[Mid-term behavior of the bone fixation in non-cemented Miller-Galante 1 total knee arthroplasty]. / Comportement à moyen terme de la fixation osseuse de prothèses totales de genou de Miller-Galante 1 implantées sans ciment.

PURPOSE OF THE STUDY: This retrospective work was conducted to analyze the quality of the bone-implant interface at mid-term in 45 cases treated with a non-cemented Miller-Galante 1 total knee arthroplasty. MATERIAL AND METHODS: All the protheses reviewed were implanted without cement. A patellar implant was cemented in 31.1 p. 100 of the cases. Female sex predominated in this series (77.5 p. 100) and the mean age at operation was 67 +/- 6 years. Pre- and postoperative assessment was based on the HSS score. Mean follow-up was 8.3 years (range 7-11 years). We used the method advocated by the International Knee Society to analyze lucent lines on tibial and femoral implants. Non-parametric tests were used for the statistical analysis with a significance level set at 5 p. 100. RESULTS: The mean HSS score rose from 55 +/- 12 preoperatively to 80 +/- 13 postoperatively, with 62.2 p. 100 good or excellent results at last follow-up. One re-operation was required for aseptic loosening. The femoral implant presented a lucent line in 24.4 p. 100 of the cases at the first follow-up examination only. The tibial implant presented an anterior lucent line at the second follow-up examination then a medial line at the last follow-up in 22.2 p. 100 and 26.6 p. 100 of the cases respectively. Presence of a lucent line (tibial or femoral) on at least one view was significantly correlated with activity (p=0.01) and tibial slope (p=0.0087). DISCUSSION: The disappearance of the lucent lines seen on the femoral component at the second follow-up examination was the expression of its secondary integration. Inversely, we observed an evolution in the lines observed on the tibia. This was probably the result of posterolateral impaction and anteromedial ascension micromovements of the tibial component. An excessive tibial slope was statistically related to development of lucent lines. It increased tibial translation on weight bearing and probably induced an abnormal alteration of the polyethylene. We did not observe any case of massive osteolysis of the tibial metaphysis as described in the literature for non-cemented knee arthroplasties. The screws of the Miller-Galante 1 prosthesis do not protrude from the tibial implant (which would risk generating polyethylene debris) and the pieces used (screws and implants) are all made of the same metal. CONCLUSION: The quality of primary fixation of the non-cemented Miller-Galante 1 tibial implant was not totally satisfactory at mid-term. Inversely, simple impaction of the femoral component was sufficient to ensure stable positioning.

[Brain abscess following the use of skull traction with Gardner-Wells tongs]. / Abcès cérébral secondaire à l'utilisation de traction crânienne par étrier de Gardner-Wells.

Brain abscess after insertion of skull traction is a rare and serious complication. Its development is secondary to superficial infection. Adequate preventive measures have to be taken: proper sterile dressing and daily care. Signs of local irritation are not always synonymous with skull migration. When gradual loosening of the skull occurs, especially associated with superficial infection, the pins must not be tightened. The more appropriate management is to investigate for penetration of the inner cranial cave. When in doubt, repositioning the pins may be necessary, as well as establishing an aggressive treatment against cutaneous infection.

[Fractures of the intercondylar eminence of the tibia in children. Apropos of 25 cases with a 1-20 year follow up]. / Fractures de l'éminence intercondylaire du tibia de l'enfant. A propos de 25 cas avec un recul de 1 à 20 ans.

PURPOSE OF THE STUDY: This study tries to clarify the diagnostic strategy in intercondylar eminence fractures of the tibia and aids the deduction of therapeutic options based on the analysis of the long-term morbidity of anterior laxity. MATERIAL AND METHODS: This retrospective, monocentric study of 25 children with a mean age of 11.8 years (7-15 years) was performed with an average follow-up of 7.2 years (1-20 years). Fractures are itemized with Meyers-McKeever modified by Zaricznyj and Zifko-Gaudernak classifications. Conservative treatment (16 patients) consisted of hemarthrosis aspiration, ligament examination, manipulation into extension and cast immobilization under general anesthesia. Surgical treatment (9 patients) consisted of wire suture fixation (4 times), wire suture fixation held by a screw (3 times) and direct screw fixation (2 times). Four patients were lost to follow-up. Patients were evaluated with the Lysholm (21 patients) and IKDC (15 patients) scores systems. Anterior laxity was checked with a KT-1000 arthrometer. Antero-posterior and lateral X-rays were performed. The statistical analysis was carried out with Mann-Whitney and Fischer tests. RESULTS: There are 18 good or very good results and only 3 medium with the Lysholm score and 5 knees graded A, 9 graded B and 1 graded C with the IKDC score. Mean anterior laxity is 1.86 mm (0 to 4 mm) after conservative treatment and 1.5 mm (-1 to 4 mm) after operative treatment. 5 patients have an anterior laxity and only 2 an anterior instability. No arthritic lesions, 1 nonunion, and 11 malunions have been observed, mainly after conservative treatment. DISCUSSION: Ligament examination under general anesthesia is useless for displaced fractures and dangerous for those were not displaced. Diagnostic arthroscopy is not yet allowed. Magnetic Resonance Imaging is useful to explore osteochondral fractures and symptomatic meniscal lesions. Laxity is the consequence of anterior cruciate ligament elongation. CONCLUSION: The diagnosis of these fractures rests on a simple radio-clinical examination to determinate the exact position, the displacement and the size of the osteochondral fragment in order to choose the best treatment. Conservative treatment will be chosen preferentially because of a poor long-term morbidity. Treatment will be surgical, preferably arthroscopic, in the others cases.