[Lateral peritalar luxation: prognostic evaluation and therapeutic approach. Review of the literature based on a clinical case]. / La luxation péritalienne latérale: appréciation pronostique et attitude thérapeutique. Revue de la littérature à partir d'un cas clinique.

The incidence of the peritalar dislocations has been estimated to be approximately 1% of all dislocations. If they are missed, the consequences are serious and lead to an important surgery of the hindfoot. Lateral dislocation is most rare than medial dislocation. The diagnosis of this lesion often requires X-rays of the foot. The CT-scan allows to confirm the diagnosis and to appreciate the associated intra-articular fracture. The reduction must be realized in urgency under anaesthesia. If the orthopaedic reduction is impossible, the surgery allows to obtain an anatomical reduction with the removal of obstacles and the fixation of the associated intra-articular fractures. The prognosis of this lesion is better if there is an appropriate and rapid treatment.

[A case of a aggressive giant-cell tumor with multiple bone metastases]. / A propos d'un cas de tumeur à cellules géantes d'évolution rapide avec métastases osseuses multiples.

PURPOSE OF THE STUDY: Giant-cell tumor are known for local recurrence. Metastases are rare (2 p. 100), and generally located in the lung. We present a case with multiple bone metastases and rapid course. MATERIAL, METHODS AND RESULTS: A 45-year-old man presented a 5 cm giant-cell tumor of his right distal tibia and two other localisation in the fifth and sixth cervical vertebral bodies. He underwent a resection of the distal tibia and reconstruction with a controlateral free vascularized fibula. The bodies of the fifth and sixth cervical vertebral were resected and replaced by an iliac crest graft. Other localisations appeared in iliac right crest, in the posterior wall of the cotyle and in the second, third and fourth cervical vertebral bodies. Chemotherapy was administered and clinical signs regressed but eight months later the patient presented a recurrence of his tumor in the distal tibia with new localisation in the left fifth rib, in the right clavicle, in the frontal bone, in right ischio-pubal branch and in the right proximal femur. A new chemotherapy was performed but had little effect and probably hasved dubic death 13 month after the first symptom. DISCUSSION: The present observation is characterised by the large number of localisations (13; the highest number found in the literature was 11 localisations) and by the rapidity of the clinical course. Low grade giant-cell tumors generally give benign metastase with a course lasting several years. The chemotherapy helpt us to slow the progression of the lesions but was unable to prevent the development of new localisation and the recurrence in the distal tibia. More over, its toxicity could have caused the death of the patient. CONCLUSION: We present the case of one patient who presented a giant-cell tumor with unusual presentation: multiple bony metastases with rapidly fatal outcome.

[Leg fractures: choice of treatment according to type of fracture]. / Fractures de jambe: choix d'une méthode en fonction du type de fracture.

The authors report the experience of the Strasbourg Center of Orthopaedics and Traumatology (France). They analyse first a series of 104 tibial shaft fractures treated by dynamic casting according to Sarmiento's technique. Their conclusion show off therapeutic indications and contra-indications. Another series of 297 tibial fractures treated by intramedullary locked nailing is presented with an analysis of all the complications and the means of avoiding them. The authors specify also the use of intramedullary nailing in the management of open fractures of the leg. Finally, they point out the indications for the external fixator in Strasbourg.

[Statistical study of a series of 355 subtalar fractures of the calcaneus. Therapeutic conclusions]. / Etude statistique d'une série de 355 fractures thalamiques du calcaneum. Conclusions thérapeutiques.

A retrospective study has been made of 355 fractures of the os calcis involving the subtalar joint in order to determine the best method of treatment. A rating system was used to assess the different types of injury. The results were correlated with the pattern of depression of the posterior articular surface, the quality of restoration of this surface and the type of trauma. We conclude that Duparc Stage V fractures require reconstruction/arthrodesis (the Stulz proceedure). Duparc Stage I fractures, and Stage III or IV with grade I depression, should be treated conservatively with early mobilisation. Stage III or IV fractures with grade II or III depression require operation in order to restore and maintain a congruent posterior joint surface to allow early mobilisation.

[Graner's intercarpal arthrodesis]. / Interkarpale Arthrodese nach Graner.

Graner's intercarpal arthrodesis was performed in 10 patients with Kienböck's disease. The procedure consists in excision of the deformed lunate bone, cartilage resection in the adjacent intercarapal joints (Fig. 5), transverse osteotomy of the capitate bone, transposition of its proximal part to the place of the lunate, fixation with Kirschner wires and filling all the remaining bone spaces with cancellous bone. Postoperative immobilisation was necessary for about three months. Eight of these patients were reviewed 1 to 4 years postoperatively. 40% were free of pain, 50% have some pain and 10% moderate to severe pain. The range of motion in the wrist was restricted between one and two thirds, the strength of the grip on average was one third of the normal values. Severe arthrotic changes were considered as contraindications for this procedure, because their further development was no stopped by the intercarpal arthrodesis and will interfere with the positive aspects of this procedure.

[Nailing according to Ender. Biomechanical study and results of 120 cases]. / L'enclourage selon Ender. Etude biomécanique et résultats à propos de 120 cas

The authors have conducted a clinical and biomechanical study of blind nailing of trochanteric fractures by the Ender's technique. The nail is introduced through the medial femoral condyle. The study was based on 120 operations. From the biomechanical standpoint, the authors studied the forces exerted in the medullary canal of the femoral shaft and the grip of the nail in the head and neck of the femur. In most of the cases the technique allowed immediate walking with weight-bearing. The results are compared with those obtained after nail-plate fixation. They were superior on three counts--less infection, less breakage of inserted material and less non-union, but the technique produced more mal-union. For this reason, the authors consider it to be an excellent technique but to be reserved for older patients.