[Osteosynthesis for proximal humeral fractures : plate or nail ? Results of a retrospective monocentric study]. / Ostéosynthèse des fractures de l'humérus proximal : plaque ou clou? Résultats d'une étude rétrospective monocentrique.

Locking intramedullary nails and locking plates are widely used. There is a lack of consensus about optimal surgical treatment. We compare these techniques. This retrospective study included 97 patients : 51 with nail, 46 with plate. Absolute and relative Constant-Murley scores and Simple Shoulder Test (SST) were used to assess postoperative function. Time of fracture union and complications were recorded. Two fragment fractures were preferentially treated by nails and 4 fragment fractures by plates. There is no difference for union except advantage for nails in 2 fragment fractures. The functional outcome is similar, relative Constant-Murley score is 72,7 ± 0,3 %, SST 6,7 ± 3,9 after nailing and relative Constant-Murley score is 65,4 ± 0,3 %, SST 6,0 ± 3,6 after plating. Number of complications is similar after plating (67,4 %) and nailing (62,7 %). We propose to promote nailing for 2 fragment fractures and treatment with plates for 4 fragment fractures. Three fragment fractures can be treated by both techniques.

L'ostéosynthèse par enclouage et par plaque sont répandus dans le traitement des fractures de l'humérus proximal. Il n'y a pas de consensus concernant le traitement chirurgical optimal. Nous avons comparé ces deux techniques. Cette étude rétrospective comprend 97 patients : 51 enclouages, 46 traitements par plaque. Les scores de Constant-Murley absolu et relatif et le Simple Shoulder Test (SST) ont été utilisés pour évaluer la fonction. Le temps de consolidation et les complications ont été évalués. Les fractures 2 fragments ont été préférentiellement enclouées et les 4 fragments traitées par plaque. Il n'y a pas de différence si ce n'est un temps de consolidation plus court après enclouage pour les fractures 2 fragments. Le résultat fonctionnel est similaire, le score de Constant-Murley relatif est de 72,7 ± 0,3 % et le SST de 6,7 ± 3,9 après enclouage. Le score de Constant-Murley relatif est de 65,4 ± 0,3 % et le SST 6,0 ± 3,6 après ostéosynthèse par plaque. Le nombre de complications est équivalent entre le traitement par plaque (67,4 %) et par clou (62,7 %). Nous proposons de favoriser l'ostéosynthèse par enclouage pour les fractures 2 fragments et par plaque pour les fractures 4 fragments. Les fractures 3 fragments peuvent être traitées selon le choix du chirurgien.

[A DESTRUCTIVE SHOULDER ARTHROPATHY]. / Une arthropathie destructrice de l'épaule.

Charcot arthropathy is a progressive, chronic and degenerative destruction of one or several joints caused by a central or peripheral neurological disorder. Approximately 25 % of the patients with syringomyelia develop this arthropathy located in the upper limb in 80 % of the cases. An early etiological diagnosis is essential to begin the treatment of the underlying neurological disorder. Afterwards, a conservative treatment of the arthropathy is preferred. We report the story of a patient with an arthropathy of the left shoulder due to Arnold-Chiari's malformation of type I with syringomyelia.

[Budd-Chiari syndrome: a case report and review of the literature]. / LE CAS CLINIQUE DU MOIS. Le syndrome de Budd-Chiari. Revue de la literature.

We report the history of a 20-year-old woman admitted for thrombosis of the sus-hepatic veins and of the inferior vena cava (IVC) with extension of the thrombus into the right atrium. The etiological research was negative and a diagnosis of idiopathic Budd-Chiari syndrome was retained. In view of the absence of vein repermeabilisation under adequate anticoagulant therapy, a venous thrombectomiy was performed under cardiopulmonary bypass, which improved the hepatic venous drainage. Budd-Chiari syndrome is a very serious disorder. Its treatment implies a step by step procedure. An effective anticoagulation must first be established. The complications of portal hypertension then require attention. For a symptomatic patient, one should assess the possibility of restoring the venous permeability, improving the hepatic drainage and decompressing the liver by radiological interventional or surgical procedures. Finally, an hepatic transplantation should be considered in case of treatment ineffectiveness, of fulminant hepatic failure, or of an evolution towards cirrhosis.