Publications by authors named "Clara Sos"

4 Publications

  • Page 1 of 1

Terrible triad injury of the elbow: a historical perspective.

Int Orthop 2022 Jun 20. Epub 2022 Jun 20.

Department of Orthopedics and Traumatology, Hôpital Pellegrin, Place Amélie Raba-Léon, 33000, Bordeaux, France.

Purpose: The aims of this study are to summarize (1) the history of terrible triad injury (TTi) treatment and (2) the clinical and biomechanical data that engendered its evolution.

Methods: A literature search was performed using five electronic databases. Results were discussed as a chronologic review of the relevant literature between 1920 and 2022.

Results: In 1962, Osborne was the first to describe a link between elbow dislocation, radial head fracture, and lateral collateral ligament complex injury via a novel mechanism: posterolateral rotatory instability (PLRI). Given that untreated elbow instability leads to post-traumatic osteoarthritis (PTOA), there has been increasing interest in elbow biomechanics since the 1980s. Data from studies in that period revolutionized the approach to elbow instability. The authors demonstrated that TTi could occur via a PLRI mechanism with a disruption of the lateral collateral ulnar ligament and a functionally competent anterior medial collateral ligament (aMCL). Since the 1990s, due to the difficulty in identifying its pathoanatomic features, some began to speculate about a sequence of injuries and mechanisms leading to TTi. However, the clinical literature has largely been unable to reproduce in vitro findings describing the pathomechanics of TTi. Some aspects of treatment remain controversial including systematic coronoid and aMCL repair.

Conclusion: Despite a growing body of biomechanics data, there is no widely accepted surgical protocol for the treatment of TTi. Functional outcomes among patients have greatly improved. Better diagnosis and treatment of infra-clinical instability after a TTi may be an important stepping stone to prevent the onset of moderate/severe PTOA.
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June 2022

Comparison of subjective outcomes of Darrach and Sauvé-Kapandji procedures at a minimum 2 years' follow-up.

Orthop Traumatol Surg Res 2021 09 1;107(5):102974. Epub 2021 Jun 1.

Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques, centre hospitalo-universitaire Tours, université de médecine de Tours François-Rabelais, 37000 Tours, France.

Introduction: In distal radioulnar joint pathology, the literature regularly recommends reserving the Sauvé-Kapandji (SK) procedure to young patients and heavy manual workers, and the Darrach (D) procedure to older patients and rheumatic wrists. However, the SK procedure is more technically demanding and requires more proximal resection of the ulna, with greater risk of instability in the ulnar stump. The aim of the present study was to determine whether the SK procedure really does show superiority.

Hypothesis: Subjective results are no better after the SK than the D procedure.

Material And Methods: Seventy of the 101 operated cases (70 patients: 40 female, 30 male; mean age at surgery, 50.2 years [range, 16.4-87.2 years]) were assessed, at a minimum 24 months. Group D comprised 44 wrists, and group SK 26. Assessment was conducted by telephone interview for pain, ranges of flexion-extension and pronation-supination, strength, stump stability and satisfaction, and by mail for the QuickDASH questionnaire. Mean follow-up was 8.2 years (range, 25 months to 17 years).

Results: The surgical revision rate was significantly higher in SK (p=0.003). Results were comparable between groups for pain, strength, range of motion and satisfaction. Mean QuickDASH score was 45.5 in group D and 26.5 in group SK. Age-matched comparison found no significant differences on endpoints.

Discussion: Subjective results after the SK procedure showed no superiority over the D procedure, despite group D patients having twice the rate of heavy manual work and sport activities. This non-difference casts doubt on the need to reserve the D procedure to elderly patients and the SK procedure to young patients and heavy manual workers, especially as the latter is more technically demanding and is associated with a higher rate of surgical revision.

Level Of Evidence: IV; retrospective study.
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September 2021

Percutaneous Reconstruction of the Medial Patello-Femoral Ligament Using Dynamic Gracilis Tendon Transfer.

Orthop Traumatol Surg Res 2021 06 31;107(4):102910. Epub 2021 Mar 31.

Service de chirurgie orthopédique et traumatologique, Centre Hospitalo-Universitaire Tours - Université de Médecine de Tours François Rabelais, 37000 Tours, France.

Background: Many techniques have been described for reconstructing the medial patello-femoral ligament (MPFL), using a variety of transplants and fixation methods to treat patello-femoral dislocation. The main challenge with static transfers is to position the femoral fixation point at the site that best restores MPFL anisometry. The objective of this cadaveric study was to propose a version of the initially described dynamic gracilis transfer technique that can be performed percutaneously.

Hypothesis: Our working hypothesis was that using a minimally invasive approach would provide better cosmesis without altering the biomechanical efficacy of the procedure.

Methods: 20 cadaveric knees were used to evaluate the feasibility and reliability of our percutaneous technique. We analysed femoral pulley location and scar length.

Results: After dissection, the position of the femoral pulley allowed superimposition of the transplant along the trajectory of the native MPFL in all 20 knees. Cumulative scar length was 6.5cm (range, 6-7.5cm).

Discussion: Percutaneous dynamic gracilis transfer is easy to perform, reproducible, and capable of creating a pulley that anatomically replicates the femoral insertion point of the native MPFL.

Level Of Evidence: IV; retrospective study.
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June 2021

Median nerve entrapment syndrome in the elbow and proximal forearm. Anatomic causes and results for a 55-case surgical series at a mean 7years' follow-up.

Orthop Traumatol Surg Res 2021 04 28;107(2):102825. Epub 2021 Jan 28.

Service de Chirurgie Orthopédique et Traumatologique, Unité de Chirurgie de la Main et des Nerfs Périphériques, Hôpital Trousseau, Centre Hospitalo-Universitaire, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France. Electronic address:

Background: Proximal median nerve (MN) neuropathy represents 1% of upper-limb compressive neuropathies. The literature reports two clinical presentations, depending on the location of the entrapment: pronator teres (PT), and anterior interosseous nerve (AIN) syndrome.

Hypothesis: There is no correlation between symptoms and location of proximal compressive structures on the MN trunk or AIN.

Patients And Methods: Clinical and paraclinical data from 55 surgical MN releases around the elbow and proximal forearm were analyzed retrospectively. Mean age at diagnosis was 56±15years. Preoperative sensory and motor deficit signs were present in 89% of cases. Reduced MN conduction velocity and/or neurogenic anomalies in the MN territory were present in 94% of cases. Intraoperative details of compressive structures were collected. Patients were followed up in consultation to assess progression of symptoms and deficits.

Results: Mean follow-up was 84±70months. Objective motor deficit signs persisted in 18 of the 35 patients (18 cases), and objective sensory signs in 19 cases. A compressive anatomical structure was systematically found. There were at least two MN entrapment sites in 13 cases (24%). No isolated AIN entrapment was found. There was a significant correlation between symptom duration and persistence of objective sensory signs (p=0.002).

Discussion: There was no correlation between entrapment site and clinical signs on examination. Surgery requires exploring all potential entrapment sites. Improvement may be incomplete in case of late treatment.

Level Of Evidence: IV; retrospective study.
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April 2021