Practical guidelines for the treatment of patellar fractures in adults.

The role of the patella is paramount in the transmission of the quadriceps muscle forces, the increase of the lever arm, the distribution of the forces on the trochlea and the centring of the extensor apparatus. Despite the low incidence of patellar factures in comparison with other lower limb fractures, the painful and functional complications, such as knee stiffness, loss of extension and patellofemoral osteoarthritis, can be very disabling and will often compromise the return to a professional or recreational activity and induce falls in the elderly population. Treatment can be conservative or surgical, provided that it is adapted to the type of fracture.

Hemiarthroplasty of the Hip in a 52-Year-old Patient with Osteogenesis Imperfecta-Related Femoral Neck Fracture: A Case Report.

Introduction: Osteogenesis imperfecta (OI)-related femoral neck fractures are rare. This is rarely described in the literature. This article presents a way to surgically treat such a fracture.

[Improvement of fracture healing with teriparatide: series of 22 cases and review of the literature].

Pseudoarthrosis is defined as a non healing fracture 9 months after trauma and without radiological progression within the last three months. Osteoporotic fractures have a greater risk of chirurgical complications. The question of giving a medical treatment in the purpose of accelerating fracture healing is an increasing concern.

Treatment of type B periprosthetic femur fractures with curved non-locking plate with eccentric holes: Retrospective study of 43 patients with minimum 1-year follow-up.

Introduction: Periprosthetic femur fracture (PFF) is a serious complication after total hip arthroplasty that can be treated using different internal fixation devices. However, the outcomes with curved non-locking plates with eccentric holes in this indication have not been reported previously. The objectives of this study were to determine: (1) the union rate; (2) the complication rate; (3) autonomy in a group of patients with a Vancouver type B PFF who were treated with this plate.

[Periprosthetic fractures].

A periprosthetic fracture is a fracture around or in proximity of a prosthetic implant. As more and more prostheses are implanted, the incidence of periprosthetic fractures also increases. Several risk factors have been outlined, some due to the patient, and some due to the implant itself.

Efficiency of the lausanne clinical pathway for proximal femoral fractures.

Unlabelled: Purpose/Introduction: The number of hip fractures is rising, due to increases in life expectancy. In such cases, patients are at risk from post-operative complications and subsequently the average length of hospitalization may be extended. In 2011, we established a clinical pathway (CP), a specific model of care for patient-care management, to improve the clinical and economic outcomes of proximal femoral fracture management in elderly patients.

Assessing dystrophies and other muscle diseases at the nanometer scale by atomic force microscopy.

Aim: Atomic force microscopy nanoindentation of myofibers was used to assess and quantitatively diagnose muscular dystrophies from human patients.

Materials & Methods: Myofibers were probed from fresh or frozen muscle biopsies from human dystrophic patients and healthy volunteers, as well as mice models, and Young's modulus stiffness values were determined.

Results: Fibers displaying abnormally low mechanical stability were detected in biopsies from patients affected by 11 distinct muscle diseases, and Young's modulus values were commensurate to the severity of the disease.

[Pseudarthrosis of the long bones].

5 to 10% of all fractures present with a delayed union, whereas 1 to 5% progress to a nonunion, which can be defined as a fracture older than 6 months and lacks any potential to heal without any further intervention. Different fracture and patient related risk factors exist, and the management of a nonunion needs a thorough clinical, radiological and biological workup to classify them in one of the two main categories, the viable nonunions that need essentially more stability, usually by a more rigid fixation, and the non-viable nonunions that need essentially a biological stimulation by decortication and bone grafting. This treatment still remains the first choice with bony healing obtained in 85 to 95% of cases, but it also comes along with certain risks, and some valuable alternatives exist if chosen on the basis of rigid criteria.

Medial femoral condyle fracture as a complication of antegrade intramedullary nailing.

A 49-year-old man suffered a closed oblique fracture of the middle third of his left femur. Closed reduction and internal fixation by intramedullary (IM) nailing were performed. Per-operative fluoroscopic imaging and initial postoperative X-rays were judged normal and the patient followed the usual rehabilitation protocol.

[Pelvic trauma].

Pelvic trauma A great variety of very polymorphous lesions of pelvic trauma are deffering from each other by their context, their anatomical aspect and therapeutic implication. In the isolated acetabular fractures, function is mainly at stake. The management consists mainly of re-establishing a joint congruence to prevent early coxarthrosis.

Late Recognized Vascular Injury after High-energy Fracture of the Proximal Tibia: a Pitfall to Know in Current Practice.

Failure to recognize associated soft-tissue injuries after high-energy proximal tibia fractures is not uncommon. Despite the progress in managing these complex injuries, a prompt diagnosis of associated arterial injuries still remains difficult. A high index of suspicion for arterial damages is nevertheless mandatory in these severe fractures.

Targeting device for intramedullary nails: a new high-stable mechanical guide.

One of the most demanding steps of an intramedullary nailing is the distal locking. The aim of this study is to evaluate clinically and prospectively a new targeting guide. Twenty-five patients were treated consecutively in two different trauma centres (level one and one general hospital) by two different surgeons who were instructed on using the new device.

Use of trochanteric nail for proximal femoral extracapsular fractures.

Proximal femoral extracapsular fractures have shown a significantly high morbidity and mortality rate at 1 year in cases of nonoperative treatment. The standard gamma nail was originally designed to provide stable fixation and allow early mobilization and weight bearing for elderly patients. The design of the standard gamma nail, however, appears to be associated with intraoperative or postoperative femoral shaft fractures in < or = 17% of patients, compromising the outcome.

Posttraumatic coccygeal instability.

Purpose: To report the middle term results of partial coccygectomy in a consecutive series of 15 patients with chronic coccygodynia.

Methods: Fifteen patients with chronic coccygodynia were referred to our outpatient clinics. The patients were investigated with dynamic lateral radiography and magnetic resonance imaging (MRI).

Closed and open grade I and II tibial shaft fractures treated by reamed intramedullary nailing.

Objective: To evaluate the results of closed and open grade I and II tibial shaft fractures treated by reamed nail and unreamed nailing.

Subjects And Methods: Between 1997 and 2000, 119 patients with tibial shaft fractures were treated with reamed tibial nails. Postoperatively 96 patients (70 closed and 26 grade I and II open fractures) were followed clinically and radiologically for up to 18 months.

Chordoma of the mobile spine: fifty years of experience.

Study Design: A consecutive series of 52 chordomas of the mobile spine observed over a 50-year period includes a retrospective review of 15 cases treated prior to 1991 and a prospective group of 37 cases treated from 1991 to 2002.

Objectives: This series reviews epidemiologic issues as well as clinical patterns of spinal chordomas. We attempt to correlate tumor extent, treatment, and outcomes over time.

[Surgical indications in spinal trauma].

Surgical indications in spinal trauma remain a controversial topic. In general, unstable cervical injuries such as displaced odontoid fractures, burst fractures or tear drop fractures require surgical intervention. Thoracolumbar compression injuries without posterior wall involvement or significant kyphosis can be treated conservatively.

[Percutaneous vertebroplasty].

Although vertebroplasty was initially a treatment of vertebral haemangioma or metastases, this procedure is now frequent option to the treatment of osteoporotic vertebral fractures. In this review article, we will discuss the indication, the techniques and the follow-up of the vertebroplasty. This is a risky procedure, which should be performed by experimented physicians working with high-resolution fluoroscopic equipments, by biplane fluoroscopy, to reduce the risk and irradiation to the patient.

Long gamma nail in the treatment of subtrochanteric fractures.

Introduction: The purpose of our study was to retrospectively evaluate the clinical and radiological results of subtrochanteric fractures treated with a long gamma nail (LGN). The LGN has been the implant of choice at our level-1 trauma center since 1992.

Materials And Methods: Over a period of 7 years, we have treated 90 consecutive patients with subtrochanteric fractures.

Anterior subluxation after reduction of a posterior traumatic sterno-clavicular dislocation: a case report and a review of the literature.

Sternoclavicular dislocations represent a rare injury. Based on our clinical experience with a patient showing an anterior subluxation after reduction of a posterior traumatic dislocation, we review the literature. The emergent reduction of the dislocation is mandatory, always keeping in mind the potentially devastating neurovascular complications.

[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.

[Osteosynthesis of per- and subtrochanteric fractures by blade plate versus gamma nail. A randomized prospective study].

Aim: To compare clinical and radiological results in per- and subtrochanteric fractures' management with 90 degrees blade plate or Gamma nail fixation; an implant allowing early weight-bearing and fracture healing in correct position remains still difficult.

Method: Between 1993 and 1995, 26 patients addressed to our Center for a Kyle IV [1] fracture were divided into 2 groups, one fixed with blade plate and the other with Gamma nail. The follow-up for all patients is 12 months.

[Preliminary results of retrograde nailing of the humerus].

A group of nine patients with a diaphyseal fracture of the humerus and treated with retrograde nailing were studied with a mean follow-up of 15.3 months. Six patients with a humeral fracture without neurological deficit showed a good shoulder and elbow mobility at the last visit.

[Treatment of diaphyseal pseudarthrosis by circular external fixator].

The aim of this retrospective study was to evaluate the effectiveness of circular external fixator according with Ilisarov technique for the treatment of diaphyseal pseudarthrosis. The union rate obtained in our serie was 91%. We assessed the complications related to surgery and analysed the reasons for failed technique.