Unstable intertrochanteric fracture of the femur. A prospective randomised study comparing anatomical reduction and medial displacement osteotomy.

We conducted a prospective randomised trial to compare the results of anatomical reduction and medial displacement osteotomy in 127 consecutive patients with unstable intertrochanteric fractures, of whom 109 completed the study. After an average follow-up of 11 months, we found no significant differences in walking ability, social status or failure of fixation in the two groups. Postoperative complication rates and the early mortality rate were not significantly different, but operating time and blood loss were significantly higher in the osteotomy group. With the use of modern sliding hip screws, medial displacement osteotomy is rarely indicated for unstable intertrochanteric fractures.

[Mitchell's osteotomy in the treatment of hallux valgus]. / Ostéotomie de Mitchell dans le traitement de l'hallux valgus.

Ninety-one (91) Mitchell osteotomies on 63 patients (60 females and 3 males) were reviewed. The average follow-up was 40 months (min. 12, max. 70). The average age at the time of the surgery was 51 years (min. 20, max. 74). The presence of a apinful bunion justified the surgery in a majority of cases (92%). The clinical evaluation was done by an independent observer. Weight bearing X-rays of the feet were made in each case. The results show a satisfactory improvement of the pain in 92% of the cases. The patients were satisfied with the appearance of their foot in 93% of the cases. The average active articular range of motion was 47 degrees (min. 20 degrees, max. 120 degrees). The Das De scale showed 75% of excellent and good results. Twelve per cent (12%) of the patients presented residual metatarsalgia. We observed minor complications in 10 cases (11%). We report no cases of avascular necrosis, pseudarthrosis or infection. Clinico-radiological correlations were made. We obtained an average correction of 13 degrees (min. -5 degrees, max. 28 degrees) of the hallux valgus and 3.5 degrees (min. -7 degrees, max. 7 degrees) of the intermetatarsal angle. We recommend the Mitchell osteotomy as long as the indication criterias and the surgical technique are respected.

[Non-cemented self-locking total arthroplasty of the hip. Clinical and radiological results after three years]. / L'arthroplastie totale de la hanche non cimentée de type autobloquant. Résultats cliniques et radiologiques à trois ans.

We reviewed 47 patients who had fifty-one (51) primary, cementless biofit total hip arthroplasties (THA) implanted at Maisonneuve-Rosemont Hospital between 1986 and 1990. An independent observer rated the patients on the Harris Hip Score (HHS) by questionnaire, physical examination and radiological assessment. The average follow-up was 40 months. Twenty-two percent (22%) of the femoral components had been revised because of incapacitating pain, limping or a HHS inferior to 60. A little more than 20% of the unrevised prostheses had a mediocre result (HHS inferior to 70). There was no correlation between results and radiological signs of instability. The femoral component of the hip arthroplasty has a poor clinical performance which compares unfavourably with cemented prostheses.