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Skeletal involvement is the major clinical complication of multiple myelomas, resulting in pathological fractures. Proximal femoral fractures are very frequent during multiple myeloma evolution and they seriously compromise survival and quality of life of patients with cancer. Early surgical treatment allows mortality and morbidity improvement. Cervicomedullary Gamma locking nail osteosynthesis allows efficient, sustainable and stable fixation associated with early patient mobilization and survival improvement. However, prolonged survival imposes regular monitoring of the osteosynthesis in order to detect and to treat equipment failure. We should not overlook the fact that the recovery of independence after pertrochanterian fracture also influences myeloma control through the possibility to perform bone marrow autograft or not.

The traditional massage of the newborn and young infant is an ancient practice in Africa and other regions. It has many benefits that are currently recognized, even in Western societies. However, it can be dangerous. We report two cases of fractures of the femur and clavicle that occurred in a 17-day-old newborn and a 1-month-old infant secondary to a traditional massage. In both cases, there was no concept of trauma or a history of osteogenesis imperfecta in the family or the presence of other fractures suggesting abuse. We concluded in a fracture caused by traditional massage in both cases. Given its many benefits as described in the literature, the traditional massage of young infants cannot be considered a harmful practice. However, it should be practiced with care to prevent the occurrence of such complications., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objectives: Evaluate the epidemio-clinical and therapeutic aspects of the femur's fracture of the child., Materiel and Methods: It was about a prospective study done from October 1st, 2005 to September 30, 2006 on all children of 0 to 15 years old admitted for femur fracture, treated and followed in the trauma center of hôpital Gabriel Touré. Disappeared patients have not been included., Results: We brought together during a period of 12 months 47 cases of fracture in 45 children representing 26 % of the activities of trauma unit of hôpital Gabriel Touré. Among our patients 25 were boys and 20 girls. The average age was 7.5 yeras +/-4. The public highway accident was the first cause (68.8%) followed by domestic accident (22.2%), sportive (6.6%), obstetrical (2.2%). The treatment was orthopaedic in 52.17% and surgical in 47.83%. Complications were the following: residual pain in 6.6%, length disparity of the limbs in 4.4%, secondary slipping in 2.2% and hypertrophic callus in 2.2%. P>0.05. The results were good in 71.7 % of the cases, passable in 24 % and bad in 4.3% of the cases., Conclusion: Femur fracture is a frequent affection by which the first cause remains the public highway accident.

This retrospective and prospective study over 49 months has permitted us to count 43 cases of pathologic fractures: the population concerned is a population of adults whose average age is 43.5 years old. The social groups, which are more affected, are these having poor economical revenue. The male sex is predominating lightly with 22 cases (51.2%). Within 16 cases (37.2%) the pathologic fracture has revealed the causal affection and 27 cases (62.8%) where the affection was already known before the occurrence of pathologic fracture. Pain, tumefaction and functional impotence constitute the main reason (motive) for consultation. Femur is the most affected bone with 26 cases over 43 cases. The principal etiologies are represented by malignant bone tumors 37.2%, osteoporosis 23.2%, and osteomyelitis 23.2%. Imperfect osteogenosa 6.9%, ricket 6.2%. The standard face and profile radiography and biopsy are the principal complementary exams. The treatment is surgical in 81.4% of cases and orthopedic in 18.6% of cases.

Osteoporosis is a frequent disease among the elderly and has major consequences in terms of mortality, morbidity and cost. Guidelines for diagnostic procedures are often difficult to apply in frail, elderly patients with multiple comorbidities. Bisphosphonates are the reference treatment for the elderly, combined with vitamin D and calcium supplementation. Vitamin D deficiency must also be treated to prevent falls and fractures. Strontium ranelate is a promising treatment in this population. Fall prevention is a major part of osteoporosis management. The potential benefit of hip protectors is questionable, even in institutionalized patients.

Purpose of the Study: We reviewed fractures of the distal femur occurring during or after total knee arthroplasty in order to identify risk factors., Material and Methods: Twelve intraoperative fractures occurred between 1990 and 2000 among 617 total knee arthroplasties performed during this period. The circumstances of these fractures were noted in comparison with other prosthetic implants. Twenty other fractures of the distal femur occurred in 20 patients who had had a total knee arthroplasty during the same time period. Mean patient age at surgery was 72 years (range 69-77). In addition to demographic data, we noted risk factors: bone demineralization related to general condition, rheumatoid arthritis or corticosteroid therapy, trochlear notch prior to the trochlear cut, bone resorption under the femoral implant, repeated knee surgery, abnormal stress on the distal femur due to hip disease, periprosthetic osteolysis without loosening related to polyethylene debris or metallosis, loosening, type of prosthesis, loss of bone stock because of the femoral implant, life of prosthesis., Results: Intraoperative fractures usually occurred in specific circumstances: use of a posterior stabilized prosthesis, probably with insufficient preparation and position of the stabilization element, probably excessive impaction in osteoporotic bone (rheumatoid arthritis), difficult exposure (arthroplasty after prior osteotomy), fracture starting from the separator passing over the posterior aspect of the tibia and reaching the intercondylar notch. Independently of these intercondylar fractures, supracondylar or diaphyseal fractures were essentially observed for revision prostheses using a femoral stem. Postoperative fractures were observed in patients who had prior surgery of the distal femur (revision of femoral osteotomy, fracture of the distal femur, arthrodesis), in patients with significant loss of bone stock (posterior stabilized prosthesis), or poor bone quality (rheumatoid arthritis), and in elderly patients with neurological impairment and frequent falls. The trochlear notch did not appear to be sufficient to be the only cause of fracture but was nevertheless an element frequently associated with other risk factors., Discussion and Conclusion: This study shows that fracture of the distal femur occurs in certain preferential circumstances. Considering these elements, a certain number of preventive measures can be discussed for technical modifications or choice of implants.

Purpose of the Study: Fractures of the distal femur near a total knee arthroplasty are usually observed in patients aged over 70 years victims of low-energy trauma. The rate of complications is high: in the literature 25-75 %, even when treated by experienced surgeons. The purpose of this study was to detail therapeutic modalities used for the treatment of these fractures with their advantages and disadvantages and to determine the morbidity of complications which do occur., Material and Methods: Twenty distal fracture of the femur were treated between 1990 and 2000 in twenty patients who had a total knee arthroplasty. Mean patient age at surgery was 72 years (range 69-77). The fracture was a short oblique fracture in four, transversal in five, long and spiral in four and comminuted in the others. In four fractures, the preoperative radiographic analysis suggested concomitant loosening. Therapeutic modalities included suspension traction for two, femorotibial external fixation for two. Retrograde nailing was possible in two patients. Fixation with a screw plate or a blade plate was used for nine fractures. The prosthesis was revised systematically if loosening was observed. This was done in three cases with preservation of the tibial piece and in two cases, changing the complete prosthesis, using a long femoral stem in all., Results: Mean follow-up was two to ten years. Immediate weight bearing was possible for four of the five patients for whom only the femoral piece was changed with a long stem. For the others, weight bearing was deferred until fracture healing was obtained after a mean five months (range 4-42). Bone healing required one, or two, revisions in three patients. Three patients died within one year of their fracture of the distal femur. There were no cases of infection or late healing. At last follow-up, the knee and function score regressed after treatment of the fracture. The two scores dropped 20 points compared with the pre-operative score (78 +/- 15 to 56 +/- 19 for the knee score and 72 +/- 16 to 54 +/- 18 for the function score). The knee score fell because of difficulty going up and down stairs and use of crutches. Treatments which stiffened the knee were traction suspension and external fixation. Loss of joint motion was about the same with or without prosthesis revision. The tibiofemoral angle measured before the fractures (postoperative goniometry) then after fracture healing or after changing the femoral prosthesis, showed an alignment of 183 degrees before the fracture and 178 degrees after healing or revision of the femoral piece. Three patients experienced another fracture of the same femur after healing of the initial fracture or after changing the knee prosthesis., Discussion: Fracture of the distal femur on a total knee prosthesis is a serious complications because of the mortality and the difficulty in achieving functional recovery after treatment. Therapeutic difficulties involve the type of skin incision, the position of the screws in relation to the femoral component, the possible need for bone graft, and finally the requirement to change the femoral piece with a centro-medullary stem.

Purpose of the Study: Pluridisciplinary management of patients with metastasis to the femur is well defined, but the choice between palliative surgery or abstention must be decided on the basis of a few evaluated prognostic criteria. We report a series of 24 cases of metastasis to the weakened or fractured femur which was evaluated with the Tokuhashi score and treated by surgery., Material and Methods: Sixteen women and eight men, mean age 71 years (58-89) underwent centromedullary nailing of the femur. These patients had metastases from breast cancer (n = 13 of the 16 women). Twenty of the 24 patients also had other metastases. The Tokuhasi score was > 6 in 16/24 patients. Fourteen patients had pain which did not respond to morphine. Thirteen had fractures and eleven weakened femurs. Time to surgery was six days (1-15). A full nail was inserted in four patients and a reconstruction nail in twenty., Results: Operative time was 93 minutes (57-123). Blood loss was 200 ml (150-350). There were no intraoperative complications (fat embolism) excepting increased comminution. Hospital stay was 23 days (8-55). Survival was 148 days (8-510) for patients with fractures and 272 days (12-730) for patients with weakened femurs. Eight patients with a fractured femur died (six within the first three postoperative weeks), two among those with preventive nailing. On average, weight bearing among the surviving patients with nailing for fracture was achieved on the 57th postoperative day (30-90). Only six patients required morphine early after surgery. Centromedullary nailing successfully relieved pain in all patients with an isolated metastasis. Mean survival in patients with a Tokuhashi score < 3 was 2.1 months. It was 17 months in those whose score was > 6., Conclusion: Centromedullary nailing for fractured or weakened femur due to metastasis is a useful therapeutic solution for patients with short life expectancy. With this technique, antalgesics can be reduced while preserving independence as long as possible. The Tokuhashi score is easy to establish. If it is less than 3, centromedullary nailing should not be attempted due to the short expected survival.

A 54-year-old man was seen with a fracture of the left femur. Plain radiographs revealed a 40-mm lytic centromedullary lesion. Magnetic resonance T1- and T2-weighted sequences showed high and low signals. After stabilization of the fracture, the tumor was removed followed by reconstruction with a vascularized fibula. The pathological examination demonstrated proliferation of non atypical CD34 and CD31 positive epithelioid cells with few lumens, accompanied by abundant fibrous stroma, sometimes masking tumor cells. Satisfactory motion was achieved with no recurrence at 20 months follow-up. Bone hemangioendothelioma can simulate metastasis and must be distinguished by immunohistochemistry. Prognosis is a subject of debate as the tumor is considered to exhibit intermediate malignancy by some authors while other consider it to be a malignant tumor.

We report a case of pathological fracture of the femoral shaft in a patient presenting a diaphyseal hydatid cyst. Surgical treatment consisted in wide resection followed by washout using a 20% hypertonic saline solution and nail plate fixation. Albendazole was given as adjuvant treatment. Postoperatively, the patient developed rhabdomyolysis with local superinfected necrosis which required early revision to remove the material. At twenty-two months, the local and general course was satisfactory. The pathological fracture healed and no secondary localization could be identified. Echinococcosis serology remained negative. The surgery-hypertonic solution-albendazole combination appears to be an attractive therapeutic solution for bone hydatid disease.

Purpose of the Study: Elastic sliding centromedullary nailing (ESCN) proposed by Métaizeau in 1987 for the prevention and treatment of limb fractures in osteogenesis imperfecta has never been evaluated. A multicentric serie was studied in order to evaluate results of these procedure., Material and Methods: Thirty-six ESCN procedures were performed in fourteen patients. Percutaneous pinning was used for the femur and distal tibia and arthrotomy for the distal femur as needed and in all cases for the proximal tibia. The pins were bent in compliance with the principles of the ESCN system. The ends of the pins were bent back to form a U pushed into the epiphysis. Reaxing osteotomies required minimal incisions. Age at the first procedure, the number of procedures and complications, and time between procedures were recorded. Pin overlap and the angle formed were also recorded. Pin gliding was evaluated. Ability to walk with or without assistance was noted., Results: The medullary canal measured 4 to 10 mm. The first procedure was performed at a mean age of four years (range 15 days to 10 years). Follow-up was eight years (range 1-12). There were 2.5 procedures per patient (range 1-5). Pins had to be changed in 75% of the bone segments. Mean time between two procedures was 3.2 years. There were no cases of defective sliding or infection. There were four cases of secondary fracture with a mean 30% pin overlap, two pin migrations, one nonunion, and one shortening. The majority of the complications occurred after the age of five years. At last follow-up, three patients could not walk, four walked with aids, and eight without aids., Discussion: The advantages of the technique (size of the pins, nailing without reaming, pin sliding in all cases, low cost) must not overshadow the drawbacks (risk of pin deformation and migration, secondary fracture). Secondary fractures might be limited by discrete valgus of the femoral shaft and preventive pin change when the angle formed approaches 30 degrees and when there is only 30% overlap left. Use of telescopic nails before the age of five years increases the risk of complications while most of the complications observed with ESCN occur after the age of five years. Twenty-five percent of the ESCN complications involved only the femur. The percent of secondary fractures was less than with telescopic nailing (3.6% versus 11%) but there were more cases of nail migration. All pins slid, compared with 6% failure of elongation with telescopic nails. Although proof is not available, surgical treatment of osteogenesis imperfecta before the age of five years appears to provide more rapid functional progress., Conclusion: Sliding centromedulary nailing is an attractive alternative before the age of five years. In older children and to the end of growth, telescopic nail or pinning should be discussed although pinning may permit more secondary fractures which can be limited by rigorous surveillance of pin position.

We observed a pathological fracture of the femur in a 21-year-old woman with a venous malformation. Physical examination and plain x-rays disclosed a pathological bone. Biopsy revealed the venous malformation. The extent of the lesion that involved the entire quadriceps muscle was detailed with duplex-Doppler, computed tomography and arteriography. The patient was treated with an intramedullary nail. Intra-operative bleeding necessitated transfusion (packed cells and frozen plasma). Outcome was favorable. Bone healing was achieved at seven months.

The authors report the case of an HIV-infected patient on highly active antiretroviral therapy (HAART) who presented with spontaneous fracture of the right femoral neck with avascular necrosis, probably related with her HIV status and HAART, and who was treated by non-cemented arthroplasty.

A 24-year-old patient with homozygous sickle cell disease developed a stress fracture of the femur. Successive x-rays demonstrated defective ossification and a spontaneous unicortical fracture with no notion of trauma or stressful activities (e.g. sports) followed six months later by a bicortical fracture with displacement and periosteal reaction leading to the diagnosis of stress fracture. This type of fracture has not been reported previously in sickle cell disease. The patient was treated with centromedullary nailing. The follow-up was uneventful. Bone healing was achieved at three months. The patient was pain free and could walk without crutches. Stress fracture is a potential diagnosis in homozygous sickle cell disease patients with defective ossification who present spontaneous pain even when plain x-rays do not visualize an overt fracture. Computed tomography or magnetic resonance imaging should be performed when available. Conventional treatment with nailing provides successful cure with good functional outcome.

Purpose of the Study: Post-radiation shaft fractures of long bones are uncommon. Late or partial healing increases the risk of stress fracture. Different fixation techniques have been proposed. Treatment of radiated bone is difficult. We report a series of 6 nonunions of the proximal femur after radiotherapy., Material and Methods: Three patients had true fractures of irradiated bones several years after radiotherapy for bone or soft tissue tumors. Three other patients had pathological fractures or malignant osteolysis related to a myeloma and treated by osteosynthesis and post-operative radiotherapy., Results: Treatment required a total of 19 surgical procedures. There were nine stress fractures of ostheosynthesis material involving locked nails, cervicodiaphyseal nails and plates. There were no vascularized grafts in this series. At last follow-up the pathological fracture had healed in three cases, was stable but not healed in two, and required prosthetic reconstruction in one., Conclusion: We emphasize the importance of rigorous patient selection for radiotherapy and the possible preventive effect of osteosynthesis in certain cases with a high risk of secondary fracture of an irradiated bone. Vascularized grafts may be useful for refractory nonunion and may be proposed as first line treatment for post-radiation fractures.

Distraction osteogenesis relies on two local factors: 1 degree mechanical stretching multiplicates the fibroblastic population; 2 degrees hypoxia, by vessel elongation and cellular compaction, induces osteogenic stress protein metabolism. Progressive return to aerobic conditions assumes permanency of the new osseous structures. The precise technical procedure of Ilizarov brings under control the osteogenic process with unprecedented human clinical results.

In elderly persons, hip fracture is frequent and associated with serious physical, functional and psychological consequences. Hip protectors seem promising for preventing hip fractures, especially in frail, institutionalized elderly persons. Despite methodological limitations, five randomized trials have reported positive results, with up to 85% risk fracture reduction in some trial. Interestingly, although 13 hip fractures occurred in subjects assigned to wear hip protector, only one occurred while the protector was actually worn. Adherence with wearing hip protectors remains a problem. Several ongoing trials will further enhance our knowledge on hip protectors effectiveness and cost-effectiveness to better define their role in hip fracture prevention.

Purpose of the Study: The aim of this study was to emphasize the importance of the distraction osteogenesis technique in the treatment of post-osteomyelitis nonunion. We report 12 cases., Patients and Methods: Mean patient age was 9.5 years. There were 7 cases of nonunion of the femur and 5 involving the tibia. Nonunion was associated with 5.9 cm shortening in 10 cases, 8.4 cm circumferential bone defect in 1 case, shortening and bone defects in 6 cases, and shortening and joint deformities in 2 cases., Results: Consolidation was obtained in 11 cases with an average delay of 11.6 months. Infection was eradicated in 75 per cent of the cases. Average residual shortening was 0.4 cm. Joint deformities and axial deviations were corrected at the same time in all cases., Discussion: The advantages of the Ilizarov technique are well known for the treatment of such deformities and musculoskeletal system disorders subsequent to osteomyelitis: nonunion, infection, shortening, joint deformities and malunion.

Purpose: To evaluate the mid-term outcome following CT-guided percutaneous resection of osteoid osteoma., Materials and Methods: 38 patients who had been treated by CT-guided percutaneous resection were included. The mean follow-up of 3.7 years. Early and mid-term outcome and histology were analyzed., Results: Histological samples were adequate in 92% of cases and a diagnosis of osteoid osteoma was confirmed in 73.7% of cases. In 6 cases, the lesion was not an osteoid osteoma: 2 mucoid cysts, 1 benign fibrous dysplasia, 1 fibromucoid lesion, 1 focal osteochondritis, 1 osteomyelitis. Cure was achieved in 84.2% of patients. Minor transient complications occurred in 23.7% of cases. The most serious complications included: 1 intramuscular hematoma, 2 femoral fractures, and 1 case of S. aureus osteomyelitis., Conclusion: This study confirms that CT-guided percutaneous resection of osteoid osteomas is effective and shows that other small lesions can also be treated using this technique.

We report two cases of prenatal diagnosis of osteogenesis imperfecta (type S of Marotaux), diagnosed at 23 and 24 weeks of gestation, revealed by of an ultrasound scan which noted an abnormal femoral incurvation. The problem of differential diagnosis with other diseases causing femoral incurvation (notably campomelic dysplasia) is difficult, especially at early stage. This question is debated here. The interest to associate ultrasound scan and uterine contents radiography is so demonstrated.

Purpose of the Study: Nineteen osteochondral fractures of the lateral femoral condyle associated with acute traumatic patellar dislocation resulting from sport injury in children were studied. The purpose of this study was to specify clinical and radiological features., Material and Method: This study was led with special care to injury circumstances, fracture visibility on X-rays, size and location of the fracture, treatment delay, presence of femoro-patellar dysplasia signs. Treatment results were evaluated on knee pain, bone consolidation and recurrent dislocation., Result: Thirteen boys and six girls aged 8 to 16 years (average 14 years) were included. The injury resulted from a rotatory-compression stress in 75 per cent cases. The patella was always in place at the time of examination. Thirteen fractures were diagnosed within 24 hours and 5 fractures were diagnosed within 1 week after injury. One fracture was not visible on X-rays and was diagnosed 6 weeks after injury. Only the lateral view showed the fracture in more than one case out of two. Seven patients whose fracture was less than 5 mm, or involving a non-weight-bearing portion, or diagnosed within more than ten days after injury, were treated by knee arthroscopy and removal of the osteochondral fragment. Twelve patients were treated by arthrotomy and excision (one case) or replacement of the osteochondral fragment (11 cases). The replaced fracture was fixed with biological glue ten times, and screwed once. The knee was immobilised in a cylinder cast and weight-bearing prohibited for six weeks. Bone consolidation was obtained in 9 cases out of 11, in an average of 8 weeks. Knee pain occurred 5 times. Recurrence of the dislocation occurred 3 times within 6 months. Eighty per cent of these children showed patello-femoral dysplasia., Discussion: This fracture complicated 31.6 per cent of traumatic patellar dislocation resulting from sport injury in children which we observed during the last ten years. It may be overlooked if it is suspected and carefully looked for by radiographic examination including antero-posterior, lateral, oblique and true skyline views of the patella. The presence of fat in the hemarthrosis may help. Early surgery is recommended. Arthroscopy may be performed to evaluate fracture location and size. After ten days, host area begins to fill in and free fragment will not fit back well. Fragments less than 5 mm, or involving a non-weight-bearing portion, or diagnosed within more than ten days after injury, may be removed., Conclusion: Lateral femoral condyle osteochondral fractures are associated with nearly one third of traumatic patellar dislocation resulting from sport injury in children. A detailed radiographic examination can help diagnosis. Treatment depends on the delay after injury, the size and location of the fracture.

Purpose of the Study: 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., Material and Methods: Twenty-four patients with floating knee were treated between 1987 and 1992. Comminution was assessed according to Winquist et al. Associated soft tissue damage was assessed according to Gustilo et al. The grade III open fractures were always treated by external fixation. Intra-medullary nailing was always performed after reaming., Results: One patient died and eighteen were reviewed. Fat-embolism syndrome occurred in three cases, one superficial infection occurred in femoral plating, nine deep infection occurred in tibial fracture: 7 for grade II and III open fracture treated by external fixation and one after nailing of a grade I open fracture. Malunion occurred in five patients: 2 shortening, 2 external rotational femoral deformity of 15 and 35 degrees, one shortening associated with external rotational femoral deformity of 30 degrees. Error in comminution evaluation was the leading cause of these malunions. Non-union occurred in 2 femoral and one tibial fracture. These complications were treated by decortication and osseous grafting. Four patients had a late diagnosis of ipsilateral ligamentous injury: antero and posterior in three and lateral isolated in one. Eighteen patients were reviewed. Results were excellent in 4, good in 7 and poor in 7. The seven poor results were: 1 amputation, four patients with ligamentous injury and 2 of the 5 malunions., Discussion: Clinical evidence of fat embolism has been reported after reaming of fractured long bones. Reaming led to an increase in pulmonary artery pressure and in pulmonary free fatty acids. Reaming in the same time femoral and tibial diaphysis increased this kind of complication. We performed femoral and tibial fixation during the same operating time: first the femur and after the tibia. Tibial open grade III fractures were fixed first by external fixation. Ipsilateral femoral and tibial nailing increase malunion: shortening and rotational malunion. This problem can be reduced but not eliminated by using locking nails: the error was established during the operation. Distal femoral fraction gives better torsional control. Fractures in the distal segment of the femur are particularly prone to the development of axial malignement. In this series, malunion occurred in three cases. Knee effusion in patient with ipsilateral femoral and tibial fracture should not be ignored. It may indicate meniscal or articular pathology, or ligament disruption. If there is suspicion of ligament injury, a supracondylar femoral fraction is recommended for nailing. After femoral and tibial fixation, the knee must be examined clinically. Early surgical repair of peripheral tears is advocated. Repair of an anterior or posterior ligament without proximal or distal avulsion may not be warranted., Conclusion: 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.

Purpose of the Study: This study was performed to analyse the clinical and radiological results obtained after the treatment of femoral fractures after total hip arthroplasties by a Charnley's extra long-stem prosthesis, and to compare these results with those obtained by alternative treatments proposed by various authors., Materials: 18 patients, whose mean age was 68.5 years (extremes: 45 to 86 years). Cooke and Newman fractures classification showed a clear prominence of type III. In 8 cases we found a femoral loosening, prior to the fracture, divided as follows: 4 in grade III and 4 in grade IV, using Vives classification. Type I fractures were always associated to complete femoral loosening., Method: Clinical results were analysed by Merle d'Aubigné's scoring system, giving a pre-fracture global score of 13.5. Post-operative radiological analysis was made on the appearance of femoral radiolucent lines and/or modification of the femoral implant., Results: 17 patients were followed, with a mean of 5 years (extremes: 1 to 14 years). Consolidation was always obtained. The global mean functional results were of 15.2, with score improvement, essentially, of soreness and stability. We found 12 good and very good results, 4 poor and 1 bad. Age (< 75 years) and fracture type (II and III) appeared to be important factors influencing the functional result, contrary to the lesional mechanism. 6 non-evolutive bone-cement radiolucent lines appeared, in immediate post-operative phase. One cement-prosthesis radiolucent line appeared later, leading to loosening and rupture of the implant. We deplore 3 stem twistings, of which only one led to implant rupture. Walking with support was possible at the 5th postoperative days., Discussion: Our functional results are encouraging (12 good results, i.e. 71 per cent), compared with other treatments. This technique improved the global functional score. This is due to the simultaneous treatment of the fracture and of the eventual pre-traumatic associated femoral loosening. The technique allows a quick resumption of autonomy, a short hospitalization time for these elderly patients. The main disadvantage of the orthopaedic treatment is the prolonged decubitus and the important risk of secondary loosening. Osteosynthesis by plate has the advantage of keeping a maximum of osseous stock, but delays weight bearing, favours the non union by a large loss of periosteum. It never permits the treatment of the associated loosening during the same operation. It is also at the origin of a cement weakening, while fixing the proximal screws, leading to the difficulty of placing the prosthesis. Major disadvantage of proposed method is the use of a high quantity of cement to ensure stability of the implants; but this has never had negative consequences in our study., Conclusion: This surgical technique seems to be a satisfying alternative to the treatment of femoral fractures on total hip arthroplasty, due to the advantages obtained. It is reserved for elderly patients. However, these findings should be taken with caution, due to our small series.

Unlabelled: The authors present a curious type of fracture of the distal end of the femur. They discuss the mechanism and the factors responsible for that lesion. The treatment and results are finally presented., Material: A 65 years old female, submitted to a crash accident while driving a car, with a seat in maximaly low position. She presented a bilateral open transverse fracture of the patella associated in the right limb to a fracture line between condyles and the patellar surface of the femur., Method: Bilateral osteosynthesis of both patella had been realised in emergency through a transverse approach. Through the fractured right patella two anteroposterior screws had been used to fix the fractured femur., Result: A plaster cst had been used for three weeks. Full weight bearing was permitted after three months. Full range of motion of both knees was noticed after six months follow-up., Discussion: The femoral fracture could have been fixed by another device like D.C.S. platescreen but it would be weaker. That type of fracture was produced because of flexed low position of the knee at the moment of the accident. Usually, supra-condylar femoral fractures are due to a force vector applied on the upper extremity of the tibia without any patellar fracture. In our case, the patella involved associated to a fracture line between the condyles and the patellar surface. The structural anatomy (noeud sutural de Chevrier) explains the solidarity of the two femoral condyles.

Introduction: Anterior open traumatic dislocation of the hip in children is rare., Materials and Methods: We report the case of a child aged 9 years, who presented following a motor vehicle accident an anterior open dislocation of the left hip associated with a fracture separation of the trochanter, a fracture of the homolateral humerus and a fracture of the contralateral femur. He was treated by open reduction of the dislocation and pinning of the various fractures., Results: After 15 months functional result of the hip was good. The radiograms showed early signs of necrosis of the femoral head., Discussion: The treatment consisted of emergency reduction of the dislocation. Despite this treatment, a review of the literature showed that necrosis of the femoral head is still frequent., Conclusion: Anterior open dislocation of the hip is a severe disease in the child and its prognosis becomes severe with the opening and the association with a fracture.