Tuberoplasty: minimally invasive osteosynthesis technique for tibial plateau fractures.

Fractures of the tibial plateau are in constant progression. They affect an elderly population suffering from a number of comorbidities, but also a young population increasingly practicing high-risk sports and using two-wheeled vehicles. The objective of this study was therefore to propose a new technique for the treatment of this type of fracture. There are a variety of classical pitfalls of conservative treatment such as defective reduction resulting in early osteoarthritis and alignment defects. Conventional treatments lead to joint stiffness and amyotrophy of the quadriceps, caused by the open technique and late loading. We propose an osteosynthesis technique for tibial plateau fractures with minimally invasive surgery. A minimally invasive technique would be more appropriate to remedy all of the surgical drawbacks resulting from current practices. The surgical technique that we propose uses a balloon allowing progressive and total reduction, associated with percutaneous screw fixation and filling with polymethylmethacrylate (PMMA) cement. The advantages are optimal reduction, minimal devascularization, soft tissues kept intact, as well as early loading and mobilization. This simple technique seems to be a good alternative to conventional treatment. The most comminuted fractures as well as the most posterior compressions can be treated, while causing the least impairment possible. Arthroscopy can be used to verify fracture reduction and cement leakage. At the same time, it can be used to assess the associated meniscal lesions and to repair them if necessary.

[Total arthroplasty, using Hardinge's approach, combined with trochanterotomy: comparative results of 200 cases]. / Arthroplastie totale de hanche par voie de Hardinge et par trochantérotomie: résultats comparés sur 200 cas.

PURPOSE OF THE STUDY: A retrospective study to compare the results obtained in our first 100 total hip prostheses inserted by Hardinge's approach and of the 100 others inserted by trochanterotomy was undertaken. MATERIAL: In the trochanterotomy group the average age was 66 years; average follow-up was 26 months. Using the Merle d'Aubigné score the initial score was 11.8. There were 65 cases of centered hip arthritis. In the Hardinge group the average age was 65 years; average follow-up was 28.3 months. The Merle d'Aubigné initial score was 12.3. There were 78 cases of centered hip arthritis. There were therefore no significant differences between the two groups and the two groups were comparable. METHODS: The quantitative variables (age, duration of operation, blood loss, blood transfusion, follow-up) were compared by Student's test. The qualitative variables (thrombo-embolic complications, dislocations, periarticular ossifications, acetabular radiolucency lines, non-union of the greater trochanter, gluteus medius palsies) were compared by the chi 2 test. RESULTS: We found no significative differences on neither the functional level nor on the orientation of the prostheses nor on the number of infectious complications between these two surgical approaches. Moreover, we found more complications such as thromboembolism and dislocations favoured by non-union of the greater trochanter in patients operated by trochanterotomy. These patients also had greater blood loss. In patients operated by Hardinge's approach, we found gluteus medius palsies (recovering secondarily); we also found a higher frequency of periarticular ossifications and a greater number of partial acetabular lines. DISCUSSION: Non-union of the greater trochanter appears in all the series of total hip arthroplasty by trochanterotomy. No technique permitted to avoid this complication which usually leads to pain and hip instability. This surgical approach is associated with higher blood loss. With Hardinge's approach there is no risk of non-union of the greater trochanter and blood loss is less important. The risk of gluteus medius palsy has to be taken in to account but digital dissection of the muscle fibers seems adequate to diminish the frequency of this complication. There is also a greater number of asymptomatic periarticular ossifications in our study but whose long term consequences are unknown. CONCLUSION: This study leads us to prefer the Hardinge approach for total hip arthroplasty. Our recent experience encourages us even because it permits osteoplastic ridge and total hip resumption. We use the trochanterotomy only for the most difficult cases specially hip arthritis secondary to severe dysplasia or congenital hip dislocations when a lowering effect of the great trochanter should also be associated.

[Fractures of the humeral shaft: role of fasciculated nailing using Hackethal's method. Apropos of 129 cases]. / Fractures de la diaphyse humérale: place de l'embrochage fasciculé selon Hackethal. A propos de 129 cas.

This retrospective study was based on 141 diaphyseal fractures of the humerus, treated by Hackethal fasciculated pinning, among 371 fractures followed up during 10 years in our department. There were six preoperative radial paralyses. The mean consolidation delay was 65 days. Six fractures did not unite and there was no sepsis. The only immediate neurological postoperative complication was a regressive cubital paralysis. 72 fractures could be followed-up with a mean of 4 years, to establish a functional result chart. 94.4 per cent of the results were good and very good, 2 shoulder stiffness and only one elbow stiffness. The displaced fractures of the humeral diaphysis on D2 to D5 zones, as well as pathological fractures are good indications for Hackethal fasciculated pinning.