Orthopaedic surgery for patients with central nervous system lesions: Concepts and techniques / F. Genêt in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 225-233 Titre : Orthopaedic surgery for patients with central nervous system lesions: Concepts and techniques Type de document : texte imprimé Auteurs : F. Genêt ; Philippe Denormandie ; M.A. Keenan Année de publication : 2019 Article en page(s) : p. 225-233 Note générale : https://doi.org/10.1016/j.rehab.2018.09.004 Langues : Anglais (eng) Mots-clés : Orthopaedic surgery  Spasticity  Neurotimy  Neurectomy  Hyponeurotization  Tendon lengthening  Tendon transfer  Arthrodesis  Heterotopic ossification Résumé : Since ancient times, the aim of orthopedic surgery has been to correct limb and joint deformities, including those resulting from central nervous system lesions. Recent developments in the treatment of spasticity have led to changes in concepts and management strategies. The increase in life expectancy has increased the functional needs of patients. Orthopedic surgery, along with treatments for spasticity, improves the functional capacity of patients with neuro-orthopaedic disorders, improving their autonomy. In this paper, we describe key moments in the history of orthopedic surgery regarding the treatment of patients with central nervous system lesions, from poliomyelitis to stroke-related hemiplegia, from the limbs to the spine, and from contractures to heterotopic ossification. A synthesis of the current surgical techniques is then provided, and the importance of multidisciplinary evaluation and management is highlighted, along with indications for medical, rehabilitation and surgical treatments and their combinations. We explain why it is essential to consider patients’ expectations and to set achievable goals, particularly before surgery, which is by nature irreversible. More recently, specialized surgical teams have begun to favor the use of soft-tissue techniques over bony and joint procedures, except for spinal disorders. We highlight that orthopedic surgery is no longer the end-point of treatment. For example, lengthening a contractured muscle improves the balance around a joint, improving mobility and stability but may be only part of the problem. Further medical treatment and rehabilitation, or additional surgery, are often necessary to continue to improve the function of the limb. Despite the recognized effectiveness of orthopedic surgery for neuro-orthopedic disorders, few studies have formally evaluated them. Hence, there is a need for research to provide evidence to support orthopedic surgery for treating neuro-orthopedic disorders. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314507 Permalink : ./index.php?lvl=notice_display&id=84127 [article] Orthopaedic surgery for patients with central nervous system lesions: Concepts and techniques [texte imprimé] / F. Genêt ; Philippe Denormandie ; M.A. Keenan . - 2019 . - p. 225-233. https://doi.org/10.1016/j.rehab.2018.09.004 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 225-233 Mots-clés : Orthopaedic surgery  Spasticity  Neurotimy  Neurectomy  Hyponeurotization  Tendon lengthening  Tendon transfer  Arthrodesis  Heterotopic ossification Résumé : Since ancient times, the aim of orthopedic surgery has been to correct limb and joint deformities, including those resulting from central nervous system lesions. Recent developments in the treatment of spasticity have led to changes in concepts and management strategies. The increase in life expectancy has increased the functional needs of patients. Orthopedic surgery, along with treatments for spasticity, improves the functional capacity of patients with neuro-orthopaedic disorders, improving their autonomy. In this paper, we describe key moments in the history of orthopedic surgery regarding the treatment of patients with central nervous system lesions, from poliomyelitis to stroke-related hemiplegia, from the limbs to the spine, and from contractures to heterotopic ossification. A synthesis of the current surgical techniques is then provided, and the importance of multidisciplinary evaluation and management is highlighted, along with indications for medical, rehabilitation and surgical treatments and their combinations. We explain why it is essential to consider patients’ expectations and to set achievable goals, particularly before surgery, which is by nature irreversible. More recently, specialized surgical teams have begun to favor the use of soft-tissue techniques over bony and joint procedures, except for spinal disorders. We highlight that orthopedic surgery is no longer the end-point of treatment. For example, lengthening a contractured muscle improves the balance around a joint, improving mobility and stability but may be only part of the problem. Further medical treatment and rehabilitation, or additional surgery, are often necessary to continue to improve the function of the limb. Despite the recognized effectiveness of orthopedic surgery for neuro-orthopedic disorders, few studies have formally evaluated them. Hence, there is a need for research to provide evidence to support orthopedic surgery for treating neuro-orthopedic disorders. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314507 Permalink : ./index.php?lvl=notice_display&id=84127

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