[Performance of magnetic resonance imaging ang genourob laximetry in anterior cruciate ligament rupture in 30 cases]. / Performance de l'imagerie par resonance magnetique et de la laximetrie a genourob dans les ruptures du ligament croise anterieur a propos de 30 cas.

INTRODUCTION: The aim of this work was to evaluate the diagnostic contribution of magnetic resonance imaging and genourob compared to intraoperative arthroscopy. The objective was to implement a protocol based on magnetic resonance imaging and / or genourob. MATERIALS AND METHODS: We did a cross-sectional study from July 18, 2016 to July 19, 2017 at the Maltese hospital comparing the results of MRI and GNRB from 30 patients compared to intraoperative arthroscopy data. RESULTS: Complete break.- In MRI, we obtained a sensitivity (Se) of 95.7%, a specificity (Sp) of 85.7%.- At the GNRB, we found a Se of 87%, a Sp of 42.9%.Partially broken.- In MRI we obtained a Se of 85.7%, a Sp of 95.7%.- At the GNRB, we found a Se of 42.9%, a Sp of 87%. CONCLUSION: MRI is better than GNRB. The GNRB does not improve the results of the MRI. It has no diagnostic contribution in the rupture of the ACL knee. It is a device used by the orthopedists to evaluate knee laxity that does not depend on the ACL alone.

INTRODUCTION: Le but de ce travail était d'évaluer l'apport diagnostique de l'imagerie par résonance magnétique (IRM) et du genourob (GNRB) par rapport à l'arthroscopie per opératoire. L'objectif était de mettre en place un protocole basé sur l'IRM et / ou le GNRB. MATÉRIELS ET MÉTHODES: Nous avons fait une étude transversale allant du 18 Juillet 2016 au 19 juillet 2017au centre hospitalier de l'ordre de malte en comparant les résultats d'IRM et du GNRB de 30 patients par rapport aux données de l'arthroscopie per opératoire. RÉSULTATS: ✓ Rupture complète.- En IRM, nous avons obtenu une sensibilité (Se) de 95,7 %, une spécificité(Sp) de 85,7%.- Au GNRB, nous avons trouvé une Se de 87 %, une Sp de 42,9%.✓ Rupture partielle.- En IRM, nous avons obtenu une Se de 85,7 %, une Spde 95,7%.- Au GNRB, nous avons trouvé uneSe de 42,9 %, une Sp de 87%. CONCLUSION: L'IRM est plus performante que le GNRB. Le GNRB ne permet pas d'améliorer les résultats de l'IRM. Il n'a pas d'apport diagnostique dans la rupture du LCA du genou. C'est un dispositif utilisé par les orthopédistes pour évaluer une laxité du genou qui ne dépend pas du LCA à lui seul.

Performance de l'imagerie par resonance magnetique et de la Laximetrie a Genourob dans les ruptures du ligament croise anterieur a Propos de 30 cas

Introduction:Le but de ce travail était d'évaluer l'apport diagnostique de l'imagerie par resonance magnétique (IRM) et du genourob (GNRB) parrapport à l'arthroscopie per opératoire.L'objectif était de mettre en place un protocole basé sur l'IRMet / ou le GNRB.Matériels et méthodes:Nous avons fait une étude transversale allant du 18 Juillet 2016 au 19 juillet 2017au centre hospitalier de l'ordre de malte en comparant les résultats d'IRM et du GNRB de 30 patients par rapport aux données del'arthroscopie per opératoire. Résultats Rupture complète:En IRM, nous avons obtenu une sensibilité (Se) de 95,7 %, une spécificité(Sp) de 85,7%;Au GNRB, nous avons trouvé une Se de 87 %, une Sp de 42,9%.Rupture partielle:En IRM,nous avons obtenu une Se de 85,7 %,une Spde 95,7%;Au GNRB, nous avons trouvé une Se de 42,9 %, une Sp de 87%.Conclusion:L'IRM est plus performante que le GNRB Le GNRB ne permet pas d'améliorer les résultats de l'IRM. Il n'a pas d'apport diagnostique dans la rupture du LCA du genou. C'est un dispositif utilisé par les orthopédistes pour évaluer une laxité du genou qui ne dépend pas du LCA à lui seul

Surgical Treatment of Angular Pott's Kyphosis with Posterior Approach, Pedicular Wedge Osteotomy and Canal Widening.

BACKGROUND: It has been observed that the correction of severe posttuberculous angular kyphosis is still a challenge, mainly because of the neurologic risk. METHODS: Nine patients were reviewed after surgery (mean follow-up 18 months). There were 2 thoracic, 4 thoraco-lumbar and 3 lumbar kyphosis. The mean age at surgery was 23. Clinical results were evaluated by the Oswestry Disability Index (ODI) and by the neurologic evaluation. Preoperative, postoperative and final follow-up X-rays were assessed. The surgery included a posterior approach with cord release and correction by transpedicular wedge osteotomy and widening of the spinal canal. RESULTS: Average kyphotic angulation was 72° before surgery, 10° after surgery and 12° at follow-up. Three out of four patients with neural deficit showed improvement. Neurologic complications included a transitory quadriceps paralysis, likely by foraminal compression of the root. CONCLUSION: A posterior transpedicular wedge osteotomy allows a substantial correction of the kyphosis, more by deflexion than by elongation, with limited neurologic risks. However it is mandatory to widely enlarge the spinal canal on the levels adjacent to the osteotomy, in order to allow the dura to expand backwards.

Modified Dunn osteotomy using an anterior approach used to treat 26 cases of SCFE.

INTRODUCTION: Osteotomy performed below the femoral neck plays a leading role in the treatment of slipped capital femoral epiphysis (SCFE). It results in anatomical reduction. Several modifications have been made to Dunn's original osteotomy technique. We have developed another modification to this technique that uses an anterior surgical approach on a traction table with fluoroscopy control. HYPOTHESES: Will this technique help to reduce the number of complications? Will its results be superior to those achieved with the standard Dunn osteotomy procedure? MATERIAL AND METHODS: This was a retrospective single-center study of 26 cases in 24 patients (2 bilateral cases). Patients were positioned supine on a traction table with fluoroscopy control. An anterior surgical approach was used. A trapezoid-shaped osteotomy was performed below the femoral head. The head's reduction was checked on the fluoroscope and the fixation confirmed. The Postel Merle d'Aubigné (PMA) score was used for the clinical assessment. The radiographic assessment was based on Southwick's angle. RESULTS: The mean slip angle of the femoral head was 57°. A mean correction of 47° was achieved. Based on the PMA score, good and excellent results were achieved in 20 cases (77%) and poor results occurred in 6 cases (23%). The surgical treatment had a significant effect on the PMA score (P=0.0008). In terms of complications, there were five cases of chondrolysis and one case of necrosis associated with chondrolysis. DISCUSSION: The anterior approach provides direct access to the femoral neck, and thereby a cautious osteotomy at the site of the slip itself. Use of a traction table makes the external manipulations, reduction and fixation procedures easier to carry out. The results of this study were comparable to published results. LEVEL OF PROOF: IV, retrospective treatment study.

[Surgery in black grain mycetoma: about 44 patients treated at aristide le dantec hospital (Dakar, Senegal) from December 2008 to March 2013]. / Chirurgie des mycétomes fongiques à grain noir. À propos de 44 patients pris en charge à l'Hôpital Aristide le Dantec de Dakar (Sénégal) de décembre 2008 à mars 2013.

Black-grain mycetomas are fungal and cannot be healed by antifungals only.We conducted this study to determine the interest of carcinologic surgery only in the management of those black-grain mycetomas.We led a retrospective study concerning 44 patients over a period of 52 months. The mean age of patients was 32.5 years. The main location of mycetomas was the foot (21 cases), the ankle (10 cases), the knee (8 cases), the leg (3 cases), the chest, the back and the pulp of the fourth finger once each. The bone was affected in 21 cases. The surgery consisted in a carcinologic excision or amputation depending on the extension of the lesion and the degree of bony infringement, with ganglionic cleaning out in case of lymphadenopathy. In the average retrospect of 25.5 months, we noted 8 cases of recurrences among which 2 on the amputated patients and 6 on the patients treated by carcinologic excision. The surgery constitutes the main therapeutic issue of the fungal mycetomas.

Résultats de l'ostéotomie tibiale d'ouverture médiale fixée par plaque verrouillée type SURFIX® dans les gonarthroses sévères

Introduction: L'ostéotomie tibiale de valgisation par ouverture médiale est indiquée dans les gonarthrose fémorotibiales varisantes modérées. Ses indications pourraient être étendues aux arthroses avancées dans les pays en développement du fait de l'accessibilité limitée des prothèses. L'objectif de cette étude était d'évaluer les résultats de l'ostéotomie tibiale de valgisation par ouverture médiale dans les gonarthroses évoluées. Matériel et méthodes: Une étude rétrospective monocentrique de 3 ans a été réalisée. Quatorze patients totalisant 16 gonarthroses avec un âge moyen 48 ans ont été opérés selon cette technique. L'ostéotomie a été fixée par une plaque verrouillée type SURFIX® Treize genoux étaient classés au stade III et trois au stade IV de la classification de Ahlbäck. L'angle tibial interne préopératoire moyen était de 82°. l'IKS genou était en moyenne de 58,33 et l'IKS fonction de 52,08. Résultats: Les patients ont été évalués avec un recul moyen de 30 mois. La correction angulaire moyenne était de 7,81°. L'IKS genou était en moyenne 87,08 et l'IKS fonction 89,16. L'angle tibial interne était de 89°. La comparaison des variations de l'IKS avant et après l'opération était significative. Onze patients étaient satisfaits du résultat de l'intervention. Conclusion: Les résultats de l'ostéotomie tibiale de valgisation par ouverture médiale instrumentée par une plaque verrouillée sont satisfaisants. Ils nous encouragent à élargir les indications dans les gonarthroses avancées dans un contexte où l'indication d'arthroplastie du genou dans le traitement des gonarthroses sévères se heurte à des difficultés économiques des patients

Children distal humerus supracondylar fractures: the Blount Method experience.

INTRODUCTION: Extension-type supracondylar fractures of the humerus in children are frequent lesions whose orthopaedic treatment remains under debate in Rigault and Lagrange type III fractures and highly controversial in type IV fractures. The objective of this study was to extend the Blount method to fractures with substantial displacement even in patients presenting significant swelling and to evaluate the results. PATIENTS AND METHODS: We conducted a prospective continuous study from December 2005 to August 2007 on 67 children: 49 boys and 18 girls with a mean age of 6 years (range, 3-14 years). The mean time lapsed from consultation to treatment was 30 h. The mean hospital stay was 72 h. In 50 children, the limb was elevated preoperatively for a mean 48 h. The fracture was reduced under fluoroscopy-guided general anesthesia with mask and immobilized with 5-cm cloth banding padded with foam. The follow-up was clinical and radiological. The mean follow-up was 16 months (range, 6-26 months). Assessment followed the 1969 SOFCOT guidelines. RESULTS: At union, mean flexion was 124 degrees , the mean extension lag was 26 degrees . At last follow-up, the mean flexion was 146 degrees , the extension lag was 0.5 degrees , and pronation and supination were free. Immediately after surgery, the mean Baumann and anteflexion angles were 75 degrees and 43 degrees , respectively; at union they were 76 degrees and 44 degrees and at follow-up 79 degrees and 42 degrees . We found no vascular or nerve lesions. According to the SOFCOT criteria, at follow-up we obtained 80.6% very good results and 19.4% good results. LEVEL OF EVIDENCE: Level IV. Therapeutic study.

[Orthopaedic treatment of floating elbow in a child: a case report]. / Traitement orthopédique du coude flottant chez l'enfant: à propos d'un cas.

The floating elbow in the child is rare and serious. The authors report a traumatic case of floating elbow without vascular and nervous lesions associated in a 6-year-old child. We treated these both fractures of the distal forearm and the supracondylar humeral by respectively cast plaster and a collar and cuff with an anatomical reduction. The radiological and clinical results were excellent with the 29 months follow-up.

Fracture of the odontoid process in children: a case report.

The authors report a case of apophysial fracture of the odontoid process in association with paresis of the upper extremities in a 5-year-old child. The fracture was treated by gradual guided self-reduction without anaesthesia, followed by a Minerva jacket cast immobilisation. Reduction was anatomical, and the neurological problems regressed within 48 hours.

Posterior surgical approaches to the elbow: a simple method of comparison of the articular exposure.

PURPOSE OF THE STUDY: Bilaterotricipital approach, triceps splitting and olecranon osteotomy are the three most common posterior approaches to the elbow. The aim of this study was to propose a simple technique to measure the exposure of distal articular surfaces of the humerus through these posterior surgical approaches. MATERIALS AND METHODS: Each approach was performed on ten cadaver elbows. After the completion of each approach, the visible articular surface was painted yellow. The elbow was then disarticulated. The unexposed articulated surface (by the approach) was painted blue. The painted surfaces were then wrapped using a net with meshes. The articular percentage of exposure was measured by calculating the mesh occupied by each painted surface. RESULTS: The median exposed articular surface for the bilaterotricipital approach, the triceps splitting and the olecranon osteotomy was 26, 37 and 52%, respectively. CONCLUSION: The method is easy to perform and is reproducible.