Dr ALLIA Jeremy
Chirurgie de la colonne vertébrale dégénérative et traumatique
Chirurgie de la Scoliose
Responsable du SOS Rachis Traumatique
Président des Chefs de Clinique de Nice
Secrétariat :
Tel.: 04.92.03.29.49
Mail: thoz.t@chu-nice.fr
Tristana Thoz
Titres & Diplômes
- Ancien interne des Hôpitaux de Nice
- Ancien interne des Hôpitaux de Paris
- Chirurgien Orthopédiste
- Master 1 (Biologie cellulaire, Anthropologie)
- DES de Chirurgie Générale
- DESC de Chirurgie Orthopédique et de Traumatologie
- DIU du Rachis
2021 The impact of confinement on orthopaedic and trauma surgical activity
The impact of confinement on orthopaedic and trauma surgical activity
Jeremy Allia, Gaya Ait Saada, Nicolas Bronsard, Jean-François Gonzalez, Pascal Boileau, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/34653645/
Abstract
Introduction: On the 16th of March 2020, in the face of a health emergency declared in France, the government imposed containment measures whose impact on orthopaedic and trauma surgery remains to be demonstrated. The hypothesis of this study was that confinement reduced orthopaedic and trauma surgical activity. The main objective was to assess orthopaedic and trauma surgical activity during confinement and to compare it to the activity outside confinement.
Materials and methods: This was a retrospective, monocentric, observational and comparative study of a continuous cohort of patients included during the confinement period of March 16th to May 11th, 2020. This cohort was retrospectively compared to a group of patients over the same non-confinement period in the previous year, from March 16th to May 11th, 2019. The primary outcome measured was the incidence rate of surgical activity in 2020 versus 2019 over an identical period. The secondary outcome was the analysis of the trauma identified.
Results: The number of patients operated on was significantly reduced during confinement: 194 patients were included in 2020, i.e. an incidence of 57 per 100,000 inhabitants against 772 patients included in 2019, i.e. an incidence of 227 per 100,000 inhabitants; p<0.001. Planned orthopaedic surgery decreased from an incidence rate of 147 in 2019 to 5 in 2020 per 100,000 inhabitants (p<0.001). Trauma surgery decreased from an incidence rate of 80 in 2019 to 50 in 2020 per 100,000 inhabitants (p: NS). We found a significant increase in patients over 65years of age during confinement, 70% compared to 61% in 2019; p=0.04. The rate of femoral neck fractures was significantly increased during confinement, 48.5% compared to 39.3% in 2019; p=0.03. Degenerative surgery was significantly reduced during confinement (p<0.001).
Discussion: This study shows that the surgical activity of orthopaedics and trauma was significantly reduced by confinement, with a difference in incidence of 170 per 100,000 inhabitants, thus confirming the hypothesis of the authors. This decrease is due to both the cessation of planned orthopaedics and the 40% decrease in the number of trauma patients. During confinement, the percentage of patients over the age of 65 with a fracture increased significantly.
Conclusion: Confinement had a significant impact on orthopaedic and trauma surgical activity.
Level of evidence: III; comparative and retrospective.
Keywords: COVID-19; Confinement; Impact; Orthopaedic surgery; Trauma surgery.
Copyright © 2021. Published by Elsevier Masson SAS.
2020 Early mortality and morbidity of odontoid fractures after 70 years of age
Early mortality and morbidity of odontoid fractures after 70 years of age
Jeremy Allia, Hugo Darmanté, Laurent Barresi, Fernand De Peretti, Christophe Trojani, Nicolas Bronsard
https://pubmed.ncbi.nlm.nih.gov/32094064/
Abstract
Introduction: Odontoid fractures are very common in older adults and are associated with a high mortality rate. The aim of this study was to evaluate the outcomes after conservative treatment of non-displaced odontoid fractures and surgical treatment of displaced fractures in patients older than 70 years. It was hypothesized that early mortality of displaced fractures is higher than in non-displaced fractures.
Material and methods: This was a single-center retrospective observational study of odontoid fractures (type II in the Anderson and Alonzo classification) in patients older than 70 years that occurred between 2014 and 2017. Conservative treatment with immobilization for 3 months was proposed when the fracture was displaced less than 2 mm (non-displaced fracture group). Surgical treatment in the form of anterior screw fixation was proposed when the fracture displacement was more than 2 mm (displaced fracture group). The primary endpoint was the mortality rate at 3 months.
Results: The study included 79 patients (46 women) who had a mean age of 85 years (70-105). The 3-month mortality in the entire cohort was 27% and the 1-year mortality was 30%. Conservative treatment was provided to the 36 patients with non-displaced fractures. The 3-month mortality rate in this group was 11%. A displaced fracture occurred in 43 patients: 17 were treated surgically by anterior screw fixation; 20 could not be operated on because of anesthesia contraindications and 6 died within 24hours of the fracture event. The 3-month mortality rate in this group was 40%; 3 of the 17 operated patients died from postoperative respiratory complications; 8 of the 20 patients with contraindications died, in addition to the 6 that died soon after the fracture occurred.
Discussion: This study confirms that mortality and morbidity are high following odontoid fractures. The mortality rate was significantly higher in patients with displaced fractures, confirming our hypothesis. The mortality rate was especially high when patients with displaced fractures could not undergo surgery because of anesthesia contraindications. Also, there was a high rate of respiratory complications after anterior screw fixation of displaced fractures.
Conclusion: Given our findings, conservative treatment should be compared to surgical treatment for displaced fractures and the anterior approach should be compared to the posterior one for surgical cases.
Level of evidence: IV.
Keywords: Anterior Screw Fixation; Conservative treatment; Elderly; Mortality; Odontoid Fracture.
Copyright © 2020 Elsevier Masson SAS. All rights reserved.
2019 A Case Series Study of Odontoid Fracture in the Elderly: A Severe Fracture Occurring Most Frequently in Osteoporotic Subjects
Lauren Natella, Nicolas Bronsard, Jeremy Allia, Laurent Hekayem, Liana Euller-Ziegler, Fernand De Peretti, Véronique Breuil
https://pubmed.ncbi.nlm.nih.gov/31044178/
Abstract
The WHO definition of osteoporosis excludes cervical fractures. Recent studies suggest that atraumatic odontoid fractures (OF) may be favored by osteoporosis but global bone status for osteoporosis diagnosis has not been described. We present a case series of patients >65 years old hospitalized for low-energy OF who had an evaluation of their bone status within 3 months after fracture, including clinical risk factors of osteoporosis, bone mineral density (BMD), vertebral fracture assessment (VFA) by dual X-ray absorptiometry, and laboratory tests. Osteoporosis was defined as a T-score ≤ -2.5 on at least one site, or a bone fragility fracture associated with a T-score ≤ -1 at one site. Thirty-three patients were hospitalized for OF, 30 of them as a consequence of a low-energy impact: 20 women and 10 men (mean age: 85 years). Eight patients died before bone evaluation, four refused, and six were lost to follow-up. Twelve patients were included: 11 women and one man (mean age: 83.8 years). Ten out of twelve patients fulfilled diagnostic criteria of osteoporosis, including eight with previous osteoporotic fractures (six severe fractures). Eight fulfilled specific treatment of osteoporosis criteria, but only two were treated. The mean follow-up period was 12.2 ± 4.1 months. Prior to OF occurrence, all lived at home and were independent; at the time of discharge, six went to a nursing home. At 3 months of follow-up (n = 10), one was dead and nine lived at home. At 12 months (n = 9), two were dead and seven lived at home. This study provides for the first time a classical evaluation of osteoporotic status for low-energy OF in the elderly and shows that it occurs in osteoporotic subjects. These preliminary results require larger-scale studies to determine whether OF could be considered as a severe osteoporotic fracture. © 2018 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
Keywords: AGING; CLINICAL TRIALS; DXA—ANALYSIS/QUANTITATION OF BONE; OSTEOPOROSIS—DISEASES AND DISORDERS OF/RELATED TO BONE.
2019 Mortality, complication, and fusion rates of patients with odontoid fracture: the impact of age and comorbidities in 204 cases
Yann Philippe Charles, Yves Ntilikina, Benjamin Blondel, Stéphane Fuentes, Jérémy Allia, Nicolas Bronsard, Maxime Lleu, Benjamin Nicot, Vincent Challier, Joël Godard, Pascal Kouyoumdjian, Nicolas Lonjon, Paulo Marinho, Julien Berthiller, Eurico Freitas, Cédric Barrey
https://pubmed.ncbi.nlm.nih.gov/30317379/
Abstract
Purpose: The French Society of Spine Surgery (SFCR) conducted a prospective epidemiologic multicenter study. The purpose was to investigate mortality, complication, and fusion rates in patients with odontoid fracture, depending on age, comorbidities, fracture type, and treatment.
Methods: Out of 204 patients, 60 were ≤ 70 years and 144 were > 70 years. Demographic data, comorbidities, treatment types and complications (general medical, infectious, neurologic, and mechanical), and death were registered within the first year. Fractures were classified according to Anderson-D’Alonzo and Roy-Camille on the initial CT. A 1-year follow-up CT was available in 144 patients to evaluate fracture consolidation.
Results: Type II and oblique-posterior fractures were the most frequent patterns. The treatment was conservative in 52.5% and surgical in 47.5%. The mortality rate in patients ≤ 70 was 3.3% and 16.7% in patients > 70 years (p = 0.0002). Fracture pattern and treatment type did not influence mortality. General medical complications were significantly more frequent > 70 years (p = 0.021) and after surgical treatment (p = 0.028). Neurologic complications occurred in 0.5%, postoperative infections in 2.0%, and implant-related mechanical complications in 10.3% (associated with pseudarthrosis). Fracture fusion was observed in 93.5% of patients ≤ 70 years and in 62.5% >70 years (p < 0.0001). Pseudarthrosis was present in 31.5% of oblique-posterior fractures and in 24.3% after conservative treatment.
Conclusions: Age and comorbidities influenced mortality and medical complication rates most regardless of fracture type and treatment choice. Pseudarthrosis represented the main complication, which increased with age. Pseudarthrosis was most frequent in type II and oblique-posterior fractures after conservative treatment.
Keywords: Epidemiology; Fusion; Morbidity; Mortality; Odontoid fracture.
2019 Hangman's fracture: Management strategy and healing rate in a prospective multi-centre observational study of 34 patients
Solène Prost, Cédric Barrey, Benjamin Blondel, Stéphane Fuentes, Laurent Barresi, Benjamin Nicot, Vincent Challier, Maxime Lleu, Joël Godard, Pascal Kouyoumdjian, Nicolas Lonjon, Paulo Marinho, Eurico Freitas, Sébastien Schuller, Jérémy Allia, Julien Berthiller, Yann Philippe Charles; French Society for Spine Surgery (SFCR)
https://pubmed.ncbi.nlm.nih.gov/31005699/
Abstract
Background: Hangman’s fractures account for 15% to 20% of all cervical spine fractures. The grading system developed by Effendi and modified by Levine and Edwards is generally used as the basis for management decisions. Nonetheless, the optimal management remains controversial. The objective of this study was to describe the treatments used in France in patients with hangman’s fractures. The complications and healing rates were analysed according to the fracture type and treatment used.
Hypothesis: Among patients with hangman’s fracture, those with disc damage must be treated surgically.
Material and methods: A prospective, multi-centre, observational study was conducted under the aegis of the French Society for Spine Surgery (SociétéFrançaisedeChirurgieRachidienne, SFCR). Patients were included if they had computed tomography (CT) evidence of hangman’s fracture. Follow-up data were collected prospectively. Fracture healing was assessed on CT scans obtained 3 and 12 months after the injury. The type of treatment and complications were recorded routinely.
Results: We included 34 patients. The fracture type according to Effendi modified by Levine and Edwards was I in 68% of patients, II in 29% of patients, and III in a single patient (3%). The treatment was non-operative in 21 (62%) patients and surgical in 11 (32%). All 28 patients re-evaluated after 1 year had evidence of fracture healing. The remaining 6 patients were lost to follow-up.
Conclusion: Hangman’s fracture is associated with low rates of mortality and neurological complications. Non-operative treatment is appropriate in Type I hangman’s fracture, with a 100% healing rate in our study. Types II and III are characterised by damage to the ligaments and discs requiring either anterior C2-C3 fusion or posterior C1-C3 screw fixation.
Level of evidence: III.
Keywords: Bone healing; Cervical spine; Fracture union; Hangman’s fracture; Surgery.
Copyright © 2019 Elsevier Masson SAS. All rights reserved.
2018 Influence of Derotation Connectors on 3D Surgical Correction of Adolescent Idiopathic Scoliosis
Influence of Derotation Connectors on 3D Surgical Correction of Adolescent Idiopathic Scoliosis
Jérémy Allia, Jean-Luc Clément, Virginie Rampal, Béatrice Leloutre, Olivier Rosello, Federico Solla
https://pubmed.ncbi.nlm.nih.gov/29494458/
Abstract
Study design: Monocentric study comparing results of simultaneous translation on 2 rods (ST2R) with derotation connectors (prospective series) or without derotation connectors (retrospective series) in Adolescent Idiopathic Scoliosis (AIS) surgery.
Objective: The objective of this study was to assess if derotation connectors influence axial, coronal, and sagittal results in AIS surgery.
Summary of background data: Conventional reduction techniques remain limited in their ability to reduce axial torsion. Direct vertebral derotation technique accomplishes partial axial derotation but decreases thoracic kyphosis.
Methods: Monocentric study including AIS surgeries performed using ST2R technique with derotation connectors (group D+, n=44) or without derotation connectors (group D-, n=24). The axial intervertebral rotation was measured between apical and neutral vertebra on pre and postoperative computed tomography scan. T test was used to compare mean values. ANCOVA analyzed the influence of connectors and covariates on the primary outcome, which was the difference between preoperative and postoperative intervertebral rotation.
Results: The mean axial torsion gain in the D+ group was 23% (+3.84 degrees, 95% confidence interval, +1.95/+5.73). In the D- group, mean axial torsion increase of 4% (-0.42 degrees, 95% confidence interval, -1.19/+2.03). The result was significantly different between the 2 groups (P=0.005). The coronal correction of the main curve angle was 80% in the D+ group and 64% in the D- group (P=0.004). Kyphosis correction was similar between the 2 groups (P=0.3) with significant increase of thoracic kyphosis in the whole series (P=0.02) and no patients with postoperative hypokyphosis <10 degrees. Multivariate analysis confirmed the influence of derotation connectors on both axial and coronal correction (P<0.05).
Conclusions: The use of derotation connectors in the surgical treatment of AIS significantly improved axial and coronal correction compared to nonuse of connectors without compromising the sagittal plane.
2018 C1 fracture: Analysis of consolidation and complications rates in a prospective multicenter series
C1 fracture: Analysis of consolidation and complications rates in a prospective multicenter series
Maxime Lleu, Yann Philippe Charles, Benjamin Blondel, Laurent Barresi, Benjamin Nicot, Vincent Challier, Joël Godard, Pascal Kouyoumdjian, Nicolas Lonjon, Paulo Marinho, Eurico Freitas, Sébastien Schuller, Stéphane Fuentes, Jérémy Allia, Julien Berthiller, Cédric Barrey
https://pubmed.ncbi.nlm.nih.gov/30193984/
Abstract
Introduction: Three types of C1 fracture have been described, according to location: type 1 (anterior or posterior arc), type 2 (Jefferson: anterior and posterior arc), and type 3 (lateral mass). Stability depends on transverse ligament integrity. The main aim of the present study was to analyze complications and consolidation rates according to fracture type, age and treatment.
Material and methods: The French Society of Spinal Surgery (SFCR) performed a multicenter prospective study on C1-C2 trauma. All patients with recent fracture diagnosed on CT were included. Consolidation on CT was studied at 3 months and 1 year. Medical, neurologic, infectious and mechanical complications were inventoried using the KEOPS data-base.
Results: Sixty-three of the 417 patients (15.1%) had C1 fracture: type 1 (33.3%), type 2 (38.1%), or type 3 (28.6%). The transverse ligament was intact in 53.9% of cases. Treatment was non-operative in 63.5% of cases, surgical in 27.0%, and surgical after failure of non-operative treatment in 9.5%. There were 8 medical complications, more frequently in patients aged >70 years, following surgery (p<0.0001). The consolidation rate was 84.2% with non-operative treatment, 100% for primary surgery, and 33.3% for secondary surgery (p=0.002). There were 10 cases of non-union, in 4.8% of type 1, 13.6% of type 2 and 33.3% of type 3 fractures (p=0.001).
Conclusion: Medical complications showed association with age and with type of treatment. Non-operative treatment was suited to types 1, 2 and 3 with minimal displacement and intact transverse ligament. C1-C2 fusion was suited to displaced unstable type 2 fracture. Displaced type 3 fracture incurred risk of non-union. Early surgery may be recommended.
Level of evidence: III.
Keywords: Atlas; C1 fracture; Complications; Consolidation; Non-union.
Copyright © 2018. Published by Elsevier Masson SAS.
- DIU rachis Nice Marseille, 2020 cours magistraux
- Early mortality and morbidity of odontoid fractures after 70 years of age, 2019 Sofcot
- Prothèses discales lombaires et reprise des activités professionnelles: Résultats d’une série de 100 patients, 2018. Sofcot.
- Intérêt des connecteurs de dérotation sur la correction axiale dans la chirurgie des scolioses thoraciques idiopathiques de l’adolescent, 2017. GES, SFCR, Sofcot.
- Symposium des fractures C1C2, Résultats des pseudarthroses des fractures de l’odontoïde, 2016. SFCR
- Equilibre Sagittal, 2015. DIU de Traumatologie et du Sport, cours magistraux
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Publications
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2021 The impact of confinement on orthopaedic and trauma surgical activity
2021 The impact of confinement on orthopaedic and trauma surgical activity
The impact of confinement on orthopaedic and trauma surgical activity
Jeremy Allia, Gaya Ait Saada, Nicolas Bronsard, Jean-François Gonzalez, Pascal Boileau, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/34653645/
Abstract
Introduction: On the 16th of March 2020, in the face of a health emergency declared in France, the government imposed containment measures whose impact on orthopaedic and trauma surgery remains to be demonstrated. The hypothesis of this study was that confinement reduced orthopaedic and trauma surgical activity. The main objective was to assess orthopaedic and trauma surgical activity during confinement and to compare it to the activity outside confinement.
Materials and methods: This was a retrospective, monocentric, observational and comparative study of a continuous cohort of patients included during the confinement period of March 16th to May 11th, 2020. This cohort was retrospectively compared to a group of patients over the same non-confinement period in the previous year, from March 16th to May 11th, 2019. The primary outcome measured was the incidence rate of surgical activity in 2020 versus 2019 over an identical period. The secondary outcome was the analysis of the trauma identified.
Results: The number of patients operated on was significantly reduced during confinement: 194 patients were included in 2020, i.e. an incidence of 57 per 100,000 inhabitants against 772 patients included in 2019, i.e. an incidence of 227 per 100,000 inhabitants; p<0.001. Planned orthopaedic surgery decreased from an incidence rate of 147 in 2019 to 5 in 2020 per 100,000 inhabitants (p<0.001). Trauma surgery decreased from an incidence rate of 80 in 2019 to 50 in 2020 per 100,000 inhabitants (p: NS). We found a significant increase in patients over 65years of age during confinement, 70% compared to 61% in 2019; p=0.04. The rate of femoral neck fractures was significantly increased during confinement, 48.5% compared to 39.3% in 2019; p=0.03. Degenerative surgery was significantly reduced during confinement (p<0.001).
Discussion: This study shows that the surgical activity of orthopaedics and trauma was significantly reduced by confinement, with a difference in incidence of 170 per 100,000 inhabitants, thus confirming the hypothesis of the authors. This decrease is due to both the cessation of planned orthopaedics and the 40% decrease in the number of trauma patients. During confinement, the percentage of patients over the age of 65 with a fracture increased significantly.
Conclusion: Confinement had a significant impact on orthopaedic and trauma surgical activity.
Level of evidence: III; comparative and retrospective.
Keywords: COVID-19; Confinement; Impact; Orthopaedic surgery; Trauma surgery.
Copyright © 2021. Published by Elsevier Masson SAS.
Close2020 Early mortality and morbidity of odontoid fractures after 70 years of age2020 Early mortality and morbidity of odontoid fractures after 70 years of age
Early mortality and morbidity of odontoid fractures after 70 years of age
Jeremy Allia, Hugo Darmanté, Laurent Barresi, Fernand De Peretti, Christophe Trojani, Nicolas Bronsard
https://pubmed.ncbi.nlm.nih.gov/32094064/
Abstract
Introduction: Odontoid fractures are very common in older adults and are associated with a high mortality rate. The aim of this study was to evaluate the outcomes after conservative treatment of non-displaced odontoid fractures and surgical treatment of displaced fractures in patients older than 70 years. It was hypothesized that early mortality of displaced fractures is higher than in non-displaced fractures.
Material and methods: This was a single-center retrospective observational study of odontoid fractures (type II in the Anderson and Alonzo classification) in patients older than 70 years that occurred between 2014 and 2017. Conservative treatment with immobilization for 3 months was proposed when the fracture was displaced less than 2 mm (non-displaced fracture group). Surgical treatment in the form of anterior screw fixation was proposed when the fracture displacement was more than 2 mm (displaced fracture group). The primary endpoint was the mortality rate at 3 months.
Results: The study included 79 patients (46 women) who had a mean age of 85 years (70-105). The 3-month mortality in the entire cohort was 27% and the 1-year mortality was 30%. Conservative treatment was provided to the 36 patients with non-displaced fractures. The 3-month mortality rate in this group was 11%. A displaced fracture occurred in 43 patients: 17 were treated surgically by anterior screw fixation; 20 could not be operated on because of anesthesia contraindications and 6 died within 24hours of the fracture event. The 3-month mortality rate in this group was 40%; 3 of the 17 operated patients died from postoperative respiratory complications; 8 of the 20 patients with contraindications died, in addition to the 6 that died soon after the fracture occurred.
Discussion: This study confirms that mortality and morbidity are high following odontoid fractures. The mortality rate was significantly higher in patients with displaced fractures, confirming our hypothesis. The mortality rate was especially high when patients with displaced fractures could not undergo surgery because of anesthesia contraindications. Also, there was a high rate of respiratory complications after anterior screw fixation of displaced fractures.
Conclusion: Given our findings, conservative treatment should be compared to surgical treatment for displaced fractures and the anterior approach should be compared to the posterior one for surgical cases.
Level of evidence: IV.
Keywords: Anterior Screw Fixation; Conservative treatment; Elderly; Mortality; Odontoid Fracture.
Copyright © 2020 Elsevier Masson SAS. All rights reserved.
Close2019 A Case Series Study of Odontoid Fracture in the Elderly: A Severe Fracture Occurring Most Frequently in Osteoporotic Subjects2019 A Case Series Study of Odontoid Fracture in the Elderly: A Severe Fracture Occurring Most Frequently in Osteoporotic Subjects
Lauren Natella, Nicolas Bronsard, Jeremy Allia, Laurent Hekayem, Liana Euller-Ziegler, Fernand De Peretti, Véronique Breuil
https://pubmed.ncbi.nlm.nih.gov/31044178/
Abstract
The WHO definition of osteoporosis excludes cervical fractures. Recent studies suggest that atraumatic odontoid fractures (OF) may be favored by osteoporosis but global bone status for osteoporosis diagnosis has not been described. We present a case series of patients >65 years old hospitalized for low-energy OF who had an evaluation of their bone status within 3 months after fracture, including clinical risk factors of osteoporosis, bone mineral density (BMD), vertebral fracture assessment (VFA) by dual X-ray absorptiometry, and laboratory tests. Osteoporosis was defined as a T-score ≤ -2.5 on at least one site, or a bone fragility fracture associated with a T-score ≤ -1 at one site. Thirty-three patients were hospitalized for OF, 30 of them as a consequence of a low-energy impact: 20 women and 10 men (mean age: 85 years). Eight patients died before bone evaluation, four refused, and six were lost to follow-up. Twelve patients were included: 11 women and one man (mean age: 83.8 years). Ten out of twelve patients fulfilled diagnostic criteria of osteoporosis, including eight with previous osteoporotic fractures (six severe fractures). Eight fulfilled specific treatment of osteoporosis criteria, but only two were treated. The mean follow-up period was 12.2 ± 4.1 months. Prior to OF occurrence, all lived at home and were independent; at the time of discharge, six went to a nursing home. At 3 months of follow-up (n = 10), one was dead and nine lived at home. At 12 months (n = 9), two were dead and seven lived at home. This study provides for the first time a classical evaluation of osteoporotic status for low-energy OF in the elderly and shows that it occurs in osteoporotic subjects. These preliminary results require larger-scale studies to determine whether OF could be considered as a severe osteoporotic fracture. © 2018 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
Keywords: AGING; CLINICAL TRIALS; DXA—ANALYSIS/QUANTITATION OF BONE; OSTEOPOROSIS—DISEASES AND DISORDERS OF/RELATED TO BONE.
Close2019 Mortality, complication, and fusion rates of patients with odontoid fracture: the impact of age and comorbidities in 204 cases2019 Mortality, complication, and fusion rates of patients with odontoid fracture: the impact of age and comorbidities in 204 cases
Yann Philippe Charles, Yves Ntilikina, Benjamin Blondel, Stéphane Fuentes, Jérémy Allia, Nicolas Bronsard, Maxime Lleu, Benjamin Nicot, Vincent Challier, Joël Godard, Pascal Kouyoumdjian, Nicolas Lonjon, Paulo Marinho, Julien Berthiller, Eurico Freitas, Cédric Barrey
https://pubmed.ncbi.nlm.nih.gov/30317379/
Abstract
Purpose: The French Society of Spine Surgery (SFCR) conducted a prospective epidemiologic multicenter study. The purpose was to investigate mortality, complication, and fusion rates in patients with odontoid fracture, depending on age, comorbidities, fracture type, and treatment.
Methods: Out of 204 patients, 60 were ≤ 70 years and 144 were > 70 years. Demographic data, comorbidities, treatment types and complications (general medical, infectious, neurologic, and mechanical), and death were registered within the first year. Fractures were classified according to Anderson-D’Alonzo and Roy-Camille on the initial CT. A 1-year follow-up CT was available in 144 patients to evaluate fracture consolidation.
Results: Type II and oblique-posterior fractures were the most frequent patterns. The treatment was conservative in 52.5% and surgical in 47.5%. The mortality rate in patients ≤ 70 was 3.3% and 16.7% in patients > 70 years (p = 0.0002). Fracture pattern and treatment type did not influence mortality. General medical complications were significantly more frequent > 70 years (p = 0.021) and after surgical treatment (p = 0.028). Neurologic complications occurred in 0.5%, postoperative infections in 2.0%, and implant-related mechanical complications in 10.3% (associated with pseudarthrosis). Fracture fusion was observed in 93.5% of patients ≤ 70 years and in 62.5% >70 years (p < 0.0001). Pseudarthrosis was present in 31.5% of oblique-posterior fractures and in 24.3% after conservative treatment.
Conclusions: Age and comorbidities influenced mortality and medical complication rates most regardless of fracture type and treatment choice. Pseudarthrosis represented the main complication, which increased with age. Pseudarthrosis was most frequent in type II and oblique-posterior fractures after conservative treatment.
Keywords: Epidemiology; Fusion; Morbidity; Mortality; Odontoid fracture.
Close2019 Hangman's fracture: Management strategy and healing rate in a prospective multi-centre observational study of 34 patients2019 Hangman's fracture: Management strategy and healing rate in a prospective multi-centre observational study of 34 patients
Solène Prost, Cédric Barrey, Benjamin Blondel, Stéphane Fuentes, Laurent Barresi, Benjamin Nicot, Vincent Challier, Maxime Lleu, Joël Godard, Pascal Kouyoumdjian, Nicolas Lonjon, Paulo Marinho, Eurico Freitas, Sébastien Schuller, Jérémy Allia, Julien Berthiller, Yann Philippe Charles; French Society for Spine Surgery (SFCR)
https://pubmed.ncbi.nlm.nih.gov/31005699/
Abstract
Background: Hangman’s fractures account for 15% to 20% of all cervical spine fractures. The grading system developed by Effendi and modified by Levine and Edwards is generally used as the basis for management decisions. Nonetheless, the optimal management remains controversial. The objective of this study was to describe the treatments used in France in patients with hangman’s fractures. The complications and healing rates were analysed according to the fracture type and treatment used.
Hypothesis: Among patients with hangman’s fracture, those with disc damage must be treated surgically.
Material and methods: A prospective, multi-centre, observational study was conducted under the aegis of the French Society for Spine Surgery (SociétéFrançaisedeChirurgieRachidienne, SFCR). Patients were included if they had computed tomography (CT) evidence of hangman’s fracture. Follow-up data were collected prospectively. Fracture healing was assessed on CT scans obtained 3 and 12 months after the injury. The type of treatment and complications were recorded routinely.
Results: We included 34 patients. The fracture type according to Effendi modified by Levine and Edwards was I in 68% of patients, II in 29% of patients, and III in a single patient (3%). The treatment was non-operative in 21 (62%) patients and surgical in 11 (32%). All 28 patients re-evaluated after 1 year had evidence of fracture healing. The remaining 6 patients were lost to follow-up.
Conclusion: Hangman’s fracture is associated with low rates of mortality and neurological complications. Non-operative treatment is appropriate in Type I hangman’s fracture, with a 100% healing rate in our study. Types II and III are characterised by damage to the ligaments and discs requiring either anterior C2-C3 fusion or posterior C1-C3 screw fixation.
Level of evidence: III.
Keywords: Bone healing; Cervical spine; Fracture union; Hangman’s fracture; Surgery.
Copyright © 2019 Elsevier Masson SAS. All rights reserved.
Close2018 Influence of Derotation Connectors on 3D Surgical Correction of Adolescent Idiopathic Scoliosis2018 Influence of Derotation Connectors on 3D Surgical Correction of Adolescent Idiopathic Scoliosis
Influence of Derotation Connectors on 3D Surgical Correction of Adolescent Idiopathic Scoliosis
Jérémy Allia, Jean-Luc Clément, Virginie Rampal, Béatrice Leloutre, Olivier Rosello, Federico Solla
https://pubmed.ncbi.nlm.nih.gov/29494458/
Abstract
Study design: Monocentric study comparing results of simultaneous translation on 2 rods (ST2R) with derotation connectors (prospective series) or without derotation connectors (retrospective series) in Adolescent Idiopathic Scoliosis (AIS) surgery.
Objective: The objective of this study was to assess if derotation connectors influence axial, coronal, and sagittal results in AIS surgery.
Summary of background data: Conventional reduction techniques remain limited in their ability to reduce axial torsion. Direct vertebral derotation technique accomplishes partial axial derotation but decreases thoracic kyphosis.
Methods: Monocentric study including AIS surgeries performed using ST2R technique with derotation connectors (group D+, n=44) or without derotation connectors (group D-, n=24). The axial intervertebral rotation was measured between apical and neutral vertebra on pre and postoperative computed tomography scan. T test was used to compare mean values. ANCOVA analyzed the influence of connectors and covariates on the primary outcome, which was the difference between preoperative and postoperative intervertebral rotation.
Results: The mean axial torsion gain in the D+ group was 23% (+3.84 degrees, 95% confidence interval, +1.95/+5.73). In the D- group, mean axial torsion increase of 4% (-0.42 degrees, 95% confidence interval, -1.19/+2.03). The result was significantly different between the 2 groups (P=0.005). The coronal correction of the main curve angle was 80% in the D+ group and 64% in the D- group (P=0.004). Kyphosis correction was similar between the 2 groups (P=0.3) with significant increase of thoracic kyphosis in the whole series (P=0.02) and no patients with postoperative hypokyphosis <10 degrees. Multivariate analysis confirmed the influence of derotation connectors on both axial and coronal correction (P<0.05).
Conclusions: The use of derotation connectors in the surgical treatment of AIS significantly improved axial and coronal correction compared to nonuse of connectors without compromising the sagittal plane.
Close2018 C1 fracture: Analysis of consolidation and complications rates in a prospective multicenter series2018 C1 fracture: Analysis of consolidation and complications rates in a prospective multicenter series
C1 fracture: Analysis of consolidation and complications rates in a prospective multicenter series
Maxime Lleu, Yann Philippe Charles, Benjamin Blondel, Laurent Barresi, Benjamin Nicot, Vincent Challier, Joël Godard, Pascal Kouyoumdjian, Nicolas Lonjon, Paulo Marinho, Eurico Freitas, Sébastien Schuller, Stéphane Fuentes, Jérémy Allia, Julien Berthiller, Cédric Barrey
https://pubmed.ncbi.nlm.nih.gov/30193984/
Abstract
Introduction: Three types of C1 fracture have been described, according to location: type 1 (anterior or posterior arc), type 2 (Jefferson: anterior and posterior arc), and type 3 (lateral mass). Stability depends on transverse ligament integrity. The main aim of the present study was to analyze complications and consolidation rates according to fracture type, age and treatment.
Material and methods: The French Society of Spinal Surgery (SFCR) performed a multicenter prospective study on C1-C2 trauma. All patients with recent fracture diagnosed on CT were included. Consolidation on CT was studied at 3 months and 1 year. Medical, neurologic, infectious and mechanical complications were inventoried using the KEOPS data-base.
Results: Sixty-three of the 417 patients (15.1%) had C1 fracture: type 1 (33.3%), type 2 (38.1%), or type 3 (28.6%). The transverse ligament was intact in 53.9% of cases. Treatment was non-operative in 63.5% of cases, surgical in 27.0%, and surgical after failure of non-operative treatment in 9.5%. There were 8 medical complications, more frequently in patients aged >70 years, following surgery (p<0.0001). The consolidation rate was 84.2% with non-operative treatment, 100% for primary surgery, and 33.3% for secondary surgery (p=0.002). There were 10 cases of non-union, in 4.8% of type 1, 13.6% of type 2 and 33.3% of type 3 fractures (p=0.001).
Conclusion: Medical complications showed association with age and with type of treatment. Non-operative treatment was suited to types 1, 2 and 3 with minimal displacement and intact transverse ligament. C1-C2 fusion was suited to displaced unstable type 2 fracture. Displaced type 3 fracture incurred risk of non-union. Early surgery may be recommended.
Level of evidence: III.
Keywords: Atlas; C1 fracture; Complications; Consolidation; Non-union.
Copyright © 2018. Published by Elsevier Masson SAS.
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Communications & Congrès
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