Combined juvenile polyposis/hereditary hemorrhagic telangiectasia syndrome

Sophie Mercier (1), Nicolas Janin (2) Published in the journal : May 2023 Category : Chirurgie orthopédique et traumatologie

Combined juvenile polyposis/hereditary hemorrhagic telangectasia (JP/HHT) syndrome is a rare genetic disorder associating both the development of hamartomatous polyps in the gastrointestinal tract and the Rendu-Osler-Weber disease. Patients affected by these two pathologies are exposed to an increased risk of digestive tract cancers and vascular malformations.

In this article, we present the case of a 73-year-old patient diagnosed with juvenile polyposis at the age of 67, following a bifocal left colon cancer. During his lifetime, this patient presented numerous epistaxis episodes without a clearly identified cause. Because his eldest daughter also suffered from repeated episodes of epistaxis, a genetic origin was then suggested.

In order to properly organize the follow-up of their patients, it is important that practitioners likely to see a person suffering from JP/HHT in consultation take into account the possibility that this person might suffer from the JP/HHT syndrome.

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Ventrolateral lumbar disk herniation as an unusual presentation

Olivier Raskin, Ludovic Kaminski Published in the journal : May 2022 Category : Chirurgie orthopédique et traumatologie

Acute lumbar pain is a common reason for patients attending primary care practices, with most of it being benign in nature.

One of its most frequent cause is a lumbar disk herniation, which can manifest itself only as a lower back pain, though it is usually associated with sciatica.

We have described herein a case of ventrolateral lumbar disk herniation crushing the psoas muscle origin, with a radiating pain that was not caused by nerve root compression. Nevertheless, like most cases of lumbar disk herniation, the pain improved with the passage of time and completely resolved within a few weeks, without any surgical procedure.

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2021 innovations in orthopedic surgery and traumatology

Maïte Van Cauter, Pierre Pirlot, Pierre-Philippe Guilmot, Loïc Thoreau, Maxime Bonnelance, Gautier Beckers, Hervé Poilvache, Daniel Morcillo, Vincent Druez, Jean-Emile Dubuc, Nadia Irda, Ludovic Kaminski, Simon Vandergugten, Alin Sirbu, Karim Tribak, Dan Published in the journal : February 2022 Category : Chirurgie orthopédique et traumatologie

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.

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2019 innovations in orthopaedic surgery and traumatology

Xavier Libouton, Nathalie Pireau, Simon Vandergugten, Vincent Cunin, Jean-Emile Dubuc, Philippe Mahaudens, Nadia Irda, Maïte Van Cauter, Ludovic Kaminski, Karim Tribak, Dan Putineanu, David Mathieu, Daniel Morcillo, Loic Thoreau, Alin Sirbu, Vincent D Published in the journal : February 2020 Category : Chirurgie orthopédique et traumatologie

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 introduced. Rather than permanently fusing the column, the material is positioned to slow the growth on the curvature’s convex side and let the concave side continue to grow and correct the deformation. This is growth modulation. In this configuration, the column is no longer blocked and retains its flexibility.

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2018 innovations in orthopedic surgery and traumatology

Th. Schubert (1), M. Van Cauter (1), O. Barbier (1), D. Mathieu, D. Morcillo, L. Thoreau, S. Vandergugten, N.Pireau, A. Sirbu, V. Druez, N. Irda, L. Kaminski, K. Tribak, D. Putineanu, J-E. Dubuc, X. Libouton, E. Thienpont, J-C. Yombi, X. Geets (2),et al. Published in the journal : February 2019 Category : Chirurgie orthopédique et traumatologie

Arthroplasty has become the standard approach for hip replacement and has even been described as “The operation of the century” in The Lancet. The drive to optimize care has led to many improvements, particularly regarding minimally invasive surgery, thereby enabling faster functional recovery. Thanks to these advances, it is now possible to consider performing a bilateral arthroplasty, when required, in the same operating session, without impacting the final result of both arthroplasties and at a lower cost. The concept of arthroplasty also extends to the structures involved in the movements of the over- and underlying joints, notably with arthroplasties able to restore the pronation-supination movements of the forearm.

The discovery of a soft tissue mass is often trivialized. Yet, when its volume exceeds 5 centimeters and it is located under the fascia, a malignant tumor must be considered, and multidisciplinary care is required. While surgery has long been regarded as the standard therapeutic option, it is now well established that the co-management with radiation therapists offers a better chance of success, especially if it can precede surgery. Strategies combining state-of-the-art radiotherapy techniques to achieve skin saving and surgical management techniques with a very conservative approach to soft tissue management and negative pressure wound therapy significantly improve the tumor control.

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Traumatic bipolar dislocation of the clavicle

Alain Colette (1), Arnaud Toussaint, Guillaume Vandemeulebroecke (2) Published in the journal : December 2018 Category : Chirurgie orthopédique et traumatologie

While acromio-clavicular dislocations are common lesions, the association with sterno-clavicular joint dislocation proves to be very rare, with less than fifty cases reported worldwide.

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Optimal Recovery and bilateral total hip prosthesis

Maïté Van Cauter, Jean-Emile Dubuc, Jean-Cyr Yombi, Olivier Cornu Published in the journal : February 2018 Category : Chirurgie orthopédique et traumatologie

The first total hip prostheses were implanted more than 40 years ago. Over the past 10 years, so-called "mini-invasive" surgeries have emerged, enabling patient's muscle mass to be preserved. This type of surgery is associated with a faster functional recovery and shorter hospital stay. Five years ago, we implemented a clinical course on arthroplasty, titled "Optimal Recovery", at the Cliniques Universitaires Saint-Luc. This protocol seeks to optimize the care of patients throughout their care journey, ensuring that standardized procedures be applied as much as possible. Patients benefit from two information sessions, one individual and one group session, and receive an information leaflet, in order to be actively included in the care process, which reduces their stress. Minimally-invasive surgical techniques, along with the adaptation of pre-, intra- and postoperative protocols, including postoperative analgesia and rehabilitation techniques, have likewise been developed in this setting. Implementing this type of care strategy has been associated with a reduction in both hospital stay and postoperative transfusion rates. The good results thereby observed enable bilateral arthroplasty to be performed at the same time, without any significant impact on either duration of the operation or functional recovery.

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The management of hip dysplasia

Maïté Van Cauter, Louis Gossing, Jean-Emile Dubuc, Olivier Cornu Published in the journal : February 2017 Category : Chirurgie orthopédique et traumatologie

Although it was hoped for that joint replacement surgery would provide longer-lasting results through the development of uncemented implants and low-friction bearings, and despite its indications being extended to younger patients, total hip arthroplasty does not allow for an implant with sufficient longevity to prevent us from considering a later revision. Moreover, replacement does not systematically offer the comfort of a native joint. The development of techniques designed to preserve the native joint and slow down or avoid osteoarthritis is therefore of particular interest. The realization of a periacetabular osteotomy (PAO) in hip dysplasia falls within this framework, increasing the acetabular coverage by a reorientation of the acetabulum. The use of preoperative three-dimensional reconstruction and planning help the surgeons to predict corrections. The use of cutting guides and an intraoperative scanner ensure accuracy and control throughout the whole intervention. PAO should therefore be recognized as the treatment of choice for acetabular dysplasia in young adults, prior to the occurrence of osteoarthritis.

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2015 innovations in orthopedic surgery and traumatology

N. Irda, D. Putineanu, K. Tribak, X. Libouton, O. Barbier, M. Van Cauter, J.-E. Dubuc, E. Thienpont, J.-C. Yombi, Th. Schubert, L. Kaminski, M. Mousny, P.-L. Docquier, X. Banse, Ch. Delloye, O. Cornu Published in the journal : February 2016 Category : Chirurgie orthopédique et traumatologie

Orthopedic surgery has been driven by technological advances for several years, thereby facilitating joint replacements while helping restore joint function and patient autonomy. New prostheses regularly emerge. They provide solutions to the problems posed by current joint replacements and render new joint replacements foreseeable, as is the case for the ankle and wrist.

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