-Diloy
- Department of Pediatric Orthopedic surgery, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Marie Vigan
- Department of Pediatric Orthopedic surgery, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
- Unité de Recherche Clinique Hôpitaux Universitaires Paris Ile-de-France Ouest, APHP, Boulogne-Billancourt, France
| | - Kalinka Donadieu
- Department of Pediatric Orthopedic surgery, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Alexandre Hardy
- Clinique du sport, Department of Orthopedic surgery, Paris, France
| | - Raphaël Vialle
- Department of Pediatric Orthopedic surgery, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
- Department for Innovative Therapies in Musculoskeletal Disease, The MAMUTH Hospital, Sorbonne University, Paris
| | - Tristan Langlais
- Department of Pediatric Orthopedic surgery, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
- Department of Pediatric Orthopedic surgery, Children's hospital, Purpan, Toulouse University, Toulouse, France
| |
Collapse
|
9
|
Rougereau G, Marty-Diloy T, Rougereau G, Boisrenoult P, Langlais T. Litigation after hallux valgus surgery in France between 2000 and 2020: A review of the two national legal research databases. Foot Ankle Surg 2022; 28:497-502. [PMID: 35063363 DOI: 10.1016/j.fas.2022.01.004] [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: 04/20/2021] [Revised: 06/18/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The objectives of this review were to: 1) describe reasons for lawsuits following primary hallux valgus surgery in France from 2000 to 2020; 2) to compare private and public practice. METHODS Civil (private practice) and administrative (public practice) court decisions in France between 2000 and 2020 were collected using the two leading legal data sources (Legifrance, Doctrine). RESULTS Seventy-two court decisions related to hallux valgus surgery were included. An appeal was filed in 93% of cases. Finally, 70.8% of the verdicts were in favor of the complainants. The average compensation awarded to a plaintiff was €55,333. The main reasons for complaint after hallux valgus surgery were: a failure to provide preoperative information (47.2%), post-operative pain/stiffness (38.9%), and infection (30.6%). A proven lack of information increased the risk of recognizing the occurrence of post-operative pain and stiffness as faulty from 13.3% to 61.5% (p = 0.01), and the average compensation from €25,330 to €76,716 (p = 0.04). The duration of the procedure was about 1.5 years longer in civil proceedings (p = 0.04). There was no significant difference between private and public activity litigation. CONCLUSION Clear and adapted patient information and its traceability could be a way to reduce the number of complaints and their consequences in case of disappointing results.
Collapse
Affiliation(s)
- Grégoire Rougereau
- Department of Orthopedics and Traumatology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
| | - Thibault Marty-Diloy
- Department of Orthopedic and Trauma Surgery, University Hospital Center, 2 Rue de la Milétrie, 86021 Poitiers, France
| | - Guillaume Rougereau
- Department of Orthopedic Surgery, Clinique du Trocadéro, 62 Rue de la Tour, 75116 Paris, France
| | - Philippe Boisrenoult
- Department of Orthopedic and Trauma Surgery, André Mignot Hospital, University Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France
| | - Tristan Langlais
- Department of Orthopedics Pediatrics, Children Hospital Purpan, Toulouse University, Toulouse, France
| |
Collapse
|
10
|
Langlais T, Rougereau G, Marty-Diloy T, Bachy M, Barret H, Vialle R, Fitoussi F. Surgical treatment in child's congenital toe syndactyly: Risk factor of recurrence, complication and poor clinical outcomes. Foot Ankle Surg 2022; 28:107-113. [PMID: 33642221 DOI: 10.1016/j.fas.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/30/2020] [Revised: 12/31/2020] [Accepted: 02/11/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Surgical treatment of toe syndactyly remains controversial. The strong demand from parents for a cosmetic release is increasing in our societies. But is it worth it? The objective was to assess medium-long term outcomes and to identify the risk factors of recurrence, complication and poor clinical outcomes. METHODS Sixty-eight toe syndactylies (38 patients) undergoing surgery between 2008 and 2017 with a follow-up higher than two years were included consecutively and retrospectively. Four children (four syndactylies) were lost to follow-up and excluded. The mean age of the first surgery was 3.9 years old (0.8-16.7) and cohort mean follow-up was 6.9 years (2.8-11.2). In all patients, web release with a commissural dorsal flap was performed and associated a cutaneous resurfacing (spontaneous epithelialization, full-thickness skin graft taken from the popliteal crease, or a hyaluronic acid ester matrix). RESULTS Eighteen syndactylies (28.1%) in 14 patients recurred and one syndactyly required revision surgery. An age of surgery above two years was the only risk factor for recurrence found in univariate (OD = 0.27[0.08;0.85];p = 0.02) and multivariate studies (IC 95% = 0.05-0.68;p = 0.02). Seven complications (11.7%) in seven syndactylies (6 patients) were reported with six keloids (9.4%) and one scar retraction (1.6%). Each complication underwent an additional procedure. African ethnicity (N = 15) represents a risk factor (N = 4/15; OD = 0.12[0.009;0.97];p = 0.02) for keloids formation. Withey's average score is 4.9 (1-11), mean OxAFQ-C score was 52/60 (30-60), 67% would repeat the surgery and 69% felt satisfied at last follow-up. The simple syndactyly would appear less satisfied than complex or complicated (p = 0.02). CONCLUSIONS Surgical treatment of child's congenital syndactyly involves a risk of recurrence (28%) and potential complications (11,7%). Performed surgical procedure over two years old increase the risk of recurrence. African ethnicity is a risk factor in scarring complication. Only half of simple syndactylies are satisfied and prone to repeat the surgery.
Collapse
Affiliation(s)
- Tristan Langlais
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France; Children's Hospital, Purpan, Toulouse University, Toulouse, France.
| | - Gregoire Rougereau
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Thibault Marty-Diloy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Manon Bachy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Hugo Barret
- Orthopedics Department, Purpan, Toulouse University, Toulouse, France
| | - Raphaël Vialle
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France; The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France
| | - Franck Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France; The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France
| |
Collapse
|
11
|
Rougereau G, Fitoussi F, Marty-Diloy T, Bachy M, Vialle R, Langlais T. Strategy and clinical outcomes of child foot surgery for macrodactyly. Orthop Traumatol Surg Res 2021; 109:103109. [PMID: 34648998 DOI: 10.1016/j.otsr.2021.103109] [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: 07/23/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Amputation of the abnormal segment seems to be the reference standard treatment for the surgical management of macrodactyly of the foot in children. Our objectives here were to detail the surgical strategies according to the cause, anatomical characteristics, and static or progressive nature of the macrodactyly and to evaluate the long-term clinical outcomes. HYPOTHESIS Conservative treatment can be an option in the management of static macrodactyly of the foot in children. MATERIAL AND METHODS We retrospectively included 24 feet in 19 patients seen consecutively. There were 12 primary and 12 secondary types. The macrodactyly was static in 9 cases and progressive in 15 cases. The treatment consisted in either conservative procedures or amputation of the segment. All patients completed the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) to evaluate their quality of life, shoe wear issues, and satisfaction with their treatment. RESULTS Mean age at first surgery was 5.8 years (range, 0.5-11.5) and the mean interval between two procedures was 2.3 years (range, 0.3-5.5). Mean number of procedures per foot was 2.2 par pied (range, 0-7). All 9 static forms were managed conservatively. Amputation was performed in 11 of the 15 progressive forms. The mean number of procedures was significantly higher in the progressive forms (4.1 vs. 1.5/pied; p=0.006). Two patients died during follow-up. The remaining 17 patients, with 22 affected feet (primary and secondary in 11 cases; progressive in 14 cases and static in 8 cases) were re-evaluated. Mean follow-up was 9.4 years (range, 2.7-20.6). The final OxAFQ-C score was 46/60 (range, 18-58). Of the 17 patients, 86% would be willing to repeat the same surgical procedures and 77% were satisfied with their treatment at last follow-up. We found no differences between the groups managed with amputation and with conservative treatment regarding quality of life, satisfaction, or shoe size difference. CONCLUSIONS Conservative treatment deserves a place in the treatment of static macrodactyly of the foot in children. Regarding amputation of the segment in progressive forms, it is important to reassure the patients and parents about the expected results but also to inform them about the risk of requiring repeat surgical procedures. LEVEL OF EVIDENCE IV, retrospective study.
Collapse
Affiliation(s)
- Gregoire Rougereau
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France; Département de chirurgie orthopédique, hôpital Pitié-Salpêtrière, Sorbonne université, Paris, France
| | - Franck Fitoussi
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Thibault Marty-Diloy
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Manon Bachy
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Raphaël Vialle
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France; Département universitaire MAMUTH des thérapies innovantes en matière de maladies musculo-squelettiques, Paris, France
| | - Tristan Langlais
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France; Hôpital des enfants, Purpan, Toulouse université, Toulouse, France.
| |
Collapse
|
12
|
Rougereau G, Marty-Diloy T, Pietton R, Koneazny C, Fitoussi F, Vialle R, Mary P, Langlais T. Forearm reconstruction by induced-membrane technique after sarcoma resection in children: technique and functional outcome in three cases. Hand Surg Rehabil 2021; 40:799-803. [PMID: 34171528 DOI: 10.1016/j.hansur.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
Forearm sarcoma is rare in children. Here, we report three cases. One child presented undifferentiated soft-tissue sarcoma involving the ulna, another had Ewing's sarcoma of the ulna, and the third had Ewing's sarcoma of the proximal radius. In the first case, there were episodes of iterative aseptic nonunion, treated surgically. At last follow-up (respectively 11, 9 and 8 years postoperatively), the mean Musculoskeletal Tumor Society (MSTS) score was 80%, 90% and 77% respectively, and all cases were in remission. The induced membrane technique to reconstruct bone defect after sarcoma resection in children is a possible limb-salvage strategy.
Collapse
Affiliation(s)
- G Rougereau
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - T Marty-Diloy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - R Pietton
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - C Koneazny
- The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - F Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - R Vialle
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - P Mary
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - T Langlais
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Department of Pediatric Orthopedics, Purpan Hospital, 330 Avenue de Grande Bretagne, 31300 Toulouse, France.
| |
Collapse
|
13
|
Delbast L, Pic JB, Marty-Diloy T, Dimet J, Lepetit C. Stabilization of the distal radioulnar joint by reconstructing the interosseous membrane's distal oblique bundle: Cadaver study. Orthop Traumatol Surg Res 2020; 106:1581-1587. [PMID: 33082121 DOI: 10.1016/j.otsr.2020.03.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/13/2019] [Revised: 02/27/2020] [Accepted: 03/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The distal radioulnar (DRU) ligaments play a key role in stabilizing the DRU joint. Ligament reconstruction in this area is an accepted treatment. However, another structure may also be a significant DRUJ stabilizer-the distal oblique bundle (DOB) of the interosseous membrane (IOM). Recent studies have described DOB reconstruction methods, which should be compared to DRU ligament reconstruction. METHODS Twelve upper limbs were used. First, a descriptive anatomy study was done to determine the prevalence and features of the DOB (insertions, thickness, and relationship with DRU ligaments). Second, biomechanical testing was done with the wrist in neutral position, supination, and pronation. Distal radius translation was evaluated first on an intact wrist then evaluated again after creating bidirectional instability. Lastly, the same tests were repeated after DRU reconstruction using the Adams-Berger technique and DOB reconstruction using the Riggenbach technique. RESULTS The DOB was present in 50% of specimens and was bilateral. Reconstructing the DOB stabilized the wrist to the same degree as the Adams-Berger technique in neutral and pronation (8% residual major instability). Stability was harder to achieve in supination (25% major instability). It was better at controlling posterior radial translation than anterior translation (3% versus 14% major instability). CONCLUSION DOB reconstruction appears to be a reliable and less invasive treatment option for DRUJ instability since it is extra-articular. However, the wrist's position and the direction of radial translation seem to alter the stabilization's effectiveness. LEVEL OF EVIDENCE IV; Cadaver study.
Collapse
Affiliation(s)
- Laurent Delbast
- Service de chirurgie orthopédique du centre hospitalier de Mont-de-Marsan, 417, avenue Pierre-de-Coubertin, BP 417, 40024 Mont-de-Marsan cedex, France.
| | - Jean-Baptiste Pic
- Service de chirurgie orthopédique du centre hospitalier de Niort, 40, avenue Charles-de-Gaulle, BP 70600, 79021 Niort cedex, France
| | - Thibault Marty-Diloy
- Service de chirurgie orthopédique du centre hospitalier universitaire de Poitiers, 2, rue de la-Milétrie, 86021 Poitiers, France
| | - Jérôme Dimet
- Centre de recherche clinique GHT des Landes, centre hospitalier de Mont-de-Marsan, 417, avenue Pierre-de-Coubertin, BP 417, 40024 Mont-de-Marsan cedex, France
| | - Cédric Lepetit
- Capio clinique Aguiléra, 21, rue de l'Estagnas, CS 60179, 64201 Biarritz, France
| |
Collapse
|