Disseminated tuberculosis with gradual evolution and unusual localization.

We present a case of disseminated tuberculosis (pulmonary, skeletal and lymph nodes) accompanied by subcutaneous abscesses and with unusual localization, osteolytic lesions of the skull caused by Mycobacterium tuberculosis var. hominis. Although the patient was immunocompetent, the disease had a gradual and unexpected progression. In the malign forms of tuberculosis, treatment must be extended for a year or more.

Elastic intramedullary osteosynthesis for the treatment of metaphysodiaphyseal non-union of the femur and tibia.

Elastic osteosynthesis is capable of producing the biomechanical conditions required to reconvert mature fibro-cartilaginous tissue interposed in the non-union in bone tissue. Theory is confirmed by a retrospective study of 54 patients affected with nonunion of the femur and tibia treated with elastic osteosynthesis.

[Elastic osteosynthesis in intracapsular fracture of the femoral neck]. / L'ostéosynthèse élastique dans les fractures transcervicales du col du fémur.

The authors present a method of treatment for transcervical fractures of the femoral neck using implants with mechanical characteristics--curved shape, smooth surfaces and elastic resistance to deformity--which respect the biomechanical properties of the normal bone. These implants maintain a close contact between the bony fragments during convalescence and preserve the blood supply of the bone. In this way, bone healing is encouraged and the development of ischaemic necrosis of the femoral head is prevented. Between 1983 and 1985, 126 fractures, of the femoral neck, 120 recent and 6 old, were treated by internal fixation with two short elastic nails. One hundred and seven patients were followed up; fracture healing occurred in 94 cases (87.8 per cent) and 13 developed non-union. There were no necroses of the femoral head.

[Osteosynthesis of femoral neck fractures with 3 curved elastic nails]. / L'ostéosynthèse des fractures du col du fémur par trois clous courbes élastiques.

The authors have treated 56 cases of fracture of the femoral neck using an original method. Three curved elastic nails were introduced into the head and neck through the greater trochanter. The results appear to be encouraging. The main advantage of the technique is minimal disturbance of the intra osseous vascular system of the head resulting in a low rate of avascular necrosis. The stability of the fixation has been studied from the biomechanical point of view. In many cases, the reduction obtained is improved immediately preceding the nailing.

[Technic for surgical reconstruction in comminuted fractures of the head of the radius]. / Tehnica de reconstituire chirurgicala in fracturile cominutive ale capului radial.

Osteosynthesis n comminuted fracture of the head of the radius is extremely difficult because of the small size of the bone fragments. The particularly rich innervation of the elbow explains the violent vasomotor reaction that accompanied injuries of the elbow, reaction responsible in the last instance of the onset of biological alterations the articulation. For this reason, the therapeutical solutions must have in view rapid restoring of the passive and active movements of the elbow. Reactions of the radius head is often followed by ossification around the radius stump, subluxation of the inferior articulation and valgus of the ulna. Osteosynthesis is only possible if there is a single detached bone fragment in posterioexternal position with respect to the radius head circumference. The authors describe an original technique, i.e. reducing the fractured bone fragments which are then fixed with a Kirschner rod, brought out percutaneously. A description is given of the operative procedure and postoperative care in the first eight patients operated. Very good results were obtained in 4 case, good results in 3 and poor results in one case.

Osteosynthesis of fractures of the femur with flexible metallic intramedullary nails.

The authors discuss their use of Ender's method in the treatment of fractures of the femur. The diameter and length of the nails depends on the type of fracture. 1) Three nails of 4 mm diameter are introduced in parallel from the medial condyle in fractures of the femoral neck; 2) 5 mm nails are used, in similar fashion, for the fixation of intertrochanteric and subtrochanteric fractures; 3) 5 mm nails are used for diaphyseal, supracondylar and intercondylar fractures, introduced in crossed fashion ("Eiffel Tower" technique) from both medial and lateral condyles. This method of fixation has proved to be extremely stable. The operation itself is quick, with no blood loss or shock. The patient can resume partial weight bearing after a week in stabilised intertrochanteric and shaft fractures, after a month in less stable types, and after three to four months in fractures of the neck of the femur. This report is based on the first 250 cases treated by this method.

[The flexible metallic intramedullary nail (Mechanical model and theoretical analysis)]. / Cuiul metalic suplu intermedular. (Model mecanic si analiza teoretica).

An ideal mechanical model is proposed for the system which includes the fractured femur and the flexible rod. Developing through calculus the consequences of hypotheses which define the model, the rigidity and the resistance of the system are evaluated. The theoretical considerations and the numerical results of the analysis indicate the superiority of the non-parallel assembly of the rods in the case of high diaphysary fractures.

[Flexible metallic intramedullary nail, an ideal osteosynthesis material for femoral fractions]. / Cuiul metalic suplu intramedular, material de osteosintezu ideal pentru fracturile femurului.

The authors have used modified Ender nails for the treatment of femural fractures. Nails of different sizes are used in different arrangements, depending on the site of the lesion. Thus, for fractures of the femural neck 3 metallic nails, with a diameter of 4 mm are used, introduced through the internal supra-condylian aspect in paralel arcs; two nails, 5 mm in diameter, are introduced in the same way for the correction of the fractures involving the trochanterian massif; for fractures sited under the trochanterian massif (diaphysis, supracondylian, and supra- and inter-condylian), 5 mm diameter nails are used, placed on the internal and external aspects of the condyl in metalic arcs. This type of intervention was demonstrated to be stable, rapid, non-haemorrhagic and with low risk of shock. Supported walking is started in the first week after surgery--in cases with fractures of the trochanterian massif and of the diaphysis--provided these are stable fractures, in the first month when unstable fractures occur at the same level, and after 3--4 months in cases of fractures of the cervical neck. The authors' experience in the treatment of 250 cases is presented.

[Our new methods in the treatment of pertrochanteric and basocervical fractures]. / Noile noastre orientari în tratamentul fracturilor pertrochanteriene si bazicervicale

The authors have employed the Ender intervention in the pertrochanteral and basi-cervical fractures, an osteo-synthesis technique which is less traumatizing and of shorter duration, providing only a very limited access of pathogenic germs and allowing for an early mobilization. In 25 patients that have been operated on the results have been very satisfactory.