Michel Mansat

A comparative study of endothelial cell markers expressed in chronically inflamed human tissues : MECA-79, duffy antigen receptor for chemokines, von Willebrand factor, CD31, CD34, CD105 and CD146

Endothelial cells play a central role in chronic inflammation: for example, they express adhesion molecules and present chemokines leading to enhanced leukocyte recruitment into tissues. Numerous markers of endothelial cells have been reported but there has been a lack of comparative data on their specificity. The present study compared the specificity of seven endothelial cell markers in the rheumatoid synovium and the colon of patients with Crohns disease. These markers were: the sulphated epitope MECA‐79, the Duffy antigen receptor for chemokines (DARC), von Willebrand factor, CD31 (PECAM‐1), CD34, CD105 (endoglin) and CD146. MECA‐79, DARC and von Willebrand factor showed a specific endothelial cell distribution. MECA‐79, which recognizes sulphated ligands for leukocyte adhesion receptor L‐selectin (CD62L), was selective for a subset of venules in highly inflamed tissue and was present in rheumatoid but not control osteoarthritic synovia. DARC was also specific for venules but had a more widespread distribution than MECA‐79, and was present in rheumatoid and control synovia. The other markers all labelled endothelial cells in venules, arterioles and capillaries. However, they also localized to other cell types. For example, CD34 stained fibroblasts, CD146 was expressed by the pericytes and smooth muscle cells of vessel walls and CD31 and CD105 labelled a broad range of cell types. Copyright

Anatomic variation of the mechanical properties of the glenoid

Finite element analysis modeling is an important tool in the design of total joint replacements. However, to use a finite element analysis the material properties of the studied bone must be known. The aim of the study was to measure the elastic properties of the glenoid bone in the axial, coronal, and sagittal planes with an ultrasound transmission technique. The relative density and Houndsfield computed tomography numbers were also assessed. Three pairs of scapulas were obtained from unembalmed human cadavers. Seventy-four cubic cancellous bone specimens of 6 mm were used for ultrasonic measurements. The study showed significant differences with anatomic location. Mechanical properties of cancellous bone were found to be higher near the direction of application of the resultant force, perpendicular to the articular surface of the glenoid. Mechanical properties were found to be significantly higher at the center and posterior edge of the glenoid (p < 0.01). Significant differences were also found in the three planes studied. The lateromedial Youngs modulus (E1) was higher than the anteroposterior modulus (E2) and the superoinferior modulus (E3) (E1 = 372 +/- 164 MPa, E2 = 222 +/- 79 MPa, E3 = 198 +/- 75 MPa).

Luxations traumatiques du genou associées à une interruption de l'artère poplitée : Étude critique rétrospective d'une série de 14 cas

PURPOSE OF THE STUDY Complex femorotibial dislocation of the knee joint generally results from high-energy trauma caused by a traffic or a contact sport accident. Besides disruption of the cruciate ligaments, in 10-25% of patients present concomitant palsy of the common peroneal nerve and more rarely disruption of the popliteal artery. The purpose of this work was to assess outcome in a monocentric consecutive series of knee dislocations with ischemia due to disruption of the popliteal artery and to focus on specific aspects of management. MATERIAL AND METHODS This retrospective series included eleven men and three women, aged 18 to 74 years (mean 47 years). The right knee was injured in five and the left knee in six. Trauma resulted from a farm accident in six patients, fall from a high level in two, a traffic accident in three and a skiing accident (fall) in one. Two other patients with morbid obesity were fall victims. Nine patients had a single injury, two presented an associated serious head injury, one a severe chest injury, and one multiple trauma with coma, chest contusion, and abdominal lesions. One patient had a fracture of the distal femur with associated ischemia. Five knee dislocations were open with a popliteal wound for three and a posteromedial wound for two. Four patients presented total sciatic nerve palsy and nine palsy of the common peroneal nerve. The dislocation was documented in ten cases: lateral (n=1), anterior (n=4), posterior (n=5). For four patients, the dislocation had been reduced during pre-hospital care. Preoperative arteriography was available for eight patients and confirmed the disruption of the popliteal artery; the diagnosis was obvious in six other patients who were directed immediately to the operative theatre without pre-operative imaging. Revascularization was achieved with a upper popliteal-lower popliteal bypass using an inverted saphenous graft. The graft was harvested from the homolateral greater saphenous vein in eight patients and the contralateral vein in six. On average, limb revascularization was achieved after 10.07 hours ischemia. Intravenous heparin was instituted for 810 days followed by low-molecular-weight heparin. The dislocation was stabilized by a femorotibial fixator in nine patients and a cruropedious cast in five. An incision was made in the anterolateral and posterior leg compartments in twelve patients. A revision procedure was necessary on day one in one patient because of recurrent ischemia; a second bypass using an autologous venous graft was successful. One other 75-year-old patient also presented recurrent ischemia on day five; the bypass was reconstructed but the patient died from multiple injuries. Seven thin skin grafts were used to cover the aponeurotomy surfaces. Mean duration of the external fixator was 3.4 months. The five patients treated with a plaster case were immobilized for 2.7 months on average. Ligament repair was performed in three patients (one lateral reconstruction and one double reconstruction of the central pivot for the two others). A total prosthesis with a rotating hinge was implanted in two patients aged 67 and 74 years after removal of the external fixator at six and seven months. Failure of the ligament repair also led to arthroplasty in a third patient. RESULTS Blood supply to the lower limb was successfully restored as proven by the renewed coloration of the teguments and-or presence of distal pulses in 13 patients. Transient acute renal failure required dialysis in one patient. Four patients developed pin track discharges and there was one case of septic arthritis of the knee joint which was cured after arthrotomy for wash-out and adapted antibiotics. Outcome was assessed a minimum 18 months follow-up (average 22 months) for the 13 survivors. The three sciatic palsies recovered partially at five and six months in the tibial territory but with persistent paralysis in the territory of the common peroneal nerve. The nine cases of common peroneal nerve palsy noted initially regressed completely or nearly completely in three patients, partially in three and remained unchanged in three. The results were assessed as a function of the final knee procedure: outcome was satisfactory for the patients with a total knee arthroplasty. Outcome of the three ligamentoplasties was good in one, fair in one, and a failure in one (revision arthroplasty). Patients treated by immobilization without a second surgical procedure complained of joint instability with a variable clinical impact; their knee retained active flexion greater than 90 degrees and complete extension. DISCUSSION An analysis of the literature and the critical review of our clinical experience was conducted to propose a coherent therapeutic attitude for patients presenting this type of trauma. The prevalence of disruption of the popliteal vascular supply in patients with knee dislocation is between 4 and 20%. The rate is closely related to that of injury to nerves and soft tissue. Ischemia should be immediately suspected in all cases of knee dislocation. The pedious and tibial pulses must be carefully noted before and after reduction of the dislocation to determine whether or not there is an organic arterial lesion. If the pulses are absent initially, they should be expected to reappear strong, rapidly and permanently after reduction. Otherwise, arteriography should be performed. Dislocation stretches the artery between two points of relative anchorage in the adductor ring and the soleus arcade to the point of rupture. Repair requires a bypass between the upper popliteal artery and the tibioperoneal trunk using an inverted saphenous graft because the walls are torn over several centimeters. The traumatology and vascular surgical teams must work in concert from the beginning of the surgical work-up in order to establish a coherent operative strategy founded on primary reduction of the dislocation, installation of a fixator and then vascular repair and aponeurotomy incisions. It would be preferable to wait until the bypass is proven patent and wound healing is complete before proposing ligament repair. This should be done after a precise anatomic work-up to assess each ligament lesion. Bony avulsion or simple disinsertion can however be repaired in the emergency setting at the time of the bypass as well as any ligament rupture which is obvious and-or situated on the medial collateral approach. Secondarily, elements of the central pivot can be repaired in young patients with an important functional demand. Arthroplasty is not warranted except in the elderly patient. Dissection of the popliteal fossa or debridement of the wound enables a careful anatomic assessment of the nerve trunks. In the event of a peroneal nerve disruption, it is advisable to fix the nerve ends to avoid retraction. Beyond three months without clinical or electromyography recovery, surgical exploration is indicated. In the event more than 15 cm is lost, there is no hope for a successful graft. Complete knee dislocation is extremely rare. It can be caused by high-energy trauma associated with several ligament ruptures, particularly rupture of the central pivot observed in 10-25% of cases with common peroneal nerve palsy. Compression, contusion or disruption of the popliteal artery is very rarely caused by the displacement of the femur or the tibia. Limb survival may be compromised. Mandatory emergency restoration of blood supply will modify immediate and subsequent surgical strategies. There has not however been any study exclusively devoted to double joint and vascular involvement. Our objective was to present a critical retrospective analysis of a consecutive series of knee dislocations with ischemia due to disruption of the common popliteal artery treated in a single center and to describe the specific features of management strategies for a coherent diagnostic and therapeutic approach.Resume Quatorze luxations du genou avec interruption de l’axe arteriel poplite ont ete retrospectivement analysees. Les circonstances du traumatisme etaient 6 accidents agricoles, 2 chutes d’un lieu eleve, 3 accidents de la voie publique et une chute a ski. Deux patientes, victimes d’une simple chute presentaient une obesite morbide. Neuf etaient mono traumatises, 4 polytraumatises et un patient presentait une fracture du femur oppose. Cinq des luxations etaient ouvertes et 13 s’accompagnaient d’une paralysie partielle ou totale dans le territoire sciatique. Une luxation etait laterale, 4 anterieures et 5 posterieures. Dans quatre cas, elle avait ete reduite sur place. Huit arteriographies preoperatoires ont ete realisees. En moyenne, la revascularisation s’est faite en 10,07 heures apres pontage poplite haut-poplite bas avec un greffon veineux saphenien. La luxation a ete stabilisee par 9 fixateurs externes femoro-tibiaux et par plâtre 5 fois. Des aponevrotomies des loges antero-laterales et posterieures de jambe ont ete pratiquees 12 fois. Deux patients ont presente une recidive de l’ischemie : un patient a beneficie avec succes d’un nouveau pontage, le second est decede de son polytraumatisme. Les 3 syndromes paralytiques sciatiques totaux n’ont partiellement recupere que dans le territoire tibial posterieur ; les 9 paralysies initiales du fibulaire commun n’ont regresse completement que 3 fois et partiellement 3 fois. Une reparation ligamentaire a ete effectuee chez 3 patients et une arthroplasties a charniere rotatoire chez 3 patients, deux en programme chez deux hommes de 67 et 74 ans, l’autre apres echec de la reparation ligamentaire. Parmi les patients traites uniquement par immobilisation, 5 se plaignaient d’une instabilite. Une analyse de la litterature et la revision critique des dossiers ont abouti a proposer une attitude coherente devant ce type de traumatisme qui reclame une prise en charge multidisciplinaire, des indications larges de l’arteriographie et doit integrer dans les decisions therapeutiques l’âge, les demandes fonctionnelles et la recuperation neurologique.

Selective capsular repair for the treatment of anterior-inferior shoulder instability : Review of seventy-nine shoulders with seven years' average follow-up

HYPOTHESIS Selective capsular repair for the treatment of antero-inferior shoulder instability gives satisfactory results at mid-range follow-up. MATERIALS AND METHODS Seventy-five patients (79 shoulders) with anterior instability underwent selective tightening of the anterior capsule and repair of any labral lesion. RESULTS At an average of seven years (5-12 years), results according to the Duplay-Walch score and Rowe score were satisfactory in 80% and 92% of the cases, respectively. Most patients (84%) were able to return to their previous sports activity at the same level, and 90% were satisfied with their surgery. Recurrence of instability was observed in 10 patients (12.6%). Restriction of motion was limited to external rotation and averaged a loss of 12.6 degrees elbow at the side, and 6 degrees at 90 degrees of abduction. Dynamometric evaluation found slight decrease in strength in internal rotation in 32 shoulders. According to the Samilson and Prieto classification, signs of osteoarthritis were present in 52% of the cases. Older age at the first episode of instability was the only factor correlated with development of postoperative osteoarthritis. DISCUSSION This study supports the results of other studies that anatomic stabilization of the shoulder demonstrates high levels of recovery of shoulder stability (recurrence rates 12.6%), with minimum restriction of range-of-motion, but with a relatively high incidence of possible development of osteoarthritis. CONCLUSION This retrospective study from a single center revealed that selective capsular repair for the treatment of posttraumatic anterior glenohumeral instability yielded a 90% of satisfaction rate and 80% excellent and good functional results. LEVEL OF EVIDENCE Level 4; Retrospective case series, no control group.

Hemiarthroplasty for osteoarthritis in shoulder with dysplastic morphology

HYPOTHESIS Hemiarthroplasty for shoulder osteoarthritis with a glenoid dysplasia gives satisfactory results at medium-range follow-up. MATERIALS AND METHODS From 1998 to 2006, 9 patients (10 shoulders) with glenoid dysplasia and osteoarthritis were treated with shoulder hemiarthroplasty. The mean age at surgery was 54 years (range, 44-73 years). At a minimum of 24 months after surgery, all patients were retrospectively reviewed with a clinical and radiographic evaluation. The average duration of follow-up was 71 months (range, 28-126 months). RESULTS One shoulder underwent revision surgery for anterior dislocation within 6 months after the initial procedure. The pain level improved significantly, with no or slight pain for 9 of the 10 shoulders. Postoperatively active external rotation and anterior elevation increased significantly, with a mean of 34.5° and 124°, respectively. The average American Shoulder and Elbow Surgeons score was 81.5 points at the last follow-up, and results were considered as excellent or satisfactory in 7 shoulders according to the modified Neer rating scale. Erosion of the glenoid was considered as slight on radiographs, and radiolucencies were seen around humeral stem in one case. DISCUSSION The opportunity of glenoid component implantation in case of anatomic shoulder replacement with dysplastic morphology has to be carefully evaluate because of bone stock insufficiency, glenoid orientation, and the age of patients. CONCLUSIONS Despite a limited number of patients in this study, hemiarthroplasty gave satisfactory clinical results in most cases. It seems to be a reliable option to treat osteoarthritis in case of dysplastic morphology of shoulder.

La fixation externe monoplan dans les fractures récentes du fémur: Étude critique d’une série de 53 cas

Resume Devant la rarete des publications sur la fixation externe (FE) dans les fractures femorales, les auteurs rapportent leur experience a propos d’une serie retrospective monocentrique de 53 cas chez 49 patients. Il s’agissait d’adultes jeunes (m = 31 ans) a predominance masculine, victimes de traumatisme a haute energie. Tous etaient polyfractures sauf 7 et 24 etaient polytraumatises. Quarante-quatre fractures etaient ouvertes (2 types I, 10 types II, 4 types IIIA, 23 types IIIB, et 5 types IIIC de Gustilo). La fracture etait diaphysaire 27 fois, et metaphyso-epiphysaire distale 26 fois. Neuf foyers presentaient une perte de substance corticale dont 4 segmentaires totales. Le fixateur axial dynamique monoplan femoro-femoral (Orthofix) a ete seul utilise. Trois patients ont ete amputes apres infection ou echec de revascularisation. Un est decede (lesion bilaterale) en raison d’un traumatisme crânien severe. Trente-huit des 53 femurs etaient alignes a 5 pres dans les deux plans et 23 etaient de longueur egale. Pour 10 patients, la F.E. a ete rapidement convertie en osteosynthese interne, et ceux-ci ont consolide en 7,4 mois en moyenne. Sur les 34 fractures restantes, 25 (17 diaphysaires et 8 metaphyso-epiphysaires) ont consolide en premiere intention sans apport osseux en 7,3 mois mais deux ont presente une fracture iterative. Neuf fractures ont evolue vers une pseudarthrose (5 diaphysaires, 4 metaphysaires distales) reprises avec succes par 5 enclouages et 4 plaques dont deux compliquees d’infection et d’une fracture iterative. Quatorze mobilisations sous anesthesie et 14 arthrolyses ont ete necessaires. L’intolerance des fiches en raison de douleurs ou d’infections superficielles a ete frequente. Au recul minimum de 1 an, la flexion active moyenne du genou etait de 90. Parmi les 34 patients evalues, 4 genoux etaient quasi bloques. Cette experience valide les indications classiques de la fixation, souligne les difficultes reductionnelles, la lenteur de l’osteogenese et la frequence des echecs de la consolidation.PURPOSE OF THE STUDY External fixation has not been widely used for femoral fractures and few series are reported in the literature. External fixation is generally reserved for severe open fractures, for vessel injury or multiple trauma with life threatening. We present a retrospective analysis of a serie treated in a single center in order to detail the indications of this fixation technique. MATERIAL AND METHODS From 1984 to Jun 2002, 49 patients with femoral fractures were treated by external fixation. The series included 36 men and 13 women, mean age 31 years. All were victims of high-energy trauma: traffic accident (n = 40), fall from high level (n = 4), firearm wound (n = 5). Multiple fractures were present in all patients except seven and 24 patients had multiple injuries. Forty fractures were open fractures: two type 1, ten type 2, four type 3a, 23 type 3b and five type 3c in the Gustilo classification. Twenty-seven were shaft fractures and 26 involved the distal metaphyseoepiphyseal portion of the femur. Loss of cortical stock was noted in five cases and total loss of a segment in four. Surgery was deferred in 19 patients, mean six days. A single-plane external fixation was used (Orthofix) with a femorofemoral frontolatateral assembly. Transepiphyseal screw fixation was also used to stabilize the distal fracture in eleven cases. RESULTS One patient with a bifocal fracture of the femur died from head trauma. Three patients required above knee amputation after failure of a vessel bypass or due to septic necrosis of the reconstruction flap. Five patients required a second reduction within days of external fixation. On the AP view, femoral alignment was successfully reestablished at +/- 5 degrees in 45 cases, ranged from 5 degrees to 10 degrees in seven and was greater than 10 degrees in one. On the lateral view, alignment was between 5 degrees and 10 degrees in 42 cases and greater than 10 degrees in one. Femur length was equal to the healthy side in 23 cases, and was shortened 1-2 cm in 26. Four metaphyseal fractures resulted in a 3 cm shortening. Bone healing time was available for 42 patients (1 death, 3 amputations, 3 lost to follow-up). Elective conversion to internal fixation was performed in ten patients (five lateral cortical plates and five centromedullary nailings). These patients all achieved first-intention bone healing with a mean time of 7.4 months. Exclusive external fixation was planned for 34 fractures. First-intention healing was achieved in 25 (17 shaft and 8 distal) without bone graft with an average time of 7.3 months. Ten patients had one or more osteitis foci on pin tracts. Two patients in this group developed recurrent fracture after removal of the external fixator. Nine fractures did not heal and required revision with centromedullary nailing (n = 5) or plate fixation with autograft (n = 4). Nailings for nonunion were successful but plate fixation was compromised by infection in one patient and recurrent fracture after plate removal in another. Fourteen patients underwent joint mobilization under general anesthesia and 14 had open arthrolysis. Mean follow-up was 2.8 years. Mean active flexion was 90 degrees (30-130 degrees). Ten patients exhibited flexion between 30 degrees and 60 degrees and 19 between 70 degrees and 100 degrees. Knee flexion was greater than 110 degrees in 15 patients. Residual 10 degrees flexion was noted in six knees. Mean leg length discrepancy was 0.4 +/- 0.6 after distal fracture and 0.8 +/- 1.3 after diaphyseal fracture. DISCUSSION The indications and results of external fixation in this series are in line with reports in the literature. For diaphyseal fractures, healing is long and difficult, partly because of the insufficient mechanical properties of external fixation. The rate of infection and stiff knee is high, particularly for distal fractures of the femur. CONCLUSION External fixation remains the only solution to stabilize certain open diaphyseal fractures or for patients with life-threatening multiple injuries. This techniques allows control of the other traumatic lesions while waiting for internal fixation. For fractures of the distal femur, external fixation can only be advocated for metaphyseodiaphyseal fractures with an intact or reconstructed epiphyseal portion.

Trapézectomie totale avec tendinoplastie de suspension et d’interposition dans le traitement de la rhizarthrose : résultats à 6,5 ans de recul moyen

OBJECTIVES Total trapeziectomy remains the main surgical treatment of trapeziometacarpal osteoarthritis. Little has been reported on the long-term results of this technique. We report in this study our experience with our technique of trapeziectomy associated with interposition and suspension tendinoplasty using the abductor pollicis longus tendon with 78 months average follow-up. METHODS Eighteen patients (22 thumbs) of 62.7 years average age underwent this procedure. According to Dell classification, there were two stage II, five stage III and 15 stage IV. Signs of osteoarthritis of the scaphotrapezoidal joint were associated in 19 cases. RESULTS At 78 months average follow-up, 73 % of the patients were painfree. Average opposition was 9.4 out of 10 according to Kapandji, the grip strength was equal to 18.5 kg and the key pinch to 4.4 kg. The quick DASH was equal to 20 over 100. Ninety-one percent of the patients were satisfied or very satisfied with the results. Space between scaphoïd and thumb metacarpal was 3.2mm and was down by 27 %. There were only two complications related to a reflex sympathetic dystrophy. DISCUSSION AND CONCLUSION Trapeziectomy associated with interposition and suspension tendinoplasty gives satisfactory functional results which are maintained with follow-up with high satisfaction rate and low complication rate.

4-Fragmentfrakturen des proximalen Humerus

Proximale Humerusfrakturen sind insbesondere bei Alteren haufig und machen etwa 5% aller Frakturen aus. In der Mehrzahl der Falle liegt keine oder nur eine minimale Dislokation vor und eine konservative Behandlung durch kurzfristige Ruhigstellung und funktionelle Ubungen reicht aus. In 15 bis 20% der Falle ist die Fraktur jedoch disloziert und stellt in der Gruppe der alteren Patienten mit Osteoporose und strukturellen Veranderungen auch heute noch eine Herausforderung fur die Therapie dar.

76 Arthroplastie de l’épaule dans les séquelles arthrosiques des instabilités

L’evolution arthrosique des instabilites de l’epaule est une notion connue. Elle survient chez des personnes souvent jeunes et actives. Le traitement se limite le plus souvent a la mise en place d’une prothese de l’epaule. Nous rapportons les resultats d’une serie monocentrique de protheses d’epaule dans cette indication. 14 patients (10 hommes et 4 femmes) d’âge moyen 57 ans au moment de l’intervention ont beneficie d’une prothese totale d’epaule dans 9 cas, et d’une prothese humerale dans 5. L’âge au moment du premier episode d’instabilite etait de 30 ans en moyenne. L’instabilite etait anterieure dans 13 cas et posterieure dans un. Le traitement initial etait chirurgical par butee dans 7 cas et non chirurgical dans 7. Une arthrose secondaire est apparue avec un delai de 26 ans. Selon Samilson, il s’agissait d’un stade 2 dans un cas, 3 dans 8, et 4 dans 5. L’usure de la glene etait concentrique dans 10 cas, et excentrique dans 4. Il existait une rupture de la coiffe dans 6 cas. L’evaluation clinique reposait sur le score de Constant et la cotation de Neer. Avec un recul moyen de 84.5 mois (48-180), les resultats selon Neer etaient excellents dans 6 cas, satisfaisants dans 3, et non satisfaisants dans 5. Le score moyen de Constant etait de 61,5 points. 72 % des patients ne presentaient aucune douleur ou minime. L’elevation anterieure progressait de 82 a 120° ; la rotation externe de -8 a 40° ; la rotation interne du sacrum a L2. Dans 7 cas, il existait une translation superieure de l’implant humeral avec un espace acromio-humeral moyen de 6 mm. Dans 7 cas, il existait une medialisation de la tete humerale avec usure de la glene dans 3 cas. Sur 9 implants glenoidiens, un lisere non evolutif etait retrouve dans 7 cas. Le taux de complications etait de 21 % et comprenait 3 ruptures de la coiffe dont une a necessite une reprise chirurgicale. Aucune recidive de l’instabilite n’a ete observee. L’âge au moment du premier episode d’instabilite, le delai entre le premier episode et la mise en place de la prothese, le degre d’arthrose, et l’existence d’une lesion de la coiffe, ont influence de maniere statistiquement significative le resultat final. Les resultats rapportes dans cette serie sont en accord avec la litterature en soulignant, a 7 ans de recul moyen, l’obtention de resultats satisfaisants dans 65 % des cas, dans ce type d’arthrose post-traumatique.

145 Triade malheureuse du coude : présentation et résultat de la prise en charge

Introduction La triade malheureuse du coude (TMC) decrite par Hotchkiss, est un traumatisme grave associant une luxation posterieure, une fracture de la tete radiale et du processus coronoide. Sa prise en charge n’est pas codifiee dans la litterature, peu prolixe a son sujet. Les buts de ce travail etaient d’analyser retrospectivement les resultats d’une serie monocentrique et de justifier notre schema de reparation chirurgicale. Materiel et Methode Entre 1996 et 2006, 23 TMC chez 16 hommes et 7 femmes d’âge moyen 46 ans (26-75) ont ete prises en charge en premiere intention. Il n’y avait initialement aucune complication vasculo-nerveuse ou cutanee. Les fractures de la tete radiale etaient de type Mason 1 deux fois, Mason 2 neuf fois et Mason 3 dix fois. Il y avait egalement 2 fractures du col du radius. La fracture coronoidienne etait de type 1 de Morrey seize fois et de type 2 sept fois. Le traitement chirurgical, realise en urgence, s’est effectue selon une ou deux voies d’abord et a consiste en une osteosynthese de la tete radiale dans 56 % ou a une arthroplastie dans 18 %. La coronoide a ete osteosynthesee dans 42 % des cas. Tous les arrachements ligamentaires ont ete repares soit 19 lateraux et 6 mediaux. Resultats Treize patients ont pu etre revuS specifiquement en consultation avec un recul moyen de 63 mois (15-128), quatre patients avaient un resultat connu au-dela de 6 mois (recul moyen de 11 mois) et cinq patients ont ete totalement perdus de vue. Tous les patients avaient un coude stable, et 90 % etaient peu ou pas douloureux. La flexion moyenne etait de 127°, le deficit moyen d’extension de 18°, la pronation moyenne de 70° et la supination de 64°. Le Mayo elbow performance score moyen etait de 87 points (75-100). Un seul patient presentait de l’arthrose sur le compartiment humero-ulnaire, 8 ans apres le traumatisme et tous avaient un coude centre sur les radiographies. Les plus mauvais resultats sur la prono-supination correspondaient aux fractures Mason 3 de la tete radiale. Conclusion La difficulte de cette pathologie reside dans la strategie chirurgicale. La voie d’abord laterale permet le retablissement de la colonne laterale de stabilite, par une osteosynthese ou par une arthroplastie de la tete radiale et la reinsertion du complexe ligamentaire collateral lateral. Une deuxieme voie d’abord mediale se justifie en cas de fracture coronoidienne type 2 ou 3, ou en cas de laxite en valgus peroperatoire persistante apres le premier temps lateral.