[Medical certificates in occupational accidents, in common law and social affairs]. / Les certificats médicaux en accidents du travail, en droit commun et en matière sociale.

Physicians are asked to complete certificates within their profession. These certificates relate to various aspects of an individual's life, from birth to the end of life. The nature of requests is striking by its diversity. As a first step, the authors recall the outline of a certificate and its structure, as well as traps, hazards and risks to avoid. In a second step they describe three specific situations for the certificate: in the context of work accidents, common law accidents and social matters. All materials can not be treated in this space, so they refer the reader to the main bibliographic sources useful in this matter.

[About medical accidents and their medicolegal implications. Information and consent]. / Réflexions sur l'accident médical et ses implications médico-légales. Le consentement eclairé.

Medical practice today is not simple because of various factors impinging on the doctor-patient relationship. The concept of consent arises from the ethical principle of patient autonomy and basic human rights. It is also the rule of law (Civil Code article 16-3) that guarantees the patient's right and freedom to decide what should or should not happen to his/her body and to gather information before undergoing a test/procedure/surgery. No one else has the right to coerce the patient to act in a particular way. The authors after a reflexion about medical accidents and their medicolegal implications, discuss the means to display in order to provide to the patients the adequate information about their disease and proposed treatment, therefore protecting the medical practitioner from the consequences of insufficient or ill information.

[Complications of spine surgery and litigations]. / Complications de la chirurgie du rachis et responsabilité médicale.

The authors describe in this article the possible complications of spine surgery. By exposing them, they wish to draw the attention of the practitioners on the multiple risks related to these operations, as well as the means to prevent them and to make them stop their effects. The "zero" risk does not exist, even for the most common operations. However there is a tendency by the judiciary system to look favourably at the demands for compensation of damage, considering that at the origin of every post operative complication exists, more or less hidden, a fault eligible for financial repair. Up to the present day, a fault must be proven in the management of a medical case. A reminder of the foundations of the medical responsibility applied to the surgery of the spine is reported, knowing well that surgical damages are not always the result of an error or a misconduct, and therefore, the surgeon is not responsible for the damage in the absence of a proven fault.

[The role of bone cement in orthopaedic surgery]. / Le rô1e du ciment en orthopédie.

Bone cement has a central role in orthopaedic surgery. It is used with success in total joint replacement since years. Newer techniques such as vertebroplasty and kyphoplasty have been used during the last years. This article describes the chemical and mechanical properties of bone cement and will describe particularly his use in total hip arthroplasty and vertebropasty and kyphoplasty.

[Osteosynthesis of trochanteric fracture with percutaneus compression plate (PC.C.P.)]. / Ostéosynthèse des fractures trochantériennes par plaque de compression percutanée (PC.C.P.).

In terms of frequency, trochanteric fractures represent one of the most common problems in adult traumatology. Considering their physical and psychological consequences, and the patients mean age, they constitute one of the most acute public health problems faced by the elderly. Surgical reduction is currently considered as preferred treatment. Stable fixation of the fracture focus by osteosynthesis allows early mobilization of the treated member, central axis of the body. A series of 35 patients with a mean age of 78, surgically treated with Gotfried percutaneous plating between June 1998 and August 2000, have been followed-up to full fracture healing. The fractures were divided according to the AO fracture classification system. All patients were treated with this minimally invasive technique, which consists of introducing a percutaneous compression plate through two tiny stab incisions. The results take into account the reduction quality, mean hospital stay, evolution, perioperative and postoperative complications. The patients early weight bearing has been possible from the third day after the operation. The mean perioperative blood loss was estimated to 90 mL. The mean mortality rate during hospital stay was 5.7%, and 11.4% after three months. The complications encountered comprised two cephalic screw cutouts, two plate breakages and one surgical wound infection. Linked to the quality of the bone, regardless of the material used, these complications are likely to those observed with other methods. This short sample allows to consider the percutaneous compression plating as a valid surgical technique, though it can be opposed the same critics than other trochanteric fractures treatments. However, it offers the benefits of a closed and rapidly performed surgical technique, theoretically beneficial to improve the vital prognosis for this type of fracture.

BOP: biocompatible osteoconductive polymer: an experimental approach.

BOP (biocompatible osteoconductive polymer) is a material proposed for osteosyntheses and for filling of bone defects in orthopaedics, neurosurgery and stomatology. It is a composite made of a copolymer of N-vinylpyrrolidone and methylmethacrylate, of polyamide-6 fibers and of calcium gluconate. The histological investigation includes the study of 30 intact rabbit femurs instrumented with a BOP rod, as well as the study of organs of the reticuloendothelial system. The currently available results show the absence of toxicity on hematopoietic tissue. Zones of osteoblastic activity surround the rods, coupled with an osteoclastic reaction which may result in the partial fragmentation of the polyamide fibers and its incorporation in the newly formed bone. We also observed the encapsulation of the material. The biomechanical approach investigated the mechanical properties of the material in bending and in shear. The radiological aspects of the investigation consisted of computerized axial tomography of the implanted femurs to measure density at the bone-implant interface.

Osteosynthesis of the proximal femur anchorage of a cervical nail.

One of the factors determining the stability of osteosynthesis is the mechanical strength of the bone fragments required for the anchorage of the implant. The aim is to study the driving of a Thornton nail in the proximal epiphysis of a human femur as a way to measure the strength of the trabecular bone and to predict the stability of the implanted system.

[Sacrococcygeal teratoma in adults]. / Tératome sacro-coccygien de l'adulte.

This report describes a case of sacrococcygeal teratoma, a rare pathology belonging to the group of presacral tumors. Its clinical presentation is very variable. In this case, the tumor presented as a pilonidal cyst, which is an atypical form. The teratoma was associated with a spinal malformation, described in 25% of all cases. It was treated by "en bloc" resection with sacrectomy.

Fractures of the hip in the elderly: therapeutic and medico-social considerations.

The factors influencing mortality and morbidity were analysed in a series of 224 elderly patients with hip fractures. It was found that mortality was influenced by the high age, the number of medical antecedents and the number of general complications occurring following surgery. Mortality rate was high in mentally deteriorated patients with a gain in autonomy in only 25% of the cases. On the contrary, mortality was less, and there were few modifications of the mental status in patients who were mentally normal upon admission. The recovery of total or partial autonomy in this group was 69.9%, justifying therefore the surgical intervention.

Hoffmann® External Fixation of Fractures of the Radius and Ulna: A Prospective Study of Fifty-three Patients.

The absence of statistical studies concerning external fixation in adult forearm fractures prompted this prospective clinical study of 53 patients with 84 fractured bones treated by external elastic fixation, using a half-frame configuration. The radial nerve is the main anatomical obstacle to be considered. Whenever possible, closed methods of reduction are used. The rate of pseudarthrosis (6% of the treated bones) is comparable or even lower than the greatly varying figures published in the literature. External fixation seems capable of restoring and maintaining the precise anatomical configuration of the forearm bones.