Post-traumatic forearm bone defect reconstruction using the induced membrane technique.

INTRODUCTION: The induced membrane technique, first described by Masquelet, is now well standardized, but little studied in post-traumatic forearm bone defect. The main aim of the present study was to analyze consolidation rates in this indication. The study hypothesis was that the induced membrane technique provides good consolidation results. METHODS: We performed a retrospective assessment of our experience with 10 cases of induced membrane forearm reconstruction. The two main etiologies were acute trauma or treatment for non-union. Functional impact was assessed on range of motion and QuickDASH. The complications rate was also examined. RESULTS: There were 3 cases of post-traumatic bone defect, and 7 of non-union treatment, including 6 septic non-unions. Mean defect size was 4.3cm. Mean interval between induced membrane stages 1 and 2 was 3.3 months. Pure cancellous iliac bone graft was systematic. Nine of the patients showed consolidation, at a mean 9.2 months; there was 1 case of non-consolidation, but no other complications. Range of motion was satisfactory; mean QuickDASH score was 22 at a mean 50.3 months' follow-up. CONCLUSION: The induced membrane technique was reliable, reproducible and technically accessible, with good functional and radiographic results and few complications. LEVEL OF EVIDENCE: IV; retrospective study without control group.

Medium-term evaluation of leg lengthening by ISKD® intramedullary nail in 28 patients: Should we still use this lengthening system?

INTRODUCTION: Lower-limb lengthening presently uses intramedullary nailing. There are motorized systems and mechanical systems, each with their specific complications. The aim of the present study was to assess the efficacy of ISKD® mechanical nails (Orthofix Inc., Texas, USA) on 3D EOS® imaging, and also complications and functional impact. HYPOTHESIS: The study hypothesis was that nail lengthening is effective but should no longer use the ISKD® system, due to the high rate of specific complications. MATERIAL AND METHODS: A single-center retrospective study included 28 patients (14 female, 14 male) undergoing limb-lengthening by ISKD® nail between 2005 and 2018. Mean age was 29 years. Twenty-four procedures were femoral and 4 tibial. Lengthening and consolidation parameters and residual discrepancy were measured on 3D EOS® imaging. Complications and functional scores were collated. RESULTS: Twenty-eight ISKD® nails were implanted in 28 patients. Mean follow-up was 75 months. Planned lengthening was achieved in 78.5% of cases, for a mean lengthening of 34.5mm. Mean lengthening and consolidation indices were respectively 0.94mm/day and 105 days/cm. Length discrepancy showed significant correction, with improvement in functional scores (p<0.01). The overall complications rate was 67.9%, 76% of which were specific to the ISKD® nail. DISCUSSION: The present study confirmed that nail lengthening is an indication of choice in lower-limb length discrepancy, but that the ISKD® system should no longer be used, due to an excessive rate of specific complications. Complications are due to deficient control of lengthening rate, not found with new-generation motorized nails, which show much fewer complications. LEVEL OF EVIDENCE: IV, retrospective study without control group.

Chromium-Cobalt Intoxication with Intense Systemic Complications following Total Hip Revision after Per-Operative Ceramic Fracture.

INTRODUCTION: Heavy metal intoxication after arthroplasty is extremely rare but could be lethal. Case Report. We report the case of a 69-year-old woman, who presented intense systemic symptoms of chromium-cobalt intoxication after revision of per-operative fractured ceramic components with metal-on-polyethylene. Systemic toxicity occurred a year after surgery and expressed brutally with mostly central neurological symptoms. Chelation associated with revision surgery allowed rapid regression of all symptoms. CONCLUSION: Revision of fractured ceramic, even per-operatively, should not be done with metal-on-polyethylene components, in order to avoid potentially lethal metal intoxication.

Leg length discrepancy after total hip arthroplasty: Can leg length be satisfactorily controlled via anterior approach without a traction table? Evaluation in 56 patients with EOS 3D.

BACKGROUND: Leg length discrepancy (LLD) occurs in about 25% of cases after total hip arthroplasty (THA) and adversely affects function if greater than 10mm. When using the direct anterior approach (DAA), limb length control is considered easier with a standard operating table than with a traction table. However, this assumption has not been confirmed. More specifically, no studies have used EOS imaging, which is currently the reference for assessing limb length. The objectives of this retrospective study were: (1) to use EOS imaging to determine whether THA via the DAA on a standard table allowed satisfactory limb length control; (2) whether LLD was associated with other parameters such as age, gender, body mass index (BMI), or side; and (3) to compare clinical score values between patients with and without LLD. HYPOTHESIS: The DAA without a traction table allows satisfactory limb length control as assessed using 3D EOS imaging. MATERIAL AND METHODS: This retrospective descriptive study included 56 patients who underwent primary THA via the DAA between March 2013 and June 2014. LLD was measured on pre- and post-operative EOS images, using sterEOS™ 3D software. Age, gender, BMI, and side of THA were collected. The 12-item Short Form score, Harris Hip Score, and Postel-Merle d'Aubigné score were determined to look for radio-clinical correlations. RESULTS: Of the 56 patients, 15 (26.8%) had an LLD >10mm before THA and 12 (21.4%) after THA. Limb length equality was restored in 7 patients with 1 with a shorter and 1 with a longer limb before THA. In 5 patients with equal limb length before THA, the operated limb was lengthened after THA, by a mean of 8.92mm (range, 5.8-10.8mm). Thus, in all, 5/56 (8.9%) patients experienced a detrimental change in limb length due to the surgery. No statistically significant differences were found between patients with and without LLD regarding age, gender, BMI, side, or clinical scores. DISCUSSION: Although the frequency of LLD after THA in our study was consistent with earlier reports, our results show that good limb length control can be obtained via the DAA with a standard operating table. Thus, 7 of the 11 patients with a shorter limb and 1 of 4 with a longer limb before THA had equal limb lengths after THA, and only 8.9% of patients experienced a detrimental increase in limb length after THA. The DAA without a traction table allows satisfactory intra-operative limb length control based on visualisation of anatomical landmarks (antero-superior iliac spines and medial malleoli). This technique is therefore valuable for limiting the risk of LLD. When combined with 3D EOS planning, it may increase the accuracy of limb length adjustment. LEVEL OF EVIDENCE: IV, retrospective study with no control group.