Criteres predictifs d'une effraction articulaire meconnue apres osteosynthese d'une fracture du col du femur

On the basis of a retrospective study comprising 91 cases of femoral neck fracture treated by DHS, unrecognized screw articular penetration was observed in 9 cases [9,9%]. The coxa valga [Garden 1] fractures are the most interested by this complication [7 cases out of 9]. With a practical purpose and to avoid remarking each time complex measurements again we found that the distance "d" separating the end of the implant from subchondral bone calculated on antero posterior and lateral views and so the angle measured on the lateral view were two criteria significantly predictive of this technical error with respectively P 0,005 and P 0,0005.Thus during the surgical procedure taking these two measurements after the installation of the pin guide would allow attention on the risk incurred. In case of doubt, we have changed the way of this pin before resorting to drilling and tapping

L'enclouage selon ender des fractures de la region trochanterienne [. propos de 100 cas]

Trochanteric fractures may lead by old patients to death or functional handicap because of the risk of decompensation of other illness. Hundred patients with an average age 80 years have been treated by Ender nailing during a four years period. The patients were for the most autonomous and had for 50% of them an ASA score level III. The act has been realised under lumbar anaesthesia for 92 patients. The blood losses were minor and the average duration of the operation was 50 minutes. The patient may stand up after three days. 26 patients died during the three first months. postoperative results show for 60 reviewed patients neither an infection nor a pseudarthosis. For 19 patients a migration of the nails has been observed. 60% of the reviewed patients are able to walk as long as before the fracture. 25% of the patients are autonomous again. 15% of the patients became invalid. For 96% of the patients the hip mobility is normal but 11% of them suffer from a moderate rigidity of the knee due to the slipping of the nails. By 30 patients a vicious lateral turned callus has been observed without any functional consequence