[A.L.J. external fixation. Indications and results in 59 cases]. / Le fixateur externe A.L.J. Indications et résultats à propos de 59 cas.

The authors report their results in 59 cases of external fixation with A.L.J. type devices inserted from November, 1984, to November, 1988, in 57 patients (2 cases of bilateral injuries). These included 49 cases of "recent" traumatology, 4 cases of "second-hand" traumatology, and 6 orthopaedic cases (tibiotarsal arthrodesis for degenerative lesions). Among the recent traumatic injuries, 38 were fractures, most often compound fractures (stages II and III), and 11 serious soft tissue lesions, for which the external fixation was used temporarily for stabilization until the wound was healed. The older traumatological lesions were 4 infected pseudarthroses. The results based on 52 cases (6 were lost to follow-up and 1 is a peculiar case) include 45 healed injuries (ie. 86.5%) and 7 failures. The soft-tissue lesions have all healed within 2 to 4 months. Among the bony lesions, some knit primarily without an additional graft (20 of 37 cases, ie 54 percent), the others after 1, 2 or 3 grafts (10 of 37 cases, ie. 27 percent). The union also occurred without any problem for all 6 tibiotarsal arthrodeses. The 7 failures occurred in cases where no additional bone graft had been performed. The discussion evidences the advantages and drawbacks of the A.L.J.

[Osteosynthesis of thalamic fractures of the calcaneus using triangulation-fixed 1/4-tube plates. Preliminary results of 32 osteosyntheses]. / L'ostéosynthèse des fractures thalamiques du calcanéum par plaques "1/4 de tube" montées en triangulation. Résultats préliminaires de 32 ostéosynthèses.

The authors present a new type of osteosynthesis fixture used in calcaneal thalamus fracture repair. This consists in triangulation fixation, the upper- and retromost part of the thalamus being the apex of the triangle. This is performed using 2 or 3 1/4-tube A.O. instrumentation plates, with adaptable positioning according to the type of fracture. This system presents two advantages compared to currently used fixation components: it is less bulky and is associated with a reduced risk of skin-related complications. Calcaneal reconstruction is much more stable because the plates are in alignment with talocalcaneal stress lines, on the one hand, and because they form a truss that counteracts secondary displacement of the reconstructed thalamus. 32 calcaneal syntheses were thus performed during the period between July 1983 and July 1988. These included 8 stage III DUPARC fracture cases (25%), 21 stage IV cases (65.6%), and 3 stage V cases (9.4%). Nine 2-plate fixtures were assembled in an circumflex-like manner and 23 operations involved setting up the fixation components in a "closed triangle". Cuboid anchorage was necessary in 11 cases. Uncomplicated cutaneous necrosis occurred only once in this series (i.e., 3.2%). The stability of this operative procedure was assessed by measurements of Boehler's angle in the immediate postoperative period and after consolidation. The fixation was perfectly stable in 94% of cases (angle loss less than or equal to 5 degrees). Secondary angle loss occurred in 6% of cases (i.e., 2 cases, 8 degrees and 12 degrees respectively), one of which was caused by untimely weight-bearing. Moreover, no case of plate disruption was reported in this series.

[Rehabilitation of the knee movement after ligamentoplasty using Mac Intosh's procedure augmented by Kennedy-Lad: a comparison between recent and old rupture of the anterior cruciate ligament]. / La récupération de la mobilité du genou après ligamentoplastie type Mac Intosh renforcé par Kennedy-Lad: étude comparative entre rupture récente et rupture ancienne du ligament croisé antérieur.

About 60 ligamentoplasties of the A.C.L. using the Mac Intosh procedure with augmentation by the Kennedy-Lad, the authors compare the rehabilitation of knee motion between fresh tears (30 cases) and old tears (30 cases) of the A.C.L. operated on by the same procedure. All the operations were performed by the same surgeon. The rehabilitation program was the same for everybody; no plaster cast, total weight-bearing after the 15th day, no more crutches-stick after the 21th day and beginning of flexion on the 12th day, 88 per cent of the knees were rehabilitated by the same physiotherapists. The plaster cast is usually incriminated to be the main reason of post-operative knee stiffness. But no plaster cast for fresh A.C.L. tear also give such a stiffness (16.5 per cent). The authors think that the initial injury increased by the surgical trauma, for a non conditioned patient are the main factors of post-operative stiffnesses. This study justifies the late reconstruction of "isolated" A.C.L. tears (between the 2nd and 3rd month), after "cooling down" of the lesions.

[Impingement syndrome of the shoulder. 50 cases treated by Neer's anterior acromioplasty]. / Le conflit sous acromio-coracoïdien. 50 cas traités par acromioplastie antérieure de Neer.

The authors present the preliminary results of 50 cases of impingement syndrome treated surgically using an operative technique which at least included an anterior Neer acromioplasty. Surgery was performed after a period of progression ranging from several months to several years. These included 2 Neer stage 1 (4%), 29 stage II (58%) and 19 stage III (38%). In all cases an anterior Neer acromioplasty was carried out. In 18 cases, an additional procedure was also performed (resection of the acromial extremity of the clavicle, suture of a rotator cuff rupture, resection reinsertion of the long head of biceps and an Apoil and Augereau deltoid flap procedure). Results could be assessed in 48 cases (2 cases lost to follow up). They demonstrated 31 very good (i.e. 64.5%), 12 good results (i.e. 25%) and 5 poor results (i.e. 10.5%).