[A peculiar tumor. Adamantinoma of the long bones. Apropos of 7 consecutive cases followed up after resection]. / Une tumeur singulière. L'adamantinome des os longs. A propos de sept cas consécutifs suivis après résection.

Seven cases of tibial adamantinoma have been reviewed. All were treated by en bloc resection and followed for one to twenty years after operation. Of five patients followed for more than three years, three have had a good result after 3, 12 and 20 years of follow-up. One patient suffered a recurrence in the soft tissues seven years after resection and remained well after thirteen years follow-up. One patient required amputation two years after resection and died from a mediastinal tumour of undetermined nature sixteen years after amputation. The two failures occurred in patients seen secondarily following recurrence after initial curettage. The tibial shaft was reconstructed in three cases by massive allografts. One of these failed because of infection but was reconstructed using autografts; one had a late fracture which united spontaneously. The third, after sound union, had to be amputated for recurrence. Two smaller resections were treated successfully by tibial and iliac autografts. Two cases were treated by free vascularised fibular transplants which united, though one suffered a late fracture which united spontaneously. Curettage, which is almost always followed by recurrence, should be rejected in favour of extensive resection. Resection is successful when done primarily but poses severe problems in reconstruction and requires a prolonged period of treatment. The small numbers in this series do not allow a judgement to be made as to the superiority of one technique over another.

[Septic leg fractures. Value of cancellous bone grafting without skin closure, aligned on the fibula]. / Fractures infectées de jambe. Intérêt de la greffe spongieuse à ciel ouvert appuyée sur le péroné.

The authors have treated 63 septic fractures of the tibia, 29 of whom were seen less than four months after the injury; the remainder were more long-standing. In both series the surgeon faced three problems--curing of the septic drainage, skin cover and bone union. In 46 cases bone excision was considered necessary: in 18 diaphyseal resection was performed. Immobilisation of the fracture was obtained by plaster cast in 14 cases, an external fixator in 48 cases, and medullary nailing in one. Reconstruction was needed in 11 cases after closed grafting, 9 of them being tibio-fibular, and in 46 after cancellous graft without skin closure. The results in 63 cases were 61 unions: 43 primary unions, 19 additional procedures to reinforce callus and 1 amputation. In two patients union remained particularly tenuous. Two patients are still showing discharge and 9 have poor skin cover. The average time to bone union was nine months and was twelve months in cases of resections greater than 3 cms. The authors are in favour of a technique of massive cancellous bone grafting of the tibia, aligned towards the fibula with partial skin closure. This procedure leads to a firmer and more rapid bone union than the Papineau technique. Secondary bone or skin procedures were needed less often. Tibio-fibular grafting was indicated in cases of limited infection and when the main tibial fragments were still uniting postero laterally.

[Complex injuries of the upper end of the 2 forearm bones]. / Traumatismes complexes de l'extrémité supérieure des deux os de l'avant-bras.

Thirty-four cases of severe trauma to the proximal ends of both bones of the forearm have been seen. All were treated surgically. A classification is proposed related to the site of the ulnar fracture. Type I is metaphyseal and the displacement is posterior, the reverse of that of a Monteggia fracture, with a posterior dislocation of the superior radio-ulnar joint. Type II is epiphyseal with anterior displacement. The superior radio-ulnar joint is intact. Type III is metaphysio-epiphyseal with anterior displacement. Type IV is the same with posterior displacement. Fractures of the radial head are present in all cases with posterior displacement and in these types, secondary displacements and non-unions are frequent (six cases). These were related to inadequate fixation of the ulna and to resection of the radial head which led to an increased strain on the ulnar fracture. Severe limitation of movements was infrequent (five cases) and was usually seen in fractures with posterior displacement. It was related to the time of cast immobilization and to the fracture of the radial head. Fractures with anterior displacement and an associated fracture of the radial head were rare but had a better prognosis in spite of the intra-articular site of the fracture. The relevance of repair of the radial column is stressed as being as important as stable fixation of the ulnar fracture.

[Arthroscopic meniscectomies. Short- and median-term results]. / Méniscectomies arthroscopiques. Résultats à court et moyen termes.

Two hundred and forty arthroscopic meniscectomies have been performed between 1980 and 1982. One hundred and ninety-eight cases have been reviewed with a follow up of between 3 and 6 months and 101 cases were reviewed with a follow up of between 6 months and 2 years. On eight occasions the arthroscopy had to be completed by an arthrotomy and one of these became septic. No sepsis was observed in the absence of arthrotomy. Three cases of phlebitis and one haemarthrosis were seen. Social and functional rehabilitation was very rapid. The stay in hospital was 2 days and resumption of sport and work was 2 or 3 times more rapid than after meniscectomy by arthrotomy. The results were excellent or good in 85 p. 100 of cases, slightly better than after arthrotomy. The prognosis was worse when there were patellar or tibio-femoral chondral lesions, and the results were not as good in lateral meniscus lesions, and particularly when there was an associated lesion of the anterior cruciate ligament. However, two patients out of three with this condition were noticeably improved. The remainder will possibly have a secondary repair of the anterior cruciate ligament. The present follow up is not sufficient to evaluate long-term results but the fact that meniscectomy was partial in 3 cases out of 4 supports the hope that the results will be stable. It is only later that it will be possible to evaluate the unobserved lesions or the incidence of recurrence.

[Radiological assessment of knee deformity in the frontal plane (author's transl)]. / Mesure radiologique des déformations frontales du genou. Procédé du profil vrai radiologique.

The radiological assessment of knee deformity in the frontal plane is often fallacious because of the difficulty in determining the correct position of rotation of the lower limb. Deformity is under-estimated when the direction of the X-ray is not perpendicular to the frontal plane. To determine the frontal plane with accuracy the authors first looked for a true lateral view which is obtained when the posterior margins of the femoral condyles are superimposed. When the position of the patient has been determined by demonstrating the true lateral position, a second radiograph is taken using a large film in a plane at right angles to the preceding film. In this way a true frontal plane is obtained which requires no reference to the position of the foot or the patella which tends to be variable. An association flexion deformity does not invalidate the result. When this technique is used it can be shown that conventional methods tend to under-estimate the degree of knee deformity.

[Osteoblastoma of 4th cervical vertebrae. Report of a case with hypertrophy of the posterior arch of 3 vertebrae]. / Ostéoblastome de la 4e vertèbre cervicale. Un cas avec hypertrophie des arcs postérieurs à 3 niveaux.

The case of a man aged 22 suffering from pain in the right side of the neck is described. Radiographs showed marked hypertrophy of the articular processes of C3, C4 and C5. C-T scanning confirmed this and showed a protrusion into the cervical canal at C.4 level. At operation, this protrusion was found to be due to an osteoblastoma. At first it was thought that the hypertrophy of the articular processes from C.3 to C.5 were due to extension of the osteoblastoma to three levels but later it was concluded that the hypertrophy was a reactive lesion. No other similar lesion has been found in the literature.

[An experimental study of the stability of Hoffmann's external fixation (author's transl)]. / Stabilité expérimentale du fixateur externe de Hoffmann. Présentation d'un nouveau matériel.

The authors have tested the stability of Hoffmann fixation in relation to the number and location of the fixating pins. A double frame configuration as described by Vidal is not superior since it allows some mobility in the plane of flexion and extension. The authors believe that a double perpendicular plane configuration is more satisfactory without the use of a transfixing pin. This method is more stable. To improve stability in valgus-varus plane, the authors have designed a device which is more rigid and which decreases by 300 per cent any residual mobility at the fracture site. A newly designed plate allows good fixation in the epiphysis. The first clinical cases in which this new fixator has been used have given promising results.

[Post-traumatic compartment syndrome of the leg (author's transl)]. / Syndrome ischémique post-traumatique des loges de la jambe--formes aiguës sans atteinte des axes artériels.

Fifteen compartment syndromes seen in the first few hours have been collected. Fourteen occurred after tibial fracture and one after a simple contusion. In typical cases it is emphasised that ischaemia affects the contents of the compartment in an insular fashion so that distal ischaemia is not present. The main arteries are sound and demonstrated by distal pulses, the vascularity of the foot, Doppler studies and arteriography. The diagnosis is difficult but must be made at the earliest opportunity by repeated clinical examination. Measurement of the compartment pressure may be useful because the decision for fasciotomy has to be made with some urgency. The critical delay for the anterior compartment is about 12 h following trauma but it is much longer for the posterior compartment. We believe that it is advisable to always perform both anterior and posterior fasciotomy. Seven cases had combined involvement. Necrotic muscle is excised, particularly if it is present in the posterior compartment, because of the risk of contracting fibrosis. In the anterior compartment, the fibrosis can be helpful and reduce the effects of foot drop. Cases in the literature have most often been associated with conservatively treated fractures. We have measured compartment pressures during intramedullary nailing. An increase in pressure is often recorded when the nail is introduced but returns to normal in a few minutes.

[Streptococcal gangrene. A report on 9 cases (author's transl)]. / La cellulite gangréneuse streptococcique. 9 cas siégeant aux membres.

The authors have treated 9 cases of streptococcal gangrene of the limbs. They describe the clinical features:local oedema, erythema, and cyanotic spots. In 7 of the cases the infected general condition was very severe. At operation, the subcutaneous soft tissues were grey-green without pus. The authors have reviewed the literature and consider that treatment should be based on early excision of the skin and subcutaneous tissues. Antibiotics are of great help but are not sufficient by themselves. Nine patients reached a stable state but sequelae have been severe with one disarticulation of the shoulder, one ankylosis of the wrist, one ankylosis of the knee and one generalised stiffness of the hand. Only five patients have been completely cured.

[Complimentary surgical procedures following treatment of non-union by the Papineau method (author's transl)]. / Les gestes complémentaires de l'opération de Papineau.

The authors have treated 82 non-unions by the Papineau method of bone grafting without skin closure. In 30 cases, a complimentary bone procedure had to be performed to reinforce bone union. This consisted of a new Papineau procedure in 18 cases and an iliac graft with skin closure in 12 cases. Infection recurred in several instances. In addition to these 30 cases, 3 secondary fractures were seen. In cases with persistently depressed scars, a fresh Papineau procedure may be needed. In cases with persistent skin ulceration, resection and skin suture should be tried before a cross-leg skin graft. The authors emphasize the frequency of vascular changes which should be looked for by arteriography.

[Deformities of the feet after Volkmann's ischemia in the lower limb (author's transl)]. / Les séquelles au pied du syndrome de Volkmann.

The authors have observed 11 cases of Volkmann's ischemia in the lower limb. The main deformity was of equinus. 10 patients were operated on. In 8 cases, arthrolysis was performed with good results in 7 cases. In 2 cases an ankle arthrodesis was done with one good result and one secondary amputation. The surgical technique of the arthrolysis is described. In most of the cases, tendon lengthenings, capsulotomy and fixation with an external fixator was required. This device was tolerated and it is concluded that it is worthwhile in severe ischaemic syndrome and that arthrolysis is preferred to arthrodesis.

[The depth of the patellar groove of the femur (author's transl)]. / Les trochlées fémorales creuses.

The authors have measured the depth of the patellar groove in a 100 human cadavers. An angle of about 143 degrees have been found to be present in normal knees, confirming the work of Brattström. When the angle was more than 150 degrees, the groove was considered to be dysplastic and likely to lead to patellar instability. In contrast when the angle was less than 138 degrees, the groove was thought to be excessively deep. This was present in 19 cases, in 13 of which there were obvious lesions of the articular cartilage. This study in cadavers has been confirmed by a scan study of 148 patients complaining of femoro-patellar syndrome. Deep patellar grooves were frequent in this series, the mean angle being 129 degrees. 80 p. 100 of the patients had an angle less than 135 degrees. It is concluded that deep patellar grooves with a lower angle than normal favour the development of patellar chondromalacia.

[Rotational displacement of eccentric cups cemented in the acetabulum (author's transl)]. / Rotation anormale de certaines cupules cotyloïdiennes excentrées scellées.

The authors have operated on 15 hips using a total prosthesis comprising a metallic head and plastic cup cemented in the acetabulum. The acetabular component is thicker at its upper part to accommodate eventual wear in the plastic. In all cases the cup rotated through 180 degrees so that, after several months, the thicker part was situated at the lower pole of the acetabulum. In two cases, a fracture of the cup was found. The cause of this abnormal rotation can be explained by a torque action taking place at each step because of the eccentric design of the cup. This was demonstrated by a prosthesis inserted into a cadaver and tested by simulated walking. 45 kilometres of walking were sufficient to provoke a rotation of 90 degrees. Conclusions are given on the use of such eccentric cups which should be avoided.