[Iatrogenic cervical fracture after femoral diaphyseal nailing]. / Fracture cervicale iatrogène après enclouage diaphysaire fémoral.

Three fractures of the femoral neck after intramedullary nailing for diaphyseal fracture are reported. In two cases, the diagnosis was established after nailing but the iatrogenic etiology may be not sure because of an imperfect primary radiological exploration. The localisation of the entry point and the rigidity of Grosse-Kempf's nail could be a contributing factor of this exceptional complication.

Hemiarthroplasty for glenohumeral osteoarthritis: results correlated to degree of glenoid wear.

Thirty patients (31 shoulders) were retrospectively reviewed after hemiarthroplasty for glenohumeral osteoarthritis. Ten shoulders had primary osteoarthritis, and 21 shoulders had secondary osteoarthritis. Glenoid surface wear was evaluated and classified as either type I, concentric, (15 shoulders) or type II, nonconcentric, (16 shoulders). Postoperative results were reviewed with the American Shoulder and Elbow Surgeons' evaluation form, Neer classification, and the Constant score. Overall, 23 (74%) shoulders achieved satisfactory results, and 8 (26%) shoulders had unsatisfactory results. Results were similar in the primary and secondary osteoarthritis groups. Outcome correlated most significantly with the status of posterior glenoid wear. Patients with concentric, type I glenoids achieved 86% satisfactory results, whereas patients with nonconcentric, type II glenoids had only 63% satisfactory results. Although pain relief was similar in both groups, the unsatisfactory results were attributed to loss of forward elevation and external rotation in patients with type II glenoids. On the basis of these results hemiarthroplasty can be an effective treatment for both primary and secondary arthritis but should be reserved for patients with a concentric glenoid, which affords a better fulcrum for glenohumeral motion.

Anatomic study of the tendinous rotator cuff of the shoulder.

The aim of this study was a better understanding of the role of the vascular supply as a pathogenic factor in rotator cuff disease. Twenty-five shoulders from unembalmed cadavers were studied after injection of the upper limb aa. with barium sulfate. The predominant arteries were the vessels of the subscapularis m. These branches originated from the axillary a. the anterior circumflex humeral a., and the posterior circumflex humeral a. The supraspinatus m. was supplied by the suprascapular a. but the acromial branch of the thoracoacromial a. supplied the tendon of the supraspinatus. The infraspinatus and teres minor tendons were vascularised by the ascending branches of the posterior circumflex humeral a. The tendon of the long head of the biceps brachii m. was supplied by a branch termed the "arcuate artery" and by a branch we describe derived from the brachial a. at the level of the latissimus dorsi tendon and travelling in a true mesotendon. There is a very real critical zone, with a lesser blood-flow, 1.5 cm from greater tubercle, situated mainly at the supraspinatus tendon. This is a convergence zone of the anterior and posterior circumflex humeral aa., the suprahumeral a. and the thoracoacromial a. The histologic studies confirmed the poor vascularity of this critical zone.