Complications associated with gamma nailing. A review of 439 cases.

We have retrospectively analysed 439 peritrochanteric hip fractures treated in our institution using the Gamma nail, with attention focused on complications. Intraoperative complications were observed in 15 patients (3.4%), consisting mainly of fractures (1.8%). Out of 323 fractures (73.6%) followed until radiographic bone healing (mean follow-up of 10 months), 261 (80.8%) healed without a problem. There were 62 postoperative complications (19.2%) with 37 patients (11.5%) requiring additional surgical procedure. The two most frequent major complications were cut out of the cephalic screw (7.1%) and diaphyseal fractures (3.1%). Other complications included fracture collapse more than 2 cm (1.5%), infection (0.9%), delayed union (0.9%) with one case of nail breakage (0.3%) and persistent pain in 20 patients (6.2%). All intraoperative fractures, nearly all cases of postoperative cut out of the lag screw and some postoperative diaphyseal fractures can be related to technical errors. Strict observance of the operative technique can decrease per- and postoperative complications.

[Coracoid process abutment according to Latarjet versus the Bankart operation. A comparative study of the results in 50 cases]. / Butée coracoïdienne selon Latarjet versus opération de Bankart. Etude comparative des résultats à propos de 50 cas.

The authors have analyzed the postoperative results in 50 patients of two surgical techniques used for the treatment of anterior recurrent dislocation of the shoulder. The study only concerns "virgin" shoulders having formally presented numerous anterior recurrent dislocations treated by the Bankart procedure or the Bristow-Latarjet operation. This work consists of a clinical evaluation with objective and subjective results on one hand, and a radiological evaluation on the other hand. The Latarjet operation gives 97% excellent and good results, as compared with 76% for the Bankart procedure. The radiological study confirms the "arthrogenetic" nature of the Latarjet operation and reveals a frequent lysis of the coracoid bone block. Nevertheless, these two factors do not affect in any way the objective and subjective results. The Latarjet operation, insofar as it is carefully executed, remains in our opinion, the prime operation, particularly with respect to the quality of the stability achieved.

Long-term sequelae of pelvis irradiation: histological and microradiographical study of a femoral head.

Despite the lack of radiological signs, a femoral head showed histological and microradiographical features of osteonecrosis, 54 years after massive irradiation of the right hip. Intertrabecular spaces were invaded by connectivo-vascular tissue with focal accumulation of mast cells, and several resorption foci were filled with mononucleated cells. Moreover, all the microradiographs showed peculiar hypercalcified lines, sometimes containing empty osteocytic lacunae, the origin of which is difficult to precise. This study suggests that massive irradiation of weight-bearing epiphyses may be responsible for particularly long-term hypovascularity, osteonecrosis and disturbed bone remodeling.

[The Herbert screw in the treatment of fractures and pseudarthrosis of the carpal scaphoid. Review of 25 cases]. / Utilisation de la vis de Herbert dans le traitement des fractures et pseudarthroses du scaphoïde carpien. Revue de 25 cas.

The Authors have reviewed the charts of 25 patients with scaphoid lesions treated with the Herbert screw and this study reports their personal experience. Between September 1983 and December 1986, 4 fresh fractures, 5 delayed unions and 16 pseudarthrosis were treated by means of this osteosynthesis procedure. The mean follow-up was 22 months. Bony union occurred in 21 patients. The series contains 2 failures defined as an absence of bony union after a post-operative delay of more than 6 months. There were 2 other cases considered as doubtful unions on X-rays. Wrist function, nevertheless, was restored in 23 patients. Plaster immobilization did not appear to be essential for every case. The short leave of absence, averaging 2 months only, is also in favour of this technique.