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D Saragaglia

Publications and source records attributed to D Saragaglia.

At least 19 recordsLinked to original sources
PubMed2006

[Chronic expanding hematoma of the soleus: a case report].

Trauma-induced hematomas of the limbs usually resorb without sequelae. In certain circumstances which are not fully understood, the hematoma may expand progressively, eventually leading to the development of a tumor-like mass in the soft tissues. We report the case of a chronic expanding hematoma observed in the right soleus muscle of a 75-year-old man. The mass grew +9 cm compared with the other side over a period of two to three years with no notion of recent trauma. Surgical biopsy disclosed a thick capsule containing "chocolate pus". Pathology and cytology examination led to the diagnosis of pseudo-tumor calcinosis subsequent to a hematoma which the patient had developed 34 years earlier when as a mountain guide he had experienced a tear of the soleus muscle. Local care required complete resection of the soleus muscle. The patient was able to resume activities without pain. Well described in the literature, encapsulated hematoma of the limbs is not well known in France. This case illustrated the potentially long latency period (34 years in our patient). Pathologically similar to tumor calcinosis, chronic expanding hematoma should be entertained as a possible diagnosis in a patient with a longstanding mass and a history of past trauma. The differential diagnosis with sarcoma is established by magnetic resonance imaging which reveals a peripheral low intensity signal on T1 and T2 sequences.

Aged↗
PubMed2005

[Posterior ankle impingement syndrome: a retrospective study in 21 cases treated surgically].

PURPOSE OF THE STUDY: The purpose of this work was to describe the posterior ankle impingement syndrome and to present a retrospective analysis of results after surgical treatment in 21 patients with a mean five years follow-up. MATERIAL AND METHODS: Twenty-one patients with a posterior ankle impingement syndrome underwent surgery between 1991 and 1999. There were 17 men and four women, mean age 33 years (18-45); 71% practiced sports, half at the competition level. For 71% of the patients, there was an acute fracture with nonunion of the posterior process of the talus; a microtrauma context was identified in 29%. The physical examination revealed pain at passive forced plantar flexion in 94% of patients with limping during exercise in 88%. Plain x-rays showed a long tail on the talus in 87% of the patients, a short tail in 9%, and a trigone bone in 4%. The posterior malleolus (or third tibial malleolus) was remodeled in 9%. Other examinations performed preoperatively completed the topographic analysis: 99Tc bone scintigraphy, computed tomography with 2D reconstruction and horizontal slices, MRI. The patients were placed in the ventral prone position for surgery via a para-achilles approach, medial in ten patients and lateral in eleven. Bone resection with combined arthrolysis of the subtalar and tibiotalar joints was performed in 20 patients (17 with nonunion of the posterior talar process, one with a trigone bone, two with malformed callus of the posterior malleolus). A soft tissue procedure was also performed in three patients (resection of a synovial cyst in one, tenosynovectomy of the long flexor of the great toe in two). RESULTS: All patients were reviewed clinically and radiographically (plain x-rays). The AOFAS score was determined. There were no cases of infection. Mean follow-up was five years (range 3-10). Results were excellent with a mean Kitaoka score of 90/100, varying with cause and type of procedure performed. Only one patient was dissatisfied (Kitaoka score 67/100); this patient presented residual dysesthesia in the territory of the posterior tibial nerve. In 90% of the patients, there was no sign of degeneration of the peritalar joints (two patients exhibited minimal remodeling of the posterior subtalar joint). 90% of the patients were satisfied or very satisfied. DISCUSSION: The posterior ankle impingement syndrome includes several pathological entities with similar clinical expression. It involves both bony and soft tissue elements in the posterior peritalar region. Repeated or acute forced plantar flexion is the main cause. Complementary explorations (bone scintigraphy, CT, MRI) besides standard radiography, are indispensable to obtain a definitive diagnosis and demonstrate the functional and mechanical impairment. Surgical treatment is simple via a posterior approach (posterolateral or posteromedial)) and in our hands has provided very good results without arthritic consequences at mid-term.

Adolescent↗
PubMed2001

[Computer-assisted knee arthroplasty: comparison with a conventional procedure. Results of 50 cases in a prospective randomized study].

PURPOSE OF THE STUDY: The aim of this work was to compare the radiographic findings after two techniques for total knee arthroplasty, one using a computer-assisted approach and the other a conventional approach. MATERIAL AND METHODS: Between January 1998 and April 1999, we conducted a prospective study randomizing 25 patients for conventional surgery (group A) and 25 for computer-assisted surgery (group B). All patients volunteered to participate in this study and gave their written informed consent. There were 35 women and 15 men, mean age 69.5 years (range 47-85). The two groups were comparable for age, gender, height, weight, orthopedic history, etiology and preoperative mobility. The preoperative hip-knee angle (HKA) was also comparable between the two groups. Mean HKA was 175 degrees, i.e. 5 degrees varus (range 162 degrees (18 degrees varus) to 210 degrees (30 degrees valgus)). Genu varum was found in 80 p. 100 of the patients in group A and in 76 p. 100 in group B, genu valgum in 16 p. 100 in group A and 24 p. 100 in group B. The same operator performed all the procedures) with the same type ok prosthesis for all patients. The goal of the operation was to position the prosthesis to produce an HKA of 180 +/- 3 degrees, a femoral angle of 90 degrees (from the mechanical axis), a tibial angle of 90 degrees and a posterior tibial slope of 0 degrees (tibial plateau at 90 degrees to the lateral tibial axis). Statview 5 PC was used for the statistical analysis. Comparisons between groups were made with the Student's t test to compare means when the validity conditions were met. RESULTS: The patients were reviewed by two surgeons, independently of the operator and the designers of the computer-assistance program. Mean duration of the procedure was longer in group B (102 mn versus 70 mn, p<0.001). There was no statistically significant difference in mean postoperative bleeding (group A=380 cc, group B=480 cc). The postoperative HKA was 181.2 +/- 2.72 degrees in group A and 179.04 +/- 2.53 degrees in group B (p > 0.05). The HKA was between 177 degrees and 183 degrees in 75 p. 100 of the patients in group A and in 84 p. 100 of those in group B. Implantation of the femoral component showed a mean angle of 91.12 +/- 2.07 degrees in group A and 89.56 +/- 1.61 degrees in group B (p=0.048). The mean tibial angle was 90.167 +/- 1.61 degrees in group A and 89.5 +/- 1.34 degrees in group B (p=0.11). On the lateral view, the femoral component was at 90 degrees to the mechanical axis in 16/21 patients in group B. These data were missing in group A. The posterior tibial slope was 90.76 +/- 2.19 degrees in group A and 89.44 +/- 2.14 in group B (p=0.18). CONCLUSION: Computer-assisted surgery for total knee arthroplasty was found to provide remarkably reliable results. Once the "growing pains" of this new material have been mastered, all surgeons should be able to expect an improvement in the positioning of prosthetic implantations.

Aged↗
PubMed2001

[Acute anterior instability of the shoulder: short- and mid-term outcome after conservative treatment].

PURPOSE OF THE STUDY: We assessed short and mid-term outcome after emergency care for acute anterior instability of the shoulder. MATERIALS AND METHOD: Between October 1990 and May 1996, 233 shoulders (206 anteromedial dislocations, 21 dislocations with spontaneous reduction, and 6 painful shoulders with unknown instability) were treated, mainly orthopedically. The series included 165 men and 68 women, mean age 42 years (range 13-95 years). One hundred fifty-eight practiced sports more or less regularly (73% of the 216 patients) and a sports accident was involved in 121 cases (52.8%). Besides the usual lesions secondary to bone displacement, there were 51 fracture-avulsions of the greater tuberosity, 7 major fractures of the anteroinferior border of the glenoid cavity, 2 fractures of the coracoid process, 10 nerve lesions (6 axillary nerve palsies and 4 partial palsies of the brachial plexus) and 10 rotator cuff tears. Orthopedic reduction was performed in the emergency room in all patients with a dislocated shoulder (82%). Immobilization, elbow to body, was prescribed for 8 to 15 days. Sixteen patients (6.8%) underwent surgery during the days following reduction, 8 for displaced fracture of the greater tuberosity, 7 for important fracture of the glenoid cavity and 1 for avulsion of the rotator cuff. RESULTS: Patient files (n=210) or phone interviews (n=185) were used to assess outcome. Mean follow-up was 38 months (12 - 72 months). All nerve lesions regressed within a few weeks without sequelae. We had 6 cases of retractile capsulitis and 4 cases of reflex dystrophy that regressed totally in 3 to 6 months. Recurrent dislocation was observed in 52 cases (24.7% recurrence rate) with 29 occurring within one year (55.8%). Among the 145 other shoulders, 84 recovered completely (58%), 52 were occasionally bothersome (36%), 8 exhibited repeated subdislocation (5.5%) and one remained pseudoparalytic. Among the factors favoring recurrence, we found patient age (higher risk in younger subjects) and lack of rehabilitation (p<0.05). DISCUSSION: Acute anterior dislocation of the shoulder is frequent, but emergency surgical repair is rarely needed (15 cases in our series, 6.9%). Mid-term recurrence is not as frequent as is often thought, warranting the choice of first intention orthopedic care. Our findings demonstrated that emergency surgery is not indicated in most cases of anterior shoulder instability, even with the arthroscopic approach, especially since the results of this method remain unclear.

Accidents↗
PubMed1999

[Comparative biomechanical study of 3 types of osteosynthesis of the Duparc grade IV fractures of the calcaneus: value of triangular internal fixation].

PURPOSE OF THE STUDY: We present an in vitro biomechanical study performed to evaluate and compare, for an experimentally produced fracture of the calcaneum (Duparc grade IV), the reaction of 3 standard models of internal fixation commonly used in these fractures and which occupy different volumes. MATERIALS AND METHODS: We compared different methods of fixation using fresh human calcanei. In two experimental series, we compared triangular internal fixation (3 1/4 tube AO plates Saragaglia), Y internal fixation (2 1/3 tube AO plates Bezes), isolated screw technique (three 3.5 diameter screws, two 4.5 diameter screws). The plates and screws were made of identical material (316L). Both series used 8 pairs of bone (talo-calcaneum system) with the same fracture submitted to a 200N to 1000N load. Stiffness and movement were analyzed using 8 references on the calcaneum. RESULTS: The stiffness and movement analysis with 8 references points demonstrated the superior resistance to bending with the triangular internal fixation. Fixation stability was significantly better than with the Y or screw technique. DISCUSSION: This study underlined the importance of triangular trabecular organization of cancellous bone on calcaneum biomechanics. We showed that the 3 (anterior, posterior and inferior) trabeculae must be repaired in calcaneum fractures to achieve horizontal and vertical stability of the talar joint. CONCLUSION: In our hands, restoration of the triangular architecture of calcaneum fractures, to resemble a roof truss, where the talus is fixed to the triangle vertex, is fundamental to obtain a rigid and stable internal fixation.

Biomechanical Phenomena↗
PubMed1998

[Anatomo-clinical consequences of the vertical sectioning of the subscapular muscle in Latarjet intervention].

UNLABELLED: The goal of this study was to assess the effects of the vertical section of the subscapularis muscle (internal rotation and muscular degeneration) during Latarjet procedure. MATERIAL AND METHODS: From October 1st, 1990, to June 30th, 1991, 40 patients were operated according to Latarjet for chronic anterior shoulder instability. A vertical section of the subscapular muscle was performed. Except for one female patient, all of them practiced sports. Preoperative delay between first dislocation and surgery averaged 59 months. Postoperative rehabilitation was aimed at external rotation, recovery began 48 hours after surgery, without specific indications as far as internal rotation was concerned. Sports activity was resumed 90 days after surgery. 38 were reviewed after 4 years. Clinical review was made according to Constant's score and by measuring strength, and amplitude of internal rotation. Radiological assessment of the shoulders was made with standard x-rays and CT. RESULTS: For global results, we noted absence of recurrence, a weighted Constant score of 88 per cent, 87 per cent of patients satisfied or very satisfied, 55 per cent of the osteoplastic ridge were on level, 16 per cent were retracted, and 29 per cent overlapped, 19 per cent non union or ridge lysis, 21 per cent glenohumeral osteophytosis. As far as clinical results are concerned, no significant difference was noted associated to osteoplastic ridge position. Internal rotation was assessed by measuring the distance hand to back (lift-off test). On the operated side it averaged 6 cm (0-18 cm), on the other side 13 cm (2-21 cm). The difference between each side was statistically very significant (p = 0.0001). Strength in internal rotation on the operated side averaged 3 kg (0-8 kg), on the other side, 6 kg (2-10 kg). The difference between each side was statistically very significant (p < 0.0001). CT was carried out on thickness and degeneration of the subscapular muscle (n = 29). Thickness of the subscapular muscle (operated side) average 10.5 (5-17 mm) after surgery, and 14.6 mm before surgery. It was thimer than on the contralateral shoulder 21 mm (10-33 mm). In both cases (shoulder before and after surgery, operated and contralateral shoulder), the difference was statistically significant. Degeneration of the subscapular muscle showed 4 stage 0, 13 stage 1, 5 stage 2, 6 stage 3, and 1 stage 4. A non statistical correlation was noted, between muscle degeneration and functional result, strength in internal rotation, distance hand to back. DISCUSSION: This series confirms efficiency and low morbidity of Latarjet procedure. Nevertheless, assessment of the subscapular muscle shows that 50 per cent of its strength and 50 per cent of its thickness were lost, 4 years after surgery. A significant degeneration (stages 2.3.4) was found in 41 per cent of the patients. This limitation is related to the trans-subscapular approach and to the absence of internal rotation postoperative rehabilitation. CONCLUSION: A randomized study comparing the vertical trans-subscapular approach to the horizontal trans-subscapular one would determine the better procedure.

Adolescent↗
PubMed1997

[Pseudotumor manifestation of metallosis in a hip prosthesis].

A pseudo-tumour due to metallosis is described in association with an iso-elastic hip replacement. This is a relatively rare lesion which may be difficult to diagnose. Scintigraphy and radiography may be helpful in distinguishing the lesion from a primary or secondary neoplasm, but the presence of osteolysis adjacent to the prosthesis will suggest the true nature of the lesion.

Aged↗
PubMed1997

Reconstruction of the lateral ankle ligaments using an inferior extensor retinaculum flap.

The aim of this study was to assess the results of 32 cases of chronic ankle instability. These were treated by ligament shortening and reinforced with an inferior extensor retinaculum flap. All patients complained of persistent functional instability unrelieved with proprioceptive exercises. Results were assessed clinically (pain, instability, recovery of sports activity, mobility) and radiologically (correction of laxity on stress x-rays). This enabled us to draw up a revision score on a scale of 100 points. We obtained a mean score of 86.7 points (45-100 points), and subjective results showed that 88% of the patients were satisfied with the surgery.

Adolescent↗
PubMed1997

[A morphometric study of the femoro-patellar joint from lateral x-ray view].

PURPOSE OF THE STUDY: The goal of this study was to specify criteria of femoro-patellar joint normality on lateral view. MATERIAL: This study was based on radiological examination of 102 knees in 51 adults (average age 26.1 years). It concerned 29 women and 22 men that had never suffered from their knee and were supposed healthy. METHODS: The radiological protocol was the following: a lateral view at 45 degrees of flexion, two lateral views in extension, with and without quadriceps contraction. The analysis was focused on patellar surface aspect, its height, its depth and covering measurement. RESULTS: We found 83.7 per cent of so-called "normal" patellar surface, and 12.7 per cent of "abnormal" patellar surface (dysplasia) in the absence of pain. DISCUSSION: We have confirmed figures advanced in others series of the literature concerning patellar height and patellar surface, as well as patellar surface depth and covering. We have underlined the interest of lateral views; in extension with quadriceps contracted and relaxed. Finally, we have defined a trochleo-patellar sign that allows to correlate patellar height to patellar surface height (ITP = 0.35 to 0.84). CONCLUSION: This study insists on the interest of radiological lateral views of the knee and determine criteria for normalities.

Adult↗
PubMed1997

[Biomechanical comparative study of three types of osteosynthesis in the treatment of supra and intercondylar fractures of the humerus in adults].

PURPOSE OF THE STUDY: Supra and intercondylar fractures are the most common fractures of the distal end of the humerus in adult. An osteosynthesis consisting of a plate is the treatment of choice. But location and type of plate always remain open for debate. The authors present the results of an in vitro biomechanical study, which compared the stiffness of three types of osteosynthesis commonly used in these fractures. MATERIAL AND METHODS: The devices were on one hand the premolded lateral plate of Lecestre and Dupont (Howmedica) used alone or in conjunction with a medial 1/3 tubular plate of the AO group, and on the other hand a posterior plate, of which we are developing a new model, the Lambda plate (Protek) "Y"-shaped, monoblock, flat and molded on the humerus during operation. The study compared these different methods of fixation on fresh human humeri. In a first part, the posterior plate was compared to the single lateral one; in a second part, the posterior plate was compared to the coupled lateral and medial plates. The three plates were made of identical material. Both studies used eight pairs of bones with supra and intercondylar fractures realized by sawing. Each bone of a pair was fixed with one of the two types of device. Each humerus underwent different loading forces; sagittal bending (anterior and posterior) and torsion. The displacements were recorded using a calibrated measuring device coupled to two displacement sensors. The stiffness was calculated on force/displacement curves. RESULTS: In anterior bending, the Lambda posterior fixation was significantly stiffer than the single lateral one (p < 0.05) (239 +/- 109 versus 129 +/- 65 N/mm), and was not significantly different of the bilateral fixation (229 +/- 93 versus 224 +/- 108 N/mm). In posterior bending, the mean stiffness of the Lambda fixation was not significantly different to that of the lateral fixation (91 +/- 27 versus 91 +/- 52 N/mm), and less than that of the bilateral one (130 +/- 39 versus 170 +/- 70 N/mm), but not significantly. In torsion the mean stiffness of the Lambda fixation was superior to that of the lateral one (146.75 +/- 50.66 versus 119.75 +/- 58.8 Nm/rad), and bilateral one (233.31 +/- 107.47 versus 212.31 +/- 113.55 Nm/rad), but again not significantly. DISCUSSION: The ideal osteosynthesis for the fractures of the humeral distal doesn't exist, because the bone undergoes antero-posterior and posteroanterior cyclical forces during elbow flexion. Therefore the best device should be placed on both sides of the bone, but anatomical reasons make this location impossible. According to our study, we think the "less worst" device is the posterior one using the Lambda plate. Its symmetrical design allows a best loading distribution on the two columns. Its thickness compensates for its posterior location and the short interval between two holes allows to put many screws (4 to 6) into the epiphysis. All supra and intercondylar fractures, comminuted or not, can be treated with this material. The single lateral device isn't still enough. Its stiffness mainly depends on the orientation of the oblique screw in the medial column. But the design of this column doesn't always allow for an optimal location of the screw, which is the reason of several failures. The bilateral device gives a stiffness, comparable to the posterior one, but doesn't allow as many screws as the Lambda plate in the epiphysis. Therefore, it can't be used in very distal fractures. CONCLUSION: In spite of the progress of the material and the accuracy of the indications, the treatment of supra and intercondylar fractures of the distal end of the humerus is always a difficult problem. The devices have to be as stable as possible to allow an early motion. The best one should be placed on both sides of the distal humerus, because of the sagittal cyclic forces it undergoes, but this location is anatomically impossible. Our study concludes that the device using the Lambda plate i

Biomechanical Phenomena↗
PubMed1995

[Traumatic luxation of the peroneal tendons. Report of 36 cases].

Between January 1970 and September 1992 we operated on 35 patients with dislocation of the peroneal tendons; in 1 patient both sides were affected. Twelve cases were acute and 24 chronic; 83% were due to injuries at sport, 90% of which were in downhill skiers. In 25 cases the fibroperiosteal detachment and the lax tendon sheath were repaired using either the technique of Meary, or that devised by ourselves. Exner suture of the lesion of the main body of the sheath was carried out in 8 cases, and other procedures in the remainder. Ninety two percent of patients had a satisfactory result. The surgical procedure adopted must depend on the patterns of injury, but the majority of cases require fibroperiosteal release with transosseus reattachment of the sheath.

Acute Disease↗
PubMed1995

Medium-term results of 173 ligamentoplasties of the anterior cruciate ligament using the MacIntosh technique reinforced by the Kennedy ligament augmentation device (LAD).

This is a retrospective study of 173 cases of chronic laxity of the knee, surgically treated between May 1985 and December 1988 using the MacIntosh technique (quadriceps-plasty) reinforced with the Kennedy ligament augmentation device (LAD). It involved 171 operations, 113 men and 58 women aged between 15 and 49 years (average 26 years), the majority of whom were active in sports both at competition (51 cases) and at recreational level (119 cases). There were 101 lesions of the medial meniscus (58.4%) and 94 lesions of the lateral meniscus (54.4%); only 41 knees had no meniscal lesion (23.6%). The results at medium term (between 4 and 8 years follow-up) were based on 107 cases (61.8%). The tolerance of the reinforcement was excellent as there were no instances of either acute or chronic synovitis in this series. The anatomical results evaluated using the Lachmann test (maximum manual Lachmann) showed no differential in 24 cases (22.8%), a differential of between 0 and 2 mm in 54 cases (50.5%), of between 2 and 4 mm in 20 cases (19%) and of > 4 mm in 9 cases (8.7%). The functional results evaluated using the Arpège CLAS system showed 83% of results to be satisfactory (score > 23). The radiological results showed that 63 knees (58.9%) had no subclinical or clinical signs of medial or lateral femorotibial osteoarthritis. In total, with an average follow-up of > 5 years (4-8 years), it was found that the MacIntosh quadriceps-plasty reinforced with the Kennedy LAD was not accompanied by any iatrogenic disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Iatrogenic hallux varus surgical procedure: a study of 14 cases.

Hallux varus occurs most frequently as a result of excessive surgical correction of musculoligamentous imbalance around the metatarsophalangeal (MTP) joint of the great toe (lateral release and medial capsuloligamentous tensioning). If untreated, the condition may lead to motion loss and degenerative arthritis. In this series, 14 cases of hallux varus were treated. Medial arthrolysis was done in each case. In five cases, reconstruction of the lateral ligament (with a 1.5-mm Ligapro suture), using a new technique, accompanied the medial release. Arthrodesis of the MTP was done in nine cases treated when there was already stiffness and arthrosis. According to a 100-point scoring system, the results were excellent in 56% and good in 44% of the MTP joint arthrodesis cases. Results were excellent in 100% of the mobilizing technique cases using Ligapro suture.

Adult↗
PubMed1995

[Tibiotarsal arthrodesis: value of external fixator associated with in situ cancellous bone graft. Initial results apropos of 18 cases].

Tibio-talar arthrodesis poses some problems and the most frequent are non-union and varus malalignment of the ankle joint. The aim of this report was to present a new technique of ankle joint arthrodesis. The principles of this procedure are as follows: firstly, the external fixation (A.L.J.) is framed, secondly, perpendicular cuts are made in the tibial plafond and talus through an anterior longitudinal approach; and thirdly, the gap is filled with cancellous bone graft which is taken preferably on the iliac crest. If the back-foot is not correctly lined up preoperatively, the external device is framed in two steps: the first step consists in putting the pins. Then perpendicular cuts are made, and the back-foot is correctly lined up using calcaneal pins. The second step consists in connecting tibial pins and foot pins using union-rods. The last step of the procedure is to fill the gap with cancellous bone graft. The external fixation device is removed after 45 days and a shortleg walking cast is put for 45 days. Between 1981 and 1992, 18 arthrodesis were performed on various diagnosis: 9 post-traumatic tibio-talar osteoarthritis, 4 residual neurologic diseases, 2 rheumatoid arthritis and 3 recent post-traumatic lesions. There were 17 patients (one bilateral case), 4 females and 13 males; the middle age at the time of operation was 44.5 years (20 to 60) and there were 10 right ankles and 8 left. The tibio-talar arthrodesis was performed alone in 14 cases, but it was associated with a talo-calcaneus arthrodesis in 4 cases. The after care was without complications except 3 pins infection which cured with antibiotics. All the cases had a good bony union within 3 to 6 months and the orientation of the backfoot was always satisfactory without varus malalignment. All the patients could put one's shoes without having recourse to orthopaedic shoes. In conclusion, this operative procedure seems to minimize the problems and pittfalls of the ankle arthrodesis.

Adult↗
PubMed1995

[Isolated rupture of the tendon of the supra spinatus muscle. Results of 49 surgical repair].

PURPOSE OF THE STUDY: The purpose of this study was to assess the results of surgical repairs in 49 << isolated >> tears of the supra- spinatus in 49 patients, 32 males and 17 females. MATERIAL AND METHODS: The average age at operation was 54,2 years (35 to 72) and the dominant side was injured in 30 patients (12 opposite side and 5 unknown). According to Constant's score the pain was permanent in 23 patients, it occurred at moderate exertion in 21 patients and at important exertion in 5. The average pain duration was 43,4 months (0 to 360 months). The range of motion was normal (40 points) in 24 patients, diminished in 15 (30 points), very diminished (10 points) in 7 and the shoulder was stiff in one patient (2 files were uncomplete). All the patients were disturbed in daily living activity and the strength assessment was disturbed because of the pain. In all cases we performed an anterior acromioplasty. At operation, 39 patients had an isolated tear of the supra-spinatus and 10 an associated tear of the long head of the biceps (7 tendinities, 1 dislocation and 2 ruptures). The size of the rupture was less than 2 cm2 in 21 cases comprised between 2 and 5 cm2 in 27 and greater than 5 cm2 in one case. The surgical procedure was a Neviaser's technique in 4 cases, a single suture in 19, a transosseous suture in 19 and a deltoid muscular flap in 7 cases (large retracted tear), in addition we performed 14 resections of the distal end of the clavicle and 4 tenodesis of the long head of the biceps. RESULTS: The results were assessed according to Constant's score on 46 patients (3 lost to follow-up), the average follow-up was 31,5 months (12 to 86). The average scores were: pain 12,3 points (3 to 15), range of motion 35,5 (14 to 40), daily living activity 17,4 (8 to 20), and strength 11,4 (< > side = 14,8 points). The total Constant's scores were 75,7 per cent (actual score) and 88,3 per cent (weighted score), according to the weighted score 24 patients had 100 per cent; 9 were comprized between 85 and 100, 5 between 65 and 85, and 8 were less than 65 per cent. The average post-operative acromio-humeral height was 9,84 mm (pre-operative height = 11 mm). DISCUSSION - CONCLUSION: If we compare the results in terms of surgical procedure the difference was not statistically significant although the transosseous suture was not so good: single suture 91,5 per cent, deltoid muscular flap 90,9 per cent, Neviaser's technique 87 per cent, and transosseous suture 79,1 per cent. Nevertheless the results are not so good (p = 0,01) if it is an industrial injury and if the post operative acromio-humeral height is diminished. On the other hand, age, sex, duration of the pain, occupation, tenodesis of the long head of the biceps and resection of the distal end of the clavicle don't have any pejorative influence on the results.

Acromion↗
PubMed1994

[Anterior instability of the shoulder associated with fracture of the coracoid process. Apropos of 3 cases].

PURPOSE OF THE STUDY: The aim of this paper is to present an unusual lesion associating anterior instability of the shoulder with a fracture of the horizontal part of the coracoid process. It emphasizes surgical treatment using the Latarjet procedure. MATERIAL AND METHODS: Three cases are presented: One case was a recurrent anterior dislocation of the shoulder associated with a fracture of the horizontal part of the coracoid process; an other case was a painful shoulder associated with pseudarthrosis of the coracoid process and a fracture of the anterior and inferior edge of the glenoid. In the last case there was a recurrent dislocation of the shoulder associated with a pseudarthrosis of the coracoid process detected intra-operatively. All the patients were operated on using the Latarjet's procedure using the fractured coracoid process. RESULTS: The three cases had a good result. DISCUSSION: The association of an anterior dislocation of the shoulder and a fracture of the coracoid process is very unusual. It is often unrecognized because of poor knowledge of this lesion or a poor quality of the radiograms performed in the emergency room. The most likely mechanism is a direct impact of the humeral head against the coracoid process during the dislocation. The fracture is located (as in our 3 cases) at the horizontal part of the coracoid process near its elbow and they are often associated lesions at the anterior and inferior edge of the glenoid. The diagnosis requires good quality radiograms and a Garth's view systematically performed after reducing the dislocation. When the shoulder is painful or unstable, surgical treatment is performed and the Latarjet's procedure takes care of the pseudarthrosis and the instability of the shoulder. CONCLUSION: Isolated fractures of the coracoid process are probably uncommon. When there is a fracture of the horizontal part of the coracoid process anterior instability of the shoulder should be suspected. This is the case when the shoulder has never been dislocated and when the standard radiograms are "normal" without "crossing lesions" at the anterior and inferior edge of the glenoid or at the humeral head (Hill-Sach lesion).

Adolescent↗