A computed tomography study of the fibula: morphology, morphometry, intramedullary anatomy, application prospects on intramedullary nailing.

PURPOSE: The intramedullary percutaneous pinning in fractures of the lateral malleolus is a technique of osteosynthesis that can reduce complications of ORIF. Our study describes the morphology and the morphometry of the fibula, in particular intramedullary, so as to specify the best fibular nail features. METHODS: We conducted a retrospective study on CT acquisitions of fibulae in vivo. We studied total length, and the distal malleolar angle. Regarding intramedullary morphology, six axial study levels were defined. Each level was assigned a morphometric classification (oval, triangular, quadrangular or irregular), and a measure of the diameter of the cavity. The distance between the smaller diameter and the malleolar tip was investigated. RESULTS: We included 50 patients for 97 fibulae. The average age was 66.5 years. The irregular morphology type was the most frequently found. The average length was 370.5 mm (SD = 18.1; CI 95% [366.9; 374.1]), the average distal malleolar angle was 163.5° (SD = 3.7; CI 95% [162.7; 164.2]). The average minimal intramedullary diameter at malleolus level was 3.2 mm (SD = 1.2; CI 95% [3.0; 3.5]), with a minimum size reaching 95.8 mm (SD = 13.8; CI 95% [93.0; 98.5]) of the malleolar tip. CONCLUSIONS: The analysis of morphological parameters of the fibula, in particular the lateral malleolus and intramedullary morphology is necessary for the design of a morpho-adapted nail. Interpersonal variability must be taken into account by the implant industry to offer nails of suited lengths and diameters.

[Comminuted intra-articular fractures of the distal humerus in elderly patients]. / Fractures articulaires complexes de l'extrémité distale de l'humérus chez le sujet âgé

Treatment of comminuted intra-articular fractures of the distal humerus in elderly patients remains a challenge in trauma surgery. These fractures are rare, but their frequency increases. Our multicenter studies collected 238 cases of comminuted intra-articular fractures of the distal humerus in patients older than 65: two hundred and five cases for the retrospective study, 33 for the prospective study with a minimum follow-up of six months. The following criterias were studied: age, sex, state of health (with ASA score), functional scores (with Katz score), osteoporosis by the OST score and dual X-ray absorptiometry. The results were evaluated according to the Mayo Elbow Performance Score (Morrey) and the Quick DASH. X-ray studies were performed in order to assess both results for prosthesis and osteosynthesis. The following criteria were studied: bone healing, quality of reduction, signs of arthritis (Broberg-Morrey), prosthetic position, mechanical complications, prosthesis fixation. There were 80% of women in good health according to the ASA score (more than 70% of ASA 1 or 2). Most of them (80%) were self-governing and living at home. Hundred and seventy-two patients had an osteosynthesis and 44 had a prosthetic reconstruction (like Coonrad-Morrey prosthesis). Patients treated with osteosynthesis were younger (mean age was 77) than those treated with prosthetic reconstruction (mean age 81). Mean follow-up was 32 months. Results of osteosynthesis were good and excellent for 77% of the patients. Complications occurred for 20% of patients with a reoperation rate of 13%. Results of prosthetic reconstruction were good and excellent for 83% of the patients with 14% of complications and 6% of reoperation. Prosthetic reconstruction seemed to be better than osteosynthesis according to the Mayo Clinic score (84 points versus 77 points for the retrospective study and 95 points versus 75 points for the prospective study). However, the statistical analysis was not significant. Treatment of these fractures must be discussed according to the physiological status of the patient and the fracture patterns (scan evaluation). In conclusion, osteosynthesis remains the standard treatment when stable fixation is feasible. However, prosthetic reconstruction should be discussed for dependant patients or with comorbidity factors, bad bone quality leading to poor osteosynthesis or complex fracture.

[Intra-articular fracture of the distal humerus: outcome after osteosynthesis in patients over 60]. / Résultats de l'ostéosynthèse des fractures articulaires de la palette humérale chez le sujet âgé

PURPOSE OF THE STUDY: This is a retrospective analysis of patients aged over 60 years treated in a single center for intra-articular fractures of the distal humerus. Outcomes were compared with published results for osteosynthesis and arthroplasty. MATERIAL AND METHODS: The cohort included 34 patients (36 fractures) reviewed at mean 35 months. Mean age was 77.6 years. Fracture types were: C1: 8, C2: 10, C3: 18. The transtricipital posteromedial approach was used in the majority of patients. Fixation was achieved with a prebent lateral plate (n=11 fractures), a Y-plate (n=9), two plates (n=4), pins or screws (n=9) and an external fixator (n=3). Outcome was assessed with the Mayo elbow score, the Bröberg radiographic score and patient satisfaction. The social impact was also noted. RESULTS: The mean Mayo elbow score was 73.3; outcome was excellent (n=13), good (n=8), fair (n=5) and poor (n=10). Pain persisted in 23 patients. The mean range of movement was 80 degrees . Patient satisfaction remained good. Ten patients did not recover their preoperative level of autonomy. Radiological signs of osteoarthritis were noted for 75% of patients and nonunion of the humeral fracture in 32%. There were three superficial infections and four neurological lesions. DISCUSSION: Good and very good outcome was noted for 59% of the osteosyntheses in this series, compared with 71% in the literature. The rate for arthroplasty is 95%. The mean range of motion is 101 degrees , 17% of patients with a prosthesis complain of pain, 5% develop a superficial infection and 6.5% suffer neurological injury. The estimated rate of revision for arthroplasty is 11% at 7 years. CONCLUSION: Beyond the age of 65 years and based on evidence reported in the literature, it would be advisable to prefer another mode of treatment for these intra-articular fractures, for example elbow arthroplasty, particularly for comminutive fractures on osteoporotic bone.

[Total hip arthroplasty for treatment of acute acetabular fracture in elderly patients]. / L'arthroplastie totale de hanche dans le traitement des fractures récentes de l'acétabulum du sujet âgé

PURPOSE OF THE STUDY: The standard treatment of displaced acetabular fractures is open reduction and internal fixation (ORIF). In elderly patients, ORIF may not be the best option because of osteoporotic bone and the necessary period of bed rest. Primary total hip arthroplasty (THA) for displaced acetabular fractures was initiated by Westerborn in 1954. Since then, several authors described their experience and since 1986 many studies have reported good results with this type of treatment. This study assessed outcome obtained in patients treated by primary THA for acetabular fracture in the orthopedic department of the Dupuytren Teaching Hospital in Limoges. MATERIAL AND METHODS: Between 1981 and 2001, 16 patients, mean age 76.1 years (range 64-89) were treated with primary THA for recent displaced acetabular fractures. Bone loss was quantified using the SOFCOT classification for acetabular revision THA: stage III was noted in four patients (25%) and stage IV in twelve (75%). No attempts were made to achieve anatomic reduction of fracture fragments, but a reinforcement ring was used, coupled with autologous bone graft for the acetabulum. All patients were assessed clinically using the Postel-Merle d'Aubigné et Harris scores and the Devane activity scale. Radiographs were used to assess union and signs of loosening according to De Lee and Charnley and the Gruen classifications. Ossifications were quantified with the Brooker classification. RESULTS: Mean follow-up was three years. The mean Harris hip score was 73.6 (range 47-93), and the mean Postel-Merle d'Aubigné score 13.8 (range 10-17). Twelve patients (75%) returned to their initial activity level on the Devane scale; only four decreased their daily activity by one level. All patients but one were satisfied. There was one case of partial neurological sensorial deficit. There were no postoperative dislocations. All fractures healed. There were six cases (37%) of heterotopic bone formation including grade IV ossification in one patient with a stiff hip which required surgical resection. There were five cases of radiolucent halo in one zone of the cup, and one case in two zones; all these lucencies were non-progressive and there was not sign of loosening at last follow-up. DISCUSSION: Orthopedic treatment for displaced acetabular fractures in elderly patients may not be suitable because of the risk of complications due to the prolonged period of decubitus. ORIF requires one surgery, but may nevertheless lead to a second operation because of osteoarthritis. Primary THA has many advantages: full weight bearing is achieved rapidly, decubitus complications are avoided, functional outcome was good with union for all of the fractures in our series. Nevertheless, despite differences between surgical procedures reported in the literature, ectopic ossifications are common and the overall rate of dislocation reaches 7% considering all reported series. CONCLUSIONS: In selected patients with a displaced acetabular fracture, we believe that an acute THA may provide several advantages including only one procedure and quick weight bearing with a lower rate of decubitus complications. In this small series, functional outcome was good for most of the patients who recovered their initial activity level.

[Development and validation of a dynamic model of the knee]. / Elaboration et validation d'un modèle numérique de genou.

The authors report the methodology of the construction of a multibody model of the knee and the validation of the kinematics of the modelled knee. The construction of the model includes: the rigid bodies represented by osseous components (femur, tibia, fibula, patella), the ligamentous structures (collateral ligaments, patellar ligament, cruciates ligaments), the muscular part represented by the quadriceps. Morphological data were acquired through 3D CT scans for the bones and a biometrical study of the ligaments (insertions, orientation, length, section). Ligament biomechanics was modelled as bilinear springs (in compression the tightness is null; in traction it is a function of length, section and Young modulus of elasticity). The quadriceps was modelled as a sliding channel with a translatory servocommand. Contacts at the interfaces (femur/patella; femur/tibia) were evaluated according to the index of penetration (distance D) between two bodies where effort was: Dx10(5) N/mm(2)). The model was tested simulating a symmetrical kneeling (800 N body weight) and required a ground link modelled as a ball and socket joint. The model was developed under ADAMS software. The validation of the kinematics of the modelled knee was provided according to the data of Wilson et al. who have shown that (i) in normal knees, internal/external rotation, abduction/adduction and all three components of translation are coupled to flexion angle both in passive flexion and extension; (ii) the tibia rotates internally as the knee is flexed. The consistency of the coupled motions support the model's premise that passive knee motion is guided by isometric fascicles in anterior and posterior cruciates, by the medial collateral ligament and by articular contact in the medial and lateral compartments. The main curves (internal/external rotations; posterior/anterior translation) of the model conforms with the framework of Wilson.

Lateral ligament reconstruction procedures for the ankle.

Capsule/ligament lesions of the lateral compartment of the ankle lead to lateral laxity, which is a prime contributor to chronic ankle instability. Lateral ligament reconstruction stabilizes the joint. Exhaustive preoperative clinical and paraclinical work-up is essential. The present article classifies, presents and criticizes the main techniques in terms of long-term stabilization and reduction of osteoarthritis risk. Anatomic ligament repair with reinforcement (mainly extensor retinaculum) or anatomic ligament reconstruction are the two recommended options. Non-anatomic reconstructions using the peroneus brevis should be abandoned. Arthroscopy is increasingly being developed, but results need assessment on longer follow-up than presently available. Postoperative neuromuscular reprogramming is fundamental to optimal recovery. Finally, the concept of complex ankle instability is discussed from the diagnostic and therapeutic points of view. The various forms of ligament reconstruction failure and corresponding treatments are reported.

Learning the skills needed to perform shoulder arthroscopy by simulation.

INTRODUCTION: Simulation for arthroscopy helps surgical trainees develop their surgery skills in a safe environment. This teaching technique has become more widespread in recent years because of the need to provide surgeons in training with an alternative to the current methods. We hypothesized that a resident in surgery could acquire the skills needed to perform arthroscopic shoulder surgery by working on a simulator. MATERIAL AND METHODS: The study was conducted over a 4-month period from June to September 2016. All the surgeons and residents in our department participated in the study. We recorded each participant's age, sex, dominant hand, and video gaming experience. We used the Arthro Mentor™ simulator from Simbionix (now 3D Systems). Testing was carried out at the start and end of training to evaluate the participant's skills and their progression. The changes were evaluated statistically. RESULTS: Fourteen surgeons were included in the study. They were split into two groups: controls and residents. There was a statistically significant improvement in the intern group between the overall pre-test score and the overall post-test score. There was no significant improvement in the overall score of the control group between the pre-test and post-test. DISCUSSION: For surgeons in training, shoulder arthroscopy simulation helps them acquire the skills needed to perform arthroscopy such as hand-eye coordination, triangulation and the ability to work in three-dimensions based on two-dimensional visual information. We believe that the benefit of simulation resides in learning the skills needed to perform a surgical procedure, not in learning the procedure itself. LEVEL OF EVIDENCE: III-case-control study.

Lung metastases of diffuse giant cell tumour of the fibular tendon sheath at the ankle: A case report.

Diffuse giant cell tumours of the tendon sheaths are described in the literature as locally aggressive soft-tissue tumours. We report the case of a 56-year-old male with a history of multiple surgical procedures for a giant cell tumour of the fibular tendon sheath at the right ankle. The multiple recurrences prompted monitoring by positron-emission tomography, which showed lung tumours. Biopsies confirmed that the tumours were metastases from the giant cell tumour of the tendon sheath. In patients with recurrent and/or diffuse giant cell tumour, positron-emission tomography is an effective monitoring tool.

Can a target zone safer than Lewinnek's safe zone be defined to prevent instability of total hip arthroplasties? Case-control study of 56 dislocated THA and 93 matched controls.

BACKGROUND: Various factors contribute to instability of total hip arthroplasty (THA), with implant orientation being a major contributor. We performed a case-control study with computed tomography (CT) data to determine whether: 1) orientation contributes to THA instability and 2) a safer target zone for stability than Lewinnek's classic safe zone can be defined. MATERIAL AND METHODS: We included prospectively 363 cases of THA dislocation that occurred during the calendar 2013 year in 24 participating hospitals. Of the 128 dislocations that occurred in patients who underwent THA at these centers, 56 (24 anterior, 32 posterior) had CT scans, thus were included in the analysis. The control group was matched 4:1 based on implant type, year of implantation, age, sex, bearing types and THA indication. Of the 428 matched control THA cases, 93 had CT scans. In all, the CT scans from 149 cases (56 unstable, 93 stable) were analyzed to determine the acetabular cup's inclination and anteversion, and the femoral stem's anteversion. RESULTS: In the unstable THA group, cup inclination was 46.9°±7.4°, cup anteversion was 20.4°±10.8° and stem anteversion was 14.2°±9.9°. In the stable THA group, cup inclination was 44.9°±5.3° (P=0.057), cup anteversion was 22.1°±5.1° (P=0.009) and stem anteversion was 13.4°±4.4° (P=0.362). The optimal total anteversion (cup+stem) of 40-60° was achieved in 16.5% of unstable THA cases and 13.9% of stable THA cases, thus this parameter does not predict stability (odds ratio [OR] of 0.40, P=0.144). The cup was positioned in Lewinnek's safe zone in 44.6% of patients in the unstable group and 68.2% of those in the stable group (OR 3.74, P=0.003). A target zone defined as 40-50° inclination and 15-30° anteversion was better able to distinguish between unstable cases (23.2%) and stable cases (71.6%) resulting in an OR of 13.91 (P<0.001). DISCUSSION: Implant positioning was the only risk factor for instability found in this study. Moreover, our findings reinforce the theory put forward by other authors that Lewinnek's safe zone is not specific enough to differentiate between stable and unstable THA implantations. The target zone for acetabular cups proposed here (40-50° inclination and 15°-30° anteversion) is related to a lower risk of instability. This orientation can be used as a guide, but must be combined with other technical elements to optimize stability. By balancing stability and biomechanics, the 40-50° inclination and 15°-30° anteversion target zone redefines the optimal positioning window. LEVEL OF EVIDENCE: III case-control study.

Comminuted fractures of the radial head treated by the Judet floating radial head prosthesis.

Excision is not a suitable treatment for all comminuted fractures of the radial head. In elbows where instability can be predicted, a replacement arthroplasty of the radial head is more effective. The aim of this paper was to present the medium-term results of the Judet floating radial head prosthesis. This operation was performed on 14 patients between 1992 and 2003, of whom 12 were reviewed at a mean follow-up of five years and three months (1 to 12 years). The outcome was assessed using the Mayo elbow performance score and a modified Disability of Arm Shoulder Hand (DASH) questionnaire. There were six excellent results, four good, one fair and one poor, as graded by the Mayo score. The mean DASH score was 23.9/100 (0 to 65.8/100). The only significant complication occurred in one patient who developed a severe complex regional pain syndrome. There were no patients with secondary instability of the elbow, implant loosening, cubitus valgus, osteoporosis of the capitellum, or pain in the forearm and wrist. Our experience, combined with that of other authors using this device, has encouraged us to continue using the Judet prosthesis in comminuted fractures of the elbow where instability is a potential problem.

Endoscopic ulnar nerve release at the elbow: Indications and outcomes.

BACKGROUND: Ulnar nerve entrapment at the elbow is the second most common nerve entrapment syndrome at the upper limp, after carpal tunnel syndrome. Many surgeons feel that ulnar nerve instability contra-indicates endoscopic nerve release. Published studies, however, found no evidence that pre-operative or intra-operative ulnar nerve instability adversely affected clinical outcomes. The objective of this prospective study was to define the indications and describe the outcomes of endoscopic ulnar nerve release at the elbow. HYPOTHESIS: Endoscopic ulnar nerve release at the elbow is a valid option even in patients with ulnar nerve instability and regardless of the severity of the compression. MATERIAL AND METHODS: We conducted a prospective single-centre study of patients scheduled for surgery based on clinical and electromyographic manifestations of ulnar nerve entrapment at the elbow. Ulnar nerve instability (incomplete dislocation, i.e., Childress A) before or during surgery was not a contra-indication to the procedure. The patients were re-evaluated 12 months after surgery. RESULTS: Seventeen patients were included in the statistical analysis. The modified Bishop's score indicated excellent or good outcomes in 15 (88%) patients (excellent in 4 and good in 11) and a fair outcome in 2 patients. Functional outcomes were not associated with the presence of ulnar nerve instability before surgery. DISCUSSION: We elected to include patients with Childress A ulnar nerve instability. Clinical outcomes in these patients were similar to those in patients without ulnar nerve instability. LEVEL OF EVIDENCE: IV, open prospective study of treatment outcomes.

Mechanisms of phosphene generation in ocular proton therapy as related to space radiation exposure.

Particle therapy provides an opportunity to study the human response to space radiation in ground-based facilities. On this basis, a study of light flashes analogous to astronauts' phosphenes reported by patients undergoing ocular proton therapy has been undertaken. The influence of treatment parameters on phosphene generation was investigated for 430 patients treated for a choroidal melanoma at the proton therapy centre of the Institut Curie (ICPO) in Orsay, France, between 2008 and 2011. 60% of them report light flashes, which are predominantly (74%) blue. An analysis of variables describing the patient's physiology, properties of the tumour and dose distribution shows that two groups of tumour and beam variables are correlated with phosphene occurrence. Physiology is found to have no influence on flash triggering. Detailed correlation study eventually suggests a possible twofold mechanism of phosphene generation based on (i) indirect Cerenkov light in the bulk of the eye due to nuclear interactions and radioactive decay and (ii) direct excitation of the nerve fibres in the back of the eye and/or radical excess near the retina.

Ilizarov's technique in correction of ankle malunion.

A case is reported of ankle malunion corrected using Ilizarov's technique. The malunion, resulting in a varus ankle deformity (30 degrees), was a consequence of a posttraumatic epiphysiodesis of the distal growth plate of the tibia (McFarland's fracture). Ilizarov's procedure is described, and the radiological evolution of the regenerate is presented. Indications of corrective surgery in ankle malunion are discussed. The advantages of Ilizarov's technique (bloodless technique, cosmetic advantage, full weight-bearing capability, immediate talotibial joint rehabilitation) are illuminated.

[Foot localization of a Kaposi's sarcoma. Apropos of a case]. / Localisation au pied d'un sarcome de Kaposi. A propos d'un cas.

With regard to a foot localization of a cutaneous Kaposi's Sarcoma, the Authors briefly evoke the manifestations of this acquired immuno deficiency syndrome (AIDS). Some clinical aspects of the AIDS, commonly looking, but often revealing the disease, may lead the patient to an orthopaedic surgeon.

[Corrections of limb deformities in children with Wagner's external fixator]. / Correction des déformations des membres chez l'enfant par fixateur externe de Wagner.

The authors describe a method of correction of limb deformities whilst allowing the length of the limb segment to be maintained. The apparatus used was the Wagner external fixator which first allows distraction at the site of an osteotomy followed by correction of angulation with suppression of this temporary lengthening.

[Penetrating wound of the leg by a foreign body and arteriovenous fistula. Apropos of a case involving the posterior tibial artery]. / Traumatisme pénétrant de jambe par corps étranger et fistule artério-veineuse. A propos d'un cas au niveau de l'artère tibiale postérieure.

The authors report a case of arterio-venous fistula of the posterior tibial artery after a gunshot wound. They emphasise the value of digital arteriography in such cases. Repair of the artery two months after injury was followed by healing.

[Ligamentoplasty using the peroneus tertius in the correction of lateral laxity of the ankle. Surgical technique]. / La ligamentoplastie au troisième fibulaire (peroneus tertius) dans les laxités latérales de la cheville. Technique chirurgicale.

INTRODUCTION: The authors present an original procedure for lateral ankle ligamentoplasty using peroneus tertius. MATERIAL AND METHODS: This muscle inconstantly present (90 p. cent), lies from the distal third of the anterior aspect of the fibula to the base of the fifth metatarsal with a caracteristic "hockey stick" shaped insertion. The width of the tendon is related to its length: in 60 per cent of cases the width exceeds 4 mm and makes the tendon biomechanically reliable. The procedure is carried out through a lateral approach. The tendon of the peroneus tertius is easily located under the extensor retinaculum. It is then dissected up to the muscle belly and its arterial supply. The neck of the talus and the lateral malleolus are exposed. A tunnel is drilled through the talar neck and the lateral malleolus and cautiously widened with a rasp. The tendon is passed through the malleolar and the talar tunnel. The transplant is thightened with the foot in neutral position (or fairly eversed) and sutured to it self. DISCUSSION: Therefore this transplant restores in an anatomical position the anterior bundle of the lateral ligament of the ankle. It can be used for a ligamentoplasty of the subtalar joint as well: the transplant after crossing the talar neck is fixed at the lateral margin of the calcanus restoring the course of the cervical talo-calcaneal ligament. CONCLUSION: This technique which is limited by anatomical consideration constitutes an alternative procedure compared with periosteal or peroneus brevis ligamentoplasty.

[Osteoid osteoma of the spine. The experience of the Rizzoli Institute]. / L'ostéome ostéoïde de localisation rachidienne. Expérience de l'Institut Rizzoli.

The authors report their experience at the Rizzoli Institute in treating osteoid osteomas localized to the spine (40 cases). This clinical study confirms that osteoid osteomas are tumors of adolescence, which are often diagnosed late due to their spinal localization. The role of additional investigations, dominated by bone scan and computed tomography is discussed. Their use should decrease the diagnosis delay. Mean follow-up in this series was 4 years, and confirmed that surgical excision had a favorable outcome. The outcome of associated scoliosis was also studied (8 cases). After tumor excision, there were 6 complete or partial corrections. Two cases remained unchanged. Curvature worsening after excision was not encountered.

[Tibio-talar arthrodesis: long term influence on the foot]. / Etude de la tolérance à long terme de l'arthrodèse talo-crurale.

PURPOSE OF THE STUDY: The aim of this study was to evaluate the long-term effect of tibiotalar arthrodesis on function, clinical and radiological tolerance, and subtalar joints. MATERIAL AND METHODS: We reviewed 37 cases of tibiotalar arthrodesis in 27 young patients who were generally manual workers. Their mean age at surgery was 46 years and mean follow-up at review was 12.8 years (range 5-26 years). Functional outcome was assessed with the Duquennoy scale. We reviewed the anterioposterior and lateral weight-bearing views as well as the lateral view in dorsal and forced plantar flexion. RESULTS: Mean functional outcome was good and very good in 66% of the cases, fair in 30% and poor in one case. Total pain relief had been achieved in 45% of the cases with a mean walking distance of 1500 m without crutches. Residual mobility at last follow-up was 13 degrees for the mediotarsal joint. This mobility allowed the arthrodesed foot to adapt to gait. Radiologically, fusion had been achieved in 83% of the cases within 3 months. The overall functional score fell off proportionally with the degree of arthrodesis valgus starting at 5 degrees. Likewise pes equinus > 10 degrees led to pain and reduced motion. The subtalar joints were affected in all cases, leading to poor adaptation of the foot on uneven ground. Grade 1 osteoarthritis affected the mediotarsal joint and was more marked in case of equine fixation. DISCUSSION: Our results are similar to those reported in the literature. We had 4 cases of nonunion in patients with risk factors previously discussed in the literature. CONCLUSION: Arthrodesis remains a useful method for treating talocrural osteoarthritis, providing good long-term results. The position of the fixation should be 90 degrees in the sagittal plane and 0 degrees to 5 degrees valgus in the frontal plane.

[Perforation of the sigmoid colon secondary to acetabular fracture]. / Perforation sigmoïdienne consécutive à une fracture de l'acétabulum.

Traumatic lesions of the colon associated with fracture of the acetabulum occurs in less than 2% of the cases. Direct perforation of the colon by a bony spike, which occurred in our patient, is even more exceptional. We were unable to find any other case reported in the literature. This case illustrates the importance of looking for intestinal lesions in all patients with pelvic injury presenting an unexplained infectious syndrome. Imaging provides clear evidence for avoiding late diagnosis and life-threatening situations.