Total hip revision using a cup design with a peg to treat severe pelvic bone defects.

When dealing with severe bone loss during acetabular revision of a total hip arthroplasty, it can be difficult to find a reliable anatomical structure to ensure high-quality primary fixation of the cup. Since 2003, we have been using an implant with a long peg that is anchored into the iliac isthmus. This structure is usually intact, even in the most severe situations of bone loss. The use of this specially designed component provides satisfactory mechanical reconstruction in cases that can be quite challenging (Paprosky and SOFCOT stage 3). The length and postoperative care for the procedure remain the same and early weight bearing is possible. The specific principles applying to this procedure, along with the anatomical features of the iliac isthmus, the implantation technique and our initial results are described in detail.

External fixation and arthrodesis.

Arthrodesis of joint is widely employed in case of infected nonunion especially after failed total knee replacement. Instead of the conventional methods of immobilization including plaster cast or internal fixation we think that the use of the external fixation is highly satisfactory, providing an excellent method of immobilization and allowing an early weight-bearing gait. In our series of more than 200 applications the Hoffmann external fixation has proved to be indicated most in arthrodesis of the knee, but has also been used in arthrodesis of the hip and in arthrodesis of the lower and upper extremities.

Guidelines for treatment of open fractures and infected pseudarthroses by external fixation.

There are three phases in the treatment of open fractures and infected pseudarthroses by the Hoffmann external fixator. During the initial phase a careful surgical debridement is performed in the bony tissues, and the external fixator is applied in a manner appropriate to the type and level of the lesion site (double- or triple-frame mounting; additional anchorages; neutralization, compression, or distraction; ligamentotaxis). During the intermediate phase both the nursing of the patient and care of the apparatus are critical for the avoidance of complications; it is during this period that granulation tissue must develop and bone infections must be controlled. In the final phase the loss of osseous substance must be treated by various means (regular tightening of the external fixator; Papineau's technique; intertibiofibular graft; free microvascular bone transplantation technique.

[Conservative treatment of deformities of the anterior chest wall]. / Traitement orthopédique des déformations thoraciques vers l'avant Résultats.

The authors have treated 55 deformities of the anterior chest wall in children. There were 37 cases of symmetrical pectus carinatum, 15 cases of asymmetrical pectus carinatum and 3 cases of pectus arcuatum. Associated lesions of the ribs, scapulae and spine are described. Treatment in every case was by plaster casts followed by a plaster jacket and exercises. The results were much more satisfactory in deformities associated with prominence than with depression of the sternum. In pectus carinatum, the results were better when the apex of the deformity was more distal. The best age for treatment was between 12 and 13 years. No patient was treated by operation.

[Treatment of open leg fractures by double frame external fixation]. / Traitement des fractures ouvertes de jambe par le fixateur externe en double cadre

The authors review 36 cases of compound fractures of the tibia of type II and III (Cauchoix Classification). The treatment used was: 1. Careful cleansing of the sound. 2. The use of an external fixation (Hoffmann) as a double frame. 3. Continous irrigation. The authors stress that initial reduction should be accurate and that stability can be obtained by compression. Additional treatment was often needed, dependent on the stage of skin healing and the state of bone union. For the skin, Davis grafts or cross-leg flaps were used. For bone union, tibio-fibular grafts or reinforcing cancellous bone grafts (Papineau's technique) were used.

[Orthopedic reduction of scoliosis by Maguelone's technic. Indications and first results]. / Réduction orthopédique des scolioses par la technique de "Maguelone". Indications et premiers résultats

The authors describe an original technique for rapid closed reduction of scoliosis (Maguelone technique). It is based on mild distraction in suspension associated with derotation without pressure points. It is painless and efficient. In 50 cases it was followed by a conservative treatment using plaster casts. In 15 other cases it was the first stage of a surgical treatment of the deformity.