Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Jan 1996
Review[Secondary internal osteosynthesis after external fixation for recent or old open fracture of the lower limb].
The purpose of our study is to analyse the indications, results and limits of secondary internal fixation after external fixation for open fracture of the lower limb. ⋯ We chose 2 types of indication, and we called them programmed and for necessity. The first group of 10 patients whose stain was moderate and whose initial setting up had permitted a perfect anatomic reduction with a rapid wound healing. Internal fixation was performed after a short duration of external fixator. An early weight bearing was allowed so that the functional recovery could be obtained quickly. The second group is represented by patients whose internal fixation was done for non union, malunion or bone defect. In such a case autogenous cancellous graft was used to fill the defect.
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Rev Chir Orthop Reparatrice Appar Mot · Jan 1996
Multicenter Study[Gleno-humeral arthroscopic arthrolysis for shoulder stiffness. Apropos of 26 cases. Société Française d'Arthroscopie].
Shoulder stiffness is a problem which covers many different conditions. In fact there is still a semantic and pathogenetic confusion. The words: capsulite retractile, frozen shoulder, adhesive capsulitis, stiff shoulder contracture have been successively used and this ambiguity renders the literature difficult to interpret. Moreover the cause of the stiffness which depends on the aetiology, is not always clearly known: capsular contraction, capsular adhesion, capsular scarring following trauma or surgery, extra capsular phenomenons in the subacromial bursa, muscles or tendons. ⋯ Arthroscopic release of shoulder contracture is feasible, safe and effective. For primary frozen shoulder, there is usually spontaneous recovery. Indications for surgery are very few. There is no evidence that arthroscopic release shortens spontaneous evolution. Therefore, we propose it in very selected cases of dramatically limited motion. One year of evolution is an acceptable time. For bipolar stiffnesses, arthroscopy allows one to recognize the exact cause of the stiffness and to treat it, especially the subacromial pathology. In this occurrence, buroscopy must be performed and cuff pathology treated. For acquired surgical stiffnesses, gain of motion is significant. Subjective and objective results are less satisfactory than those of primary frozen shoulder, due to persistance of pain and lack of strength. The alternative is open release, but arthroscopic release has less morbidity. It can be proposed early as soon as capsular tissue has healed (for instance 6 months).
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Rev Chir Orthop Reparatrice Appar Mot · Jan 1996
[Ipsilateral fractures of the femoral and tibial diaphyses].
Simultaneous ipsilateral femoral and tibial fractures cause a floating knee. Treatment of such patients is complicated by fat-embolism syndrome (12 per cent), local soft tissue damage, ipsilateral knee ligament tear (5 to 39 per cent) and delayed shortening or torsional deformity. Our study aimed to determine the frequency of complaints about the knee and to study the causes of malunion. ⋯ Simultaneous ipsilaterla femoral and tibial fracture, or so called floating knee, occurs in patients who are involved in a high-velocity injury. Knee instability is however the major cause of poor results.
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Rev Chir Orthop Reparatrice Appar Mot · Jan 1996
[Treatment of pseudarthrosis of the clavicle by bone plate with screw fixation and autologous spongiosa graft].
The authors review and evaluate the operative treatment of mid-shaft clavicular non-union by compression plate osteosynthesis and most frequently by decortication and autogenous bone grafting. ⋯ Symptomatic non-union of the mid-shaft clavicular is a rare complication, mainly after non-operative treatment (11 cases in 12 years in our series). Factors responsible for non-union are the initial high velocity injury, the cominution, the overlapping and great displacement, the paucity of cancellous bone at this site and the trapezius interposition. Internal fixation by compression plating, decortication and bone grafting in atrophic non-union often encountered is a safe reliable method allowing uncomplicated healing and acceptable functional results.
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Rev Chir Orthop Reparatrice Appar Mot · Jan 1996
[Selective indications of skull radiography after head injury in children].
Skull X-rays are systematically performed on children after head injuries in most hospitals. However, the discovery of a skull fracture as an isolated finding rarely warrants intervention. In february 1994, we stopped performing systematical skull X-rays in children after head injuries. We report the results of this experience. ⋯ Routine skull X-rays after head trauma are not justified either for financial or radioprotection reasons. In this study, more than half of the children were less than five years old and ran a higher risk of irradiation.