[Composite nail transfer by the traditional method]. / Transfert d'unité unguéale par la méthode traditionnelle.

INTRODUCTION: We have retrospectively reviewed our experience in the treatment of traumatic loss of the whole nail complex. METHOD: Contraindications for our technique are cases suitable for microsurgical transfer and cases with a poorly vascularised recipient bed. Under local anaesthesia, we harvested the nail unit composed of the eponychiurn matrix, nail table, hyponychium and lateral folds. The transfer to the recipient finger was also performed under local anaesthesia. Post operative cryotherapy for 72 hours was combined with a prostaglandin E1 infusion (50 micrograms per day during 3 days). The functional result was assessed by the coin test and the cosmetic result by VAS (from 1 to, 10). RESULT: Eleven patients were operated on according to the technique between April 1995 and June 1997. Minimum follow-up was 6 months. Average follow-up was 13 months. There were 9 men and 2 women with a mean age of 31 years (range: 13-40). Among the 14 injured fingers, the index was involved 2 times, the middle finger 5 times, the ring finger 3 times and little finger 4 times. The aetiology was a burn in one case and direct trauma in the other 13. We obtained 11 good results; 2 nails with slight dystrophy and one failure secondary to an infection (the burn case). The coin test was good in 13 cases and the mean cosmetic VAS was 8/10. DISCUSSION: Our technique is easy and well accepted by the patient. It gave 11 good results out of 14 cases. According to the literature, this method has fallen into disuse due to its unpredictable results. It seems to us that this technique has to be put into balance with microvascular transfer; a much more sophisticated operation and with a nail prosthesis which is not always well accepted and is very difficult to fix. A major prerequisite remains a well vascularised recipient bed. Cryotherapy in the post operative period decreases the metabolism and avoids ischaemia during the phase of revascularisation, and explains the quality of our results.

[Long-term results of Insall's total condylar knee prosthesis (10-to-13-year follow-up)]. / Résultats à long terme de la prothèse totale du genou total condylard'Insall (recul de 10 à 13 ans).

We have studied 10 to 13 years postoperatively the first 105 total knee arthroplasties using the Total Condylar, a semiconstrained prosthesis with sacrifice of the cruciate ligaments, inserted between 1979 and 1983, in 99 patients (6 were bilateral). The average age of these patients was 73.5 years at the time of arthroplasty. At the time of this review, 46 patients had died (49 prostheses) and 10 were lost to follow-up. Five knees had failed (4 infections), requiring prosthesis removal in three cases. The other 38 patients (41 knees) survived: 35 were available for detailed clinical and roentgenographic evaluation, 6 knees had only a clinical, x-ray, questionnaire or telephone evaluation. To evaluate the results of these prostheses, we used 3 different rating systems the SOFCOT rating system the Hospital for Special Surgery rating system the new scoring system of the Knee Society. The results with the HSS system were excellent or good in 80% of the cases. The rate of satisfactory results, somewhat lower than those of North American studies, is probably explained by the advanced age of our patients. All these prostheses were cemented. There was no aseptic loosening at 10 to 13 years follow-up. In assessing these results we can confirm the reliability of the first model of the Insall prosthesis, in spite of a small range of sizes, and of a rudimentary ancillary, which resulted in important positioning mistakes. We can confirm that a cemented knee prosthesis with sacrifice of the cruciate ligaments is reliable at more than 10 years of follow-up. The technical advancements: larger range of component sizes metal backed tibial plates better ancillary, which permits exact and reproducible placement posterially-stabilized system should yield even better long-term results, approaching those of total hip arthroplasty.

[Long-term result of lumbar disk chemonucleolysis (a 8-12 years follow-up)]. / Résultat à long terme de la chimionucléolyse discale (8 à 12 ans de recul).

INTRODUCTION: This study is an attempt to assess the effects of chemonucleolysis over an extended period of time (8 to 12 years follow-up). MATERIAL AND METHODS: From 1981 to 1985, chemonucleolysis using Chymopapain was performed on 134 patients for the relief of radicular pain from herniated lumbar discs. The long term results were evaluated in 110 patients. This represented a total follow-up rate of 82 per cent. 24 patients were lost to follow-up. RESULTS: Of the 110 patients who had been reviewed at 8 to 12 years follow-up: 76 patients did not need other treatment than the initial chemonucleolysis. The results were excellent or good in 69 patients (63 per cent) and fair in 7 patients (6 per cent). 34 required surgery (31 per cent). This rate does not reflect the real failure rate of chemonucleolysis: 7 patients underwent early surgery and corresponded with the beginning of our experience with chemonucleolysis. 7 patients needed surgical treatment after a successful initial result for two to nine years. The real failure rate concerned 19 patients (17 per cent). These patients did not have any pain relief following chemonucleolysis. Surgical treatment was undertaken on the average 18 months after chemonucleolysis. One patient had suffered from radicular pain 6 years following the first chemonucleolysis. In this case, iterative chemonucleolysis had been done on the same lumbar level. It was effective on the radicular pain but not on the back pain. Chemonucleolysis had been effective in 70 per cent of the patients. DISCUSSION: Our study showed that the long term results following chemonucleolysis were effective and the mortality rate was low. (No severe complication in this study). This study is compared with the literature, studying the results of chemonucleolysis patients, or comparing patients treated by chymopapain or surgical discectomy. CONCLUSION: We conclude that chemonucleolysis is an effective and safe method for treating sciatica by herniated lumbar discs.

[Posterior luxation of the tibia on total knee prosthesis: apropos of 6 cases]. / Luxation postérieure du tibia sur prothèse totale du genou: à propos de 6 cas.

PURPOSE OF THE STUDY: Posterior dislocation of Total knee arthroplasty is an infrequent but serious complication. Six cases of this complication were treated from 1979 to december 1993, all occurring on primary arthroplasties. MATERIAL AND METHODS: Knee arthroplasty was performed once for rheumatoid arthritis, five times for osteoarthritis. All cases occurred with a semi constrained prosthesis sacrifying posterior cruciate ligament: 2 Total condylar without posterior stabilisation, and 4 posterior stabilised prosthesis. In one case the dislocation occurred on a very severe rheumatoid arthritis: the patient, confined in a wheel chair, was not reoperated. In two patients, the dislocation was due to rotatory malposition of the tibial component. In the last three cases, we did not found any cause to the dislocation, except ligament laxity: 2 of these patients had, pre operatively, a valgus deformity. In 6 cases, we found only 2 problems on extensor system (one patellar dislocation and one patellectomy). RESULTS: 5 patients required a surgical treatment In 2 cases, we used a more constrained prosthesis, with poor results, but the knee was stable. Once, by changing the position of the tibial component, and using a thicker plate. In 2 patients we only put a thicker tibial polyethylene component. These 3 patients had a good stability: 2 have an excellent result with H.S.S. rating system, the third one has a poor result explained by patellar pseudoarthrosis occurring after traumatic patellar fracture. DISCUSSION: With our patients and cases published in North American works, we have studied the different mechanisms of such a posterior dislocation: rotatory disorder on tibial component, ligament laxity in flexion, extensor system deficiency, valgus deformity with important postero lateral release. CONCLUSION: The causes of posterior dislocation on Total knee arthroplasties must be known: we have to try to prevent such a complication. If it occurs, a precise analysis will permit a logical curative treatment, which must avoid constrained prosthesis.