Résultats de la fixation centromédullaire par broche de Kirschner des fractures de la clavicule de l'adulte

Introduction : Dans les pays à ressources limitées, la broche de Kirschner est un implant de choix dans le traitement des fractures de la clavicule. L'objectif de cette étude rétrospective était de décrire les résultats de la fixation centromédullaire par broche de Kirschner des fractures de la clavicule de l'adulte. Patients et Méthode : Cette étude a concerné 21 patients (22 fractures). L'âge moyen était de 32 ans. Les fractures étaient fermées (n=19) et ouvertes (n=3). L'ostéosynthèse a été réalisée dans un délai de13 jours à foyer ouvert de manière rétrograde sans amplificateur de brillance. Une broche de Kirschner de 2 à 3 mm de diamètre a été utilisée par foyer de fracture. L'évaluation des résultats a concerné la réduction de la fracture, la cicatrisation de la plaie opératoire, la consolidation, les complications selon Millet, et les résultats définitifs selon Constant. Résultats : La réduction était satisfaisante (n=20). Il persistait une comminution initiale (n=2). La cicatrisation a été obtenue chez tous les patients dans un délai moyen de 3 semaines (2-4). La consolidation a été obtenue chez tous les patients avec un délai moyen de 3 mois (2-5). L'ablation de la broche a été réalisé à 2 mois chez tous les patients sous anesthésie locale en ambulatoire. Les complications notées étaient mineures. Au recul moyen de 2 ans (1-4), 15 patients (16 épaules) ont été revus. Le résultat fonctionnel final moyen selon le score de Constant était de 90 (88- 96). Conclusion : Cette étude suggère que la fixation centromédullaire par broche de Kirchner à foyer ouvert de manière rétrograde des fractures de la clavicule de l'adulte donne de bons résultats anatomiques et fonctionnels. Cette technique est simple. Elle n'est pas onéreuse

Mandibular fractures: a comparative analysis between young and adult patients in the southeast region of Turkey

OBJECTIVE: The purpose of this study was to review and compare the differences between mandibular fractures in young and adult patients. MATERIAL AND METHODS: Patients treated at the Oral and Maxillofacial Department of Dicle University during a five-year period between 2000 and 2005 were retrospectively evaluated with respect to age groups, gender, etiology, localization and type of fractures, treatment methods and complications. RESULTS: 532 patients were included in the study, 370 (70 percent) males and 162 (30 percent) females, with a total of 744 mandibular fractures. The mean age of young patients was 10, with a male-female ratio of 2:1. The mean age of adult patients was 28, with a male-female ratio of 3:1. The most common causes of injury were falls (65 percent) in young patients and traffic accidents (38 percent) in adults. The most common fracture sites were the symphysis (35 percent) and condyle (36 percent) in young patients, and the symphysis in adults (36 percent). Mandibular fractures were generally treated by arch bar and maxillomandibular fixation in both young (67 percent) and adult (39 percent) patients, and 43 percent of the adult patients were treated by open reduction and internal fixation. CONCLUSION: There was a similar gender, monthly and type of treatment distribution in both young and adult patients in the southeast region of Turkey. However, there were differences regarding age, etiology and fracture site. These findings between young and adult patients are broadly similar to those from other studies. Analysis of small differences may be an important factor in assessing educational and socioeconomic environments.

Evaluation of the results of treatment of transverse patellar fractures with cancellous screws

Tension band wiring [TBW] is the most common method used to treat displaced transverse patellar fractures. While TBW is very efficient to compress the fracture during knee flexion, it is not that effective during knee extension. The aim of this study is to evaluate the results of treatment of transverse patellar fractures with cancellous screws. Twenty patients with displaced transverse patellar fractures were treated by open reduction and fixation by small set cancellous screws. The mean age of patients was 36.6 +/- 1 7.4 years. There were sixteen males. Road traffic accidents accounted for the majority of trauma. The mean time lapse before surgery was 4.5 days. Two screws were used in sixteen, three screws in three and four screws in one patient. The mean time to clinical union was 9 +/- 2.3 weeks while the mean time to radiological union was 13 +/- 3.6 weeks. All Patients completed six months follow up period. Using a modified Hospital for Special Surgery [HSS] knee scoring system, thirteen patients were excellent, five good and two fair results. Patients improved throughout the follow up period. Results were not affected by age, sex, time lapsed before the operation, and the number of screws used. Complications included prominent hardware in one patient, limited range of movements in six patients in which one developed 20° extensor lag. We concluded that the use of cancellous screws in the treatment of transverse patellar fractures yielded satisfactory outcome with low rate of complications in most cases

Morphologic evaluation of the lower cervical vertebrae and its surgical applications among Egyptians

Lower cervical spine stabilization necessitates precise knowledge of different osseous morphometric measures of the cervical vertebrae for accurate and safe application of fixation devices. Human cadaveric studies revealed significant variability world wide raising the issue of possible differences among races. This study was conducted on 28 osseous cadaveric models to obtain morphometric measurements among Egyptians. For posterior measures, 1.6 mm Kirschner wires were inserted in the cervical pedicles and lateral masses bilaterally to assess different linear and angular measurements. Linear measurements of the vertebral body were also assessed and presented. All result was correlated with their surgical importance for both posterior and anterior lower cervical spine surgery. The results of this study revealed morphometric differences between Egyptians and other races. Although most of these differences are not statistically significant, yet it raises the necessity of extreme accuracy that should be considered in insertion of posterior cervical pedicle and lateral mass screws concerning, the point of insertion, length, diameter, sagittal and transverse angles in and offsets. For anterior surgery, the transverse, sagittal and vertical measurements of the vertebral body should be precisely assessed for safe and adequate decompression as well as defining the ideal lengths of screws for anterior plating of the lower cervical spine