The interest in minimally invasive approaches for total hip replacement (THR) has not waned in any way. We carried out a prospective and comparative study in order to analyse the interest of the anterolateral minimal invasive (ALMI) approach in comparison with a minimally invasive posterior (MIP) approach. A group of 35 primary THRs with a large head using the ALMI approach was compared with a group of 43 THR performed through a MIP approach. The groups were not significantly different with respect to age, sex, bony mass index, ASA score, Charnley class, diagnoses and preoperative Womac index and PMA score. The preoperative Harris Hip Score was significantly lower in the ALMI group. The duration of surgical procedure was longer and the calculated blood loss more substantial in the ALMI group. The perioperative complications were significantly more frequent in this group, with four greater trochanter fractures, three false routes, one calcar fracture, and two metal back bascules versus one femoral fracture in MIP group. Other postoperative data (implant positioning, morphine consumption, length of hospital stay, type of discharge) are comparable, such as the early functional results. No other complication has been noted during the first 6 months. The ALMI approach uses the intermuscular interval between the tensor fascia lata and the gluteus medius. It leaves intact the abductor muscles, the posterior capsule and the short external rotators. The early clinical results are excellent, despite the initial complications related to the initial learning curve for this approach and the use of a large head. The stability and the absence of muscular damage should permit acceleration of the postoperative rehabilitation in parallel with less perioperative complications after the initial learning curve.
For us, exposure and implant positioning through the ALMI approach and the PMI approach are comparable and reliable. However, we recommend caution during the initial learning curve in osteoporotic patients due to the higher rate of peroperative complications for the ALMI approach.
Monteggia fracture is an infrequent lesion, which associates ulna fracture and radial head dislocation. Equivalent Monteggia can occur by associated lesions such as olecranon fracture or radial neck or head fracture. We report an unusual case of Monteggia equivalent lesion associating a fracture of the proximal third of the ulnar shaft and a growth plate fracture Salter I of proximal-radial physis and divergent displacement due to a bottle-opener effect of the radial head over the capitellum during trauma. Surgical care consisted of intramedullary pinning of the radial head and fixation by a plate for ulna with a very good outcome.
The authors report a case of posterior sternoclavicular dislocation surgically reduced and stabilized with tenodesis, according to the Burrows technique completed by temporary wire fixation. The patient presented postoperative pericardiac tamponade appearing progressively from brachiocephalic blood vessels bleeding. Emergency drainage was surgically placed associated with removal of the material, thus curing the patient. This complication, although exceptional, formally contraindicates the use of wire fixation in surgery of the sternoclavicular joint.
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