Introduction: Balancing the patellofemoral joint (PFJ) in total knee arthroplasty (TKA) involves avoiding over-stuffing. The purpose of this study was to assess how often a strategy of recreating the anterior space of the trochlea (full extension) led to the trochlea depth being recreated in both mid-flexion (30-40 degrees) and deep flexion (80-90 degrees). Methods: One hundred and twenty two consecutive patients undergoing robotic-assisted TKA had femoral components placed according to functional alignment principals and were assessed. The femoral component was sized and positioned in order to ensure that the anterior flange was within 2 mm of the native anatomy, corresponding to a patella position of full extension (0 degrees flexion). Trochlea depth restoration in 3 positions along the floor of the trochlea groove was compared and measured. The trochlea was defined as balanced if the prosthesis was within 2 mm of the native anatomy. Patients were divided into over-stuffed (prosthesis >2 mm above the native anatomy) or under-stuffed (prosthesis >2 mm beneath the native anatomy). Results: All patients 122/122 (100%) had a balanced trochlea in full extension. In total 54 TKA were over or under-stuffed at either mid-flexion or deep flexion. In mid-flexion, 3/122 (2.5%) trochlea were over-stuffed and 39/122 (32%) trochlea were under-stuffed. In deep flexion, 25/122 (20.5%) of trochlea's were overstuffed and 30/122 (24.6%) were under-stuffed. In mid-flexion, balanced trochlea components were more externally rotated relative to the posterior condylar axis compared to unbalanced components (2.35 degrees external rotation vs 1.21 degrees, p=0.004). There were no other significant differences observed between the balanced and unbalanced trochlea groups in mid or deep flexion. Conclusion: Over 40% of TKA over or under-stuff the trochlea in deeper flexion despite the anterior flange being positioned within 2 mm of the native anatomy in full extension. The rate of over or under-stuffing in mid and deep flexion was similar (>40%); however, in mid-flexion, under-stuffing of the native trochlea was more common. The concept of PFJ over or under-stuffing in TKA needs to be redefined to consider the full arc of flexion of the trochlea groove, and the biomechanical and clinical consequences of under-stuffing the trochlea investigated further.

Introduction: Osteoarticular infections (OAIs) constitute serious paediatric conditions that may cause severe complications. Identifying the causative organism is one of the mainstays of the care process, since its detection will confirm the diagnosis, enable adjustments to antibiotic therapy and thus optimize outcomes. Two bacteria account for the majority of OAIs before 16 years of age: Staphylococcus aureus is known for affecting the older child, whereas Kingella kingae affects infants and children younger than 4 years old. We aimed to better define clinical characteristic and biological criteria for prompt diagnosis and discrimination between these two OAI. Materials and methods: We retrospectively studied 335 children, gathering 100 K. kingae and 116 S. aureus bacteriologically proven OAIs. Age, gender, temperature at admission, involved bone or joint, and laboratory data including bacterial cultures were collected for analysis. Comparisons between patients with OAI due to K. kingae and those with OAI due to S. aureus were performed using the Mann–Whitney and Kruskal–Wallis tests. Six cut-off discrimination criteria (age, admission’s T°, WBC, CRP, ESR and platelet count) were defined, and their respective ability to differentiate between OAI patients due to K. kingae versus those with S. aureus was assessed by nonparametric receiver operating characteristic (ROC) curves. Results: Univariate analysis demonstrated significant differences between the two populations for age of patients, temperature at admission, CRP, ESR, WBC, and platelet count. AUC assessed by ROC curves demonstrated an exquisite ability to discriminate between the two populations for age of the patients; whereas AUC for CRP (0.79), temperature at admission (0.76), and platelet count (0.76) indicated a fair accuracy to discriminate between the two populations. Accuracy to discriminate between the two subgroups of patients was considered as poor for WBC (AUC = 0.62), and failed for ESR (AUC = 0.58). On the basis of our results, the best model to predict K. kingae OAI included of the following cut-offs for each parameter: age < 43 months, temperature at admission < 37.9 °C, CRP < 32.5 mg/L, and platelet count > 361,500/mm3. Conclusions: OAI caused by K. kingae affects primarily infants and toddlers aged less than 4 years, whereas most of the children with OAI due to MSSA were aged 4 years and more. Considering our experience on the ground, only three variables were very suggestive of an OAI caused by K. kingae, i.e., age of less than 4 years, platelet count > 400,000, and a CRP level below 32.5 mg/L, whereas WBC and ESR were relatively of limited use in clinical practice.

Abuse should be suspected in infant femoral fractures without significant trauma, especially if the child is non-ambulatory. Review the epidemiological and radiological characteristics of femoral fractures in children under 36 months old to identify those potentially related to child abuse. Cases involving 102 patients presenting with 103 femoral fractures between January 1990 and December 2020 were investigated, paying close attention to mechanisms of injury, fracture patterns, and their possible relations to child abuse. The annual incidence of femoral fractures in patients under 36 months old was estimated at 24.6 per 100 000; the incidence in infants under 13 months was significantly higher than among children between 13 and 36 months old. Most infants under 13 months suffered from transverse or oblique metaphyseal/diaphyseal fractures (93.2%), whereas 67.8% of older children presented with spiral shaft fractures. Data confirmed child abuse in 4.9% of all patients (one with bilateral fractures); femoral fractures were incompatible with their reported mechanisms of injury in 31 patients (30.4%), whereas 12 fractures (11.8%) occurred in unexplained circumstances. More than 50% of femoral fractures occurred with low-energy trauma. The difference in patterns according to patients’ ages suggested different mechanisms of trauma in ambulatory and non-ambulatory infants. Confirmed abuses and unclear or inconsistent mechanisms of trauma, raised potential total child abuse cases to 47.1% of our cohort. Level of evidence: Level IV.

Background and Objectives: Septic arthritis of the knee is presumed to be the most frequent form of Kingella kingae-induced osteoarticular infection. This study aimed to report on the clinical course, biological parameters, and results of microbiological investigations among children with K. kingae-induced septic arthritis of the knee. It also assessed the modified Kocher–Caird criteria’s ability to predict K. kingae-induced septic arthritis of the knee. Methods: The medical charts of 51 children below 4 years old with confirmed or highly probable K. kingae-induced arthritis of the knee were reviewed. Data were gathered on the five variables in the commonly-used Kocher–Caird prediction algorithm (body temperature, refusal to bear weight, leukocytosis, erythrocyte sedimentation rate, and C-reactive protein level). Results: Patients with K. kingae-induced arthritis of the knee usually presented with a mildly abnormal clinical picture and normal or near-normal serum levels of acute-phase reactants. Data on all five variables were available for all the children: 7 children had zero predictors; 8, 20, 12, and 4 children had 1, 2, 3, and 4 predictors, respectively; no children had 5 predictors. This gave an average of 1.96 predictive factors and a subsequent probability of ≤ 62.4% of infectious arthritis in this pediatric cohort. Conclusions: Because the clinical features of K. kingae-induced arthritis of the knee overlap with many other conditions affecting this joint, the Kocher–Caird prediction algorithm is not sensitive enough to effectively detect K. kingae-induced septic arthritis of the knee. Excluding K. kingae-induced arthritis of the knee requires performing nucleic acid amplification assays on oropharyngeal swabs and joint fluid from those young children presenting with effusion of the knee, even in the absence of fever, leukocytosis, or a high Kocher–Caird score.

Objectives: The aim of this study was to evaluate the incidence of OA with isolated ACLR in comparison with ACLR with ALLR at medium-term follow-up. We hypothesized that there would be no differences between the groups. Methods: Patients who underwent ACLR 1 ALLR with hamstring tendon autograft between January 2011 and March 2012 were propensity matched to patients who underwent isolated ACLR with bone–patellar tendon–bone (BPTB) or hamstring tendon autograft in the same period. Medium-term radiographic evaluation was performed using the International Knee Documentation Committee (IKDC) radiographic OA grading scale, modified Kellgren-Lawrence grade, and the surface fit method to assess percentage of joint space narrowing. Clinical outcomes were assessed with the following measures: IKDC, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner, and ACL Return to Sport after Injury. Results: A total of 80 patients (42 ACLR 1 ALLR and 38 isolated ACLR) were analyzed with a mean follow-up of 104 months. There was no significant difference between groups for joint space narrowing in the medial or lateral tibiofemoral or lateral patellofemoral (PF) compartment. However, 36.8% in the isolated ACLR group versus 11.9% in the ACLR 1 ALLR group had narrowing of the medial PF compartment (P = .0118). A lateral meniscal tear increased the risk of lateral tibiofemoral narrowing by nearly 5 times (odds ratio, 4.9; 95% CI, 1.547-19.367; P = .0123). The risk of medial PF narrowing was .4-fold with an isolated ACLR (odds ratio, 4.8; 95% CI, 1.44-19.05; P = .0179). Between the isolated ACLR group and the ACLR 1 ALLR group, the secondary meniscectomy rate was 13.2% versus 11.9% (not significantly different). There was no difference between groups in KOOS, Tegner, or IKDC scores. There was also no difference between groups for grades of osteoarthritic change for any classification system. Patients who received a BPTB graft had medial PF joint narrowing in 66.7% of cases as compared with 11.9% in those who received ACLR 1 ALLR (P = 0.118). Conclusions: ACLR 1 ALLR did not increase the risk of OA in the lateral tibiofemoral compartment when compared with an isolated] ACLR at medium-term follow-up. Isolated ACLR using BPTB was associated with a significantly increased risk of medial PF joint space narrowing.

The ability of kinematic alignment (KA) to consistently restore trochlea anatomy in total knee arthroplasty (TKA) is unknown despite recreation of constitutional anatomy being its rationale for use. The purpose of this study was to assess if alignment choice in TKA effects the ability to restore the native trochlea groove. One hundred and twenty-two consecutive patients undergoing robotic-assisted TKA using the MAKO image-based robotic platform had simulated femoral components placed according to kinematic, mechanical and functional alignment principals. Implant position and trochlea restoration between groups were compared. Restoration was assessed by shift (medial–lateral) and depth relative to the native groove from three consistent points; full extension (0°), mid-flexion (30°–40°) and deep flexion (70°–80°). Three hundred and sixty-six alignment options were analysed. Femoral alignment was significantly different between groups. Of KA, 13.1% compared to 3.3% of FA plans were outside safe coronal boundaries. The trochlear groove was translated the most by MA compared to KA and FA (full extension, MA 7.84 ± 1.99 mm lateral to the native groove, KA 6.40 ± 2.43 mm and FA 6.88 ± 1.74 mm, p ≤ 0.001). In full extension, FA most closely restored the trochlear groove depth in all three positions of flexion. Alignment philosophy led to significant differences in trochlea groove recreation. A kinematically placed femoral component led to positioning considered unsafe in over 13% of cases. A functionally placed femoral component most closely restored trochlea depth in all three positions of flexion.

The aim was to investigate the contribution of robotics assisted total hip arthroplasty (THA) through direct anterior approach (DAA) in improving radiographic precision, functional results and complications. This retrospective study compared 100 primary conventional THA (cTHA) to 50 primary robotic THA (rTHA) through DAA. All cups were placed with the objective of having no anterior overhang while respecting the safe zones (SZ). Radiographic analysis included cup inclination and anteversion, vertical and horizontal changes of the rotation centre (ΔVCOR, ΔHCOR), acetabular and femoral offset. SZ were 30–50° of inclination and 10–30° of anteversion. Outliers were defined as medial displacement of the COR > 5 mm, vertical displacement of the COR > 3 mm superiorly. Harris hip score (HHS) and complications were compared at one year of follow-up. The robotic cups were better oriented with 98% in the global SZ versus 68% in the cTHA group (p = 0.0002). The COR was on average better restored in the robotic group in both the horizontal and vertical planes (Δ HCOR =  − 5.0 ± 5.0 vs − 3.4 ± 4.9, p = 0.03; Δ VCOR = 1.6 ± 3.3 vs 0.2 ± 2.7, p = 0.04). There were fewer outliers in the rTHA group concerning VCOR (28% versus 10%, p = 0.03). There was no significant difference in HHS and complication rate at one year. The use of robotics for THA by DAA provided an advantage in controlling the orientation of the cup and the restoration of its rotation centre. Thanks to the 3D planning on CT scan, it allowed to respect the thresholds while avoiding the anterior overhangs.

Nowadays, Kingella kingae (K. kingae) is considered as the main bacterial cause of osteoarticular infections (OAI) in children aged less than 48 months. Next to classical acute hematogenous osteomyelitis and septic arthritis, invasive K. kingae infections can also give rise to atypical osteoarticular infections, such as cellulitis, pyomyositis, bursitis, or tendon sheath infections. Clinically, K. kingae OAI are usually characterized by a mild clinical presentation and by a modest biologic inflammatory response to infection. Most of the time, children with skeletal system infections due to K. kingae would not require invasive surgical procedures, except maybe for excluding pyogenic germs' implication. In addition, K. kingae's OAI respond well even to short antibiotics treatments, and, therefore, the management of these infections requires only short hospitalization, and most of the patients can then be treated safely as outpatients.

Background and ObjectivesMost cases of spondylodiscitis in children aged between 6 and 48 months old could be caused primarily by K. kingae. The present prospective study aimed to determine whether an innovative and indirect diagnosis approach - based on detection of K. kingae DNA in the oropharynx of children with suspected spondylodiscitis – provides sufficient evidence that this microorganism is responsible for the infection.MethodsWe prospectively analysed infants admitted for spondylodiscitis, considering above all the results of PCR realized in oropharyngeal swabs and in blood samples.ResultsFour of the 29 performed K. kingae-specific real-time PCR assay in blood were positive (13.8%), whereas 28 of the 32 K. kingae-specific real-time PCR assay realized on throat swabs were positive (87.5%).ConclusionsThis study demonstrates that performing oropharyngeal swab PCR is able to detect K. kingae in almost 90% of the toddlers with confirmed spondylodiscitis. That provides strong arguments for the hypothesis that K. kingae should be considered as the main aetiological pathogen to suspect in children between 6 and 48 months old with spondylodiscitis. Finally, it seems to us reasonable that oropharyngeal swab may become an early decision-making tool for the indirect identification of K. kingae in spondylodiscitis.

Distal patellar tendon avulsions are rare injuries in healthy individuals, and to date, no case affecting skeletally mature teenagers and adolescents has been reported. In the majority of cases, distal patellar tendon avulsions are associated with severe intra-articular knee lesions, signifying a high-energy trauma. We present the case of a 15.5-year-old female who was admitted to the emergency department after a knee injury. The mechanism of injury was a combination of landing after a jump off a scooter and sudden deceleration with a fixed foot. Lateral radiographs revealed a distal patellar tendon avulsion. An MRI was conducted to accurately diagnose concomitant lesions. The MRI revealed a complete tear of the ACL, and associated bone bruises on the lateral femoral condyle, and also on the posterolateral tibial plateau. A knee joint exam under general anesthesia demonstrated good stability during valgus stress testing and only a grade 1 positive Lachman test. Therefore, we decided to only reconstruct the extensor mechanism and to abstain from a primary ACL reconstruction. The presented case and review of the literature demonstrate the clinical relevance of this atypical lesion. In fact, a distal patellar tendon avulsion after physeal fusion of the proximal tibia should raise a strong suspicion of severe associated intra-articular knee lesions and requires prompt MRI investigation. However, controversy still exists regarding the management of these injuries, in particular concerning the question of whether to address both injuries in a single stage or in 2 stages.

AIMS:We aimed to describe the epidemiological, biological, and bacteriological characteristics of osteoarticular infections (OAIs) caused by Kingella kingae.METHODS:The medical charts of all children presenting with OAIs to our institution over a 13-year period (January 2007 to December 2019) were reviewed. Among these patients, we extracted those which presented an OAI caused by K. kingae and their epidemiological data, biological results, and bacteriological aetiologies were assessed.RESULTS:K. kingae was the main reported microorganism in our paediatric population, being responsible for 48.7% of OAIs confirmed bacteriologically. K. kingae affects primarily children aged between six months and 48 months. The highest prevalence of OAI caused by K. kingae was between seven months and 24 months old. After the patients were 27 months old, its incidence decreased significantly. The incidence though of infection throughout the year showed no significant differences. Three-quarters of patients with an OAI caused by K. kingae were afebrile at hospital admission, 11% had elevated WBCs, and 61.2% had abnormal CRPs, whereas the ESR was increased in 75%, constituting the most significant predictor of an OAI. On MRI, we noted 53% of arthritis affecting mostly the knee and 31% of osteomyelitis located primarily in the foot.CONCLUSION:K. kingae should be recognized currently as the primary pathogen causing OAI in children younger than 48 months old. Diagnosis of an OAI caused by K. kingae is not always obvious, since this infection may occur with a mild-to-moderate clinical and biological inflammatory response. Extensive use of nucleic acid amplification assays improved the detection of fastidious pathogens and has increased the observed incidence of OAI, especially in children aged between six months and 48 months. We propose the incorporation of polymerase chain reaction assays into modern diagnostic algorithms for OAIs to better identify the bacteriological aetiology of OAIs. Cite this article: Bone Joint J 2021;103-B(3):578-583.

Aim: This retrospective study’s objective was to evaluate osteoarticular infection in infants less than 12 months of age, with a particular focus on biological features and bacteriological etiology. Material & methods: We retrospectively reviewed the medical records of every infant younger than 12 months old admitted in our institution for a suspected osteoarticular infection between January 1980 and December 2016. Results: Sixty-nine patients records were reviewed, including eight neonates, 16 infants from 1 to 5 months old, and 45 from 6 to 12 months old. Conclusion: Neonates and infants aged from 6 to 12 months old were more exposed to infections. Staphylococcus aureus remained the main pathogen in children <6 months, whereas Kingella kingae has become the most frequently isolated microorganism in infants aged from 6 to 12 months old.

Osteoarticular infections of the chest wall are relatively uncommon in pediatric patients and affect primarily infants and toddlers. Clinical presentation is often vague and nonspecific. Laboratory findings may be unremarkable in osteoarticular chest wall infections and not suggestive of an osteoarticular infection. Causative microbes are frequently identified if specific nucleic acid amplification assays are carried out. In the young pediatric population, there is evidence that Kingella kingae is 1 of the main the main causative pathogens of osteoarticular infections of the chest wall.

C with functional or anatomic asplenia are at high risk for invasive meningococcal disease, especially with encapsulated strains. Nongroupable (unencapsulated) meningococcal strains, which are commonly associated with asymptomatic nasopharyngeal carriage and considered as nonpathogenic, rarely cause invasive disease. Herein, we report a rare case of meningococcemia due to nongroupable Neisseria meningitidis in a splenectomized child despite meningococcal vaccination. A 10-year-old female presented to the emergency department with acute onset fever, headache and myalgia. Her past medical history included splenectomy for trauma at the age of 9 years. The patient was started on penicillin prophylaxis and vaccinated with 2-dose series of MenACWY-TT and MenB-4C after splenectomy. On physical examination, the patient was found to be febrile to 39.4°C, tachycardic (110 beats/ min) and hypotensive (80/40 mm/Hg). A nonblanchable petechial rash was present on the patient’s abdomen, lower legs and arms. After blood and cerebrospinal fluid cultures were obtained, treatment with empirical intravenous ceftriaxone was started for presumed meningococcemia. Laboratory evaluation showed leukopenia (3600/mm), thrombocytopenia (88,000/mm), elevated C-reactive protein (48 mg/dL) and disseminated intravascular coagulation. Lumbar puncture revealed no evidence of meningitis. Due to persistent hypotension, resuscitation was initiated with intravenous fluids and inotropes, and the patient was transferred to pediatric intensive care unit. On day 2, N. meningitidis (sensitive to ceftriaxone, but resistant to penicillin with a minimum inhibitory concentration of 0.5 mg/L) growth was noted in blood culture, confirming the diagnosis of meningococcemia. The isolate was determined to be nongroupable by both slide agglutination for serogroups A, B, C, E, W, X, Y and Z (Remel, Lenexa, KS) and real-time PCR. She was treated with 10 days of intravenous ceftriaxone and made a full recovery without any sequelae. During

BACKGROUND:The quadriceps tendon (QT) autograft is known as an effective graft for anterior cruciate ligament (ACL) reconstruction and shows a similar functional outcome to the bone-patellar tendon-bone (BPTB) in randomized controlled trials, with a lesser incidence of complications. Up until now, only 2 studies have compared QT to hamstring tendon (HT) autograft.HYPOTHESIS:The functional outcomes of the QT technique are at least as good as those of the HT technique, with the same morbidity.STUDY DESIGN:Cohort study; Level of evidence, 3.METHODS:Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31, 2012. Fifty underwent ACL reconstruction with the QT and 45 with the HT. The same surgical technique, fixation method, and postoperative protocol were used in both groups. The following parameters were evaluated: surgical revisions, functional outcome (Lysholm, Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner, subjective International Knee Documentation Committee), joint stability (KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne-Trumper score), and isokinetic strength. Descriptive statistics are presented for these variables using the Student t test.RESULTS:Eighty-six patients (45 QT, 41 HT) were reviewed with a mean follow-up of 3.6 ± 0.4 years; minimum follow-up was 3 years. There were 4 reoperations in the QT group (including 1 ACL revision) and 3 in the HT group (including 2 ACL revisions) ( P > .05). The Lysholm (89 ± 6.9 vs 83.1 ± 5.3), KOOS Symptoms (90 ± 11.2 vs 81 ± 10.3), and KOOS Sport (82 ± 11.3 vs 67 ± 12.4) scores were significantly better in the QT group than in the HT group. In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements ( P < .005). The negative Lachman component was higher in the QT group than in the HT group (90% vs 46%, P < .005). There was a trend for the negative pivot-shift component to be higher in the QT group than in the HT group (90% vs 64%, P = .052). The Shelbourne-Trumper score was the same in both groups. There was no difference between groups in terms of isokinetic strength.CONCLUSION:The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft, without affecting morbidity.

Notre hypothèse est que l'utilisation d'un transplant de tendon quadricipital avec pastille osseuse (BQT) est une alternative fiable aux techniques dites classiques de ligamentoplastie du ligament croisé antérieur (LCA). Notre objectif est de comparer l'efficacité et la morbidité d'un transplant BQT avec une technique aux ischiojambiers (DIDT). Entre le 01/01/2012 et le 31/12/2012, 95 patients ont bénéficié du ligamentoplastie isolé du LCA soit avec BQT soit avec DIDT dans notre centre. La technique chirurgicale ainsi que le matériel de fixation utilisé étaient les mêmes dans les deux groupes. Ont été évalués : le nombre de reprises chirurgicales, le résultat fonctionnel (Lysholm, KOOS, Tegner, IKDC subjectif), la stabilité (KT 1000, Lachmann, Pivot Shift), la douleur antérieur (score de Shelbourne et Trumper) et les résultats isocinétiques. L'analyse statistique a été descriptive puis comparative pour l'ensemble des critères de jugement entre les deux groupes à l'aide de test t-Student. Nous avons obtenu un avis favorable du comité d'éthique de notre institution. Quatre-vingt-six patients (45 BTQ, 41 DIDT) ont été inclus avec un recul moyen de 3,5 ans. Les caractéristiques démographiques (incluant le niveau et type de sport) des deux groupes étaient comparables. Il y a eu 4 réopérations dans le groupe BQT dont une reprise de LCA et 3 dans le groupe DIDT dont 2 reprises de LCA (p > 0,005). Les scores de Lysholm (89 ± 6,9 vs 81 ± 5,3) ainsi que KOOS symptômes (90 ± 11,2 vs 81 ± 10,3) et KOOS sport (82 ± 11,3 vs 67 ± 12,4) sont retrouvés significativement plus important dans le groupe BQT. La différence moyenne de stabilité par rapport au côté opposé était de 1,1 ± 0,9 mm dans le groupes BQT et de 3,1 ± 1,3 mm dans le groupe DIDT (p < 0,005). La proportion Lachmann négatif était plus faible dans le groupe BQT (90 % vs 46 %, p < 0,005). Le score de Shelbourne était équivalent dans les deux groupes. En ce qui concerne l'analyse isocinétique, aucune différence n'était statistiquement significative. Les résultats de BQT à un recul de 3,5 ans sont au moins équivalent aux IJ avec une morbidité qui n'est pas augmenté. Les scores fonctionnels sont retrouvés plus important dans le groupe BQT. De même, la différence de laxité avec le côté controlatérale est en faveur du BQT. Le score de douleur antérieur est équivalent dans les deux groupes. BQT représente une alternative fiable avec des résultats très satisfaisants pour la reconstruction du LCA.

L’évolution de l’épidémiologie des fractures de l’acétabulum s’accompagne d’une progression des indications de prothèses totales de hanche (PTH) de première intention. Quoique grevée d’un taux de complications important cette procédure est une alternative thérapeutique pour les patients âgés ou présentant des lésions non synthésables. Nous avons évalué les indications, les résultats fonctionnels et les complications de patients traités par PTH primaire pour des fractures de l’acétabulum. Les patients traités pour une fracture de l’acétabulum par une PTH primaire associée ou non à une ostéosynthèse de 2000 à 2014, avec un recul minimum de 1 an furent inclus à cette étude rétrospective monocentrique continue. Nous avons collectés les données démographiques, épidémiologiques (type de fracture et de traumatisme, lésions associées), opératoires et postopératoires (scores cliniques, critères radiologiques et complications). Vingt patients de 64,2 ans (45–81) furent inclus. Nous retrouvions 50 % de fractures intéressant le mur postérieur + les autres étaient transverses (20 %), 2 colonnes (10 %), colonne antérieure + hémitransverse postérieure (10 %), T-Type (10 %). Cinquante-cinq pour cent résultaient d’un traumatisme à haute énergie et 45 % à faible cinétique. Cinq patients présentaient une fracture du col ou de la tête fémorale associés (25 %). Tous les patients étaient opéré par voie postérieure, nous retrouvions 1 PTH seule (5 %), 4 PTH avec anneau (20 %) et 15 PTH + ostéosynthèse par plaque (75 %). Trente-cinq pour cent des cupules étaient à double mobilité, 75 % des implants fémoraux étaient cimentés. Nous comptions 2 luxations et un hématome précoces et tardivement – 2 infections, 4 ossifications hétérotopiques, 3 luxations récidivantes et 2 fractures péri-prothétiques. Quarante pour cent de patients présentait au moins une complication avec 25 % de révision. La mortalité était de 30 % à 4,5 ans (2–7) postopératoire. Le score de Harris était de 82 (28–100) à 4,2 ans (1–13). Lorsque les fractures de l’acétabulum sont comminutives avec une faible qualité osseuse les échecs d’ostéosynthèse sont fréquents et les conversions secondaires en PTH présentent des résultats contrastés. Les résultats cliniques des PTH primaires sont satisfaisants lorsque la technique chirurgicale est adaptée afin d’assurer stabilité et longévité, l’utilisation de double mobilité et d’implants cimentés semblent favorables. Ainsi la PTH primaire associée à l’ostéosynthèse est donc un traitement en un temps fiable et nécessaire dans la stratégie thérapeutique des fractures de l’acétabulum du patient âgé et ostéoporotique, en respectant ses spécificités techniques et des indications strictes.