Orthopédie | Louvain Médical

A look at adhesive capsulitis in 2024

Lucile Breyne (1), Jean-Emile Dubuc (2-3), Olivier Cornu (2-3), Gaëtan Opsomer (4) Published in the journal : December 2024 Category : Orthopedics

Frozen shoulder, also known as adhesive capsulitis, is a common condition encountered in clinical practice among patients complaining of shoulder problems. It manifests itself in three distinct phases, initially causing severe pain, followed by stiffness and functional impairment, and ultimately gradual recovery. The diagnosis of frozen shoulder is primarily clinical, with physical examination being the only method of diagnosis, and is characterized by loss of both active and passive shoulder mobility. While the majority of cases are idiopathic, some risk factors have been identified, such as diabetes, thyroid disorders, and immobilization. Initial treatment is predominantly conservative and includes analgesics, corticosteroid injections, and physical therapy, depending on the disease phase. Surgery is reserved for exceptional cases and avoided especially in the early stages. Although many aspects of this condition remain mysterious, this article is intended to inform general practitioners about the existence of frozen shoulder, so that they can provide early information to patients, initiate appropriate additional investigations, and begin initial therapeutic measures as soon as possible.

Isolated rupture of the anterior cruciate ligament in adults: what treatment and for whom?

Lamine Gakuba Rwema*, Olivier Cornu*, Gérald Delfosse, Sami Ftaita, Louis Debarre, Quentin Vraux, Jean-Emile Dubuc, Emmanuel Thienpont Published in the journal : September 2024 Category : Orthopedics

Anterior cruciate ligament (ACL) injuries are one of the most common ligament injuries in athletes. The primary goal of treatment is to restore stability and function to the knee while preventing secondary lesions. Treatment modalities depend on the anatomic characteristics of the rupture, associated lesions, residual stability, and functional requirements of the patient. Conservative treatment consists of several weeks of physical therapy. A subsequent re-evaluation may still lead to surgical treatment at a later stage.

Although there are a variety of surgical treatments, the most common procedure remains ACL ligamentoplasty with one or more grafts (autografts, allografts).

The aim of this article is to recall the epidemiology, biomechanics, and current management of these lesions, thus allowing a better understanding by general practitioners, orthopedists, and sports physicians.

Study of the benefits of cryotherapy in postoperative anterior total hip arthroplasty

Antoine Ledoux, Stéphanie Meirlaen, Julie Manon, André Claude Mbaga Ntjam, Jean-Emile Dubuc, Maité Van Cauter, Olivier Cornu Published in the journal : September 2023 Category : Orthopedics

The aim of this prospective study was to evaluate the influence of a cryotherapy device compared to conventional cold packs in postoperative anterior total hip arthroplasty to assess the benefits in terms of rehabilitation, analgesia, and blood loss.

Existing literature suggests that cryotherapy may be beneficial in reducing postoperative pain (1) and blood loss in joint replacement surgery (2,3). However, no study has comprehensively evaluated these effects on patient rehabilitation and mobilization.

Firstly, our cohort comprised 158 patients, 14 of whom were excluded during hospitalization. The control group, consisting of 72 patients, received cold packs twice a day and, if necessary, on demand. The interventional group, also comprising 72 patients, received the cryotherapy machine three times a day during the first two postoperative days.

Secondly, our results showed a significant improvement in the revalidation score on the third postoperative day in the cryotherapy group. We could not confirm the significant impact on the clinical outcome. Moreover, no difference was noted in pain medication intake or blood loss. Finally, we can consider cryothera- py as a simple, non-invasive approach that does not increase the risk of adverse effects when used in immediate postoperative total hip arthroplasty (2).

The management of distal radius fracture in adults: the identification of “the good treatment for the good patient”

Antoine Vanderlinden, Ghady El Khoury, Maxime Bonnelance, Xavier Libouton, Olivier Barbier Published in the journal : May 2022 Category : Orthopedics

The distal radius fracture is the most commonly encountered condition in the emergency departments (1). Its treatment is primarily aimed to improve pain and restore function (2).

The treatment modality depends on the anato-mical fracture characteristics and on functional demands of the patient, as well. It can vary from simple splinting to a complex surgical intervention.

For high-demanding patients, operative fracture treatment consisting of post-reduction radial shortening >3mm, dorsal tilt >10 degrees, or intraarticular displacement with step off >2mm has proven to be associated with improved radiographic and patient reported outcomes (3). Instead, for patients with limited functional demands, conservative treatment is still the preferred option (3).

This article sought to provide management and follow-up strategies for distal radius fracture in adults.

Periprosthetic joint infection: general principles for primary care physicians

Quentin Muller (1), Randy Buzisa Mbuku (1), Hervé Poilvache (1), Maïté Van Cauter (1), Jean-Cyr Yombi (2), Olivier Cornu (1) Published in the journal : October 2021 Category : Orthopedics

Prosthetic joint infection (PJI) is a dramatic complication, with devastating and costly consequences for both the patient and healthcare system. Despite the progress made in the past decades, its incidence remains stable at around 0.5 to 2%. With the ageing population, the number of prostheses steadily increases, with consequently an increased number of infections. PJI management is complex and requires a multidisciplinary approach, including surgical treatment and antibiotic administration. A delayed diagnosis likely displays serious consequences for the patient. This article summarizes the general management principles of prosthetic joint infections, mainly designed for primary care physicians.

Comparative study of collagenase injections versus fasciectomy in Dupuytren's contracture: a 1-year follow-up

Alexandre Hupez (a-b), M.D., Christine Detrembleur (c), Ph.D, Fernand Van Innis (a), M.D., Serge Troussel (a), M.D., Xavier Libouton (b-c), M.D, Ph.D., Thierry Lequint (a), M.D. Published in the journal : April 2017 Category : Orthopedics

This study sought to evaluate the use of collagenase injections for Dupuytren's contracture (19 compared to fasciectomy, with 19 patients assessed in each group. We measured loss of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint extension at baseline and 12 months post-injection, along with its impact on patients' daily life, pain, and satisfaction. Whereas there was no significant between-group difference observed for loss of MCP joint extension, PIP joint extension proved lower for the surgical group compared to the injection group. The injection group exhibited significant improvements in terms of pain, daily activities, and satisfaction regarding the MCP joints, with no between-group differences observed for the PIP joints.