We provide a link to the original description of the ''delta'' reverse shoulder arthroplasty published in 1993 by Paul Grammont and Emmanuel Baulot. While many surgeons view ''anatomic reconstruction'' as essential for virtually all operations, Grammont recognized that not all reconstructions needed to be anatomic and in fact some problems with so-called anatomic reconstructions could be solved by developing nonanatomic approaches. Through careful reasoning and intuition, Grammont and Baulot suggested placing the ball of the shoulder on the glenoid and the concave matching surface on the humerus in patients with an absent rotator cuff (essentially rendering any anatomic reconstruction ''nonanatomic'' when the cuff function could not be normally restored). They argued the deltoid muscle could compensate for an absent rotator cuff if four conditions were present: (1) a lever arm effective from the start of movement; (2) a fixed center of rotation; (3) inherent stability; (4) maintenance of adequate external rotation.
Chronic recurrent multifocal osteomyelitis (CRMO) is a very rare condition of unknown etiology and most commonly occurs during childhood or adolescence. The purpose of this paper is to present a case of CRMO in a vertebral location with severe kyphosis, spinal cord compression, and neurological dysfunction requiring anterior decompression and fusion. After 12 weeks, the patient was physically able to return to school. At 2-year follow-up, neurological and functional outcomes are fair. Magnetic resonance imaging shows good restoration of the sagittal spine alignment despite residual mild kyphosis, and restoration of a normal sagittal diameter of the spinal canal.
This study demonstrates the importance of a superior approach to acetabulum with intrapelvic osteotomy of the iliac ala in certain fractures of the acetabulum. This study is based on the dissection of 15 formolized and 5 frozen subjects, the surgical treatment of 17 acetabular fractures, and the performances of 2 Chiari-type osteotomies and 2 Salter-type osteotomies. We investigated the gluteus medius muscle and its pedicle in relation to the iliac ala. Landmarks for the osteotomy lines and the gluteal pedicles are defined in terms of the requirements of different surgical approaches. The superior approach for acetabular fractures was made using a skin incision of Smith-Petersen type. The underlying principle is the performance of an intrapelvic osteotomy of the iliac ala, the anterosuperior part of the ala being tilted outward and backward and pedicled on the gluteal muscles. This provides intra- and extrapelvic exposure of the acetabular walls. The advantages and drawbacks of this route of approach in surgery of the pelvic girdle are discussed in terms of the types of fracture treated and tumoral locations. The anatomic findings are illustrated from traumatology and tumoralpathology. This approach seems particularly suitable for acetabular fractures interrupting the pelvic ring.
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