[Results of unicondylar femoral fractures: a review of 28 patients]. / Resultats des fractures unicondyliennes du femur. Etude rétrospective à propos de 28 observations.

BACKGROUND: Unicondylar femoral fractures are rare. They form a particular entity of the femoral lower extremity fractures. THE PURPOSE of this work was to evaluate the anatomical and functional results of unicondylar femoral fractures on pain, mobility, walking and stability of the knee. METHODS: We reviewed, retrospectively, 28 patients presenting unicondylar femoral fracture. There were 19 men and 9 women, with average age of 54 years (22 - 87 years), victims essentially of domestic accident. The fracture was alone in 65 % of cases. According to Nordin's classification, the fracture was of type I in 3% of cases, type II in 35 % of cases, type III in 20 % of cases and type IV in 42 % of cases. Twenty five patients had a surgical treatment after a median period of 7 days post-accident, 3 patients were treated orthopedically. RESULTS: After 3 years follow up, results were noted according to MEGY's score which takes into account walking, mobility, pain and the stability. Clinically, we noted 26 good and very good results and 2 moderate results. Anatomically, we obtained 75 % of satisfactory reductions. CONCLUSION: Unicondylar femoral fractures remain rare. It is important to recognize them and to make the exact diagnosis of their type. Surgical treatment exposes old subjects to risk of dismantling anatomical osteosynthesis because of osteoporoses.

[Fracture of the radial head: the role of excision]. / Fractures de la tête radiale : place de la résection.

AIM: We assessed retrospectively forty cases of radial head fractures treated by excision. METHODS: The series is composed of men in 60% of cases and women in 40% of cases. The age of patients ranged from 15 to 68 years with an average of 37 years. According to Duparc classification, the fracture was type II in 20% of cases, type III in 32%, type IV in 42% and type V in 6%. An associated lesion in the same elbow was seen in 50% of cases; elbow dislocation was present in 38% of cases. The average of operative delay was 14 days (0 - 40 days). RESULTS: The functional result was evaluated according to clinical score of Western Orthopaedic society. The results were satisfactory. We have noted a correlation between functional result and associated lesions, the delay of excision and postoperative immobilisation. Valgus ulna and ascension of the radius was minors and well tolerated exceptly in cases of fractures associated to elbow dislocations. CONCLUSION: According to the results, we think that excision of radial head can be proposed essentially for the treatment of isolated radial head fracture.

[Arthroscopy of the shoulder. Technics and indications. About 64 cases]. / L'arthroscopie de l'épaule. Technique et indications. A propos de 64 cas.

Arthroscopic surgery replaced at present more and more conventional articular surgery because its anatomic character, its less morbidity and its more simple post-poerative care. After knee, the shoulder is considere as the articulation witch benefit of the progress of arthroscopic technics. Autors reported their experience in shoulder arthroscopy witch is introduced in the service since 1999. The gol of this study is to describe the technic of the shoulder arthroscopy and to precise its main indications.

Intraligamentous ganglion cyst of the anterior cruciate ligament (about a case).

UNLABELLED: UNKNO WLOGEMENT: Ganglion cysts have been reported in all joints, with varying frequency in location. A few cases have been described concerning ganglia of the anterior cruciate ligament (ACL) particularly intraligamentous cysts. AIM: The aim of the study is to report specific particularities of intraligamentous ganglion cyst of the ACL. CASE: We report a new case of intraligamentous ganglion cyst of the anterior cruciate ligament treated successfully with arthroscopic aspiration followed by partial excision of the cyst wall after MRI examination. The MR findings, clinical features and arthroscopic findings were evaluated comparatively. Diagnosis was confirmed by means of histological study after arthroscopic excision. The cyst was fluid-filled, with low T1-weighted signal intensity and high T2-weighted signal intensity. Pain was the most frequent clinical sign without any history of trauma. Postarthroscopy outcome was painless. Histologic diagnosis corresponded to ganglion cyst. CONCLUSION: An intraligamentous ganglion cyst of the ACL is extremely rare and suggests some diagnostic and therapeutic particularities.

[Diagnosis and treatment of Brodie's abcess in adults: about twenty cases]. / Diagnostic et traitement de l'abces de brodie chez l'adulte: a propos de vingt patients.

BACKGROUND: Brodie's abscess is a bone abscess described as a localized primary purulent collection with sclerotic wall. Since the first report of Sir Benjamin Brodie in 1832, many papers described different clinical and treatment aspects. Pathogeny and therapy still remain not clearly elucidated. AIM: The aim of our study is to describe clinical aspect and to study the result of treatment including surgery and antibiotics. METHODS: Our study is retrospective including 20 patients admitted to the author's institution for isolated bone abscess. The mean age of these patients is 30 years old (14 up to 46 years) with male predominance. Symptoms were chronic including localized pain with no systemic illness. The erythrocyte sedimentation rate was elevated in 2/3 of the cases. Roentegenogram was typical in 18 cases showing metaphysic cyst with sclerotic wall. Tibia was the most involved bone, 14 among 20 cases. Bacteriological study of the abscess pus isolated staphylococcus in 12 cases and pseudomonas in two cases. No organism was identified in the six remaining cases. Histopathological study showed chronic osteomyelitis with granulation including lymphocytes and plasma cells in all cases. Surgery and antibiotics were adequate for treatment in all cases. Our approach consisted in curettage without primary skin closure, cast immobilisation and antibiotics. RESULTS: Our patients were followed up over a median period of six years (8 months to 10 years). Overall, the results of treatment were good and in the long-term the abscess disappeared in all cases without recurrence. The erythrocyte sedimentation rate was normalized in 10 weeks and roentegenologically, the abscess disappeared progressively without osteomyelitis complication. CONCLUSION: According to our study, we believe that surgical treatment based on total excision of the bone collection and the sclerotic wall is the best method of therapy. As a matter of fact, healing was obtained without grafting in all cases and in the long-term follow up, abscess disappeared without recurrence and fistulisation.

[Use of Hoffman external fixation for extra-articular upper metaphysealtibial fractures]. / Traitement des fractures Sous-tuberositaires du tibia par le fixateur externe de Hoffman. A propos de 46 cas.

Treatment of extra-articular upper metaphyseal tibial fractures can be difficult. Orthopedic treatment is frequently complicated by second displacement These fractures are inappropriate for locked intra-medullary nailing because of the shorteness of the proximal extremity. Damages of soft tissues. frequently associated with these factures, expose internal osteosynthesis to many risks. For these reasons, we opted for external fixation. Our study was a retrospective analysis of 46 extra-articular metaphyseal tibial fractures treated by external fixation with Hoffman material. The average follow-up was 24 months. Consolidation was obtained within 4 months in average. Septic complications. inherent to the method were uncommon or minor. Functional results were satisfactory in 84% of cases. So, external fixation with Hoffman material. with particular recommandations, is a promising method for the treatment of extra-articular of proximal metaphyseal tibial fractures.

[Use of radial shortening for Kienbock disease]. / Apport de l'ostéotomie de raccourcissement du radius dans le traitement de la maladie de Kienbock: indications et résultats. A propos de 20 cas.

Kienbock disease is caused by aseptic necrosis of the lunate. The aim of this work is to evaluate the results of the radial shortening procedure for the treatment of stages II. Illa IIb of the disease. We retrospectively reviewed 20 cases of Kienbock disease. This series is composed of 9 men and 11 women. The average age was 32 years. According to Litchman's classification; 17 patients were operate on in stage III (14 IIIa; 311Ib) and 3 patients were operate on in stage III. Average of shortening was: 4 mm. the mean Follow -up was 05 years. Functional results were evaluated according to Michon score. The results were good in 18 cases and poor in 02 cases. Radiologic results were good: Ameliorations were obtained in 3 patients with stage II; 16 stabilizations in 17 patients with stage IIIa and 1 deterioration in 4 patients with stage IIIb. Radial shortening is effective in the treatment of Kienbock disease in wrists that do not have degenerative changes in adjacent carpal joints. Pain, range of motion and strength can be expected to improve but the radiographic aspect of the lunate changes is not likelly to undergo much chance, if any. Osteotomy was effective even in patients who had zero or positive ulnar variance; and an inclination angle of the distal part of the radius.