Approche cinetique de la pathogenie des fractures de cheville [a propos de 50 cas]

Theorical and clinical approach of bimalleolar ankle fractures. Pathogenical findings in 50 cases. Study of weight, speed and position of the ankle at the time of injury. Re-estimation of kinetic energy absorbed by the joint at that moment. Comparison between Kinetic energy and radiographic aspects of fractures. We note a certain vulnerability of the ankle in abduction position and the relative resistance of the joint when a foot is in adduction at the moment of traumatism

Tumeur a cellules geantes a localisation tres rare au rachis lombaire: resection totale des vertebres L1 et L2

A young woman with lumbago, progressive paraplegia and L1 osteolysis needed biopsy and posterior fixation by ROY-CAMILLE plates. The pathologist answer was giant cell tumor. Radiotherapy was necessary for this case. Three months later a second localization on L2 was found. Then the authors decided an embolization and total vertebrectomy of L1 andL2 by double approach for a bigger plating and anterior grafting. Immediate post operative result was good and has been maintained for 3 weeks with pretty well evolution of paraplegia. But after 21 days, a fatal meningitis due to cloacae enterobacter occured. The interest of this observation is emphasized by the exceptional localization of giant cells tumor in two lumbar vertebrae and by the difficulties of diagnosis and treatment

Sciatique scanner et chirurgie

A homogenous series of 26 cases of slipped-disclumbosciatic covered by means of "tomodensitometry" and surgically treated amount of patients who had accidents during working hours, the importance of this study is to support the diagnosis and to lay the indicated surgical operation after the lumbar canal anatomy study, the roots' position and especially the straight sight of the hernia, of its size and its situation.The aim of this study is to match out the scanner-given-items with the discoveries obtained from the surgical operations. Of the 23 cases out of 26, confirmation of tomodensitometric lesions, during surgical operation, have been reported. In three cases, a moot point mainly linked to a technical insufficiency, has been noticed. The reliability of the scanner in the accurate slipped- disclumbosciatic diagnosis [88%] is in favour of a larger utilization of this almost harmless complementary examination. Its accuracy nowadays goes beyond that of the radiculography. Tomodensitometry is to be secured for the post-surgical operation stage, namely when doubting about the "discal" etiology, in front of a clinical atypic board, a baldy systematized sciatica or very difficult to correctly follow medical treatment and especially when advised not to bring in a "radiculography"

decortication osteomusculaire dans le traitement des pseudarthroses septiques

The authors report their experiment in treating osteitis and septic non-union. - The problem of fractured osteitis is relatively simple, the fracture being united. Different surgical methods are considered together, all having in common the excision of infected and necrotic tissue. Opinions are divided between supporters of " closed " treatment with " irrigation-drainage ", and " open " treatment with cicatrization by a second intention. The latter being favored by most of the participants. Directed antibiotherapy remains a valuable addition; its utilization locally is discussed. - The treatment of septic " non-union " is more complicated in respect to healing. Different methods are examined with ' osteo-muscular decortication, used alone, led to healing in 17 out of 20 cases of non-union. It constitutes the first and formes treatment for non-union. Isolated, it is reserved for non-union without loss of osseous matter. A PAPINEAU intervention is the method of choice for septic non-union with loss of osseous matter. It was used once or twice in 51 cases and led to union and drving in 75% of the cases. Negative re-results were most often the apanage of diaphysaric resections. Inter-tibio-fibular grafting was only used in 8 cases, usually after the failure of other methods. It allowed union in 6 cases. It retains a non-negligible place after failure of a PAPINEAU intervention, which it can complete in case of insufficient solidity. Of 101 observations of septic non-union, 6 patients underwent amputation. This is most often the result of major traumatologic damage and deficient techniques. Its place should be more and more reduced. The authors conclude by recalling the importance of preventing post-operatory-infection, not by gross means but by rigorous measures in the organization, hygiene and education of hospital staff

Enucleation traumatique ouverte de l'astragale: un cas rare suivi de reposition puis d'arthrodese

The authors report on a rare open traumatic talus dislocation The bone has been three hours out of the ankle. After cleaning-surgery and re-including of the talus with fixation by pins, an ankle arthrodesis was performed with spongious graft and trans-talar nail three months after the injury. No immediate complications were observed after surgery. Later on, the beginning osteo-necrosis was followed by partial revascularization of the bone. [9 months after]. At that date, the patient went to work. Also, the authors have reviewed 33 cases published in the literature