This book is based on the talks presented by a group of experts in Nice, on May 8, 9, 10, during the Nice Shoulder Course 2008. There is probably no other field in orthopaedic surgery where knowledge in anatomy, pathogenesis, diagnosis and treatment has expanded so greatly in the last 20 years. The diagnosis and treatment of patients with shoulder pathologies remain both challenging and exciting. Surgeons are now capable to perform true shoulder repairs and reconstructions using sophisticated implants (anatomical and non anatomical) as well as videosurgery for mini-invasive approaches.
There are, of course, many (maybe too many) different methods to treat shoulder lesions. Today, the problem that surgeons face is not a «lack of information», but a real «intoxication», due to the explosion of techniques, instruments, implants and devices available for both arthroscopic and arthroplastic procedures. The orthopaedic surgeons who want to gap the bridge between traditional operations and newer approaches are often lost «deep in the jungle». This is why the Nice Shoulder Course continues to be organized on a two-year basis.
The ambition of the Nice Shoulder Course, and therefore of this book, is to present the current state of knowledge and the latest concepts in both arthroscopic and arthroplastic shoulder surgery. There is no better way to find your way in the jungle than to follow «experimented guides»: these guides are world leaders in shoulder surgery who can make the difference between necessary and superfluous, between myths and facts.
I have been fortunate to assemble such a group of experimented guides, of whom many are close friends of mine. Their task has been to reveal to you the state of the art of shoulder arthroscopy and arthroplasty. All of them are international experts who have made major contributions to diagnosis, techniques, implant design and engineering principles in the shoulder. They all try to make shoulder pathology more understable and shoulder surgery more reproducible and more beneficial to patients. They have all accepted to share their knowledge without any restriction to help you to make the right diagnosis for your patients, to understand why certain reconstructive shoulder procedures should be performed and some others should not and, finally how those procedures should be performed in a more reliable way.
Let me thank them for the efforts they have made and the time they took from their practices, and more importantly their families, to help you to find your way in the jungle ! Let me thank you for joining us ! Let's follow them ! Let's begin our journey !
Nous avons délibérément souhaité aborder en quatre étapes les prothèses de genou sous un aspect original, pratique surtout très chirurgical: Nous avons appris avec le goniomètre à mesurer les axes. Fort de ces mesures nous avons amélioré nos techniques, la reproductibilité de notre chirurgie. Le deuxième volet du livre comporte l'intégration des surfaces: coefficient de frottement, usure mais aussi géométrie articulaire. Biomatériaux et dessins se côtoient. Les nouvelles technologies nous permettent désormais de mieux appréhender la troisième dimension incarnée par la notion de volume: il s'agit non seulement de l'encombrement prothétique mais aussi de l'analyse globale qui est devenue la somme des analyses élémentaires. Ce raisonnement permet une chirurgie mieux comprise intégrant le retentissement des choix réalisés à chaque étape. Mais ce raisonnement acquis au fil du temps dans les trois dimensions serait de peu de valeur pour nos opérés si la dimension fonctionnelle( humaine) ne reprenait tous ses droits dans la dernière partie de cet ouvrage. Les chapitres essentiels ont été rédigés par les intervenants européens. Souvent originaux, ils permettront aux chirurgiens de trouver les données qu'une communication ne permet pas de détailler. Nous espérons que ce livre du congrès sera à l'origine d'échanges et débats. Merci à tous ceux qui ont contribué à son élaboration. l'ALRM et son Président Philippe Neyret.
L'abord du rachis ne consiste pas uniquement en un geste technique car il s'intègre dans la prise en charge totale d'un être en souffrance.
Ainsi, le fait opératoire doit être argumenté. certes, en tenant compte de critères anatomiques, physiologiques et cliniques, mais également moraux. en effet, la décision opératoire doit être préservée de tout lucre et vanité. ce modeste travail proposé atteindra son but, si dans l'indication chirurgicale cette dimension éthique est prise en compte.
La toxine botulinique intégrée à une prise en charge globale, est devenue en quelques années, le traitement de première intention pour les troubles du tonus de l'enfant paralysé cérébral. Ce traitement a démontré son efficacité et sa sécurité : ainsi en 2009 en France, l'AFSSAPS a étendu ses autorisations pour la toxine botulinique dans le traitement des membres supérieurs et inférieurs. Elle a donné également un cadre précis à son utilisation. Ce 4ème congrès du CMCR des Massues Croix-Rouge française dont celui de 2003 (toxine botulinique et membre inférieur) ayant permis un échange international des pratiques, évaluations et des résultats de ce traitement à l'époque. Ce congrès se focalise sur le membre supérieur avec également un partage d'expériences multidisciplinaires et internationales sur les évaluations, les indications et les prises en charge associées ainsi que la place des autres thérapeutiques.
Le GTEBO est affilié à la Société France en Orthopédie Traumatologie (SOFROT), elle-même société- fille de la Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT).
En créant fin 2007 le Groupe de Travail et d'Étude sur les Bmp en Orthopédie, nous avons avant tout souhaité faire de la pédagogie auprès des orthopédistes, amenés à utiliser de mieux en mieux ces protéines. Mais nous avons aussi voulu combiner les compétences en ce domaine, partager nos expériences, les analysez et en tirer conseils et recommandations. Cet ouvrage en est la concrétisation. Enfin, nous avons souhaité faire un état des lieux et mettre en place un système simple, qui permette de connaître facilement l'utilisation de ces produits dans notre pays.
Autour de ces trois axes est articulé notre site internet www.gtebo.com.
The forearm is not a couple of two bones connecting the mobile elbow with the wrist/hand unit, the performing part of the upper limb. It is a real joint-system allowing to rotate the hand around a longitudinal axis, to better position the hand and to grasp objects. At each end a complex joint is present. Both bones have a well determinated anatomical special structure and both are connected with interosseous membrane of which the real function, pathology and treatment remain unrevealed. This is the framework of which this instructional course is dealing with. It is impossible to discuss the forearm without flirting with elbow and wrist joints. Both soft tissue and hardware problems, active and structural disorders, adults and children, congenital, acquired, degenerative, (post)traumatic pathology are discussed. It is obvious that the topic is incomplete. We have stressed on these problems which are specific to the forearm and not on those which involve the forearm as well as other joints. We are convinced that with this course a better understanding of this «forgotten» joint will be provided. All authors have a particular interest in the topic, have presented and published on his subject and their opinion is often the gold standard for a particular aspect of this subject.
The goal of this book is to focus on the techniques and strategies available to treat highlydemanding patients with early osteoarthritis of the knee.
Orthopaedic Surgeons are more and more faced with young and active patients who ask for quick solutions, seek pain-free knees and wish to participate in sports. Their expectations are constantly increasing and surgeons are afraid to disappoint them.
Do recent technological innovations really improve outcomes? Is there still a place for corrective osteotomies in 2014? What are the true limits of Unicompartmental Knee Arthroplasties? How can we improve our perioperative strategy? Which sports activities can we authorize after surgery? What is the future of the treatment of knee osteoarthritis: Robotic surgery, Custom knee implants, Regenerative medicine?
The Lyon School of Knee Surgery, in association with international renowned specialists, presents and analyzes the outcomes of different treatment options.
Les diverses structures osseuses, cartilagineuses, synoviales et ligamentaires, qui constituent le squelette et les articulations du poignet, sont d'une complexité extrême, tant morphologique que mécanique. Le moindre mouvement se répercute à tout l'ensemble quel que soit sa nature : physiologique bien sûr, mais aussi pathologique, que se soit en rapport avec une lésion osseuse ou avec une atteinte ligamentaire. D'où la nécessité de considérer le carpe comme un tout suivant une "conception holistique" pour reprendre l'expression très heureuse de Kapandji. Nous avons regroupé dans les six premiers chapitres des notions fondamentales. Certaines sont connues d'autres beaucoup moins. Dans les chapitres suivants nous envisageons les différents tableaux cliniques rencontrés dans la pratique, ainsi que leur étiologie.
Indeed we have an unfortunately large number of failures - many of which are due to surgical mistakes. A critical and often overlooked part of performing an ACL reconstruction is to analyze all of the associated structures : What is the role and importance of the socalled anterolateral ligament or the anterolateral complex? How much do surgical technique, graft choice, tunnel location, and fixation methods influence outcomes? What is the role of biology and the menisci in restoring stability? Finally, what impact do rehabilitation, proprioception, muscular control and strength, and neurologic control have on return to sport following ACL reconstruction?
We will develop and try to understand all of these aspects of ACL reconstruction.
Time flies! If I think that two years have passed since the last edition of the Nice Shoulder Course, and more than ten since the first edition, I can hardly believe it. Time flies when a lot of interesting things happen, and there is no time to stop or slow down, because things change and go ahead.
And when I look back on the more than ten years since the first edition, I am happy to see that things have changed, and that we were able to say new things that have become common practice today.
This is what keeps the Nice Shoulder Course a thrilling experience each and every edition. That we have the chance and honor to gather the opinion leaders of our specialty around a relatively small event compared to large international congresses.
Judging from the feedback of our particpants, our aim has been attained for both the participants and the faculty, both tell us that they go home having learned (yes, even the Faculty). All say that they particularly appreciate the high level of exchange, the density and the proximity of the course.
In keeping with our traditions, this new edition will again be very intense. It will be as intense as it's preparation was.
I am very grateful to our Faculty, that they have agreed to share their knowledge with us, my assistants and colleagues who have spent long (and intense) hours behind the scientific work, to all our collaborators and the small, but very efficient team that manages the oh, so many and diverse aspects of this event, and without whom this course would not be what it is.
Thank you, our participants, for your faithfulness and continuing interest. It is always with great joy that we see names that have become familiar over the years, and it is with just as much joy that we see the new ones. The number of names that have become familiar grows each year and this year we had to close the registrations well before the course.
Last but not least, thank you to all the patients who presented to us with some shoulder pathology ; they all taught us something through all these years!
I do hope that you will enjoy the course, as much as reading this book!
Finding the right treatment for a young patient (< 60 years) with glenohumeral osteoarthritis is still a challenge. In case of failure of conservative therapy, surgical treatment must be considered. The indications for a surgical treatment depend not only on the radiological findings but also on the explicit age of the patients, their occupation, activity level, duration of symptoms, comorbidities and concomitant shoulder pathology.
Arthroscopic management of glenohumeral arthritis includes capsular release, removal of loose bodies, subacromial decompression, axillary nerve neurolysis, biceps tenodesis, chondroplasty, microfracturing, and humeral osteophyte resection. This can result in pain relief, but usually does not improve shoulder motion. However, these effects are temporary and results are unpredictable.
Furthermore, these techniques do not provide a definitive solution for advanced-stage glenohumeral arthritis. Osteotomy or bone graft in case of glenoid dysplasia has yielded disappointing results as well.
Today, an unacceptable compromise in quality of life may constitute a valid indication for shoulder replacement in young patients who seek so-called «high-performance shoulders» to attain their expectations and aspirations. Initial pain relief and functional improvement are usually excellent after shoulder arthroplasty; however, these gains are short-lived in the younger population, with a dramatic decline in functional outcome and survival rate at mid- to long-term follow-up. The concerns about shoulder arthroplasty in this population are mainly due to the higher demands on the operated shoulder, the higher expectations regarding the surgical result, and the longevity of the prosthetic shoulder due to increased life expectancy.
Younger patients who receive a total shoulder arthroplasty have a higher rate of glenoid component loosening and rotator cuff tears, likely related to higher activity levels, and therefore, alternative strategies have been sought. Hemiarthroplasty has been used as an alternative, with limited benefit in the long term, likely due to unaddressed glenoid disease and a substantial rate of glenoid erosion. Biologic resurfacing of the glenoid in conjunction with hemiarthroplasty has led to disappointing results. Reverse shoulder arthroplasty is sometimes needed in younger patients in specific and difficult cases, like failed cuff repair, failed instability surgery or posttraumatic arthritis. However, long-term results of this semi-constrained prosthesis remain to be proven in the younger population.
We have invited colleagues and friends from different continents to report their surgical experience in this difficult field, and whom I thank for having accepted our invitation. We have also built a database including more than 1500 young patients with glenohumeral arthritis. The aim of the Nice multicenter study was to evaluate mid- to long-term outcomes following shoulder arthroplasty in patients younger than 60 years at the time of surgery. We have studied the results of shoulder arthroplasty in this challenging patient population according to the different etiologies, according to patients' age and have looked for complications. This study could not have been conducted without the hard work and motivation of all those who participated in it: surgeons, assistants, fellows, residents, staff, nurses, secretaries, and last but not least, our patients.
We hope that the material presented here will help surgeons to better understand and resolve the difficult problem of glenohumeral arthritis in younger patients.
Belonging to the University of Medicine of Montpellier, the oldest practising Faculty of Medicine in the Western world, entails many obligations but also many joys. Celebrating the institution's 800th anniversary is an honour and an exceptional opportunity. Having a book retracing these 800 years published in 2020 makes it possible to underline this opportunity, and especially to share the history of our Faculty of Medicine with as many people as possible. This first edition in English makes possible to fill a need often expressed by our international visitors from many different countries around the world who admire our heritage and our history. These visitors are often disappointed because they cannot bring home a souvenir of their visit in the form of a book. This is now possible thanks to the remarkable work by Professor Jean-Pierre Dedet who makes us travel along the centuries in this clear and perfectly illustrated book with more than 200 illustrations.
This book «Teaching Medicine in Montpellier: a 900 year-long story» is the result of the careful analysis of many written documents and of discussions and cross-references with actors of the contemporary period during the last three years. It is a very enjoyable and interesting book, and will be followed by an edition in French. Belonging to this very old University also requires a duty of memory, fulfilled by this book that recalls the importance of multiculturalism at the beginning of this University, the will of religious and/or political authorities over the centuries to support the development of this institution, and the importance of focusing on Human beings in the medical approach, according to the Hippocratic principles. Celebrating 800 years is a reminder of these principles in a modern world where humanist values are often undermined by the rapid pace of scientific progress.
This congress organized by Professor Boileau is a world reference in the field of shoulder surgery with speakers from all over the world. You will find in the table of contents all the subjects concerning digitized shoulder discussed at this conference.
What Are the Complications after Shoulder Arthroplasty? Can We Avoid Them?
A concern regarding shoulder arthroplasty (SA) is the possible Intraoperative and postoperative complications that can jeopardize and/or compromize the functional results. Intraoperative complications during SA must be anticipated. Postoperative course after SA can be complicated by neurologic problems, periprosthetic fractures, rotator cuff tears, instability, stiffness, implant loosening, osteolysis, infection, and even death. In addition, there is a substantial rate of associated complications. Many questions remaine unanswered: What are exactly the complication rates after SA? What are the risk factors?
The type and rate of complications depends highly on the diagnosis. For instance, we know now that the fracture sequelae patients had a higher rate of complications when compared with those operated for primary osteoarthritis. We also know that the rate of infection is higher in revisions than in the primary cases. In addition, there is a possibly higher complication rate with certain type of prosthesis: for instance, the rate of complications with the reverse shoulder arthroplasty (RSA) is higher than the ones observed with an anatomical, conventional unconstrained shoulder arthroplasty (ASA). The type of prosthesis fixation (cemented, press-fit or uncemented implants) may also influence the nature and rates of complications.
The experience of the shoulder surgeon is, of course, one of the main factors that influence the intra and postoperative complication rates after SA. This is the reason why we have asked a group of shoulder experts to share their knowledge regarding their complications during and after SA. These experts were invited to participate to the Nice Shoulder Course - Current Concepts in Nice on June 7, 8, 9 2012. The reports of these experienced shoulder surgeons and analysis of the available literature represent the basis of this book.
The goal of this book is therefore to determine: 1) the nature and rate of the complications after SA; 2) whether diagnosis influences the type and rate of complications (OA, RA, Fracture and Fracture Sequelae); 3) whether the type of prosthesis implanted influences these complications (hemi, total, reverse, stemless prostheses); 4) whether these complications affect functional results and scores after SA; and 5) how it is possible to prevent and avoid them.
The information provided by this book should hopefully allow surgeons to improve their practice in order to prevent some of the complications, when possible, but also to give patients realistic expectations regarding the complication nature and rates after SA.
The ambition of this book is to present the current state of knowledge and the latest concepts and approaches in both arthroscopic and arthroplastic shoulder surgery, as well as in fractures of the proximal humerus. This book, «Shoulder Concepts 2012», is based on the talks presented by a group of shoulder experts and friends in Nice, on June 7, 8, 9, during the Nice Shoulder Course 2012.
These world leaders in shoulder surgery have accepted to share their knowledge with you. Let me thank them for the efforts they have made and the time they took from their practices, and more importantly from their families. The quality of instruction given at the Nice Shoulder Course is clearly determined by their enthusiasm and experience.
We have tried to present the latest and more relevant information in anterior instability, posterior instability, acromio-clavicular joint separation, rotator cuff tears, muscle-tendons transfer, proximal humerus fractures, reverse prosthesis.
It is our hope that this book will help you to give the best care to your patients. We hope to convince all the participants of the course and all the readers of this book that shoulder surgery is really a «nice surgery»!
Captivating, interesting, funny, and thrilling tale. This book is aimed to all musculoskeletal doctors, including general practitioners, traumatologists, sports medicine physicians, radiologists, neurologists, rheumatologists, surgeons, and physiotherapists.
The comic format allows for highly visual illustrations that are memorable. dynvervology, which includes the lacertus syndrome, is currently not well-known, yet in the future, it will become selfevident to everyone. The simple explanations of sometimes difficult concepts make it an easy and fluid read. "
The author has in this book done the close-to impossible, namely illustrated and voiced his journey into understanding a commonly misunderstood and overlooked, yet exceedingly prevalent, condilon called lacertus syndrome.
The story unfolds as a tale of learning, showing through his journey and experience how bias and poor understanding lead to patient misdiagnosis and mistreatments.
"This book is about much more than lacertus syndrome. lt describes a new philosophy about how we should look at nerve compression in terms of diagnosis and surgical treatment. lt is applicable to nerve entrapment all over the body.
All medical and surgical doctors, as well as hand therapists, should take the brief plunge to read this wonderful work of art, science, and philosophy. 1 am very glad that I did. Thank you so much Vincent Martinel !!!!"
Dr Donald Lalonde, Professor of Plastic Surgery, Dalhousie University, Saint John, Canada
Vincent Martinel is an orthopaedic surgeon who practices since 2008 at the Ormeau Pyrénées clinic in Tarbes, France. He is passionate about upper limb surgery, as well as the mountains, fishing and .... drawing.
This book has also benefited of contribution from Elisabet Hagert, Thomas Apard and Benjamin Ferembach.
