[Surgical treatment of acetabulum fractures [Report of 52 cases]]

This piece of work consists of a study of 52 cases of acetrabular fractures treated with open reduction and internal fixation in the service of Traumatology Orthopedics of the H.U.C Ibn Rochd of Casablance from 1994 to 2004. The average patient age was 37 years. A road traffic accident was the most involved causative mechanism [90%]. The left side was the most affected [60%]. The Judet and Letournel views confronted to the computed tomography data lead to establish diagnosis, to make classification by Judet and Letournel classification and to appreciate congruency by the Duquennoy-Senegas classification. The Kocher-Langenbeck approach was use in 88% of the cases. We have used plates to fix fractures. Screw were use in association with plates in 73%. The functional outcome is assessing according to the Postel Merle D'aubigne score and the results were excellent to good in 65%, fair in 25% and poor in 10% of the cases. We have won 47% on the both vertical and horizontal congruency TT3 and TC3. As complication, we noted 12 cases of osteoarthritis [30%], 9 cases of heterotopic ossifications [23%] and one case of osteonecrosis of femoral head [2.5%]

[Autogenous bone graft reconstruction and Kerboull ring aseptic acetabular loosening]

62 cases of acetabulum reconstruction by Kerboull cross were performed from 1998 to 2003. This reconstruction was realized in 62 cases of acetabulum loosening with bone defect : type III or IV of the SOFCOT classification. The mean follow up was 4 years. We note an increase of PMA score in 92% and 1 losening due to infection. Reconstruction of the acetabulum. Its fixation, the reconstruction of the acetabulum with Kerboull cross is a good alternative to bone defect in acetabulum. Its fixation, the reconstruction of the acetabulum by the bone grafting and the automatic centralization of the hip seems to be the major points of this technique

Patellar ligament ruptures concerning 6 cases

In this study, six cases of patellar ligament ruptures [five recent ones and one inveterate] affecting only the tendon fibers were reported. The osseous stripping of the rotular point and of the anterior tibia tuberosity was not considered. A surgical treatment was done. More sutures were undertaken to wipe out lesions [five cases] or transosseous points [one case]. A protection centering in the Mac Laughlin way achieved the repair in all the cases. An immediate reeducation was undertaken for five times. There were excellent results over the active extension [six cases]

Actinomycosis of the psoas iliac muscle: concerning a case

Actinomycosis are bacterial infections considered non contagious, caused by Actinomyces, gram positive filamentous bacilli, mucuous buccal digestive saprophytes. The abdominal or pelvic locations are rare, and may stimulate a neoplasic affection by causing delicate diagnosis problems. We here report a case of actinomycosis of the right ilio-psoas muscle in a fifty-year old patient with a tumor syndrome of the right iliac fossa, with no abdominal pelvic compression. We did not notice any entrance. The actinomycosis diagnosis was led thanks to anatomo-pathologic exam. The treatment consisted of a tumor resection with betalactamine based antibiotherapy. The pelvic actinomycosis is a rare affection with a difficult diagnosis because of the failure to recognize it as well as its presentation that is similar to a neoplasic process

Traumatic avulsion of the triceps tendon with fracture dislocation of the elbow. a case report

The distal traumatic avulsion of the triceps muscle is an exceptional lesion. The clinical presentation is associated with an intense sudden pain of the posterior side of the elbow with loss of active extension of the fore-arm and the palpation of a depression above the olecranon. The presence of small avulsed bone fragment of the olecranon over a lateral X-ray view of the elbow confirms the diagnosis. The antero-posterior and lateral views of the elbow also help to investigate for any bone lesion, particularly a fracture of the radial head. The trans-osseous and periosteal reinsertion often yield good results. The related observation is remarkable. In fact, it is to our knowledge, that this is the first case of traumatic avulsion of the tricipital brachial tendon associated with a fracture-laxation of the right elbow with a fracture of the radial head and a postero-lateral sublaxation of the elbow

Bimalleolar fractures and their equivalents [about 200 cases]

Bimalleolar fractures rank third after lower radius fractures and above femur fractures. Those fractures gave post traumatic arthrosis in long term result. We reported retrospective analysis of 200 medical records after a follow up of eight years. The average age was 37.4 years with sex-ratio of 3/1. The road accident is the most frequent cause, the fall rank second. In Weber classification, the stage C was the most with 56%. 16% of patients have tibio-fibular diastasis, 28 patients have posterior fragment along. 16 patients have osteochondral depression, astragalo-tibial dislocation at 49 patients. 8 patients had polytraumatism, and 51% of patients with polyfractures. Open ankle fracture in 22%. The result after conservative treatment was satisfactory in 82%, the surgical result was good in 96% of patient at an average of four years and half. 15 patients present post traumtic arthrosis. Arthrosis was at patient with dislocation ankle fracture, osteochondral depression and open fractures. The result comparison with literature confirm the importance and interest of surgical treatment and orthopedic treatment must be reserved in management in this fractures

[Osteosynthesis of pertochanteric fractures by screw [DHS]]

Our retrospective study concerns 46 patients operated on because of pertrochanteric fractures by DHS from December 1992 to November 1993, and supervised till the consolidation with minimal delay of 6 months. These fractures supervene in old persons [mean age is 61,6 years old], the age brackets are 24 and 8 years. The walking after osteosynthesis has been precocious for all the patients. We noticed one death, 1 superficial infection, any case of vicious callus by varus or pseudarthrosis, and 2 disinsertions of material. The average delay of consolidation in our patients is 45 days with extremes [30-60 days]. The functional results are very good [42 cases], mean [3 cases] and bad [1 case]. The serew [DHS] still subject of critics about all the methods of surgical treatment of the pertochanteric fractures. Newertheless, it presents the advantage of the closed focus surgery, in comparison with the pinning of Ender and the plaque lamina, the precocious supervision what ever is the fracture type

[ dislocation-fracture of the Hip [correlation between the type of injury, therapeutic process and the anatomo functional evolution]]

In this retrospective study of 44 cases collected between 1982 and 1992, we try to analyse the lesional relation ship of the luxations - fractures of the hip, the therapeutic processes and the anatomic and functional evolution of this articulation. The mean age of our patients is 35 years old, the extreems are 13 and 70 years. The highway accident is the most fruquent etiology. In 77% of the cases, the luxation has been associated to the fracture of the posterior panes. The lesional association was varied [cranial traumatism, sciatic lesion]. The treatment was orthopedic especially and consisted in the reduction of the luxation emergently and the traction. The surgical treatment of the fracture depended on the result of the reduction, the articular congruence, the fracture type and the residual displacement. The delay was 1 to 10 years, we noticed 24% of bad result, the cephalic necrosis is more frequent in the luxation -fracture than in pure luxations. The risk of arthrosis is important in relation ship with the fractures of isolate socket, we noticed a non neglectable frequency of the periarticular ossifications. We insist on the rigorous pathologic complete physical examination, the emergent treatment, the accurate value of the state of articular congruence [roof theed, socket head] in order to diminish the risk of complications [necrosis, senile coxarthritis]