Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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MacFarland fracture is a joint fracture of the ankle in children. The fracture line passes through the medial part of the lower epiphyseal disk of the tibia. Prognosis is dominated by later risk of malalignment and osteoarthritis. MacFarland fracture usually occurs subsequent to adduction trauma. The aim of this study was to analyze prognosis in a retrospective series of children with MacFarland fractures. ⋯ Careful radiologic and clinical surveillance is needed and should be continued to the end of growth (fusion of the tibial cartilage) in children with high risk fractures in order to detect epiphysiodesis early and avoid secondary malalignment. Surgical correction does remain possible and gives good results.
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Rev Chir Orthop Reparatrice Appar Mot · Jun 2000
Review[Postoperative compressive spinal epidural hematomas. 15 cases and a review of the literature].
In the literature, the frequency of postoperative compressive spinal epidural hematomas (SEH) appearing very low, we conducted the present study to determine the frequency of this complication in their unit and look for causative and predisposing factors. ⋯ Although postoperative SEH is relatively rare, it may have dramatic consequences. In our opinion, reintervention must be performed as soon as possible after the onset of neurologic deficit, the work-up investigations only prolonging the critical surgical delay, which is probably the only alterable prognostic factor.
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Rev Chir Orthop Reparatrice Appar Mot · Jun 2000
Review[Fractures of the shaft of the humerus: systematic plate fixation. Anatomic and functional results in 156 cases and a review of the literature].
Based on our experience with plate fixation of humeral shaft fractures and an analysis of the international literature, we attempted to answer the following questions. What functional outcome and what complications can be expected after surgery? Are the classical complications of open fracture surgery (screw fixation, wiring, plate fixation without compression.) as frequent after plate fixation using the Müller technique? ⋯ Plate fixation according to the Müller technique is a reliable osteosynthesis method with few initial failures or malunions as evidenced by data in the literature. Infection is also rare. Although the radial nerve risk makes this technique rather difficult, excellent functional results can be achieved.
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Rev Chir Orthop Reparatrice Appar Mot · Jun 2000
[Sagittal equilibrium of the pelvis: analysis of the inclination of the ischio-pubic ramus from the horizontal].
The sagittal equilibrium of the spine and pelvis has been examined in numerous studies looking for the origin of certain posture disorders of the spine and the cause of lower back pain. Sagittal x-rays of the pelvis provide an analysis of the degree of inclination of the pelvis from the horizontal and the bi-coxo-femoral axis and information on the form of the sacrum. There is no radiographic parameter however which analyzes the transition between the pelvis-sacrum component and the femoral component, i.e. the periacetabular region. In the sagittal plane, a line tangent to the ischio-pubic ramus would appear to best reflect the orientation of the periacetabular region and the muscular forces applied to this region. The purpose of this work was to analyze the inclination of the ischio-pubic ramus from the horizontal and its relations with other sagittal radiographic parameters in a population of growing children with spinal disorders. ⋯ The interdependence of sagittal radiographic parameters of the pelvis and the spine have been largely demonstrated. Certain pathological situations (isthmic spondylolysis with spondylolisthesis, lower back pain, etc.) can be explained by the value of these parameters, particularly incidence. The inclination of the ischio-pubic ramus from the horizontal reflects the periacetabular region. When analyzed in the sagittal plane, it was found to be a more stable parameter, independent of most clinical criteria (particularly age, and etiology) and of the other radiographic parameters studied. The only determining factor appears to be acquisition of the upright position. The consistency of this parameter constrasts with the variability of the other radiographic parameters of the pelvis and the spine, particularly incidence, although the inclination of the ischio-pubis ramus is an expression of a region different than the pelvis. This study suggests that the periacetabular region plays a key role in acquisition of the upright position in humans. The periacetabular region would be a fixed point around which the lower limbs and spine describe varying orientations.
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Rev Chir Orthop Reparatrice Appar Mot · Jun 2000
[Implantation of iliosacral screws. Simulation of optimal placement by 3-dimensional X-ray computed tomography].
Percutaneous iliosacral screws are used advantageously to fix unstable pelvic girdle avoiding the morbidity of open access for conventional screw fixation. The insertion technique must be precise due to the risk of injury to the lumbosacral nerve trunk, the cauda equina roots, and the first sacral nerve. We undertook a study of the implantation site of iliosacral screws looking for a means of standardizing the drilling procedure on the basis of 3D computed tomography (CT) data. ⋯ The 3D CT reconstructions of the sacral wing can be used to determine the precise optimal position of the two iliosacral screws. The principle orientations can be deducted from the plane of the sacral plate. Approximate indications can help reduce operative time and exposure to irradiation (patient and surgeon). Percutaneous iliosacroiliac screw fixation cannot be proposed for all patients.