Reliability of the Harris Hip limping sub-score in patients undergoing total hip arthroplasty.

PURPOSE: In patients undergoing total hip arthroplasty, limping is a significant symptom, often assessed with the limping sub-score of the Harris Hip Score. However, the reliability of this sub-score has not been specifically investigated. The purpose of this study is to investigate the intra- and inter-rater reliability of this sub-score. METHODS: Thirty patients undergoing THA were recruited and performed a gait analysis before surgery and three months after surgery. In addition, 30 asymptomatic participants were included. In total, 90 visits were analysed in this study. The HHS limping sub-score was assessed for each visit using a video (front and back view side-by-side) of a ten metre walk at a self-selected speed. Two orthopaedic surgeons evaluated the limping of each video in two different grading sessions with a one week delay. To avoid recall bias, the patient's number identity was randomized and different for each grading session and each rater. The weighted Cohen's Kappa coefficient was used to quantify the intra- and inter-reliability. The reliability of three components was studied: the presence of limping, its severity, and the compensation type. RESULTS: For all components, the agreement for intra-rater reliability ranged from moderate to strong and from none to moderate for the inter-rater reliability. CONCLUSION: These results do not encourage the use of HHS-limping sub-score for data involving different raters in both clinical and research contexts. It calls for improved consensus on limping definitions or the creation of objective measures.

Radiographic signs and hip pain 5 years after THA with a cemented stem predict future revision for aseptic loosening: a prospective cohort study.

BACKGROUND AND PURPOSE: We aimed to evaluate the long-term predictive value of radiographic abnormality and/or hip pain assessed 5 years following primary total hip arthroplasty (THA) and the occurrence of revision for aseptic loosening between 5 and 25 years postoperatively. PATIENTS AND METHODS: We included all primary THAs performed between 1996 and 2011 (same uncemented cup, polyethylene-ceramic bearing, 28 mm head, cemented stem) and prospectively enrolled in the institutional registry, for whom baseline and follow-up radiographs were available. At 5 years radiographically we assessed femoral osteolysis and/or stem migration. Pain was evaluated with the Harris Hip pain subscore. Kaplan-Meier survival and Cox regression analyses were performed. RESULTS: 1,317 primary THAs were included. 25 THAs (2%) were revised for aseptic stem loosening. Any abnormal radiographic sign at 5 years was present in 191 THAs (14%). Occasional hip pain was reported by 20% and slight to severe pain by 12% of patients at 5 years. In patients < 60 years, 10 of the 12 later revised for aseptic stem loosening had abnormal radiographs at 5 years vs. 5 of the 13 later revised in those ≥ 60 years. Hazard ratios (HR) were 34 (95% confidence interval [CI] 7-155) in younger vs. 4 (CI 1-11) in the older group. HR for association of hip pain at 5 years with future revision was 3 (CI 1-5). CONCLUSION: The presence of abnormal radiographic signs 5 years after THA was strongly associated with later revision for aseptic stem loosening, especially in patients < 60 years. The association between pain at 5 years and future revision was much weaker.

Extensive skin necrosis following total hip arthroplasty performed through the direct anterior approach.

BACKGROUND: Total hip arthroplasty is a widely performed surgical procedure, which enables patients to regain mobility, alleviates pain, and improves overall quality of life. Periarticular multimodal drug infiltration (PAI) is increasingly being used as an effective postoperative pain management, decreasing the systemic consumption of opioids. Extensive postoperative skin necrosis without a deep joint infection as a complication of total hip arthroplasty with PAI has not yet been described. CASE PRESENTATION: A 71-year-old patient who underwent total hip arthroplasty of the right hip for primary osteoarthritis through the Direct Anterior Approach presented postoperatively a large area of necrotic skin at the incision. Joint infection was excluded. An extensive debridement was performed and the tissue defect was reconstructed by a pedicled anterolateral thigh flap. The skin maintained a satisfactory appearance at 1 year postoperatively, and the hip was pain-free with restored ranges of motion. The patient was able to walk with no support and without limitation. CONCLUSION: We address the possible risk factors, discuss the use of epinephrine in PAI and explore possible treatment options for such a complication.

[What surgical treatment for femoro-acetabular impingement?] / Quelle prise en charge chirurgicale pour le conflit fémoro-acétabulaire ?

Femoroacetabular impingement (FAI) is a frequent cause of hip pain in young people and athletes. It requires a complete work-up, including X-rays, hip arthro-MRI and CT coxometry with measurement of femoral torsion. The surgical management of CFA must be adapted to the morphological anomalies of the femur (cam), acetabulum (pincer) and femoral torsional disorders. Most CFA can be treated by hip arthroscopy, with correction of the cam and suture of the labrum. Some CFA with a bulky or posterior cam require surgical hip dislocation. A femoral rotation or derotation osteotomy can correct an associated torsional disorder. In cases of marked retroversion of the acetabulum, anteverting periacetabular osteotomy can reorient the acetabulum.

Le conflit fémoro-acétabulaire (CFA) est une cause fréquente de douleurs de hanche chez le sujet jeune et l'athlète. Il nécessite un bilan par radiographie, arthro-IRM de hanche, coxométrie scanographique avec torsions fémorales. La prise en charge chirurgicale du CFA doit être adaptée en fonction des anomalies morphologiques du fémur (came), du cotyle (pince) et des troubles torsionnels du fémur. La majorité des CFA peuvent être traitées par arthroscopie de hanche avec correction de la came et suture du labrum. Certains CFA avec une came volumineuse ou postérieure nécessitent une prise en charge par luxation chirurgicale de hanche. Une ostéotomie fémorale de rotation ou dérotation peut corriger un trouble torsionnel associé. En cas de rétroversion marquée du cotyle, une ostéotomie périacétabulaire d'antéversion permet de réorienter le cotyle.

[Customized 3D cutting guides : what applications in orthopedic surgery ?] / Guides de coupes 3D sur mesure : quelles applications en chirurgie orthopédique?

3D printing is a technology that has been evolving rapidly over the past twenty years. It is an additive manufacturing process which allows the creation of objects without geometry restrictions. This process has applications in orthopaedic surgery through personalized cutting guides and implants which offer the possibility to treat complex pathologies such as tumoral surgery, architectural defects of the acetabulum and malunions. Although their use cannot be recommended for routine knee and hip prosthetic surgery, their value in high tibial osteotomies seems promising. Despite its high cost, this technology is of growing interest in orthopaedic surgery.

L'impression 3D est une technologie en évolution rapide depuis une vingtaine d'année. Il s'agit d'un procédé de fabrication par addition de matière permettant la réalisation d'objets sans limitation de forme. Ce procédé trouve des applications en orthopédie pour l'obtention de guides de coupes et d'implants sur mesure offrant la possibilité de traiter des pathologies complexes comme la chirurgie tumorale, les défauts architecturaux de l'acétabulum et les cals vicieux. Si leur utilisation ne peut être recommandée de façon routinière pour la chirurgie prothétique de genou et de hanche, leur intérêt dans les ostéotomies du tibia semble prometteur. Bien que d'un coût élevé, cette technologie trouve un intérêt croissant en chirurgie orthopédique.

Reduced Infection Rate After Aseptic Revision Total Knee Arthroplasty With Extended Oral Antibiotic Protocol.

BACKGROUND: The optimal postoperative antibiotic duration has not been determined for aseptic revision total knee arthroplasty (R-TKA) where the risk of periprosthetic joint infection (PJI) is 3%-7.5%. This study compared PJI rates in aseptic R-TKA performed with extended oral antibiotic prophylaxis (EOAP) to published rates. METHODS: Aseptic R-TKAs consecutively performed between 2013 and 2017 at a tertiary care referral center in the American Midwest were retrospectively reviewed. All patients were administered intravenous antibiotics while hospitalized and discharged on 7-day oral antibiotic prophylaxis. Infection rates and antibiotic-related complications were assessed. RESULTS: Sixty-seven percent of the 176 analysis patients were female, with an average age of 64 years and body mass index of 35 kg/m2. Instability and aseptic loosening comprised 86% of revision diagnoses. Overall, 87.5% of intraoperative cultures were negative, and the remainder were single positive cultures considered contaminants. PJI rates were 0% at 90 days, 1.8% (95% confidence interval 0.4%-5.3%) at 1 year, and 2.2% (95% confidence interval 0.6%-5.7%) at mean follow-up of approximately 3 years (range, 7-65 months). CONCLUSION: EOAP after aseptic R-TKA resulted in a PJI rate equivalent to primary TKA, representing a 2- to-4-fold decrease compared with published aseptic R-TKA infection rates. Further study on the benefits and costs of EOAP after aseptic R-TKA is encouraged.

Acetabular Peri-Prosthetic Fractures-A Narrative Review.

Acetabular peri-prosthetic fractures are rare but their incidence is rising due to the increased prevalence of total hip arthroplasty, the increasing life expectancy and the growing functional demand of an ageing population, the incidence of primary total hip arthroplasty is increasing. They are either intra-operative or post-operative and have various aetiologies. Several factors such as implant stability, bone loss, remaining bone stock, fracture pattern, timing, age and co-morbidities of the patients must be considered for adequate treatment. To date, the literature on this subject has been sparse and no universally recognized treatment algorithm exists. Their rarity makes them a little-known entity and their surgical management represents a challenge for most orthopaedic surgeons. This review aims to present an update on epidemiology, the diagnostic work up, existing classification systems, surgical approaches and therapeutic options for acetabular peri-prosthetic fractures.

[Dislocation after total hip arthroplasty : how to avoid it ?] / Luxations de prothèse de hanche : comment les éviter ?

Dislocation after hip replacement is a complication that can have dramatic consequences for the patient. The purpose of this article is to review the different parameters influencing stability and how to reduce this risk. The approach, the diameter of the femoral head, and the use of dual-mobility acetabular cups have led to a drastic reduction in the rate of dislocation, particularly in patients at risk, in cases of imbalance of the spino-pelvic complex, or in cases of revision surgery. The inclusion of patients in dedicated clinical pathways and participation in preoperative education sessions also contribute to the reduction of dislocation risk.

La luxation après prothèse de hanche est une complication qui peut avoir des conséquences dramatiques pour le patient. Cet article a pour but de revoir les différents paramètres influençant la stabilité prothétique et pouvant diminuer ce risque. La voie d'abord, le diamètre de la tête fémorale et l'usage de cotyles à double mobilité ont permis une diminution drastique du taux de luxation, en particulier chez les patients à risque, en cas de déséquilibre du complexe spino-pelvien ou en cas de reprise chirurgicale. L'inclusion des patients dans des itinéraires cliniques dédiés et la participation à des séances d'information préopératoire participent également à la réduction du risque de luxation.

[Giant cell tumor of bone]. / Tumeur à cellules géantes de l'os.

Giant cell tumor is a benign epiphyseo-metaphyseal bone tumor affecting the young patient. It is characterized by an extensive osteolysis, a high potential for recurrence, a risk of malignant transformation and pulmonary metastases. Curettage and cavity filling is the most common treatment, even in the case of a pathological fracture. A wide resection with prosthetic reconstruction must sometimes be considered. Better knowledge of the role of RANK-L in the pathophysiology of these tumors has led to clinical trials involving denosumab. Treatment with denosumab is suggested for inoperable lesions, or for aggressive lesions, in particular of the spine, pelvis, and sacrum before en bloc resection.

La tumeur à cellules géantes est une tumeur osseuse bénigne épiphysométaphysaire touchant le sujet jeune. Elle est caractérisée par une ostéolyse parfois extensive, un potentiel de récidive élevé, un risque de transformation maligne et de métastases pulmonaires. Le curetage-comblement est le traitement de choix, y compris en cas de fracture pathologique. Une résection plus large avec reconstruction prothétique doit parfois être envisagée. La meilleure connaissance du rôle de RANK-L dans la physiopathologie de ces tumeurs a conduit à des essais cliniques impliquant le dénosumab. Un traitement par celui-ci est proposé pour les lésions inopérables ou agressives, notamment du rachis, du pelvis et du sacrum, avant une résection en bloc.

[Lessons learned from 25 years of an institutional hip and knee arthroplasty registry]. / Leçons apprises par 25 ans d'un registre institutionnel des prothèses de hanche et de genou.

Since 1996, the Geneva Arthroplasty Registry at the University Hospitals of Geneva (HUG) has been collecting, archiving and disseminating relevant high-quality information on primary total hip and knee arthroplasties and revision procedures performed at the Division of Orthopaedics and Traumatology. Patients are followed throughout their lifetime with the prosthesis. The registry has been essential to better understand and subsequently improve the care of patients with hip and knee replacements. It will continue to fulfil its mission and to work towards an even more effective transfer of the knowledge obtained to all stakeholders and as well as towards its implementation.

Depuis 1996, le registre genevois des arthroplasties aux HUG recueille, archive et diffuse des informations pertinentes de haute qualité concernant les arthroplasties primaires de la hanche et du genou ainsi que les procédures de révision réalisées au Service de chirurgie orthopédique et traumatologie de l'appareil moteur. Les patients sont suivis pendant toute leur vie avec la prothèse. Le registre a été essentiel pour mieux comprendre et ensuite améliorer la prise en charge de patients avec arthroplastie de hanche et de genou. Il continuera à remplir sa mission et à assurer une transmission encore plus efficace des connaissances obtenues vers tous les groupes concernés (stakeholders) et à leur implémentation.

Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial shaft fractures: a retrospective cohort study.

BACKGROUND: The purpose of this study was to evaluate the association between epidemiological, clinical and radiographic factors of patients with tibial shaft fractures and the occurrence of acute compartment syndrome. METHODS: 270 consecutive adult patients sustaining 273 tibial shaft fractures between January 2005 and December 2009 were included in this retrospective cohort study. The outcome measure was acute compartment syndrome. Patient-related (age, sex), fracture-related (high- vs. low-energy injury, isolated trauma vs. polytrauma, closed vs. open fracture) and radiological parameters (AO/OTA classification, presence or absence of a noncontiguous tibial plateau or pilon fracture, distance from the centre of the tibial fracture to the talar dome, distance between tibial and fibular fracture if associated, and angulation, translation and over-riding of main tibial fragments) were evaluated regarding their potential association with acute compartment syndrome. Univariate analysis was performed and each covariate was adjusted for age and sex. Finally, a multivariable logistic regression model was built, and odds ratios and 95% confidence intervals were obtained. Statistical significance was defined as p < 0.05. RESULTS: Acute compartment syndrome developed in 31 (11.4%) cases. In the multivariable regression model, four covariates remained statistically significantly associated with acute compartment syndrome: polytrauma, closed fracture, associated tibial plateau or pilon fracture and distance from the centre of the tibial fracture to the talar dome ≥15 cm. CONCLUSIONS: One radiological parameter related to the occurrence of acute compartment syndrome has been highlighted in this study, namely a longer distance from the centre of the tibial fracture to the talar dome, meaning a more proximal fracture. This observation may be useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients). However, larger studies are mandatory to confirm and refine the prediction of acute compartment syndrome occurrence. Radiographic signs of significant displacement were not found to be correlated to acute compartment syndrome development. Finally, the higher rate of acute compartment syndrome occurring in tibial shaft fractures associated to other musculoskeletal, thoraco-abdominal or cranio-cerebral injuries must raise the level of suspicion of any surgeon managing multiply injured patients.

[Sport participation after hip and knee replacement]. / Peut-on faire du sport avec une prothèse de hanche ou de genou ?

Hip and knee replacement are among the most successful orthopaedic interventions in terms of satisfaction and they are now proposed to younger patients. Recommendations regarding return to sports are based on expert opinions and on the results of surveys performed among surgeons. Sports activities are classified as recommended, recommended with some level of experience, and discouraged. They take into account the risks associated with sports activities, but are not necessarily in line with the growing expectations of patients. This article addresses the risks related to return to sports, recommended sports, and the rate and appropriate timing of sport resumption. The main predictor remains the motivation of the patient and the pre-operative sporting level.

Le remplacement prothétique de la hanche ou du genou donne satisfaction à un grand nombre de patients, permettant aujourd'hui d'étendre les indications à des patients plus jeunes. Les recommandations concernant la reprise du sport reposent sur des avis d'experts et des enquêtes menées auprès de chirurgiens, et classent les activités en activités recommandées, recommandées avec un certain niveau d'expérience et déconseillées. Elles tiennent compte des risques liés à la pratique sportive, mais ne sont pas toujours en phase avec les attentes croissantes des patients. Cet article pose la question des risques associés à la reprise du sport après chirurgie, des sports recommandés ainsi que du taux et du délai de reprise. Le principal facteur prédictif de reprise du sport demeure la motivation du patient et le niveau sportif préopératoire.

Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures: a retrospective cohort study.

BACKGROUND: The aim of the study was to evaluate the relation between demographic, injury-related, clinical and radiological factors of patients with tibial plateau fractures and the development of acute compartment syndrome. METHODS: All consecutive adult patients with intra-articular tibial plateau fractures admitted in our urban academic medical centre between January 2005 and December 2009 were included in this retrospective cohort study. The main outcome measurement was the development of acute compartment syndrome. RESULTS: The charts of 265 patients (mean age 48.6 years) sustaining 269 intra-articular tibial plateau fractures were retrospectively reviewed. Acute compartment syndrome occurred in 28 fractures (10.4%). Four patients presented bilateral tibial plateau fractures; of them, 2 had unilateral, but none had bilateral acute compartment syndrome. Non-contiguous tibia fracture or knee dislocation and higher AO/OTA classification (type 41-C) were statistically significantly associated with the development of acute compartment syndrome in multivariable regression analysis, while younger age (<45 years), male sex, higher Schatzker grade (IV-V-VI), higher tibial widening ratio (≥1.05) and higher femoral displacement ratio (≥0.08) were significantly associated in the analysis adjusted for age and sex. CONCLUSIONS: Two parameters related to the occurrence of ACS in tibial plateau fractures were highlighted in this study: the presence of a non-contiguous tibia fracture or knee dislocation, and higher AO/OTA classification. They may be especially useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients), and should rise the suspicion level of the treating surgeon. In these cases, regular clinical examinations and/or intra-compartmental pressure measurements should be performed before and after surgery, even if acute compartment syndrome seemed unlikely during initial assessment. However, larger studies are mandatory to confirm and refine both factors in predicting the occurrence of acute compartment syndrome.

The Accuracy of Acetabular Component Position Using a Novel Method to Determine Anteversion.

BACKGROUND: This study compares the differences in acetabular component position, leg length discrepancy, and hip offset between the anterior and posterior approach. A novel method is applied to determine the acetabular anteversion using the C-arm tilt angle for the anterior approach. METHODS: Hundred consecutive anterior total hip arthroplasties were matched according to gender, body mass index, and age to a cohort of 100 primary total hip arthroplasties operated on through a posterior approach. Postoperative radiographs were analyzed to determine cup inclination, cup anteversion, leg length discrepancy, and hip offset. RESULTS: The mean inclination was 40.8° (range 33°-48°) and 45.1° (range 33°-55°) for the anterior and posterior approach, respectively. Using the new C-arm tilt plane technique, an average acetabular anteversion of 18.4° (range 11°-26°) was achieved with the anterior approach compared with 23.6° (range 8°-38°) with the posterior approach. Hundred percent cups in the anterior group and 81% in the posterior group fell within the safe zone (P < .001). There was no difference in the overall hip offset between the operated side and the contralateral side for the anterior (P = .074) and posterior (P = .919) group. There was no difference in leg length discrepancy between the 2 approaches (P = .259). CONCLUSION: Intraoperative fluoroscopy-assisted direct anterior approach was associated with improved acetabular component positioning. However, no benefit was shown with regards to restoration of hip offset or leg length.

Influence of body mass index on revision rates after primary total knee arthroplasty.

PURPOSE: Studies demonstrate that revision rates after primary total knee arthroplasty (TKA) tend to be higher in obese patients. However, the existence of a body mass index (BMI) threshold remains unexplored. METHODS: We conducted a prospective cohort study of 2442 primary TKAs in 2035 patients (69.1 % women; mean age 72 years; mean follow-up 93 months, range 38-203). We evaluated the influence of BMI in five categories on all-cause revision after TKA using incidence rates (IR), hazard ratios (HR), and Kaplan-Meier survival analysis. Adjustment for baseline imbalances was performed using Cox regression analysis. RESULTS: Over the study period, 71 revisions occurred. Revision rates were 3.2 cases/1000 patient-years for patients of normal weight, 3.4/1000 for overweight patients and 3.0/1000 for patients classified as obese class I. At BMI ≥ 35, a significant increase in revision was noted. Comparing BMI ≥ 35 vs. < 35, there were 6.4 vs. 3.2 /1000. Crude HR was 2.0 [95 % confidence interval (CI) 1.2-3.3, p = 0.009], and the adjusted HR was 2.1 (95 % CI 1.2-3.6, p = 0.008). CONCLUSION: All-cause revision rates after primary TKA doubled in patients with a BMI of 35 but were similar in those with a BMI <35.

Body mass and weight thresholds for increased prosthetic joint infection rates after primary total joint arthroplasty.

BACKGROUND AND PURPOSE: Obesity increases the risk of deep infection after total joint arthroplasty (TJA). Our objective was to determine whether there may be body mass index (BMI) and weight thresholds indicating a higher prosthetic joint infection rate. PATIENTS AND METHODS: We included all 9,061 primary hip and knee arthroplasties (mean age 70 years, 61% women) performed between March 1996 and December 2013 where the patient had received intravenous cefuroxime (1.5 g) perioperatively. The main exposures of interest were BMI (5 categories: < 24.9, 25-29.9, 30-34.9, 35-39.9, and ≥ 40) and weight (5 categories: < 60, 60-79, 80-99, 100-119, and ≥ 120 kg). Numbers of TJAs according to BMI categories (lowest to highest) were as follows: 2,956, 3,350, 1,908, 633, and 214, respectively. The main outcome was prosthetic joint infection. The mean follow-up time was 6.5 years (0.5-18 years). RESULTS: 111 prosthetic joint infections were observed: 68 postoperative, 16 hematogenous, and 27 of undetermined cause. Incidence rates were similar in the first 3 BMI categories (< 35), but they were twice as high with BMI 35-39.9 (adjusted HR = 2.1, 95% CI: 1.1-4.3) and 4 times higher with BMI ≥ 40 (adjusted HR = 4.2, 95% CI: 1.8-9.7). Weight ≥ 100 kg was identified as threshold for a significant increase in infection from the early postoperative period onward (adjusted HR = 2.1, 95% CI: 1.3-3.6). INTERPRETATION: BMI ≥ 35 or weight ≥ 100 kg may serve as a cutoff for higher perioperative dosage of antibiotics.

[Total Hip arthroplasty in patients younger than 50 years]. / Arthroplastie totale de hanche chez les sujets de moins de 50 ans.

Total hip replacement can provide pain relief and restore function in patients suffering from hip arthritis, including in those under the age of 50. However, shortened implant longevity in this age group has been a concern because the clinical results after revision surgery are inferior to those after primary hip arthroplasty. Technical choices (approach, implants, type of fixation and bearing couple) must be made to maximise longevity based on published data and thoroughly discussed with the patient. Finally, long term results (clinical outcome and implant longevity) associated with this surgery are such that it appears unnecessary to postpone the surgery once the indication is established.

L'arthroplastie de hanche est le traitement de choix de la coxarthrose, y compris chez les patients de moins de 50 ans. La longévité raccourcie des implants dans cette classe d'âge est source d'inquiétude car la chirurgie de reprise est associée à des résultats cliniques inférieurs à la chirurgie première. Les choix techniques (voie d'abord, choix des implants, type de fixation et couple de frottement) doivent contribuer à maximiser la durée de vie des implants en étant basés sur des données publiées et faire l'objet d'une discussion approfondie avec le patient. Finalement, les résultats à long terme (gain fonctionnel et longévité) de cette intervention sont tels qu'il n'est pas nécessaire de retarder le geste chirurgical une fois l'indication posée.

[The infected diabetic foot: diagnosis and management]. / Pied diabétique infecté: du diagnostic a la prise en charge.

Foot infections are a frequent and potentially harmful complication of diabetes mellitus. In one skin ulceration out of two, further evolution towards infection occurs and often leads to amputation increasing morbidity and health care costs. Skin disruptions, favored by the sensorimotor neuropathy and vascular disease, constitute the initial factors leading to this complication. To ensure effective care, these cases must be managed by a multidisciplinary team in a specialized center. All caretakers involved with patients suffering from diabetes mellitus must be capable of preventing and recognizing diabetic foot infections, as well as informing the patients about this complication and its management.

[Lower limb amputation: indication, preoperative workup and complications]. / Amputations du membre inférieur: indications, bitan et complications.

The main causes of lower limb amputations are peripheral artery disease (92% of the cases) and trauma (7%). The selection of the amputation level aims at optimizing the chances of healing and the functionality of the involved limb. Foot preserving amputations offer the best functional outcome but the healing process is frequently slow and difficult. After a below-knee amputation, 60% of the patients are capable of ambulating again, whereas only 20% of the patients undergoing an above-knee amputation ambulate autonomously. Complications after amputations are frequent, can occur a long time after surgery and must be managed by a highly specialized team.

High-energy blunt pelvic ring injury incidence and polytrauma caseload in a single level I trauma center during COVID-19 related pseudo-lockdown measures: a retrospective cohort study based on a prospective registry.

BACKGROUND: Pelvic ring injuries are potentially lethal lesions associated with polytrauma patients and need an efficient trauma team for their management. The purpose of this study was to evaluate the incidence of high-energy blunt pelvic ring injuries and the absolute number of polytrauma patients in a single level I trauma center during the 2020 pseudo-lockdown period related to the Coronavirus pandemic, and to compare it with corresponding periods in 2014-2019 in order to better understand the need of organized and dedicated personnel and infrastructures. METHODS: This retrospective cohort study was based on data prospectively recorded into the institutional Severely Injured Patients' Registry. Data were obtained for each year period (January 1st to December 31st) and corresponding pseudo-lockdown period (March 16th to June 19th). High-energy blunt pelvic ring injuries inclusion criteria were: (1) Registry entry between January 1st, 2014 and December 31st, 2020; (2) age ≥ 16 years old; and (3) pelvic ring injury presence. Corresponding exclusion criteria were: (1) death before admission; (2) transfer from another institution > 24 h after trauma; (3) penetrating, blast, burn and electrical injuries, drownings; (4) patients living outside the defined institution's catchment area; and (5) any document attesting the patient's will to not participate in any study. Polytrauma patients inclusion criteria were: (1) Registry entry between January 1st, 2014 and December 31st, 2020; (2) age ≥ 16 years old; and (3) Injury Severity Score ≥ 16. Corresponding exclusion criteria were: (1) death before admission; (2) transfer from another institution > 24 h after trauma; and (3) any document attesting the patient's will to not participate in any study. Categorical variables were reported using proportions and continuous variables using medians and interquartile ranges. Because data were exhaustive for the authors' level I trauma center, no inferential statistics were computed. RESULTS: The incidence of high-energy blunt pelvic ring injuries and the absolute number of polytrauma patients remained within range of previous years despite pseudo-lockdown measures. CONCLUSIONS: These observations bring better knowledge about pseudo-lockdown's impact on trauma and may help for future health strategy planning by pointing out the importance of maintaining the activity of level I trauma centers in terms of personnel and infrastructures.