Comparative study of femoral diaphyseal morphometry in two male populations, in France and a French West Indies island: an example of clinical relevance of comparative anatomy for orthopedic practice.

Our aim, through a comparative study of two populations, one European and the other Afro-Caribbean, was to find out whether there were differences in radiographic measurements of femoral diaphyseal canal diameter, thickness of the medial and lateral cortex, and global diaphyseal diameter. We studied the nailed femurs of adult males in a population of 54 Europeans and 52 Afro-Caribbeans. Both populations were comparable in terms of age, height and weight. The measurements were taken with a ruler on the narrowest area of the hourglass, the isthmus, on an antero-posterior radiograph. The diameter of the femoral canal was classified into three intervals: <13 mm, 13-14 mm and >14 mm. The femoral canal diameter was significantly larger in the European patients, 14.3 (11-19) versus 13.4 (11-15.6), while the thickness of the lateral cortex was significantly larger in the Afro-Caribbean patients, 8.50 (6-12) versus 7.72 (5.4-11.5). Patient distribution according to the intervals was different in both groups: 59% of the Afro-Caribbeans were in the average interval versus 24.1% of the Europeans. For nearly 53.7% of the Europeans, the diameter of the femoral canal fell in the last interval versus 15.4% of the Afro-Caribbeans. The fact that the femoral canal is narrower in the Afro-Caribbean population may be linked to a thicker lateral cortex. The diameters of the nails used were larger in the European population, 12.6 mm (10-15) versus 12.1 mm (11-14) in the Afro-Caribbean population. The global diameters of both populations' femurs were similar (28.9 mm for the European sample vs. 29 mm). The present study may have an impact on the implants used in the orthopedic surgery (intramedullary nailing, arthroplasty implants). The range of usable implants must be complete and there must be precise pre-operative planning. A study of computed tomography scans could complement our measurements.

Long-term results with Bankart procedure: a 26-year follow-up study of 50 cases.

BACKGROUND: The purpose of this study was to evaluate the long-term outcome (>20 years) of patients who underwent an open Bankart procedure, many of them contact athletes, in terms of shoulder stability, return to sport, and the development of osteoarthritis. METHODS: We retrospectively reviewed 49 patients (50 shoulders) who underwent an open Bankart procedure for recurrent shoulder instability. There were 36 contact athletes (73%) in this cohort. Mean follow-up was 28 years (25-32). Clinical examination was performed by an independent reviewer, with standard shoulder radiographs obtained. RESULTS: Eight patients had recurrence of dislocation after a new traumatic episode, in six cases while playing rugby, with two of them requiring re-operation. Forty (82%) patients returned to their previous level of sports activities, including all 31 rugby players. No statistically significant loss of motion occurred in this group, although there was slight loss of flexion (6 degrees ) and external rotation (9 degrees ). The mean Rowe score at final follow-up was 82 (25-97), and all but two patients considered themselves satisfied with the results of the surgery. Thirty-four (69%) patients showed signs of osteoarthritis at follow-up, as follows: Stage 1 -18, Stage 2 - 5, Stage 3 - 5, and Stage 4 - 1. CONCLUSION: At long-term follow-up, patients undergoing an open Bankart procedure for recurrent shoulder instability obtained a high percentage of shoulder stability, and reliably returned to high-level sports activities. However, 69% did show radiographic signs of osteoarthritis.

Lateral femoral cutaneous neuropathy and its surgical treatment: a report of 167 cases.

Surgical treatment of lateral femoral cutaneous neuropathy (LFCN) is performed only after failure of conservative management. We reexamined 167 cases (7 bilateral) of LFCN of various etiologies (idiopathic, abdominal surgery, iliac crest bone grafting, trauma, and total hip arthroplasty) operated on between 1987 and 2003. Average follow-up was 98 months (20-212). The intervention was performed under local anesthesia in 139 cases (83%). Surgical release of the nerve was performed in 153 cases (92%) and transection in 14 cases (8%). Surgical treatment of LFCN led to improvement and patient satisfaction in 130 cases (78%). The results depended on several factors, especially the underlying etiology, duration of symptoms before intervention, and integrity of the nerve. Nerve release remains the first-line surgical technique, improving painful symptoms in many cases while preserving sensation of the thigh. It can be performed under local anesthesia by an experienced surgeon.