[Morel-Lavallée lesion in orthopaedic surgery (Nineteen cases)]. / Épanchement de Morel-Lavallée en chirurgie orthopédique (À propos de 19 cas).

AIMS: The object of this work is the study of especially ancient clinical forms of the effusion of Morel-Lavallée, to discuss the place of deep fascial fenestration by Ronceray and to propose criteria of therapeutic indication. PATIENTS AND METHOD: Our study concerns a continuous retrospective series over 20 years from 1989 till 2009. Eleven men and eight women, 36.7 year-old on average were treated for an effusion of Morel-Lavallée. The dominant etiology was represented by the accidents of the public highway. The collection was discovered after 41.4 days on average (extremes of 1-180 days). The volume of the collection was on average of 1237cm(3) (extremes 60cm(3)-12L). RESULTS: The conservative treatment concerned all patients who had a recent collection lower than three weeks and three others who had an ancient collection. The surgical treatment was established after all 10 times among which four in first intention and six times after failure of the previous treatment. The cure was obtained in 91% of the patients who had a recent collection by the only conservative method and among four patients by the method of Ronceray. To the three others, it was obtained after iterative unbridlings and talcage treatment. CONCLUSION: The authors insist on certain rare forms met in Africa in particular the "virtual form", the ancient forms and the too plentiful forms (12L). They plead for use deep fascial fenestrations by Ronceray for these last ones.

[Entrapment of the median nerve after neglected dislocation of the elbow: a case report]. / Incarcération du nerf médian après luxation négligée du coude : à propos d'un cas.

Entrapment of the median nerve is a rare complication following dislocation of the elbow. The authors report a case of incarceration of the median nerve in a neglected dislocation of the elbow in an 18-year-old right-handed boy. The patient sustained a closed injury of the right elbow during a game. The initial treatment was performed by a traditional bonesetter and consisted of attempts at reduction followed by immobilization in extension. There was persistent pain and limitation of movement in the elbow and paraesthesiae in the long finger. This led the patient to consult us at 45 days postinjury. Radiographs showed a posterolateral dislocation of the elbow. Surgical reduction was carried out 6 months posttrauma. After opening of the capsule, we discovered the median nerve blocking the olecranon fossa, passing at the level of the groove of the trochlea where it was wedged between the latter anteriorly and the olecranon posteriorly before resuming its normal course. Reduction was obtained and the nerve replaced in its normal position. The postoperative course was uneventful with disappearance of the paresthesiae and restoration of a good range of movement of the elbow. The authors discuss the mechanism, the clinical forms and propose a new type according to the classification of Fourrier.

[Olecranon osteotomy in the treatment of distal humeral fractures in adults: anatomical and functional evaluation of the elbow in 14 cases]. / L'ostéotomie de l'olécrâne dans le traitement des fractures de la palette humérale de l'adulte : évaluation anatomique et fonctionnelle du coude à propos de 14 cas.

Osteotomy of the olecranon is commonly used to gain exposure for reconstruction of bi-condylar fractures of the distal humerus (type 13-C of classification AO), but there is controversy because of the considerable complications inherent in this technique. The aim of our study is to examine the anatomical and functional consequences of this technique of exposure on the elbow. This is a retrospective study over a continuous 7-year period. We confined ourselves to patients more than 15 years old who had presented with a bi-condylar fracture (type C of the AO) of the distal humerus, internally fixed through an osteotomy of the olecranon. We reexamined and evaluated 14 treated patients who had been operated in our service. There were nine men and five women with an average age of 34 years (range 17 to 70 years). According to the AO classification, we found 14 fractures distributed in the following way: three type C1, seven type C2 and four type C3; the fracture was open in two cases. The osteotomy was carried out in all the cases using an osteotome, extra-articular in six cases and intra-articular way in eight cases. Repair was always performed using tension band wiring. The evaluation was based on anatomical and functional criteria (Mayo Elbow Performance Score). No case of radial and ulnar paralysis was found. Thirty-six percent of the olecranon fixations were of bad quality and we found one case of olecranon pseudarthrosis. No case of heterotypic calcification was found, on the other hand, there was a case of post-traumatic osteoarthritis of the elbow. On the functional level, we obtained 36% of excellent results, 28.5% of good results, 7% of average results and 28.5% of bad results. Osteotomy of the olecranon is one of the techniques for exposure of the articular surface during reconstruction of fractures of the distal humerus. A rigorous technique allows one to avoid complications.

[Malunion of fractures of the midshafts of the radius and ulna in adults. A series of 10 cases]. / Cals vicieux diaphysaires des deux os de l'avant-bras chez l'adulte. A propos de dix observations.

The authors evaluated the management of malunions of midshaft fractures of the radius and ulna in an Orthopedic and Traumatology departement at Le Dantec University hospital (Dakar, Sénégal). Over a six-year period, there were 10 cases found for analysis. All patients presented with disabilities due to limited pronosupination. Surgical care improved the pronosupination amplitude in all patients. The role of conservative treatment of these fractures in causing malunion is discussed. Correction of these malunions should be by osteotomy, followed by rigid internal fixation with a plate and screws.

[The traffic elbow. A series of 9 cases]. / Le coude de portière. A propos de neuf observations.

"Traffic elbow" is a condition occurring when high energy trauma involves a patient's elbow resting on the window of the car or completely outside it. This is a prospective study over 30 months of 9 patients with "traffic elbow" and therefore sufferring complex open trauma to the elbow. There were 8 men and 1 woman with a median delay of 4 hours before arrival in hospital. The dominant member was affected in 3 cases. The severity of the lesions, using the Mangled Extremity Severity Score (MESS), was more than 7, comprising lesions corresponding to type 1 of the complex trauma of the superior member (TCMS) in 2 patients and a MESS score of between 3 and 6 corresponding to types 2 or 3 of the TCMS for the other 7 patients. The therapeutic possibilities are limited considering the frequent context of polytrauma. In 4 cases we performed a debridement and external humero-ulnar fixation, in 3 cases a debridement and stabilization with Kirschner's wires completed by a fenestrated cast, and in 2 cases a lifesaving amputation. All patients, except those that had had amputation, developed deep sepsis that resolved after adequate treatment. Assessment of the non-amputee patients according to the Mayo Performance Score, yielded more than 70% of bad results. The authors stress the gravity of these lesions whose prognosis is guarded both concerning mobility of the elbow and the frequent neurovascular complications.

Modified Dunn osteotomy using an anterior approach used to treat 26 cases of SCFE.

INTRODUCTION: Osteotomy performed below the femoral neck plays a leading role in the treatment of slipped capital femoral epiphysis (SCFE). It results in anatomical reduction. Several modifications have been made to Dunn's original osteotomy technique. We have developed another modification to this technique that uses an anterior surgical approach on a traction table with fluoroscopy control. HYPOTHESES: Will this technique help to reduce the number of complications? Will its results be superior to those achieved with the standard Dunn osteotomy procedure? MATERIAL AND METHODS: This was a retrospective single-center study of 26 cases in 24 patients (2 bilateral cases). Patients were positioned supine on a traction table with fluoroscopy control. An anterior surgical approach was used. A trapezoid-shaped osteotomy was performed below the femoral head. The head's reduction was checked on the fluoroscope and the fixation confirmed. The Postel Merle d'Aubigné (PMA) score was used for the clinical assessment. The radiographic assessment was based on Southwick's angle. RESULTS: The mean slip angle of the femoral head was 57°. A mean correction of 47° was achieved. Based on the PMA score, good and excellent results were achieved in 20 cases (77%) and poor results occurred in 6 cases (23%). The surgical treatment had a significant effect on the PMA score (P=0.0008). In terms of complications, there were five cases of chondrolysis and one case of necrosis associated with chondrolysis. DISCUSSION: The anterior approach provides direct access to the femoral neck, and thereby a cautious osteotomy at the site of the slip itself. Use of a traction table makes the external manipulations, reduction and fixation procedures easier to carry out. The results of this study were comparable to published results. LEVEL OF PROOF: IV, retrospective treatment study.

[Surgery in black grain mycetoma: about 44 patients treated at aristide le dantec hospital (Dakar, Senegal) from December 2008 to March 2013]. / Chirurgie des mycétomes fongiques à grain noir. À propos de 44 patients pris en charge à l'Hôpital Aristide le Dantec de Dakar (Sénégal) de décembre 2008 à mars 2013.

Black-grain mycetomas are fungal and cannot be healed by antifungals only.We conducted this study to determine the interest of carcinologic surgery only in the management of those black-grain mycetomas.We led a retrospective study concerning 44 patients over a period of 52 months. The mean age of patients was 32.5 years. The main location of mycetomas was the foot (21 cases), the ankle (10 cases), the knee (8 cases), the leg (3 cases), the chest, the back and the pulp of the fourth finger once each. The bone was affected in 21 cases. The surgery consisted in a carcinologic excision or amputation depending on the extension of the lesion and the degree of bony infringement, with ganglionic cleaning out in case of lymphadenopathy. In the average retrospect of 25.5 months, we noted 8 cases of recurrences among which 2 on the amputated patients and 6 on the patients treated by carcinologic excision. The surgery constitutes the main therapeutic issue of the fungal mycetomas.

[Femoral neck fracture complicating orthopedic reposition of a dislocated hip: four cases]. / Fracture du col fémoral compliquant la réduction orthopédique d'une luxation de hanche: á propos de 4 observations.

Posterior dislocation of the femoral head with fracture is an exceptional hip injury. Emergency reduction is required. Reposition into the acetabular cavity of the dislocated femoral head may not be feasible. Irreducibility, instability, and more rarely accidental fracture of the femoral neck may also occur. We encountered this latter complication in four patients and report here its frequency and mechanism and propose preventive therapeutic measures. Seventy dislocations and fracture-dislocations of the hip were treated in our unit from March 1997 to February 2003. Among these cases, fourteen hip dislocations were complicated by femoral head fractures. Fracture of the femoral neck occurred during reduction in four. All four cases occurred in men, mean age 49.7 years, who were traffic accident victims (drivers or passengers). There were two Pipkin IV fracture-dislocations and two Pipkin II. The first reduction, achieved under general anesthesia in an emergency setting, was performed by an orthopedic surgeon in one patient and a general surgeon in three patients. Arthroplasty was used to treat the femoral neck fracture in three patients and pinning in one. We reviewed retrospectively the clinical and imaging data before and after reduction. Sub-capital fracture situated 4.0 cm (mean, range 3.5-4.5 cm) from the lesser trochanter occurred in all four cases. The head remained attached above and posteriorly to the acetabulum and was rotated less than 90 degrees . The fragment remaining in the acetabulum was displaced in two cases. In one patient, the fracture-dislocation of the head was associated with a fracture of the posterior rim of the acetabulum. This complication appears to result from an abrupt inappropriate reduction movement. The neck fracture would occur when capsulomuscular retention of the femoral head is associated with a head defect which catches on the rim of the acetabulum during the reduction movement. Neck fracture during reduction of traumatic hip dislocation is a serious complication. Prevention of this iatrogenic event requires a slow, progressive reduction limiting the trauma to a minimum; first intention open surgery may be required in selected cases.

[Retrograde intramedullary nailing for humeral shaft fractures in adults. Evaluation of anatomical and functional results in 63 cases]. / Embrochage centromédullaire ascendant des fractures diaphysaires de l'humérus de l'adulte. Evaluation des résultats anatomiques et fonctionnels a propos de 63 cas.

PURPOSE OF THE STUDY: Many methods have been proposed for treatment of displaced humeral shaft fractures in adults. This study was designed to evaluate the anatomical and functional results of patients treated by retrograde intramedullary nailing through the lateral condyle. MATERIALS AND METHODS: Sixty-three fresh traumatic fractures of the humerus were treated between January 2000 and January 2003. Five patients were lost to follow-up. The AO classification and the Hackethal classification modified by De La Caffinière were used. Outcome was assessed according to the modified Stewart and Hundey classification. RESULTS: We had 23 very good results, 26 good results, five passable results and four bad results. The bad results were three cases of non-union and one case with poor function (stiffness of elbow and shoulder). Mean delay to union was ten weeks four days. There were no cases of iatrogenic radial nerve palsy or pin migration. CONCLUSION: Retrograde intramedullary nailing is a reliable method, easy to perform and of low economic cost. We propose it for all types of displaced shaft humeral fractures.

[Anterior transolecranon fracture-dislocations of the elbow in children: A case report and review of the literature]. / Fracture-luxation trans-olécrânienne antérieure du coude de l'enfant : revue de la littérature à propos d'une observation.

Anterior transolecranon fracture-dislocations of the elbow are rare in children and the literature is poor in recommendations for the management of these lesions. We report a new case with a type of lesion that has not been described previously and discuss this pathology. Based on a literature review, we propose a classification into four types of anterior transolecranon fracture-dislocations of the elbow in children, thereby guiding surgical indications. We recommend reduction and synthesis using a figure-eight tension-band wire in avulsions and transverse type I and II fractures. The bone plate is the best indication in type III oblique fractures in older children.

Concomitant sickle cell disease and skeletal fluorosis.

Skeletal fluorosis typically manifests as a diffuse increase in bone density, whereas avascular necrosis of the epiphyses and diaphyseal marrow are the main skeletal manifestations of sickle cell disease. The diagnostic and therapeutic challenges raised when both disorders are present are illustrated by two cases in Senegalese patients from an area characterized by high fluoride contents in the water and soil. Both had SS sickle cell disease. Skeletal fluorosis was diagnosed during evaluation for avascular necrosis in one patient and in the wake of septic arthritis in the other. Femoral head necrosis is difficult to identify in a patient with skeletal fluorosis. The bone lesions due to sickle cell disease and those due to fluorosis can mimic other bone diseases, most notably metastases. The combination of sickle cell disease and fluorosis results in significant medullary canal narrowing due to cortical thickening and to accumulation of necrotic bone. When performing hip replacement surgery, careful reaming of the medullary canal may reduce the risk of iatrogenic femoral fracture and inappropriate stem placement.

[Chronic osteomyelitis at Dantec UHC , at Dakar]. / Ostéomyélite chronique au CHU A. Le Dantec, a Dakar.

The authors report 82 cases of osteomyelitis treated and followed up at the CHU Le Dantec, from March 1979 to September 1991. The patients were young, with an average age of 18 and a half years. Some susceptibility factors were identified: malnutrition (12.20%) and sickle cell anemia (26.83%). The infection was more frequently located on long bones of the lower limber (62.77%) and mainly on the metaphysis. Fistula forms with sequestra were the most frequent ones. Sixty-six patients were healed right after the first operation, 13 after two operations, 3 after three operations, the laters were mainly relapsing cases related to insufficient curreting of the infected bone or persisting sequestrum.

[Scapulo-thoracic mycetoma. A rare localization, a particular form]. / Mycétome scapulo-thoracique. Une localisation rare, une forme particulière.

INTRODUCTION: An uncommon form and a rare localization of mycetoma is reported. The aim of this report was to distinguish this inhabitual form of mycetoma from some tropical diseases like onchocerca and other fungal diseases. CASE REPORT: A 55 year old man was admitted 10 years after a septic worm-hole for a scapulo-thoracic tumor. This encapsulated mass was a bending and rounded polyfistular one attached to the dorsal aspect of left shoulder. The fistula discharge a serosanguineous or purulent exudate. The characteristic red granule was not visible. The tumor was removed and histological examination was performed. A typical granuloma of red granule of streptomyces pelletieri was found. A good result was obtained with associated cotrimoxazole treatment. DISCUSSION: Scapulo-thoracic form included: scapular, axillary and chest form of mycetoma. All these localizations are rare. One of them can be complicated by osteitis or pleuro-pulmonary localization. Streptomyces pellitieri is the actinomycetic causal agent. This encapsulated form is uncommon. CONCLUSION: Scapulo-thoracic mycetoma is rare. Encapsulated and pedicular form is uncommon. Around Sahel areas, differential diagnosis must be evoked such as parasitic and mycobacterial infections.

[Deep onchocerciasis of the left thigh. An unusual case]. / Onchocercome profond de la cuisse gauche. A propos d'un cas isolé.

INTRODUCTION: Commonly onchocercoma has been presented as superficial and multiple nodules. When it's unique and deeply situated, its clinical diagnosis is difficult. An uncommon form of onchocercoma is reported. CASE REPORT: A 37 years old man presented a big tumor at the inferior third of the left thigh like lipoma or liposarcoma because of microcalcifications. The tumor was removed. It was a cyst containing a liquid like an "mango juice". The histological examination was performed. Degenerated microfilariae of Onchocerca volvulus was found. DISCUSSION: A big and deep onchocerma of the thigh is uncommon and diagnosis before operation is very difficult. Histological examination have eliminate filarial infections like Dracunculus medinensis and have given the right diagnosis. Radiological microcalcifications and absence of microfilariae at the parasilogical and ophthalmological examinations recall an "aged" onchocercoma. For this reason, we didn't realise a chemotherapy. CONCLUSION: This tumor in Sahel areas is very difficult to diagnose before operation. The histological examination is very important in this case. We don't use chemotherapy because this onchocercoma looks old without alive microfilariae.

[Trochanteric fractures in elderly patients: management and prognosis of 68 cases]. / Fractures pertrochantériennes du sujet âgé: prise en charge et pronostic à propos de 68 cas.

The authors studied restrospecively their cases of trochanteric fractures to evoluate the frequency, the mortality, the morbidity and the results according to the diferent types of osteosynthesis used. 68 cases were collected in a 45 months. Mean age was 75 with 33 men and 35 women. 28 patients were sick before the accident. Using the A.O. classification, the patients were divided in three groups: 19 type A1, 37 type A2 and 12 type A3. 28 patients were operated an emergency basis. An A.O. nail plaque was used in the 43 cases and a staca screw plaque was used in the 11 remaining cases. Early in hospital mobilisation and weigh bearing with assistant was used and continued after discharge. After 17 months of follow up and according to Merle d'AUBIGNE'S, criteria, 91. 42% of the patients showed satisfactory results--16 patients died 8 of them had another desease. Anatomically, bone consolidation was gained after a mean period of 97 days and 40 % of Coxa-vara was reorganised. The frequency of trochanteric fracture inthe elderly is 69,3% in our experience. The patients operated on in emergency for whom a stacca nail plate had a better results with an earlier walking autonomy. In mean follow up there was no different in the two groups.

[Recent traumatic peroneal tendon dislocation: a case report]. / Luxation traumatique recente des tendons péroniers à propos d'une observation.

Peroneal tendons dislocation describes a permanent or intermittent displacement of these tendons out of the retro malleolar sucket to its lateral side. It was described in fist in 1803 by Monteggia. It remains a rare affectation, dominantly of traumatic causes, mostly by passed in emergency situation. Also in its rarity, it remains remarkable for its diagnostic interest but also for its management which remains only surgical. This case concerned an adult of 24 years old, victim of closed trauma of the right ankle, the ankle was forced in varus and supine position. Ths initial diagnosis was a benign sprain which was later rectified 14 days after for a diagnosis of peroneal tendons dislocation. During the operation, a rupture of the retinaculum like type II of Eckert and Davis was noticed. A simple suture technique using Exner method give a good result 14 months later. The authors insist after this case indifferential diagnosis with sprain and recommended a surgical repair in recent lesions.

[Fibrodysplasia ossificans progressiva or Munchmeyer disease apropos of 2 cases]. / Fibrodysplasie ossifiante progressive ou maladie de Munchmeyer à propos de 2 observations.

Fibrodysplasia ossificans progressiva or myositis ossificans progessiva or still Munchmeyer disease is a genetic ailment with dominant autosomic transmission. It includes a high rate of change and doesn't appear any race. The authors gave an account of two remarks about it on a causal and late discovery upon two young black Africans. The first observation is a nine year-old-boy, without any similar family previous history and who has been hospitalized in maxillo-facial milieu for a mandible osteitis staphiloccocus. It showed some muscular ossifications of paravertebral, cervical, dorsal and lumbar nature--from a spontaneous appearance and evolving progressively since the age of three months. The radiographic results displayed some specific bones disorders which enable to retain the diagnosis above. The second observation is the case of a twenty four-year-old-woman who has previously benefitted from a surgical exploration a non-inflammatory muscular tumefication at the right arm which occurred at the age of twenty one. Three years later, she took surgery for the restriction of the oral gap and a right hand side lumbar paravertebral tumefaction which was thus restricting the mobility of the rachis. The radiological results have found some specific bone disorder++ at the hands and the feet which enable to link the paravertebral ossifications to their fibrodysplasic origin. Munchmeyer disease remains a affection of easy radio-clinical diagnosis. The essential point is to precociously think of it before the specific osseous anomalies occurring at the level of the feet and the hands. The functional or even vital prognosis remains closely linked to both the important and the topography of conjunctivo-muscular ossifications.

[Traditional bonesetter's gangrene of limb in children in Regional Hospital of Kaolack (Senegal)]. / Gangrène de membre à la suite d'un traitement traditionnel de fractures par attelle en bambou chez l'enfant à l'Hôpital régional de Kaolack (Sénégal).

Little published data exist on the morbidity and mortality associated with poor trauma care in developing countries. This report highlights our experience with iatrogenic limb gangrene related to fracture management by traditional bonesetters. Children with bonesetter's gangrene were identified from a prospectively recorded paediatric surgery database at the Regional Hospital of Kaolack in Central Senegal. 21 children were treated for bonesetter's gangrene during a 18-month period (January 2007 up to June 2008). The average age was 10 years (range, 5 to 15 years). Bonesetter's gangrene was more common in boys (90.5%) and occurred almost exclusively in children from rural areas where access to health care was limited. 16 children underwent proximal extremity amputation. Complications included one case of tetanus. Bonesetter's gangrene is a preventable complication that results from a failure of child health planners to recognize the importance of basic trauma care. Management of fractures should be considered an essential component of child health programs in developing countries.

[Intramedullary pinning of the radius in acute Galeazzi's fractures in adults: 23 case reports]. / Embrochage centromédullaire du radius dans les fractures récentes de Galeazzi chez l'adulte : À propos de 23 cas.

OBJECTIFS: Consensual treatment of the Galeazzi's fracture is a plate osteosynthesis of the radius more or less associated to the confection of a plaster cast in distal radio-ulnar joint (DRUJ) dislocation. The authors are reporting in this study the clinical and functionnal results of the intra-medullary pinning of the radius in this type of fracture in adult. METHODS: During a prospective study from January 2003 to December 2006, 23 patients (20 men and three women), average-aged of 32 years (16-70 years) presenting with a Galeazzi's fracture were treated by an intra-medullary pinning of the radius. The DRUJ dislocations were locked 17 times by a brachio-ante-brachio-palmar plaster cast in the supination position, and six times by an ulno-radial pinning. Only the 16 over-aged patients presenting with closed recent fractures were included in this study. The DRUJ dislocation was ranked according to Mansat, the radial fracture according to Müller (AO). The assessment of the treatment results used Mestdagh's criteria. In this study, each pseudarthrosis of the radius was considered as a failure. RESULTS: The DRUJ dislocation was reparted into six sprains, eight subdislocations, and three Galeazzi's fracture equivalents. The radius fractures were simple (n=20) or wedge fractures (n=3). These fractures were located at the proximal third (n=13), middle third (n=7) and distal third (n=3). The average consolidation delay was 10 weeks (8 to16 weeks). Two pseudarthrosis have been observed and then treated by a plate osteosynthesis. At the mean follow up of 37 months (18 to 41 months), the mean score according to Mestdagh was 7.8 points, with 20 satisfying results. Nineteen patients were satisfied by their treatment; the reasons were: the esthetic care of their scar, and the good functionnal resumption, as well as before the fracture. CONCLUSION: The intra-medullary pinning of radius in Galeazzi's fractures, in contrary to the previous studies, give good results compared to a plate osteosynthesis treatment. The systematic complementary lock by brachio-ante-brachio-palmar plaster cast during 3 to 4 weeks has balanced the stability defect that Mikic was reproaching to it. Moreover, it confers the benefits of elastic closed osteosynthesis. That less simple and less expensive method represents an alternative to a plate osteosynthesis in Galeazzi's fractures in adult, if it is well standardized.

[Latarjet procedure for recurrent anterior instability of the shoulder. Report of 41 cases]. / Traitement De La Luxation Anterieure Recidivante De L'Epaule Par La Technique De La Butee Osteoplastique Selon Latarjet. A Propos De 41 Cas.

AIMS: Evaluate the technique of Bristow-Latarjet in the treatment of the recurrent dislocation of the shoulder. PATIENTS AND METHODS: It was a continuous retrospective study on 46 cases selected in the CHU of Dakar over 11 years. From our criteria of inclusion, 41 patients were retained. There were 37 men for 4 women, whose average age at the time of the intervention was 29 years (extreme: 20 - 44 years). The management of the first episode was unsuited in 25 times. The average time of the first repetition was 10 months and its number varied between 5 and 36 episodes. The treatment of the recurrences was also misfit in 23 times. All our patients were treated according to the technique of Bristow-Latarjet. A standard immobilization Mayo clinic during 3 weeks was made with a systematic rehabilitation. The evaluation was done according to the scale of Constant with 45,6 months an average retreat. RESULTS: We found: 7 excellent cases (17%); 14 very good cases (34%); 9 good cases (22%); 6 average cases (15%); 5 bad cases (12%). Five cases of omarthrosis (3 types II and 2 types III of Samilson-Prieto) were found like two surface cases of sepsis. There was neither post-operative recurrence nor iatrogenic nervous attack. CONCLUSION: The recurrent anterior dislocation of the shoulder represents a frequent complication of primary dislocations of the shoulder touching especially young subjects. Stabilization by the anterior coracoid abutment according to the technique of Bristow-Latarjet led well represents one of the best techniques for its treatment.