Multiple indications: one time or separate surgeries?
Prof Bertrand COULETa, Dr Philippe DENORMANDIEb, Prof Christian FONTAINEc, Prof Isabelle LAFFONTd, Prof Bernard PARATTEe
a CHU de Montpellier, Département de Chirurgie Orthopédique, b Chirurgie Orthopédique, CHU Raymond Poincaré, 92380 Garches, c Chirurgie Orthopédique, CHU de Besançon, d MPR CHRU Montpellier, Euromov Université de Montpellier, e MPR CHU Besançon
The surgical management of brain-injured patient is often considered remote from the initial accident and after a series of more or less long hospitalizations. Several joint segments or more members may necessitate taking joint load. Consensus is not strictly established order and to define the possible association gestures to achieve. The aim of this chapter is to clarify the principles to know to establish a comprehensive management strategy for these patients whose four limbs can be achieved.
Surgery may be considered in several phases of the history of these patients:
• Early, if marked vicious attitude (equine, flexion of the elbow or wrist ...) stoping the functional recovery.
• Secondary, patients returned home with some autonomy and for whom a surgical program is intended to improve the function.
• Late in the often non-functioning patients, presenting vicious attitudes hindering the nursing and the origin of trophic disorders.
Some major principles guide these multiple surgery programs:
• Consolidate up interventions to limit hospitalizations.
• Systematically involve corrections of deformities neighboring and interdependent joint segments: Hip / Knee, Shoulder / Elbow, Front and rear foot.
• Correct each member at large when possible.
• Treating both legs at the same time because whether for improvement of walking or just a facilitation nursing, bilateral correcting if necessary will greatly facilitate the postoperative period.
• Taking charge of the joint upper and lower members is desirable to limit the always difficult periods of hospitalization for the patient. The limiting factor is often the availability of surgical teams and the failure to combine programs requiring postoperative too complex rehabilitative programs.
• Some heavy surgically gestures should not be associated only with caution and in case of necessity.