Procedure: Cup-and-ball - 1st version

. : Already the 100…

L.D. : Already, it is quickly known as! The monthly realization of the newspaper is a true proof and I do not remember a number which was done simply. However, the newspaper reached its cruising speed and we are far from turbulences of the beginning.

 

. : Turbulences?

: With the whole beginning I cumulated the functions of editor association, journalist, freelance journalist, secretary, governed
from pub, archivist, channel, manager and I pass from there. I avoided signing my papers in
the newspaper in order not to let show through a certain loneliness. And then, the drafting was gradually packed, the growth problems were solved and flow
of work became more
homogeneous.

. : Why did you create this newspaper?

: It is necessary to go back to the Eighties. We lived a true efflorescence of the csotcina.comedic techniques. Each one manufactured its hardware with complete freedom. In all the fields: arthroplasty, osteosynthesis, , rachis, we were confronted with weekly innovations of which much remained without a future but of which some worked the csotcina.comedy of today. Because of the clinical absence of retreat of these innovations, the indexed science magazines could not publish them and the usual means for the csotcina.comedists to put itself at the current was to attend at the days or the various congresses which multiplied. There was thus a mass of information not disseminated as of many authors who did not have any means of expressing their point of view apart from the duplicated lecture note of their congress. At the end of my boarding school at , I had mentioned this problem at meetings of service and we had concluded with Gerard Saillant that there was largely the place in France for a new newspaper of csotcina.comedy. But we reflected then according to the conventional models of publication whose is very complex and the project stagnated.

 

. : And then?

: Then I fell one day on a medical newspaper from format says “tabloid” and I realized instantaneously that it was the answer to our project. Indeed we could with this formula publish teaching items or of topicality without interfering with the indexed medical literature. The juxtaposition of advertizing spaces and editorial made it possible to benefit from the quadrichromy and to illustrate largely the items while financing the realization of the newspaper. I quickly forwarded a model to Gerard Saillant who found that the firm was worth the sorrow to be tried. We have advanced in the concept then spoke we to the Owner, Raymond .

 

. : What did he think about it?

: It entirely supported us but I remember very particularly one of his comments at the end of my presentation: “, all that represents a large job!”. The first difficulty was to find an original title. I did not leave myself there. The bond which approached the most idea that I had publication was “csotcina.comedic Platform” but there existed already a review called Medical Tribune. Finally, not finding any bond satisfactory, I told myself that it was necessary to leave the analogical reasoning with the medical press and to raise the fundamental questions: why is a medical check read? To put itself at the current, to improve, for better controlling its trade… and here how to the word emerges Maîtrise which is a word fraught with direction.

 

. : And then?

: Then a team should have been trained. Gerard Saillant dealt more particularly with the scientific committee and me editorial committee. By the word of mouth and with much of telephone calls we managed to join together a small team of enough courageous colleagues to launch out in the adventure. In order to avoid any I tried to come into contact with colleagues of all the corners of France. One of these collaborators of the first hour was Philippe of Lyon which I saw only several years after and which told me thereafter: “You know, for me, that was for a long time only one vote on the telephone”.

 

. : How did you make for the items?

: For the I did not have too many difficulties because I had six months in front of me. The headings considered were practically the same ones as today i.e. the interview, the synthesis, the report of congress, the technique and the topicality. I thus had all the leisure to polish this first number and I carried out the foolish character of the firm only to the for which I had only thirty days.

 

. : How you did you leave there?

: At the time I would have told you that I and that, according to the devoted formula, the young people succeed of the impossible things because precisely they do not know that they are impossible; but today, with the passing, it appears obvious to me that I profited broad wave of sympathy and the support of my Masters. Moreover, the advertisers i.e. the manufacturers of implants, had engaged over one year and they kept to their commitments. Their fidelity made it possible the newspaper to appear during long months what gave him its chance to endure. Lastly, there was really a need to modernize the communication in our profession. After a fashion we obtained items; it should be said that the newspaper made only 16 pages. But I do not forget enthusiasm and the satisfying with which the committee members of drafting invested themselves in the monthly realization of the newspaper.

 

. : One of the elements of success seems to have been the interview…

: Indeed and I find that justified. What had struck me during my boarding school, it is at which point the rare abstract discussions with my Owners had been enriching. Because behind each technique, each indication, there are experience and a history whose scientific paper cannot report. However, this routing, the tests and the errors and the circumstances which lead to a surgical innovation are fundamental. These are the contingencies which make the originality of a route and one can understand them only when one belongs to a service. But the boarding school has only a time. It seemed to me damage that these individual experiments are lost for the vast majority of the colleagues and I tested by these interviews, and their environment favourable with the confidences, to prolong our boarding schools to some extent. Thus, when the interview is successful, the reader csotcina.comedist with truly the feeling to have shared an experiment with the person interviewed.

 

. : Who makes the interviews?

: Eight times out of ten it is me. In practice it is about a free conversation from one to two hours which is recorded then typed. Of this rather long text it is necessary to extract the best without betraying the thought of the person interviewed, which is not always easy when the conversation is in English. This setting conversation is a rather arduous work. When the interview is written I return it to the author who reads again it and corrects it with its own way. I am not fixed on this work which I delegate readily each time possible, because I think that the conversations are successful much when his interlocutor well is known. In addition, I particularly regaled myself with my Masters and I think that feels in the text. But the success of the interview is due above all to the personality of questioned.

 

. : Who was the first?

: It was which had recommended to me. The conversation took place in a coffee of the Palate of the Congresses at the time of of 1990.

. : Where did you find the time necessary to carry out this monthly magazine?

: It is a little the fruit of the circumstances. After five last years with the Hospital of Paris with an activity centered on traumatology I obtained a post of hospital practitioner part-time job. I had a small liberal activity in private clinic but I wished to continue a hospital career and I continued to make one full quasi-time with the Hospital. I thus used all the time not devoted to a liberal activity or leisures to make live this review. Moreover, during the guards at the hospital, the times of startup of the block or the intervals between the interventions were such as certain evenings, I thought that I could have managed a weekly magazine!

 

. : Precisely, apart from the newspaper, which do you make?

: Not large-thing, I am Instructor d' csotcina.comédie! More seriously, I endeavor to be with the height of triple function of care, teaching and search which is those of the teaching hospital ones. But it is because I always remained in teaching hospital medium which I could ensure the realization of the newspaper. Indeed, the frequentation of the interns and the senior registrars, the frequentation or the organization of congress and finally the need for publishing original items allow to be unceasingly in an environment of publications. Many items of the newspaper are the fact of fortuitous meetings, encouragement to be put on paper of outlined work or of popularization of confidential work. I do not see how while devoting oneself only to functions of care in a field specialized, one can publish ten numbers a year.

 

. : What do you think of this triple function of the teaching hospital ones?

: In what relate to me I believed there. I invested much in teaching. I endeavoured to train the interns and to help them to operate as often as possible, I wrote the whole of the program of the boarding school in the Impact collection which was the subject of multiple republications and I carried out search in fields as various as the bulbo-medullary angle, the MRI of the cap of the rotators or the magnetic shoulder prosthese. As a whole, for all the university body, it seems to me that the function of care and teaching is well filled. It is of use of on the low number of lectures which the instructors make, but is to forget that they deal daily of the interns and the hospital students, that they make pass from multiple controls of knowledge and ensure of many exchange rates apart from faculties. It is a true workload. The things on the level of search because in this field, for that which wants to be invested, it is really a martyrdom. We still did not leave the problems of Bernard who burned his pieces of furniture to make his enamels. Done everything obstacle with the fundamental research and one has often hardly other choice but to make clinical research. However, this triple function so difficult to conclude, does not seem much to impress our supervisions since we are more and more embedded administrative tasks.

 

. : It is true for all the surgeons…

: Obviously and if we do not react, the things will not be arranged because is with us to define limit our share. I think that it is time to make an use of rational time of the csotcina.comedist. One could take for standard the activity of an Hospital practitioner except . I am completely of agreement so that there is good patient information and of their family as well as good monitoring of the continuations in the short and medium term of operated. I also think that the patient's medical records justify that one devotes time to it. I moreover am convinced than the surgeon must take part in the various meetings which govern the activity of the establishment of care in which he exerts. I am finally certain that an csotcina.comedist who does not keep up to date is exceeded in five years. But under these conditions, and with the means it has today, I do not see how it can operate more than one day per week. If it is wanted that the surgeons can still ensure all their responsibilities and continue to operate it is necessary to give them the means of them. But for that one will need well that we define all together and with realism, which it is that one working week of csotcina.comedic surgeon.

 

. : Which are your fields of predilection?

: By the means of traumatology, I was brought to interest me in many fields. It is quite difficult for an csotcina.comedist not to operate hips and knees. However the two key periods of my boarding school were the hospital Saint Antoine at Mr André and Pity-Salpétrière at Mr Raymond . I am thus particularly interested in the rachis and the shoulder. It is on the level of the shoulder that it remained, for my generation, the most fields to be explored. I thus pushed a little the reflection towards this hinge. The magnetic prosthesis of shoulder was a very interesting program but very sophisticated and with few clinical repercussions because of the cost report of clinical benefit realization. On the other hand, with regard to the higher complex fractures of the end of the humerus, I think that the Cup-and-ball is a true contribution with the traumatology of the shoulder. Finally these last last years at the hospital led me to interest me in the traumatology of the hand and in particular in the lesions of the carpus.

 

. : You have which clinical retreat with the Cup-and-ball?

: I started in 1989 very prudently and with time I did not have reasons to go into reverse. In the complex fractures I have approximately 30% of necrose with the result that 70% of the patients have escaped with the prosthesis and in the 30% of necroses, half is not embarrassed. In fact, in the complex fractures which occur readily in the elderly persons, the functional result depends especially on the consolidation of the tuberosities. The Cup-and-ball, by preserving the head, leaves the tuberosities in an osseous environment whereas in a prosthesis, they are plated against the metal of humeral prosthesis.

 

. : Why to have imagined such an operative paragraph?

: Because in the majority of the complex fractures of the upper end of the humerus, there exists a metaphyseal size reduction which imposes, if one wants to remake the anatomy, of the chamber of fracture; in other words, one needs a “jack” between the diaphysis and the head. But under these conditions, because of the weak osseous capture in the head, conventional osteosyntheses go bankrupt and the head hoods in . One is reduced by it, if one wants to be preserving, to accept a synthesis on an approximate reduction. The Cup-and-ball, enables him to maintain the distraction while exerting the thrust on all the cephalic section, which distributed the stresses best. Provided the installation is done without useless damage, the rate of necroses is very acceptable. The Morse taper of the humeral stem is designed to accept a prosthetic head, but in practice I was seldom confronted with the need for “” the implant.

 

. : Not easy to get, your implant!

: It is true that marketing was not aggressive. In fact, for very a long period, I wished that there be no dissemination of the implant, in order to know exactly what one could expect. When I acquired the certainty that this operative paragraph was advantageous, posed the problem of the obligatory extension towards humeral prosthesis, even total. Indeed, in the event of necroses or even in the course of intervention, the passage to humeral prosthesis should not pose problem. And long-term one must be able in the event of to consider a totalization. In a legitimate preoccupation with an economy, the manufacturer wished to marry the existing Cup-and-ball with a range of shoulder prosthesis and we thus tried to associate the Cup-and-ball with shoulder prosthesis. This solution had advantages but unfortunately more disadvantages than provided for. The stems and the , perfectly adapted to the shoulder prosthese, were cumbersome in the fractures and sometimes even complicated the intervention. It was thus necessary to remake stems and a more adapted to traumatology, which in a context of merger of society and regulation news, required a few years.

 

. : And with regard to the rachis?

: In this field, my head office being Pity, I was very early initiated with osteosynthesis. It was the cradle of the pedicular screw and the plate. In parallel, in Saint Vincent of Paul, the school then developed all the possibilities of the stem and the hook. Screw, hook, plate and stem that made four elements. I knew that the whole of infinite biological diversity was coded by four bases: adénine-cytosine-guanine-thymine and that thus basic of the synthesis of the rachis allowed infinite combinations, but I had not measured the extent of the commercial possibilities that would generate! At all events, I did not develop of hardware of rachis and a posteriori I regret it because it is an enthralling intellectual exercise. With the Hospital I worked much with the vertebral medical school of Robert . That allowed me thanks to a close cooperation with Jean-Yves , to discover the medicine of the back and to have an approach minus mechanist of the low back pain.

 

. : You will operate much coccyx…

: One needs an end well for the rachis! This characteristic of my surgical activity is the consequence of a lucky find of Jean-Yves who highlighted, in the , of the faults of the kinetics which are unmasked at the time of the comparison of radiographs sitted and upright of the coccyx. One discovers kind of the or subluxations. These dynamic radiographs made it possible to give an objective basis to the surgery of the coccyx. Now, there exists with the Hospital of Paris a consultation of the coccyx. The medical care based on the infiltrations makes it possible to cure a good number of these chronic pains and invalidating coccyx. In the event of failure, the surgical resection is proposed. The aforementioned gives approximately 80% of good performances. We are thus today far from the pejorative judgments that our old had left us on the .

 

. : Let us return to csotcina.comedic Maîtrise; what did you for this special issue?

: The drafting was leaving for a parodic number which would enable us to slacken a little. The book with share is thus called “csotcina.comedic Treachery” and I hope that he will amuse the colleagues. With regard to the interview I thought that the pastiche of a meeting with a historical character would be rich in humorous possibilities. I chose for several reasons. It is very known and left the image of a surgeon with strong personality. He exerted in the center of Paris, certainly not exactly in the ships of today, but in the old Hospital located on other side of the Notre Dame Square, and that gives him a contemporary image. Lastly, its statue throne in the center of the exchange rate of the current Hospital where I exerted eleven years. I can tell you that after each fracture discussed I felt his marble glance to question me on the quality of my reduction. In short, it is an old knowledge.

 

. : And then?

: well I finally did not invent this interview. The bibliography on is relatively dense and its enough enthralling life to be told such as it is. The character is of a personality richer and less caricatural than it appears to with it with the first access. Admittedly it was proud and haughty with its pars but it had the surgical qualities exceptional and acquired hard by years of labor and deprivation. It stays far from being a son of archbishop. Especially, its history is of any surgical or corporative society with conventional antagonisms and the eternal combinations. I thus relatively adhered to the historical sources. I borrowed much from the thesis on of Paul submitted in 1933 to the medical faculty of Paris. The interview is supposed to proceed after the three glorious ones where the people of Paris raised themselves… Unpopular Charles X signs it
July 25th, 1830 four ordinances which are the signal of the revolution. The first suspends freedom of the press; the second dissolves the new Room; the third amends with the profit of the throne, by restricting it, the number of the delegates and the electorate; fourth fixes at September the new elections. The barricades answer this and by three days of Parisian insurrection, July 27th, 28th and 29th the people drive out the Bourbons. It is the duke of Orleans which it on August 9th becomes either king de France but king of the French.

The account of the surgical consequences of these three great days is extracted from a work written by Prosper in 1830. If I do not have at any time referred to the disease of , it is that it was not yet question in 1830, theoretical year of the conversation.

 

. : After the past, let us see the future: where does csotcina.comedic Control go?

: Exactly where the colleagues will want that it goes. This newspaper is not an institution and it must be faithful to its specification of origin: i.e. a space of communication placed at the disposal of the profession. One of the current questions is that of the importance which the communication will take on Internet. We started, gradually, a free site and opened with all where one can now find a hundred full stories with all their illustrations. The very many inspections which we record testify to a real interest for this medium. I think that as of today, one would have, from where that one is, capacity to reach technical informations concerning such or such intervention, such or such implant. Admittedly financing of the scientific publications at a cost, but the old system is often paradoxical. Surgeons develop techniques within an institutional framework which does not claim right on the publications; then papers are written voluntarily and corrected voluntarily by pars. And in the final analysis the scientific circle should relatively expensive pay information which it produced voluntarily. It is all that which Internet can call in question.

 

. : But should well be financed the scientific publications…

: Certainly but I think that with Internet more large numbers of people will have access to more information for more low costs. The true problem to be solved is that of the validation of information and the constitution of “official” sites.

 

. : Why are you surgeon?

: It is true that I often put this question in the interviews! In my case the answer is not simple. I grew in Dakar, in Senegal, and my father had a small joinery. Very small, I liked the environment of the workshop where all the craftsmen of the production line of a piece of furniture worked. Did that have an influence on the choice of csotcina.comedy? In fact, I was attracted by architecture and if I had been in Paris I would have probably made the Art schools; but in Dakar, the choice was reduced. The medical college delivered French diplomas and the reforms facilitated the input in medicine. Among my first instructors, I was very impressed by Rene Louis who was remarkable teaching in anatomy. I never saw somebody “installing” a board to chalk like him. I did not have the surgical vocation yet but for me, under its influence, the surgery could be only csotcina.comedic. I was very moved to interview it, 25 years after, in Marseilles.

 

. : And then?

: I finished my studies of medicine in Paris, then I passed the boarding school. The results being very late, it was of use then to pass the boarding schools of area which made it possible to take immediate functions of intern, except . I found myself thus internal in cardiology in Chartres. A few months afterwards, when I was appointed in Paris I chose the surgery and I began csotcina.comedy in Chartres.

 

. : You do not regret this choice?

: We make a beautiful trade but it seems to me that it becomes increasingly difficult to practice. I do not have the feeling which we are currently encouraged to override us. If it is true that there is true freedom only in the stress, we live one period of very great freedom!