[Internal screwed plate for recent fractures of the humeral diaphysis in adults]. / Plaque vissée interne dans les fractures récentes de la diaphyse humérale de l'adulte.

PURPOSE OF THE STUDY: Can medial plating of the humerus, through an antero lateral approach, diminish incidence of iatrogenic radial palsies? MATERIAL AND METHODS: We carried out a prospective study of medial plating of humeral shaft fractures through an antero lateral approach between 1988 and 1997. 41 fractures were fixed, 36 were followed up for a mean period of 5.8 years. The indications were multiple injuries (10), displaced fractures (23), and failure of conservative treatment (3). Road traffic accidents and sports injuries were the cause in 68 per cent of cases. Two fractures were open and in 9 cases there was a radial palsy. Bone graft was never used. The approach to the medial aspect of the humerus an antero lateral incision was the essential feature of the technique. After a slightly curved incision on the antero lateral aspect of the arm, the space between biceps and brachialis anterior was bluntly dissected. The assistant holded the elbow flexed in order to relax the biceps and rotated il laterally to expose the medial aspect of the bone. Splitting brachialis fibres longitudinally exposed the fracture site. It was easy to check if the radial nerve was trapped and, if not, the nerve seen during the operation. Postoperatively patients were given a simple sling and mobilised freely, including rotation. RESULTS: We had no intra-operative complications, no infections, no fixation failure, no post operative radial palsies and no non-unions. Results were excellent in 89 per cent of cases (full recovery of pain free range of movement). Four patient had a restriction of elbow movements of 10 degrees but without any discomfort. The mean time to union was 80 days. All radial nerve palsies recovered between 24 hours and 1 year. The plate was removed in 11 cases. Iatrogenic complications of humeral plating have led to the increased popularity of intramedullary nailing. Even if secondary radial palsies and non-unions have decreased, union of the humeral shafts is often difficult. Placing the plate into the medial surface allowed to preserve the radial nerve, but still permitted to check its continuity when it was trapped in the fracture site. CONCLUSION: Restoration of the length and rotational alignment of the humerus puts the radial nerve in the best condition for its recovery. An antero lateral approach and a medially placed plate allowed to avoid secondary radial plasies and non-unions, which can complicate internal fixation of the humeral shaft.

[Value of Illizarov's method in the treatment of long bone pseudarthrosis. Apropos of a A.S.A.M.I.F series of 87 cases]. / Intérêt de la méthode d'Ilizarov dans le traitement des pseudarthroses des os longs. A propos d'une série de 87 cas de l'A.S.A.M.I.F.

This study is the outcome of multicenter endeavour compiling 87 cases of pseudoarthrosis managed according to principles set forth by G.A. Ilizarov. All clinical forms are described: simple pseudoarthrosis (non-infected and without loss of substance); septic pseudoarthrosis; pseudoarthrosis with loss of bone substance, both septic and aseptic. This method is used in the majority of cases. This method is used in the majority of cases after several consecutive unavailing attempts with conventional therapeutical procedures. Considering all situations, the lesions heal in over 90% of cases and the infection subsides with an equal rate of success. Such results are achieved within a period of 5 months. Sequelae or complications imputable to the method are few. Indications are specified, which depend upon the clinical form of the treated pseudoarthrosis, as well as upon the surgeon's personal skill.

[Osteosynthesis of thalamic fractures of the calcaneus using triangulation-fixed 1/4-tube plates. Preliminary results of 32 osteosyntheses]. / L'ostéosynthèse des fractures thalamiques du calcanéum par plaques "1/4 de tube" montées en triangulation. Résultats préliminaires de 32 ostéosynthèses.

The authors present a new type of osteosynthesis fixture used in calcaneal thalamus fracture repair. This consists in triangulation fixation, the upper- and retromost part of the thalamus being the apex of the triangle. This is performed using 2 or 3 1/4-tube A.O. instrumentation plates, with adaptable positioning according to the type of fracture. This system presents two advantages compared to currently used fixation components: it is less bulky and is associated with a reduced risk of skin-related complications. Calcaneal reconstruction is much more stable because the plates are in alignment with talocalcaneal stress lines, on the one hand, and because they form a truss that counteracts secondary displacement of the reconstructed thalamus. 32 calcaneal syntheses were thus performed during the period between July 1983 and July 1988. These included 8 stage III DUPARC fracture cases (25%), 21 stage IV cases (65.6%), and 3 stage V cases (9.4%). Nine 2-plate fixtures were assembled in an circumflex-like manner and 23 operations involved setting up the fixation components in a "closed triangle". Cuboid anchorage was necessary in 11 cases. Uncomplicated cutaneous necrosis occurred only once in this series (i.e., 3.2%). The stability of this operative procedure was assessed by measurements of Boehler's angle in the immediate postoperative period and after consolidation. The fixation was perfectly stable in 94% of cases (angle loss less than or equal to 5 degrees). Secondary angle loss occurred in 6% of cases (i.e., 2 cases, 8 degrees and 12 degrees respectively), one of which was caused by untimely weight-bearing. Moreover, no case of plate disruption was reported in this series.

[Butel's hip screw-plate in osteosynthesis of fractures of the upper end of the femur. Apropos of 241 osteosyntheses (100 true cervical fractures and 141 fractures of the trochanter)]. / La vis-plaque B.H.P. dans l'ostéosynthèse des fractures de l'extrémité supérieure du fémur. A propos de 241 ostéosynthèses (100 fractures cervicales vraies et 141 fractures du massif trochantérien).

Butel's hip plate was used for osteosynthesis of 241 fractures of upper end of femur (100 true cervical - 141 trochanteric and subtrochanteric fractures). Results for true cervical fractures were assessed as satisfactory in 89.5% of cases, with only 3 pseudarthroses and 4 cases of femoral head necrosis (2 septic, 2 aseptic), a total complication rate of 7.5%. These clinical results confirm the value of screw fixation at several cephalic anchorage sites (demonstrated biomechanically) in true cervical fractures. Results in trochanteric and subtrochanteric fractures were rated as satisfactory in 86.9% of cases, complications including 2 ruptures of plate, 1 sepsis and 4 early loosening of plate. The latter sequela was avoided by an improved choice of indication for the procedure and by substitution of this compound material (screw-plate) for a monobloc piece ("anti-loosening cervicocephalic screw apparatus"), in compound fractures of trochanter.

[Fractures of the lower end of the humerus in adults: influence of per- and postoperative tactics on results. Apropos of 70 osteosyntheses]. / Les fractures de la palette humérale de l'adulte: influence de la tactique per et post-opératoire sur les résultats. A propos de 70 ostéosynthèses.

Results in 70 cases of osteosynthesis of lower end of humerus in adults were analyzed as a function of the fracture line, and the operative (approach route, type of support, attitude towards ulnar nerve transposition) and postoperative (with or without plaster immobilization) tactics. Best results were obtained in simple joint fractures (condyles, capitellum, Hahn Steinthal) with a good outcome in 89% of cases, while prognosis was poorer (68.5% of delayed good results) in more or less comminuted supra- or inter-condylar fractures (41 cases). Results are better in these latter types of fracture when an extra-articular trans-olecranon posterior approach is used. Ulnar nerve transposition was performed 43 times without adverse effects and osteosynthesis by 2 posterior screw plates (one on external and one on internal column) in 50% of cases. Valid comparison of results with or without postoperative plaster immobilization was not possible since only 8 patients were not plastered.