[The Department of Orthopaedics and Traumatology of the University Clinics of Brussels, Erasme Hospital]. / Le Service d'Orthopédie-Traumatologie des Cliniques Universitaires de Bruxelles, hôpital Erasme.

On the occasion of the thirty years since its inauguration, the Department of Orthopaedics and Traumatology of the University Hospital Erasme reviews the milestones of its development. Various original new techniques have been implemented: monitoring of implants using strain gauges, external fixation of the limbs, external minifixation, miniinvasive anterior approach in hip arthroplasty, knee ligamentoplasties, orthopaedic microsurgery and composite tissue allotransplantation. The care of aged patients takes place in close collaboration with the Department of Geriatrics. Two new clinical units have been created, the Unit of Hand and Peripheral Nerve Surgery, and the Centre for Sports. The Department has organized an efficient Bone Bank. The new day care hospital improves the possibilities of ambulatory surgery. The article details as well the activities of teaching and research of the members of the Department.

[Historical review of the treatment of fractures. Contribution of the Belgian surgery to the origin and development of osteosynthesis]. / Aperçu historique du traitement des fractures. Apport de la chirurgie belge dans la naissance et le développement de l'ostéosynthèse.

The word osteosynthesis was proposed by A. Lambotte in 1904. His definition, given in 1908, is still valid today: "Osteo-synthesis is the artificial contention of the bone fragments of fractures, by special devices acting directly on bones, exposed or not, with the aim to strongly fix them in their original position". The authors review the methods of contention before the invention of osteosynthesis and later the developments of bone fixation techniques. They insist in particular on the durable innovations of various pioneers including A. Lambotte, R. Danis, R. Hoffmann and G. Küntscher. The School of Brussels has been implicated in the developments and conceptualisation of osteo-synthesis.

[The orthopedics-traumatology department]. / Le Service d'Orthopédie-Traumatologie.

The Department is involved in clinical and research activities. We pioneered the clinical application of "smart of Orthopaedic implants". The monitoring concept, bringing a high added value, helps in assessing fracture healing or implant fixation. The technique, featuring the 21st century, also requires advanced knowledge in biomaterials. Such implants have been used during the ESA Parabolic Flight Campaigns. These measurements are a prerequisite to establish prevention programs of the bone demineralisation during space flights but also in disuse osteoporosis. The Department is deeply involved in external fixation. In vitro studies of the mechanical insertion and holding parameters of external fixation pins have been performed to produce new implants, which efficiency has been proved by a clinical study. We defined original clinical principles of external fixation as its use in upper limb indications, to maintain microsurgery transplant, preserving devascularization and providing adequate fixation. Our biomechanical approach of the upper limb, now confirmed by others research groups, questioned old clinical concepts. The isokinetic evaluation assesses the dynamic function of articulations, i.e. after arthroplasty, and is also used for medico-legal evaluation. The clinical research touches orthopaedic (or systemic) diseases as algodystrophy, Kienböck disease, Kashing Beck. We conducted a multidisciplinary research on the effect of electromagnetic fields (EMF) on cells differentiation. In addition to possible healing properties, it helps as an objective support to analyse the exposure to the environmental EMF.

Treatment of mandibular fractures by external fixation.

This series encompasses thirteen fractures of the mandible treated by external fixation. The indications were five fractures of edentulous mandible, four fractures through missile wounding, and four fractures without soft tissue lesion treated in Africa. Twelve patients were found to show good or excellent results. In our indications, this method is a successful approach to the treatment of the fractured jaw.

External fixation of the clavicle for fracture or non-union in adults.

A technique of osteosynthesis of the clavicle with Hoffmann external fixation was used to treat twenty patients for selected indications, including an open fracture, inability of a patient to tolerate prolonged conservative treatment, or a painful non-union. No vascular or pleural complication was observed. The average time that the external fixator was retained was fifty-one days. All of the clavicles united well. Mobility of the shoulder returned to normal in all patients.

[Does one have to be aggressive in the surgical management of diverticular disease of the colon (author's transl)]. / Faut-il être agressif dans le traitement chirurgical de la diverticulite colique?

A series of 61 consecutive cases with diverticular disease and its complications is presented. Fourteen cases with uncomplicated diverticular disease and 3 with massive GI tract hemorrhage underwent an uneventful (segmental) resection. Of 6 cases operated for fistula formation 1 died. Surgical therapy for abscessformation, peritonitis and "pseudo-tumoral" obstruction (38 cases) carried a high mortality (26.3%). The application of a one-staged aggressive and curative surgical approach lowers the mortality considerably, especially in the complicated forms of the disease. In a group of 30 cases so treated only 1 death occurred (3.3%). This in contrast with a group of 31 patients treated with a two-staged and initially palliative procedure with a mortality of 10 (32.2%). The Hartmann procedure with total excision of the lesion and avoidance of an enteroenteric anastomosis gives excellent results in the treatment of the complicated forms of the disease.