Search

Purpose of the Study: This approach was developed to avoid gluteus maximus muscle injury which is divided when using the common Langenbeck-Kocher approach. The posterior perigluteal approach also provides better visualization of the posterior aspect of the acetabulum., Material and Methods: A semi-circular incision is made from the fascia lata at the anterior aspect of the greater trochanter and then directed to the posterio-superior iliac spine. The gluteus maxirnus is then simply retracted medially with blunt retractors. Sixty eight acetabular fractures have been operated with this approach including both mixed and complex fractures of the posterior column. Occasionally fractures of both columns have been operated in two procedures, one posterior and then a second anterior approach., Results: The posterior perigluteal approach preserves gluteus maximus muscle tone. It seems to avoid post-operative ossification., Conclusion: We propose an approach which, compare to the Langenbeck- Kocher approach, is less traumatic, and as easy to perform.

The authors reported a case of osteomyelitis of the acetabulum associated with a septic hip arthritis in an eight year old child. They confirmed the difficulties of the diagnosis of this rare disease, and they pointed out the importance of tomographic scan (CT scan).

Functional treatment of humeral shaft recent fractures by A. Sarmiento's method was described in 1977. It is based on fixation with a plaster or plastic sleeve individually molded. This sleeve keeps free the adjacent joints, allowing an early functional rehabilitation and a fast consolidation. A 50 cases serial study from 1983 to 1987, confirms the advantages of a method which allies reasonable means, safety and complete reliability to obtain a good and rapid consolidation (one case of non-union due to a technical failure), and rapidly recovered function. We had frequently resulting axial defects: 16 patients have mal-union with more than 10 degrees of angular deformity but without any functional consequences. The advantage of this method compared to usual orthopaedic, or surgical treatments leads us to propose it to most of our patients.

The authors report a case presenting with a very rare localization of brucellosis: the isolated involvement of a single bone of the metatarsus, in a child in otherwise excellent general condition. The lesions of the diaphysis and epiphyses induced a fragility of the epiphyseal cartilage and a minimal traumatism resulted in a detachment of the epiphysis which was the first clinical sign. The bacteriological examination of a sample of pus led to the early diagnosis of brucellosis, therefore allowing efficient treatment.

Thirty-four cases of severe trauma to the proximal ends of both bones of the forearm have been seen. All were treated surgically. A classification is proposed related to the site of the ulnar fracture. Type I is metaphyseal and the displacement is posterior, the reverse of that of a Monteggia fracture, with a posterior dislocation of the superior radio-ulnar joint. Type II is epiphyseal with anterior displacement. The superior radio-ulnar joint is intact. Type III is metaphysio-epiphyseal with anterior displacement. Type IV is the same with posterior displacement. Fractures of the radial head are present in all cases with posterior displacement and in these types, secondary displacements and non-unions are frequent (six cases). These were related to inadequate fixation of the ulna and to resection of the radial head which led to an increased strain on the ulnar fracture. Severe limitation of movements was infrequent (five cases) and was usually seen in fractures with posterior displacement. It was related to the time of cast immobilization and to the fracture of the radial head. Fractures with anterior displacement and an associated fracture of the radial head were rare but had a better prognosis in spite of the intra-articular site of the fracture. The relevance of repair of the radial column is stressed as being as important as stable fixation of the ulnar fracture.