[Value of orthopedic treatment of distal fractures of the forearm in children. Apropos of 152 cases]. / Place du traitement orthopédique dans les fractures du quart inférieur des deux os de l'avant-bras chez l'enfant. A propos de 152 cas.

PURPOSE OF THE STUDY: Distal forearm fractures in children are frequent. Management is conservative except in rare cases which will be discussed. MATERIAL AND METHODS: Retrospective analysis of 152 distal forearm fractures after 10 and a half months (6 to 48 months) of follow-up was carried-out. Age ranged from 2 to 16 years (mean 10 years). Orthopaedic treatment was proposed in each case, but in 5, surgical treatment was required at onset. Clinical and radiological fracture reduction analysis was conducted immediately post op and during follow-up. 92 per cent of these fractures had a posterior or posterolateral angulation (with a mean angulation of 28 degrees 5). Among these cases, 64 per cent had instability criteria. Degree of translation when present (79 cases) was at 100 per cent in 55 cases (70 per cent); greater than 50 per cent in 11 cases (14 per cent) and less than 50 per cent in 13 cases (16 per cent). In 12 cases (8 per cent), the displacement was anterior with a degree of translation greater than 50 per cent in 6 cases and an angulation always greater than 30 degrees in the 6 remaining cases. RESULTS: In 5 cases, surgical treatment was necessary due to initial instability and/or irreducibility. In 147 cases, analysis of instability criteria, reduction and cast quality, and of fracture location showed displacements in cases of non-adapted and incorrect X-ray work up (6 cases of 6); in 18 cases of 24 when the cast was adapted but with incorrect X-ray work-up; in 5 cases of 10 when the cast was non-adapted with correct X-ray work-up, in 3 cases of 7 when the fracture was superiorly located; and in 6 cases of 6 when cast was prematurely opened. DISCUSSION: Close reduction is possible for fractures with large displacement but must be done perfectly and the cast must be adapted. If instability, irreducibility and/or incorrect reduction exist, management must include posterolateral and intrafocal percutaneous pinning, especially in older children. While rare, this indication must be known.

[Recent fractures of the base of the 1st metacarpal bone. A study of a series of 138 cases]. / Fractures récentes de la base du premier métacarpien. Etude d'une série de 138 observations.

Fractures on the base of the first metacarpal are uncommon lesions, affecting young subjects and have major social repercussions (an average of 3.5 months off work). The authors have analysed the clinical and radiological results of a series of 138 recent fractures of the base of the first metacarpal with a mean follow-up of 7 years (12 month-14 years). They used a classification into 5 types (Bennett's with a large fragment = 22%, Bennett's with a small fragment = 20%, Rolando = 15%, extraarticular fractures = 36%, Comminuted fractures = 6%) which are easy to recognize on standard x-rays, or preferably on Kapandji views, allowing a standardized therapeutic approach. 70% of patients were younger than 40 and in one half of cases the causal accident was a motor vehicle accident. 12% of fractures were open and 45% were associated with other traumatic lesions. In this series, 35% of cases were treated orthopedically, 57% according to Iselin's technique, 5% by direct osteosynthesis and 3% by external fixation with a mean immobilization of 40 days. A number of clinical and radiological criteria were studied in the 88 patients reviewed. A 100-point grading system was established and, independent of the type of treatment, the authors obtained 61% of very good results, 23% of good results, 12% of moderate results, 2% of poor results and 2% of very poor results. Articular lesions constituted a factor of severity and failure to respect opening of the commissure appeared to be more pejorative than a small imperfection of reduction. The authors noted that simple treatment according to Iselin's technique still has many indications despite progress in miniaturized osteosynthesis.

[Foot localization of a Kaposi's sarcoma. Apropos of a case]. / Localisation au pied d'un sarcome de Kaposi. A propos d'un cas.

With regard to a foot localization of a cutaneous Kaposi's Sarcoma, the Authors briefly evoke the manifestations of this acquired immuno deficiency syndrome (AIDS). Some clinical aspects of the AIDS, commonly looking, but often revealing the disease, may lead the patient to an orthopaedic surgeon.