Search

Introduction: Human spontaneous osteonecrosis of the knee (SPONK) is still challenging as the current treatments do not allow the production of hyaline cartilage tissue. The aim of the present study was to explore the therapeutic potential of cartilage regeneration using a new biphasic scaffold (type I collagen/hydroxyapatite) previously loaded or not with concentrated bone marrow cells., Material and Methods: Female rabbits were operated of one knee to create articular lesions of the trochlea (three holes of 4 × 4mm). The holes were left empty in the control group or were filled with the scaffold alone or the scaffold previously loaded with concentrated bone marrow cells. After two months, rabbits were sacrificed and the structure of the newly formed tissues were evaluated by macroscopic, MRI, and immunohistochemistry analyses., Results: Macroscopic and MRI evaluation of the knees did not show differences between the three groups (p > 0.05). However, histological analysis demonstrated that a higher O'Driscoll score was obtained in the two groups treated with the scaffold, as compared to the control group (p < 0.05). The number of cells in treated area was higher in scaffold groups compared to the control group (p < 0.05). There was no difference for intensity of collagen type II between the groups (p > 0.05) but subchondral bone repair was significantly thicker in scaffold-treated groups than in the control group (1 mm for the control group vs 2.1 and 2.6 mm for scaffold groups). Furthermore, we observed that scaffolds previously loaded with concentrated bone marrow were more reabsorbed (p < 0.05)., Conclusion: The use of a biphasic scaffold previously loaded with concentrated bone marrow significantly improves cartilage lesion healing.

Purpose: During tibial tubercle transfer, popliteal vessels are at risk from drills and screws. The risk is around 0.11%, as described in the literature. We reviewed knee injected CT scan for analysis of the location of arteries, identified landmarks allowing minimizing risks, and defined a safe zone., Material and Method: Distances between the posterior cortex and arteries were measured on CT scans from 30 adults (60 knees) at three levels (proximal part of the tibial tuberosity, 20 mm and 40 mm distally). Data were used to create a "risk map" with different angular sectors where the frequency of the presence of arteries was analyzed in each area. We also analyzed the position of 68 screws of 47 patients who underwent a medial tibial tuberosity transfer., Results: The nearest distance between artery and the posterior tibial cortex was found at the level corresponding to the top of the tuberosity with less than 1 mm, while the largest distance was found at the distal level. We were able to define a safe zone for drilling through the posterior tibial cortex which allows a safe fixation for the screws. This zone corresponds to the medial third of the posterior cortex. When the safe zone is not respected, screws that overtake the posterior cortex may be close to arteries as observed for 37 of the 68 screws analyzed., Conclusion: We described new landmarks and recommendations to avoid this complication during tibial tuberosity transfer.

Neuroarthropathy or Charcot disease is a destructive joint pathology. Upper limb involvement is unusual and often due to syringomyelia. We reported a patient with spontaneous posterior right shoulder dislocation. Thereafter, she presented a quick joint destruction evoking a Charcot shoulder disease after excluding infectious and rheumatologic diseases. Explorations of this Charcot disease lead to the discovery and treatment of syringomyelia. A conservative management of her shoulder neuro-arthropathy has been proposed to the patient. Shoulder involvement in Charcot disease is unusual: only 5% of cases. 18 cases have been reported in English literature. Two theories try to explain Charcot disease: neuro-vascular and neuro-traumatic. There is no efficient treatment for Charcot shoulder disease but it can be prevented by surgical treatment of syringomyelia. Charcot shoulder is a rare and morbid disease for which conservative treatment is recommended because of disappointing results of arthroplasty and arthrodesis.

Case: A 38-year-old woman who had returned to sports activity (running) after having clinically recovered from anorexia nervosa presented with a bilateral femoral neck stress fracture that was treated with bilateral hip osteosynthesis., Conclusion: Although exercise is usually considered to be beneficial for health, heavy exercise (such as running) after recovery from anorexia nervosa may be associated with an increased risk of fracture.

Introduction: Bare-metal stents are used to treat arterial stenotic lesions. Morbidity and mortality are less important compared with other techniques. Drug-eluting balloons are often used to treat stent stenosis. We reported the case of a bare-metal stent infection after drug-eluting balloon and a review on the subject., Material and Method: Two weeks after percutaneous transluminal angioplasty with paclitaxel-eluting balloon and a bare-metal stent, our patient presented an infection of the stent. Diagnosis was based on the clinical presentation, positron emission tomography findings and isolation of Propionibacterium granulosum in repeated blood cultures. Adapted antibiotic therapy was given for three months with removal of the surgical bare-stent. Antibiotic therapy was interrupted after a second positron emission tomography. A literature search (PubMed and Cochrane) was performed on the subject., Results: We found 49 cases of peripheral bare-metal stent infection including our patient. This is a rare but serious complication with a high morbidity (25% amputation rate) and mortality (30%). It seems to be underestimated. Treatment is based on surgical ablation of the bare-metal stent and intravenous antibiotics. The role of the paclitaxel-eluting balloon is not clearly established but some authors believe that it can produce a local immunosuppression., Conclusion: We report the first case of bare-metal stent infection after paclitaxel-eluting balloon. This complication is rare and difficult to diagnose. Manifestations are often limited to skin signs. Functional and vital prognosis is poor., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objectives: Common video systems for video-assisted thoracic surgery (VATS) provide the surgeon a two-dimensional (2D) image. This study aimed to evaluate performances of a new three-dimensional high definition (3D-HD) system in comparison with a two-dimensional high definition (2D-HD) system when conducting a complete thoracoscopic lobectomy (CTL)., Methods: This multi-institutional comparative study trialled two video systems: 2D-HD and 3D-HD video systems used to conduct the same type of CTL. The inclusion criteria were T1N0M0 non-small-cell lung carcinoma (NSCLC) in the left lower lobe and suitable for thoracoscopic resection. The CTL was performed by the same surgeon using either a 3D-HD or 2D-HD system. Eighteen patients with NSCLC were included in the study between January and December 2013: 14 males, 4 females, with a median age of 65.6 years (range: 49-81). The patients were randomized before inclusion into two groups: to undergo surgery with the use of a 2D-HD or 3D-HD system. We compared operating time, the drainage duration, hospital stay and the N upstaging rate from the definitive histology., Results: The use of the 3D-HD system significantly reduced the surgical time (by 17%). However, chest-tube drainage, hospital stay, the number of lymph-node stations and upstaging were similar in both groups., Conclusions: The main finding was that 3D-HD system significantly reduced the surgical time needed to complete the lobectomy. Thus, future integration of 3D-HD systems should improve thoracoscopic surgery, and enable more complex resections to be performed. It will also help advance the field of endoscopically assisted surgery., (© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Purpose: The bony anatomy of the human ilium has been well described from a qualitative perspective; however, there are little quantitative data to help the surgeon to perform bone marrow aspiration from the iliac crest in the thickest part of the ilium. The minimum thickness of the spongiousus bone in an iliac wing (transverse thickness between the two tables) is an important factor in ensuring the safe placement of a trocar between the two tables of the iliac wing. For example, with an 8-gauge (3.26 mm) trocar, one can consider that if the transverse thickness of the spongiousus bone of the iliac wing is <3 mm, it will be difficult to insert the trocar safely between the two tables., Methods: For this study, we measured spongiousus bone thickness on 48 iliac wings to map the ilium in six sectors, which were defined by drawing lines from equidistant points spaced along the rim of the iliac crest to the centre of the hip. These sectors can be transposed in the same manner to any patient. To evaluate the risks to reach vascular or neurologic structures, 410 trocars were introduced in the different sectors of 20 iliac bones of ten cadavers., Results: A map was constructed indicating the thickness of the spongiousus bone in each sector. The thickness data was used to create a map that identifies the sites where bone marrow can be obtained with a trocar of 3-mm diameter according to the thickness of the spongiousus bone. Sectors 2, 3 and 6 appear to be more favourable for accommodating a 3-mm diameter trocar. Sectors 1, 4 and 5 comprise the areas with the thinnest parts of the iliac crest, with some areas being thinner than the trocar diameter. The sector system reliably predicted safe and unsafe areas for trocar placement. In cadavers, dissection demonstrated nine vascular or neurologic lesions created when trocars were introduced into sectors 1, 5 and 6., Conclusion: Using the sector system, trocars can be directed away from neural and vascular structures and towards zones that are likely to contain larger bone marrow stock.

Purpose: Should the trocar suddenly lose contact with bone during bone marrow aspiration, it may result in visceral injury. The anatomy of the ilium and the structures adjacent to the iliac bone were studied to determine the danger of breach by a trocar introduced into the iliac crest., Methods: The authors followed two series of patients, one series to do measurements of distance and angles of the structures at risk to the iliac bone and the other to evaluate the risk of a trocar being directed outside the iliac wing during bone marrow aspiration. The authors also examined 24 pelvices by computed tomography (CT) scans of mature adults (48 iliac crests). Lines dividing the iliac wing into six equal sectors were used to form sectors (e.g. sector 1 anterior, sector 6 posterior). Vascular or neurological structures were considered at risk if they were accessible to the tip of a 10-cm trocar introduced into the iliac crest with a possible deviation of 20° from the plane of the iliac wing on the three-dimensional reconstruction. The authors tracked bone marrow aspiration of six different surgeons and calculated among 120 patients (480 entry points) the number of times the needle lost contact with bone in each sector of aspiration., Results: The sector system reliably predicted safe and unsafe areas for trocar placement. Among the 480 entry points in the 120 patients, 94 breaches were observed and higher risks were observed in the thinner sectors. The risk was also higher in obese patients and the risk decreased with more experienced surgeons. The trocar could reach the external iliac artery on pelvic CT scans in the four most anterior sectors with a higher frequency in women. Posterior sectors were at risk for sciatic nerve and gluteal vessel damage when the trocar was pushed deeper than 6 cm into the posterior iliac crest. In cadavers, the dissection demonstrated nine vascular or neurological lesions., Conclusions: Using the sector system, trocars can be directed away from neural and vascular structures and toward zones that are likely to contain larger bone marrow stock.

Background: It is unclear whether late THA dislocations are related to mechanical impingement or to a biological mechanism that decreases the stability provided by the capsule (eg, inflammation secondary to osteolysis). It is also unknown if alumina-on-alumina bearing couples decrease the risk of late dislocation as a result of the absence of wear and osteolysis., Question/purposes: We asked (1) whether the cumulative number of dislocations differed with alumina-on-alumina (AL/AL) or alumina-on-polyethylene bearings (AL/PE); (2) whether patient factors (age, sex, and diseases) affect risk of late dislocation; (3) whether mechanical factors (component malposition, penetration resulting from creep and wear) or (4) biologic hip factors at revision (thickness of the capsule, volume of joint fluid removed at surgery, histology) differed with the two bearing couples., Methods: One hundred twenty-six patients (252 hips) with bilateral THA (one AL/AL and the contralateral AL/PE) received the same cemented implants except for the cup PE cup or an AL cup. The cumulative risk of dislocation (first-time and recurrent dislocation) was calculated at a minimum of 27 years. We measured cup position, creep and wear, and capsular thickness in the hips that had revision., Results: AL/PE and AL/AL hips differed by the cumulative number of dislocation (31 with AL/PE versus four with AL/AL) and by the number of late dislocations (none with AL/AL, 28 with AL/PE). Cause of osteonecrosis, age, and sex affected the number of dislocations. The frequency of component malposition did not differ between the two bearing couples. The risk of late dislocation appeared less in AL/AL hips with increased capsular thickness (mean, 4.5 mm; range, 3-7 mm) compared with the thinnest (mean, 1.2 mm; range, 0.2-2 mm) capsule of AL/PE hips., Conclusions: AL/AL bearing couples decreased the cumulative risk of dislocation as compared with AL/PE bearing couples.

Purpose: The purpose of this study was to evaluate the impact of tobacco abuse in the consolidation of fractures., Methods: We retrospectively identified all patients with a diaphyseal fracture (femur, tibia, or humerus), between January 1999 and December 2010, in our orthopaedic trauma registry (Erasme hospital, Brussels, Belgium). Thirty-eight diaphyseal nonunions (ten femurs, 16 tibias and 12 humerus) were identified. Each nonunion was paired (on age, sex and location) with two control-healed fractures (76 control patients). The chi-squared test and a binary logistic regression were used for statistical analysis., Results: In multivariate analysis, smoking (tobacco use) was significantly associated with nonunion, whether the fracture was open or closed (p < 0.01). In univariate analysis, open fracture was associated with a higher risk of nonunion (p < 0.05), while external fixation was associated with better bone healing (p < 0.05)., Conclusion: Tobacco is confirmed as a deleterious factor for diaphyseal bone healing.