Fixateur externe monolatéral pour fracture diaphysaire du tibia avec mesures des contraintes sur le fixateur. [Strain gauge measurements on a one-side external fixation: a prospective series of 11 tibial shaft fractures]

PURPOSE OF THE STUDY: External fixation is often the treatment of choice for open complex fractures of the tibia. For closed tibial shaft fractures, it is generally a second choice alternative. The purpose of this study was to determine whether fusion of closed and open fractures of the tibia can be successfully achieved with a one-side external fixator equipped with strain gauges and to evaluate complications of this type of treatment. MATERIAL AND METHODS: A consecutive series of 11 mid shaft fractures of the tibia (4 closed fractures and 7 Gustilo grade I and II open fractures) in 11 patients (mean age 29 years) were treated with a one-side external fixator. Strain was measured weekly to adjust the treatment. A Sarmiento walking cast was applied in all cases 4 weeks after removal of the external fixator. RESULTS: All 11 fractures healed without complications and without pin tract infection. Mean delay to consolidation was 20.5 weeks (range 13 - 29.5 weeks). One patient required a revision procedure for decortication and bone graft at 12 weeks. Weight bearing (50% of body weight on the injured limb) was achieved at 6.7 weeks (mean) and total weight bearing at 11.9 weeks. The external fixator's strain curves were compatible with normal healing in 3 cases, with slow healing in 3 and with retarded healing in 3 others. Two of the curves did not show recognizable patterns despite a favorable clinical and radiological course to healing. DISCUSSION: Early detection of a pathological pattern of fracture healing followed with a strain gauge enabled adaptation of treatment in all cases. Decortication with bone grafting was necessary in one patient. In two other cases, compression of the fracture with the external fixator or dynamic locking were sufficient to achieve a favorable healing pattern. This small series demonstrated that bone healing can be achieved within usual delays with external fixation and without major complications. Use of strain gauges on the external fixator allowed early detection of retarded healing and subsequent modification of the treatment protocol. This type of treatment might be an interesting therapeutic alternative for the treatment of closed fractures of the tibial shaft

Mon enfant marche mal. Les anomalies du morphotype des membres inférieurs. [Gait disorders and lower leg deformities in children]

Gait disorders and lower legs deformities in children are frequent causes of parental concern and of medical advice. These deformities should be analysed systematically as well as their consequences for daily activities. We should define precisely type, localisation and importance of the deformity: femoral or tibial torsion, knock knees, bow legs. The evaluation should always be done according to age of the child because these deformities are most often a step toward adult morphotype. Sometimes they could be the manifestation of some generalised or localised pathology that should be investigated and treated. Nevertheless patience and explanations, regular follow-up allow to reassure the parents. There is in the great majority of case no place for any conservatrice and especially surgical treatment for theses disorders spontaneously healing in 95% of cases

The value of early postoperative bone scan in slipped capital femoral epiphysis

The purpose of this study was to evaluate the sensitivity and predictive value of early postoperative bone scan for detection of avascular necrosis (AVN) of the femoral head after surgical treatment of slipped capital femoral epiphysis. We reviewed records of 49 patients (64 hips) operated on between 1980 and 1997 with a mean follow-up of 3 years. Sixty-one out of 64 hips went through an early postoperative bone scan. The three hips that developed AVN showed significant loss of radionuclide uptake. There were neither false-positive or false-negative cases in this series. Early postoperative bone scan has an excellent sensitivity and predictive value for detection of AVN after surgical treatment of slipped capital femoral epiphysis

La prothèse de hanche douloureuse. [Painful total hip arthroplasty]

The results of the total hip prostheses in terms of cost-efficiency make one of the surgical procedures the most efficient. Usually, the articular pains disappear completely and the patient function improves. Outside, turned out failures, which require a revision, some patients present residual pain persisting after the intervention or appearing secondarily. Considering the important number of total hip arthroplasties, this clinical situation is not so rare and the generalist, as the specialist, can be confronted there. The experience shows that the surgical revisions, in the absence of a precise diagnosis are disappointing and often do not improve the patient. This article presents the diagnostic and therapeutic steps advised to face this problem