[Longevity factors in total trapezometacarpal prostheses]. / Facteurs de longévité des prothèses totales trapézométacarpiennes.

We report the long term outcome of the trapeziometacarpal prosthesis in a personal series of 13 cases with a follow-up ranging from 12 to 17 years. This ball and socket prosthesis with a metal on polyethylene pairing is cemented. Several modifications were performed along the years: such as increased range of motion, better fit between the metacarpal medullary canal and the proximal part of the stem and addition of a versatile, intermediate component in order to re-establish length of the first ray. The status of the metacarpo-phalangeal joint is critical. Natural hyperextension of this joint has been seen in about two-third of th normal individuals. If the metacarpal component become loose, the thumb column become shorter and hyperextension of the metacarpophalangeal joint is followed by an adduction contracture of the metacarpal which produces a shear force component on the cup and finally the loosening of the cup (sequential loosening). Keeping or re-establishing the length of the first ray is the major principle in the trapeziometacarpal prosthesis. On the other hand, metacarpophalangeal arthrodesis is a contraindication for a trapeziometacarpal prosthesis. Trapeziometacarpal prosthesis should only be used as a last resort when there is severe pain. If the dominant hand is involved, intensive use is a contraindication. The trapezium must be large enough to accommodate the cup. The author recommends a posterior approach which preserve the anterior ligaments and allows a proper bone resection and a good positioning of the cup.

[Intramedullary pinning for humeral diaphysis fractures. A minimal risk osteosynthesis. 82 cases]. / Embrochage centromédullaire des fractures de la diaphyse humérale. Une ostéosynthèse à risque minimum. A propos de 82 cas.

PURPOSE: This study was designed to evaluate the complication rate of a novel intramedullary pinning technique described in 1988. After 10 years of clinical experience, it was possible to establish a significant difference in terms of healing delay compared with other fixation methods or conservative treatment. MATERIALS AND METHODS: During a 10-year period, a total of 82 fractures, mostly isolated, unstable fractures, were treated. Retrograde intramedullary pinning (RIMP) was used for proximal and midshaft fractures and antegrade pinning (AIMP) for distal fractures. Statistical analysis was used to investigate the role of all parameters that may influence healing delay. RESULTS: 92.7% of the fractures healed in an average time of 9 weeks. Neither location nor fracture type, nor even an intrefragmental gap had any significant influence on healing delay. There were 7 primary axial deviations of more than 10 degrees in which union was achieved and 6 nonunions. These nonunions were mostly proximal fractures and inappropriate fixation. No radial nerve injury, no infection, and no deterioration of the fracture site was observed. There were 27 pin migrations, mainly towards the shoulder, which dit not affect the final anatomic and functional outcome. Functional result was good in 88% of cases. Four algodystrophy syndromes and 6 nonunions induced stiffness, mainly in the shoulder. DISCUSSION: Intramedullary pinning using this technique did not induce any severe iatrogenic condition. Healing delay compares favorably with better results of conservative treatment. Improving surgical technique should further minimize disadvantages of this method. CONCLUSION: Humeral intramedullary pinning technique has a low complication rate. It is a good compromise between conservative treatment and conventional osteosynthesis. It causes little trauma to the patients, allows stabilization of any fracture site, and delay to bone union is similar to that with conservative treatment.

[Treatment of distal metaphyseal fractures of the tibia with the interlocking flexible osteosynthesis system]. / Traitement des fractures métaphysaires distales du tibia par ostéosynthèse flexible centromédullaire verrouillée.

PURPOSE: Accurate anatomic identification of distal metaphyseal fractures of the tibia is necessary when comparing the fixation ability of internal fixation devices. First, we have set the dimensions of the metaphyseal area. The purpose of this study was to evaluate the Interlocking Flexible Osteosynthesis system in properly selected distal metaphyseal fractures, not to be confused with distal shaft fractures. PATIENTS: This study involves 28 fractures, including 10 diaphyseal-metaphyseal fractures, and 18 pure metaphyseal fractures, 9 of which were distal fractures involving the inferior half of the metaphysis. Five of them were segmental fractures. RESULTS: There were 5 severe complications: early loosening (1), nonunions (2), severe malalignments in 2. These resulted from a combination of insufficient distance between the tips of pins, with severe demineralization of bone tissue. The authors have emphasized the technical means available to avoid this. Twenty-five fractures united at a mean of 13.5 +/- 5 weeks (all types). CONCLUSION: Such a fixation is reliable as long as certain technical rules are respected, which requires a great deal of experience with the method.

[Long-term radiologic evolution of coral implanted in cancellous bone of the lower limb. Madreporic coral versus coral hydroxyapatite]. / Evolution radiologique à long terme du corail implanté en os spongieux au membre inférieur. Corail madréporique versus hydroxyapatite de corail.

PURPOSE: The study aimed to compare two successive series of procedure using first pieces of natural madreporic coral, then coralline hydroxyapatite in traumatology. The goal of this work was to evaluate long term radiological features of absorption and influencing factors. MATERIAL: Within six years, 65 pieces were used; only impaction articular fracture on the lateral tibial plateau (31) and calcaneum fractures (23) were included 21 cases completed inclusion criteria. As there were 3 secondary infections, 18 had therefore, an aseptic evolution and were included in this series. METHODS: Absorption was evaluated in five degrees according to the volume of the remaining piece on X-rays. We also took into consideration the position of the pieces and the amount of surfaces in contact with cancellous bone. RESULTS: Among the 18 pieces followed up for more than 19 months (average 40), there were 4 sequestrations (1 tibia, 3 calcaneum), all were natural madreporic coral, the others presented osteointegration. Only natural madreporic coral pieces were absorbed, but never completely and the absorption was slow (3 to 7 years) and never complete. A radiolucent line was present in 7 out of 10 pieces of madreporic coral and none around coralline hydroxyapatite. Three developed favorably. Four were sequestred. Number of surfaces in contact with cancellous bone was correlated with osteointegration. DISCUSSION: The calcium carbonate which makes up the natural madreporic coral pieces is the site of destruction by osteoclasts. The radiolucent line is the specific witness of this biochemical activity. The radiolucent line proceeds sequestrations. No substitute of coralline hydroxyapatite has presented the same sign of peripheral absorption or sequestration. Coralline hydroxyapatite could be the correct coralline material to fill cancellous defect after elevation of an articular depression. In every case, the piece of coral must be fitted in contact with the cancellous bone in the depth of the bone. Conditions of osteoconduction of madreporic coral must be reconsidered. The degree and speed of peripheral absorption must be controlled before weight bearing is allowed.

[Treatment of acromio-clavicular dislocations using coracoacromial ligament plasty]. / Traitement des dislocations acromio-claviculaires au moyen d'une plastie coraco clavi-acromiale (CCA).

PURPOSE: Plasty transfer using the coracoacromial ligament (Cadenat) for the treatment of acromioclavicular separation is usually too weak and too short. The authors used a reinforcement flap, made by a lateral supraclavicular detachment of the superior fibrous-capsular sheath. MATERIAL AND METHOD: Twenty-six acromioclavicular separations were radiographically studied using an axillary view. Twenty-one patients had a posterior dislocation of the lateral end of the clavicle. A pouch formed by the superior detachment was present in all cases with posterior displacement. In 19 case out of 26, this detachment was used to create a quadrangular flap with acromial support. The end of the coracoacromial ligament was attached to this long flap which provided adequate reinforcement along its entire length. RESULTS: There was a statistical correlation (p = 0.05) between the posterior component of the separation and the presence of this detachment. In the 19 reinforced plasties, no recurrence of posterior dislocation was reported, a mild undercorrection and 2 overcorrections were noted. Recurrent posterior dislocation was reported in the 7 non-reinforced coracoacromial plasties, and superior dislocation was reported twice. DISCUSSION: Posterior acromioclavicular dislocation is present in 80 per cent of cases. Diagnosis mainly uses the axillary view. It is always associated with a lateral supraclavicular detachment providing a 3 to 5 cm long downward flap which is used as a natural reinforcement for the coracoacromial ligamentoplasty.

[Conditions for the consolidation of fractures of the femoral diaphysis after locked intramedullary flexible osteosynthesis]. / Conditions de consolidation des fractures de la diaphyse fémorale après ostéosynthèse centromédullaire flexible verrouillée.

PURPOSE OF THE STUDY: We present here the clinical results achieved with locked intramedullary flexible osteosynthesis (LIFO) system in femoral fractures. The two major advantages of the device are its flexibility an ease of use. MATERIAL AND METHODS: Over a period of 6 years, 42 patients were treated. Two died and 7 were lost for follow-up, leaving 33 cases available for evaluation. Fourteen cases were specifically analysed for callus morphological characteristics: volume, length and width, and compared to 18 cases from a previous series involving 27 intramedullary unmatched appaired nailings. RESULTS: Results in the 33 patients of this series are: no nonunion, 1 osteomyelitis in an open fracture, 4 malunions (2 primary iatrogenic malunions, 2 secondary cases due to a weak fixation). Fractures united at a mean delay of 10 weeks, that is, 4 weeks less than with a nail. Morphological callus study also showed that the LIFO system generates about 25 per cent longer of peripheral new bone formation than a nail. CONCLUSION: A LIFO construct with 3 or even 4 pins yields a shorter healing time than a nail. Furthermore, it generates a callus of 25 per cent longer around the fracture. The four pins construct was found to be as dependable as a locked nail, and minimizes inventory. This technique is indicated in the treatment of all common femoral shaft fractures in adults.

[Treatment of metaphyseal fractures of the tibia by the Ilizarov external fixator]. / Traitement des fractures métaphysaires proximales du tibia par fixateur externe d'Ilizarov.

PURPOSE: This external fixation was used for 46 of 60 cases of proximal tibial metaphyseal fractures, over a 10 years period. The choice of an external fixation was determined by the poor reputation of internal fixation for even complex closed fractures. The reasons for the choice of the Ilizarov device were: the possibility of fitting the fixation pins close to the knee joint if necessary, the circular nature of the system, and finally the possibility of adding an intrafocal mounting (I.F.M.) which can bring the displaced bone fragments together using shaped blockstops pins. The program theoretically foresaw an initial sequence using external fixation until bone continuity was achieved, followed by a complementary plaster for one or two months. MATERIALS: 7 of the 46 fractures were lost for follow-up. Of the remaining 39 cases, there were 5 early complications: one knee septic arthritis which led to stop the method before the second month. Each of these 5 failures were due to improper use of the method. 34 cases have been followed for more than two years. RESULTS: 29 cases of consolidation of which 3 initial displacements were wrongly considered as acceptable. There was no case of displacement while the fixation was in place. There were 5 nonunions: 2 at the diaphyseal level in long metaphyso-diaphyseal fractures, 2 were comminutive metaphyseal fractures in which the fixation had been removed by error before the third month. With this fixation, neither the traumatic opening, nor the presence of a fibular fracture significantly affected consolidation. The healing period was however longer when the fracture was more extensive and comminutive. The bone gaps were treated by interfocal mounting (I.F.M.) but loss of bone stock persisted; they affected the occurrence of nonunion. CONCLUSION: Each failure of the method is explained by its improper use. The Ilizarov fixation is an excellent mechanical response to these fractures: on condition that the technical rules are respected, that an intrafocal mounting is used to remove interfragmentary gaps, and that the fixator is kept in place long enough, according to the size and comminutive nature of the fracture. This fixation is reliable in these conditions but does not compensate intrafocal bone loss exceeding 40 per cent of the metaphyseal bone mass.

[Evaluation of impaction on bone nail and bone plate of the pertrochanteric fracture]. / Evaluation de l'impaction sur clou-plaque des foyers de fracture pertrochanterienne.

PURPOSE OF THE STUDY: Impaction in pertrochanteric fracture sites is a well known phenomenon; the screw-plate system is designed to stabilise the fracture. Although easier to use, the risk with the nail-plate system is postoperative penetration of the nail into the joint. The present study was conducted to determine the exact conditions of the impaction, and to identify possible ways to improve the nail-plate system. MATERIAL-METHOD: The study included 129 cases of pertrochanteric fracture, excluding sub-trochanteric fractures. All fractures were fixed with a 130 degrees angulated nail-plate. In all cases, consolidation was uneventful after 8 to a 12 weeks. The anatomical type of fracture, i.e. stable or unstable, was determined according to the size of the intermediary fragment, including the trochanter minor. The displacement was measured as the difference between the length of the nail and the length of the femoral head and neck measured along the axis of the femoral neck. The parameters examined were: fracture stability degree, bony mineralisation (Singh Index), nail length, femoral neck, length nail position in the femoral head, and above all, fracture reduction. All these parameters were computerised and compared using Stat View statistics software. RESULTS: Impaction was observed in 43 per cent of cases. Among these, 25 per cent were rated as slight (1 to 5 mm), 18 per cent as moderate (over 5 mm) and 9 per cent as marked (10 to 25 mm). Impaction was associated with demineralisation of the bone tissue (p = 0.001). The anatomical classification of the fracture was not a determining factor (p = 0.19), as marked displacements were also recorded in stable fractures. A posterior and inferior position of the intramedullary nail in the femoral head is one of displacement determining factors (p = 0.004, two-sided 1 test). Valgus over-correction is the most important factor, especially when it is associated with bony demineralisation (p = 0.02) and an inadequately centred intramedullary pin (p = 0.02). Shorter the femoral neck, and shorter the nail, greater was the frequency of nail articular penetration. DISCUSSION: The risk of articular penetration therefore reaches 15 per cent in petrochanteric fractures repaired with a nail plate, set at an angle of 130 degrees. A short neck, a cervicodiaphyseal angle superior to 140 degrees, and demineralisation are the three determining parameters. Stable or unstable fracture has in fact little effect on displacement incidence, and therefore does not, on its own, warrant the use of a prosthesis in comminuted fractures. The authors compared their results to literature on progressive sliding system: the incidence of complications associated with this type of fracture treatment is identical, but the determining parameters are different. CONCLUSION: The study shows that the nail-plate is efficient and provides simple and solid fracture fixation. However, this osteosynthesis material needs to be modified in order to improve its fixation in the femoral head.

[Locked nail plate: a new treatment for unstable pertrochanteric fractures]. / Le clou plaque verrouillé: un nouveau traitement pour les fractures pertrochanteriennes instables.

PURPOSE OF THE STUDY: This work is the outcome of a preliminary study on pertrochanteric fractures which showed that impaction with simple nail plates (SNP) was lead by hypercorrection in valgus demineralization and malposition of the nail in the femoral neck. To improve anchoring of the nail in the cervico-cephalic part, the authors propose to use a locked nail-plate (LNP), an innovative device based on the addition to the normal nail plate, of a screw securing neck and nail. MECHANICAL STUDY: Mechanical flexion and compression tests carried out on 8 pairs of femurs of fresh cadavers showed comparable rigidity for the two mounting, SNP and LNP. The difference became apparent at an equivalent load through a perforation in the SNP across the femoral head and by separation of the head from the LNP without any perforation. CLINICAL STUDY: 56 patients operated on between June 1994 and June 1996 were included 30 cases could be followed. There was only one complication: one dismantling of the plate from the diaphysis. The other 29 cases consolidated within an average of 8 weeks without any complications. Locking of the nail was effective and there was never cutting out the head by the nail nor any impaction in the focus of the fracture site. This was despite the fact that, in 12 cases there was advanced demineralization, in 8 cases hypercorrection in valgus, and in 13 cases of misalignment of the nail in the neck, all three of these being recognized as causes of articular deterioration. DISCUSSION: Pertrochanteric fractures currently represent a serious public health problem for which costs are definitely going to grow in the near future. We need a method for solid osteosynthesis simple and relatively inexpensive, but which also avoids the common mechanical complications. The LNP seems to correct SNP problems. This modification represents an improvement and should be used for any unstable pertrochanteric fracture.

[Healing modalities in unstable tibial fractures treated by locked flexible intramedullary fixation]. / Modalités de consolidation des fractures instables du tibia traitées par ostéosynthèse centro-médullaire flexible verrouillée.

PURPOSE OF THE STUDY: This clinical study aimed specifically to evaluate the role of flexibility in aseptic consolidation of unstable tibial fractures on compact bones. The device employed was made of intramedular nails placed separately and locked together using an original proximal system. MATERIAL: 125 unstable compact bone fractures of the tibial shaft were treated by this method for almost 6 years. 110 cases were included in this study. 30 per cent of the fractures were open. The topographical breakdown of fracture sites on the diaphysis was 6 times, in the upper third (Sector I), 23 times in Sector II and 66 times in the lower third (Sector III). In 13 cases, there were sequential fractures of which the upper site was in Sector I. 57 cases were simple sites (A), 27 were sites with edges greater than 50 per 100 of the diaphyseal circumference (B), and 26 per 100 of comminuted sites (C). The distance measured in the fracture sites after osteosynthesis were 66 times within 3 mm, 24 cases from 4 to 10 mm, 12 cases from 11 to 15 mm, and 8 cases over 16 mm. METHODS: 110 cases were followed for more than 6 months. Consolidation was established on standard clinical and radiological criteria. The value of parameters affecting consolidation and the time period recorded were validated by a precise statistical evaluation using Stat. View II software, and Fisher and Yates tables. RESULTS: Complications due to implants were rare and minor. There were only 4 cases of nonunion resulting from secondary desaxation of two pins apparatus. 16 cases of nonunion (14.5 per 100) were recorded but 3 were forseeable nonunions, because of a traumatic bone loss. 8 cases were Sector I fractures of which 7 were Sector I unsequental fractures. 7 cases had a gap of 10 to 15 mm, and 5 of 16 to 20 mm. Thus 42.1 per 100 of cases in Sector I were not consolidated compared to only 6.1 per 100 of cases in Sector III. Primary consolidation of the 94 cases was achieved in an average of 11.08 +/- 3.19 weeks (minimum 6 weeks, maximum 20 weeks). Time for consolidation did not appear to be affected by anatomical type, opened fracture (degree 1 or 2) nor number of nails used. But, there were significant differences according to topography and postoperative gap at the fracture site. Sector II fractures took 15 days less than Sector I fracture: average 10.5 as compared to 12.6 weeks. The cases with a gap of 0 to 3 mm consolidated at an average of 10.6 weeks, those with 4 to 10 mm: 11.39 weeks, with a gap of 11 to 15 mm: 14.4 weeks, and the cases superior to 16 mm: 14.8 weeks. DISCUSSION: Compared to the interlocking nail, this procedure gave an average shortening of consolidation delay of 1 month for closed and degree 1 and 2 open fractures. This rapidity of consolidation can only be explained by the flexibility parameter. Thus it is only the flexibility of the device which can explain that even with a gap of 11 to 15 mm left within the fracture site, consolidation occurred 1 time out of 2 and 9 times out of 10 when the gap was 4 to 10 mm. Finally, this mechanical parameter can explain that consolidation is by far the shortest for low fractures although these are reputed to be the least osteogenic.

[Treatment of complex bicondylar fractures of the tibial plateau by semi-circular anterior diaphyseal-epiphyseal plate]. / Traitement des fractures bituberositaires complexes du plateau tibial par plaque diaphyso-épiphysaire semi-circulaire antérieure.

PURPOSE: One third of all tibial plateau fractures are bicondylar, and some of them have posterior separation and metaphyseal comminution. In these cases, it may be difficult to reconstruct at the same time tibial axis, bone continuity and articular surface. The authors propose a new method for the treatment of these fractures. METHOD: Reduction is facilitated by permanent extension using a transcalcaneal pin. Knee approach involves elevation of the anterior tibial tuberosity (ATT). The new plate used is available for each side. It presents an epiphyseal surrounding anterior part applied on the epiphysis above the ATT and a vertical part applied medially. All the separated fragments are temporarily stabilized by pins which are used to guide the definitive plate. For this an aiming plate duplicating the epiphyseal part of the definitive plate is used to insert the pins. Then, the definitive plate is slided without removing the pins. The pins also guide cannulated screws. MATERIAL AND RESULTS: Out of 32 tibial fractures treated from January 1994 to June 1996, 3 cases were operated on using this method. All 3 cases have a frontal separation fracture, cartilage depression and metaphyseal complex fracture. Perfect articular reconstitution, fusion and axis were obtained. A fourth case was a proximal tibial fracture, very close to a total knee prosthesis. DISCUSSION: Complex bicondylar fractures are one of the most difficult fractures to treat. Identification of the lesions should be envisioned before operation and especially the separated posterior fragments. The peroperative extension combined with the anterior approach with ATT elevation provided a complete view of intra articular fracture and correction of the axis. The semi-circular anterior plate allowed the fixation of all the fragments, and furthermore, the original procedure using temporary pins to guide the definitive plate has avoided to loose the reduction.

[Flexible locked centromedullary osteosynthesis. Results of 125 cases of unstable cortical bone fractures of the tibia]. / L'ostéosynthèse centromédullaire flexible verrouillée. Résultats sur 125 cas de fractures instables du tibia en os compact.

We present a series of 125 cases of centromedullary fixation with a flexible locked nail of unstable cortical bone fractures of the tibia in which we studied healing conditions in order to identify parameters which would predict the rate of consolidation. One hundred ten fractures followed more than 6 months were included in the statistical analysis. For 94 fractures, primary consolidation was achieved in a mean 11 weeks. Fractures situated in the lower portion of the tibia healed the fastest (10 weeks). However, opening the fracture site and comminutive fractures did not affect the rate of healing except for proximal fractures and for fractures with a gap exceeding 10 cm. These two parameters, width of the bone gap (whether trauma induced or iatrogenic) and proximal localization of the fracture were the cause of the cases with long periods of non-consolidation (14.5%). The speed of peripheral osteogenesis is considered to be accelerated with the flexible nail as seen in our 94 cases where no conversion was necessary. This method provides a mean 1 month gain over consolidation times compared with locked nailing where the distal locking probably increases the rigidity of the system.

Locked intramedullary flexible osteosynthesis. A mechanical and clinical study of a new pin fixation device.

We report the use of a new method of locked intramedullary flexible osteosynthesis (LIFO) in the treatment of 118 unstable fractures of the femur and tibia. The implant utilises a set of flexible pins with a separate locking device for their proximal ends. The LIFO system proved capable of stabilising unstable fractures, and most of the complications occurred during the early testing. At follow-up, 19 of 21 femoral fractures had healed; one become infected and one showed defective callus. Of the 78 tibial shaft fractures, five failed to consolidate and five had inadequate callus. Reaming of the tibial medullary canal was never necessary. Of 28 open fractures only one became infected. The system was most difficult to use in comminuted distal fractures of the tibia, with five failures of healing in 19 cases; these cases require considerable technical proficiency. The flexibility of the system appears to promote earlier consolidation of open fractures, and normal consolidation times for fractures with interfragmentary gaps of up to 10 to 12 mm. A comparative study of callus density in tibial fractures showed a mean improvement of 50 days in cases treated by the LIFO system compared with similar cases treated by rigid nailing.

[Long-term results of the total trapezio-metacarpal prosthesis in osteoarthritis of the thumb]. / Résultats à long terme de la prothèse totale trapézo-métacarpienne dans la rhizarthrose.

The author reviewed 13 of 14 trapeziometacarpal prostheses inserted more than twelve years ago. All operated patients had non traumatic arthrosis. The long time results seem to be good in spite of a high level of loosening. Combined metacarpophalangeal arthrodesis dived to a fast loosening of the metacarpal device then shortening of the whole column of the thumb. The posture in hyperextension of the metacarpophalangeal joint was the main consequence and phalangeal joint was the main consequence and finally led to the loosening of the trapezial cup. The author considers that the modification of the metacarpal device will protect the metacarpophalangeal stability then the trapezial cup against the loosening.

[Posterior depression-separation fracture in bimalleolar fractures]. / La fracture séparation-enfoncement postérieure dans les fractures bimalléolaires.

The authors analyse the anatomic character and the functional consequences of the posterior depression-separation in ankle fractures. The posterior depression fracture was present in 20 per cent of the ankle fractures of the studied series. The major depression was noticed 1 by 3. The lesion justified a specific operation. Its presence had also to be searched in rotation fractures treated conservatively, when the lateral malleolus was uncorrectly reduced. These two situations unnoticed or neglected create an incontinence of the talus leading to a triple desaxation, even if it does not appear on usual x-ray views. Tomographic sagittal x-ray views are on that score an important contribution to the diagnostic. Ankles showing such a residual defect deteriorated to an early articular narrowing during the first 6 months and to arthrosis during the first or second year.

[Recurrent posterior traumatic luxation of the hip and anteversion defect of the femoral neck in adults. Apropos of a case, general review of the literature]. / Luxation récidivante postérieure traumatique de hanche et défaut d'antéversion du col du fémur chez l'adulte. A propos d'un cas, revue générale de la littérature.

The recurrent traumatic posterior dislocation of the hip is exceptional. On the reported observation, an anteversion fault of the femoral neck was demonstrated. This deformity had already been pointed out in cases of simple traumatic dislocation. It had never been noted in case of recurrent dislocation. It appears logical in case of important fault, not to be satisfied with a posterior capsulorrhaphy, but to combine it with a femoral rotation osteotomy.

[The locked pin: a simple method to avoid migration in slight osteosynthesis]. / La broche boutonnée: un moyen simple d'éviter la migration dans les ostéosynthèses légères.

The authors propose to broaden the principle of the pin lock in slight osteosyntheses. The purpose of the inserted tip device is to prevent the forward migration of the pin, the skin perforation by retrograde and to ease its removal after bone union.

[Mechanical consequences of the surgical treatment of lumbar stenosis]. / Conséquences mécaniques de la cure chirurgicale de la sténose lombaire.

In a series of 84 cases of lumbar stenosis duly controlled with lateral X-rays at each visit, 7 post-operative slips were discovered (8 p. cent). They occur very early, are moderate and do not seem to become worse. The functional repercussion was actually present on only 2 instances. 5 occurred spontaneously, 2 represented the aggravation of an arthritic spondylolisthesis. The preferred localization is L4-L5 and the slip seems to develop especially on pinched but still thick discs, and spines with an over-lordosis. Multi-levels total lamino-arthrectomy promotes slipping but this wide resection is not an exclusive factor. The knowledge of anatomical factors of risk enables to limit the indication of a stabilizing arthrodesis and the low slipping risk versus the much higher percentage of failure because of insufficient resection, prompts the author to keep performing wide releases on demand.

[Treatment of humeral diaphyseal fractures in adults using centro-medullary pinning. Operative technic and indications]. / Traitement des fractures de la diaphyse humérale de l'adulte par embrochage centro-médullaire (ECMA). Technique opératoire et indications.

The ascending intramedullary "pinning" technique is known for twenty-five years. Theoretically successful for the diaphyseal humeral fractures in adults, it appeared until now with some disadvantages which limited its use. By adding some modifications, the authors show that this technique is worthwhile in dislocation fractures in adults.