[Madelung's deformity - Why choose the Sauvé-Kapandji osteotomy?] / Maladie de Madelung ­ Pourquoi avoir choisi une ostéotomie selon Sauvé-Kapandji?

For bilateral Madelung's deformity in a 14-year-old girl we did the Sauvé and Kapandji operation without additional radius osteotomy. The operation was justified by the protrusion of the head of the ulna, the limitation of the rotation and diminution of the strength of the wrist, and inability to do sporting activity. The clinical findings were referred to the instability of the inferior radio ulnar joint There was no pain. The post operative review showed no pain, with recovery of grasp and of sporting activity (gymnastic and dance). The esthetic result satisfied the surgeon and the patient The operation permitted repositioning of the inferior radio ulnar joint. We have not seen synostosis of the osteotomy and the width of it increased progressively without radiological and physical instability of the inferior radio ulnar joint. The literature study allows us to discuss the different treatment possibilities and to explain our choice.The simplicity of this operation is interesting, because it was possible to stabilize the carpal joint, with abolition of the physical problems of this youg girl, without the needing osteotomy of the radius, which takes longer to recover, in those cases without pain before the operation.

[Thoracic outlet syndrome. A study of 45 cases treated between 1975 and 1993]. / Syndrome de la traversée thoraco-cervico-brachiale. Étude de 45 cas traités entre 1975 et 1993.

Since 1970 we have experience of more than 100 cases of the thoracic outlet syndrome. We have rewied 45 patients operated on between 1975 and 1993.The cause, in agreement with the literature, was in 30% a road accident (cervical spine and clavicular disease), in 54% malformations (cervical rib) with a similar frequency of involvement with neurological pathology of the upper limb.We always found a vascular symptomatology, wich increased in shoulder abduction. In 82% of the cases we found an associated neurological deficit. The diagnosis was confirmed with electromyography and arteriography.The treatment was in initially medical and in resistant case, surgery was performed. We have use a supra-clavicular approach with scalenotomy of the scalenus anterior muscle, resection of the distal part of the cervical rib or an anterior fibrous band. We did not do (first operation) a resection of the first rib throught a transaxillary approach, in order to avoid elongation of the brachialplexus roots.We found 80% good results from the opinion of the patients and after clinical examination.We have operated on 6 recurrent cases throught a supra-clavicular approach (fibrous sheath) or by trans axillary approach with resection of the first rib in case of lack of response to scalenotomy.

[Intra-operative fractures in hip arthroplasties: predisposing factors]. / Fractures per-opératoires : facteurs favorisants.

In a multi center study 51 cases of intraoperative femoral fractures in THA from 6 medical centers of eastern France were analysed with respect to epidemiology and predisposing factors. The male/female rate was 0,5 and the average age 73 years.The fractures involve the diaphysis in 33% and a cortical defect in 33%. The fracture occured in 50% of cases during reaming, or impaction of the femoral stem, and in 25% of cases during dislocation, these findings correspond to those described in the literature.The predisposing factors are of two types :- The rarefaction of the bone mineralisation due to the age and high proportion of females. 33% of the cases are a fracture of the femoral neck (elderly women).- Reoperation (27 cases) with 22 replacement of THA. In these cases of loosening, the fragility of the cortical bone (cement granuloma, chamber of mobility) is well known. On the other hand, we did not find that calcification or ankylosis are predisposing factors (only 8/51).

Biomechanical evaluation of different instrumentation for spinal stabilisation.

The varying problems following arthrodesis of the lumbar spine with rods or plates (too much rigidity for the first and insufficient stability for the second) have led us to conceive another type of material, flexible but with enough stability, to favorise healing of bone graft, and decrease the induced pathology on adjacent levels. An experimental study of three types of material: rigid, semi-rigid and flexible was performed on eighteen fresh cadaver spinal segments without and then with discectomy and corporectomy to find out the various types of behaviour. The flexible device seems more supple than the other materials tested: more mobility, less stiffness. Rising hysteresis is explained by plastic deformation. The semi-rigid device presents strong osseous stresses on the L3 level and a large hysteresis corresponding most likely to a mobility between the screws and plates. The rigid device has less mobility, especially in torsion, ascribed to the transverse connection. The stability is high with a small hysteresis. This is of value for bone loss or instability with displacement of the vertebral body.The second study was a modeling of the flexible device validated by comparison to the experimental study. The strains in the wire were high, decreasing with increasing diameter, but is still lower than the elastic limit. The proximity of the elastic limit may allow plastic deformation of the wire. Howewer less strains were found on the screw fixation but increase with the increase diameter of the wire. The influence of the bone quality on the behavior of the device was demonstrated.

[The De La Caffinière trapezo-metacarpal prosthesis in rhizarthrosis of the thumb. Apropos of 20 cases surgically treated between 1978 and 1990]. / Prosthèses trapézo-métacarpiennes De La Caffinière dans la rhizarthrose du pouce. A propos de vingt cas opérés entre 1978 et 1990.

The authors have studied twenty total prosthesis of de la Caffinière. These prostheses have been inserted between 1980 and 1990 at the "centre de Traumatologie et d'Orthopédie de Strasbourg", following a trapezo-metacarpal arthritis. According to a post-operative average of five years, the results are good in 70% cases. A study of the mobility and of the strength of the hand, as well as one of the radiography, allows to make bring out two complications: the first, rarely studied for this prosthesis, is a rigidity of the trapezo-metacarpal articulation due to post-operative ossifications. Consequently the post-operative ossifications. Consequently the post-operative benefit decreases proportionally to the importance of the rigidity; the second, already pointed out in few articles, is the presence of radio lucent lines which is asymptomatic in 20% of cases. The causes founded are different from the one already published. Anyway, in spite of those risks, it is globally useful in the majority of cases. Therefore the authors remain loyal to this intervention in the presence of an isolated trapezio metacarpal arthritis to the patients with are not subjected to handicrafts.