[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.

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.

Long-term prognosis of tarsal dislocations.

Eighty tarsal dislocations treated between 1954 and 1979 are presented. Our of 48 cases reviewed after a mean follow-up time of 7 years, satisfactory results were achieved in 30 (62%). Osteonecrosis of the talus was not recorded whereas necrosis of the navicular developed in 5 patients. Failures are to be related to significant osteoarthritic changes which occurred after a long period particularly in compound injuries with associated fractures of the tarsal bones. Early closed reduction and immobilization in a below-knee cast for 4 weeks is recommended in pure luxation; associated fractures of the talus and navicular require surgical fixation as far as possible. Except in total open dislocation of talus or navicular replacement was by far preferred to removal and primary arthrodesis.