Introduction

Latissimus dorsi transfer is a procedure used in massive irreparable posterosuperior rotator cuff tears, in young patient with severe pain and significant functional impairment. The purpose of this retrospective study was to evaluate its clinical, radiological and electromyographic results.

Purpose of the study: Computed tomography is recommended for the preoperative work-up of joint fractures as it allows an optimisation of the access as a function of the injury. During the operation, 2D radiographic or fluoroscopic controls are still widely used. After one year’s experience, we evaluated the potential pertinence of using 3D reconstructions intraoperatively with a mobile isocentric fluoroscope (iso-C-3D).

Material and methods: All operations for which the amplifier was used were collected prospectively. The type of fixation as well as the details of the installation and measures taken intraoperatively were noted.

Results: At one year, intraoperative 3D reconstructions were made during 48 operations in 47 patients: fracture of the calcaneum (n=13), thoracolumbar spin (n=12), acetabulum (n=11), tibial condyles (n=9), odontoid (n=2), pelvis (n=1). The installation was habitual for the calcaneum and odontoid fractures. For the other localizations, use of a carbon plateau table facilitated good quality imaging for spinal and tibial condyle fractures; a carbon orthopaedic table was useful for acetabulum and pelvis fractures. With the intraoperative 3D reconstruction the surgeon was able to check the freedom of the canal after reduction and fixation. For the calcaneum fractures, reduction of the thalamic fragment was revised in one patient; in another, an intra-articular screw was replaced. One intra-articular screw stabilizing the posterior wall was also changed during an acetabulum fixation.

Discussion: During our first year of use, 3D reconstruction intraoperatively has allowed us to avoid three early reoperations (for two calcaneums and one acetabulum). Classical 2D imaging of these two localizations is difficult to interpret because of the spherical form of the hip joint and, for the calcaneum, the difficulty in obtaining quality retrotibial images. Quality images requires specific installation, limiting interference with metallic supports.

Conclusion: The results we have obtained in our first year of use of the ISO-C-3D amplifier has led us to generalise its use for percutaneous fixation procedures involving the acetabulum and the calcaneum.

Purpose: According to the Ottawa rules, x-rays are not needed after knee trauma unless one or more of the following clinical criteria are present: age over 55 years, pain at palpation of the head of the fibula, pain at palpation of the anterior aspect of the patella, impossible knee flexion beyond 90°, inability to walk four steps immediately after trauma and at the emergency consultation. We conducted a prospective study in a consecutive series of patients to check the validity of this rule in daily practice.

Materials and methods: From December 2001 to January 2002, we included all patients consulting in an emergency situation for recent trauma involving only the knee joint. We excluded patients aged less than ten years, wounds without trauma, trauma more than two days before consultation, and patients with a history of trauma involving the same knee. An emergency physical exam was performed in all cases with identification of the study criteria. Standard x-rays (AP and lateral view in the supine position) were obtained for all patients. The patients and the x-rays were seen later by a senior orthopaedic surgeon and a senior radiologist who noted the presence of fracture requiring specific therapeutic management. The sensitivity, specificity and positive and negative predictive values of the Ottawa rule were determined for search for fracture.

Results: One hundred thirty-eight patients met the inclusion criteria during the study period. The sensitivity and negative predictive value of the Ottawa rule were 100%; the specificity was 36%, and the positive predictive value was 25%. Nineteen fractures (14%) requiring specific therapeutic management were identified: all patients had at least one positive sign. Seventy-six patients (55%) without fracture had at least one positive sign. Forty-three patients (31%) without fracture did not have any positive sign. The x-rays were not contributive for these patients.

Discussion and conclusion: This study demonstrated the validity of the Ottawa rule in the clinical setting of our practice. With widespread use of this rule, approximately one-third of the x-rays performed for recent trauma involving the knee alone could be avoided.