Search

At the local scale, seismic risk is often poorly estimated when considering equal hazard values across any given community. Indeed, past damaging earthquakes have shown that site conditions, which may amplify or deamplify ground shaking, have an influence on the spatial distribution of damage in urban areas. In eastern Canada, Leda clay deposits from the old Champlain Sea are of particular concern for strong site effects in many parts of Quebec and Ontario. To capture the variability in seismic site response, microzonation maps characterizing average shear wave velocity for the upper 30 m of soil, and predominant resonance frequency have been developed for Montreal, Ottawa, and Quebec City. The maps derived from seismic and borehole measurements have been used to develop shake map scenarios but have not been validated, because there have not been any significantly large, close earthquakes in recent years, and because the seismograph network coverage is not adequate to provide a detailed picture of variations in shaking across a city. Nevertheless, all the three cities are in or near active seismic zones, and felt reports, although less accurate than instrumental data, are numerous and provide a dense dataset showing relative shaking levels across a region. Using intensity data for several moderate earthquakes collected largely via the Canadian internet “Did You Feel It?” page, we systematically compare reported shaking levels to soil conditions indicated by the microzonation maps. This study shows a clear correlation between high-reported intensities and soft soils for Montreal where the number of observations is the largest. The results suggest that intensity data collected via the internet and social media could provide a viable method for validating microzonation maps and shaking scenarios.

Resume Objectifs La resection des tumeurs osseuses malignes du bassin entraine d’importantes pertes de substances rendant les gestes de couverture difficiles. Le lambeau pedicule de gluteus maximus permet certaines reconstructions mais son utilisation en cas de sacrifice vasculaire n’est pas clairement etablie. L’objectif de notre etude etait d’etudier sa vascularisation afin d’evaluer la possibilite de sacrifice vasculaire lors d’une resection carcinologique d’une tumeur du bassin. Patients et methode Nous avons d’abord realise une cartographie vasculaire du muscle gluteus maximus en utilisant des modelisations en 3 dimensions (3D) a partir d’angioscanners chez des malades atteints d’un syndrome de Leriche. Ces modelisations furent comparees a une dissection cadaverique de 2 muscles injectes. Une deuxieme modelisation en 3D a partir de scanners postoperatoires fut realisee chez des malades ayant eu un lambeau de gluteus maximus apres chirurgie carcinologique du bassin. Resultats Dix malades atteints de syndrome de Leriche ont eu une modelisation en 3D a partir de leurs scanners. Trois systemes arteriels distincts furent identifies. Sept malades eurent un lambeau issu du muscle gluteus maximus dont 3 cas de lambeau d’Hemi Gluteus maximus Inferieur pedicule retourne (HGI). D’apres la modelisation, la richesse du reseau vasculaire permettrait le sacrifice du pedicule gluteal superieur sans compromettre la viabilite de ce lambeau. Conclusion Notre etude a permis de confirmer la richesse du reseau vasculaire du muscle gluteus maximus et d’envisager la possibilite theorique de sacrifier le pedicule gluteal superieur sans mettre en peril un lambeau musculaire pedicule HGI.

There is currently no active fault map for the intraplate western Quebec seismic zone (WQSZ) in eastern Canada, and consequently, no detailed finite-fault source models which are critical for seismic hazard assessments in this region with a rapidly growing population. While previous numerical stress modelling studies have shown that mostly NNW-SSE to NW-SE-striking faults exhibit the highest potential for reactivation under the present-day tectonic stress field, such modelling is unable to take into account the interaction of faults and earthquakes. This study attempts to identify possible future rupture zones using Coulomb stress analysis. We explore the static stress transfer caused by select earthquakes (MW > 4.5) in the past century to proximal ‘receiver’ faults in the WQSZ, with a focus on those that exhibit a relatively high reactivation potential, to identify faults that have been promoted to failure. The significance of Coulomb stress changes (ΔCFS) observed on the nearby ‘receiver’ faults varied widely. Among the events analyzed in this study, only the 1935 MW 6.1 Témiscaming earthquake caused extensive positive Coulomb stress change (≥ 0.1 Bar) on its receiver fault. The modelled fault rupture extents suggest a range of earthquake magnitudes of MW 6-7. This work is the first attempt to provide a physical basis for seismic hazard assessment input parameters in the WQSZ based on the results of numerical stress modelling.

Earthquakes pose potentially substantial risks to residents in the Western Quebec seismic zone of eastern Canada, where Ottawa and Montreal are located. In eastern Canada, the majority of houses are not constructed to modern seismic standards and most homeowners do not purchase earthquake insurance for their homes. If a devastating earthquake strikes, homeowners would be left unprotected financially. To quantify financial risks to homeowners in the Western Quebec seismic zone, regional earthquake catastrophe models are developed by incorporating up-to-date public information on hazard, exposure and vulnerability. The developed catastrophe models can quantify the expected and upper-tail financial seismic risks by considering a comprehensive list of possible seismic events as well as critical earthquake scenarios based on the latest geological data in the region. The results indicate that regional seismic losses could reach several tens of billions of dollars if a moderate-to-large earthquake occurs near urban centres in the region, such as Montreal and Ottawa. The regional seismic loss estimates produced in this study are useful for informing earthquake risk management strategies, including earthquake insurance and disaster relief policies.

Site amplification factors in National Building Codes are typically specified as a function of the average shear wave velocity over the first 30 m (Vs30) or site class (A, B, C, D and E) for defined ranges of Vs30 and/or ranges of depth to bedrock. However, a single set of amplification factors may not be representative of site conditions across the country, introducing a bias in seismic hazard and seismic risk analyses. This is exemplified by significant differences in geological settings between East and West coast locations in North America. Western sites are typically characterized by lower impedance contrasts between recent surface deposits and bedrock in comparison to Eastern sites. In North America, site amplification factors have been derived from a combination of field data on ground motions recorded during West Coast earthquakes and numerical models of site responses that are meant to be representative of a wide variety of soil profiles and ground motions. The bias on amplifications and their impact on seismic hazards is investigated for the Montreal area, which ranks second for seismic risks in Canada in terms of population and hazard (PGA of 0.25 g for a 2475 years return period). Representative soil profiles at several locations in Montreal are analyzed with 1-D site response models for natural and synthetic ground motions scaled between 0.1 to 0.5 g. Since bedrock depths are typically shallow (&lt, 30 m) across the island, bedrock shear wave velocities have a significant influence on the impedance contrast and amplifications. Bedrock shear wave velocity is usually very variable due to the differences in rock formations, level of weathering and fracturing. The level of this uncertainty is shown to be greatly decreased when rock quality designation (RQD) data, common information when bore hole data are logged, is available since it is highly correlated with both shear and compression wave velocities. The results are used to derive region-specific site amplification factors as a function of both Vs30 and site fundamental frequency and compared to those of the National Building Code of Canada (2015). The results of the study indicate that there are large uncertainties associated with these parameters due to variability in soil profiles, soil properties and input seismic ground motions. Average and confidence intervals for the mean and for predictions of amplification factors are calculated for each site class to quantify this uncertainty. Amplifications normalized relative to class C are obtained by accounting for the correlation between site class amplifications for given ground motions. Non-linearity in the analysis of equivalent linear 1-D site response is taken into account by introducing the non-linear G/Gmax and damping ratios curves. In this method, it is assumed that the shear strain compatible shear modulus and damping ratio values remains constant throughout the duration of the seismic excitation. This assumption is not fully applicable to a case when loose saturated soil profile undergo heavy shaking (PGA &gt, 0.3 g). In this study, all simulations with input motion PGA &gt, 0.3 g have been performed by using the EL method instead of the NL method considering that cohesive soils (clay and silt) at Montreal sites are stiff and cohesionless soils (sand and gravel) are considerably dense. In addition, the field and laboratory data required to perform NL analyses are not currently available and may be investigated in future works.

The hypothesis that very large earthquakes kill predominantly rural people is tested for the case of Colombia. For models of the eight largest earthquakes that have occurred in Colombia, the hypothetical ratios of rural to urban fatalities are calculated. Choosing these historic ruptures does not mean that they are expected to reoccur soon; instead, they are selected to sample fatalities in realistic models. The fatalities due to the assumed earthquakes are calculated by the tool Quake Loss Alerts for Rescue and Mitigation (QLARM), using the population data from the 2018 Columbian census. The minimum population for a settlement to be classified as urban is 35,000. The results do not depend on this limit. The condition for a model calculation to be accepted is that it matches the maximum intensities of shaking reported in the literature for the earthquake in question. Of the eight hypothetical earthquakes, today four would predominantly kill rural people, three would be urban, and one is about evenly split. However, the sum of the hypothetical fatalities in the eight test earthquakes is 79% urban and only 21% rural. This means that the observation that worldwide more than 90% of earthquake fatalities are rural does not apply to Colombia. The reasons for this contrast are that on average the Colombian test earthquakes are only about half as long as the ruptures modeled in the worldwide sample. Relatively short ruptures (75 km on average in Colombia) can rip through industrial areas without many villages because Colombia is strongly industrialized. By implication, this result means that the observation that most large earthquakes kill mostly rural people cannot be applied universally. The likely ratio of rural to urban earthquake fatalities has to be determined for each country separately for the assessment of the ratio of mitigation efforts to be allocated locally.

Multifactorial aetiology defines non-unions, with a biological and a mechanical distortion of the timeline of bone healing. Research on new advances to increase osteogenesis and promote non-union healing is strongly directed towards new forms of cell products. Basic science and research on non-union treatments is needed to compile preclinical data on new treatments. Bone marrow concentration and expanded mesenchymal stromal cells still require extensive clinical research to confirm efficacy in non-union treatment. Solid preclinical studies, precise cell product definition and preparation, and appropriate ethical and regulatory approvals are needed to assess new advanced therapy medicinal products.Cite this article: EFORT Open Rev 2020;5:574-583. DOI: 10.1302/2058-5241.5.190062

An analysis of seismic risk using our tool QLARM has been performed for the Batken region including the cities of Aidarken and Kadamjay, 100 km SW of Osh. The damage to residential buildings and induced casualties has been estimated for a set of seismic scenarios of typical and maximum magnitude considering the existing seismicity data. Population and building datasets have been built based on up-to-date information, and for the two cities, satellite photographs and a field survey have been used. A preliminary soil response zonation is proposed using seismic ambient noise analyses. In the investigated region, the probability of damaging earthquakes with M > 6 is judged to be low because the slip accumulation rate along individual faults is only in the range of 0.01–0.3 cm/year. The amplification of seismic waves by soil deposits is estimated to be low; however, the proposed zonation needs to be complemented by additional seismic measurements. The calculations indicate that the combined fatalities of Kadamjay and Aidarken in a hypothetical earthquake of magnitude between 6.0 and 6.6 are fewer than 100.

Resume Contexte Les reconstructions par prothese massive sont largement repandues apres resection d’une tumeur osseuse. Le design, le mode de fixation et le type de charniere a utiliser font encore debat. Le but de cette etude etait de determiner la survie, les complications et les resultats fonctionnels d’une serie homogene de patients adultes dont le defect osseux suivant l’ablation d’une tumeur du femur distal etait reconstruit par le meme modele d’endoprothese cimentee a charniere fixe avec un suivi minimum de 5 ans. Notre hypothese principale etait que le descellement et l’infection seraient les types d’echec les plus frequents et que ce mode de reconstruction etait fiable dans les resections de femur distal. Patients et methodes Tous les patients adultes de plus de 17 ans avec une reconstruction par prothese massive modulaire Stanmore Mets® cimentee a charniere fixe suivant une resection de femur distal pour une tumeur primitive osseuse dans 4 centres referents francais de 2004 a 2013 ont ete inclus. Les donnees epidemiologiques, le score fonctionnel MSTS, les resultats de l’examen clinique et radiologique, les complications, les courbes de survie avec les types d’echec selon la classification d’Henderson ont ete evalues. Resultats Cent trente-six patients (68 hommes et 68 femmes) d’âge moyen 41,2 [17–77] annees ont ete inclus. Le suivi moyen etait de 81 [61–134] mois. Trente-deux patients (38 %) ont connu 67 complications ayant conduit a une intervention chirurgicale, la plupart infectieuses (n = 28) ou mecaniques (n = 26). La survie prothetique globale etait de 78 %a 5 ans. D’apres la classification d’Henderson, il y a eu 30 echecs prothetiques. Le score moyen MSTS etait de 82 %. Discussion Les resultats sont comparables a la litterature et aux autres modes de reconstruction. Les recentes meta-analyses suggerent que le type de charniere et de fixation des tiges influent peu sur la survie. Des etudes internationales comparatives sont indispensables pour determiner la place exacte de chaque type de reconstruction en fonction du profil du patient. Niveau de preuve IV, serie multicentrique retrospective.

Artículo con numerosos autores, sólo se recogen el primero y los pertenecientes a la UAM, Background and study aim: Advanced therapy medicinal products (ATMP) frequently lack of clinical data on efficacy to substantiate a future clinical use. This study aims to evaluate the efficacy to heal long bone delayed unions and non-unions, as secondary objective of the EudraCT 2011-005441-13 clinical trial, through clinical and radiological bone consolidation at 3, 6 and 12 months of follow-up, with subgroup analysis of affected bone, gender, tobacco use, and time since the original fracture. Patients and methods: Twenty-eight patients were recruited and surgically treated with autologous bone marrow derived mesenchymal stromal cells expanded under Good Manufacturing Practices, combined to bioceramics in the surgical room before implantation. Mean age was 39 ±13 years, 57% were males, and mean Body Mass Index 27 ±7. Thirteen (46%) were active smokers. There were 11 femoral, 4 humeral, and 13 tibial non-unions. Initial fracture occurred at a mean ±SD of 27.9 ±31.2 months before recruit- ment. Efficacy results were expressed by clinical consolidation (no or mild pain if values under 30 in VAS scale), and by radiological consolidation with a REBORNE score over 11/16 points (value of or above 0.6875). Means were statistically compared and mixed models for repeated measurements estimated the mean and confidence intervals (95%) of the REBORNE Bone Healing scale. Clinical and radiological con- solidation were analyzed in the subgroups with Spearman correlation tests (adjusted by Bonferroni). Results: Clinical consolidation was earlier confirmed, while radiological consolidation at 3 months was 25.0% (7/28 cases), at 6 months 67.8% (19/28 cases), and at 12 months, 92.8% (26/28 cases including the drop-out extrapolation of two failures). Bone biopsies confirmed bone formation surrounding the bioce- ramic granules. All locations showed similar consolidation, although this was delayed in tibial non-unions. No significant gender difference was found in 12-month consolidation (95% confidence). Higher consoli- dation scale values were seen in non-smoking patients at 6 ( p = 0.012, t -test) and 12 months ( p = 0.011, t -test). Longer time elapsed after the initial fracture did not preclude the occurrence of consolidation. Conclusion: Bone consolidation was efficaciously obtained with the studied expanded hBM-MSCs com- bined to biomaterials, by clinical and radiological evaluation, and confirmed by bone biopsies, with lower consolidation scores in smokers, This research received funding from the European Union’s Sev- enth Framework Programme ( FP7/FP7-HEALTH-2009 ) with the RE- BORNE Project (under G.A. 241876), and the European Union’s Horizon 2020 Programme ( H2020-SC1 2016-2017 ), with the OR- THOUNION Project (under G.A. 7333288)

International audience; Adipose tumors of the limbs are the most common soft tissue lesions and are essentially benign (lipomas). However, in some cases, they can be considered as tumors with intermediate malignancy (atypical lipomatous tumor [ALT]) or sarcoma lineage (liposarcoma [LS]). The essential work-up for a potential adipose tumor consists of a clinical examination and initial ultrasound imaging to determine the size (more or less than 5 cm), the location (over or under the fascia) and any potential atypical vascularization. As needed, MRI will complete the assessment and validate the ultrasound results and confirm the fatty nature of the lesion. Percutaneous biopsy will be done when a deep fatty lesion is larger than 5 cm (long axis), with detection by amplification of the MDM2 gene that guides the diagnosis towards ALT or dedifferentiated LS. Superficial lesions without atypia are not challenging from a surgical point of view. However, large ALT can be more difficult to manage. Their local malignancy does not justify sacrificing any critical structures. As for true LS, their treatment is well defined, with tumor excision addressed at a center belonging to the Network of Sarcomas Reference Centers in France (NETSARC+) and for potential (neo)adjuvant treatment if needed. Inappropriate treatment of a malignant tumor can have serious consequences (loss of chance to survive or to be cured) for the patient. Furthermore, treatment at a specialized cancer center has been proven to be effective as it improves overall survival and reduces local recurrences.

International audience; Hip arthroplasty represents a large proportion of orthopaedic activity, constantly increasing. Automating monitoring from clinical data warehouses is an opportunity to dynamically monitor devices and patient outcomes allowing improve clinical practices. Our objective was to assess quantitative and qualitative concordance between claim data and device supply data in order to create an e-cohort of patients undergoing a hip replacement. We performed a single-centre cohort pilot study, from one clinical data warehouse of a French University Hospital, from January 1, 2010 to December 31, 2019. We included all adult patients undergoing a hip arthroplasty, and with at least one hip medical device provided. Patients younger than 18 years or opposed to the reuse of their data were excluded from the analysis. Our primary outcome was the percentage of hospital stays with both hip arthroplasty and hip device provided. The patient and stay characteristics assessed in this study were: age, sex, length of stay, surgery procedure (replacement, repositioning, change, or reconstruction), medical motif for surgery (osteoarthritis, fracture, cancer, infection, or other) and device provided (head, stem, shell, or other). We found 3,380 stays and 2,934 patients, 96.4% of them had both a hip surgery procedure and a hip device provided. These data from different sources are close enough to be integrated in a common clinical data warehouse.

Vertebral osteomyelitis (VO) represents 4–10% of bone and joint infections. In Western countries, its incidence seems to increase, simultaneously with an increasing number of comorbidities among an ageing population. This study aimed to assess the evolution of VO epidemiology in France over the 2010–2019 decade. A nationwide cross-sectional study was conducted using the French hospital discharge data collected through the French diagnosis-related groups ‘Programme de Médicalisation des Systèmes d'Information’. VOs were detected with a previously validated case definition using International Classification of Diseases 10 (ICD-10) codes, implemented with the French current procedural terminology codes. The study population included all patients hospitalised in France during the 2010–2019 decade, aged 15 years old and more. Patient and hospital stay characteristics and their evolutions were described. During the study period, 42 105 patients were hospitalised for VO in France involving 60 878 hospital stays. The mean VO incidence was 7.8/100 000 over the study period, increasing from 6.1/100 000 in 2010 to 11.3/100 000 in 2019. The mean age was 64.8 years old and the sex ratio was 1.56. There were 31 341 (74.4%) patients with at least one comorbidity and 3059 (7.3%) deceased during their hospital stay. Even if rare, device-associated VOs (4450 hospital stays, 7.3%) highly increased over the period. The reliability of the method, based upon an exhaustive database and a validated case definition, provided an effective tool to compare data over time in real-life conditions to regularly update the epidemiology of VO.

Introduction The capacity of the hydroxyapatite-coated trochanteric screwed plates used with modular hip implants to restore abductor system efficacy after proximal femoral tumor resection has never been assessed. We therefore conducted a retrospective study aiming to: (1) quantitatively evaluate abduction conservation on dynamometry according to use of digastric reinsertion, conserving continuity between the gluteus medius and vastus lateralis muscles, or not, and of standard versus small-offset; (2) assess radiographic trochanteric plate fixation; (3) assess functional scores; and (4) assess complications. Hypothesis Trochanteric reinsertion better conserves abduction strength when reinsertion is digastric. Patients and methods Thirty-one patients undergoing proximal femoral tumor resection between 2006 and 2016 with reconstruction by Stanmore METS™ modular implant with trochanteric plate were included. Twenty-one had digastric fixation between the gluteus medius and vastus lateralis and 10 had simple trochanteric fixation without digastric continuity. Abduction strength was compared between sides on dynamometer. Sixteen patients had full assessment of muscle strength, by a single observer; there were 8 deaths, 5 patients lost to follow-up, and 2 cases of material removal. Results Abduction strength conservation versus the contralateral side was 55.2 ± 23.3% (range, 5.8–86.1%): 66.6 ± 13.0% (46.4–86.1) with versus 36.0 ± 24.7% (5.8–63.2%) without digastric continuity (p = 0.01); severe limp rate was 4/21 when digastric continuity was preserved (19%) versus 6/10 (60%) (p = 0.04), and radiologic trochanteric reinsertion stability rate was 19/21 (90%) versus 4/10 (40%) (p = 0.005). Standard femoral offset conserved greater abduction strength: 64.9 ± 20.0% versus small-offset 45.4 ± 23.2% (p = 0.05). Toronto Extremity Salvage Score (TESS) was 89 ± 9.4%, and Musculoskeletal Tumor Society (MSTS) score 75.4 ± 5.4%. There were 6 complications (19%): 4 infections, 1 dislocation, and 1 plate removal; the single dislocation (3%) was in the digastric conservation group. TESS (90.7 ± 7.8% vs 88.3 ± 4) and MSTS score (75.6 ± 4.0% vs 75.1 ± 3.7) and complications [4/21 (19%) vs 2/10 (20%)] did not differ according to digastric or non-digastric reinsertion (p = 1). Conclusions Abduction strength with a modular implant using a hydroxyapatite-coated trochanteric plate was better conserved by digastric trochanteric reinsertion, resulting in less limping, although the complications rate and functional scores were unaffected. Longer term assessment is needed to confirm this conservation of abduction strength. Level of evidence IV, retrospective study without control group.

Resume Introduction Les plaques trochanteriennes vissees revetues d’hydroxyapatite des protheses modulaires n’ont jamais ete etudiees en ce qui concerne leur capacite a retablir un systeme abducteur efficace dans le cas d’une resection tumorale du femur proximal. Aussi, nous avons mene une etude retrospective ayant pour objectifs : (1) la mesure dynamometrique evaluant quantitativement la conservation de l’abduction en fonction de l’utilisation d’un digastrique (preservation de la continuite entre les tendons du gluteus medius et du vastus lateralis) et du type d’Offset, (2) la fixation radiographique des plaques trochanteriennes, (3) les scores fonctionnels, (4) les complications. Hypothese La reinsertion trochanterienne permet une meilleure conservation de la force en abduction avec une reinsertion en digastrique. Patients et methodes Nous avons examine 31 patients ayant eu une resection carcinologique tumorale femorale proximale entre 2006 et 2016 et ayant eu une reconstruction par une prothese modulaire Stanmore METS™ avec plaque trochanterienne. Vingt-et-un des 31 cas avaient eu la fixation du digastrique entre moyen gluteal et vaste lateral et 10 une fixation trochanterienne simple sans continuite digastrique. La force a ete testee de maniere comparative entre les deux cotes au moyen d’un dynamometre. Seize patients ont pu beneficier d’une investigation complete par un observateur unique de la force musculaire (8 deces, 5 perdus de vue et 2 deposes de materiel). Resultats La conservation de la force en abduction etait de 55,2 ± 23,3 % [5,8–86,1] par rapport au cote controlateral. La force musculaire en abduction par rapport au cote controlateral avec et sans continuite digastrique etait respectivement de 66,6 ± 13,0 % [46,4–86,1] contre 36,0 ± 24,7 % [5,8–63,2] (p = 0,01), la presence d’une boiterie severe dans 4/21 (19 %) contre 6/10 (60 %) (p = 0,04) et la stabilite radiologique de la reinsertion trochanterienne dans 19/21 (90 %) contre 4/10 (40 %) (p = 0,005). L’utilisation d’un modele d’offset femoral Standard augmentait la force d’abduction, avec 64,9 ± 20,0 % par rapport a un offset femoral Small a 45,4 ± 23,2 % (p = 0,05). Nous avons mesure un score Toronto Extremity Salvage Score (TESS) a 89 ± 9,4 % dans cette etude, et un score Musculoskeletal Tumor Society (MSTS) score a 75,4 ± 5,4 %. Nous avons observe 6 complications (19 %) (4 infections, 1 luxation et 1 depose de plaque), la seule luxation (3 %) observee dans le groupe avec conservation digastrique. Les scores TESS (90,7 ± 7,8 % vs 88,3 ± 4 %) et MSTS (75,6 ± 4,0 % vs 75,1 ± 3,7 %) et les complications (4/21 [19 %] vs 2/10 [20 %]) n’etaient pas differents respectivement avec ou sans reinsertion digastrique (p = 1). Conclusions La conservation de la force d’abduction etait meilleure en cas de reinsertion trochanterienne en digastrique par prothese modulaire avec plaque trochanterienne revetue d’hydroxyapatite, se traduisant par un moindre taux de boiterie, mais le taux de complication n’etait pas modifie par la conservation du digastrique de meme que les scores fonctionnels. Une evaluation a plus long terme est necessaire pour valider la conservation de la force d’abduction. Niveau de preuve IV, etude retrospective sans groupe temoin.

Resume Introduction Les fractures de la cheville et de l’arriere-pied presentent un taux important de complications notamment infectieuses qui varie de 1 a 48 % selon les etudes. Hypothese Le traitement des infections osteo-articulaires (IOA) survenant apres le traitement chirurgical d’une fracture de la cheville et de l’arriere-pied est a haut risque d’echec. Nous avons analyse les resultats du traitement de ces complications. Materiel et methodes Au total, 33 patients (34 cas) ont ete pris en charge pour une IOA de la cheville et de l’arriere-pied entre 2010 et 2015. La guerison de l’infection etait definie par l’absence de fistule, de signes inflammatoires locaux et generaux et la normalisation de la proteine C reactive au recul minimum de 2 ans. L’arthrodese sans infection etait definie comme un succes alors que la recidive de l’infection, et l’amputation etaient considerees comme un echec de prise en charge de ces IOA. L’âge moyen lors du traumatisme etait de 52 ans (16–85). Le delai median du diagnostic d’IOA etait de 44 jours (2–830). Resultats La duree moyenne de suivi etait de 20 mois (3–59). Vingt-deux patients ont ete consideres comme gueris de l’infection (65 %). Sept cas ont necessite une arthrodese (21 %). Le taux d’echec etait de 15 % avec 5 amputations transtibiales. Une couverture cutanee par lambeau a ete necessaire pour 15 patients (44 %), dans un delai median de 33 jours (0–167). Discussion Cette etude, bien que retrospective et avec un effectif reduit, confirme le mauvais pronostic des infections apres traitement chirurgical des fractures de la cheville et/ou de l’arriere-pied, dont le patient doit etre informe. Type d’etude Niveau de preuve : IV, etude retrospective, observationnelle.

Resume Contexte La courbure de la diaphyse femorale est habituellement consideree comme inscrite dans un plan sagittal. De nombreux travaux ont evalue son rayon de courbure mais tres peu ont analyse l’orientation du plan dans lequel elle s’inscrit. L’orientation de ce plan peut influencer la rotation des clous centromedullaires ou des tiges de reprise a appui diaphysaire. Aussi, nous avons mene une etude anatomique 3D afin : (1) d’analyser en 3 dimensions la courbure de la diaphyse femorale, en precisant l’orientation du plan dans lequel elle s’inscrivait, (2) de rechercher les relations entre l’orientation de la courbure et les parametres anatomiques du femur. Hypothese L’hypothese etait que ce plan dans lequel s’inscrit la courbure femorale n’est pas sagittal mais antero-lateral. Materiel et methodes Un examen tomodensitometrique (TDM) a ete realise sur des femurs secs, provenant du laboratoire d’anatomie. Les reconstructions 3D ont ete analysees pour caracteriser la courbure de la diaphyse, les rayons de ses differentes portions et determiner le plan dans lequel elle s’inscrivait par rapport au plan frontal de reference habituel defini par 3 points : face posterieure des condyles et du massif trochanterien. Les parametres suivants ont ete analyses : la taille, l’angle cervico-diaphysaire, le valgus femoral et l’anteversion du col. Resultats Quarante-cinq femurs ont ete analyses. La plus grande courbure s’inscrivait dans un plan oriente en moyenne de 78,3° ± 14,9° (35,2° a 106,7°) en antero-lateral. La correlation entre l’orientation de la courbure femorale et l’angle cervico-diaphysaire (R = 0,172), la taille (R = 0,095), le valgus (R = 0,104) et la courbure totale (R = 0,60) etaient faibles. Discussion Les implants a fixation diaphysaire sont concus pour une courbure femorale s’inscrivant dans un plan sagittal strict. Les tiges longues de reprise a ancrage diaphysaire peuvent donc avoir une tendance a la rotation laterale lors de leur insertion. La correction de cette rotation laterale pour eviter une anteversion peut entrainer de ce fait un press-fit moins satisfaisant. La courbure femorale doit etre prise en compte dans le design des implants a fixation endomedullaire. Niveau de preuve IV, etude anatomique sans groupe temoin.

Background and objectives Soft tissue sarcoma localization in distal extremities (DESTS) of the limbs (hand/fingers, and foot/toes) is unusual. The literature is scarce about their behavior and this study was designed to assess their epidemiological characteristics, outcomes, and prognosis compared to other limb localizations (OLSTS). Methods From 1980 to 2010, adult DESTS and OLSTS in 22 centers were included. Demographics, tumor type, treatment modalities, and latest follow-up status were collected. Primary endpoints were overall survival and local/metastatic recurrence incidences. Results Two hundred five DESTS and 3001 OLSTS were included. The patients were younger, with more female and smaller tumors in DESTS. There were more clear cell/epithelioid sarcomas, synovial sarcomas, and myxoid liposarcomas vs more dedifferentiated liposarcomas in OLSTS. DESTS tumors were less irradiated and more often amputated (24.3% vs 3.4%). The five-year survival rate was 78.2% compared to 68.6% in OLSTS and after multivariate analysis, STS localization did not impact survival or local/metastatic recurrence. Conclusion Though rare and smaller than other limb localizations, DESTS are to be considered as aggressive. Despite a higher amputation rate, the prognosis remains the same as in OLSTS. Limb sparing vs amputation should be carefully assessed in DESTS, especially if grade 3 or of a poor prognosis histological subtype.

Resume Introduction La creation des centres de reference pour les infections osteoarticulaires (CRIOA) a eu pour but d’optimiser la prise en charge de ce type d’infection, grâce a une concertation multidisciplinaire. L’objectif de cette etude etait d’etudier l’influence de la mise en place du Centre de reference des infections osteoarticulaires du Grand Ouest (CRIOGO) sur le traitement arthroscopique des arthrites septiques (AS) de l’epaule et du genou. L’objectif secondaire etait d’identifier d’autres facteurs d’echec de ce traitement. L’hypothese H0 etait l’absence de difference entre le groupe « succes » et le groupe « echec ». Materiel et methode Cette etude retrospective monocentrique a inclus 52 patients traites pour une AS entre le 01/01/2000 et le 31/12/2013 par lavage arthroscopique associe a une antibiotherapie d’au moins 4 semaines. Les criteres d’exclusion etaient un diagnostic retrospectif d’arthrite rhumatismale apres analyse bacteriologique negative, un arret precoce du traitement antibiotique et un suivi inferieur a 4 semaines. L’echec etait defini comme l’absence de guerison apres traitement de premiere intention. Le critere de jugement principal etait la date de la prise en charge par rapport a la date de mise en place du CRIOGO au premier trimestre 2010. L’influence de criteres pre- et peroperatoires, inherents au patient, au traitement realise et au germe identifie a ete recherchee. Resultats A la revision, 17 (32,9 %) patients etaient en echec de traitement de premiere intention et 5 (9,6 %) n’etaient pas gueris en fin de traitement, quel que soit le type de reprise. Le taux d’echec diminuait significativement apres la mise en place du CRIOGO : 42,9 % avant contre 11,8 % apres (p = 0,03). Dans le groupe echec, 70,6 % des patients etaient immunodeprimes contre 37,2 % dans le groupe succes (p = 0,01). Ni le delai de prise en charge (p = 1), ni le type de germe, ni un lavage antiseptique (p = 0,25) ou une synovectomie (p = 0,62) n’influencaient le resultat du traitement. Discussion La prise en charge multidisciplinaire des AS permet d’ameliorer le succes therapeutique. Niveau de preuve III, etude retrospective comparative.

International audience; BACKGROUND: The management of prosthetic joint infection usually consists of a combination of surgery and antimicrobial therapy. The appropriate duration of antimicrobial therapy for this indication remains unclear. METHODS: We performed an open-label, randomized, controlled, noninferiority trial to compare 6 weeks with 12 weeks of antibiotic therapy in patients with microbiologically confirmed prosthetic joint infection that had been managed with an appropriate surgical procedure. The primary outcome was persistent infection (defined as the persistence or recurrence of infection with the initial causative bacteria, with an antibiotic susceptibility pattern that was phenotypically indistinguishable from that at enrollment) within 2 years after the completion of antibiotic therapy. Noninferiority of 6 weeks of therapy to 12 weeks of therapy would be shown if the upper boundary of the 95% confidence interval for the absolute between-group difference (the value in the 6-week group minus the value in the 12-week group) in the percentage of patients with persistent infection within 2 years was not greater than 10 percentage points. RESULTS: A total of 410 patients from 28 French centers were randomly assigned to receive antibiotic therapy for 6 weeks (205 patients) or for 12 weeks (205 patients). Six patients who withdrew consent were not included in the analysis. In the main analysis, 20 patients who died during follow-up were excluded, and missing outcomes for 6 patients who were lost to follow-up were considered to be persistent infection. Persistent infection occurred in 35 of 193 patients (18.1%) in the 6-week group and in 18 of 191 patients (9.4%) in the 12-week group (risk difference, 8.7 percentage points; 95% confidence interval, 1.8 to 15.6); thus, noninferiority was not shown. Noninferiority was also not shown in the per-protocol and sensitivity analyses. We found no evidence of between-group differences in the percentage of patients with treatment failure due to a new infection, probable treatment failure, or serious adverse events. CONCLUSIONS: Among patients with microbiologically confirmed prosthetic joint infections that were managed with standard surgical procedures, antibiotic therapy for 6 weeks was not shown to be noninferior to antibiotic therapy for 12 weeks and resulted in a higher percentage of patients with unfavorable outcomes. (Funded by Programme Hospitalier de Recherche Clinique, French Ministry of Health; DATIPO ClinicalTrials.gov number, NCT01816009.).

International audience; Surveillance and traceability of medical devices (MD) is a challenge in health care systems. In the perspective of reusing EHR data to automate the monitoring of medical devices, we carried out a comparison of the main MD knowledge bases (MD-KDB) currently available in France. Four MD-KDBs (ANSM, Gudid, Exhausmed and CIOdm) were compared quantitatively and through an example of a shoulder prosthesis. The number of MDs registered differs from one MD-KDB to another. Domain terminologies used in MD-KDBs differ in terms of granularity and in the ease of querying. Waiting EUDAMED, the European MD-KDB, it seems necessary so far to use and combine information coming from several MD-KDBs to address MD monitoring.

In patients with knee infection, arthrodesis by external fixation is a limb-salvage procedure appropriate in highly selected patients. No hardware that might lead to infection is left in situ. However, the fusion rate is limited. Use of a device that applies compression in the coronal plane has been suggested in combination with sagittal external fixation to increase the fusion rate but has not been the focus of published studies. The objectives of this retrospective study were to determine: 1) the fusion rate and, 2) the rate of infection eradication.Knee arthrodesis using an external fixator and a compression clamp provides higher fusion rates compared to reports of external fixation without compression.We retrospectively studied 30 patients who underwent knee arthrodesis using external fixation and a compression clamp. The reason for arthrodesis was recurrent infection after total knee arthroplasty in 18 patients and septic arthritis in 12 patients. There were 16 females and 14 males with a mean age of 66.0±11.6 years (range, 30-83 years). Mean follow-up was 42.5±23.6 months (range, 24-106 months).Fusion was achieved in 25 (83%) patients, after a mean of 7.5 months (range, 6-12 months). Of the 8 patients with severe bone loss (≤25% bone contact), 4 experienced non-union, compared to 1 of the 22 patients whose bone loss was moderate or mild (50% and50% bone contact, respectively) (p=0.01). After at least 2 years of follow-up, the infection was eradicated in 28 (93%) patients. Complications occurred in 9 patients and consisted of pin-site infection managed by lavage (n=3), recurrent infection requiring revision surgery for debridement and lavage combined with material exchange and antibiotic therapy (n=2), and femoral shaft fracture (n=3) or traumatic fracture of the arthrodesis (n=1) treated by changing the clamp and fixator assembly.The fusion rate achieved using this combined technique is high and better than obtained with external fixation alone. Our results confirm that infection eradication is obtained more often than with nailing. This one-stage, simple, reproducible procedure does not leave any foreign material in situ.IV, retrospective observational cohort study.

Large earthquakes are unavoidable because globally the plate motions accumulate stress, which leads to ruptures of the crustal rocks hundreds of kilometers long. In developed areas, this brings buildings to collapse, which injures and kills occupants. Potential rescuers are never well informed about the extent of an earthquake disaster because communication along the rupture is interrupted. We have documented that the underestimate of fatality numbers lasts for at least the crucial first few days, often for weeks. For earthquakes that cause thousands of casualties, the extent of underestimation is usually an order of magnitude. To reduce this uncertainty of whether help is required and how much, we have assembled a data set and constructed algorithms to estimate the number of fatalities and injured within an hour of any earthquake worldwide in the computer tool QLARM. Our estimates of the population and the makeup of the built environment comes from government and internet sources. For large earthquakes, the hypocenter and magnitude is calculated and distributed by the GEOFON group at the Geoforschungszentrum (GFZ) in Potsdam, Germany and the Geological Survey (USGS) in Golden, USA within 6 to 10 minutes. Based on this information, the QLARM operator responds with an estimate of the number of casualties within 30 minutes of the earthquake, on average. These estimates are available to anyone by email alerts without charge. Since 2003, the QLARM operator has issued more than 1,000 casualty alerts at any time of the day pro bono. The USGS delivers a similar service called PAGER, which is based on different data sets and algorithms. The two loss estimates are usually close, which should give governments and news organizations confidence that these alerts are to be taken seriously. The QLARM research group also publishes research results, estimating the likely numbers of future casualties in repeats of historical large earthquakes. In such efforts the QLARM group has discovered that, contrary to the general assumption, the rural population suffers more by an order of magnitude under very large earthquakes than the urban population. It is also clear that the poorer segment of the population in cities and countryside suffer more than the affluent members of society because the former’s houses are weaker and collapse more readily. To be even more useful, a worldwide data set of hospitals and schools is needed in order to provide first responders with locations and likely damage to these critical facilities. Crucially, reliable school location data would enable first responders to focus rescue efforts on schoolchildren who die beneath the rubble of their schools in the hundreds to thousands in large earthquakes. Unfortunately, such data are not available from official sources in most developing countries, and we are not aware of good alternatives. The data on schools in open data platforms such as OpenStreetMap is sporadic. UNICEF runs a global school mapping initiative, but we have been unable to obtain their assistance to date.

Introduction Les spondylodiscites infectieuses (SDI) representent 4 a 10 % des infections osteo-articulaires. Leur incidence dans les pays occidentaux semble augmenter, parallelement a l’augmentation des comorbidites dans une population vieillissante. L’objectif de cette etude epidemiologique etait d’evaluer l’evolution des SDI en France sur la derniere decennie. Materiels et methodes Une etude transversale a ete realisee a partir des donnees medico-administratives du programme de medicalisation des systemes d’informations (PMSI). Les SDI etaient identifiees par un algorithme precedemment valide, base sur des codes diagnostiques CIM-10 et des codes d’actes CCAM. La population incluait tous les patients de 15 ans et plus hospitalises en France pour SDI sur la periode 2010–2019. Les caracteristiques des patients et des sejours ont ete decrites. Resultats Sur la periode, 42 105 patients ont ete hospitalises, correspondant a 60 878 sejours. L’incidence annuelle moyenne des SDI sur 10 ans etait de 7,8 cas pour 100 000 habitants, augmentant de 6,1 en 2010 a 11,3 en 2019. L’âge moyen etait de 64,8 ans et le sexe ratio de 1,56, stable sur la periode. Le diagnostic microbiologique etait renseigne pour 40 916 sejours (67,2%, stable par rapport aux precedentes etudes 2003 et 2008), represente majoritairement par des Cocci gram positif. Au moins une comorbidite etait retrouvee chez 31 341 patients (74,4%), augmentant de 66,0% en 2010 a 76,7% en 2019; 3059 patients (7,3%) etaient decedes en hospitalisation. Bien que rares, les SDI sur materiel concernaient 4450 sejours (7,3%) et augmentaient fortement sur la periode, de 4,7% en 2010 a 8,9% en 2019. Conclusion L’incidence des SDI, notamment sur materiel, a fortement augmente durant la derniere decennie. Les donnees du PMSI permettent le developpement d’outils fiables et exhaustifs pour le suivi et l’actualisation reguliere des donnees epidemiologiques.

Modular locking revision total hip arthroplasty femoral implants have been little assessed over the long term. We therefore conducted a retrospective assessment of the Renaissance™ fully hydroxyapatite-coated distal locking cementless femoral modular revision implant at a minimum 10 years' follow-up, analyzing: 1) survivorship, 2) complications, 3) radiologic and functional results, and 4) prevalence of thigh pain.This implant shows more than 90% 10-year survival.Between December 2002 and December 2008, 213 implant exchanges were performed in 206 patients, including 97 Renaissance™ stems in 93 patients. Three patients were excluded for missing data. Survival was analyzed for 94 stems in 90 patients at a mean 11.2±3 years' follow-up; radiographic and clinical assessment was performed for 48 stems in 45 patients. The survival criterion was implant fracture and/or femoral stem removal.Survival was 93.5% at 10 years (95% CI: 86-97) and 91.3% at 15 years (95% CI: 82.9-96). Eight stems (8.5%) were exchanged or removed by last follow-up: 5 for infection (5.3%) and 3 for implant breakage (3.2%). The complications rate was 18.1% (N=17, including the 8 stem revisions): 3 stem exchanges for breakage (3.2%), 9 stem infections (9.6%), 3 dislocations (3.2%), and 2 traumatic greater trochanter fractures (2.1%). For the 45 patients with long-term clinical assessment, the mean Postel Merle d'Aubigné and Harris Hip scores were respectively 15±3 and 80 ±19 at last follow-up. Metaphysis reconstruction was satisfactory in 36/48 cases (75.0%). Seven of the 48 stems (14.6%) assessed at longest follow-up, in 45 patients, were causing thigh pain, unrelated to stress-shielding, distal locking screws or metaphyseal filling index.The Renaissance™ fully hydroxyapatite-coated modular locking stem with curved nail showed 90% 10-year survival, with satisfactory functional results and little thigh pain.IV; case study without control group.