[Traumatic bilateral rotatory C1-C2 dislocation in an adult: case report and review of the literature]. / Luxation rotatoire bilatérale traumatique C1-C2 de l'adulte: une observation et revue de la littérature.

Trauma led to bilateral rotatory atlantoaxial dislocation in a 23-year-old woman. Clinical diagnosis of this uncommon dislocation of the cervical spin is generally difficult and often made late. Typical signs include pain in the upper cervical spine and a fixed rotated position of the head. Integrity of the transverse ligament of the atlas is a determining factor for atlantoaxial stability and allows orthopedic treatment after reduction using moderate traction on the head. As for most authors, orthopedic was successful in our patient who totally recovered cervical spine mobility without pain.

Grit-blasted titanium femoral stem in cementless primary total hip arthroplasty: a 5- to 10-year multicenter study.

A total of 133 cementless primary total hip arthroplasties using the Zweymuller-Alloclassic grit-blasted titanium tapered stem were performed in 3 institutions. The patient cohort was divided into 2 subgroups, nonselected and selected, on the basis of excellent bone stock and age (<65 years old at surgery). Acetabular components were all cementless, and bearing surfaces were all alumina-ceramic on polyethylene. After a 7.3-year average follow-up period (range, 5-10 years), 118 primary femoral replacements in 109 patients could be reviewed fully. Mean age at surgery was 55.7 years (range, 27-84 years). According to the Merle d'Aubigne and Charnley rating system, clinical results were graded excellent and good in 89% of hips and fair in 11%. Radiologically, early subsidence >2 mm could be detected in 4 hips (3.4%). Calcar atrophy and spot welds were noted in 77% and 82% of hips. Femoral osteolysis granuloma was noted in 4 hips (3.4%). There has been no stem fracture and no ceramic head breakage. The survivorship at 10 years with definite femoral aseptic loosening (radiographic failure) as the endpoint was 100% (95% Wilson confidence interval, 78.4%-100%; worst scenario, 95.4%). A significant difference between the nonselected and selected patient subgroups was observed only for early reoperation (P =.03) and proximal stress shielding (P =.01). Press-fitting but not filling the femoral canal with a rough titanium, straight, tapered femoral component represents, at intermediate follow-up, a promising cementless option in primary total hip arthroplasty.

Complications of Marchetti locked nailing for humeral shaft fractures.

In this retrospective study 50 humeral fractures (36 acute, 6 pathological fractures and 8 non-unions) were treated by retrograde locked bundled Marchetti nailing. No intraoperative complications occurred. Postoperative complications included 7 non-unions (4/36 acute fractures and 3/8 delayed union), and 2 intraarticular penetrations of the secondary nails. However, at the subsequent removal of the implant 5 supracondylar fractures occurred.

[Retro-duodenal papillary perforation after endoscopic sphincterotomy. Role of surgical treatment by exclusion of the duodenum. Apropos of 3 cases]. / Perforation papillaire rétroduodénale après sphinctérotomie endoscopique. La place du traitement chirurgical par exclusion du duodénum. A propos de 3 cas.

Among the complications of endoscopic sphincterotomy whose rate is about 10% of cases, the retroduodenal papillary perforation represents about 1% of cases. The diagnosis lies on radiological examination which may show during the sphincterotomy the extravasation of the contrast fluid used for the retrograde cholangiography; it can be suggested by the presence of clinical signs of retroperitoneal sepsis or peritonitis. The treatment depends on the severity or peritonitis. The treatment depends on the severity of the clinical symptomatology; it is generally a medical treatment associating nasogastric aspiration and antibiotherapy, and more rarely a surgical one. There is no consensus concerning surgical modalities. We report 3 cases of retroduodenal papillary perforation treated surgical by a duodenal exclusion aiming to transform a complex fistula in a bilio-pancreatic fistula which can be more easily managed by somatostatine-like drugs.