[Ender's so-called alignment nailing in the treatment of trochanteric fractures in the young adult, and under certain circumstances: is it reasonable? Study of a series of 50 cases]. / L'enclouage de Ender dit d'alignement, dans le traitement des fractures trochantériennes de l'adulte jeune, et dans certaines circonstances, est-il licite? Etude d'une série de 50 cas.

The technique and results of an original method of "alignment Ender's nailing", combining standard Ender's nailing with post-operative traction is described. This method is directed towards young patients in two well-defined situations: the complexity of the trochanteric fracture and the debilitation of the patient. A consecutive series of 50 cases have been analysed. There were no infections and no technical failures. A detailed study of hip and knee function and of the anatomical reconstruction in both antero-posterior and lateral planes with a mean follow-up of 20 months has shown 82.6 per cent of good and very good results.

[Osteosynthesis and radiotherapy of the proximal femur: report of 6 cases]. / Ostéosynthèse et radiothérapie du fémur proximal.

PURPOSE OF THE STUDY: Post-radiation shaft fractures of long bones are uncommon. Late or partial healing increases the risk of stress fracture. Different fixation techniques have been proposed. Treatment of radiated bone is difficult. We report a series of 6 nonunions of the proximal femur after radiotherapy. MATERIAL AND METHODS: Three patients had true fractures of irradiated bones several years after radiotherapy for bone or soft tissue tumors. Three other patients had pathological fractures or malignant osteolysis related to a myeloma and treated by osteosynthesis and post-operative radiotherapy. RESULTS: Treatment required a total of 19 surgical procedures. There were nine stress fractures of ostheosynthesis material involving locked nails, cervicodiaphyseal nails and plates. There were no vascularized grafts in this series. At last follow-up the pathological fracture had healed in three cases, was stable but not healed in two, and required prosthetic reconstruction in one. CONCLUSION: We emphasize the importance of rigorous patient selection for radiotherapy and the possible preventive effect of osteosynthesis in certain cases with a high risk of secondary fracture of an irradiated bone. Vascularized grafts may be useful for refractory nonunion and may be proposed as first line treatment for post-radiation fractures.

[Screwed-plate osteosynthesis and reconstruction of fractures of the calcaneus]. / Reconstruction-ostéosynthèse par plaque vissée des fractures thalamiques du calcanéum.

The authors have treated 182 fractures of the calcaneus. Ninety-nine of these were operated on and plated. The results were studied in 75 cases with a follow up of 1 to 6 years. The technique used a lateral approach; a plate was always used, sometimes with a heterogeneous bone graft (Kiel bone). The operation was followed by 3 weeks of plaster cast fixation followed by mobilisation of the foot. A good functional result was obtained in 82 p. 100 of cases, but a satisfactory anatomical reduction in only 73 p. 100. Some mobility of the subtalar joint was conserved in 73 p. 100 of cases. The indications are described. This type of operation should be performed in displaced fractures with 2, 3 or 4 fragments. In more comminuted fractures the authors consider that primary arthrodesis is advisable. Conservative treatment is indicated in slightly displaced fractures or when local conditions make operation inadvisable.

[Nailing for alignment combined with the Sarmiento method. An interesting combination in the treatment of unstable diaphyseal fractures of the tibia]. / L'enclouage d'alignement associé à la méthode de Sarmiento. Une association intéressante dans le traitement des fractures diaphysaires instables du tibia.

The authors have reviewed 51 cases of unstable fracture of the tibia treated by nailing followed 3 weeks later by bracing using the Sarmiento technique. The results confirmed the basis of Kuntscher nailing with reaming. This combination of two techniques can rival more sophisticated techniques such as locked nailing. Several complications were noted - one sepsis, one non-union, two malunions and one shortening of 2 cms.

[Uncommon surgical treatment of a tibial fibrous bone dysplasia]. / Traitement chirurgical original d'une localisation tibiale d'une dysplasie fibreuse des os.

The authors present an original method of treatment in prevention of fracture of the tibial shaft applied in one case of polyostosic fibrous dysplasia of bone. They treated this localization by closed intramedullary reaming and stuffage with cancellous bone grafts.

[The value of perforating cryopreserved massive bone allograft. Histologic data of an allograft removed after 27 months]. / De l'intérêt de perforer les allogreffes osseuses massives cryoconservées? Données histologiques à propos d'une allogreffe déposée à 27 mois.

The authors reported one documented observation of a deep-frozen, non irradiated, intercalary allograft; it was perforated by drilling and then fixed by a blade plate. This allograft was removed 27 months after its implantation. Histological examination of the removed bone graft showed newly formed mature bone which developed near preexisting devitalized bone. The external cortex was also revitalized and reossified close to the periosteum, as it was previously reported. But osteogenesis filled all the paths of the perforations and extended to the haversian canals located in the vicinity of the perforations. The authors conclude that cortical perforations induce both cortical and medullary osteogenesis of the graft. If osteogenesis is observed in the whole medullary canal, it is more focal and located in the vicinity of the holes in the cortex.

[Resection-reconstruction of the femur shaft by a massive allograft fixed by an interlocking nail]. / Résection-reconstruction diaphysaire fémorale par allogreffe massive fixée par clou médullaire verrouillé.

Case report of a central midshaft osteosarcoma of the femur, treated conservatively under Rosen procedure. Bone resection was followed by reconstruction with a deep frozen (-196 degrees) conserved massive homograft, fixed by an interlocked Kuntscher's nail. The purpose of this paper is to expose the advantages of this type of fixation, V.S. conventional nails, or plates. X-Ray showed a bridging bone spindle between host and graft cortical bone, induced by initial stability of the nail, and a rapid fusion after secondary dynamisation of the nail, by removing one screw. We obtained an early functional recovery and a complete and rapid autonomy necessary to allow social and school reinsertion, whatever should the medium or long term presumed survival be.

[10-year follow-up of a homogeneous series of 467 total hip prostheses of the Charnley-Müller type. Study of 167 cases]. / Devenir à plus de 10 ans d'une série homogène de 467 prothèses totales de hanche de type Charnley-Müller. Etude de 167 cas revus.

Four hundred and sixty-seven hips were operated upon by the authors between 1969 and 1974 using the Charnley-Müller prosthesis. 167 were reviewed with more than a ten-year follow-up. Eighty-one per cent were satisfactory after the initial procedure. In 56 cases an aseptic loosening had to be revised. At the femoral level, a varus position of the stem and the presence of cement between the calcar and the prosthesis appeared to be the responsible factors. At the acetabular level the causes of the loosening were an excess of cement, more than 10p. 100 uncovering of the cup by the acetabulum and, particularly, asymmetrical wear of the cup of more than one mm. A pathological study of 20 cases showed that particles of cement cause granulomata to develop all round the prosthesis. Polyethylene wear increases the frictional torque and produces micro-fractures of the cement at the bone-cement interface. It is concluded that the femoral stem should be as thick as possible and that the collar of the prosthesis is useless. Frictional torque should be as low as possible. The use of a metal mesh appears to be beneficial for the cementing of the acetabular cup.

[Traumatic bilateral rotatory C1-C2 dislocation in an adult: case report and review of the literature]. / Luxation rotatoire bilatérale traumatique C1-C2 de l'adulte: une observation et revue de la littérature.

Trauma led to bilateral rotatory atlantoaxial dislocation in a 23-year-old woman. Clinical diagnosis of this uncommon dislocation of the cervical spin is generally difficult and often made late. Typical signs include pain in the upper cervical spine and a fixed rotated position of the head. Integrity of the transverse ligament of the atlas is a determining factor for atlantoaxial stability and allows orthopedic treatment after reduction using moderate traction on the head. As for most authors, orthopedic was successful in our patient who totally recovered cervical spine mobility without pain.

[High grade osteosarcoma of the lower limb. Complications and results of the treatment of 20 patients]. / Ostéosarcome de haut grade de malignité du membre inférieur. Complications et résultats du traitement de 20 patients.

UNLABELLED: Over 11 years we treated 30 osteosarcomas: 20 of them were high grade non metastatic osteosarcomas of the lower limb, which were treated by neoadjuvant chemotherapy (Rosen T10, or OS 87 protocol of the French Society for Pediatric Oncology). MATERIAL AND METHODS: There were 12 males and 8 females; the mean age was 19 years (range 12-51). The site of the tumor was the femoral neck (1 case), femoral diaphysis (2 cases), distal femur (12 cases), proximal tibia (4 cases), distal tibia (1 case), 3 were IIA and 17 IIB according to Enneking system. Conservative treatment was performed in 17 cases: there were 12 knee prostheses, 4 allografts and 1 knee arthrodesis with allograft. RESULTS: a) Surgical complications: Mechanical complications occurred in 10 patients. The function was preserved 8 times. In 2 patients the knee became stiff. An infection occurred in 3 patients: a conservative treatment was possible in 2 of them with a fair result. In the third case, an above-the-knee amputation had to be done. b) Functional results were studied according to Enneking rating. 14 arthroplasties (12 done as first surgical treatment and 2 after mechanical complication) had a 68, 19 score. c) Oncologic results: 8 patients were good respondents and 12 patients were bad respondents to chemotherapy according to Huvos grading. One local relapse was observed which could be treated by mean of a second chemotherapy and a prosthetic reconstruction. The patient is still alive and disease-free at 7 years (9 years after the diagnosis of the osteosarcoma). 5 patients had distant metastasis (lung, bones, and brain). One out of 5 was good respondent and 4 out of 5 are presently dead. Using Kaplan Meier statistical analysis, the overall survival wzs 76.8 per cent and the event-free survival was 67.4 per cent at 80 months. CONCLUSION: We preferred a simple prosthetic reconstruction without osseous sleeve or an intercalary allograft if possible: these procedures allow the patient very rapid autonomy to have despite a prolonged chemotherapy.

[A reliable orthopedic technic in the treatment of humeral diaphyseal fractures in the adult: the hanging plaster. Report of a series of 74 cases (author's transl)]. / Une technique orthopédique fiable dans le traitement des fractures diaphysaires humérales de l'adulte: le plâtre pendant. Analyse d'une série de 74 cas.

The authors treated 74 humeral shaft fractures with "hanging cast" technique. They study the benefits and difficulties of the method, compared to other orthopaedic and surgical possibilities. Stiffness of the shoulder represent the most important part of 12% bad results. There are only 3% pseudarthrosis. It is a simple and safe treatment, with appliance to most humeral shaft fractures in cooperant patients.

Anatomical basis for distal sartorius muscle flap for reconstructive surgery below the knee. Anatomical study and case report.

We report a case of a woman presenting with a long-term non-healing wound below the tibial tubercle that underwent a successful sartorius muscle flap. We performed an anatomical study of the vascularisation of the sartorius muscle. The vascular supply to the distal part of the sartorius muscle was studied in 15 limbs by dissection and after red ink and latex injections. The artery of the sartorius muscle flap arises most of the time from the saphenous artery or the descending genicular artery and is supplied through anastomoses by branches of the posterior tibial artery and the medial inferior genicular artery. The flap is useful for covering wounds around the knee, as well as the proximal and the middle thirds of the leg. The surgical technique is relatively simple, with a low morbidity from muscle harvesting.

[Twenty-year record of osteosynthesis of bone metastases. Analyses of 300 cases]. / Bilan de 20 ans d'ostéosynthèse des métastases osseuses. Analyse de 300 cas.

The authors have analysed the results of 300 operations for metastases in bone carried out in the last 20 years. The best results were obtained where prosthetic replacement was possible, and where deposits in long bones were treated by closed intramedullary fixation. This type of surgery gives satisfactory, comfortable function and should be part of a multidisciplinary approach in the management of patients with cancer.

[Value of multiple cortical perforations for the rehabilitation of massive deep-frozen bone allografts. Experimental study in sheep]. / Intérêt des multiperforations corticales dans la réhabitation des allogreffes osseuses massives cryoconservées. Etude expérimentale chez le mouton.

Incorporation of massive cortical bone allografts in human is slow and remains incomplete. Late biopsies of implanted allografts or histological studies of explanted allografts always show the partial substitution of necrotic bone by new bone from the host. The aim of the present study was to evaluate the effect of drilling the massive deep-frozen cortical allografts in order to induce osteogenesis. Thirteen sheep were operated on and a standard segment of the proximal ulna was removed and the gap filled either by an unperforated allograft or by a perforated one. Based on histological and microradiographic examination, a quite complete substitution of the perforated allografts was observed but in this model no statistically significant difference was observed between perforated and unperforated allografts. Further study is needed to assess the effect of the perforations.

[Open fractures of the leg - Series from the University Hospital Hautepierre]. / Fractures ouvertes de jambe - La série du C.H.U. Hautepierre.

Nineteen cases were studied retrospectively between 1982 and 1993. All had been stabilised immediately by external fixators. Free or pedicle flap and early bone graft was carried out as required.Bone stability was obtained by Hoffmann or Orthofix fixators which allowed later manoeuvres for skin covers. The stabilisation by the fibula was attempted by intertibio-fibula grafting (ITF). Skin cover was obtained in 13 cases by pedicle flaps, in 4 by a free flap and 2 cases healed by secondary intention. The local flaps were 5 medial gastrocnemius or soleus flaps, 4 fasciocutaneous flaps, 3 medial gastrocnemius muscular cutaneous flaps and one cross-leg flap. These flaps were done on average at the 17th day (between 4th and 45th day). Four free flaps were done: 2 pure cutaneous flaps and 2 osteo-cutaneous flaps. A second flap was required in 3 cases because of infection or loss of soft tissue. A medial gastrocnemius flap and 2 free fibula flaps were done at the 105th and 210th day.Bony union was obtained primarily in 6 cases. Thirteen bone grafts were necessary of which 7 were done electively before three months (4 decortication grafts, 3 ITF). Additional bone graft was needed in 4 cases. Six non-unions were seen, 2 sterile which were treated by one decortication/graft and one ITF and 4 infected (21%) which were treated successfully by 2 ITF grafts and 2 free fibula flaps. Overall consolidation occurred by 9.9. months with good alignment in 15 cases. The complications were 2 varus and one 15° external rotation malunions and one shortening of 2 cm. Ankle movements were normal in 5 cases, reduced by 25% in 5 cases and by half in one case. There was one fixed equinus of 15° and one arhtrodesis. Five patients were able to run. The average number of general anaesthetics required was 5.7 and the average length of hospitalisation 120 days.In conclusion, the authors emphasise the beneficial role of early skin cover in the outcome of these fractures which is otherwise characterised by secondary contamination. They were extremely satisfied with the results of composite free grafts in cases of loss of substance of bone and soft tissue. At present, they tend towards locked nailing for these fractures preferably without reaming whenever possible. Skin cover can than be planned during the first 5 days after injury.

[Infection following closed intramedullary nailing by Kuntscher's method in 1059 fractures]. / Le risque septique de l'ostéosynthèse à foyer fermé d' après une série continue de 1059 enclouages selon G. Kuntscher.

This paper investigates the incidence of infection following Kuntscher intramedullary nailing of 1059 open or closed fractures treated between January 1967 and December 1980. The fractures comprised 503 of the tibia 440 of the femur and 116 of the humerus. The literature over the past 10 years demonstrates that infection following plating or nailing with open reduction is more frequent than after closed intramedullary nailing. This paper confirms that nailing with open reduction for tibial and femoral fractures increases the infection rate to 5.7% and 3.5% respectively. Closed intramedullary nailing by Kuntscher's method is considered to be sound treatment in a university service for the treatment of fractures of the shaft of the tibia, femur and humerus with an infection rate of less than 1% in closed fractures.

[Multiple perforation in cryogenically preserved bone allografts. Comparative histological and microradiographic study of perforated and non-perforated allograft in sheep]. / Les multiperforations des allogreffes osseuses cryoconservées. Etude histologique et microradiographique comparative d'allogreffes perforées et non perforées chez le mouton.

Incorporation of massive cortical bone allografts in the human is slow and remains incomplete. Late biopsies of implanted allografts or histological studies of explanted allografts always show the partial substitution of necrotic bone by new bone from the host. The aim of the present study was to evaluate the value of drilling the massive deep-frozen cortical allografts in order to induce osteogenesis. Thirteen sheep were operated on and a standard segment of the proximal ulna was removed and the gap filled either by an unperforated allograft or by a perforated one. Based on histological and microradiographic examination, a complete substitution of the perforated allografts was observed but in this model no statistically significant difference was observed between perforated and unperforated allografts. Further study is needed to assess the effect of the perforations.

Complications of Marchetti locked nailing for humeral shaft fractures.

In this retrospective study 50 humeral fractures (36 acute, 6 pathological fractures and 8 non-unions) were treated by retrograde locked bundled Marchetti nailing. No intraoperative complications occurred. Postoperative complications included 7 non-unions (4/36 acute fractures and 3/8 delayed union), and 2 intraarticular penetrations of the secondary nails. However, at the subsequent removal of the implant 5 supracondylar fractures occurred.