[Treatment of fractures of the posterior axial arch. Results of 41 cases]. / Traitement des fractures de l'arc postérieur de l'axis. Résultats de 41 cas.

The authors have treated 41 fractures of the neural arch of the axis without neurological impairment. Eleven cases were treated surgically and the remainder conservatively by traction for several weeks followed by cast immobilisation. Only one fracture failed to unite. In the surgical cases, an anterior interbody fusion was performed a few weeks after the accident. Thirty cases were followed up. The functional results were satisfactory in 27 and poor in three. The residual mobility of the neck was much better after conservative management with about two thirds range of normal movement both in the sagittal and horizontal planes. A study on cadavers showed that a displacement of up to 5 mm at the fracture site was compatible with good stability because the ligaments and the discs were normal. It is concluded that most cases should be treated conservatively and that surgical treatment should be given only to cases with considerable displacement, marked instability or in cases of non-union.

[The arterial blood supply of the skin flap of the dorsal foot]. / Contribution à l'étude de la vascularisation artérielle du lambeau du dos du pied.

The dorsal foot skin supplied by the arteria dorsalis pedis the dorsal venous arch, the peroneal sensory nerves and the musculus extensor digitorum brevis is a very good myocutaneous flap. The material on which the study was carried out, consisted of 20 feet from standard cadavers, injected with a mixture of terebenthene and minium through the arteria tibialis anterior. The m. extensor digitorum brevis is 6.1 cm long, 1.7 cm wide, 3.9 mm thick. It is mainly supplied by the a. dorsalis pedis and its branches: the a. tarsea dorsalis (constant) and the a. metatarsea dorsalis (12 of 20 specimens). The average diameter of the a. dorsalis pedis at the upper limit of the m. extensor retinaculum was 2.14 mm and this was chosen as the most proximal limit of the dorsalis pedis flap. The a. tarsea dorsalis was present in all the specimens, with a diameter of 0.95 mm at its origin and a length of 35 mm. On average, this artery divided into four branches to the m. dorsalis pedis. The a. metatarsea dorsalis was present in 12 of 20 specimens, with an average diameter of 0.53 mm and a length of 22 mm. On average, this artery divided into three branches to the m. dorsalis pedis. We drew three lines in the proximal, middle and distal third of each flap design and calculated the sum of arterial branch sections with our lines. We think this provides a reasonable indication of the comparative richness of the cutaneous blood supply in the flap. The mean number of cutaneous branches was 10 in the proximal third, 6.7 in the middle third (13 if branches supplying the m. extensor pedis brevis are included) and 5 in the distal third. The myocutaneous dorsalis pedis arterialized flap can be safely used as an island flap to cover the ankle or heel and as a free flap for palm defects.

Long-term results in the treatment of fracture-dislocations of Galeazzi in adults. Report on twenty-nine cases.

The authors report 29 cases of a true Galeazzi fracture, (i.e. displaced fracture of the radial shaft and disruption of the distal radioulnar joint). In 1/4 of the cases, dislocation was overlooked and the injury was mistaken for a so-called "isolated" fracture of the radius. By accurate open reduction and compression plating of the fracture, both the torn radioulnar ligaments and the articular disc could be repaired and healed. Additional percutaneous Kirschner pinning across the ulna and the radius in order to avoid redislocation, does not seem to be necessary. It is important, however, to hold the reduction of the radioulnar dislocation in a plaster cast for 4-6 weeks, since the 8 persistent displacements of the ulnar head always resulted in a lack of pronosupination of more than 25 degrees. In these cases, pain and disability may require later surgical management. Late resection of the ulnar head or a Sauve-Kapandji procedure which yield an obvious cosmetic and functional improvement, are preferred to any immediate surgical repair of the radioulnar ligaments. This operation was carried out 3 times, but failed twice. Nevertheless out of 25 patients reviewed after a mean follow up time of 6.5 years, the results were gratifying in 20 who could resume their previous occupation 4 to 12 months postoperatively.

[Hinge prosthesis of the knee. Apropos of 185 cases]. / Les prothèses à charnière du genou. A propos de 185 cas.

On hundred and ninety-five hinge prostheses have been inserted between 1970 and 1981, most of them of the G.U.E.P.A.R. type. One hundred and forty-three were followed up. The etiology of five per-operative deaths is discussed. It is concluded that this dramatic event was related to gas embolism. Precautions necessary to avoid such accidents are described particularly at the time of release of the tourniquet. There were 11 cases of sepsis, eight loosenings and four post-operative fractures of the femur or tibia. The functional results were found to be satisfactory but better with the G.U.E.P.A.R. type than with the Shiers prosthesis. Most of the post-operative pain originated from the patella; this aspect of the pain should be able to be avoided by systematic use of patellar resurfacing. The authors conclude that a hinge prosthesis should be used only in cases of severe deformity, of severe instability or in cases of failure of resurfacing procedures.

[Thyroid autonomous nodule. Surgical treatment and postoperative outcome, retrospective study of 102 cases (author's transl)]. / Le nodule thyroïdien hyperfixant et extinctif. Traitement chirurgical et devenir post-opératoire. Etude rétrospective de 102 observations.

Follow-up of 102 patients operated upon for autonomous thyroid nodules is reported. Retrospective study of operative findings and aftermath of surgery clearly demonstrates that the patho-physiological concept of autonomous nodule does not snugly fit practical problems experienced with the management of such patients. The autonomous nodule can be a malignancy. Ipsilateral thyroid lobectomy seems more suitable than nodulectomy. Gross appearance of the thyroid remnant makes sometimes post-operative hormonotherapy unexpectedly advisable. From a theoretical point of view, post-operative thyroid scan, TSH assay and TRH test are mandatory, to assess recovery.