[Total hip arthroplasty after treatment of acetabular fracture]. / Arthroplastie de hanche pour séquelle de fracture de l'acétabulum.

PURPOSE OF THE STUDY: The aim of this retrospective analysis was to examine complications and technical difficulties observed during implantation of total hip arthroplasty (THA) after treatment of an acetabular fracture. MATERIAL AND METHODS: Forty patients (thirty men and ten women), mean age 50 years, were included in the study. The acetabular fracture had been treated surgically in 23 and orthpedically in 17. Mean time from initial trauma to implantation of the THA was eleven years. Hydroxyapatite-coated cups were inserted without cement in 32 patients. Cemented cups in eight (with two Kerboull cross, one Muller ring, and five simple polyethylene). Five femoral stems were cemented. Preoperative planning was designed to restore the center of the initial hip rotation to avoid excessive cup medialisation. Acetabular defects found intra-operatively were significantly greater in the group of patients treated orthopedically than in those treated surgically (p = 0.02). Autografts were thus used more frequently in the former (65%). RESULTS: One patient presented an intraoperative complication. The postoperative complications included phlebitis (n = 1), infection (n = 1), fibular nerve paralysis (n = 2), dislocation (n = 4), and heterotopic ossification (n = 7). The rate of postoperative complications was significantly higher in the group of patients treated surgically (52.2% versus 17.6%, p < 0.02). At last follow-up, mean 52 months, the mean Postel-Merle-d'Aubigne function score was 16.7. The rate of acetabular revision was 15% with four cemented cups being replaced at more than ten years due to aseptic loosening. Two press-fit cups were replaced early for infection in one patient and disassembly in another. DISCUSSION: Despite the high rate of complications, the mid-term results were good, encouraging us to continue this procedure as the first intention treatment using either a press fit cup with or without an autograft, or a cemented cup with a metal ring (Kerboull or Burch-Schneider).

[Surgical treatment of acetabular fractures: outcome in a series of 60 consecutive cases]. / Traitement chirurgical des fractures de l'acétabulum: résultats d'une série continue de 60 cas.

PURPOSE OF THE STUDY: The aim of this study was to analyze clinical and radiographic results after surgical treatment of acetabular fractures. MATERIAL AND METHODS: We reviewed 60 consecutive fractures of the acetabulum with loss of joint congruency at mean 5-years follow-up after treatment. There were 49 men and 11 women, mean age 41 years. According to the R.O. grading, the fractures were: 22 class A (33.3%) including 17 type A1, 23 class B (38%) including 10 type B1a2, 14 class C (23.3%) and 1 unclassifiable. Eight of the patients had associated pelvic injury, 40 had hip dislocations and 9 had sciatic nerve injury. Ten femoral head fractures were discovered during the surgical procedure. Three surgical approaches were used: 1) Kocher Langenbeck approach (28 cases), 2) Mears and Rubash triradiate approach (8 cases), 3) extended iliofemoral approach (22 cases), 4) other approaches (2 cases). Anteroposterior and 45 degrees oblique view of the pelvis were obtained for all patients following admission. Computerized tomography scans were performed in all cases. Fracture displacement and congruency of the femoral head with the roof were documented according to the SOFCOT radiographic criteria. The quality of reduction was assessed using the Matta criteria and the Duquennoy and Senegas criteria. Clinical outcome was assessed at follow-up using the Postel-Merle-d'Aubigné score. RESULTS: Anatomic reduction was achieved in 62% of the cases (1 mm or less displacement on all views) and congruency of the femoral head with the roof was excellent in 73% of the cases. Clinical outcome was satisfactory in 80% (excellent or good). Operative complications included significant ectopic bone in 21, and in 2 others sciatic nerve palsy that had resolved at 1 year follow-up. Three patients developed avascular necrosis of the femoral head. DISCUSSION: Clinical outcome depends on the quality of the reduction. Class C and class B fractures with roof injury should thus be treated by large surgical exposure. The triradiate approach increases the incidence of ectopic bone. The higher incidence of ectopic bone in patients treated by osteotomy of the trochanter compared with patients without osteotomy of the trochanter was significant (p<0.05). Avascular necrosis of the femoral head was associated with delayed reduction (66% of the cases). CONCLUSION: Our good clinical results are encouraging; we are pursuing the use of surgical treatment for displaced acetabular fractures. Clinical outcome depends on the use of the appropriate surgical approach.

[The first anti-cancer center in Lyon (1923): surgeon Leon Berard and Auguste Lumiere]. / Le premier centre anticancéreux de Lyon (1923) Le chirurgien Léon Bérard et Auguste Lumiére.

At present, little is known about the creation of cancer hospitals. I will report on that of Lyons, France, with the famous surgeon, Léon Bérard (1870-1956). A specialist of neck surgery, he was the first to carry out major thoracoplasties. The cancer hospital was inaugurated in 1923 under the Great Dome of the hôtel-Dieu hospital. (The dome is the creation of the famous architect Germain Soufflot (1748)). In 1933, the cancer hospital moved in the newly-built Edouard Herriot Hospital; it became independent in 1958, two years after the famous surgeon's death, and it was rightly named after him: "Centre anticancéreux Léon Bérard". Its creation and its quick development owes a lot to generosity of Auguste Lumière, one of the two inventors of cinematograph. Auguste Lumière sponsored radiotherapy material and, at Léon Bérard's request (as there was a lack of space in Edouard Herriot hospital), created a centre for cancer patients (Bon Abr Hospital, rue Mistral, with Dr Vigne). A Lumière gave his time as well as his money for the centre; he was the car-driver, he helped L. Bérard with his university classes, and he often comforted the patients while running a private clinic (La Clinique Lumière), which combined dispensary services with research. (Micheline Bonin)