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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_17 | Pages 20 - 20
24 Nov 2023
Morin B Tripathi V Iizuka A Clauss M Morgenstern M Baumhoer D Jantarug K Fuentes PR Kuehl R Bumann D Khanna N
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Aim

Staphylococcus aureus (SA) can cause various infections and is associated with high morbidity and mortality rates of up to 40%. Antibiotic treatment often fails to eradicate SA infections even if the causative strain has been tested susceptible in vitro. The mechanisms leading to this persistence is still largely unknown. In our work, we to reveal SA interactions with host cells that allow SA to persist at the site of infection.

Method

We established a sampling workflow to receive tissue samples from patients requiring surgical debridement due to SA bone-and joint or soft-tissue infections. We developed a multiplex immunofluorescent staining protocol which allowed us to stain for SA, leukocytes, neutrophils, macrophages, B-cells, T-cells, DAPI and cytoplasmatic marker on the same sample slide. Further, distance of SA to cell nuclei was measured. Interaction of immune cells and SA on a single cell level was investigated with high-resolution 3D microscopy. We then validated our findings applying fluorescence-activated cell sorting (FACS) on digested patient samples. Finally, we aimed to reproduce our ex vivo patient results in an in vitro co-culture model of primary macrophages and clinical SA strains, where we used live cell microscopy and high-resolution microscopy to visualize SA-immune cell interactions and a gentamicin protection assay to assess viability of SA.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 117 - 117
1 Mar 2008
Benoit B Laflamme Y Morin B Grimard G
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The most commonly used surgical techniques used to treat recurrent or habitual patellar dislocation in the child do not specifically address the patella alta, one of the major causes of patellar dislocation. Twelve knees in eight patients had a lowering of the patella by total tendon transfer, lateral release and vastus medialis obliquus advancement. At two years of follow-up, only one knee had redislocated. Radiographically, the patellar height was anatomically restored in all other knees. All patients were pain free. This surgical technique is a good treatment option in the immature patient with recurrent or habitual patellar dislocation.

Patella alta is one of the major causes known to predispose children to recurrent or habitual patellar dislocation. However, the surgical treatment of such a condition, before squeletal maturity, is rarely if ever mentioned in the literature.

Twelve knees in eight patients were treated with a surgical procedure designated to correct patella alta, the major predisposing factor causing recurrent patellar dislocation. The technique involves lowering of the patella by total tendon transfer, lateral release and vastus medialis obliquus advancement. All patients were complaining of recurrent or habitual dislocations leading to functional disability. Patellar height was assessed radiographically by the Koshimoto index (PT/FT) and Caton-Deschamps index (AT/AP). The average at surgery was 10.9 years and mean follow-up was 45.1 months.

Follow-up revealed redislocation in one knee. This patient required a second operation to achieve patellar stability. At the latest follow-up, all operated knees were functionally stable and pain free. The average preoperative ratios were 1.28 (PT/FT) and 1.53 (AT/AP) which improved to 0.97 (PT/FT) and 0.96 (AT/AP) at the time of follow-up. Few complications were noted.

This technique is a valid surgical alternative to treat the immature patient presenting with functional disability related to recurrent or habitual patellar dislocation associated with patella alta.


The Journal of Bone & Joint Surgery British Volume
Vol. 89-B, Issue 9 | Pages 1172 - 1177
1 Sep 2007
Benoit B Laflamme GY Laflamme GH Rouleau D Delisle J Morin B

We retrospectively reviewed the operative treatment carried out between 1988 and 1994 of eight patients with habitual patellar dislocation. In four the condition was bilateral. All patients had recurrent dislocation with severe functional disability. The surgical technique involved distal advancement of the patella by complete mobilisation of the patellar tendon, lateral release and advancement of vastus medialis obliquus. The long-term results were assessed radiologically, clinically and functionally using the Lysholm knee score, by an independent observer.

The mean age at operation was 10.3 years (7 to 14) with a mean follow-up of 13.5 years (11 to 16). One patient required revision. At the latest follow-up, all patellae were stable and knees functional with a mean Lysholm knee score of 98 points (95 to 100). In those aged younger than ten years at operation there was a statistically significant improvement in the sulcus angle at the latest follow-up (Student’s t-test, p = 0.001). Two patients developed asymptomatic patella infera as a late complication.

This technique offers a satisfactory treatment for the immature patient presenting with habitual patellar dislocation associated with patella alta. If performed early, we believe that remodelling of the shallow trochlea may occur, adding intrinsic patellofemoral stability.


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 1 | Pages 58 - 65
1 Jan 1997
Naudie D Hamdy RC Fassier F Morin B Duhaime M

We reviewed retrospectively 22 patients (23 limb segments) with fibular hemimelia treated by amputation or limb lengthening to evaluate these methods of treatment. There were 12 boys and 10 girls, all with associated anomalies in the lower limbs. Twelve patients (13 limb segments) had early amputation and prosthetic fitting and ten had tibial lengthening using the Ilizarov technique.

At the latest follow-up, the twelve patients who had amputation were functioning well and had few complications. The ten patients who had lengthening had suffered numerous complications, and all had needed either further corrective surgery or to wear braces or shoe-raises. Two of the ten lengthened limbs required late amputation for poor function or cosmesis. There were fewer hospital admissions, clinic visits, and periods of absence from school in the amputation group.

Our findings suggest that amputation is a more effective method of management than limb-lengthening in severe fibular hemimelia. The Ilizarov method is an attractive alternative for selected patients, but its exact role is not yet established. One problem is that families often have unrealistic expectations of the surgical and prosthetic technology available and may refuse amputation when this has been recommended.