[Volar fixed angle plate LCP 3.5 for dorsally distal radius fracture. About 24 cases]. / Ostéosynthèse antérieure par plaque à vis verrouillée LCP 3.5 dans les fractures de l'extrémité inférieure du radius à déplacement postérieur. A propos de 24 cas.

PURPOSE OF THE STUDY: Fracture of the distal radius with posterior displacement is the most common wrist fracture. Pinning is generally proposed. The problem is that a secondary displacement may persist, even for the least complex fractures. With the advent of the fixed-angle plate with a self-locking screw, we considered using this method in combination with an anterior approach to the radius. We report our preliminary results. MATERIAL AND METHODS: From November 1 to March 31, 2003, among the 195 fractures of the distal radius with posterior displacement which we treated in our unit, 135 were treated with orthopedic reduction, 36 with Kapandji pinning and 24 with a T-shaped anterior locking compression plate (Synthès, LCP 3.5. During the early part of this series, the LCP was used for emergency situations in young adults with a posterior displacement exceeding 20 degrees . Starting in November 2002, the technique was also proposed for revisions for secondary displacements after orthopedic reduction or pinning procedures. Secondary displacement was noted on the standard X-rays and the clinical analysis included a measurement of muscle strength, the DASH score and the clinical evaluation score used by the SOFCOT symposium in November 2000. RESULTS: Twenty-four patients (14 female, 10 male, mean age: 54.5 years) presented 14 extra-articular fractures and ten articular fractures. At admission, mean frontal inclination of the radial glenoid was 13 degrees with a posterior displacement of 25.45 degrees and an ulnar variance measuring+4mm. Eighteen patients were reviewed at mean 16 months follow-up. Mean frontal inclination of the glenoid was 23.95 degrees with mean anteversion 5.45 degrees . Using the SOFCOT criteria, 11 outcomes were anatomic and seven presented moderate displaced healing. The wrist force (Jamar was 95% of the value measured on the healthy side. The mean DASH score was 38.47. Outcome was considered excellent for nine cases, good for six, fair for three and poor for zero. Complications were: reflex dystrophy (n=4), carpal tunnel syndrome (n=1), cheloid scar (n=1), glenoids in the pulse gutter (n=10), and secondary fracture along the upper border of the plate (n=3). CONCLUSION: This study demonstrated that, used on the anterior aspect of the radius, the locking compression plate provides satisfactory treatment for fractures of the distal radius with posterior displacement. Because of the angular stability, the reduction can be maintained over time so that secondary displacement is no longer a problem. This is a difficult technique which requires particular skill. We no longer recommend the LCP 3.5 plate due to the poorly adapted ergonometry, the late fracture over the plate and the fact that the material is not removed.

[Comparative study of the anatomic and clinical effect of Weaver or subtotal subscapularis tendon section in Latarjet procedure]. / Etude comparative de deux techniques de section du tendon du muscle subscapulaire dans l'opération de Latarjet.

PURPOSE OF THE STUDY: The aim of this work was to compare the anatomic and functional effect on the subscapularis muscle of two ways of sectioning its tendon during Latarjet procedure: complete vertical section and Weaver section (partial section of the lower third preserving the upper part of the tendon). MATERIAL AND METHODS: We compared two series (eight-year interval) of patients comparable for age, gender, form of instability, type and level of sports activity. Twenty-nine patients underwent complete vertical section (group 1) and 30 Weaver section (group 2). All were reviewed with minimum four year follow-up. The clinical analysis involved strength of internal rotation, the maximal hand-back distance, and the Constant and Duplay scores. The radiographic analysis was coupled with computed tomography in 46 patients (23 in each group). Loss of subscapularis muscle thickness compared with the non-operated side was noted as was the Bernageau fatty infiltration stage. RESULTS: No recurrent dislocation was noted in either group. There were six cases of nonynion in group 1 and seven in group 2. The Gerber was positive in five patients in group 1 and zero in group 2 (P=0.01). Loss of internal rotation strength between the operated and healthy side, expressed in percentage, was 48.4% for group 1 and 17.9% for group 2 (P<0.0006). In group 1, the fatty infiltration stage of the subscapularis muscle was: stage 0 (n=3), stage 1 (n=11), stage 2 (n=3), stages 3 and 4 (n=6). In group 2, these stages were: stage 0 (n=21), stage 1 (n=1), stage 1 (n=2) and zero stage 3 and 4 (P<0.0001). DISCUSSION: The Latarjet operation remains the reference procedure for anterior stabilization of the shoulder joint. The choice of the incision technique for the subscapularis muscle tendon remains a subject of debate. Recent studies have demonstrated the importance of subscapularis muscle trophicity to obtain a good mid- and long-term clinical outcome. We have ourselves demonstrated elsewhere that complete section of the subscapularis tendon leads to secondary tears and subsequent fatty degeneration. CONCLUSION: Our study demonstrates that Weaver section in the Latarjet procedure enables placing the bone block in conditions equivalent to those achieved with total section while preserving better trophicity of the subscapularis muscle.

[Using the DRP 2.4 device for volar plating of distal radius for dorsally displaced wrist fractures. Report of 22 cases]. / Ostéosynthèse antérieure par plaque à tête de vis verrouillée DRP 2.4 dans les fractures à déplacement postérieur de l'extrémité distale du radius. A propos de 22 cas.

OBJECTIVE: Our first experience of palmar plating for dorsally displaced distal radius fracture with locking compression plate showed good results. But ancillary tools was ineffective, so we report our early experience with the DRP 2,4 device. METHODS: Between January and October 2004, 22 patients (16 women, 6 men), mean age 56,8 years (age range: 24-77 years), underwent internal reduction and fixation using DRP 2.4 by Henry's approach. By AO classification there was 10 A3 and 12 C1 or C2 fracture. On pre operative X Ray, radial inclination was 13.9 degrees , and dorsal tilt was 27 degrees . RESULTS: Seventeen patients were reviewed with mean follow-up of 11 months (5 to 17). On postoperative X Ray, radial inclination was 22,7 degrees and palmar tilt was 2,1 degrees. At 6 month radiological findings found no loss of postoperative reduction. According to SOFCOT's criteria's, we noticed 9 anatomical results and 8 moderate malunion. Clinical results (Green and O'Brien) showed 6 excellent, 7 good, 4 fair and no poor results. Mean DASH score was 13.5. Strength recovery was 82% of opposite side. Complications concerning 6 patients with, 4 reflex sympathetic dystrophy, and 2 screwdriver breakage during insertion. DISCUSSION: Volar plating with DRP 2.4 is an effective technique, but obtain anatomical reduction remind challenging for the surgeon. CONCLUSION: DRP 2.4 volar plating is an effective treatment for dorsally displaced fracture. Controlled study with orthopaedic reduction and K Wire fixation are need for determining the place of each treatment.

[Intra- and interobserver reproducibility of the French version of the Constant-Murley shoulder assessment during rehabilitation after rotator cuff surgery]. / Etude de reproductibilité intra et inter-observateur de la version française du score de Constant au cours de la rééducation des coiffes opérées.

PURPOSE OF THE STUDY: The Constant-Murley scapular score is currently considered to be the gold standard for shoulder assessment in Europe. Few studies have examined the metrological qualities of this score. Our aim was to study the reliability and validity of the French version in a population undergoing reeducation after rotator cuff surgery. We wanted to determine how pertinent the score is during the reeducation phase (1-12 months after surgery). MATERIAL AND METHODS: Fifty-three patients volunteered to participate in this study. Shoulder assessment was performed by three observers. Intraobserver reproducibility was determined for 102 tests and two series of 32 and 56 tests were used to determine interobserver reproducibility. The internal coherence was studied on a sample of 61 tests. Three observers analyzed the apparent validity of the Constant Murley score. RESULTS: The correlations were satisfactory (intraobserver 0.96; interobserver 0.91 and 0.89 with the Spearman test) and sensitive (intraobserver 0.01; interobserver 0.07 and 0.01 with the Wilcoxon test). Despite satisfactory internal coherence (Cronbach alpha=0.75), the reproducibility of the overall score did not correspond necessarily to the reproducibility of the constituent scores. The measurement error might be related to patient- and observer-related interpretation variability. The apparent validity of the French version might be criticized for assessing rotator cuffs after surgery. CONCLUSION: A precise consensual protocol is needed for conducting the shoulder assessment and establishing the Constant-Murley score during the reeducation phase after rotator cuff surgery.

[Chronic expanding hematoma of the soleus: a case report]. / Hématome encapsulé des membres à expansion progressive: à propos d'une localisation au muscle soléaire.

Trauma-induced hematomas of the limbs usually resorb without sequelae. In certain circumstances which are not fully understood, the hematoma may expand progressively, eventually leading to the development of a tumor-like mass in the soft tissues. We report the case of a chronic expanding hematoma observed in the right soleus muscle of a 75-year-old man. The mass grew +9 cm compared with the other side over a period of two to three years with no notion of recent trauma. Surgical biopsy disclosed a thick capsule containing "chocolate pus". Pathology and cytology examination led to the diagnosis of pseudo-tumor calcinosis subsequent to a hematoma which the patient had developed 34 years earlier when as a mountain guide he had experienced a tear of the soleus muscle. Local care required complete resection of the soleus muscle. The patient was able to resume activities without pain. Well described in the literature, encapsulated hematoma of the limbs is not well known in France. This case illustrated the potentially long latency period (34 years in our patient). Pathologically similar to tumor calcinosis, chronic expanding hematoma should be entertained as a possible diagnosis in a patient with a longstanding mass and a history of past trauma. The differential diagnosis with sarcoma is established by magnetic resonance imaging which reveals a peripheral low intensity signal on T1 and T2 sequences.

Crystalloid versus cold blood cardioplegia and cardiac troponin I release.

BACKGROUND: Cardiac troponin I (CTnI) has been shown to be a marker of myocardial injury. The aim of this study was to compare antegrade crystalloid cardioplegia with antegrade cold blood cardioplegia with warm reperfusion using CTnI release as the criteria for evaluating the adequacy of myocardial protection. METHODS AND RESULTS: Seventy patients were randomly assigned to receive crystalloid or blood cardioplegia. CTnI concentrations were measured in serial venous blood samples drawn just before cardiopulmonary bypass and after aortic unclamping at 6, 9, 12, and 24 hours and daily thereafter for 5 days. ANOVA with repeated measures was performed to test the effect of the type of cardioplegia on CTnI release. The total amount of CTnI released was higher in the crystalloid cardioplegia group than in the blood cardioplegia group (11.2 +/- 8.9 versus 7.8 +/- 8.6 micrograms, P < .02). CTnI concentration was significantly higher in the crystalloid group than in the blood group in the samples drawn at hours 9 and 12. Three patients in each group had ECG evidence of perioperative myocardial infarction. Eight patients in the crystalloid group and five patients in the blood group had CTnI evidence of perioperative myocardial infarction. CTnI release was significantly lower in patients requiring no electrical defibrillation after aortic unclamping. CONCLUSIONS: Cold blood cardioplegia followed by warm reperfusion is beneficial in an unselected group of patients with a preserved left ventricular function undergoing an elective first coronary artery bypass grafting. CTnI allowed the diagnosis of small perioperative necrotic myocardial areas. The need for electrical defibrillation after aortic unclamping was related to a higher release of CTnI. A further study is necessary to determine whether this technique was beneficial because of cold blood cardioplegia, warm reperfusion, or both.