M.M. Niane

Children distal humerus supracondylar fractures: The Blount Method experience

INTRODUCTION Extension-type supracondylar fractures of the humerus in children are frequent lesions whose orthopaedic treatment remains under debate in Rigault and Lagrange type III fractures and highly controversial in type IV fractures. The objective of this study was to extend the Blount method to fractures with substantial displacement even in patients presenting significant swelling and to evaluate the results. PATIENTS AND METHODS We conducted a prospective continuous study from December 2005 to August 2007 on 67 children: 49 boys and 18 girls with a mean age of 6 years (range, 3-14 years). The mean time lapsed from consultation to treatment was 30 h. The mean hospital stay was 72 h. In 50 children, the limb was elevated preoperatively for a mean 48 h. The fracture was reduced under fluoroscopy-guided general anesthesia with mask and immobilized with 5-cm cloth banding padded with foam. The follow-up was clinical and radiological. The mean follow-up was 16 months (range, 6-26 months). Assessment followed the 1969 SOFCOT guidelines. RESULTS At union, mean flexion was 124 degrees , the mean extension lag was 26 degrees . At last follow-up, the mean flexion was 146 degrees , the extension lag was 0.5 degrees , and pronation and supination were free. Immediately after surgery, the mean Baumann and anteflexion angles were 75 degrees and 43 degrees , respectively; at union they were 76 degrees and 44 degrees and at follow-up 79 degrees and 42 degrees . We found no vascular or nerve lesions. According to the SOFCOT criteria, at follow-up we obtained 80.6% very good results and 19.4% good results. LEVEL OF EVIDENCE Level IV. Therapeutic study.

Fracture of the odontoid process in children: A case report

The authors report a case of apophysial fracture of the odontoid process in association with paresis of the upper extremities in a 5-year-old child. The fracture was treated by gradual guided self-reduction without anaesthesia, followed by a Minerva jacket cast immobilisation. Reduction was anatomical, and the neurological problems regressed within 48 hours.

Fracture du corps du talus associée à une fracture malléolaire médiale: à propos d’un cas bilatéral

RésuméLes auteurs rapportent une observation de fracture bilatérale comminutive du talus associée à une fracture de la malléole médiale. Il s’agissait d’un automobiliste, âgé de 39 ans, victime d’un accident de la circulation routière. Les auteurs discutent le mécanisme lésionnel, les aspects thérapeutiques et évolutifs de cette lésion rare.AbstractThe authors report a case of bilateral and simultaneous medial malleolar and talar body fractures. A case of 39-year-old man sustained a trauma of both ankle from road traffic accident. The mechanism, management, and outcome of this lesion are discussed.

Traitement orthopédique du coude flottant chez l’enfant : à propos d’un cas

The floating elbow in the child is rare and serious. The authors report a traumatic case of floating elbow without vascular and nervous lesions associated in a 6-year-old child. We treated these both fractures of the distal forearm and the supracondylar humeral by respectively cast plaster and a collar and cuff with an anatomical reduction. The radiological and clinical results were excellent with the 29 months follow-up.

Bilateral Floating Hip and Floating Knee: a Rare Complex Injury

We report a rare complex injury of a 45-year-old man who sustained a bilateral floating hip and floating knee and hospitalised in our service six days after a traffic accident. The floating knees were open type III and II of Cauchoix score in phase of suppuration. He also presented with a floating ankle on the right side. The treatment consisted of regular debridement and an amputation at the middle-thigh of the left side. On the right side, the infection was taken care of and after conservative treatment, the knee became stiff. The authors showed the rarity of this case, complicated by amputation on one side and stiffness of the knee on the other.