With high technology equipments for diagnosis, in solidarity and cooperation, we have planned to provide our patients with good medical and surgical treatments of orthopedic and traumatic congenital and hereditary diseases.
The surgery to replace a joint with a prosthesis is called arthroplasty. A prosthesis is "complete" when it replaces all the components of the joint. It consists of several synthetic mechanical parts (prosthetic implants) of the same shape as the joint. It provides, as far as possible, the same services as a natural joint (flexibility, stability, etc.).
For the knee: depending on the patient's pathology, the surgeon will place either a Total Knee Prosthesis (PTG) or a Unicompartmental Prosthesis (PUC).
For the hip: depending on the patient's pathology, the surgeon will either place a Total Hip Prosthesis (PTH) or an Intermediate Hip Prosthesis (PIH).
It is proposed when one suffers "too much" from a very worn joint. No means currently available can repair a damaged joint. When the pains become too embarrassing, despite the well-conducted medical treatment (drugs, infiltrations, rehabilitation), prosthetic replacement is the only solution. It is pain and discomfort with movements that constitute the determining elements of the intervention and which fix the moment.
A prosthesis is made up of several materials which will articulate with each other with friction forces (friction couple):
- Metal alloys are articulated with polyethylene parts: metal-polyethylene friction couple.
- Metal alloy parts can be articulated with other metal alloy parts: metal-metal friction couple.
- Ceramic parts can be articulated with polyethylene: ceramic-polyethylene friction couple.
- Ceramic parts with another ceramic part: ceramic-ceramic friction couple.
Arthroscopy is performed in the operating room, under general or epidural anesthesia. The arthroscope is a tube a few millimeters in diameter, fitted with an optical system and a lighting system; it is coupled to a miniaturized video camera, itself connected to a television screen.
The arthroscope is placed inside the knee through a small hole; one or sometimes several other small cutaneous orifices are necessary for the introduction of fine instruments into the joint. During the entire examination, the knee is swollen with fluid (physiological saline).
a) Operative arthroscopy:
It is possible by arthroscopy to perform a number of intra-articular surgeries, without the need to open the knee, and this, thanks to the use of miniaturized instruments of high precision. The intervention may relate to:
- menisci: ablation, most often partial, limited to the injured area of the meniscus and retaining all of its healthy portion. Arthroscopy can also be used to suture a meniscus in the rare cases where this is possible.
- cartilage: regularization of cartilage when it is cracked, irregular, hypertrophic. This regularization can, if necessary, interest the bone underlying the cartilage or allow the removal of a fragment of osteochondritis.
- the synovium: excision of adhesions, folds (plica), partial or total removal of the synovium.
- arthroscopy can remove small, free bone or cartilage fragments from the joint (foreign bodies).
- arthroscopy is finally used for certain more important operations of the knee, in particular during the treatment of ruptures of the cruciate ligaments, of certain fractures of the tibial plates… By avoiding to open the joint, it makes the intervention less traumatic.
b) Diagnostic arthroscopy:
Much more rarely arthroscopy is used to find the cause of a disorder in the functioning of the knee (pain, swelling, blockages, instability, etc.). In the majority of cases, in fact, the clinical examination, and modern additional examinations (radiographs, scanner, MRI, etc.) make it possible to make the diagnosis, and the use of diagnostic arthroscopy is only indicated if their information is insufficient. . Arthroscopy allows you to look at:
- the joint cavity,
- menisci (internal and external),
- cartilages (of the kneecap, femur, tibia),
- the synovial membrane (pocket surrounding the joint),
- the cruciate ligaments.
Minimally invasive hand and foot surgery
Reducing the incision, limiting cutaneous aggression, simplifying post-operative operations have been an obsession in surgery, especially orthopedic surgery. Thanks to technological advances (arthroscopic cameras and optics for example), the development of specific instrumentation and the improvement of surgical practices, minimally invasive surgery has become possible for many procedures. (Hand, shoulder, knee surgery, etc.)
Foot surgery, like other surgical specialties, continues to take advantage of the latest technological innovations to enrich and progress on the path of as minimal an approach as possible, especially for this surgery , a significant aesthetic component is to be taken into consideration.
Obviously, minimally invasive foot surgery is not a simple "miniaturization" of so-called "conventional" surgical techniques, it requires specific materials and equipment (mini scalpels, specific strawberries, image intensifier), as well as perfect mastery on the part of the surgeon (rigorous operating and postoperative protocols, learning curve, etc.). Its progress in recent years has made it almost essential in the therapeutic proposals intended for the correction of hallux valgus.
Intramedullary osteosynthesis or with traumatic or pathological fracture plates
Osteosynthesis means reassembly of bone fragments. This designates a surgical technique aimed at reducing bone fractures. During osteosynthesis, the bone fragments are fixed using screws, plates, nails or pins. The fractured bone is thus fixed and can be replaced and consolidated stably.
Not all bone fractures are treated by osteosynthesis or internal bone fixation. Osteosynthesis is more particularly suitable for bone fractures, that is, when the skin or soft tissues are damaged. Multiple bone fractures, bone fractures of the leg, and fractures in patients with osteoporosis are usually treated by osteosynthesis.
Depending on the location of the fracture and the type of fracture, different methods of osteoporosis are used, such as screw osteosynthesis, plate osteosynthesis, bone marrow osteosynthesis, brace osteosynthesis, pin fixation. Kirschner, an external fixator and dynamic plate screws. The materials used today are generally titanium.
What preparations are made?
The main pre-intervention examination is the accurate representation of the fracture using a radio or MRI. Depending on the results of the examination, a decision is made on which osteosynthesis method to use.
Before surgery, routine exams are performed before an operation, i.e. blood test, blood pressure measurement and ECG. The patient should stop taking hemostatic drugs and be on an empty stomach before the operation.
How is the operation going?
The surgical method used to reduce the fracture depends on the location and type of the fracture. Depending on the location of the fracture and the patient's state of health, the procedure is performed under general anesthesia, epidural or local anesthesia. So the operation can be done on an outpatient basis.
Osteosynthesis by screw
During osteosynthesis, the bone fragments are fixed with screws. For this, we make a hole in one of the fractured parts. In the other bone fragment, a thread is drilled for the screw (traction screw) or a screw is used whose end is already threaded (cancellous screw). In both cases, the bone fragments are fused by the traction of the screw.
During plate osteosynthesis, the bone fragments are fixed with a plate. The surgeon clears the fractured bone and screws a plate to the fracture line. He then fixes the plate to the different bone fragments using screws in the bone. The fragments are thus assembled robustly.
Osteosynthesis by medial nail
During osteosynthesis with a medial nail, an opening is made in the medular cavity of the fractured bone. The surgeon makes a canal in the medular cavity, in which he fixes a long nail. This nail holds the bone fragments together like an internal rod. The medial nail is sometimes stabilized with a transverse bolt so that it cannot move. The correct positioning of the nail is controlled by radio.
Osteosynthesis by guying
Guying osteosynthesis is a technique in which the bone fragments are compressed together. In this relatively complex process, the bone fragments are provided with steel wires tightened by a banding.
Fixing with Kirschner pins
Kirschner wires are elastic steel rods, used in the event of fracture on small bones such as on the fingers or collarbone.
The pins are placed inside the bone except at the top end where they come out. Once the fracture has been resolved, the pins can be removed.
Most often, a splint or a cast is also placed, since the pins alone are not enough to stabilize the fracture.
In the case of an external fixator, the fracture points are fixed using an external device. To do this, the surgeon makes small skin incisions at the fracture, through which he drills different holes in the bone. Metal plugs are implanted in the bone through the skin and connected by a metal bar on the outside, thereby stabilizing the fracture on the outside.
Dynamic plate screw
The dynamic plate screw is a surgical procedure used to reduce fractures of the femoral neck (fractures of the femoral neck close to the hip).
For this, a screw is placed in the femoral head. On the external face of the femur is fixed a plate provided with a tube into which the free end of the plate screw can be inserted. The plate screw allows the patient's weight to be displaced so as to compress the fracture line.
What is the success rate of treatment?
It is possible to stabilize fractures with different methods of osteosynthesis until the bones are fully consolidated. In general, this process allows excellent healing of fractures.
What are the risks or complications of treatment?
Osteosyntheses are part of standard fracture reduction techniques and generally take place without complications. As with all operations, infections, nerve damage, hemorrhages, or blood clots can sometimes occur. In rare cases, stiffness of the joints, necrosis of the bone fragments or adhesion of the ligaments is observed. Sometimes compartment syndrome can occur.
What happens after the surgery?
After the intervention, the patient is in the recovery phase and placed under surveillance. We start very early with physiotherapy exercises to prevent stiffness in the joints and to avoid muscle wasting as much as possible.
The time it takes for the bone to fully consolidate and be fully restrained depends on the osteosynthesis technique used and the healing process. The healing time after a fracture is at least 6 weeks, but can last several months. A solicitation and partial mobilization using crutches or supports is generally possible before.
Different factors determine whether the osteosynthesis material should be removed after the fracture is fully resolved. The commonly used material (titanium) can in principle remain in the body for life. Unless there are compelling reasons, screws and plates are not generally removed today.
Orthopedic treatment of limb deformities in newborns and children
What is clubfoot?
Marina Carrère d'Encausse and Benoît Thevenet explain the clubfoot: The clubfoot is a malformation of the foot described in medicine since Hippocrates. It is the most common orthopedic deformity today, affecting approximately one in 1,000 newborns. Mostly boys.
The clubfoot is due to a retraction of certain muscles and tendons of the leg, associated with bone malformations. The foot cannot therefore normally rest on the ground. There are four main deformations:
- the equine: when the foot, in forced extension, goes up towards the ankle and never rests on the heel. Only tiptoe touches the ground. We talk about equine in reference to the horse's hooves, which also seems to walk "on tiptoe". In Latin, equus actually means "horse".
- the hindfoot varus: when the heel goes inward while normally, when looking at a person from the back, the heel is slightly outside the leg.
- supination: when the foot is oriented towards the sky rather than towards the ground.
- adduction: when the forefoot is turned inward.
The clubfoot can be diagnosed as early as the fifth month ultrasound. During the ultrasound, you have to imagine that the baby is moving but his foot remains fixed in one position and does not move at all. Clubfoot treatment begins very early, usually from birth, as the feet of newborns are still very malleable. They contain practically no bone but cartilage, a kind of soft tissue.
If the clubfoot is not quickly taken care of, the deformation will worsen throughout life and exert stress on the joints, poor support for walking, osteoarthritis, pain ... A one of the benchmark techniques today is the Ponseti method, named after the surgeon who developed it in the 1950s in the United States. To avoid the operation, he had the idea of treating the clubfoot with plasters.
Clubfoot: straightening babies' feet
The plasters will help straighten babies' feet.
Adapted techniques make it possible to reshape the feet of newborns. The so-called "Ponseti" technique, named after one of the first orthopedic surgeons to try to avoid the operation, involves treating clubfoot non-surgically with plasters.
The Ponseti technique is a corrective treatment for clubfoot, which consists in applying a succession of plasters or shells, changed regularly, to obtain an almost normal alignment of the bones and muscles of the foot.
In France, several teams rather use another method, which consists of placing babies' feet in the right position by small tablets and bandages.
Despite this, the operation is still quite frequent during growth when the ankle is somewhat too stiff. The procedure involves cutting the tendon through a small incision in the back of the leg.
Clubfoot: intense rehabilitation
Physiotherapy puts the club foot back in the right axis.
In the past, to facilitate walking, victims with clubfoot wore very large shoes.
Currently, ultrasound makes it possible to carry out a prenatal diagnosis and therefore, care from birth by a physiotherapist. Indeed, from the first days of life, the place of physiotherapy is essential, with daily sessions. The treatment of clubfoot therefore requires a significant commitment from parents over time.
Rehabilitation sessions, started quickly, can sometimes be enough. But for some children with severe forms, treatments can be more complex
Clubfoot: when surgery is necessary
Please note: surgical images: a small incision is used to cut the Achilles tendon.
When the malformations are too severe for physiotherapy to correct them, it is necessary to go to a heavier treatment.
Follow-up is also necessary because small malformations can persist. They would then cause pain a little later in adolescence.
Bone tumors are growths of abnormal cells in the bone. Bone tumors can be cancerous (malignant) or non-cancerous (benign).
Cancerous tumors can appear in the bone (primary cancer) or other organs (such as the breast or prostate) and spread to the bones (metastatic cancer).
Tumors can cause unexplained bone pain, which worsens gradually, swelling, or a tendency to fracture easily.
The diagnosis is sometimes based on the results of an imaging examination (such as an X-ray, a CT scan or a magnetic resonance image), but often requires the taking of a sample of tumor or bone tissue for examination under a microscope ( biopsy).
Bone tumors can be non-cancerous or cancerous, and primary or metastatic.
Primary bone tumors originate in a bone. Primary bone tumors can be benign or malignant.
Metastatic bone tumors are cancers that spread to bones from other areas of the body (for example, from the breast or prostate).
Spread to other areas is called metastatic spread (see Development and spread of cancer). Metastatic bone tumors are always cancerous.
In children, most bone tumors are primary and not cancerous. Some bone tumors (such as osteosarcoma and Ewing's sarcoma) are primary and cancerous. Very few are metastatic (like neuroblastoma and Wilms' tumor).
In adults, most malignant bone tumors are metastatic. Overall, benign bone tumors are relatively common, but primary malignant bone tumors are rare. Each year, they affect only about 2,500 people in the United States. This number does not include multiple myeloma, a cancer that develops in the bone marrow rather than in the hard bone tissue that makes up the bone.