[Osteochondritis dissecans of the acetabulum. Apropos of a case]. / L'ostéochondrite disséquante du cotyle. A propos d'un cas.

Osteochondritis dissecans acetabuli is a rare affection. The observation presented is one of a 23 year old man, who presented hip blockages in external flexion rotation. X-ray only allowed to find a sequestrum in the acetabulum by tomography-Arthroscanner confirmed the osteochondritis without cartilage rupture. Arthroscopy eliminated a cartilage lesion and directed towards a cavity filled by spongious bone through an extra articular approach.

Recurrent posterior instability of the shoulder.

Seven cases of recurrent posterior instability of the shoulder were reviewed, three with recurrent subluxation and four with recurrent posterior dislocations. All were treated surgically, one by inverted Putti-Platt, one by glenoplasty and five by posterior bone block procedures. The follow-up goes from three to 17.5 years (mean 8.5 years). Clinical history and physical examination were the most accurate diagnostic methods. There were three excellent, one fair, and one poor results with two failures. The poor result and failure cases are due to technical errors, particularly because of wrong positioning of the graft in posterior bone block procedures. We suggest a bone graft with a projection of at least 15 mm beyond the glenoid rim to obtain a good result with this technique. Osteoarthritis does not seem to develop at long-term in our patients even with a poor result except for those with iatrogenic origin. The functional results are stable over time except for patients with osteoarthritis.

Acetabular reconstruction with a bipolar prosthesis. Five year results of the Dautry technique.

We report the results of acetabular reconstruction using a bipolar prosthesis bearing on cancellous bone graft in 37 patients after a minimum of five years. There was a satisfactory clinical outcome in 58% when assessed by pain, range of movement and stability, with greater improvement in the pain score than of the other parameters. Radiological migration of the prosthesis was a frequent finding although this did not always correlate with symptoms. Better results were obtained in cases of primary or secondary protrusio acetabuli than after the revision of previous total arthroplasties.

[Surgical treatment of metastases of the humerus]. / Traitement chirurgical des métastases de l'humérus.

Surgical treatment of metastasis disease of the humerus was applied for 46 lesions among 42 patients, i-e 22% of overall osteosyntheses for skeletal metastasis. Two patients only are still alive at 3 and 4 years. The mean survival time is 8.1 months and at 3 months 50% died. Metastasis disease of the humerus becomes evident late during the evolution of the primary cancer, but 26% are revealing lesions. For 9.5% the primary tumor remains unknown. After review of the surgical methods generally used, indirect osteosynthesis by intra-medullary pinning according to Hackethal, without bone cement, is alleged. So the arm is immediately mobilized and a complementary irradiation is applied in post-operative. Prophylactic fixation of impending fractures is encouraged in order to suppress pain, and for better function. This paper demonstrates the changing concept of internal fixation of pathologic fractures and recommends intra-medullary nailing or pinning.

[Thrombopenia induced by heparin in orthopedic surgery. Apropos of 12 cases]. / Les thrombopénies induites par l'héparine en chirurgie orthopédique. A propos de 12 cas.

Treatment with heparin for the prevention of thrombosis in orthopaedic surgery may sometimes be responsible for thrombopenia. This can be associated with arterial or venous thrombotic complications. Twelve cases of heparin-induced thrombopenia are reported here. Three cases were demonstrated by a diminution of the platelet count which reversed when heparin treatment was discontinued. Nine patients presented with arterial and/or venous thromboses whose progress was favourable in the long term. The replacement of heparin treatment by anti-vitamin K from the 5th or 6th day can avoid the thrombotic complications of heparin-induced thrombopenia.

[The snapping hip. Late results of 24 surgical cases]. / La hanche à ressaut. Résultats tardifs de vingt-trois cas opérés.

The sensation of a 'snapping hip' is due to a tight iliotibial band sliding abnormally over the greater trochanter during certain movements of the hip. Diagnosis is strictly by clinical examination. Radiographs and other investigations are unnecessary, expensive and may be psychologically harmful. We have assessed the results of operation in 35 such hips in 23 patients, reviewed at between 2 and 17 years. A cruciate incision was made in the iliotibial band over the greater trochanter, and the four flaps produced were sutured back on themselves, or to adjacent structures. The results were disappointing, with 30% of patients having a successful result, 30% a recurrence of symptoms and over 60% continuing to experience pain of a varying degree. In the majority of patients operation is not justified, but may be indicated if there is demonstrable abnormality, after trauma or in the presence of severe, intractable pain.

[Os acromiale: significance--diagnosis--pathology. Apropos of 28 cases including 2 with fracture separation]. / L'os acromial: signification--diagnostic--pathologie. A propos de 28 observations dont 2 décollements-fractures.

In relation to two rare cases of fracture-separation of the os acromiale, 26 other cases of defective epiphysial fusion were studied. A review of the literature confirmed the rarity of this anomaly of the scapula which predisposes to subacromial impingement and rotator cuff rupture. The diagnosis is radiological. It requires both an antero-posterior and an axillary view which, together with a CT scan, precisely shows the os acromiale. It should be distinguished from a fracture of the acromion to avoid unnecessary immobilisation and post-traumatic effects. Degenerative changes provoke an impingement syndrome, the surgical treatment of which must include arthrodesis of this ossicle.

[Sternoclavicular dislocations. Observations on the treatment and result of 49 cases]. / Les disjonctions sterno-claviculaires. Considérations sur le traitement et les résultats de 49 cas.

Over a period of 19 years, 49 dislocations of the sternoclavicular joint were treated. Two were epiphyseal separations. The dislocation was an isolated injury in only 41% of the patients. There were associated injuries to the scapula in 55% and to the thorax in 37%. Forty dislocations were anterior, 8 retrosternal and one merely unstable. Seventeen were treated by operation, 15 by closed reduction and 17 were left untreated. We have been able to review 55% of these patients with an average follow up of 6.7 years; 15 were between 2 and 6 years after injury, and 12 between 6 and 16 years. The end result was achieved by 3 months; 42% of patients had an excellent result, 58% were satisfied and 25% disappointed with the final outcome. Operative treatment gave 66% of excellent results, whereas immobilisation, particularly with unreduced dislocations, accounted for most of those judged unsatisfactory. Closed treatment should be undertaken initially, but if reduction is not achieved an operation should be carried out. If old unreduced dislocations are unsatisfactory they should be stabilised by myoplasty, or by excision of the inner end of the clavicle if the articular surface is damaged.

[Arthroplastic resection of the shoulder. Results and indications apropos of 35 cases]. / La résection arthroplastique de l'épaule. Résultats et indications à propos de 35 cas.

The only aim of this retrospective study of 35 patients who had undergone resection of shoulder is to report overall results of this well established operation. Although no result could be rated as excellent, those in one half of the patients were evaluated as good and in one quarter as acceptable. The shoulder can be used in two-thirds of cases and of major importance is that pain is absent in two-thirds and tolerable in 80% of cases. In addition to cases of septic arthritis and poorly tolerated recurrent luxations, this operation is indicated for elderly patients with a fracture-luxation or compound fracture of upper end of humerus. However, the operation requires very strict conditions and re-attachment of the cap of rotator muscles. Resection of shoulder should therefore conserve a place in the therapeutic arsenal of shoulder disorders.

[The articular cartilage of the patella in scanning electron microscopy]. / Aspects du cartilage rotulien en microscopie électronique à balayage.

The authors have studied 50 samples of patellar cartilage, normal and pathological, obtained by biopsy, using a scanning electron-microscope. The normal cartilage shows characteristic regular wave-like undulations. The size of these waves varied between 5,000 and 7,000 nm and the undulations were linked by regularly-spaced fibrillary bridges. In a case with an osteochondral fracture, the fracture site was covered by peripheral cartilage, as had previously been shown by Ghadially. Eighteen cases of patellar chondropathy were divisible into three groups: group I (four cases) showed fibrillary chondropathy, of cerebriform appearance and without fibres. Group II (12 cases) showed a fibrillary chondropathy with loss of geometrical regularity and a staghorn appearance. Group III (two cases) showed an oedematous chondropathy with destruction of fibres. In group II, the presence of bundles of fibres with microfractures indicates a potential for progress to frank arthrosis.

[Erect dislocation of the shoulder (luxatio erecta humeri). General review apropos of 10 cases]. / La luxation en mât de l'épaule (luxatio erecta humeri). Revue générale à propos de 10 observations.

Subglenoid dislocation of the shoulder is uncommon. The clinical picture is striking and the radiographic appearances are characteristic, with the head of the humerus lying inferior to the glenoid and the shaft directed upwards and internally rotated. Complications such as associated fractures and injury to the brachial plexus or acillary vessels may occur. Fracture of the greater tuberosity or rupture of the rotator cuff is always seen. Post-traumatic frozen shoulder is common and leads to a poor functional result. The authors describe ten cases and review the literature. The mechanism of the injury is discussed and experimental evidence which supports the current concepts of shoulder instability is reviewed.

[Paralysis of the serratus anterior muscle. Results of treatment of 12 cases including 9 surgically treated and a general review of the literature]. / La paralysie du grand dentelé. Résultat du traitement de 12 cas dont 9 opérés et revue générale de la littérature.

An analysis of the results of treatment in twelve cases of serratus anterior paralysis, nine of which were treated operatively, and a review of the literature has shown that, in lesions that fail with conservative treatment by physiotherapy, surgical treatment rapidly restores normal strength and function. Long follow-up, between 3 and 23 years, confirms the effectiveness and reliability of muscle transfers, particularly of pectoralis major.

[Microsurgical transplantation of bone tumors of uncertain prognosis in athymic nude mice]. / Transplantation microchirurgicale chez la souris nude athymique des tumeurs osseuses de pronostic incertain.

Eight cases of human bone or soft tissue tumours were transplanted to nude mice. After such transplants to nude mice which are immunologically deficient, the malignant tumors developed like benign tumours, but maintaining malignant cytological characteristics. The transplants of normal human tissues or of benign tumours decreased in size or remained stable. The technique allowed a change of an original diagnosis of osteosarcoma to a final diagnosis of chondrosarcoma. It made it possible to diagnose a benign osteoblastoma, the diagnosis of which was doubtful before the transplant between osteosarcoma and chondroblastoma. It was possible to diagnose the malignancy of a haemangiopericytoma of muscle. Two aggressive tumours--a non-ossifying fibroma and a giant-cell tumour--were rated as benign after transplantation. This technique also allowed a more precise diagnosis of the grade of one chondrosarcoma and one osteosarcoma. Finally, transplantation also made it possible to test the efficacy of chemotherapy. In a patient so treated, the extreme cell proliferation after transplantation to the nude mouse led to a change in the drugs administered.

[X-ray computed tomography in the study of anterior instability of the shoulder. Study of a series of 23 cases]. / Apport de la scanographie dans l'étude de l'instabilité antérieure de l'épaule. Etude d'une série de 23 cas.

The place of standard CT scan imaging more particularly when combined with double contrast arthrography, is defined in the preoperative screening of patients with anterior instability of the shoulder. The joint scan provides complete data on the anatomic elements of the shoulder lesion, particularly with reference to the glenoidal labrum and the anterior capsular structure. It is also of major diagnostic value in painful subluxations.

Therapeutic aspects of limb lesions due to hunting weapons: a study of twenty cases.

The authors report 20 cases of limb lesions provoked during hunting accidents by traditional weapons (gauges 12 and 20) or by 5.5 mm bullets of 22 L.R. Lesions caused by shotguns (gauge 12, 20) are much more serious when done point-blank or at very short shooting distance. The treatment of skin and bone lesions shall be realized in several steps: emergency removal of the foreign bodies with cutting out of non viable bone fragments. Immobilization and depending on the development, two therapeutic solutions may be chosen: either skin graft then bone graft or Papineau's method. Lesions caused by 5.5 mm bullets are much less serious because losses of substances are less important.

[Shoulder radiographic evaluation. Radiographic examination of shoulder and scapular girdle trauma (author's transl)]. / Le complet radiologique de l'épaule. Approche radiologique des traumatismes de l'épaule et de la ceinture scapulaire.

The Shoulder Radiographic Evaluation ("Complet Radiologique de l'Epaule") is completed by four positions: Standard A-P, Axillary axial view, Profil of the scapula, A-P in arm abduction. This paper focuses on the radiographic examination of the components of scapular girdle and shoulder articular complex. Several positions are described as routine positions in trauma. This radiographic procedure is of helpful interest for clinical, therapeutic and forensic applications.