Intrafocal pinning for dorsally displaced distal radius fractures

Intrafocal pinning of dorsally displaced distal radius fractures, as described by Kapandji in 1976, was very popular during the last two decades of the last century. This method has clear economic advantages over other modern methods of internal fixation such as locking plates. The authors aim at presenting the results of a series of 56 patients operated for distal radius fractures between 1994 and 1999. All patients were clinically reviewed and radiographically assessed at a mean of 16 months follow-up. The authors believe that intrafocal pinning remains a valuable method for the treatment of dorsally displaced extra-articular distal radius fractures; however, it should be used with caution in presence of epiphyseal and dorsal metaphyseal comminution

Guiding principles and pearls in a stepwise surgical technique of revision total knee arthroplasty

The authors aim at reviewing the guiding principles in revision total knee arthroplasty according to a stepwise procedure. Strict preoperative planning is of paramount importance for this surgery. Thorough clinical history and physical exam, the assessment of limb deformity and knee range of motion as well as knee stability in flexion, extension and mid-flexion are crucial. Blood exam, standardized radiographic views, and CT scan are powerful tools for etiologic diagnosis of total knee arthroplasty failure. Templating is unique and mandatory to provide the surgeon with the critical data concerning the valgus position of the femoral component, the AP size of the femoral component, and the optimal position of the joint line; these three parameters are determinant for the final clinical outcome. A stepwise surgical technique with close adherence to the guiding principles of revision knee arthroplasty should be adopted from skin incision to closure. Femoral and tibia components with modular stem are ideally set at their optimal position as predetermined by templating. Any residual implant-bone gap is filled with metallic augment or bone graft. Finally, repositioning of the patella on a symmetrical bone cut presents a great value for a successful procedure

Kapandji technique as a minimally invasive procedure for selected patients with two- and three- part fractures of the proximal humerus

Current algorithms for decision making in proximal humerus fractures consider the fracture pattern along with the patient characteristics and surgeon's experience. Minimally invasive techniques for reduction and internal fixation of many types of these fractures have recently been widely promoted, especially with the use of the newly developed locking plate systems. Intramedullary flexible nailing is one of the oldest techniques using minimally invasive reduction and fixation of proximal humerus fractures. Kapandji technique uses the "Deltoid V" landmark as entry point for intramedullary insertion of the flexible nails into the humeral head. The authors report their experience with this procedure in twenty-six, relatively young patients with good bone quality, presenting with displaced 2- or 3-part extra-articular fracture of the proximal humerus, treated with percutaneous reduction and intramedullary flexible nailing as described by Kapandji. Nineteen medical records were available for this retrospective review, with 9 to 12 months follow-up. There were 15 excellent and 1 good results when patients were assessed for pain, function and range of motion of the shoulder. The authors submit that Kapandji technique is a valuable procedure for management of extra-articular displaced 2- and 3- part proximal humerus fractures in young patients with good bone quality

[Core decompression in stage 1 idiopathic necrosis of the femoral head]

The osteonecrosis of the femoral head is a progressive multi-etiologieal disease; its prim urn inoveizs is circulatory and the pathophysiology is still unexplained. Ficat and Arlet classified this disease into 5 stages from 0 to IV. The progression from one stage to another is inevitable if surgical treatment is not performed early. The MRI is currently the investigation of choice in detecting infraradiological stage I necrosis. The core decompression as proposed by Ficat and Arlet allows to excise the necrotic zone, confirm the histological diagnosis, decompress the intramedullary increased pressure and favor the ncovascularization of the femoral head. The aim of this study is to present the mid-term results of the core decompression in a series of 17 hips in 16 patients with an average age of 46 years that were operated upon in stage I idiopathic necrosis of the femoral head, 4 to 6 weeks after the symptoms appeared. The MRI demonstrated the zone of necrosis iii 16 hips. The histological examination confirmed the diagnosis of necrosis in 16 hips including the one which was negative on MRI. The Merle d'Aubigne hip score was used for the clinical evaluation and showed to be less than 15 in all hips preoperatively. This score improved to 18 [full value] after a mean follow-up of 8 years, ranging from 3 to 13 years. The X-rays of the operated hips remained normal at the final follow-up in all cases. The very high percentage [100%] of recovery and healing in stage I femoral head necrosis hi this series may be explained by the absence of obvious etiological factors [idiopathic necrosis] and moreover by the short delay between the onset of the symptoms and the operative treatment. We believe that the MRI is the examination of choice that should be done early hi patients with a painful hip and normal X-rays and that core decompression performed soon is an excellent procedure to treat stage I idiopathic necrosis of the femoral head

Importance of putting a registry for hip arthroplasty in Lebanon

A registry for hip arthroplasty is an excellent method for the surveillance of complications and of short-, mid- and long-term results of a procedure which is becoming increasingly more frequent. Surveillance may lead to improvement of results, reflected by a decrease in the rates of revisions performed after primary surgery, and of health expenses. In addition, registry data can be used for epidemiological studies. This article proposes a financial projection of savings which can be obtained as a result of hip revision rate reductions

rupture spontanee bilaterale simultanee du tendon quardricipital. a propos d'un cas chez une patiente hemodialysee avec hyperparathyroidie

The bilateral simultaneous spontaneous rupture of the quadriceps tendons is a rare condition. Of the pathologies associated with this condition, in the literature, chronic renal failure with hyperparathyroidism is of special interest. In this context, the frequency of this lesion is related to the chronicity of the renal disease. We report a case treated surgically with a good functional result in a patient under dialysis with hyperparathyroidism