Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Jun 2007
Clinical Trial[Treatment of proximal humeral fractures by Telegraph nail: prospective study of 34 cases].
Many developments have been devoted to improving osteosynthesis of proximal humeral fractures, but indications remain controversial. Anterograde nailing using a locked self-stabilizing nail is an attractive conception which has provided promising results. The purpose of this study was to assess the early results observed in a series of patients treated with a first-intention Telegraph nail. ⋯ The Telegraph nail provides reliable fixation for the treatment of extra-articular and simple articular fractures of the proximal humerus. Dislocated fractures are classical indications for arthroplasty, with acceptable results for a only slightly invasive procedure. The risk of osteonecrosis does not necessarily deteriorate shoulder function and secondary revision for insertion of a prosthesis is still possible. The radio-clinical correlations show the importance of reduction quality to obtain a good final clinical result. Among the nine cases of poor outcome, six were related to a misaligned callus with persistent valgus deviation of the head (alpha F<30 degrees ) and in some cases, excessive posterior tilt. The solidity and stability achieved with the Telegraph nail enabled healing in all cases of fracture in this series with immediate postoperative reduction in most. The stability being related to the quality of bone stock, primary arthroplasty remains an important indication when it appears that a solid osteosynthesis cannot be achieved.
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Rev Chir Orthop Reparatrice Appar Mot · Jun 2007
[Computer-assisted combined femoral and tibial osteotomy for severe genu varum: early results in 16 patients].
The aim of this work was to assess radiographic outcome after double femoral and tibial osteotomy for severe genu varum. Among 197 computer-assisted osteotomies performed in our department between August 2001 and February 2006, 16 (8.1%) were double level osteotomies. ⋯ Computer-assisted double-level osteotomy is a reliable, accurate and reproducible method for the treatment of severe genu varum. The two failures observed in this series were within a tolerable range (177 degrees and 179 degrees). The use of a navigation procedure simplifies a technique which in general requires skillful application to achieve the preoperative objective. The development of this technique is important in order to avoid an oblique joint space which can compromise the success of subsequent prosthesis implantation.