[Allograft-prosthesis composite arthroplasty for posttraumatic floating elbow]. / Coude ballant post-traumatique traité par prothèse totale manchonnée avec une allogreffe massive.

Loss of bone stock in the elbow joint raises serious problems for reconstruction surgery. Total allograft-prosthesis composite arthroplasty is an attractive alternative to revision prosthesis and isolated osteoarticular allografts known to have many drawbacks. Use of this method is rather recent for revision procedures and tumor surgery and posttraumatic cases are rare (five reported cases). We report a case of posttraumatic floating elbow treated with this technique. At 75 months follow-up, the clinical result was excellent with the Mayo Clinic performance score at 100/100. Allograft-native bone fusion was complete and there were no complications, particularly no loosening. This composite technique is particularly well adapted for patients with major bone and joint loss. It can avoid the specific problems associated with each of the techniques used alone. The allograft reconstructs bone stock while the prosthetic component avoids the clinical expression of graft epiphyseal lysis.

[Associated fracture of the posteromedial tubercle and the lateral process of the talus: a case report. Contribution of computed tomography]. / Fracture associée du tubercule postéro-médial et de l'apophyse latérale de l'astragale: un cas. Apport de la tomodensitométrie.

PURPOSE OF THE STUDY: Fracture of lateral process of the talus is an uncommon injury, fracture of the posteromedial tubercle of the talus is quite rare, and association of the two lesions is not reported previously. We report a case of an associated fracture of posteromedial tubercle an lateral process of the talus. PATIENT AND METHODS: The mechanism of injury was forced ankle dorsiflexion and pronation, this mechanism was responsible of an avulsion of the posteromedial tubercle by the postero talotibial ligament and a fracture of lateral process by compression between the lateral malleolus and the calcaneus. RESULTS: Conventional radiographs permitted the diagnosis of the lateral process fracture but the fracture of the posteromedial tubercle was showed only on CT scans. DISCUSSION: The fracture of the posteromedial tubercle was treated by internal fixation, through a posteromedial approach. At 12 months follow-up the patient was able to walk without pain and radiographic result was excellent (no avascular necrosis of the tubercle and no Arthrosis of subtalar joint).

[Elastic intramedullary nailing of the tibia with the Marchetti-Vicenzi nail. 43 treated cases]. / L'enclouage élastique du tibia à foyer fermé par clou de Marchetti-Vicenzi. A propos de 43 cas traités.

PURPOSE OF THE STUDY: The purpose of this study was to analyse the results of tibial intramedullary nailing using an unreamed "Universal Elastic Bundle Nail". MATERIAL AND METHODS: Forty-three intramedullary nailing of tibial shaft were done in 43 patients with recents fractures, from May 1993 and May 1996. There were 36 males and 7 females. The average age was 31.5 years (range 17-68 years). Thirty-three were injured in a traffic accident (20 motorcycles, 5 pedestrians and 8 car passengers), seven were injured in a home accident (fall) and three had a sport injury. There were 13 open fractures according to Gustilo: 5 grade I, 7 grade II and one grade III B. Eight fractures involved the proximal metaphyseal part of the tibia, 16 the distal metaphyseal part and 14 the tibial shaft; in five cases there were segmental fractures. According to AO classification there were: 10 fractures type A, 24 fractures type B and 9 fractures type C (5 segmental fractures). In 5 cases there were associated femoral fractures: three ipsilaterals and two controlaterals. All were treated in the same time: four by UEBN device and one by AO's nail. All the patients with type B and C fractures were positioned on a Maquet table with a boot traction or transcalcaneal pin traction (in the distal fractures). The nail was introduced after closed reduction through a vertical transpatellar tendon incision, without reaming procedure. RESULTS: Forty one fractures healed after an average time of 96 days (60-120). In 11 open fractures bone union occurred after 98 days (85-120). The distal fractures healed after a mean time of 86 days (60-120), proximal fractures in 123 days and mid shaft fractures in 98 days. In type A fractures bone union occurred after an average time of 68 days, while bone union occurred after a mean time of 100 days in type B and C fractures. Two patients with an open proximal type B fracture, had a delayed union: both healed after proximal screws removal. Two fractures healed with a valgus angulaton 5 degrees and 10 degrees. No infection, no loss of reduction and no bundle migration has been noted. DISCUSSION: The Marchetti-Vicenzi's nail (UEBN) permitted a stable fixation in tibial fractures. The use of this unreamed nailing coupled with an automatic distal locking in the metaphyseal cancellous bone, reduced operative time and shortened X Ray's radiation exposure. At the follow-up fracture healing occurred in 41 cases 95.3 p. 100 at four months. Two delayed union occurred after four months, the two cases were open fractures grade II. All the two cases healed after secondary procedure without any loss of function. Malunion occurred in two patients (in only one case there was a major valgus angulation 10 degrees), the two cases were related to technical error. We had no cases of infection or leg shortening or bundle migration in the ankle joint. CONCLUSION: We believe that Universal Elastic Bundle Nail allows a stable and safety fixation in open or closed tibial fractures without pseudarthrosis and without infection (in our series).

[Reconstruction of a complex defect of the upper third of the humerus by pedicle transplant of the lateral edge of the scapula. A case report]. / Reconstruction d'une perte de substance complexe du tiers supérieur de l'humérus par transplant pediculé du bord latéral de l'omoplate. A propos de un cas.

Vascularized bone transfer of the lateral border of the scapula is exceptionally used in orthopaedic surgery. The authors report a case of pedicle transfer of the lateral border of the scapula designed to reconstruct a nine centimetre bone defect of the upper third of the humerus following a gunshot wound. A complementary conventional bone graft was performed one month later and consolidation was achieved at the fourth month.

PLD score evaluation of the quality of life after severe (Grade III) open tibial fractures

Grade III open tibial fractures often require long hospitialized and many operations. They always leave unsightly scars and functional results are sometimes very poor. We wanted to establish a predictive score for use in all cases to help us to decide if amputation would give a better result or not. We devised a "PLD" scoring system with a maximum of twenty points, comprising data that concern the patient (0 to 4), the lesions (0 to 14) and the delay of bone coverage(0 to 2). Patient outcome was quantitatively scored by assessing the function (15 points) and the quality of life (professional, sport and leisure, social and psychologic, 15 points). Twenty-seven cases of grade III open tibial fracture were reviewed for this study. Traffic accidents (23 cases) were very frequent. For each case, the total hospital stay and the type and the number of interventions were noted. PLD scores were calculated at emergency and after one month. Final outcome was evaluated at the latest patients follow-up. Results showed that if the PLD score in emergency or at one month was < 5, the final resut was good or excellent (>25) for more than 80 percent of patients. If the score at one month was < 5, the result was judged poor (<20) in more than half the cases. If the PLD score in emergency or at one month was o 20, all such cases required an amputation in emergency or at a later stage. (AU)

[Coxa vara in children. Apropos of 28 cases]. / Les coxa-vara infantiles. A propos de 28 cas.

Infantile coxa-vara is an infrequent lesion and two etiologic factors have been recognised: mechanical and genetic. As in Blount's disease, the same populations (black and scandinavian people) are usually affected. Twenty eight patients with 42 infantile coxa vara were reviewed. The diagnosis was often late. The radiographs showed the decrease of the neck-shaft angle and the signs of cervical dystrophy. The aggravation of the coxa vara is usual and pseudarthrosis or osteo-arthritis can be observed. Thirty six femoral valgus sub-trochanteric osteotomies were done. The results were best when the surgery was done before the age of 9 years. When the surgery was done later, an epiphysiodesis of the greater trochanter was associated to the femoral osteotomy if the epiphyseal cartilage was fused. Langenskiold's osteotomy was used only when the neck-shaft angle was lower than 80 degrees. The results were evaluated according to the neck shaft angle and the morphology of the femoral head: 22 very good and good, 11 fair and 3 bad results were noted.

[Blount's disease in the Antilles. Apropos of 26 cases]. / La maladie de Blount aux Antilles. A propos de 26 observations.

Blount's disease is associated with agenesis of the medial tibial plateau leading to tibia vara. It appears to be more frequent in Scandinavian countries and in black populations. Twenty-six cases had been seen in Martinique (Antilles) of whom twenty were children. A classification into six stages was described. Stage IV is a critical one. Before it, corrective osteotomy will often lead to complete healing. After stage IV, lateral epiphysiodesis must be added to avoid recurrence of deformity. The technique of osteotomy was variable according to the age of the child and the obliquity of the joint line. In young children, a subtraction closing wedge osteotomy is suitable. In older children a "V" shaped osteotomy is recommended to lessen the amount of shortening. At the end of the growth period, a medial opening wedge osteotomy is advisable. In adults (six cases) whose deformity can reach as much as 50 degrees with considerable ligamentous laxity, reefing of the ligament must be added to the osteotomy. The problem of the opposite knee is discussed. Even when the disease is not bilateral, it can tend to develop towards arthrosis.

[The venous vascularization of the pancreas]. / La vascularisation veineuse du pancreas

The venous vascularisation of the pancreas has been studied in the West African on 157 pieces, by the method of injection-corrosion. The polymeric plastic used for this operation was Rhodopas A X 85.15. The results are quite comparable to those reported in Couppie's thesis (Lyon, 1957) on the European. The venous drainage of the head of the pancreas is secured by four arches: anterior, posterior, inferior and intra-glandular, formed by three pancreatico-duodenal veins (inferior-anterior, superior-posterior, inferior-posterior). Three other venous trunks, independant from that system, and which are not reported in the former descriptions, participate in the formation of secondary, inconstant new arches. For the body and the tail of the pancreas, the disposition in two types described by Calas was found, but with an inverted respective percentage. The lower pancreatic vein was often demonstrated with particular clearness. For the neck of the pancreas, the venous vascularisation is secured by the isthmic veins, sometimes linked in a pre-glandular arch.