The congress of the French-speaking was held last October in Biarritz. We met his first there and chair, Christian . It informed us on the genesis and the objectives of the and traced us the main lines of its professional route.

 

. : What is what the ?

. : The initials mean International association for Dynamic Osteosynthesis. Association was created by my Master in 1986. I say my Master, because I have the honor to appear among his pupils, having had the possibility of working in his service in Strasbourg during an exchange inter in 1980. The was conceived to promote techniques of osteosyntheses, with an essential purpose of formation, as well of the young surgeons as of the ancillary medical personnel of surgical unit in particular and Manipulator of Electroradiology). Quite naturally, the spearhead of the School Of Strasbourg being the locked , the had initially concentrated on the teaching of this technique. But quickly the exchange rates suggested by the enlarged their programs with the whole of the techniques of osteosyntheses.

. : It is European, French or of Strasbourg?  

.: All was born from Strasbourg under the impulse of and Arsene Grosse in 1986. They created the which was only French at the beginning, but with an international vocation like the “I” of the initials implied it. This first , Frenchwoman, explains the paradox of the emergence of known as national under the aegis of an international ! There were thereafter more and more associations throughout the world. At the beginning Mr was the chairman of the international . Currently it is Gilbert ; one cannot thus dissociate the of the School Of Strasbourg.

. : There are thus several ?

. : Yes of course. The first was thus French into 95, then this Association extended in Italy, in Germany, in Europe; thereafter there was the creation of new in addition to the Atlantic and in Asia. Problems of language make that the labels always do not give the initial ; for example, in the United States where the system functions more in statute of Foundation rather than of Association, one obtains F and not A.

. : Then this annual convention is that of the French-speaking .

. : Yes and the current chairman has been Jean-Marc for one year. But there are in addition true international congresses under the aegis of the international .

. : Which were your functions in the ?

. : I was the first chairman of the France, then of the Francophone creates into 98 during 11 years. Quickly the first training courses on the locked were diversified to approach external fixing and epiphyseal osteosyntheses by anatomical plates. We took the term of osteosynthesis to the most general direction to leave the exclusive initial idea of the locked . I adhered in this broad frame of mind and the meetings always wanted to enlarge the topics of discussion. Since its creation, the permanently remained open towards outside by inviting fellow-members sometimes members of other official associations and having ideas very different as of ours. What I always found interesting in the , it is the open-minded and the dynamism.

. : You think that other society was more sectarian?

. : In the past, I think that yes! But you made well use the imperfect one in your question. The generations following one another, one less attends these old quarrels of Schools of and one ended up admitting that the Doctrinaire approach did not have any more a place in surgery. Today, of different philosophies can be allowed and adopted by the same operators, which was inconceivable a few years ago. You came from a more or less dogmatic School and implemented the precepts of the initial mould without daring to change anything during all your career! 

. : During the 11 years of your Chair, how did you live the development of the ?

. : Initially I with satisfaction saw that other associations very closed have adopted methods of , which gave an opening to start debates which proved to be enthralling and to make us admit, with the ones as with the others, whom he did not have there a Truth but several solutions possible with a given problem. Finally, the surgery is a little as kitchen: different “receipts” make it possible to reach the consolidation or the cure. Each one admits today more easily than the same aim can be reached by different means.

. : How is the financed?

. : Initially, it was financed by the royalties of the nails Grosse and , which made it possible to make turn this association with a secretariat, an head office in Strasbourg. Currently the patents fell into the public domain, he thus does not have there more royalties, which required a reorganization. The main sponsor remains but we also enlarged sponsoring with other partners like . As for other associations in the same way standard, all the difficulty of the is to preserve its intellectual independence and to avoid having a too commercial label.

. : In the operation of the , did you have conflicts of philosophy of osteosynthesis?

. : There always was a very active technical committee. Thus novel ideas, for little which they were discussed within this office, could be taken into account then developed to test prototypes in laboratory of anatomy. Then surgeons members of the belonging to a network of pilot centers recognized as expert in the studied sector proceeded to a stage pre-private clinic. If the results of the latter were positive, the last phase of dissemination on a grand scales of the implant or the concept initially proposed was then considered. It is what I lived in connection with the front armlever. On the basis of the principle that a method having brought the proof of its effectiveness to the lower extremity could be quite as effective a priori to the upper limb, I at the time had forwarded the idea to which was therefore and manufactured the implants. The idea was a locked of the two bones of the front armlever. One initially studied a nail of to discuss not only the fresh diaphyseal fractures, but also of the problems of pseudarthroses and vicious cal. For reasons of cost, I wanted that with only one nail one can discuss any side and any length of . The implant, telescopic and out of alloy made malleable, could shorten, in particular for the internal Syndrome of of the wrist on vicious cal of distal radius with inversion of the radio-ulnar index; or to lengthen the as for the disease of , to maintain the length respective of the two bones. The idea was to design an implant which gives a compression to the level of the chamber of fracture, nonunion or osteotomy, which physiology does not bring to the upper limb. One published more than 80 cases, all indications confused i.e., fresh fractures, nonunions, osteotomies correct, which consolidated. Then I developed a nail of radius, since the idea was of the two bones of the front armlever.

. : How was this nail of radius?

. : It was preformed with a curvature predetermined and could be used as well on the right as on the left. Four prototypes were posed successfully, but there no was continuation because one was at the time with the birth of the gamma nail, and that in term of market, there was not photo; the gamma nail had then mobilized all the attention of engineers de . Now from other laboratories launch out in osteosynthesis of the front armlever; blow perhaps will re-examine this project of more closely locked front armlever.

Double locked front armlever

 

. : For which reasons you did make career in Brest?

. : I am Breton of birth and core. Born in Nantes, I was during childhood and adolescence, then am become again Nantes by the studies of medicine. Having always wanted to make surgery, a priori csotcina.comedic, I passed the boarding school of Nantes, Rennes and Brest into Breton convinced. I was received in the three cities. Having been received first with the contest of Brest and having already heard of the Brest-native csotcina.comedic School about my future Master Bernard Courtois, I thus came to Brest accordingly.

.: Why Brittany?

. : I adore the sea. When I thought to become surgeon in Brittany, I saw 50% of work and 50% of boat, but it was a dream. Reality was 99,9% of work… but they were enthralling and without regret!

. : Why to have chosen csotcina.comedy?

. : Because it is a very positive speciality. I started by making one year of visceral surgery and became . While making the inspection the evening, I fell practically systematically on thinned down patients to the “reserved” forecast. To reassure, it was often necessary to lie to the patients or the families… And why not oneself is said, why not them his because that does not arrive only at the others. Actually, I found this speciality extremely hard, and vis-a-vis this visceral surgery quasi comparable to a surgery of , often palliative, csotcina.comedy appeared very positive to me while relieving, by restoring a function, by giving again with the patients the taste of living. The patients speak about the difference in their life “before” their intervention and about the quality of their life “afterwards”; I found this reality very stimulative.

. : When one is internal in Brest, one has how much csotcina.comedic departments with the choice?

. : Currently two, a service of adults and one of children directed by Bertrand . But at the time there was one of them, that of Bernard Courtois. I began the boarding school into 78 and I was at his place into 79. It had opened the service into 75. It is somebody of very cultivated, deeply human, and intellectually very honest. He brought to me much and I owe him much. To see always regularly with each remains for me one privileged moment. He was at the same time a pupil of Blackbird of and , which was extremely rare at the time since the choice of a School excluded practically the access to the other university from “opposite”.

 

. : Which was its speciality?

. : It had the characteristic to know perfectly the hip of the birth at 90 years. Its service was, at the time, trainer at the same time in pediatry and an adult, which was an aubaine for us. But anxious to enlarge the spheres of activity of the service, Bernard Courtois incited us all to go to see elsewhere what occurred to evolve/move and put into practice different philosophies, techniques and hardware that we each one had learned in other French centers or even foreigners. It is what permanently diversified the service and which made the wealth of the Brest-native School. Become since 1993 department head, I remain very attached to this design become a true tradition impossible to circumvent for the interns in formation and which enriches the team continuously. Thus I made six months of training course inter-CHU at in Strasbourg.

. : Which memory do you have some?

. : A large Mr him also, I regard it as my second Master in csotcina.comedy. It was a large foreman with a remarkable direction of the organization. I learned much from things with and Arsène Grosse. It is what explains the persistence of the relations between Brest and Strasbourg. The it is that also, much of human; at the beginning Association was in fact a group of friends.

. : Let us return to Brest: you made there your ?

. : Initially, a #D1FFFF medal in csotcina.comedy, then a beginning of in vascular surgery and general; for the surgical crop, it was more undeniable in particular for the anatomy. Then I became assistant assisting in Anatomy-csotcina.comedy, since I am in fact anatomist on the university level.

. : You were monitor of anatomy?

. : Of course, throughout all boarding school. During the preparation of the contest, the anatomy was my matter preferred with the surgery. Also I started to teach the anatomy at the beginning of the boarding school. The university party of my was the anatomy, thereafter I was appointed then PU in anatomy.

. : Which personalities marked you in this discipline?

. : The most extraordinary memory of the pedagogy to the true direction of the word, which I guard am without question Maurice . During the preparation of the contests of and PU, it was of rule of “floor” of the questions of anatomy with the Master of Amiens. Unforgettable memories! One felt very small in front of this well of learning, this control of the verb, this enormous crop, impressive. When it took again our questions, it always did it with benevolence in our connection, but with a real brilliance! Anatomical description was each time skilfully mingled with concepts of development, anthropology, of histology, medical or surgical therapeutic implementations… All passed there, one drank whey literally; any medical specialty became limpid and logical. With such a Master, the Anatomy explained Pathology and conversely: a true osmosis enters two Sciences, the pleasure of learning in a pure state. He taught me that an exchange rate was to be conceived like a true challenge at the same time with respect to oneself and of the students, that the contents of teaching were to always be called into question and taken again the old woman in order to improve clearness of it.

. : Did your last how long?

. : 4 years. Then, I was appointed lecturer. The anatomy is not an easy channel since all in double is done, i.e. it is necessary to prepare at the same time in anatomy but also in csotcina.comedy, which requires a rather considerable investment. I was finally appointed pH into 88 to 38 years.

. : Which types of activity did you develop?

. : Except teaching and work of anatomy, I followed to the clinical plan a rather conventional development, at least to France, namely that at the beginning I did much traumatology, and gradually the years passing, traumatology regressed with the profit of the programmed activity. Influenced by my Courteous Master, I kept a predilection for the hip, as well for the preserving surgery as prosthetic, search in this field always attracted me. Thus I developed a sealed retentive cup and a reinforcement with ischio-pubic hook variable length. Currently I work on long femoral stems of recovery starting from anatomical work 3D.

Reinforcement with variable ischio-pubic hook.

Reinforcement with variable ischio-pubic hook. Surgery of 1st intention (and climbed): osteosynthesis of a complementary stop

 

. : I.e.?

. : There is more than 15 years, I contributed to the creation of an analysis laboratory of the Medical image entitled or Laboratory of the Data processing, in partnership with the 3Ecole Nationale Sup3erieure of Telecommunications located in Brest. The idea was to bring closer the fields of competence to the Health and Life sciences and those to the Engineerings. This laboratory, currently INSERM, allowed the development of certain work in particular on the imagery 3D.

. : In practice, which was the aim?

. : It was to use competences of engineer to go beyond what we surgeons could have developed separately, because actually we need competences in fields very different as of ours like mathematics or data processing, to develop new tools which are the imagery 3D or the surgery computer-assisted. The beginning of this adventure goes back to more than 15 years now. In parallel, I was interested in the adjustment of implants. We already referred to the of front armlever, there were also pins anti-expulsion designed initially for the fractures of the olecranon.

. : It is you who imagined these pins with a inner loop?

. : That of which you speak is a copy, this system had in my eyes an overall dimension too important which was likely to create a discomfort for the patient. What I developed, it is a pin with in the dishing of the “cane” a welded ring in which the yarn of hooping passes. I reported myself of a reality: by experiment and through the literature, whatever the method of pin setting of the olecranon, which one remains into intramedullary or that one crosses the cortical former one of the , the secondary rate of migration of the pins borders 30% for the majority of the teams. These prepared pins are put at the engine using a special chuck fitted with a room containing the “cane”, the yarn of staying being taken in the ring, the secondary risk of expulsion is definitively eliminated. Different lengths and gauges, these pins are usable also for the stays of great trochanter, internal malleoli or .

. : What of other?

. : With society, I developed an anatomical plate for femoral shaft fracture on variously combined intramedullary implants, which they are prosthetic stems of hip and/or knee or trochanteric nails and/or . In spite of interesting clinical outcomes and for reasons which escape to me, decided to stop marketing this implant in France whereas it maintains export of it abroad.

. : What do you think of the plates with cables?

. : I did not leave on this runway because with my direction, it is not the Breton one which speaks, this type of osteosynthesis is frequently responsible for negotiable instrument “yarn to cut butter” at the origin of circumferential osteolyses. This is why I have a preference a priori for the fixing of the plate by screws. In addition, the principle of this plate soon will be begun again by . We have the project to make evolve/move the starting idea by offering 3 possibilities of fixing to any level of the plate and according to the quality of the diaphyseal bone: boltable screws , wire of hooping, or ribbons of tightening, a little like collars of electrician in order to avoid the phenomenon of yarn to cut butter. One will thus obtain a complete modularity for the same implant at the beginning and a great flexibility in use for the operator. Always in the field of the resumption of arthroplasty of hip, I also worked on a retentive cup sealed out of polyethylene containing a ring split to limit the risks of luxation. It is not a cup “” with the clean direction of the term, since it is provided for an escape of the prosthetic head in order to avoid the pulling up of the implant.

. : What do you think of the cups of double mobility?

. : It is an interesting, original solution and which proved reliable. I would perhaps more readily use it with couples. One currently witnesses a true passion for the wrongfully called solutions “”, which they are retentive cups or double mobilities; one thus sees young fellow-members at the beginning of installation “reassuring themselves” by posing almost systematically such implants. I hope that the security connects today will not have a too high price to pay in a few years at young and active subjects. I believe that it is necessary to keep the cool head and to limit the indications of these various systems.

. : And on the femoral slope?

. : We led to Brest of the three-dimensional anatomical studies of the femoral canal which made it possible to specify this anatomy and in the future to design long stems of recovery better adapted to the osseous anatomical curvatures. It is surprising to note that the majority of the femoral diaphyseal implants, that they are long stems of recovery or intramedullary nails, forward aberrant radii of sagittal curvature not corresponding to anatomical reality. I have for a long time discussions with Gilbert in connection with the nails Grosse and ; their radius of sagittal curvature was initially of , which caused real preventive difficulties at the time of of metastatic femurs. The current nails arrived at , one considers even soon radii of 1,… One approaches the real anatomy gradually! The aim of this study is to optimize the sagittal curvatures of the long boltable stems of recovery and to avoid the inconsistancy which consists with   to have to expose again diaphysis for (with all the mechanical, vascular and infectious risks that contains), finally to adapt the bone to a badly drawn implant; it appeared more judicious to us to adapt the implant to the bone and not the reverse.

. : Do you use systems of imagery computer-assisted to make osteosyntheses?

. : We are about to start in traumatology. The difficulty is to make admit with teams which change and which work at hours sometimes advanced in the night, to consume much time for the installation of these systems, which explains the reserve of much. Personally I make use of it especially for the joint replacements of hip and knee like for the osteotomies of tibia. We also use it in Brest for the of knee. Currently I navigate more than one joint replacement of hip on two.

. : To do what?

. : To control before all the length but also lateralization. We are spirit to make evolve/move the completely open system which we experienced to control the antéro-posterior plan and in the long term prosthetic stability.

. : How did you make before regulating the length?

. : Like everyone, i.e. using preoperative copies and of reference mark like the summit of the great trochanter, the center of the prosthetic head, with all the clinical inaccuracies that implies. The computer tools are not yet reliable at 100%, but it can give figures about the Misters One can think that navigation will become soon a banal that all the surgeons will use, as well as the sailors who would not conceive any more to navigate without GPS!  The whole, it is that the instrument is reliable and that it does not consume too much time. From this point of view, at least for the system that we use, it is still a catastrophe: the procedure raises us of more than n an intervention which requires usually less than one hour… The investment in time remains heavy for the moment, but it is the price of the precision; let us not forget that the first reason for complaint after joint replacement of hip in the United States is the difference in length of the members. The European csotcina.comedists ineluctably will know very soon the same vexations.

. : On did instabilities, that change the things?

. : For the moment not, on the other hand there is a research task to push to arrive there. One can think that in the long term the computer tools will ensure at the same time the equality length and the stability of the hinge. It is necessary to forget the fixed and static criteria a little angles of and tilt which we all learned in descriptive anatomy and which one endeavors more or less to reproduce during the positioning of the prosthetic parts. It becomes necessary to conceive reality in its dynamics (movements of the everyday life influencing hip and pelvic version) and to admit that the future stability of a prosthetic hip is related to the relative positioning of each component compared to the other. During the preparation of the femur, one regulates the using graters; but if the first grater goes where one wants, the last often goes where she wants. Thus for a given of a femoral neck, there exist many combinations of positionings of the cup guaranteeing a stable, and risk-free hip of “”. It is in this daily reality that the computer tools will take all its interest.

. : Does there exist a specific pathology of the sea in csotcina.comedy?

. : Sea, not really. The moisture of the oceanic climate would support degenerative osteoarthritis at certain people. The paradox it is that people often compare Brittany to the rain; there exists in fact of skin cancers because of an aggressive sunning. One finds this pathology as much at the fisherman that in the farmer. But this is not related to the sea. In addition, thanks to progress of tracking the conventional pathology of the Breton hip became more one legend that a reality. The interns of the service do not see almost any more stops of hip, femoral osteotomies and even less Chiari osteotomies.

. : On is a more general level, there really a Breton regionalism?

. : Yes, but peaceful! A little with the manner of Alsatian which remains very attached to their area and their traditions. I understand and find sympathetic nerve very the attachment with his area of origin. It is at the same time a wealth and a diversity which it is necessary to adhere to and preserve.

. : Are people who come to settle in Brittany, whatever their profession, badly received?

. : Not, I do not believe it, there is no barrier of language and Brittany is even rather hospital. That the Breton one is reserved, even is often said. In fact, it is only one transitory reserve corresponding to one period of discovered and observation. Once the current passed, the relations become authentic and especially they resist time!