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Purpose of the Study: We report the results of an experimental study designed to investigate the behaviour of two types of interference screws (bioabsorbable versus titanium) in a context of Staphylococcus aureus infection. The main objective was to study one of the possible sources of failure for the treatment of acute arthritis of the knee after arthroscopic reconstruction of the cruciate ligament., Material and Methods: We used six interference screws made of titanium and six bioabsorbable screws (PLLA-PDLLA). All screws measured 9mmx25mm, were cannulized and sterilized. These screws were submitted to a protocol elaborated in cooperation with the bacteriologists. After contamination with a strain of S. aureus, the screws were washed four times in saline solution to eliminate germs adsorbed in the aqueous phase. The last step was trypsination to detach germs remaining fixed onto the screws and contained in the biofilms of glycocalix. A germ count was made after each step. For each screw, we determined the difference (Delta) corresponding to the number of germs really adherent to the screw. Mann-Whitney analysis was performed., Results: On average, the germ count in the aqueous phase was 0.0855.10(5)/ml for the titanium screw versus 0.223.10(5)/ml for the bioabsorbable screw. The mean count of germs fixed in the biofilm (mean Delta) was 17.695+/-3.88.10(5) for the titanium screw and 45.86+/-3.61.10(5) for the bioabsorbable screw. The difference was statistically significant (p=0.0039)., Discussion: Our experimental results support the efficacy of abundant arthroscopic lavage in a context of infection, confirming the results of very recent studies. However, irrespective of the type of material used, bioabsorbable screws are more prone to persistent microbial adherence than titanium screws. It is hypothesized that the hydrophilic, more porous microstructure of bioabsorbable screws favors bacterial adherence. In practice, this implies that arthroscopic washout must be as abundant and as complete as possible, yet may not be sufficient to clean the entire surface of potentially contaminated screw positioned deep in a bony tunnel.

The tibial valgus osteotomy whatever its technique has a survival rate of about 85 % to 10 years, if we consider the reoperation as a criterion of failure, with a confidence index at 78%. The age, weight, sex and functional signs have no impact on the outcome. We have found no evidence in the preoperative radiographic assessment, neither the medial pinch, or varus epiphyseal neither varisant gap, which could be a failure and a reoperation before the tenth year. Good results were observed significantly when there is an over-valgus at least 3 degrees of global axis of the lower limb. This corresponds to a valgus epiphyseal by more than 2 degrees . The substantial reduction in the gap varisant that lowers the overall time varisant below 200 kg cm provides the same positive results. The outcome will depend directly on the accuracy of the calculation of the preoperative correction performed and the quality of surgical achievement. Because of the need for precision, navigation technique appears as reliable, simple which makes it also possible to monitor the front slope and tibial rotation induced. The osteosynthesis must be stable and rigid to avoid postoperative loss of correction.

Purpose of the Study: We report our experience with vascularized fibular transplant using the technique described by Urbaniak for the treatment of avascular necrosis of the femoral head., Material and Methods: Sixteen patients, mean age 39 years 4 months at surgery, were evaluated at mean 3 years 6 months follow-up (minimum 15 months). Mean pain score (analog visual scale) was 6.25/10. Mean Postel-Merle-d'Aubigné (PMA) function score was 12. The Ficat classification was grade 2A (n=9) or grade 2B (n=7)., Results: There were no cases of infection or migration of the fibula. The only complication at the donor site was one case of paresia of the long extensor of the hallux which resolved spontaneously. There were five failures which required a hip prosthesis (31%). Three failures occurred early during the first 18 months. Two were late. These patients had grade 2B (n=4) or grade 2A (n=1) necrosis. At last follow-up, eleven hips had not required prosthetic revision (69%). The pain score improved in 81% of patients: mean score=2.3. Nine patients were satisfied or very satisfied (81%). Among these eleven hips, function was good or excellent in eight (72%). Walking distance was improved in nine patients, unchanged in one and worse in one. Joint motion improved in nine patients, was unchanged in one and decreased in one. Nine patients resumed their full-time job. Mean sick leave was 13.3 months. Radiographically, only two of the initial Ficat grade 2A hips remained at this stage. Likewise only one of the three hips initially rated grade 2B remained at this stage. Overall radiographic results were: failure (n=5), worsening (n=9), stabilization and no improvement (n=2). Among the nine 2A hips, one was converted to a total hip prosthesis and five femoral heads remained spheric. Among the seven 2B hips, four were converted to a total hip prosthesis and two femoral heads collapsed., Discussion: At mean follow-up (3.5 years), 69% of the hips had not required total hip arthroplasty. The grade 2A hips did better but the small sample size did not allow statistical comparison. There was a clear discordance between the clinical presentation and the radiographic findings among the hips which were not treated with a prosthesis: good function score, maintained occupational and daily life activities contrasting with unfavorable radiographic evolution. Results could be improved by detailed quantification of the lesion using 3D imaging and by associating intraoperative navigation.

Complete resection of the trapezium combined with interposition and ligament reconstruction with flexor carpi radialis remains the author's preferred method thumb basal joint arthritis the surgical treatment. Elevating half of the tendon takes a long time and is not so easy to perform. Using palmaris longus tendon with a fragment of muscle seemed to be more practical and quicker. It allowed simultaneously stabilization (tendon part) and an effective interposition (muscle part).

Unlabelled: In the treatment of multiple recurrences of carpal tunnel syndrome due to fibrosis, following repeated nerve release, the authors propose interposition of a composite dermal fat graft raised from the inguinal region, and report four clinical cases using this technique. The objective of this study was to evaluate the efficacy of the graft in terms of clinical and electromyographic results and determine the course of the graft by a postoperative MRI study and a longer follow-up., Clinical Results: Nocturnal paraesthesiae resolved in 2 patients, was improved in one patient and remained unchanged in another patient. Objectively, neurological examination showed improvement in 3 cases and no change in 1 case. Electromyographic results: At last follow-up, EMG was improved in only one case. Magnetic resonance imaging: MRI visualized the graft with a fat signal on T1-weighted sequences in every case, with an increase in size over time in 3 cases. The efficacy of the dermal fat graft may seem disappointing, as none of the patients were cured. However, with a mean follow-up of more than two years, we have not observed any deterioration of the clinical features, and no surgical revision for carpal tunnel syndrome. This technique appears to increase graft survival, as the blood supply to the subdermis is restored more rapidly via the dermis, which is anatomically a very vascular tissue. There is nevertheless a discrepancy between the clinical results, and EMG and MRI findings, which could be explained by the anatomical lesion of the median nerve, surgically released several times, and by alterations of the perineurium.

The distally based lateral supramalleolaire flap with a retrograde blood flow on the perforating branch of the peroneal artery is a good flap to treat loss of skin involving the ankle, the region behind the Achilles tendon, and the foot. Based on the results of an anatomical study, the authors describe a modification of this flap which can be raised on the infero-lateral collateral artery, with an anterograde blood flow. In fact, clinical experience of six cases shows that vascular pedicle component (perforating branch of the peroneal artery, infero-lateral collateral artery) and blood flow (anterograde, retrograde) can be calculated according to the regional vascular network, arc of rotation and the type of flap. Because of the many possible combinations, it can be considered to be a flap with variable vascular pedicle raised "à la carte". However, according to our clinical cases, the anterograde blood flow does not seem to have resolved the problems of venous congestion of this flap.

Kirner's disease is a rare deformity of the distal phalanx of the little finger, with a combination of camptodactyly and clinodactyly and clinodactyly. A review of the literature and analysis of our cases show that this anomaly appears to result from a unusual insertion of the deep flexor over the growth cartilage. No treatment is required in view of the absence of any clinical and functional symptoms.

From January 1988 to May 1991, 30 patients (mean age: 27 years old; range: 15 to 45) sustained 57 tendon injuries in 49 fingers. They were treated by primary repair with assisted post-operative mobilisation by a dynamic splint. Adhesion of extensor apparatus rate was 12 p. cent but only one had a functional impairment. No other complications were noted. At the thumb level (3 out of 49 fingers) the Kapandji-test was respectively at 8.8 and 9/10 without any extensor lack. At the long fingers level TAM was excellent in 91 p. cent of cases, good in 4 p. cent, fair and poor in 2 p. cent. According to Allieu classification results were good and excellent in 9 p. cent of cases. These results were better when injury was localised to or up to zone 5 according to Verdan's classification, and when there was no associated bone nor articular injuries or cutaneous defects. Subjective results were less good (70 p. cent of satisfactory results) because of pain, grip strength lack or disability. Assisted mobilisation allowed intrinsic healing and avoided adhesion when application date and rehabilitation protocol were respected. It was more beneficial for distal and complex injuries.