Rémi Gauthé

Clinique Saint-Hilaire

Résumé Introduction L’ostéosynthèse à charnière postérieure (OCP) est une technique de fixation de l’articulation sacro-iliaque (SI) indiquée comme traitement des fractures instables de l’anneau pelvien classées Tile C. Hypothèse L’OCP est efficace sur le plan fonctionnel à plus d’un an de recul selon le score de Majeed. Méthode Une série monoce...

Introduction: Posterior hinge fixation (PHF) is a sacroiliac joint fixation method indicated for the surgical treatment of unstable pelvic ring fractures (Tile C). Hypothesis: PHF yields good functional outcomes based on the Majeed score at more than 1 year of follow-up. Methods: A single-center, retrospective study of patients who had a Tile C pel...

Résumé Introduction Le déséquilibre sagittal antérieur (DSA) représente un facteur de gravité dans l’étude des pathologies rachidiennes. L’étude stabilométrique de la position dynamique du centre de pression (CP) permet d’apprécier le contrôle de la position orthostatique. Ces analyses permettent de connaître la dépense énergétique utilisée pour c...

Introduction Degenerative processes induce loss of lumbar lordosis and anterior sagittal imbalance (ASI). Optoelectronic study provides kinematic analysis of movement and can also detect ASI. The aim of the present study was to assess gait kinematic modifications induced by ASI. Methods Thirty-five healthy male volunteers were subjected to reversi...

Background data: Anterior sagittal imbalance (ASI) is a severity factor in spinal pathology. Stabilometric study of the dynamic position of the center of pressure (CoP) assesses orthostatic control. These analyses provide the energy expenditure used for this control. Hypothesis: Stabilometric signs are associated with ASI indicate increased energy...

Surgical results in tarsal tunnel syndrome are variable, and etiology seems to be a factor. Three possible etiologies can be distinguished. The aim of the present study was to compare surgical results according to etiology. Three continuous retrospective series (45 patients overall) of tarsal tunnel syndrome were compared. Group 1 presented a perma...

Objective To evaluate the clinical and radiological outcomes of patients undergoing one-level oblique lumbar interbody fusion (OLIF) combined with posterolateral fusion (PLF) with pedicle screws for the treatment of degenerative lumbar spondylolisthesis (DS) with a minimum follow-up of 1 year. Methods A retrospective analysis of prospectively coll...

Résumé Introduction Les arthrodèses lombaires inter-somatiques par voie antérieure trouvent une place dans le traitement des spondylolisthésis L5-S1 par lyse isthmique (SPLL). L’extension de cette arthrodèse au niveau L4-L5 est parfois requise. L’abord antérieur de ce disque est réputé difficile du fait des rapports anatomiques de la jonction ilio...

Résumé L’abord du plexus sciatique et de la partie latérale du sacrum est difficile. Une voie antérolatérale sous-péritonéale peut être agrandie par la section de l’os coxal au-dessus de l’acetabulum et l’abaissement vers le dehors de l’aile iliaque et de la fesse. Cet abord trans-iliaque antéro-latéral permet d’exposer le tronc lombo-sacré, les pr...

The approach to the sciatic plexus and lateral part of the sacrum is difficult. A subperitoneal anterolateral approach can be extended by sectioning the iliac bone above the acetabulum and lowering it toward the external part of the iliac wing and buttock. This transiliac anterolateral approach exposes the lumbosacral trunk, first sacral foramina a...

Résumé Introduction La chirurgie des sténoses lombaires vise à améliorer la qualité de vie de patients dont l’âge tend à s’accroître. L’utilisation de techniques mini-invasives semble correspondre aux besoins des sujets âgés dont la demande fonctionnelle est croissante. Hypothèse La technique UNILIF permet une amélioration des scores fonctionnels...

Background Anterior lumbar interbody fusion finds a place in L5-S1 isthmic spondylolisthesis (ISPL) treatment. Extension of this arthrodesis at L4-L5 level is sometimes required. Anterior approach of the L4L5 disc is considered difficult due to the anatomical relationship between the iliocava junction (ICJ) and the spine. Hypothesis Does the lumbo...

Introduction In lumbar stenosis, surgery aims to improve quality of life in increasingly elderly patients. Minimally invasive techniques better suit the requirements of elderly patients with increasing functional demand. Hypothesis The UNILIF unilateral lumbar interbody fusion technique improves functional scores at 1 year in over-80 year-olds, wi...

Introduction: Tranexamic acid (TXA) has been shown to reduce bleeding. Patients with spinal tumors are fragile and acute anemia may be harmful. Tumor excision surgery is reputed to be hemorrhagic and treatment may increase thromboembolic complications. The aim of this study was to compare blood loss with or without perioperative TXA injection. The...

Several types of atlantoaxial instability can justify surgical fixation. The instrumented fusion procedure described by Harms with screw fixation of the C1 lateral masses and C2 pedicles is a demanding technique that provides lasting stabilization. However, it has been associated with nerve and vascular complications due to the local anatomical con...

Background: Clips implanted during intracranial neurosurgical procedures sometimes migrate intradurally with rare cases of spinal migration. The appearance of radicular symptoms of topography concordant with the position of the foreign body leads to discussion about the optimal therapeutic strategy. Case description: We report the case of a 52-y...

Introduction: Among the various options for internal fixation of acetabular fractures, the enlarged iliofemoral approach is less often used, being more invasive, although providing greater exposure enabling control of all components in complex fractures. Even so, the impact of its invasiveness has not been confirmed, and long-term results are not...

Résumé Introduction La chirurgie orthopédique génère 20 % des contentieux médicaux hospitaliers mais peu d’études analysent les motifs et les conséquences de ces recours et elles sont le plus souvent limitées à un seul centre. Aussi, nous avons mené une analyse rétrospective des contentieux sur 4 centres hospitaliers universitaires (CHU) avec pour...

Introduction: Orthopedic surgery produces 20% of medical malpractice claims. However only a few studies have examined the reasons for and consequences of these disputes, and they have usually been limited to a single hospital. This led us to perform a retrospective analysis of the claims at four teaching hospitals in northwestern France. The goals...

Introduction Rapporter les résultats radiologiques et fonctionnels des patients atteints de fractures lombaires comminutives traitées par arthrodèse circonférentielle en deux temps. Matériel et méthodes Cette série prospective, multicentrique, regroupe 74 patients atteints de fractures lombaires comminutives. La prise en charge thérapeutique compr...

Background: The use of fluoroscopy is necessary during proximal femoral fracture (PFF) osteosynthesis. The frequency of these procedures justifies a description of radiation exposure and comparisons between different techniques and between the different surgical team members. Methods: This observational prospective and comparative study includes...

Introduction: Isolated gastrocnemius tightness is common and often associated with ankle and foot pathologies. The pathophysiology of this association is not clearly established. A review was performed to assess repercussion of gastrocnemius tightness on gait, and to evaluate scientific knowledge on this field. Materials and methods: The review was...

Background: The anterior approach to lumbar spine surgery has grown in popularity in the past few years; spinal fusion of the last two lumbar levels is often required. While there are alternatives to bone grafting available, including recombinant human bone morphogenetic protein 2 or bone substitutes, only cancellous autologous bone has all the re...

Aim: To report the radiological and functional results of a multicentre, prospective case series of patients with comminuted lumbar fractures treated with two-stage circumferential arthrodesis. Methods: A multicentre, prospective case series of 74 patients with comminuted lumbar fractures was analyzed. The strategy entailed initial posterior ost...

Objective: Spinal pathologies often induce gait disorders with multifactorial origins such as lumbar pain, radicular pain, neurologic complications, or spinal deformities. However, radiography does not permit an analysis of spinal dynamics; therefore, sagittal balance dynamics during gait remain largely unexplored. This prospective and controlled...

Introduction Avec 20 % des procédures judiciaires, les chirurgiens représentent la spécialité la plus exposée un sinistre tous les deux ans par chirurgien. Ils portent principalement sur le risque infectieux ou encore les fautes techniques. Notre travail repose sur une analyse de litiges secondaires à une prise en charge dans un service d’orthopédi...

Résumé Une décompensation aiguë de myélopathie cervicale est survenue après un traumatisme sans fracture en présence d’un os-odontoïdeum associé à un kyste rétro-odontoïdien compressif. La patiente de 51 ans présentait un statut neurologique Fränkel C, Nurick grade I et un syndrome pyramidal. L’IRM initiale a mis en évidence un hyper-signal T2 intr...

An episode of acute decompensation of cervical myelopathy occurred after an injury without fracture of an os odontoideum associated with a compressive retro-odontoid cyst. The 51-year-old female patient presented Fränkel C, Nurick grade 4 neurological status and pyramid syndrome. The initial MRI demonstrated an intramedullary T2 hyperintense signal...

Les fractures bimalléolaires apparaissent susceptibles chez le patient âgé d’être à l’origine de complications spécifiques et d’un impact majeur sur l’autonomie. Cette étude multicentrique avait pour but d’évaluer ces éléments dans une population gériatrique opérée.

Introduction: Posterior cervical arthrodesis is associated with osteosynthesis. C2 pedicular screwing affords a good bone anchoring but involves neurological and vascular risks. Purpose: To determine C2 pedicular screwing feasibility from a large cohort of cervical CT scans. To describe the visible anatomical parameters during a surgical procedu...

Résumé Le cas d’une pneumencéphalie symptomatique survenue au décours immédiat d’une chirurgie de décompression lombaire est ici rapporté. Une arthrodèse L2-L4 associée à une fenestration du canal lombaire ont été réalisées chez un homme de 69 ans porteur d’une sténose lombaire invalidante. Aucun écoulement de liquide céphalorachidien n’a été const...

Introduction: In the elderly, ankle fractures are likely to cause specific complications and have a major impact on their autonomy. The goal of this multicentre study was to assess these outcomes in a geriatric population treated operatively. Material and methods: This retrospective study included 477 patients with ankle fractures treated surgic...

We report a case of symptomatic postoperative pneumocephalus after lumbar decompression. A 69-year-old man was operated on for a severe lumbar stenosis with a L2–L4 arthrodesis and a spinal decompression. No cerebrospinal fluid leakage was visible but one of the two aspirative drains was accidentally disconnected in recovery room. After 1 day, comp...

Le traitement arthroscopique des lésions des segments moyen et postérieur du ménisque médial peut être difficile en cas d’insuffisance de décoaptation du compartiment fémoro-tibial médial. Des lésions chondrales iatrogènes peuvent être provoquées lors du passage des instruments. L’objectif principal de cette étude anatomique était d’évaluer, sous c...

Background: Arthroscopic treatment of tears in the middle and posterior parts of the medial meniscus can be difficult when the medial tibiofemoral compartment is tight. Passage of the instruments may damage the cartilage. The primary objective of this cadaver study was to perform an arthroscopic evaluation of medial tibiofemoral compartment openin...

Nous rapportons le cas d’un garçon de 13 ans ayant consulté pour une raideur et une douleur du coude apparues en plusieurs années. Il avait pour seul antécédent une fracture supracondylienne (FSC) fermée non déplacée survenue 7 ans auparavant et d’évolution favorable. Les examens ont montré l’existence d’une hypoplasie de la joue latérale de la tro...

This prospective monocentric study investigated the effect of corticosteroids plus bortezomib to reduce anti-HLA antibodies before renal transplantation. Included were 23 patients with stable immunization against HLA and awaiting a kidney transplant (KT). Treatment consisted of bortezomib (1.3 mg/m) plus 40 mg of dexamethasone intravenously on days...