De Chirurgie Research Articles

Vittorio Putti's decalogue of fractures: a historical perspective in orthopaedic trauma practice.

This article explores the historical significance and lasting impact of Vittorio Putti's "Decalogue of Fractures" in the field of orthopedic trauma. Putti served as director of the Rizzoli Orthopedic Institute in Bologna from 1915 until his death in 1940 and was one of the founding members of the "Société Internationale de Chirurgie Orthopédique et de Traumatologie" (SICOT). He also played a key role in organizing the third SICOT World Congress, held in Bologna in 1936.The "Decalogue" distills Putti's extensive clinical experience and remains a cornerstone of modern traumatology. He developed the *Decalogue* to enhance the principles of fracture treatment, addressing what he viewed as suboptimal outcomes. This article examines each of the tenets, emphasizing their influence on contemporary fracture management and the evolution of orthopaedic trauma care. It also reflects on Putti's forward-thinking vision for a comprehensive trauma network, underscoring his belief in the critical importance of specialization and centralization to ensure efficiency, quality, and consistency, principles that continue to shape orthopaedic practice today.

Prise en charge des cancers thyroïdiens localisés de souche vésiculaire différenciée

The incidence of follicular-derived thyroid cancers has increased worldwide in recent decades, mainly papillary thyroid cancers at low recurrence risk. A process of de-escalation in the initial management and follow-up of these patients has therefore been implemented in parallel. This article provides the best practice recommendations made by the French learned societies (Société française d'endocrinologie, Société française de médecine nucléaire, Association française de chirurgie endocrine, Société française d'oto-rhino-laryngologie et de chirurgie de la face et du cou), european and international learned societies (European Society for Medical Oncology and the American Thyroid Association), in the management of follicular-derived thyroid cancer without distant metastases. The extent of thyroid surgery and lymph node dissection, strategies of radioiodine ablation, follow-up protocols and the management of excellent prognosis papillary cancers ≤ 10 mm will be addressed.

Stenosis of the colorectal anastomosis after surgery for diverticulitis: A national retrospective cohort study.

The aim of this work was to investigate the association between early postoperative anastomotic leakage or pelvic abscess (AL/PA) and symptomatic anastomotic stenosis (SAS) in patients after surgery for left colonic diverticulitis. This is a retrospective study based on a national cohort of diverticulitis surgery patients carried out by the Association Française de Chirurgie. The assessment was performed using path analyses. The database included 7053 patients operated on for colonic diverticulitis, with surgery performed electively or in an emergency, by open access or laparoscopically. Patients were excluded from the study analysis where there was (i) right-sided diverticulitis (the initial database included all consecutive patients operated on for colonic diverticulitis), (ii) no anastomosis was performed during the first procedure or (iii) missing information about stenosis, postoperative abscess or anastomotic leakage. Of the 4441 patients who were included in the final analysis, AL/PA occurred in 327 (4.6%) and SAS occurred in 82 (1.8%). AL/PA was a significant independent factor associated with a risk for occurrence of SAS (OR = 3.41, 95% CI = 1.75-6.66), as was the case for diverting stoma for ≥100 days (OR = 2.77, 95% CI = 1.32-5.82), while central vessel ligation proximal to the inferior mesenteric artery was associated with a reduced risk (OR = 0.41; 95% CI = 0.19-0.88). Diverting stoma created for <100 days or ≥100 days was also a factor associated with a risk for AL/PA (OR = 3.08, 95% CI = 2-4.75 and OR = 12.95, 95% CI = 9.11-18.50). Interestingly, no significant association between radiological drainage or surgical management of AL/PA and SAS could be highlighted. AL/PA was an independent factor associated with the risk for SAS. The treatment of AL/PA was not associated with the occurrence of anastomotic stenosis. Diverting stoma was associated with an increased risk of both AL/PA and SAS, especially if it was left for ≥100 days. Physicians must be aware of this information in order to decide on the best course of action when creating a stoma during elective or emergency surgery.

Protocole à fin de constitution d’un registre français des prothèses de hanche

INTRODUCTION: Use of joint prostheses is growing widely, in particular in developed countries. The « Société Française de Chirurgie Orthopédique et Traumatologique » (SOFCOT) has submitted in 2007 to the «Commission Nationale Informatique et liberté» (CNIL) a project for creating a hip prostheses registry. More recently, the « Conseil National Professionnel de chirurgie Orthopédique et Traumatologique » (CNP-COT) developed a national implants and observatory registry on surgical orthopaedic and traumatologic practices and pathologies (RENACOT) aiming to assure traceability and materio-vigilance of hip implants used in France. The main objective of the study is to report the current state of surgical techniques, used implants and their evolutions in hip arthroplasty in France using retrospective data provided by a multicenter registry since 2006.MATERIAL ET METHODS: On the one hand, the research systematically lists the main characteristics of all implants used in hip arthroplasty; and on the other hand, these informations are correlated with epidemiologic, demographic data, CROMs and PROMs. The study group consists by all patients receiving a hip reconstruction either in traumatology (femoral neck fractures) or above all for degenerative diseases. The data are collected in 2 questionnaires. The link between primary and revision surgery of the same prosthesis is automatic through the patient social security N°, sex and operated side.RESULTS: Patient demographics provides the corresponding population epidemiologic information’s. Registered data are available through 3 modes: 1- In running time, the registry board members only can accede to all collected data by internet 2- A biennal report of the national hip replacement activity 3- Any particular request about a specific matter or implant DISCUSSION One of the major registry interests in case of revision is the possibility to assure an automatic link with the corresponding primary arthroplasty. This is only possible if the primary questionnaire is already implemented and if the correspondence between the primary arthroplasty and the same hip reoperation/revision can automatically be established from the moment where both questionnaires are correctly completed in the registry. The CNP, through the RENACOT spreading use, aims to extend such registry practice to all orthopaedic and traumatologic surgical fields.

Practice variations in the surgical treatment of small bowel obstruction in Quebec

Background: Small bowel obstruction (SBO) is a common emergency and selectively requires surgical management. There is growing evidence supporting the use of laparoscopic surgery (LS) compared to open surgery for SBO. Methods: An online survey-based cohort study examining surgeon characteristics, patient factors, and clinical situations that impact decision making regarding the use of LS for SBO was sent to the 538 members of the Association Québécoise de Chirurgie and their answers were collected over a 4-month period in 2019. Results: The response rate was 27.1% (n=146). The gender, sex or the practice setting did not have an impact on the surgical approach. It was noted that surgeons who were more comfortable with laparoscopy used it more often (P=0.002). The three factors favoring the initial approach by laparotomy were most frequently cited: hostile abdomen, severe abdominal distension, and hemodynamic instability. Young surgeons had more homogenous answers (P=0.03). The surgeons having a practice oriented into LS had different decision criteria compared to those doing more open surgery. Conclusion: This article emphasizes key clinical scenarios and determinants that shape the surgical strategy for SBO treatment. The authors aim for this research to stimulate more discussions and contemplation about using laparoscopic methods for treating SBO in certain patients, thereby potentially elevating the frequency of surgeons adopting this approach. Moreover, considering the existing literature supports LS as a viable and safe method for SBO treatment, and noting the enhanced outcomes for patients, it becomes increasingly vital to advocate for this conversation.

Update About the Management of Low-Density Lipoprotein Cholesterol and Hypertriglyceridemia in Lower Extremity Peripheral Artery Disease Patients: Consensus of the French Society of Vascular Medicine and the French Society for Vascular and Endovascular Surgery

A French intersociety consensus on behalf the Société Française de Médecine Vasculaire and the Société de Chirurgie Vasculaire et Endovasculaire was proposed in 2021 for the management of patients with lower extremity peripheral artery disease (LEAD). Recent studies have been published and an update of this consensus about the management of low-density lipoprotein cholesterol (LDLc) and hypertriglyceridemia was required. A steering committee of 12 vascular physicians and surgeons defined questions of interest about LDLc and hypertriglyceridemia management. A French expert panel voted the proposals. Consensus was considered to have been achieved if more than 80% of the responses corresponded to either "Agreement" or "Disagreement". Among the 56 experts who were asked to participate, 46 (82%) accepted. After the first round of the Delphi procedure, the 4 proposals reached consensus. The following suggestions and recommendations were approved: 1. For LEAD patients treated by the highest tolerated statin dose±ezetimibe and who have an LDLc ≥0.70g/L, we recommend adding a proprotein convertase subtilisin/kexin type 9 inhibitor. 2. For LEAD patients treated by statin and who have elevated triglyceride level between ≥150mg/dL and ≤500mg/dL, we suggest adding Icosapent Ethyl. 3. Before adding Icosapent Ethyl in LEAD patients treated with statin, we suggest looking for symptoms that may suggest atrial fibrillation. 4. For LEAD patients treated by Icosapent Ethyl and who have symptoms that suggest atrial fibrillation, we recommend performing an electrocardiogram. This update will help clinicians to improve LEAD patient management.

Recurrence After Surgery for Primary Hyperparathyroidism in 517 Patients With Multiple Endocrine Neoplasia Type 1: An Association Francophone de Chirurgie Endocrinienne and Groupe d'étude des Tumeurs Endocrines study.

To assess recurrence according to the type of surgery for primary hyperparathyroidism (pHPT) in multiple endocrine neoplasia type 1 ( MEN1 ) patients and to identify the risk factors for recurrence after the initial surgery. In MEN1 patients, pHPT is multiglandular, and the optimal extent of initial parathyroid resection influences the risk of recurrence. MEN1 patients who underwent initial surgery for pHPT between 1990 and 2019 were included. Persistence and recurrence rates after less than subtotal parathyroidectomy (LTSP) and subtotal parathyroidectomy (STP) were analyzed. Patients with total parathyroidectomy with reimplantation were excluded. Five hundred seventeen patients underwent their first surgery for pHPT: 178 had LTSP (34.4%) and 339 STP (65.6%). The recurrence rate was significantly higher after LTSP (68.5%) than STP (45%) ( P < 0.001). The median time to recurrence after pHPT surgery was significantly shorter after LTSP than after STP: 4.25 (1.2-7.1) versus 7.2 (3.9-10.1) years ( P < 0.001). A mutation in exon 10 was an independent risk factor of recurrence after STP (odds ratio = 2.19; 95% CI: 1.31; 3.69; P = 0.003). The 5 and 10-year recurrent pHPT probabilities were significantly higher in patients after LTSP with a mutation in exon 10 (37% and 79% vs 30% and 61%; P = 0.016). Persistence, recurrence of pHPT, and reoperation rate are significantly lower after STP than LTSP in MEN1 patients. Genotype seems to be associated with the recurrence of pHPT. A mutation in exon 10 is an independent risk factor for recurrence after STP, and LTSP may not be recommended when exon 10 is mutated.

H05 Jean-Nicolas Marjolin (1780–1850): a name to remember

Abstract Jean-Nicolas Marjolin was born in Ray-sur-Saone, in eastern France, in 1780. His education was sponsored by his mother as his father had died when he was 1 year old, leaving them impoverished. He studied Medicine at The Commercy Hospital, north-eastern France, before he left for Hôtel-Dieu hospital in Paris where he met Guillaume Dupuytren, who recruited him to the ‘Societe Anatomique’, a society created to promote the study of clinical anatomy. He became, successively, an assistant in anatomy (1805), a prosector (1806) and a doctor (MD) in 1808. He even established his own medical school in 1810. It was very popular as he admitted students from less privileged backgrounds to study medicine for free. His brilliant teaching style caused conflict with his ambitious mentor Dupuytren, who saw him as a threat after he was hired as Dupuytren’s assistant at Hôtel-Dieu. Marjolin was also a member of the Académie de Médecine, and surgeon to Louis-Philippe I, the French king at the time. His son René also became a surgeon and married Cornelia Scheffer, the daughter of the famous painter Ary Scheffer. In 1828, Marjolin described four types of ulcers that he named ‘ulcere verruqueux’ in Mimoires de l’Acadimie de Chirurgie, which was a manual of anatomy at that time. However, he did not specify whether the ulcers were malignant or associated with longstanding ulcers. In 1850, the year that Marjolin died, Robert Smith, Professor of Surgery at Trinity College, Dublin, described locally destructive ulcers that developed in scars following burns, floggings and lacerations as the ‘warty ulcers’ of Marjolin. After Smith’s death in 1873, Marjolin was again forgotten until 30 years later, when John Chalmers DaCosta, Professor of Surgery at Jefferson Medical College, Philadelphia, described two cases of carcinomatous change in chronic varicose leg ulcers as examples of Marjolin ulcers. John Fordyce, an American dermatologist, subsequently described a chronic ulcer undergoing malignant change as a Marjolin ulcer in 1907. These definitions of Marjolin ulcer by DaCosta and Fordyce included malignancy developing in sinuses, as well as malignancy in scars and persistent ulcers. These declarations defined the term ‘Marjolin ulcer’ in modern usage and preserved Marjolins’ name for future generations. Currently ‘Marjolin ulcer’ refers to a rare malignant transformation within chronic ulcers or scars with squamous cell carcinoma as the commonest subtype. Its exact cause remains unknown, despite being described by Jean-Nicolas Marjolin almost 200 years ago.

Standard practice in the treatment of unstable pelvic ring injuries: an international survey

PurposeUnstable pelvic ring injury can result in a life-threatening situation and lead to long-term disability. Established classification systems, recently emerged resuscitative and treatment options as well as techniques, have facilitated expansion in how these injuries can be studied and managed. This study aims to access practice variation in the management of unstable pelvic injuries around the globe.MethodsA standardized questionnaire including 15 questions was developed by experts from the SICOT trauma committee (Société Internationale de Chirurgie Orthopédique et de Traumatologie) and then distributed among members. The survey was conducted online for one month in 2022 with 358 trauma surgeons, encompassing responses from 80 countries (experience > 5 years = 79%). Topics in the questionnaire included surgical and interventional treatment strategies, classification, staging/reconstruction procedures, and preoperative imaging. Answer options for treatment strategies were ranked on a 4-point rating scale with following options: (1) always (A), (2) often (O), (3) seldom (S), and (4) never (N). Stratification was performed according to geographic regions (continents).ResultsThe Young and Burgess (52%) and Tile/AO (47%) classification systems were commonly used. Preoperative three-dimensional (3D) computed tomography (CT) scans were utilized by 93% of respondents. Rescue screws (RS), C-clamps (CC), angioembolization (AE), and pelvic packing (PP) were observed to be rarely implemented in practice (A + O: RS = 24%, CC = 25%, AE = 21%, PP = 25%). External fixation was the most common method temporized fixation (A + O = 71%). Percutaneous screw fixation was the most common definitive fixation technique (A + O = 57%). In contrast, 3D navigation techniques were rarely utilized (A + O = 15%). Most standards in treatment of unstable pelvic ring injuries are implemented equally across the globe. The greatest differences were observed in augmented techniques to bleeding control, such as angioembolization and REBOA, more commonly used in Europe (both), North America (both), and Oceania (only angioembolization).ConclusionThe Young-Burgess and Tile/AO classifications are used approximately equally across the world. Initial non-invasive stabilization with binders and temporary external fixation are commonly utilized, while specific haemorrhage control techniques such as pelvic packing and angioembolization are rarely and REBOA almost never considered. The substantial regional differences’ impact on outcomes needs to be further explored.

Staged Revision Hip Arthroplasty With Femoral Impaction Bone Grafting for Prosthetic Joint Infections: Radiostereometric Analyses and Clinical Outcomes at Minimum 5-Year Follow-Up

BackgroundThere are ongoing concerns regarding the use of bone graft following prosthetic joint infection and subsequent implant subsidence. The aim of this study was to determine whether the use of a cemented stem combined with femoral impaction bone grafting (FIBG) at second stage revision for infection results in stable femoral stem fixation, determined by accurate methods, and good clinical results. MethodsA prospective cohort of 29 patients underwent staged revision total hip arthroplasty for infection using an interval prosthesis followed by FIBG at the final reconstruction. The mean follow-up was 89 months (range, 8 to 167 months). Femoral implant subsidence was measured with radiostereometric analysis. Clinical outcomes included the Harris Hip Score, Harris Pain score and Société Internationale de Chirurgie Orthopédique et de Traumatologie activity scores. ResultsAt 2-years follow-up the median stem subsidence relative to femur was −1.36 mm (range, −0.31 to −4.98), while the cement subsidence relative to femur was −0.05 mm (range, 0.36 to −0.73). At 5-years follow-up, the median stem subsidence relative to femur was −1.89 mm (range, −0.27 to −6.35), while the cement subsidence relative to femur was −0.06 mm (range, 0.44 to −0.55). There were 25 patients who were confirmed infection-free after the second stage revision with FIBG. The median Harris Hip Score improved from 51 pre-operatively to 79 at 5 years (P = .0130), and Harris Pain score from 20 to 40 (P = .0038). ConclusionsStable femoral component fixation can be achieved with FIBG when reconstructing the femur after revision for infection without compromising infection cure rates and patient-reported outcomes.

Peri-operative management of obese patients in digestive surgery: Clinical practice guidelines from the French Society of Digestive Surgery

The French Society of Digestive Surgery (Société Française de Chirurgie Digestive [SFCD]) has elaborated clinical practice guidelines for the management of the obese patient undergoing gastro-intestinal surgery. The literature was analyzed according to the GRADE® (Grading of Recommendations Assessment, Development and Evaluation) methodology divided into five chapters: preoperative management, modalities of transportation and installation of the patient in the operating room, specific characteristics related to laparoscopic surgery, specific characteristics related to traditional surgery, and postoperative management. Each question was formulated according to the PICO format (Patients, Intervention, Comparison, Outcome). Synthesis of expert opinions and the application of the GRADE methodology produced 30 recommendations among which three were strong and nine were weak. The GRADE methodology could not be applied for 18 questions, for which only expert opinion was obtained. These clinical practice guidelines can help surgeons optimize the peri-operative management of the obese patient undergoing gastro-intestinal surgery.

Extent of thyroidectomy: When should hemithyroidectomy be performed? Recommendations from the Francophone Association for Endocrine Surgery, the French Society of Endocrinology and the French Society of Nuclear Medicine

These recommendations, drawn from current data in the medical literature, incorporate the risks of hemithyroidectomy (HT) and total thyroidectomy (TT) and clarify the place of these two procedures in clinical settings. Discussions leading to a consensus were then assessed by the Francophone Association for Endocrine Surgery (Association francophone de chirurgie endocrinienne [AFCE]), along with the French Society of Endocrinology (Société française d'endocrinologie [SFE]), and the French Society of Nuclear Medicine (Société française de médecine nucléaire [SFMN]). The complication rate was twice as high after TT compared to HT. Total thyroidectomy requires life-long thyroid hormone supplementation, whereas such supplementation is required in only 30% of patients after HT. When surgery is indicated for Bethesda category II nodules, and in the absence of any indication for surgery on the contralateral lobe, HT is recommended. In patients with thyroid cancer (TC)≤1cm requiring surgical management or TC≤2cm, in the absence of risk factors for TC and in the absence of pre- or intraoperative detection of extrathyroidal extension, lymph node metastases (cN0) and/or suspected contra-lateral disease, HT is the preferred technique as long as the patient accepts the possibility of TT which might be required when aggressive forms of cancer are detected on definitive cytohistology (extrathyroidal extension, lymphovascular invasion, high-grade histology). For TC measuring between 2 and 4cm, the debate between HT and TT remains open today, although some surgeons tend to prefer TT. In patients with TC>4cm, macroscopic lymph node involvement (cN1), signs of extrathyroidal extension or predisposing factors for TC, TT is the treatment of choice.

Surgical load in major fractures — results of a survey on the optimal quantification and timing of surgery in polytraumatized patients

PurposeIt is known that the magnitude of surgery and timing of surgical procedures represents a crucial step of care in polytraumatized patients. In contrast, it is not clear which specific factors are most critical when evaluating the surgical load (physiologic burden to the patient incurred by surgical procedures). Additionally, there is a dearth of evidence for which body region and surgical procedures are associated with high surgical burden. The aim of this study was to identify key factors and quantify the surgical load for different types of fracture fixation in multiple anatomic regions.MethodsA standardized questionnaire was developed by experts from Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT)-Trauma committee. Questions included relevance and composition of the surgical load, operational staging criteria, and stratification of operation procedures in different anatomic regions. Quantitative values according to a five-point Likert scale were chosen by the correspondents to determine the surgical load value based on their expertise. The surgical load for different surgical procedures in different body regions could be chosen in a range between “1,” defined as the surgical load equivalent to external (monolateral) fixator application, and “5,” defined as the maximal surgical load possible in that specific anatomic region.ResultsThis questionnaire was completed online by 196 trauma surgeons from 61 countries in between Jun 26, 2022, and July 16, 2022 that are members of SICOT. The surgical load (SL) overall was considered very important by 77.0% of correspondents and important by 20.9% correspondents. Intraoperative blood loss (43.2%) and soft tissue damage (29.6%) were chosen as the most significant factors by participating surgeons. The decision for staged procedures was dictated by involved body region (56.1%), followed by bleeding risk (18.9%) and fracture complexity (9.2%). Percutaneous or intramedullary procedures as well as fractures in distal anatomic regions, such as hands, ankles, and feet, were consistently ranked lower in their surgical load.ConclusionThis study demonstrates a consensus in the trauma community about the crucial relevance of the surgical load in polytrauma care. The surgical load is ranked higher with increased intraoperative bleeding and greater soft tissue damage/extent of surgical approach and depends relevantly on the anatomic region and kind of operative procedure. The experts especially consider anatomic regions and the risk of intraoperative bleeding as well as fracture complexity to guide staging protocols. Specialized guidance and teaching is required to assess both the patient’s physiological status and the estimated surgical load reliably in the preoperative decision-making and operative staging.

Abstract P2-15-10: Impact of the withdrawal of textured breast implants from the market on breast reconstruction practices

Abstract Background: In November 2018, the SOFCPRE (Société Française de chirurgie plastique, reconstructrice et esthétique) recommanded that textured Biocell© implants should no longer be used because of a potential risk of anaplastic large cell lymphoma (ALCL). This decision was confirmed in April 2019 by the French Medicines Agency (ANSM, Agence nationale de sécurité du médicament), and the French Medical Regulatory Authority. In the Georges-François Leclerc Cancer Center (Dijon, France), we suspended the use of textured Biocell© implants from November 2018 onwards, in favour of smooth surface, round implants. Objective: To assess the impact of textured implant withdrawal on surgical practices in breast reconstruction (BR) in a single French cancer center. Methods: This is a retrospective, single-centre study in the Georges-François Leclerc Cancer Center (Dijon, France). Surgical practices of BR and complications were compared between 2 periods: before the withdrawal of textured implants from the market (Period 1: September 2017-November 2017) and after (Period 2: December 2018-March 2020). Patients were included if they were operated on for the first time for immediate or secondary BR in either period. Univariate analysis was performed to compare before vs after groups, and to analyse surgical practices (rates of autologous techniques and breast implant) of BR and complications ((defined as any complication grade IIIB or higher according to the Clavien Dindo classification) between the 2 periods. Results: Data from 168 and 159 BR were collected from Periods 1 and 2 respectively. Characteristics were comparable between groups.The rate of BR with implants was significantly lower in period 2 compared with period 1 (23.9% vs 53.6%; p&amp;lt; 0.001). Similarly, autologous BR increased significantly in period 2 for muscle sparing latissimus dorsi (2.4% vs 12.6%; p&amp;lt; 0.001) and exclusive fat grafting (9.5% vs 21.5%; p&amp;lt; 0.01). Others autologous techniques was comparable between the two periods (DIEP and latissimus dorsi). The number of complications decreased in period 2 (10% vs 18.4% in period 1, p=0.04). Conclusion: After the withdrawal of textured implants, we observed a significant change in surgical practices for BR in our center. The rate of reconstruction with implants decreased in favour of autologous techniques. This change in practice was accompanied by a decrease in complications. Surgical techniques for breast reconstruction between the two periods Period 1: September 2017-November 2017;Period 2: December 2018-March 2020. DIEP, Deep Inferior Epigastric Perforator; SD, Standard deviation Citation Format: CLEMENTINE JANKOWSKI, Maxime Martinez, Vincent Laura, Pierre Burnier, CHARLES COUTANT. Impact of the withdrawal of textured breast implants from the market on breast reconstruction practices [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-15-10.

Comment je fais… une omentosplénectomie par laparotomie au cours d’une chirurgie de réduction tumorale complète ?

Comment je fais… une omentosplénectomie par laparotomie au cours d’une chirurgie de réduction tumorale complète ?

Information

SI KOT (SICOT - Societe Internationale de Chirurgie Orthopedique et de Traumatologic) The largest international society of orthopedics and traumatology, founded in October 1929 in Paris, currently unites more than 2500 specialists from 81 countries. As stated in the Charter of the society, SICOT sees its goal in its work in orthopedics and traumatology, in support of young orthopedists and traumatologists, in favor of the exchange of experience and establishment of relationships between orthopedists and traumatologists from different countries

Multi-Disciplinary Care Planning of Ovarian Cancer in Older Patients: General Statement-A Position Paper from SOFOG-GINECO-FRANCOGYN-SFPO.

Simple SummaryThis position paper aims to provide practitioners a proposal for multidisciplinary care planning for older patients with ovarian cancer from the time of suspected diagnosis. The first-line treatment of advanced ovarian cancer involves several interdependent sequences: cytoreductive surgery, (neo)adjuvant chemotherapy and maintenance targeted treatments. In older patients, care planning must be adapted to their geriatric parameters and consider the geriatric impact of each treatment sequence to allow treatment completion. Care planning should be centered on patient motivation and imply multidisciplinarity. Each step of treatment plan should be reconsidered in light of a geriatric assessment and follow-up. Studies are needed to prospectively evaluate the impact of geriatric vulnerability parameters at each step of the treatment agenda and the impact of geriatric interventions on patient outcomes.In this position paper the Société Francophone d’OncoGériatrie (SOFOG; French-speaking oncogeriatric society), the Société Française de Pharmacie Oncologique (SFPO, French society for oncology pharmacy), the Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO, National Investigators’ Group for Studies in Ovarian and Breast Cancer) and the Groupe Français de chirurgie Oncologique et Gynécologique (FRANCOGYN) propose a multi-disciplinary care planning of ovarian cancer in older patients. The treatment pathway is based on four successive decisional nodes (diagnosis, resectability assessment, operability assessment, adjuvant, and maintenance treatment decision) implying multidisciplinarity and adaptation of the treatment plan according to the patient’s geriatric covariates and her motivation towards treatment. Specific attention must be paid to geriatric intervention, supportive care and pharmaceutical conciliation. Studies are needed to prospectively evaluate the impact of geriatric vulnerability parameters at each step of the treatment agenda and the impact of geriatric interventions on patient outcomes.

Recommandations françaises récentes sur la prise en charge des arthrites septiques sur articulation native de l’adulte

Septic arthritis (SA) is a rare but severe condition due to its mortality and the risk of joint destruction responsible of functional disability. In 2020, the Société française de rhumatologie (SFR) in cooperation with the Société française de pathologies infectieuse de langue française (SPILF) and the Société française de chirurgie orthopédique et traumatologique (SOFCOT) developed sixteen clinical practice recommendations for the diagnostic and management of adult native joint SA. They remind the importance of initial microbiological investigations, in particular synovial fluid analysis and blood cultures to be carried out if possible before any antibiotic therapy. They also underline the place of additional exams (X-rays, ultrasound, others) and the major therapeutic principles: duration and modalities of antibiotic therapy with proposals adapted to the most frequent germs, place of joint drainage whether medical or surgical, early rehabilitation and monitoring.

In-house 3D printing: Why, when, and how? Overview of the national French good practice guidelines for in-house 3D-printing in maxillo-facial surgery, stomatology, and oral surgery

3D-printing is part of the daily practice of maxillo-facial surgeons, stomatologists and oral surgeons. To date, no French health center is producing in-house medical devices according to the new European standards. Based on all the evidence-based data available, a group of experts from the French Society of Stomatology, Maxillo-Facial Surgery and Oral Surgery (Société Française de Chirurgie Maxillofaciale, Stomatologie et Chirurgie Orale, SFSCMFCO), provide good practice guidelines for in-house 3D-printing in maxillo-facial surgery, stomatology, and oral surgery. Briefly, technical considerations related to printers and CAD software, which were the main challenges in the last ten years, are now nearly trivial questions. The central current issues when planning the implementation of an in-house 3D-printing platform are economic and regulatory. Successful in-house 3D platforms rely on close collaborations between health professionals and engineers, backed by regulatory and logistic specialists. Several large-scale academic projects across France will soon provide definitive answers to governance and economical questions related to the use of in-house 3D printing.

Does increased patient comprehension decrease preoperative anxiety before digestive surgery?

There exists a misalignment between the information given by a surgeon and the information retained by the patient. Inability to assimilate relevant information can be a factor of preoperative anxiety. The aim of this study was to assess patients' information retention according to a Fédération de Chirurgie Viscérale et Digestive (FCVD) questionnaire. From 29 June 2020 to 2 August 2020, a prospective, comparative multicenter study was conducted among 89 patients who were about to undergo digestive surgery. They were included either in a standard group (management in accordance with the usual French guidelines) or experimental group, which received a second consultation, one week before surgery. The day before being operated, all the patients filled out 3 questionnaires analyzing their percentage of retention according to two scales: the Amsterdam Preoperative Anxiety and information Scale (APAIS) and the visual analogue scale for anxiety (VAS-A). Patient comprehension of the FCVD information was 94% and 63% in the experimental and the control groups, respectively (P<0.001). The standard group was significantly more anxious than the experimental group, with VAS-A rates of 6.2 and 4.6 (P=0.014), respectively. On the other hand, according to the APAIS scale, they were similarly anxious, with scores of 11.3 versus 11.9, respectively (P=0.200). A second transmission of exhaustive information shortly before digestive surgery was conducive to improved retention. Enhanced comprehension and memorization reduced preoperative anxiety.