Dislocation of the elbow with ipsilateral forearm fracture. Six particular cases.

Elbow dislocation associated with ipsilateral radial shaft fracture is an infrequent injury (nine cases reported in the literature). We present six new cases observed between 2006 and 2012, with an average age of 31 years and a mean follow-up of 18 months. The forearm fracture and ipsilateral dislocation of the elbow were probably caused by forearm hypersupination with extension of the elbow. The dislocation was reduced by manipulation before open reduction and osteosynthesis of the forearm fracture. Four elbows were stable after reduction; two markedly unstable elbows necessitated temporary humero-ulnar external fixation; one case needed a ligamentoplasty several months later. Despite the complexity of the traumatic lesion, the clinical and radiological outcomes were acceptable.

[The Department of Orthopaedics and Traumatology of the University Clinics of Brussels, Erasme Hospital]. / Le Service d'Orthopédie-Traumatologie des Cliniques Universitaires de Bruxelles, hôpital Erasme.

On the occasion of the thirty years since its inauguration, the Department of Orthopaedics and Traumatology of the University Hospital Erasme reviews the milestones of its development. Various original new techniques have been implemented: monitoring of implants using strain gauges, external fixation of the limbs, external minifixation, miniinvasive anterior approach in hip arthroplasty, knee ligamentoplasties, orthopaedic microsurgery and composite tissue allotransplantation. The care of aged patients takes place in close collaboration with the Department of Geriatrics. Two new clinical units have been created, the Unit of Hand and Peripheral Nerve Surgery, and the Centre for Sports. The Department has organized an efficient Bone Bank. The new day care hospital improves the possibilities of ambulatory surgery. The article details as well the activities of teaching and research of the members of the Department.

[Treatment of severe proximal humeral fractures by proximal nailing (Telegraph). A prospective preliminary study]. / Traitement des fractures complexes de l'humérus proximal par enclouage verrouillé (Telegraph). Résultats d'une étude prospective préliminaire.

Treatment of complex fractures of the proximal humerus is still controversial. This prospective study was designed to evaluate the results of open reduction and proximal nailing in complex fractures of the proximal humerus. Fifteen patients aged 39 to 83 years (average: 59 years) presenting severely displaced fractures of the proximal humerus were observed after open reduction and fixation by proximal nailing (Telegraph) combined with screwing and/or osteosuture of the tuberosities. The patients were evaluated at one year clinically and radiologically. The Constant score, DASH score and Simple Shoulder Test were calculated. Complementarily, patients were submitted to an isokinetic test. At one year follow-up, the average range of motion was 85 degrees (40 degrees-170 degrees) for elevation, 82 degrees (40 degrees-170 degrees) for abduction, L3 for internal rotation and 34 degrees (10-60 degrees) for external rotation. The average visual analog score was 3 points (0-8 points). The Constant score varied from 17 to 92 points (average: 48 points). Isokinetic evaluation showed mostly a strength deficit in abduction even for patients presenting an excellent result. Functional results were related to the quality of the surgical reduction but also to patients' collaboration. Various treatment methods for complex fracture of the proximal humerus are reported in the literature. When a nearly anatomical reduction is achieved, the here-described method of open reduction and proximal nailing permits to obtain good functional results in most patients. This option should be considered for young patients and even in the elderly where results are comparable to that obtained with hemiarthroplasty in the same condition.

[External fixation at the wrist and hand]. / Fixation externe au poignet et à la main.

Distraction radio-metacarpal external fixation is an excellent technique for the osteosynthesis of distal radius fractures, in particular of comminuted articular fractures. The alternative is the locked palmar plate, a more demanding technique. The published literature does not allow concluding if one method is better than the other. The other main possible indications of external fixation at the wrist are comminuted fractures of the base of the thumb metacarpal, distal radius osteotomies, and wrist arthrodeses. At the hand, external minifixation is an excellent technique of osteosynthesis. Stable bone fixation is obtained, allowing early active mobilization of the fingers. The technique is especially indicated to treat open lesions or to perform lengthening, but we use also external minifixation to treat closed fractures, to perform arthrodesis or to cure non-unions, and to maintain the length of the thumb after trapeziectomy for osteoarthrosis.

[Management of the meniscal lesion]. / Prise en charge de la lésion méniscale.

About 1,5 million arthroscopies are each year performed in the world, 50 % for meniscal affections. The menisci participate in the femoro-tibial load transmission and in the joint shock absorption; they contribute to the knee stability and play a role in the joint lubrication. The menisci are therefore important structures, and, in the case of a lesion, surgical abstention or repair should be favoured. When a meniscectomy has to be performed, it should be economical, preserving the meniscal wall. Meniscectomy is contra-indicated in the child and in the case of knee osteoarthrosis. Meniscal healing is compromised if the knee is unstable. If after total meniscectomy a patient presents symptomatic early osteoarthrosis, without marked loss of alignment, meniscal allografting is a therapeutic option, especially at the lateral compartment.

[Reconstruction of the knee anterior cruciate ligament: single or double bundle?]. / Reconstruction du ligament croisé antérieur du genou: simple ou double faisceau?

Anatomical and biomechanical studies have shown that the anterior cruciate ligament (ACL) consists of two distinct bundles, the anteromedial (AM) and posterolateral. Each bundle has its specific role during the motion of the knee. ACL reconstruction techniques have focused on the restauration of the anteroposterior stability by substituting the more isometric AM bundle. Although these ligamentoplasties provide overall good results, in the last ten years double-bundle ACL reconstruction techniques have been developed, to better replicate the ligament anatomy. Despite the growing number of published studies, including randomized controlled trials comparing single bundle and double bundle reconstructions, there is still a lack of evidence of any superiority of the double-bundle technique. Furthermore, many series are criticized for their poor assessement of rotational stability, using most of the time subjective pivot shift clinical testing. Among the methods available to measure tibial rotation, 3-D optoelectronic evaluation is an attractive tool and has been used in some studies reporting rotational mesurements after ACL single-bundle reconstruction. Our Department of Orthopaedics and Traumatology has been using double-bundle techniques for a few years. We conducted a preliminary prospective randomized study, in order to compare single and double-bundle techniques by clinical and optoelectronic evaluations.

Surgical resection for colon cancer: laparoscopic assisted vs. open colectomy.

BACKGROUND/AIMS: Laparoscopic surgery has been considered for more than a decade for treatment of colorectal cancer. Although its benefits in term of postoperative comfort and parietal preservation are commonly accepted, its efficiency to achieve proper oncologic resection and to prevent tumor recurrence are still debated. The purpose of this retrospective study is to compare results of a minimally invasive laparoscopic approach to these of open surgery for treatment of colorectal cancer. METHODOLOGY: From January 1st 1999 to September 30th 2004, 239 patients underwent colorectal cancer resections; 28 of these patients underwent surgery in an emergent context and were excluded from this study. Accurate follow-up was available for 165 of the 239 patients (69%). For the study, 165 patients were divided into 3 groups: 39 patients underwent a laparoscopically assisted surgery (L group), 120 patients underwent an open colectomy (O group) and 6 patients initially treated with a laparoscopic approach were converted to open colectomy (L/O group) (conversion rate: 8.8%). RESULTS: Sex ratio, mean age and A.S.A. score, as well as patients' past records were similar in the 3 groups. Histological staging was more often stages 3 and 4 in the O group (62.5%) comparing to the L group (41%) (p < 0.5). Mean operating time was slightly longerwhen a laparoscopically assisted approach was used. Overall early mortality rate of this study was 1.8%. Combined local and general overall morbidity rate was 36%. Overall incidence of anastomotic fistulae was 4% and reintervention rate during the early postoperative period was 8%. Postoperative ileus period was often longer for patients of the O group but without statistical significance. Mean duration of hospital stay was similar in the 3 groups. Data concerning surgical resection did not show any difference between groups. None of the patients experienced a metastatic skin settlement. Overall anastomotic stenosis rate was low (2%). The overall locoregional recurrence rate was 12%, without difference between the 3 groups. Forty-two percent of these recurrences were secondarily treated by curative surgery. Similar survival rates as well as oncological spreading frequencies were found. CONCLUSIONS: Results obtained when comparing minimal invasive laparoscopically assisted surgery to open procedure are similar and efficient.

Case report: revision of failed Sauvé-Kapandji procedure with an ulnar head prosthesis.

The Sauvé-Kapandji procedure has been developed in order to solve distal radioulnar joint (DRUJ) disorders. Postoperative results are variable. Complications such as painful ulnar stump, ulnar instability and loss of grip strength have often been described. We report the case of a painful ulnar stump instability resulting from a Sauvé-Kapandji procedure. After several attempted salvage procedures, a custom-made Herbert distal ulnar head prosthesis was implanted. Long-term results showed complete pain relief, improvement of the range of motion and satisfactory grip strength recovery. Our findings confirm that the Herbert custom-made ulnar head prosthesis appear to be a reliable salvage solution for failed Sauvé-Kapandji procedures.