Learning the skills needed to perform shoulder arthroscopy by simulation.

INTRODUCTION: Simulation for arthroscopy helps surgical trainees develop their surgery skills in a safe environment. This teaching technique has become more widespread in recent years because of the need to provide surgeons in training with an alternative to the current methods. We hypothesized that a resident in surgery could acquire the skills needed to perform arthroscopic shoulder surgery by working on a simulator. MATERIAL AND METHODS: The study was conducted over a 4-month period from June to September 2016. All the surgeons and residents in our department participated in the study. We recorded each participant's age, sex, dominant hand, and video gaming experience. We used the Arthro Mentor™ simulator from Simbionix (now 3D Systems). Testing was carried out at the start and end of training to evaluate the participant's skills and their progression. The changes were evaluated statistically. RESULTS: Fourteen surgeons were included in the study. They were split into two groups: controls and residents. There was a statistically significant improvement in the intern group between the overall pre-test score and the overall post-test score. There was no significant improvement in the overall score of the control group between the pre-test and post-test. DISCUSSION: For surgeons in training, shoulder arthroscopy simulation helps them acquire the skills needed to perform arthroscopy such as hand-eye coordination, triangulation and the ability to work in three-dimensions based on two-dimensional visual information. We believe that the benefit of simulation resides in learning the skills needed to perform a surgical procedure, not in learning the procedure itself. LEVEL OF EVIDENCE: III-case-control study.

Pyoderma gangrenosum or necrotising fasciitis? Diagnostic and therapeutic wanderings.

A case of post-traumatic lower-limb pyoderma gangrenosum (PG) in a 77-year-old female is reported. The diagnosis of PG is frequently one of exclusion, and it is therefore unsurprising that the condition was initially mistaken for necrotising fasciitis then for necrotising bacterial dermo-hypodermitis. Medical and surgical treatment for those conditions proved ineffective. This fact, together with the atypical presentation, promoted a re-evaluation of the diagnosis. The clinical findings and investigation results converged to suggest PG, and a therapeutic trial was initiated. The good treatment response and negative findings from tests for other conditions established the diagnosis of post-traumatic PG.

Lung metastases of diffuse giant cell tumour of the fibular tendon sheath at the ankle: A case report.

Diffuse giant cell tumours of the tendon sheaths are described in the literature as locally aggressive soft-tissue tumours. We report the case of a 56-year-old male with a history of multiple surgical procedures for a giant cell tumour of the fibular tendon sheath at the right ankle. The multiple recurrences prompted monitoring by positron-emission tomography, which showed lung tumours. Biopsies confirmed that the tumours were metastases from the giant cell tumour of the tendon sheath. In patients with recurrent and/or diffuse giant cell tumour, positron-emission tomography is an effective monitoring tool.

Endoscopic ulnar nerve release at the elbow: Indications and outcomes.

BACKGROUND: Ulnar nerve entrapment at the elbow is the second most common nerve entrapment syndrome at the upper limp, after carpal tunnel syndrome. Many surgeons feel that ulnar nerve instability contra-indicates endoscopic nerve release. Published studies, however, found no evidence that pre-operative or intra-operative ulnar nerve instability adversely affected clinical outcomes. The objective of this prospective study was to define the indications and describe the outcomes of endoscopic ulnar nerve release at the elbow. HYPOTHESIS: Endoscopic ulnar nerve release at the elbow is a valid option even in patients with ulnar nerve instability and regardless of the severity of the compression. MATERIAL AND METHODS: We conducted a prospective single-centre study of patients scheduled for surgery based on clinical and electromyographic manifestations of ulnar nerve entrapment at the elbow. Ulnar nerve instability (incomplete dislocation, i.e., Childress A) before or during surgery was not a contra-indication to the procedure. The patients were re-evaluated 12 months after surgery. RESULTS: Seventeen patients were included in the statistical analysis. The modified Bishop's score indicated excellent or good outcomes in 15 (88%) patients (excellent in 4 and good in 11) and a fair outcome in 2 patients. Functional outcomes were not associated with the presence of ulnar nerve instability before surgery. DISCUSSION: We elected to include patients with Childress A ulnar nerve instability. Clinical outcomes in these patients were similar to those in patients without ulnar nerve instability. LEVEL OF EVIDENCE: IV, open prospective study of treatment outcomes.

Internal fixation of the fibula in ankle fractures: a prospective, randomized and comparative study: plating versus nailing.

AIM: Open reduction and internal plate fixation of the fibula is the gold standard treatment for ankle fractures. The aim of this study was to perform a prospective randomized study to compare bone union, complications and functional results of two types of internal fixation of the fibula (plating and the Epifisa FH intramedullary nail). MATERIALS AND METHODS: Inclusion criteria were: closed fractures, isolated displaced fractures of the lateral malleolus, inter- and supra-tubercular bimalleolar fractures, and trimalleolar fractures. This study included 71 patients (mean age 53 ± 19): plate fixation group (n=35) and intramedullary nail fixation group (n=36). In seven cases, intramedullary nailing was technically impossible and was converted to plate fixation (the analysis of this sub-group was performed independently). Two patients died and two patients were lost to follow-up. The final comparative series included 32 cases of plate fixation and 28 cases of intramedullary nail fixation. Union, postoperative complications and Kitaoka and Olerud-Molander functional scores were analyzed after one year of follow-up. RESULTS: There was no significant difference in the rate of union (P=0.5605) between the two types of fixation. There were significantly fewer complications (7% versus 56%) and better functional scores (96 versus 82 for the Kitaoka score; 97 versus 83 for the Olerud-Molander score) with intramedullary nailing than with plate fixation. CONCLUSION: Intramedullary nailing of the lateral malleolus in non-comminuted ankle fractures without syndesmotic injury is a reproducible technique with very few complications that provides better functional results than plate fixation. LEVEL OF EVIDENCE: II (randomized prospective study).

Treatment of comminuted distal radius fractures by resurfacing prosthesis in elderly patients.

In elderly patients, distal radius fractures are often associated with osteoporotic bone. Under these conditions, anatomic resurfacing implants may provide satisfactory results in terms of range of motion, pain and function. Between July 2009 and January 2012, eight elderly patients were treated with the SOPHIA™ implant at our hand surgery department. Inclusion criteria were isolated comminuted distal radius AO type C2 fractures in patients greater than 70 years of age. All patients were reviewed in February 2013 by an independent surgeon. Clinical, functional and radiographic assessments were performed. Mean follow-up was 25 months (range 17-36 months). Mean ROM was 45° (range 40-50°) in flexion and 44° (range 40-50°) in extension. Mean pronation-supination range was 160°. Mean grip strength was 18 kgf. Mean Quick DASH was 18.2/100 (range 6.82-29.55) and mean pain on VAS was 2.33 (range 0-4). X-rays did not reveal any implant loosening or ulnar translation of the carpus. Use of a wrist resurfacing implant led to rapid recovery of autonomy in elderly patients with comminuted distal radius fractures. It parallels the use of shoulder or elbow prostheses for complex joint fractures in the elderly.

Surgical management of recurrent dislocation after total hip arthroplasty.

Dislocation is a major complication of total hip arthroplasty (THA), whose frequency has been unaffected by improvements in surgical techniques and implants. The dislocation rate depends on multiple factors related to the patient, hip disease, and surgical procedure and is therefore also dependent on the surgeon. The many published studies on THA dislocation, its causes, and its treatment have produced conflicting results. The objective of this work is to review the management of THA dislocation, which is a severe event for both the patient and the surgeon. This lecture starts with a brief review of data on THA dislocation rates and the many factors that influence them. Emphasis is then put on the evaluation for a cause and, more specifically, on the challenges raised by detecting suboptimal cup position. Next, reported techniques for treating THA dislocation and the outcomes of each are discussed. Finally, a management strategy for patients selected for revision surgery is suggested.

Distal humerus fractures in patients over 65: complications.

INTRODUCTION: Fractures of the distal humerus in patients over the age of 65 remain a therapeutic challenge. Treatment options include conservative treatment, internal fixation or total elbow arthroplasty. The complications of these different treatment options were evaluated in a multicentre study. MATERIALS AND METHODS: Four hundred and ninety-seven medical records were evaluated. A retrospective study was performed in 410 cases: 34 received conservative treatment, 289 internal fixation and 87 underwent total elbow arthroplasty. A prospective study was performed in 87 cases: 22 received conservative treatment, 53 internal fixation, and 12 underwent total elbow arthroplasty. Patients were evaluated after at least 6 months follow-up. RESULTS: The rate of complications was 30% in the retrospective study and 29% in the prospective study. The rate of complications in the conservative treatment group was 60%, and the main complication was essentially malunion. The rate of complications was 44% in the internal fixation group and included neuropathies, mechanical failure or wound dehiscence. Although complications only developed in 23% of total elbow arthroplasties, they were often more severe than those following other treatments. DISCUSSION: Complications develop in one out of three patients over 65 with distal humerus fractures. Three main types of complications were identified. Neuropathies especially of the ulnar nerve, especially during arthroplasty, must always be identified, the nerve requiring isolation and transposition. Bone complications, due principally to mechanical failure, were found following internal fixation. Despite technical progress, care must be taken not to favor excessive utilization of this treatment option in complex fractures on fragile bone. Although there were relatively fewer complications with total elbow arthroplasty they were more difficult to treat. Ossifications were frequent whatever the surgical option and can jeopardize the functional outcome.

Epidemiology of distal humerus fractures in the elderly.

INTRODUCTION: Despite recent treatment advances, management of distal humerus fractures in the elderly remains one of the most challenging aspects of trauma surgery. Although these fractures are relatively rare, they fall under the umbrella of osteoporotic fractures, which themselves are increasing in frequency. MATERIAL AND METHODS: Two studies were performed: one retrospective study of 410 patients over a 10-year period and one prospective study of 87 patients over a 1.5-year period. This allowed us to analyse the epidemiology of distal humerus fractures in subjects above 64years of age in 19 different French hospitals. All of the included patients were reviewed, except for one subject in the retrospective study who had died, but whose data was still used. RESULTS: Most of the fractures were AO type C, occurred in women in more than 80%, and occurred in nearly one of two persons above 80 years of age. Most of the patients had a high level of autonomy and lived at home. Unlike other upper limb fracture sites, nearly 90% of patients required surgical treatment. The presence of osteoporosis was found to have a tremendous impact on fracture care, complications and results. CONCLUSION: Functional status is more important than chronological age in this patient population; the former must be taken into account when determining treatment indications. LEVEL OF EVIDENCE: Level IV.

Percutaneous iliosacral screw fixation in unstable pelvic ring lesions: the interest of O-ARM CT-guided navigation.

INTRODUCTION: The reference surgical treatment for unstable posterior pelvic fracture is percutaneous iliosacral screw fixation, isolated or in association with other techniques. As there is a risk of passage outside the bone when performing screw fixation under fluoroscopy, new image-guidance techniques have been developed: fluoronavigation, peroperative 3D navigation, CT-linked navigation, etc. Since September 2011, our department has performed iliosacral screw fixation under CT control linked to navigation so as to optimize screw positioning. This innovative technology has been used in neurosurgery in our center since 2007, for disc implants, spinal fracture, vertebral arthrodesis and intracerebral localization. MATERIAL AND METHODS: Six patients were treated by iliosacral screw fixation for posterior pelvic ring fracture lesion. The O-ARM (Medtronic(®)) computer-assisted surgical navigation system was used, combining surgical navigation and peroperative 3D imaging. This kind of osteosynthesis is suitable for non-displaced or prereduced fracture. A radiation dose report is drawn up at end of surgery. DISCUSSION: Postoperative course does not differ from other percutaneous osteosynthesis techniques, combing the advantages of a percutaneous approach (reduced infection and blood-loss rates, etc.) while optimizing iliosacral screw positioning. To date, no radiation overexposure has been found. CONCLUSION: The precision and safety of iliosacral screw fixation are now unequalled, meeting the basic computer-assisted surgery principles of reduced morbidity without overexposure to ionizing radiation. Indications for computer-assisted surgery should therefore be extended to iliosacral pathologies (arthritic, tumoral and inflammatory), non-displaced acetabular fracture, etc.

Percutaneous fixation of tibial plateau fractures under arthroscopy: a medium term perspective.

INTRODUCTION: Arthroscopically assisted percutaneous internal fixation has found its place in the treatment of Schatzker I-III tibial plateau fractures, with good short-term results reported. The objective of this study was to observe the progression of osteoarthritis at the medium term through clinical and radiological assessment. PATIENTS AND METHODS: Twenty-seven patients were treated with arthroscopy-assisted percutaneous fixation for stage I-III Schatzker tibial plateau fractures. RESULTS: Twenty-one patients were reviewed with a mean follow-up of 59.5 months (range, 24-138 months); satisfaction was good except for return to sports activity. The mean IKS score was 85.2 for the knee score and 91 for function. The mean Lysholm score was 86 points, with a mean Tegner activity score of 4. A mean score of 25.5 and 8 points was found for the clinical and radiological Rasmussen scores, respectively; 47.6% of the patients presented early osteoarthritis on radiological evaluation. DISCUSSION: The medium-term functional results were comparable to the short-term results. The patients were satisfied except for return to sports activity. Age at surgery appears as a prognostic factor for osteoarthritis. CONCLUSION: Arthroscopic internal fixation remains the technical reference for Schatzker I-III tibial plateau fractures despite the appearance of osteoarthritis, which remains less extensive than in open surgery. LEVEL OF EVIDENCE: Level IV. Retrospective study.

Is external rotation the correct immobilisation for acute shoulder dislocation? An MRI study.

INTRODUCTION: Anterior dislocation of the shoulder is frequent, with high rates of recurrence. Immobilization in external rotation (ER) seems to improve results, although few studies have actually demonstrated this. The present MRI study examined the impact of ER on labral and capsular ligamentous complex lesions after primary dislocation. MATERIAL: A prospective study was started up on January 1st, 2007. Inclusion criteria were: acute initial anteromedial dislocation of the shoulder, without past history of shoulder trauma. There were 23 such patients, with a mean age of 37 years. METHODS: Early MRI scan used the following protocol: one acquisition in internal rotation followed by one in ER. Study criteria were: hemarthrosis, ER amplitude, rotator cuff status, bone lesion, and labral lesion stage (Habermeyer's classification) and displacement (Itoi criteria). RESULTS: There were 12 right and 11 left shoulders. Mean time to MRI was 3.7 days. There were three rotator cuff tears, no glenal lesions, and 14 humeral notches. Hemarthrosis was almost systematically present, with its distribution modified by ER in 75% of cases; three patients showed no posterior hemarthrosis, in whatever rotation. Mean ER was 37 degrees. On Habermeyer's classification, there were 12 stage-1 lesions, and 10 stage-2; one patient had no labral lesion. All separated labra were reduced in ER, five (21%) totally. In six cases, labral displacement changed according to rotation. All anterior joint effusion was reduced in ER, in three cases totally. DISCUSSION: According to Itoi among others, immobilization in ER is the way to reduce recurrence of anterior dislocation. The present study confirmed that labral reduction was systematic with ER, but it was by no means always complete. ER seemed more effective in reducing the separation. Results further confirmed that ER reduced anterior capsule volume, a recurrence factor. CONCLUSION: ER reduced hemarthrosis, anterior capsule detachment and labral lesions, and never the contrary. The interest of immobilization in ER to prevent shoulder instability needs confirming by long-term clinical studies; we are therefore extending the present MRI study by a clinical study of ER immobilization in all patients showing significant labral lesion reduction. LEVEL OF EVIDENCE: Level IV. Retrospective therapeutic study.

Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixed-angle plate.

We randomized 103 patients over the age of 50 with an unstable closed intra- or extra-articular dorsally displaced distal radius fracture to have either palmar fixed-angle plating (n=50) or 'mixed pinning' (n=53) and compared the clinical and radiological outcomes at 3, 6, 12 and 26 weeks after surgery in a prospective study. Postoperative palmar tilt was significantly better in those stabilized with K-wires, but loss of reduction was statistically less in those stabilized with a plate. At 26 weeks, functional results, assessed by DASH and Herzberg scores, were better in those fixed with a plate.

Patellar chondropathy prevalence at anterior cruciate ligament reconstruction: analysis of 250 cases.

INTRODUCTION: Anterior knee instability caused by anterior cruciate ligament (ACL) deficiency results in meniscal as well as chondral femorotibial and/or femoropatellar damages over a more or less long duration delay. This study's objectives were, in chronically deficient ACL patients, to assess onset delay for developing chondral patella lesions and also analyse these lesions characteristics in relation to laxity duration. HYPOTHESIS: Chondral patellar lesions in ACL deficient knees get worse with time. MATERIAL AND METHODS: We reviewed 250 charts of patients who had undergone arthroscopically assisted surgery for knee anterior laxity. The arthroscopic procedures were conducted between January 1995 and January 2005. Chondral damages were evaluated at surgery according both to International Cartilage Repair Society (ICRS) and Bauer and Jackson classifications. The data were analyzed using the Kruskal-Wallis test and the Fisher exact test. RESULTS: Of the 250 analysed charts, 72 patients (28.8%) were found to present chondral patella lesions. The majority of these lesions were superficial and involved the lateral facet area. We observed a statistically significant ICRS worsening grade in relation to laxity duration. DISCUSSION: Few publications in the literature report patellar involvement in anterior laxity of the knee. However, our results are comparable to those of the rare series found. The pathomechanics of these lesions has not yet been precisely identified and requires further biomechanical studies. CONCLUSION: Patellar damage is frequent with anterior laxity (28.8% in our series) and duration is correlated with statistically significant aggravation of these lesions. Currently, the assessment of these patellar lesions is considered less important than meniscal and femorotibial lesions, even though the natural history of ACL disruption seems to be evolving toward degeneration of all the compartments of the knee, including the femoropatellar compartment.

[Comminuted intra-articular fractures of the distal humerus in elderly patients]. / Fractures articulaires complexes de l'extrémité distale de l'humérus chez le sujet âgé

Treatment of comminuted intra-articular fractures of the distal humerus in elderly patients remains a challenge in trauma surgery. These fractures are rare, but their frequency increases. Our multicenter studies collected 238 cases of comminuted intra-articular fractures of the distal humerus in patients older than 65: two hundred and five cases for the retrospective study, 33 for the prospective study with a minimum follow-up of six months. The following criterias were studied: age, sex, state of health (with ASA score), functional scores (with Katz score), osteoporosis by the OST score and dual X-ray absorptiometry. The results were evaluated according to the Mayo Elbow Performance Score (Morrey) and the Quick DASH. X-ray studies were performed in order to assess both results for prosthesis and osteosynthesis. The following criteria were studied: bone healing, quality of reduction, signs of arthritis (Broberg-Morrey), prosthetic position, mechanical complications, prosthesis fixation. There were 80% of women in good health according to the ASA score (more than 70% of ASA 1 or 2). Most of them (80%) were self-governing and living at home. Hundred and seventy-two patients had an osteosynthesis and 44 had a prosthetic reconstruction (like Coonrad-Morrey prosthesis). Patients treated with osteosynthesis were younger (mean age was 77) than those treated with prosthetic reconstruction (mean age 81). Mean follow-up was 32 months. Results of osteosynthesis were good and excellent for 77% of the patients. Complications occurred for 20% of patients with a reoperation rate of 13%. Results of prosthetic reconstruction were good and excellent for 83% of the patients with 14% of complications and 6% of reoperation. Prosthetic reconstruction seemed to be better than osteosynthesis according to the Mayo Clinic score (84 points versus 77 points for the retrospective study and 95 points versus 75 points for the prospective study). However, the statistical analysis was not significant. Treatment of these fractures must be discussed according to the physiological status of the patient and the fracture patterns (scan evaluation). In conclusion, osteosynthesis remains the standard treatment when stable fixation is feasible. However, prosthetic reconstruction should be discussed for dependant patients or with comorbidity factors, bad bone quality leading to poor osteosynthesis or complex fracture.

[Intra-articular fracture of the distal humerus: outcome after osteosynthesis in patients over 60]. / Résultats de l'ostéosynthèse des fractures articulaires de la palette humérale chez le sujet âgé

PURPOSE OF THE STUDY: This is a retrospective analysis of patients aged over 60 years treated in a single center for intra-articular fractures of the distal humerus. Outcomes were compared with published results for osteosynthesis and arthroplasty. MATERIAL AND METHODS: The cohort included 34 patients (36 fractures) reviewed at mean 35 months. Mean age was 77.6 years. Fracture types were: C1: 8, C2: 10, C3: 18. The transtricipital posteromedial approach was used in the majority of patients. Fixation was achieved with a prebent lateral plate (n=11 fractures), a Y-plate (n=9), two plates (n=4), pins or screws (n=9) and an external fixator (n=3). Outcome was assessed with the Mayo elbow score, the Bröberg radiographic score and patient satisfaction. The social impact was also noted. RESULTS: The mean Mayo elbow score was 73.3; outcome was excellent (n=13), good (n=8), fair (n=5) and poor (n=10). Pain persisted in 23 patients. The mean range of movement was 80 degrees . Patient satisfaction remained good. Ten patients did not recover their preoperative level of autonomy. Radiological signs of osteoarthritis were noted for 75% of patients and nonunion of the humeral fracture in 32%. There were three superficial infections and four neurological lesions. DISCUSSION: Good and very good outcome was noted for 59% of the osteosyntheses in this series, compared with 71% in the literature. The rate for arthroplasty is 95%. The mean range of motion is 101 degrees , 17% of patients with a prosthesis complain of pain, 5% develop a superficial infection and 6.5% suffer neurological injury. The estimated rate of revision for arthroplasty is 11% at 7 years. CONCLUSION: Beyond the age of 65 years and based on evidence reported in the literature, it would be advisable to prefer another mode of treatment for these intra-articular fractures, for example elbow arthroplasty, particularly for comminutive fractures on osteoporotic bone.

[Total hip arthroplasty for treatment of acute acetabular fracture in elderly patients]. / L'arthroplastie totale de hanche dans le traitement des fractures récentes de l'acétabulum du sujet âgé

PURPOSE OF THE STUDY: The standard treatment of displaced acetabular fractures is open reduction and internal fixation (ORIF). In elderly patients, ORIF may not be the best option because of osteoporotic bone and the necessary period of bed rest. Primary total hip arthroplasty (THA) for displaced acetabular fractures was initiated by Westerborn in 1954. Since then, several authors described their experience and since 1986 many studies have reported good results with this type of treatment. This study assessed outcome obtained in patients treated by primary THA for acetabular fracture in the orthopedic department of the Dupuytren Teaching Hospital in Limoges. MATERIAL AND METHODS: Between 1981 and 2001, 16 patients, mean age 76.1 years (range 64-89) were treated with primary THA for recent displaced acetabular fractures. Bone loss was quantified using the SOFCOT classification for acetabular revision THA: stage III was noted in four patients (25%) and stage IV in twelve (75%). No attempts were made to achieve anatomic reduction of fracture fragments, but a reinforcement ring was used, coupled with autologous bone graft for the acetabulum. All patients were assessed clinically using the Postel-Merle d'Aubigné et Harris scores and the Devane activity scale. Radiographs were used to assess union and signs of loosening according to De Lee and Charnley and the Gruen classifications. Ossifications were quantified with the Brooker classification. RESULTS: Mean follow-up was three years. The mean Harris hip score was 73.6 (range 47-93), and the mean Postel-Merle d'Aubigné score 13.8 (range 10-17). Twelve patients (75%) returned to their initial activity level on the Devane scale; only four decreased their daily activity by one level. All patients but one were satisfied. There was one case of partial neurological sensorial deficit. There were no postoperative dislocations. All fractures healed. There were six cases (37%) of heterotopic bone formation including grade IV ossification in one patient with a stiff hip which required surgical resection. There were five cases of radiolucent halo in one zone of the cup, and one case in two zones; all these lucencies were non-progressive and there was not sign of loosening at last follow-up. DISCUSSION: Orthopedic treatment for displaced acetabular fractures in elderly patients may not be suitable because of the risk of complications due to the prolonged period of decubitus. ORIF requires one surgery, but may nevertheless lead to a second operation because of osteoarthritis. Primary THA has many advantages: full weight bearing is achieved rapidly, decubitus complications are avoided, functional outcome was good with union for all of the fractures in our series. Nevertheless, despite differences between surgical procedures reported in the literature, ectopic ossifications are common and the overall rate of dislocation reaches 7% considering all reported series. CONCLUSIONS: In selected patients with a displaced acetabular fracture, we believe that an acute THA may provide several advantages including only one procedure and quick weight bearing with a lower rate of decubitus complications. In this small series, functional outcome was good for most of the patients who recovered their initial activity level.

Non-invasive imaging correlates with histological and molecular characteristics of an osteosarcoma model: application for early detection and follow-up of MDR phenotype.

BACKGROUND: In an orthotopic rat osteosarcoma model, histological and molecular findings were compared with the results of non-invasive imaging methods to assess disease progression at the primary site, the pattern of metastatic dissemination and the chemoresistance phenotype. MATERIALS AND METHODS: Primary tumor engraftment, vascularization, growth and metastatic spread were evaluated using 18FDG tomoscintigraphy. Bone neoformation in the primary tumor and metastasis was determined using 18FNa confirmed by classical histological studies. Chemoresistance phenotype was assessed by analysis of MDR1 and MRP1 genes expression compared to 99mTc MIBI imaging. RESULTS: 99mTc MIBI imaging correlated with the overexpression of the MDR1 and MRP1 genes. 18FDG, 18FNa and 99mTc tomoscintigraphies revealed that the pattern of vascularization, bone neoformation and hematogeneous metastatic dissemination in our animal model mimics its human counterpart. CONCLUSION: Multimodality, non-invasive imaging is a valid surrogate marker of histological and molecular characteristics in an orthotopic osteosarcoma model in immunocompetent rats; it allows extensive in vivo follow-up of osteosarcoma, including longitudinal analysis of chemoresistance.

Comminuted fractures of the radial head treated by the Judet floating radial head prosthesis.

Excision is not a suitable treatment for all comminuted fractures of the radial head. In elbows where instability can be predicted, a replacement arthroplasty of the radial head is more effective. The aim of this paper was to present the medium-term results of the Judet floating radial head prosthesis. This operation was performed on 14 patients between 1992 and 2003, of whom 12 were reviewed at a mean follow-up of five years and three months (1 to 12 years). The outcome was assessed using the Mayo elbow performance score and a modified Disability of Arm Shoulder Hand (DASH) questionnaire. There were six excellent results, four good, one fair and one poor, as graded by the Mayo score. The mean DASH score was 23.9/100 (0 to 65.8/100). The only significant complication occurred in one patient who developed a severe complex regional pain syndrome. There were no patients with secondary instability of the elbow, implant loosening, cubitus valgus, osteoporosis of the capitellum, or pain in the forearm and wrist. Our experience, combined with that of other authors using this device, has encouraged us to continue using the Judet prosthesis in comminuted fractures of the elbow where instability is a potential problem.

[Perforation of the sigmoid colon secondary to acetabular fracture]. / Perforation sigmoïdienne consécutive à une fracture de l'acétabulum.

Traumatic lesions of the colon associated with fracture of the acetabulum occurs in less than 2% of the cases. Direct perforation of the colon by a bony spike, which occurred in our patient, is even more exceptional. We were unable to find any other case reported in the literature. This case illustrates the importance of looking for intestinal lesions in all patients with pelvic injury presenting an unexplained infectious syndrome. Imaging provides clear evidence for avoiding late diagnosis and life-threatening situations.