Contrasting energy allocation strategies of two sympatric Merluccius species in an upwelling system.

This study investigated the somatic growth and energy allocation strategy of two sympatric hake species (Merluccius polli and Merluccius senegalensis), coexisting under the strong influence of the Mauritanian upwelling. The results revealed that ontogeny, bathymetry, geography and reproduction shaped the differences found between the condition dynamics of the two species. Aside from species-specific differences, individuals were observed in better condition in the northernmost area (more influenced by the permanent upwelling) and in the deepest waters, probably the most favourable habitat for Merluccius spp. Both species also displayed contrasting trade-offs in energy allocation probably due to the dissimilarity of their habitats, which favours the existence of divergent adaptive strategies in response to different ontogenic requirements. It was hypothesized that M. polli invests in mass and energy reserves while sacrificing growth, as larger sizes may not provide an ecological advantage in a deeper and more stable environment. Moreover, M. senegalensis capitalizes on a steady growth without major disruptions, enabling earlier spawning at the expense of a lower somatic mass, which is fitting to a less stable shallower environment. This study sheds new light on differences in the biological traits and life strategies of Merluccius spp., which permit their overlap in a complex upwelling system and may contribute to the long-lasting scientific-based management of these species.

[Early short-term treatment of neonatal hip instability with the Pavlik harness]. / Traitement précoce et court des instabilités néonatales de hanche par harnais de Pavlik.

PURPOSE OF THE STUDY: The purpose of this work was to study early short-term treatment of reducible dislocated or very unstable dislocated hips using the Pavlik harness. This approach is based on the theory of that dislocation favors dysplasia and that spontaneous correction occurs if the hip is reduced and stable. Very easily dislocated hips have been qualified as "major instability" if voluntary dislocation was easily achieved. In this case, it is very difficult to predict whether postnatal capsuloligamentary retraction will occur in the reduced or dislocated position. MATERIAL AND METHODS: We retained for study 34 patients with 44 pathological hips; 15 hips presented reducible dislocation and 29 major instability. Treatment began early at 3.4 days of life on average and lasted 27.9 days. RESULTS: Outcome was very good for 39 hips with stabilization and spontaneous correction of the acetabular dysplasia, good in four with late correction of the dysplasia, and a failure in one. There were no major complications, none of the patients presented post-reduction osteochondritis. DISCUSSION: Two different entities can be distinguished: dislocation producing dysplasia which is symptomatic neonatally and would imply pathogenic in utero events, and primary dysplasia which can be asymptomatic at birth and for which correction is not spontaneous. If the hip is symptomatic at birth, treatment should begin immediately and be continued to confirmation that the reduced hip is stable, i.e. about three to five weeks on average. Simple dysplasia of dislocatable hips should be excluded from this strategy because of their favorable spontaneous course. Likewise for irreducible dislocated hips because of the higher risk of complications. Under these conditions, this therapeutic strategy is effective for the reduction, stability, and correction of dysplasia achieved in 97.7% of cases without increasing the rate of complications.

Evaluation of Different Oral Formulations of Clindamycin Extended Release in Dogs.

The purpose of this study was to evaluate the pharmacokinetics of extended-release formulations (ERFs) of clindamycin with polymeric-based matrices. In a crossover study, 21 healthy adult dogs were randomly assigned (in groups of 7) to receive a single oral dose (20 mg/kg) of clindamycin without excipients (control) or an extended-release formulation containing clindamycin+Hydroxypropyl methylcellulose (HPMC)+poloxamer at a ratio of 1 : 0.04 : 0.5 (ERF1) or containing clindamycin+HPMC+acrylic acid polymer (AAP) at the same proportions (ERF2). Serum clindamycin concentrations were determined for pharmacokinetic analysis prior to and at several time intervals after each treatment. Following the oral administration in study dogs, each ERF resulted in therapeutic serum clindamycin concentrations for 60 h, whereas the control treatment resulted in therapeutic serum clindamycin concentrations for only 12 h. All pharmacokinetic parameters for ERF1 and ERF2 were significantly different from those of the control treatment. These results indicate that both ERFs composed of a polymeric matrix containing clindamycin, HPMC, and AAP or poloxamer demonstrated an adequate pharmacokinetic-pharmacodynamic relationship for a time-dependent drug and provided a longer release period than clindamycin alone following oral administration in dogs. Given that the minimum effective serum concentration of clindamycin is 0.3 µg/mL, a dose interval of 60 h could be achieved for each tested ERF. This minimum inhibitory concentration has the potential to be effective against several susceptible bacteria involved in infections in dogs. The treatment of dogs with either ERF may provide several benefits over treatment with clindamycin alone.

[Bed rest and skin traction for Perthes' disease: review of the literature]. / La traction au lit dans le traitement de la maladie de Legg-Perthes-Calvé: revue de la littérature.

Long-term bed rest with skin traction, which isolates children with Perthes' disease from their social and educative environment, could be considered as incompatible with the ethics of modern therapeutics. Adaptation for home care has been proposed, but remains burdensome. We searched the literature in order to ascertain the real advantages and disadvantages of bed rest with skin traction and to evaluate the statistical value of published results. Considering that poor outcome is the natural course of the disease in 10-20% of patients, and that the number of patients in this group is further divided according to age and treatment, the number of patients in each treatment arm is rarely sufficient to validate any given treatment. For hips with limited abduction, traction does not appear to be warranted. Conversely, traction could be useful if the aim is to modify the natural course of the disease in precise situations, for example for Herring group B and or B/C patients with bone age above 6 years with a stiff hip. In this case, skin traction should not last more than two weeks and, to be considered useful, should achieve 30 degrees abduction documented on the ap view.

[Immediate weight bearing after treatment of stable epiphysiolysis]. / La mise en charge postopératoire précoce après traitement par vissage des épiphysiolyses stables.

PURPOSE OF THE STUDY: The purpose of this study was to ascertain whether immediate weight bearing after surgery for chronic or stable epiphysiolysis treated with a single percutaneous screw increases the risk of greater displacement. MATERIAL AND METHODS: Epiphysiolysis procedures (n=30) performed in 25 patients were reviewed retrospectively. One percutaneous screw was inserted under fluoroscopic control in all cases. For ten patients (from 2002), weight bearing was allowed immediately after surgery. The Southwick grading system was applied to classify each epiphysiolysis into one of three stages according to the cervicoepiphyseal angle measured on the lateral radiograph. Clinical and radiographic controls were obtained in all children at 1, 3, 6, and 12 months. Outcome was assessed using the Heyman and Herndon criteria. RESULTS: The study population included 17 boys and 8 girls (mean age 12 years 18 months). The left side was involved in 12, the right in 8 and both in 5. Weight bearing was allowed immediately after surgery in 10 patients with a stable epiphysiolysis (4 stage I, 5 stage II, 2 stage III). Time to weight bearing was 3 months on average for the others. Mean follow-up was 4 years (range 1-8 years). Clinically, none of the ten patients presented pain or limping at last follow-up. Abduction was limiting in 9 and internal rotation in 19. There was no increase in the displacement for patients with immediate weight bearing. DISCUSSION: Most teams advise against weight bearing for 6 weeks to 3 months. We were unable to find any pathophysiological reason for this attitude. It would be more logical to wait until complete fusion of the subcapital growth cartilage before authorizing weight bearing. This raises the question of the effect of this practice on postoperative displacement For stable epiphysiolysis, there is no evidence that not allowing weight bearing had an effect on the evolution if the screw is correctly positioned and at least 4 or 5 spires are engaged within the epiphysis.

Detection of hepatitis B virus in the liver by in situ hybridization (ISH) in HBsAg seropositive and seronegative patients.

The presence of hepatitis B virus (HBV) DNA in the liver of 119 patients was studied to assess the diagnostic value of in situ hybridization (ISH) and its relationship with viral replication and histological liver damage. Liver biopsies of 119 patients (55 hepatitis B surface antigen -HBsAg- seropositive and 64 HBsAg seronegative) were studied retrospectively. Among the HBsAg seropositive patients, the ISH was positive in 26 cases (47%) and negative in 29 (53%) and the former group had higher levels of serum transaminases. The hepatocyte number with positivity for HBsAg and hepatitis B core antigen (HBcAg) in the liver were similar in both ISH-positive and -negative patients. The histological activity index (Knodell) was higher in ISH-positive patients (11 vs 7, p < 0.001). Six patients out of 12 were positive by PCR. In the HBsAg seronegative patients, the ISH was negative in 57 cases and positive in 7. These 7 were positive for anti-HBs (5 cases) and/or anti-HBc (6 cases); 4 were confirmed by PCR. Thus, our data suggest that the ISH technique is useful for detecting viral nucleic acid in the liver, but that the HBV-DNA cannot always be considered as a replication marker, because we also show that some HBsAg seronegative patients with chronic liver disease do have HBV-DNA in their liver cells.

Evaluation of the pre-S (pre-S(1)Ag/pre-S(2)Ab) system in hepatitis B virus infection.

The diagnostic and prognostic value of pre-S(1)Ag and pre-S(2)Ab was investigated in 69 HBsAg surface antigen positive patients--14 with acute hepatitis B, 30 with chronic liver disease (six chronic persistent hepatitis, 14 chronic active hepatitis, 10 with cirrhosis) and in 25 asymptomatic carriers. Pre-S(1)Ag was found in all patients with chronic hepatitis B virus (HBV) infection regardless of viral replication. In contrast, pre-S(2)Ab was not detected in any patients. Acute hepatitis was studied sequentially with periodic controls at 20 day intervals. Pre-S(1)Ag cleared before HBsAg in six of 14 (43%) patients who progressed favourably, and the two antigens cleared simultaneously in eight of 14 (57%) cases. Patients with early clearance of pre-S(1)Ag progressed favourably, thus indicating the prognostic value of this test, which, however, is still of limited practical application given the small temporal difference between the moment of clearance of the two antigens. The first markers to clear, however, were HBeAg and DNA-HBV, which showed significant differences with respect to the clearance of HBsAg. Moreover, pre-S(2)Ab appeared before HBsAb in 57.1% of our patients and was found in some patients before pre-S(1)Ag and HBsAg had cleared (42.8%), thus allowing complete viral clearance and acute HBV infection to be predicted earlier.

Intraepithelial and lamina propria leucocyte subsets in inflammatory bowel disease: an immunohistochemical study of colon and rectal biopsy specimens.

AIMS: To gain new insights into the pathogenesis and differential diagnosis of ulcerative colitis and colonic Crohn's disease. METHODS: Immunohistochemistry for different leucocyte subsets was performed in biopsy specimens of the sigmoid colon and rectum from 55 patients with inflammatory bowel disease and 11 healthy controls. RESULTS: Colonic biopsy specimens from patients with active ulcerative colitis had significantly higher numbers of CD45+ and CD3+ leucocytes compared with those from patients with inactive disease, and higher numbers of total leucocytes and macrophages than those from patients with Crohn's disease. Rectal biopsy specimens from patients with Crohn's disease had greater numbers of intraepithelial leucocytes (CD45, CD3 and CD8 cells) than specimens from patients with active or inactive ulcerative colitis, or from healthy controls. CONCLUSIONS: Because of the phenotypic differences in the inflammatory infiltrate in the mucosa from the sigmoid colon and the rectum, the segment of the intestine to be biopsied should be specified. Assessment of the leucocytic component of the intraepithelial infiltrate in rectal biopsy specimens was more useful than examination of colonic biopsy specimens in the differential diagnosis of ulcerative colitis and Crohn's disease.

[Prospective study of the incidence of post-transfusion hepatitis after the exclusion of donors positive for anti-HCV ELISA 2]. / Estudio prospectivo de la incidencia de hepatitis postransfusional después de la exclusión de los donantes anti-VHC ELISA 2 positivos.

BACKGROUND: The incidence of post transfusional hepatitis (PTH) after the exclusion of anti-HCV ELISA 2 positive donors is not well known. The aim of this study was to determine the incidence and type of PTH in 113 post transfused patients. METHODS: A post transfusional follow up was performed for at least one year with periodic controls of transaminase levels. When an increase in GPT level compatible with PTH was demonstrated investigation of all the virus related with the transfusion was carried out in both the donor and the transfused subject: HAV, HCV, HEV, HBV and CMV. RESULTS: Four cases (3.5%) were detected which fulfilled the PTH criteria with the following characteristics: short period of time between transfusion and the increase in GPT level, moderate GPT increase, moderate clinical expression and good evolution. In all the cases the viral study was negative and other non viral possibilities were eliminated. CONCLUSIONS: Transfusions are currently relatively safe and the increase in transaminases may not be related with transfusion.

Interferon-alpha in patients with chronic hepatitis C and normal transaminase levels.

OBJECTIVE: to assess the response to interferon-alpha therapy in patients with chronic hepatitis C and normal alanine transferase levels. METHODS: 16 patients with normal transaminases (group A) and 36 patients with elevated ALT levels (group B) were treated with interferon-alpha-2b at a dose of 3 MU for 6 months. The biochemical, virological (HCV RNA in serum, liver and peripheral blood mononuclear cells) and histological responses were analyzed. RESULTS: no significant differences were observed between the two groups in age, sex, parenteral or sporadic transmission, hepatic lesion, Knodell index or HCV genotype, except for the higher proportion of women in group A. We found no significant differences between the groups in rates of patients with normal ALT in the follow-up period (6 months post-interferon, group A 44%, group B 17%) or in post-therapy negativization of HCV RNA levels (group A 31%, group B 17%). In 7 patients (44%) in group A, ALT remained normal throughout the study, whereas in the rest of the patients we observed some elevation during or after interferon treatment. Post-therapy mean Knodell index was 6 +/- 3 in group A versus 9 +/- 4 in group B (p < 0.05). CONCLUSIONS: the response to interferon was similar in patients with normal or elevated transaminases.

[Malignant transformation of multiple chondroma. Apropos of a case]. / Transformation maligne des lésions d'enchondromatose multiple. A propos d'un cas.

Malignant transformation of multiple chondromas observed in Ollier's disease is a well known possibility. In the clinical case of a 52 year old woman reported here, the sarcomatous transformation of two endochondromatous foci occurred successively in less than one year. One was located in the calcaneus, the other within the proximal metaphysis of the ipsilateral fibula. This case is worth reporting for two reasons: the successive occurrence of these sarcomatous lesions led to a amputation below the knee, later completed by an extended radical resection of the fibula. This combination allowed to preserve the knee with a good functional result and without local recurrence, this clinical case may be compared with that reported by Goodman in 1984. Both cases show that sarcomatous transformations may occur almost simultaneously after a long quiscent period and suggest the existence of a factor that could trigger or favor a malignant transformation process.

[Scarf osteotomy of hallux valgus in children and adolescents]. / Traitement de l'hallux valgus de l'enfant et de l'adolescent par ostéotomie scarf.

PURPOSE OF THE STUDY: The aim of this study was to analyze the results of surgical treatment of hallux valgus using scarf osteotomy in children and adolescents. MATERIAL AND METHOD: Twelve children and adolescents (19 feet) operated on with scarf osteotomy were reviewed retrospectively with a mean follow-up of 15 months. Clinical and radiographic results were assessed. RESULTS: We obtained 10 good results (asymptomatic cases), 9 poor with residual symptoms such as pain or cosmetic problems. Two populations could be identified considering the metatarsus varus and distal metatarsal angle. Those with metatarsus varus >/= 10 degrees or normal distal metatarsal angle had good results. Those without metatarsus varus had poor results. There was no disturbance of growth. DISCUSSION: Scarf osteotomy can be used in children without risk of hindering growth. Nevertheless, good results can be achieved only in cases of true metatarsus varus and normal distal metatarsal angle. In other cases, a different osteotomy of the first metatarsal would be preferable.

[Recurrent aggressive chondroblastoma: two cases and a review of the literature]. / Récidive de chondroblastome agressif.

Chondroblastoma is a rare benign bone tumor. Treatment currently consists of curettage and bone graft. Prognosis depends basically on a relatively high rate of recurrence, between 5 and 38%, sometimes with local seeding of soft tissues and joint space. Such recurrences require wide resection with arthrodesis or even amputation. A 13-year-old girl with a humeral head chondroblastoma as treated by curettage and iliac bone graft. Six months later, a recurrence occurred with extension into the rotator cuff and the metaphysis. Remission was achieved by extensive surgical resection and hemiarthroplasty. The second case was a 14-year-old boy with a chondroblastoma of the right talus. He was treated by curettage and packing with bone substitute. After 2 recurrences with soft tissue and intra-articular extension, we performed a wide resection with reconstruction using a vascularized fibular graft. Many other cases in the literature illustrate such complications. We tried to find factors predictive of recurrence. Recurrence is observed when curettage was incomplete or when tumor cells were disseminated during surgery. Chondroblastoma is a benign bone tumor, but prognosis depends on the rapidity and severity of recurrence. Curettage should be as complete as possible and care should be taken to avoid contaminating the operative field.

[2 cases of adenocarcinoma of nasal cavities and paranasal sinuses]. / Dos casos de adenocarcinoma de fosas nasales y senos paranasales.

Malignant tumors of the paranasal sinuses are relatively rare. Generally squamous cell carcinoma appear to be dominant. Adenocarcinoma make up 12 to 15 percent of all nasal and paranasal sinus malignancies. Adenocarcinomas are most often seen in the middle turbinate and ethmoid sinus. We report 2 cases and discuss its clinical findings, the treatment and possible etiologies.

[Epidermolysis bullosa letalis]. / Epidermólisis bullosa letal.

A case of epidermolysis bullosa letalis in a newborn is described by the authors. The girl had numerous lesions for all the tegument except on the face, palms and soles. Something of them were bullous. The histopathological examination revealed a bulla with detachement dermoepidermic. Without infiltrate in dermis. The roof of the bullae is conservate. In the PAS stain we show the detachement over of the basal membrane.

Developmental dysplasia of the hip in neonates: evolution of acetabular dysplasia after hip stabilization by brief Pavlik harness treatment.

BACKGROUND: The recommended treatment duration in neonates with developmental dysplasia of the hip (DDH) varies depending on whether prolonged Pavlik harness therapy is believed to favourably affect the course of the acetabular dysplasia. According to one theory, several months of additional Pavlik harness therapy after achieving hip reduction contributes to correct the acetabular dysplasia. Another theory holds that hip dislocation induces the acetabular dysplasia, which corrects spontaneously once the femoral head is properly seated in the acetabulum. Here, we evaluated this second theory by studying outcomes after early brief Pavlik harness therapy. HYPOTHESIS: Acetabular dysplasia associated with neonatal hip instability undergoes self-correction provided stable hip reduction is achieved very early after birth. Therefore, the duration of Pavlik harness therapy can be substantially shortened. MATERIALS AND METHODS: We defined hip instability as either reducible hip dislocation or a very easily dislocatable hip with a soft clunk precluding determination of spontaneous hip position as dislocated or reduced. Static and dynamic ultrasound scans were obtained. Patients with ultrasonographic instability (pubo-femoral distance>5mm with less than 50% of coverage) underwent a second physical examination and received treatment. We re-evaluated 42 abnormal hips in 30 patients after a mean follow-up of 6.7 years (range, 5-14 years). Mean age at treatment initiation was 5 days (range, 1-15 days) and mean treatment duration was 34 days (range, 15-75 days). RESULTS: Mean acetabular angle was 20° (range, 12°-30°) and mean Wiberg's lateral centre-edge angle was 30° (range, 22°-35°). Blunting of the lateral angle of the bony roof was noted in 8 hips at last follow-up. In 1 patient whose hip was stable clinically but unstable by ultrasonography at 21 days of age, recurrent dislocation occurred at 5 months of age. The Severin class was 1a in all patients. DISCUSSION: Despite continuing controversy about whether hip dislocation induces dysplasia or vice versa, the need for early treatment is universally recognised. The optimal treatment duration, however, remains debated. Proponents of the familial determinism of DDH consider that acetabular shaping is genetically programmed when the femoral head is centred in the acetabular socket. Others advocate routine prolongation of Pavlik harness therapy for 2 months or longer, based on the opinion that this strategy decreases the dislocation recurrence rate and that mechanical hip unloading may promote correction of the dysplasia. Mean treatment duration in our population was 34 days and our sole objective was to treat the instability. The hip was reduced and held in its proper position long enough to allow sufficient capsule and ligament tightening to stabilise the hip. Under these conditions, the acetabular dysplasia underwent self-correction that was not related to treatment duration. CONCLUSION: Very early Pavlik harness therapy to ensure rapid hip reduction and stabilisation optimises the potential of the acetabulum for spontaneous remodelling. LEVEL OF EVIDENCE: Level IV, retrospective study.

Characterization of the inflammatory response in the uteri of cows infected naturally by Neospora caninum.

Bovine neosporosis manifests during gestation, when the fetus may be vulnerable to pathogens. Experimental studies of Neospora caninum-infected cattle have been performed, but little is known about the in-utero inflammatory response. The aim of this study was to characterize the inflammatory response in the uteri of pregnant and non-pregnant cows infected naturally with N. caninum. Four groups of seven animals were studied. Two groups consisted of N. caninum-seropositive pregnant and non-pregnant cows and the other two groups contained N. caninum-seronegative pregnant and non-pregnant cows. Uterine and placental samples were subjected to immunohistochemistry using antibodies specific for N. caninum, CD4, CD8, CD14 and CD21. The non-pregnant seropositive and seronegative groups did not show a difference (P >0.05) in the types of cells present. There were more lymphocytes in the uteri of the seropositive pregnant animals (P <0.05) than in the seronegative pregnant animals, but this was not considered to be consistent with an inflammatory process. N. caninum cysts were detected in eight seropositive cows; five were non-pregnant and three were pregnant. CD4(+) T cells were distributed in the endometrium and myometrium of the non-pregnant cows and were sparse in the placentomes of pregnant cows. CD8(+) T cells were distributed in a similar manner, but were present in smaller number. There were no cells expressing CD14 or CD21. The results of the study suggest that there is no consistent uterine inflammatory response against N. caninum in naturally infected animals.

Early correction of paediatric malunited distal metaphyseal radius fractures using percutaneous callus osteoclasis ("Calloclasis").

INTRODUCTION: Closed reduction of secondary displacements of distal metaphyseal radius fractures is an easy procedure only when performed within the first ten to fifteen days post-trauma, prior to the occurrence of malunion. When a hard bony callus prevents proper reduction, an open osteotomy is generally advocated. HYPOTHESIS: We suggest the use of a less invasive technique which aims at correcting early malunion when closed reduction is made impossible: the percutaneous callus osteoclasis. MATERIALS AND METHODS: Callus osteoclasis consists in a series of multiple bone-drilling in a postage stamp pattern performed under image intensifier using a large diameter pin, at a distance from the growth plate. Once the bone has been weakened, reduction is obtained by using the pin as an intrafocal lever. The pin is then pushed through the opposite cortex to ensure postero-lateral stabilization. RESULTS: Twenty-one patients were managed using this technique and reported good results with no complications. DISCUSSION: This technique offers a low aggressive management of malunions and may be performed within two to six weeks after trauma. LEVEL OF EVIDENCE: Level IV. Multicenter retrospective study.

Paralytic congenital talipes equinovarus of unknown origin: A new entity. Multicenter study of 42 cases.

BACKGROUND: Paralysis of the lateral and/or anterior leg muscles can lead to relapse of treated talipes equinovarus. HYPOTHESIS: The muscle function impairment is due to isolated permanent paralysis, and early palliative tendon transfer may prevent recurrence of the deformity. MATERIAL AND METHODS: Forty-two cases of congenital talipes equinovarus that recurred after conservative therapy were reviewed after a mean follow-up of 10 years. In 39 cases, second-line surgery was performed (posteromedial release, n=33; and muscle transfer, n=26). Outcomes were evaluated clinically. RESULTS: Separating the cases into two groups, based on whether muscle transfer was performed, showed a statistically significant difference: muscle transfer intended to restore eversion and/or dorsal flexion of the foot was associated with significantly better functional outcomes. DISCUSSION: In addition to providing etiological insights, the identification of paralysis in patients with talipes equinovarus can influence treatment decisions, depending on the nature of the muscle deficiencies, with the goal of preventing recurrences. Early muscle transfer to restore eversion and/or dorsal flexion of the foot may provide the best functional outcomes by minimizing the need for soft-tissue release. LEVEL OF EVIDENCE: IV, retrospective multicentre study.

Posteromedial elastic stable intra-medullary nailing (ESIN) in volarly displaced metaphyso-diaphyseal distal radius fractures in child.

INTRODUCTION: The distal metaphyso-diaphyseal fractures of the radius with volar angulation are generally considered unstable. Too distal to be treated with classic elastic stable intramedullary nailing (ESIN) via a laterodistal approach and too proximal to be stabilized with simple conservative treatment, they are sometimes treated by plating. PATIENTS AND METHODS: To avoid the disadvantages of the open exposure necessary for this latter fixation and to prevent volar angulation while respecting the curvature of the radius, radial elastic nailing with posteromedial distal entry was used in 16 patients. These patients were reviewed with an average follow-up of 4.5 months. RESULTS: Six patients presented a mean volar angulation of 7°, eight a mean posterior angulation of 5.5°, and two were aligned at 0°. On the AP view, seven patients presented a mean residual varus of 6.5°, four a mean residual valgus of 5°, and five were at 0°. The pronating curvature of the radius and the radioulnar index remained intact in all cases. One case of extensor digitorum tenosynovitis was observed and disappeared after wire removal. DISCUSSION: For the unstable fractures of the distal third of the radius, certain authors propose systematic classic ESIN, but the lateral point of entry inevitably entails a varus misalignment, which is no longer the case if the entry is medial.