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This paper describes the life and work of Louis Ombrédanne, one of the founding fathers of the SICOT, a notorious French orthopaedic and paediatric surgeon with a strong interest in plastic surgery and reconstruction of post-traumatic defects and also with limb lengthening and treatment of sequalae. Born in Paris in 1871 as a son of a general practitioner doctor, Ombrédanne was a brilliant student enjoying anatomy and surgery since the early years. He was appointed as a Surgeon in 1902 in Paris and became Professor of Surgery in 1907. During the First World War, he worked in Verdun, one of the most exposed hospitals near the battlefield where over 700.000 people died and many cases were affected by head and neck burns and destructions, requiring surgical reconstruction. After the war, Ombrédanne developed Pediatric Surgery and it seems that his powerful drive and charisma explain why these specialties are studied together with orthopaedics in Europe and later in the World. Many innovations like the anaesthetic inhaler with face mask were authored by Ombrédanne and also techniques of limb lengthening, thoracic plasty. He described malignant hyperthermia in children and worked in the Sick Children Hospital in Paris, today Hôpital Necker. In 1929, Ombrédanne participated with a group of enthusiastic surgeons and teachers from many countries to the creation of SICOT during a historical meeting held in Hotel Crillon in Paris. This paper introduces Ombrédanne's work to the current readers and is a tribute to the work of our ancestors who made possible the development of our specialty.

International audience; BackgroundIn the context of acetabular reconstruction, bone defects can be filled with processed or unprocessed bone allografts. Published data are often contradictory on this topic and few studies have been done comparing processed allografts to fresh-frozen ones. This led us to conduct a large study to measure the factors impacting the survival of THA revision: (1) type of allograft and cup, (2) technical factors or patient-related factors.HypothesisAcetabular reconstruction can be performed equally well with frozen or processed morselized allografts.Materials and methodsThis retrospective, multicenter study of acetabular reconstruction included 508 cases with a minimum follow-up of 5 years. The follow-up for the frozen grafts was shorter (7.86 years ± 1.89 [5–12.32]) than that of the processed grafts (8.22 years ± 1.77 [5.05–15.48]) (p = 0.029). However, the patients were younger at the time of the primary THA procedure in the frozen allograft group (51.5 years ± 14.2 [17–80]) than in the processed group (57.5 years ± 13.0 [12–94]) (p < 0.001) and were also younger at the time of THA revision (67.8 years ± 12.2 [36.9–89.3] versus 70 years ± 11.7 [25–94.5]) (p = 0.041).ResultsThere were more complications overall in the frozen allograft group (46/242 = 19.0%) than the processed allograft group (35/256 = 13.2%) (p = 0.044) with more instances of loosening in the frozen group (20/242 [8.2%]) than in the processed group (6/266 [3.3%])(p = 0.001). Conversely, the dislocation rate (16/242 = 6.6% vs. 17/266 = 6.4%) (p = 0.844) and infection rate (18/242 = 7.4% vs. 15/266 = 5.7%) (p = 0.264) did not differ between groups. The subgroup analysis reveal a correlation between the occurrence of a complication and higher body mass index (BMI) (p = 0.037) with a higher overall risk of complications in patients with a BMI above 30 or under 20 (p = 0.006) and a relative risk of 1.95 (95% CI: 1.26–2.93). Being overweight was associated with a higher risk of dislocation (relative risk of 2.46; 95% CI: 1.23–4.70) (p = 0.007). Loosening was more likely to occur in younger patients at the time of the procedure (relative risk of 2.77; 95% CI: 1.52–6.51) (p = 0.040) before 60 years during the revision. Lastly, patients who were less active preoperatively based on the Devane scale had an increased risk of dislocation (relative risk of 2.51; 95% CI: 1.26–8.26) (p = 0.022).DiscussionOur hypothesis was not confirmed. The groups were not comparable initially, which may explain the differences found since the larger number of loosening cases in the frozen allograft group can be attributed to group heterogeneity. Nevertheless, morselized allografts appear to be suitable for acetabular bone defect reconstruction. A randomized study would be needed to determine whether frozen or processed allografts are superior.Level of evidenceIII, comparative retrospective study.

RESUME Notre experience des allongements des membres inferieurs dans les inegalites de longueur des membres inferieurs et la securite donnee par les techniques chirurgicales actuelles developpees depuis plus de 30 ans nous ont incites a utiliser ces possibilites therapeutiques chez les sujets de petite taille, adolescents et adultes jeunes. En effet, notre societe nous renvoie a une image normee du corps, ceci ayant pour consequences d’entrainer parfois des difficultes d’ordre psychologiques et sociales chez les sujets porteurs d’une petite taille. Le traitement chirurgical permettra des allongements de 10 a 20 cm lorsque les aspects psychologiques de cette petite taille ont ete correctement cernes, ces patients en tireront alors un benefice reel. Faut-il encore definir les limites ethiques de cette chirurgie en differenciant bien les indications cosmetiques des indications therapeutiques vraies. Cette chirurgie reparatrice permettra alors de completer un traitement medical insuffisant ou de suppleer celui-ci lorsqu’il s’est avere impossible (par exemple achondroplasie).

The published online version contains mistake in the author list for the author name "Di Iorio Alexandre" was incorrectly presented.

The objective was to identify predictive factors for intraprosthetic dislocation (IPD) and to understand how improvements in dual mobility cups (DMC) have helped to reduce dramatically the occurrence of this complication. DM mobile inserts retrieved from 93 hips were divided into three groups: first-generation DMC with IPD (“firstDMC-IPD”), first-generation DMC with over 15 years of implantation without IPD (“firstDMC-noIPD”), and latest-generation DMC (“newDMC”). The predictive factors for IPD based on clinical, prosthetic, radiological and intraoperative characteristics were analysed by multivariate analysis. The surface of each retrieved mobile insert was analysed using three-dimensional CT scan in order to compare their rim wear. Three predictive factors for IPD were found: a high BMI, a wide rough stem neck and a large cup size. Wear of the firstDMC-noIPD inserts was significantly less than those of firstDMC-IPD inserts and significantly more than those of newDMC inserts. For the firstDMC-IPD inserts, the rim’s outer surface wear was significantly greater than the rim’s inner surface wear. IPD is a specific complication related to wear of the DM mobile insert due to failure of the liner’s retaining rim, especially from the rim’s outer surface. This long-term issue is different to the early traumatic complication, which can happen after an attempt at closed reduction of a DM THA dislocation. Recent modifications in the design and the coating of contemporary DMC and femoral stems, as well as improvements in the mobile insert itself, seem to corroborate our assumptions about the IPD mechanism and contribute to the quasi-disappearance of this complication.

Patella infera described by Caton et al.The measurement is made in 1982 is an accompanying symptom in certain knee affections secondary to the abnormal situation of the patella. The measurement is made on the X-ray with sagittal view after measuring the patellar height, using the original technique described by the author, when the ratio between the articular surface of the patella and the distance form the patellar tip to the tibial tubercle. Indications of surgery may be when this ration is inferior or equals 0.6. The origin of the patella infera can be mechanical or inflammatory. The operative technique addresses the etiology. In current practice, the patellar height and the patellar tendon length may be evaluated using a sagittal section MRI. In the authors’ experience, when the Caton ratio is lower or equals 0.6 and when the length of the patellar tendon is over 25 mm, the indication of surgery includes proximal transfer of the tibial tubercle. If the length of the patellar tendon is less than 25 mm, it is often necessary to perform a patellar tendon lengthening (PTL). This type of surgery is contraindicated in the authors’ experience in depressive or pusillanimous subjects. The two surgical techniques are described. Both techniques use an anterior and medial approach. The proximal transfer of the tibial tubercle (PTT) includes medial and lateral retinaculum release. The tibial tubercle is detached and transferred upwards according to the pre-operative planning generally 1 or 2 cm and is fixed with 2 screws. PTL includes a medial and lateral retinaculum release often with the fat pad. The patellar tendon is dissociated in the middle over its whole length, and the medial pad is detached of the tibial tubercle and the lateral of the patella. After lengthening, the edges of the tendon are sutured, and this suturing reinforced. Alternative procedures may be used when PTT or PTL are not possible, using transplantation with an allograft of the extensor system or a plasty with hamstring muscles.