Search

Charcot foot (CF) is a rare complication of diabetes associated with foot deformities and foot ulcers. Peripheral arterial disease (PAD) is a factor of poor prognosis in patients with diabetic foot ulcers (DFUs). However, PAD has infrequently been studied in CF. We aimed to determine the prevalence, the characteristics and the prognosis of PAD in a large group of patients with diabetic CF. We retrospectively compared 56 patients with diabetic CF to 116 patients with diabetic foot without CF. The prevalence of PAD in patients with CF was 66.1%. Compared to patients without CF, patients with CF had similar risks to have PAD (OR 0.98, 95%CI 0.50-1.94, p= .97) and neuro-ischemic DFUs (OR 1.19, 95%CI 0.57-2.49, p= .65), more risk to have lesions of distal arteries (OR 4.17, 95%CI 1.76-9.94, p= .001) and less risk to need revascularization (OR 0.14, 95%CI 0.06-0.36, p< .001). In patients with CF, PAD was strongly predicted by DFUs (OR 24.55, 95%CI 1.80-334.43, p= .016) and coronary artery disease (OR 17.11, 95%CI 1.75-167.43, p =.015). Survival rate and limb salvage rate in patients with CF were not worsened by PAD and by neuro-ischemic DFUs, respectively. In conclusion, we show that PAD should not be overlooked in patients with diabetic CF, especially in those having DFUs or coronary artery disease. PAD in patients with CF differed from that of patients without CF since it predominated in distal arteries and required less often revascularization.

L’année 2021 nous permet d’éclairer l’impact des techniques mini-invasives en chirurgie d’arthroplastie de hanche, la poursuite des progrès dans l’arthroplastie du genou, la place de stratégies non conventionnelles dans le contrôle des infections d’implants et l’intérêt d’une nouvelle installation pour la réalisation des techniques d’arthroscopie de l’épaule. L’optimisation des techniques chirurgicales en arthroplastie de hanche permet d’identifier les patients pour lesquels un contrôle sanguin postopératoire s’avère nécessaire mais aussi, dès lors d’optimiser les patients avant l’intervention afin de réduire le risque d’anémie postopératoire et la nécessité d’une transfusion. Le bénéfice de l’arthroplastie du genou n’a jusqu’à présent pas égalé celui de la hanche. Néanmoins, le développement des stratégies de resurfaçage respectant l’anatomie individuelle du patient soutenu par la technologie moderne et particulièrement la robotisation et le recours aux implants sur mesures laisse augurer de progrès significatifs. L’infection constitue une complication redoutable de la chirurgie d’arthroplastie. Aux stratégies classiques viennent s’ajouter de nouvelles approches thérapeutiques comme la chirurgie deux temps en un et une meilleure définition de la place de l’antibiothérapie suppressive au long cours. Enfin, Il semble qu’une position optimale pour les patients qui bénéficient d’arthroscopies de l’épaule soit celle en décubitus dorsal, évitant les inconvénients des positions semi-assise et en décubitus latéral, la première étant associée à un risque anesthésique accru et la deuxième à des difficultés chirurgicales en cas de conversion vers une voie ouverte et un risque de lésion du plexus brachial., [2021 innovations in orthopedic surgery and traumatology] The year 2021 enabled us to shed light on the impact of minimally invasive techniques in hip arthroplasty surgery, continued progress in knee arthroplasty, place of unconventional strategies in the control of implant infections, and interest of a new surgical positioning for performing shoulder arthroscopy techniques. The optimization of surgical techniques in hip arthroplasty renders it now possible to identify those patients for whom a postoperative blood control proves necessary but also, therefore, for optimizing the patients before the intervention in order to reduce the risk of postoperative anemia and transfusion requirement. The benefit of knee replacement surgery has so far not matched that of hip replacement. Nevertheless, the development of resurfacing strategies respecting the individual anatomy of the patient, supported by modern technology and particularly robotization and using custom-made implants, augurs well for significant progress. Infection is a serious complication of arthroplasty surgery. To the classic strategies were added new therapeutic approaches, such as two-stage surgery in one stage and a better definition of the place of long-term suppressive antibiotic therapy. Finally, an optimal position for patients benefitting from shoulder arthroscopy is that in the supine position, avoiding the disadvantages of semi-sitting and lateral decubitus positions, with the first associated with increased anesthetic risks and the second with surgical difficulties in the event of conversion to an open approach, with a risk of injury to the brachial plexus.

BACKGROUND: Diabetic foot infection (DFI) is a frequent and potentially both limb- and life-threatening complication of diabetic foot ulcer (DFU). [...]

AIM : The distal tibiofibular syndesmosis (DTFS) is frequently injured during ankle trauma. The sequelae can be significant, including chronic instability, early osteoarthritis and residual pain. The aim of this study is to summarize the current state knowledge about these injuries by answering four questions. HOW COMMON ARE SYNDESMOSIS INJURIES?: They frequently occur in the context of an ankle sprain (20-40% of cases) or during various types of ankle fractures (20-100% of cases). They cannot be ruled out based solely on fracture type and must be investigated when a fibular or posterior malleolar fracture is present. HOW ARE THEY DIAGNOSED?: Clinical examination and imaging are essential but do not provide a definitive diagnosis. Ultrasonography, CT scan and MRI have high sensitivity, but their static nature does not allow a treatment strategy to be defined. Dynamic radiographs must be taken, either with load or during a procedure. If instability is detected, stabilization is the general rule. HOW IS THE SYNDESMOSIS REDUCED AND STABILIZED?: In fracture cases, reduction is achieved by restoring the length and rotation of the distal fibular fragment, preferably during an open procedure. In sprain cases, reduction is not a problem unless there is ligament interposition. Tibiofibular fixation is done 1.5 to 3cm from the talocrural joint, while ensuring the reduction is perfect. WHAT OUTCOMES CAN BE EXPECTED?: The main complication-non-healing of the syndesmosis-is attributed to poor initial reduction. This or functional discomfort during weight bearing will require removal of the fixation hardware. In most cases, this allows functional recovery and correction of the inadequate reduction. Persistence of instability will require ligament reconstruction or fusion of the syndesmosis. Chronic instability can lead to ankle osteoarthritis. LEVEL OF EVIDENCE : V, expert opinion.

Surgical treatment of lateral ankle instability can be performed with or without allograft. We compared these two technical options referring to patients’ functional, radiological and ultrasound data. Forty patients were surgically treated for lateral pain- ful instability of the ankle. Twenty patients underwent ligamentoplasty using the Broström-Gould technique and twenty underwent a ligamentoplasty by allograft tendon. Patients were matched in age and gender. The assessment was done at 2.5 years postoperatively by functional scores (Olerud & Molander, and Foot & Ankle Outcome), dynamic x-rays (focused on varus and anterior drawer stress tests) and ultrasound examination (focused on anterior talo-fibular and calcaneo-fibular ligaments). No significant difference was found between the two techniques for all scores. Functional scores were more than 75% and the com- plication rate was low (<10%). Regarding the surgical technique, the tendon allograft could not prove to be more beneficial.

Ankle fractures are frequently treated using surgical interventions, and are associated with a high rate of postoperative complications. We wonder if complications can be anticipated and correlated to patient demographics, lifestyle, fracture or surgery related factors. We retrospectively reviewed all medical reports of patients who underwent ankle fracture surgery between 2013 and 2017. We focused our risks factors analysis on 5 common complications : poor wound healing, surgical site infection, malunion, nonunion and chronic pain. Multivariate logistic regression was performed to analyze significant risk factors for these complications. We identified 433 patients. Complications were present in 26% of the cases. The most frequent complication was poor wound healing (10%) associated with deep surgical site infection in 6%. Malunion was found in 7% and nonunion in 3%. Seven percent of patients suffered from chronic pain. More severe fractures happened to be a risk factor for poor wound healing (p = 0,032) and malunion (p < 0,001). Open fractures had respectively 6 to 9 times more mal- (p = 0,012) and nonunion (p = 0,018). Overweight patients with alcohol abuse were doubling their chances of cutaneous (p = 0,030) and infectious (p = 0,040) complications, and tripling their risks of ankle fracture nonunion (p = 0,003). Female and patients operated at night (p = 0,045) seemed to be more at risk to develop chronic pain (p = 0,028). Complications of ankle fracture treatment are frequent and their risks increases with more complex and open fractures. This study brings new evidence concerning the combined effect of overweight and alcohol abuse on poor wound healing, surgical site infection and non-union.

L’année 2019 nous amène à évoquer trois thématiques : l’apport de l’imagerie 3D dans la planification des arthroplasties de l’épaule, la reconstruction articulaire du coude par greffe ostéoarticulaire taillée en miroir et enfin la chirurgie de la scoliose par modulation de croissance, sans fusion vertébrale. La pathologie de l’épaule est une des plus fréquentes du système locomoteur, touchant environ la moitié de la population. L’arthrose gléno-humérale, quelle que soit son étiologie, peut justifier le recours à un remplacement prothétique. Le devenir de ces implants n’atteint cependant pas le taux de survie des implants prothétiques de la hanche et du genou. La sévérité des pertes osseuses, particulièrement au niveau de la glène de l’omoplate, et la difficulté d’orienter avec précision les implants rend compte pour une bonne part d’échecs fréquents et trop précoces. La planification de la chirurgie à l’aide d’un logiciel de planification à partir de reconstructions 3D scanner permet d’anticiper ces problèmes et d’établir une stratégie chirurgicale adaptée. Le devenir des arthroplasties du coude dans le temps reste limité, particulièrement chez le sujet jeune et actif. L’utilisation d’une reconstruction ostéochondrale permet de postposer le recours à l’arthroplastie de plusieurs années. Cette chirurgie difficile par la nécessité d’une congruence articulaire parfaite est actuellement rendue possible par l’usage d’une planification en miroir à partir de l’articulation saine et la sélection de l’allogreffe la plus appropriée sur base de l’imagerie scanner. La chirurgie est rendue possible par la mise à disposition du chirurgien de guides de coupe pour l’articulation lésée et l’allogreffe, assurant la correction avec exactitude, conformément à la planification préopératoire. La scoliose atteint principalement une population jeune et tend à s’aggraver avec la croissance. Jusqu’à présent, la chirurgie visait à rétablir l’équilibre sagital du rachis en bloquant les segment, The year 2019 has provided us three major themes: the contribution of 3D imaging in the planning of shoulder replacements, joint reconstruction of the elbow by mirrored osteoarticular graft, and finally scoliosis surgery by modulation of growth, without vertebral fusion. Shoulder disease is one of the most common conditions involving the musculoskeletal system, affecting about half of the patients with musculoskeletal complaints. Gleno-humeral osteoarthritis, whatever its etiology, may justify prosthetic replacement. However, the fate of these implants does not attain the survival rates of prosthetic hip and knee implants. The severity of bone loss, particularly within the scapula, and the difficulty of precisely orientating implants both account for a large part of common and too early failures. Planning surgery using planning software from 3D reconstruction scans can anticipate these problems and enable us to establish an appropriate surgical strategy. The fate of elbow replacements remains limited over time, especially in the young and active subject. Using osteochondral reconstruction allows us to postpone arthroplasty for several years. The need for perfect joint congruence is currently made possible via mirror planning from the healthy joint and selection of the most appropriate allograft based on scanner imaging. Surgery is made possible by the surgeon's provision of cutting guides for the injured joint and allograft, ensuring accurate correction, in accordance with preoperative planning. Scoliosis mainly affects a young population, tending to worsen with growth. Until now, surgery has been aimed at restoring the spine’s sagittal balance by fusion of the bony segments to prevent further deformation. This strategy has implemented constraints on the spine segments left free of instrumentation and bone fusion with potentially secondary discoradicular pathologies at these levels. The concept of using residual spine growth to correct deformation has recently been