Transarticular approach and retrograde plate osteosynthesis (TARPO) using implants with angular stability -- a series of 17 cases of complex distal femoral fractures type C3/AO.

AIM: The aim of this retrospective study was to evaluate the outcome of distal femoral fractures type C3 AO, using TARPO technique and plates with angular stability. MATERIAL AND METHODS: The study included 17 fractures type C3 AO, with 4 open fractures: 1 type I, 1 type II, and 2 type IIIA with bone loss Gustilo. All patients were operated by TARPO technique using Less Invasive Stabilization System-LISS (4 cases), Locked Compression Plates-LCP (8 cases) and plates with polyaxial stability (5 cases). The excellent stability of the construct allowed fast knee rehabilitation. The follow-up period included at least 12 months. RESULTS: 15 fractures healed within a mean time of 12.6 weeks,while 2 cases with open fractures and bone loss required secondary bone grafting. We recorded no infection or implant failures. The outcome using Neer scale was excellent in 9 cases and satisfactory in 7 cases (1 patient with discontinued follow-up). CONCLUSIONS: This demanding TARPO technique has the advantage of a faster rate of union and improved exposure of the knee joint. The locked plates provide a unique alternative in distal femoral fractures type C3 AO, as well as in osteoporotic and open fractures.

Surgical approach in difficult tibial pilon fractures.

AIM: The aim of the present study is to emphasize the optimal moment and approach for tibial pilon complex fractures and their complications. MATERIAL AND METHODS: We have investigated and treated 7 patients with complex fractures of the tibial pilon with tendencies to complications. According to AO classification,we have recorded 4 fractures type 43C2 AO, 2 fractures type 43C3 AO (with one open fracture type IIIA Gustilo) and 1 fracture type 43B3 AO. According to soft tissue status, surgical treatment was performed by a one-step or two-step approach. RESULTS: All fractures healed after an interval of 13.6 weeks(range 8-28 weeks) with one delayed consolidation. The open fracture was complicated by posttraumatic arthrosis. No infections or implant failures were recorded. According toOvadia score, objective and subjective evolution showed good results in 5 cases, one excellent result and one poor result. CONCLUSIONS: Fracture type and the soft tissue status are crucial for the results of operated fractures. These arguments determine the application of one-step or two-step surgical procedure as well as optimal implant choice.

[Dynamic condylar screw in reverse oblique trochanteric fractures]. / Utilitatea surubului de compresie condilian (DCS) în fracturile intertrohanteriene.

The aim of the study was to evaluate the results of internal fixation with Dynamic Condylar Screw (DCS) in reverse oblique trochanteric fractures. In a two years period 238 patients with trochanteric fractures were treated in our department. In 31 cases (13%) the fracture has reverse obliquity (type II Evans). Internal fixation was performed with Ender nails (4 cases), AO condylar blade plate (11 cases), Dynamic Hip Screw (3 cases), Gamma nail (3 cases) and DCS (10 cases). Results 4 month after the surgery reveal that Gamma nail and DCS used in reverse oblique fractures were superior to other types of implants. Placement of DCS may be difficult in fractures with large displacement and technical solution in such fractures are presented. In conclusion we consider that, in type II Evans trochanteric fractures, internal fixation with DCS is a good option.

[Osteomyelitis, a cause of prolonged fever in adults]. / Osteomielita, cauza de sindrom febril prelungit la adult.

A 35 years old male patient with an unexplained prolonged fever, after serial unsuccessful investigations in 3 different services, suffers a fracture of the lower third of the right femur produced by a minor trauma. This raises the suspicion of a pathological fracture. The surgical intervention and the microbiological exam confirms the existence of an osseous infection with Gram-negative germs, and the clinical course is uneventful after stabilization with an external fixator and appropriate antibiotic therapy. Osteomyelitis, although rare in adults, should be included in the differential diagnosis of any prolonged fever of unknown origin in adults.

[An open type-IIIB segmental fracture of the lower limb with soft-tissue lesions]. / Fractura etajata a membrului inferior cu leziuni de parti moi deschise tip III B.

Open fractures are a challenge to the orthopaedic surgeon. The bigger the wound the higher the risk of contamination. The prognostic depends also upon the degree of comminution, the time of admittance, the antibiotherapy as well as the treatment options. The latter vary according to the surgeon's preference, the site of the fracture and the existing implants in a unit. We therefore present a case of a young male patient with a type-IIIB fracture of the lower limb, with an excellent result at 11 weeks postoperatively.

The improvement of fertility at women with bicervical bicornuate uterus and double vagina.

In the present work there are presented 3 clinical cases with genital malformations of the type: bicervical bicornuate uterus with double vagina, from among which one case belongs to the type of communicating uterus (uterus in H). The diagnosis is formulated through the clinical examination and the type of the malformation is determined by histerogram and endoscopy. The urogram is compulsory. The surgical indication is given by infertility (at least two obstetrical failure in antecedents), dyspareunia, dysmenorrhea, meno-metrorrhagia, primary sterility. The surgical technique is accurately described, consisting in sectioning by vaginal route the cervical and vaginal longitudinal septum and in sectioning by abdominal route the septum which separates the 2 uterine horns, according to the Bret technique.

The treatment with 2-brom-alfa ergocriptine in the syndrome amenorrhea-galactorrhea.

In this study, the authors present the results obtained in thirteen cases with amenorrhea-galactorrhea treated with 2-brom-alfa-ergocriptine in which the menstruation has reoccurred in eleven patients, three of them becoming pregnant. The authors have accurately described the evolution of the three pregnancies, which were delivered at term and the children born were normal. The present study was elaborated in the Sterility Department of the Clinic of Obstetrics and Gynecology "Giulesti", University School of Medicine, Bucharest. The study refers to the use of 2-brom-alfa-ergocriptine (Parlodel-Sandoz) in the treatment of the amenorrhea-galactorrhea syndrome associated with sterility.

[Study of blood copper as an early screening test in aggravated dysplasia and cancer of the cervix uteri]. / Etude de la cuprémie comme test de dépistage précoce dans les dysplasies aggravées et dans le cancer du col utérin.

PIP: Blood copper levels were studied in 100 patients with suspicious lesions of the uterine cervix of which 31 were simple dysplasia, 48 were aggravated dysplasia, and 21 were cervical cancer. While normal blood copper levels do not exclude the possibility of malignancy, levels greater than 130 mcg per 100 ml call for close supervision of an aggravated dysplasia. Levels greater than 199 mcg per 100 ml should arouse suspicion of incipient carcinoma (microcarcinoma or invasive carcinoma).^ieng

[Prophylaxis of prematurity]. / Profilaxia prenaturitatii.

PIP: The study of premature birth, its causes, and possible prophylactic measures is of considerable importance because of the high incidence of prematurity (average 6-9%; approximately 9% in Rumania) and because it is the most important single cause of perinatal and infant mortality, requires long and expensive treatment, and often entails serious aftereffects. Prenatal medical examination is essential to detect the p ossibility and risk of premature birth. After reviewing possible causes of prematurity and factors that may indicate a special risk (e.g., prior occurrence of premature births), a method of evaluating the risk factor, based on statistical and epidemiologic studies, is described, as well as measures that can be taken to reduce the risk.^ieng