[An original procedure for cement diaphyseal extraction. The segmental cement extraction system or SEG-CES]. / Un procédé original d'extraction des gaines cimentées diaphysaires. Le segmental ciment extraction system ou SEG-CES.

PURPOSE OF THE STUDY: We report our first eleven uses of a new cement mantle extraction system. The basis of this technique relies on a cement bone interface with a lower strength compared to the old cement-new cement interface. MATERIAL AND METHODS: The first stage of the procedure consists in a specific preparation of the inner surface of the old cement, mantle. It should be clean and dry after being abraded with a stainless steel wire brush. Then a thin cement syringe filled with low Viscosity PMMA cement, is injected in the old mantle in a retrograde fashion. A threaded rod with nuts is centered within the cement sheath to the bottom and held until the injected cement has fully polymerised. Then the threaded rod is unscrewed from the femur; nuts are established along the entire length of the cement column. To prevent trochanteric fracture occurring upon cement extraction, its is important to clear away sufficient bone from the lateral aspect of the canal. A series of extraction rods are then used to sequentially remove the cement mantle. The removal rod is screwed back into the threaded channel at a distance of every one to three nuts, and then attached to the slap hammer via a quick release connection. Cement extraction is performed using deliberate slaps of the slap hammer. The last segment is drilled with the use of a distal plug drill centering sleeve. After having inserted the plug removal rod, the last segment is extracted. We used this technique eleven times in 8 hips for 5 loosening of femoral component and 3 revisions hip arthroplasties without loosening and 2 revisions knee arthroplasties without loosening (an extraction system for the femur and the tibia). RESULTS: For the 5 loosening cases extraction was easy. In 2 cases, cement mantle was removed as a single "en bloc" piece. In the 3 other cases, the extraction was segmental only in the distal third of the cement mantle. Without loosening, the extraction was completely segmental. In all cases, cement mantles were successfully removed. There was no fracture and no loss of bone stock. There was only one "fissuration" alpha the great trochanter and we only made one distal window. All hip arthroplasties were replaced and arthrodesis were performed after removal of the knee arthroplasties. DISCUSSION: The cement-assisted mantle removal technique appears to be a simple, quick and effective methods for cement mantle removal. Perforation and diaphyseal window can be avoided by the technique even when loosening does not exist. However, it is necessary to establish a thorough preoperating plan in order to eliminate contraindications such as too narrow or too curved sheath. CONCLUSION: It appears that this new procedure will facilitate future reoperations which are reputed to be difficult and dangerous.

[Benign retroperitoneal pelvic schwannoma. Apropos of 2 cases]. / Les schwannomes bénins rétropéritonéaux pelviens. A propos de 2 observations.

Authors have described 2 cases of benign schwannomas of pelvian origin and with abdominal extension. The diagnosis is often late because of the absence of early clinical signs and of specific investigations. The reliability of the diagnosis is based on the mobid anatomy of the surgical pieces, the hypervascularization. Schwannomes with bone adherences complicate the surgical treatment. These tumors very seldom degenerate. The pronostic is related to the risk seldom degenerate. The pronostic is related to the risk of recurrence if their ablation is incomplete.

[Thalamic fractures of the calcaneus. Value of computed x-ray tomography in therapeutic decisions]. / Les fractures thalamiques du calcanéum. Intérêt de la tomodensitométrie dans la décision thérapeutique.

The authors have studied 35 fractures of the calcaneal thalamus and compared the information provided by plain radiology and CT scans of the calcaneal tuberosity, especially those connected with the condition of the posterior subtalar joint. In 8 cases out of 35, the study of the CT sections yielded information that allowed changing the indications for treatment. The authors emphasize the quality of the data obtained, which makes it possible to justify a functional treatment or to establish a preoperative schedule.