Acetabular reconstruction with a bipolar prosthesis. Five year results of the Dautry technique.

We report the results of acetabular reconstruction using a bipolar prosthesis bearing on cancellous bone graft in 37 patients after a minimum of five years. There was a satisfactory clinical outcome in 58% when assessed by pain, range of movement and stability, with greater improvement in the pain score than of the other parameters. Radiological migration of the prosthesis was a frequent finding although this did not always correlate with symptoms. Better results were obtained in cases of primary or secondary protrusio acetabuli than after the revision of previous total arthroplasties.

Recurrent posterior instability of the shoulder.

Seven cases of recurrent posterior instability of the shoulder were reviewed, three with recurrent subluxation and four with recurrent posterior dislocations. All were treated surgically, one by inverted Putti-Platt, one by glenoplasty and five by posterior bone block procedures. The follow-up goes from three to 17.5 years (mean 8.5 years). Clinical history and physical examination were the most accurate diagnostic methods. There were three excellent, one fair, and one poor results with two failures. The poor result and failure cases are due to technical errors, particularly because of wrong positioning of the graft in posterior bone block procedures. We suggest a bone graft with a projection of at least 15 mm beyond the glenoid rim to obtain a good result with this technique. Osteoarthritis does not seem to develop at long-term in our patients even with a poor result except for those with iatrogenic origin. The functional results are stable over time except for patients with osteoarthritis.

[Rupture of the extensor apparatus of the knee]. / Des ruptures de l'appareil extenseur du genou : A propos de 45 cas.

The authors describe 45 cases of rupture of the extensor apparatus of the knee (excluding fracture of the patella).Some new ideas are put forward concerning the frequent cause by road accidents and the contribution of certain predisposing features which cause degenerative changes of the tendon.Operation was performed in all cases. The extensor apparatus was reconstructed by suture, cerclage or reinsertion, together with the use of procedures described by Mac Laughlin and Scuderi.The results are presented in detail. 90% are very good or good but complications during operation or in the post operative phase were frequent and occurred in 27% of the cases.

[Shoulder radiographic evaluation. Radiographic examination of shoulder and scapular girdle trauma (author's transl)]. / Le complet radiologique de l'épaule. Approche radiologique des traumatismes de l'épaule et de la ceinture scapulaire.

The Shoulder Radiographic Evaluation ("Complet Radiologique de l'Epaule") is completed by four positions: Standard A-P, Axillary axial view, Profil of the scapula, A-P in arm abduction. This paper focuses on the radiographic examination of the components of scapular girdle and shoulder articular complex. Several positions are described as routine positions in trauma. This radiographic procedure is of helpful interest for clinical, therapeutic and forensic applications.

[X-ray computed tomography in the study of anterior instability of the shoulder. Study of a series of 23 cases]. / Apport de la scanographie dans l'étude de l'instabilité antérieure de l'épaule. Etude d'une série de 23 cas.

The place of standard CT scan imaging more particularly when combined with double contrast arthrography, is defined in the preoperative screening of patients with anterior instability of the shoulder. The joint scan provides complete data on the anatomic elements of the shoulder lesion, particularly with reference to the glenoidal labrum and the anterior capsular structure. It is also of major diagnostic value in painful subluxations.

[Fracture of the coracoid process (author's transl)]. / Fractures de l'apophyse coracoïde. A propos de 10 observations.

The authors have treated 10 cases of fracture of the coracoid process of the scapula. The case histories have been reviewed. The mechanism was an indirect one in most cases. Associated lesions such as fractures of the clavicle were frequent. The diagnosis may be difficult and special X-ray techniques were needed. In most of the cases, conservative treatment was indicated. Only one case associated with an acromio-clavicular dislocation was treated operatively.

[Paralysis of the serratus anterior muscle. Results of treatment of 12 cases including 9 surgically treated and a general review of the literature]. / La paralysie du grand dentelé. Résultat du traitement de 12 cas dont 9 opérés et revue générale de la littérature.

An analysis of the results of treatment in twelve cases of serratus anterior paralysis, nine of which were treated operatively, and a review of the literature has shown that, in lesions that fail with conservative treatment by physiotherapy, surgical treatment rapidly restores normal strength and function. Long follow-up, between 3 and 23 years, confirms the effectiveness and reliability of muscle transfers, particularly of pectoralis major.

[Os acromiale: significance--diagnosis--pathology. Apropos of 28 cases including 2 with fracture separation]. / L'os acromial: signification--diagnostic--pathologie. A propos de 28 observations dont 2 décollements-fractures.

In relation to two rare cases of fracture-separation of the os acromiale, 26 other cases of defective epiphysial fusion were studied. A review of the literature confirmed the rarity of this anomaly of the scapula which predisposes to subacromial impingement and rotator cuff rupture. The diagnosis is radiological. It requires both an antero-posterior and an axillary view which, together with a CT scan, precisely shows the os acromiale. It should be distinguished from a fracture of the acromion to avoid unnecessary immobilisation and post-traumatic effects. Degenerative changes provoke an impingement syndrome, the surgical treatment of which must include arthrodesis of this ossicle.

[Microsurgical transplantation of bone tumors of uncertain prognosis in athymic nude mice]. / Transplantation microchirurgicale chez la souris nude athymique des tumeurs osseuses de pronostic incertain.

Eight cases of human bone or soft tissue tumours were transplanted to nude mice. After such transplants to nude mice which are immunologically deficient, the malignant tumors developed like benign tumours, but maintaining malignant cytological characteristics. The transplants of normal human tissues or of benign tumours decreased in size or remained stable. The technique allowed a change of an original diagnosis of osteosarcoma to a final diagnosis of chondrosarcoma. It made it possible to diagnose a benign osteoblastoma, the diagnosis of which was doubtful before the transplant between osteosarcoma and chondroblastoma. It was possible to diagnose the malignancy of a haemangiopericytoma of muscle. Two aggressive tumours--a non-ossifying fibroma and a giant-cell tumour--were rated as benign after transplantation. This technique also allowed a more precise diagnosis of the grade of one chondrosarcoma and one osteosarcoma. Finally, transplantation also made it possible to test the efficacy of chemotherapy. In a patient so treated, the extreme cell proliferation after transplantation to the nude mouse led to a change in the drugs administered.

[Simultaneous bilateral avulsion of the quadriceps and Achilles tendons in 1 limb and of the patellar tendon in the other in a hyperparathyroid patient on chronic hemodialysis]. / Avulsion bilatérale simultanée des tendons quadricipital et rotulien et rupture du tendon tricipital chez un hémodialysé hyperparathyroïdien.

A case of simultaneous rupture of three tendons is reported in a patient who had suffered a bilateral nephrectomy six years earlier and was on chronic haemodialysis. The quadriceps tendon and the patellar tendon were repaired surgically. The rupture of the tendo Achillis was left untreated. Six days later a parathyroidectomy was performed; nine months later recovery was excellent. A review of the literature has been made. The role of hyperparathyroidism in the strength of the bone-tendon junction is discussed.

[Osteochondritis dissecans of the acetabulum. Apropos of a case]. / L'ostéochondrite disséquante du cotyle. A propos d'un cas.

Osteochondritis dissecans acetabuli is a rare affection. The observation presented is one of a 23 year old man, who presented hip blockages in external flexion rotation. X-ray only allowed to find a sequestrum in the acetabulum by tomography-Arthroscanner confirmed the osteochondritis without cartilage rupture. Arthroscopy eliminated a cartilage lesion and directed towards a cavity filled by spongious bone through an extra articular approach.

[The articular cartilage of the patella in scanning electron microscopy]. / Aspects du cartilage rotulien en microscopie électronique à balayage.

The authors have studied 50 samples of patellar cartilage, normal and pathological, obtained by biopsy, using a scanning electron-microscope. The normal cartilage shows characteristic regular wave-like undulations. The size of these waves varied between 5,000 and 7,000 nm and the undulations were linked by regularly-spaced fibrillary bridges. In a case with an osteochondral fracture, the fracture site was covered by peripheral cartilage, as had previously been shown by Ghadially. Eighteen cases of patellar chondropathy were divisible into three groups: group I (four cases) showed fibrillary chondropathy, of cerebriform appearance and without fibres. Group II (12 cases) showed a fibrillary chondropathy with loss of geometrical regularity and a staghorn appearance. Group III (two cases) showed an oedematous chondropathy with destruction of fibres. In group II, the presence of bundles of fibres with microfractures indicates a potential for progress to frank arthrosis.

[Thrombopenia induced by heparin in orthopedic surgery. Apropos of 12 cases]. / Les thrombopénies induites par l'héparine en chirurgie orthopédique. A propos de 12 cas.

Treatment with heparin for the prevention of thrombosis in orthopaedic surgery may sometimes be responsible for thrombopenia. This can be associated with arterial or venous thrombotic complications. Twelve cases of heparin-induced thrombopenia are reported here. Three cases were demonstrated by a diminution of the platelet count which reversed when heparin treatment was discontinued. Nine patients presented with arterial and/or venous thromboses whose progress was favourable in the long term. The replacement of heparin treatment by anti-vitamin K from the 5th or 6th day can avoid the thrombotic complications of heparin-induced thrombopenia.

[Wounds of the hand by injection of fluids under high pressure (author's transl)]. / Les blessures de la main par injection de fluides sous haute pression.

The result of mechanisation and technical improvements in industry, wounds by high pressure pistols are very serious. They are often neglected at first for they may be undiagnosed. To the toxicity of the injected product, which diffuses far from the minimal point of entry, may be added the destructive effect of the high pressure on the cell spaces of the hand, which are narrow and inextensible. Surgical treatment includes the association of antibiotics, anti-inflammatory drugs, analgesics and wide removal of the affected tissues as well as the foreign material. Active physiotherapy after immobilisation in a functional position, will permit recovery of satisfactory movements. Amputation is unfortunately often necessary, thus great efforts should be made to prevent work accidents.

[Arthroplastic resection of the shoulder. Results and indications apropos of 35 cases]. / La résection arthroplastique de l'épaule. Résultats et indications à propos de 35 cas.

The only aim of this retrospective study of 35 patients who had undergone resection of shoulder is to report overall results of this well established operation. Although no result could be rated as excellent, those in one half of the patients were evaluated as good and in one quarter as acceptable. The shoulder can be used in two-thirds of cases and of major importance is that pain is absent in two-thirds and tolerable in 80% of cases. In addition to cases of septic arthritis and poorly tolerated recurrent luxations, this operation is indicated for elderly patients with a fracture-luxation or compound fracture of upper end of humerus. However, the operation requires very strict conditions and re-attachment of the cap of rotator muscles. Resection of shoulder should therefore conserve a place in the therapeutic arsenal of shoulder disorders.

[Surgical treatment of metastases of the humerus]. / Traitement chirurgical des métastases de l'humérus.

Surgical treatment of metastasis disease of the humerus was applied for 46 lesions among 42 patients, i-e 22% of overall osteosyntheses for skeletal metastasis. Two patients only are still alive at 3 and 4 years. The mean survival time is 8.1 months and at 3 months 50% died. Metastasis disease of the humerus becomes evident late during the evolution of the primary cancer, but 26% are revealing lesions. For 9.5% the primary tumor remains unknown. After review of the surgical methods generally used, indirect osteosynthesis by intra-medullary pinning according to Hackethal, without bone cement, is alleged. So the arm is immediately mobilized and a complementary irradiation is applied in post-operative. Prophylactic fixation of impending fractures is encouraged in order to suppress pain, and for better function. This paper demonstrates the changing concept of internal fixation of pathologic fractures and recommends intra-medullary nailing or pinning.