Surgical Treatment of Angular Pott's Kyphosis with Posterior Approach, Pedicular Wedge Osteotomy and Canal Widening.

BACKGROUND: It has been observed that the correction of severe posttuberculous angular kyphosis is still a challenge, mainly because of the neurologic risk. METHODS: Nine patients were reviewed after surgery (mean follow-up 18 months). There were 2 thoracic, 4 thoraco-lumbar and 3 lumbar kyphosis. The mean age at surgery was 23. Clinical results were evaluated by the Oswestry Disability Index (ODI) and by the neurologic evaluation. Preoperative, postoperative and final follow-up X-rays were assessed. The surgery included a posterior approach with cord release and correction by transpedicular wedge osteotomy and widening of the spinal canal. RESULTS: Average kyphotic angulation was 72° before surgery, 10° after surgery and 12° at follow-up. Three out of four patients with neural deficit showed improvement. Neurologic complications included a transitory quadriceps paralysis, likely by foraminal compression of the root. CONCLUSION: A posterior transpedicular wedge osteotomy allows a substantial correction of the kyphosis, more by deflexion than by elongation, with limited neurologic risks. However it is mandatory to widely enlarge the spinal canal on the levels adjacent to the osteotomy, in order to allow the dura to expand backwards.

Modified Dunn osteotomy using an anterior approach used to treat 26 cases of SCFE.

INTRODUCTION: Osteotomy performed below the femoral neck plays a leading role in the treatment of slipped capital femoral epiphysis (SCFE). It results in anatomical reduction. Several modifications have been made to Dunn's original osteotomy technique. We have developed another modification to this technique that uses an anterior surgical approach on a traction table with fluoroscopy control. HYPOTHESES: Will this technique help to reduce the number of complications? Will its results be superior to those achieved with the standard Dunn osteotomy procedure? MATERIAL AND METHODS: This was a retrospective single-center study of 26 cases in 24 patients (2 bilateral cases). Patients were positioned supine on a traction table with fluoroscopy control. An anterior surgical approach was used. A trapezoid-shaped osteotomy was performed below the femoral head. The head's reduction was checked on the fluoroscope and the fixation confirmed. The Postel Merle d'Aubigné (PMA) score was used for the clinical assessment. The radiographic assessment was based on Southwick's angle. RESULTS: The mean slip angle of the femoral head was 57°. A mean correction of 47° was achieved. Based on the PMA score, good and excellent results were achieved in 20 cases (77%) and poor results occurred in 6 cases (23%). The surgical treatment had a significant effect on the PMA score (P=0.0008). In terms of complications, there were five cases of chondrolysis and one case of necrosis associated with chondrolysis. DISCUSSION: The anterior approach provides direct access to the femoral neck, and thereby a cautious osteotomy at the site of the slip itself. Use of a traction table makes the external manipulations, reduction and fixation procedures easier to carry out. The results of this study were comparable to published results. LEVEL OF PROOF: IV, retrospective treatment study.

Traitement par la méthode d'Ilizarov des pseudarthroses des os longs

Introduction: Plusieurs techniques permettent de traiter les pseudarthroses des os longs. L'objectif de ce travail était d'évaluer les résultats préliminaires du traitement de ces lésions avec la méthode d'Ilizarov. Matériels et méthodes: Dans cette étude prospective réalisée entre janvier 2007 et juin 2013, 11 patients avec un âge moyen de26ansontétéopérésselon laméthoded'Ilizarov. Ils'agissaitdeneuf pseudarthroses post-traumatiques et deux pseudarthroses congénitales. La pseudarthrose siégeait au tibia (n=9), à l'humérus (n=1), et au fémur (n=1). Les modalités thérapeutiques étaient une compression pure sans abord du foyer (n=8), une compression après abord du foyer pour ablation de matériel d'ostéosynthèse et débridement (n=2) et une compression-distraction bifocale ou technique de « l'ascenseur »( n=1). Les résultats ont été analysés avec un recul moyen de 2,5 ans selon les critères anatomiques et fonctionnels de l'ASAMI. Résultats: La consolidation osseuse était obtenue chez 10 patients qui ont tous repris leur activité. Les résultats anatomiques étaient excellents (n=5), bons (n=4), moyen (n=1), et mauvais (échec) (n=1). Les résultats fonctionnels étaient excellents (n=3),bons(n=5), moyens(n=2) et mauvais (n=1). Conclusion: Dans cette étude préliminaire portant sur 11 cas de pseudarthroses des os longs traitées par la méthode d'Ilizarov la consolidation osseuse a été obtenue chez 10 patients qui ont tous repris leur activité. Cette technique est contraignante pour le chirurgien et le malade, mais constitue une alternative fiable pour le traitement des pseudarthroses

Résultats de l'ostéotomie tibiale d'ouverture médiale fixée par plaque verrouillée type SURFIX® dans les gonarthroses sévères

Introduction: L'ostéotomie tibiale de valgisation par ouverture médiale est indiquée dans les gonarthrose fémorotibiales varisantes modérées. Ses indications pourraient être étendues aux arthroses avancées dans les pays en développement du fait de l'accessibilité limitée des prothèses. L'objectif de cette étude était d'évaluer les résultats de l'ostéotomie tibiale de valgisation par ouverture médiale dans les gonarthroses évoluées. Matériel et méthodes: Une étude rétrospective monocentrique de 3 ans a été réalisée. Quatorze patients totalisant 16 gonarthroses avec un âge moyen 48 ans ont été opérés selon cette technique. L'ostéotomie a été fixée par une plaque verrouillée type SURFIX® Treize genoux étaient classés au stade III et trois au stade IV de la classification de Ahlbäck. L'angle tibial interne préopératoire moyen était de 82°. l'IKS genou était en moyenne de 58,33 et l'IKS fonction de 52,08. Résultats: Les patients ont été évalués avec un recul moyen de 30 mois. La correction angulaire moyenne était de 7,81°. L'IKS genou était en moyenne 87,08 et l'IKS fonction 89,16. L'angle tibial interne était de 89°. La comparaison des variations de l'IKS avant et après l'opération était significative. Onze patients étaient satisfaits du résultat de l'intervention. Conclusion: Les résultats de l'ostéotomie tibiale de valgisation par ouverture médiale instrumentée par une plaque verrouillée sont satisfaisants. Ils nous encouragent à élargir les indications dans les gonarthroses avancées dans un contexte où l'indication d'arthroplastie du genou dans le traitement des gonarthroses sévères se heurte à des difficultés économiques des patients

[Morel-Lavallée lesion in orthopaedic surgery (Nineteen cases)]. / Épanchement de Morel-Lavallée en chirurgie orthopédique (À propos de 19 cas).

AIMS: The object of this work is the study of especially ancient clinical forms of the effusion of Morel-Lavallée, to discuss the place of deep fascial fenestration by Ronceray and to propose criteria of therapeutic indication. PATIENTS AND METHOD: Our study concerns a continuous retrospective series over 20 years from 1989 till 2009. Eleven men and eight women, 36.7 year-old on average were treated for an effusion of Morel-Lavallée. The dominant etiology was represented by the accidents of the public highway. The collection was discovered after 41.4 days on average (extremes of 1-180 days). The volume of the collection was on average of 1237cm(3) (extremes 60cm(3)-12L). RESULTS: The conservative treatment concerned all patients who had a recent collection lower than three weeks and three others who had an ancient collection. The surgical treatment was established after all 10 times among which four in first intention and six times after failure of the previous treatment. The cure was obtained in 91% of the patients who had a recent collection by the only conservative method and among four patients by the method of Ronceray. To the three others, it was obtained after iterative unbridlings and talcage treatment. CONCLUSION: The authors insist on certain rare forms met in Africa in particular the "virtual form", the ancient forms and the too plentiful forms (12L). They plead for use deep fascial fenestrations by Ronceray for these last ones.

Children distal humerus supracondylar fractures: the Blount Method experience.

INTRODUCTION: Extension-type supracondylar fractures of the humerus in children are frequent lesions whose orthopaedic treatment remains under debate in Rigault and Lagrange type III fractures and highly controversial in type IV fractures. The objective of this study was to extend the Blount method to fractures with substantial displacement even in patients presenting significant swelling and to evaluate the results. PATIENTS AND METHODS: We conducted a prospective continuous study from December 2005 to August 2007 on 67 children: 49 boys and 18 girls with a mean age of 6 years (range, 3-14 years). The mean time lapsed from consultation to treatment was 30 h. The mean hospital stay was 72 h. In 50 children, the limb was elevated preoperatively for a mean 48 h. The fracture was reduced under fluoroscopy-guided general anesthesia with mask and immobilized with 5-cm cloth banding padded with foam. The follow-up was clinical and radiological. The mean follow-up was 16 months (range, 6-26 months). Assessment followed the 1969 SOFCOT guidelines. RESULTS: At union, mean flexion was 124 degrees , the mean extension lag was 26 degrees . At last follow-up, the mean flexion was 146 degrees , the extension lag was 0.5 degrees , and pronation and supination were free. Immediately after surgery, the mean Baumann and anteflexion angles were 75 degrees and 43 degrees , respectively; at union they were 76 degrees and 44 degrees and at follow-up 79 degrees and 42 degrees . We found no vascular or nerve lesions. According to the SOFCOT criteria, at follow-up we obtained 80.6% very good results and 19.4% good results. LEVEL OF EVIDENCE: Level IV. Therapeutic study.

[Orthopaedic treatment of floating elbow in a child: a case report]. / Traitement orthopédique du coude flottant chez l'enfant: à propos d'un cas.

The floating elbow in the child is rare and serious. The authors report a traumatic case of floating elbow without vascular and nervous lesions associated in a 6-year-old child. We treated these both fractures of the distal forearm and the supracondylar humeral by respectively cast plaster and a collar and cuff with an anatomical reduction. The radiological and clinical results were excellent with the 29 months follow-up.

Fracture of the odontoid process in children: a case report.

The authors report a case of apophysial fracture of the odontoid process in association with paresis of the upper extremities in a 5-year-old child. The fracture was treated by gradual guided self-reduction without anaesthesia, followed by a Minerva jacket cast immobilisation. Reduction was anatomical, and the neurological problems regressed within 48 hours.

[Olecranon osteotomy in the treatment of distal humeral fractures in adults: anatomical and functional evaluation of the elbow in 14 cases]. / L'ostéotomie de l'olécrâne dans le traitement des fractures de la palette humérale de l'adulte : évaluation anatomique et fonctionnelle du coude à propos de 14 cas.

Osteotomy of the olecranon is commonly used to gain exposure for reconstruction of bi-condylar fractures of the distal humerus (type 13-C of classification AO), but there is controversy because of the considerable complications inherent in this technique. The aim of our study is to examine the anatomical and functional consequences of this technique of exposure on the elbow. This is a retrospective study over a continuous 7-year period. We confined ourselves to patients more than 15 years old who had presented with a bi-condylar fracture (type C of the AO) of the distal humerus, internally fixed through an osteotomy of the olecranon. We reexamined and evaluated 14 treated patients who had been operated in our service. There were nine men and five women with an average age of 34 years (range 17 to 70 years). According to the AO classification, we found 14 fractures distributed in the following way: three type C1, seven type C2 and four type C3; the fracture was open in two cases. The osteotomy was carried out in all the cases using an osteotome, extra-articular in six cases and intra-articular way in eight cases. Repair was always performed using tension band wiring. The evaluation was based on anatomical and functional criteria (Mayo Elbow Performance Score). No case of radial and ulnar paralysis was found. Thirty-six percent of the olecranon fixations were of bad quality and we found one case of olecranon pseudarthrosis. No case of heterotypic calcification was found, on the other hand, there was a case of post-traumatic osteoarthritis of the elbow. On the functional level, we obtained 36% of excellent results, 28.5% of good results, 7% of average results and 28.5% of bad results. Osteotomy of the olecranon is one of the techniques for exposure of the articular surface during reconstruction of fractures of the distal humerus. A rigorous technique allows one to avoid complications.

[Femoral neck fracture complicating orthopedic reposition of a dislocated hip: four cases]. / Fracture du col fémoral compliquant la réduction orthopédique d'une luxation de hanche: á propos de 4 observations.

Posterior dislocation of the femoral head with fracture is an exceptional hip injury. Emergency reduction is required. Reposition into the acetabular cavity of the dislocated femoral head may not be feasible. Irreducibility, instability, and more rarely accidental fracture of the femoral neck may also occur. We encountered this latter complication in four patients and report here its frequency and mechanism and propose preventive therapeutic measures. Seventy dislocations and fracture-dislocations of the hip were treated in our unit from March 1997 to February 2003. Among these cases, fourteen hip dislocations were complicated by femoral head fractures. Fracture of the femoral neck occurred during reduction in four. All four cases occurred in men, mean age 49.7 years, who were traffic accident victims (drivers or passengers). There were two Pipkin IV fracture-dislocations and two Pipkin II. The first reduction, achieved under general anesthesia in an emergency setting, was performed by an orthopedic surgeon in one patient and a general surgeon in three patients. Arthroplasty was used to treat the femoral neck fracture in three patients and pinning in one. We reviewed retrospectively the clinical and imaging data before and after reduction. Sub-capital fracture situated 4.0 cm (mean, range 3.5-4.5 cm) from the lesser trochanter occurred in all four cases. The head remained attached above and posteriorly to the acetabulum and was rotated less than 90 degrees . The fragment remaining in the acetabulum was displaced in two cases. In one patient, the fracture-dislocation of the head was associated with a fracture of the posterior rim of the acetabulum. This complication appears to result from an abrupt inappropriate reduction movement. The neck fracture would occur when capsulomuscular retention of the femoral head is associated with a head defect which catches on the rim of the acetabulum during the reduction movement. Neck fracture during reduction of traumatic hip dislocation is a serious complication. Prevention of this iatrogenic event requires a slow, progressive reduction limiting the trauma to a minimum; first intention open surgery may be required in selected cases.