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Les auteurs présentent une série de 21 poignets opérés de rhizarthrose, ayant bénéficié d'une trapézectomie avec interposition du tendon du fléchisseur radial du carpe dans la loge trapézienne. L'objet de cette étude est de valider la méthode utilisant la totalité du tendon, au vu des résultats qui pourront 8tre comparés aux autres techniques. La trapézectomie est l'alternative à la prothàse trapézométacarpienne ; elle peut s'associer à une ligamentoplastie. La technique opératoire simple et univoque est conduite avec un abord dorsal ; elle permet de laisser le tendon inséré à la base du 2e méta, empêchant sa migration postopératoire, et de combler l'espace avec un spacer volumineux. La série comporte 20 patients (1 cas bilatéral), essentiellement des femmes, d'êge moyen 64 ans, parfois opêrês à la suite de l'échec d'une arthroplastie préalable. Le recul moyen est de 2 ans. Tousles patients ont été interrogés, examinés et radiographiés ; le recul du premier métacarpien ainsi que l'angle entre 1er et 2e métacarpiens en abduction active du pouce ont été mesurés cliniquement plutôt que sur les radiographies. On déplore 2 algodystrophies responsables des seuls échecs. Subjectivement, 82 % des patients ont un bon résultat ; l'utilisation du pouce est le plus souvent normale. Le recul du ler métacarpien et l'analyse des différentes données montrent que la technique est appropriée, donnant des résultats comparables aux autres techniques. La perte de force de flexion du poignet due au prélèvement du FCR n'est jamais gênante ; en l'absence de complication spêcifique, il apparaît que cette ligamentoplastie d'interposition seule est une bonne technique, adaptée aussi à la reprise de la chirurgie prothétique. [ABSTRACT FROM AUTHOR]

The aim of this work is to show the merits of retrograde scaphoid fixation through a dorsal approach using two Herbert screws in both recent and old fractures, without the need for bone grafting. Fifty three scaphoid fractures were operated on by the author between 1992 and 2000, using a dorsal approach (mean follow-up 4 years). The time between trauma and surgery, the type of fracture, the mode of bone fixation, the time of immobilisation, and the clinical and radiological results were all been evaluated. All fractures but one united, in a mean time of 75 days. The time needed to achieve bone union increases with the delay in treatment, as does the time for clinical healing which may be as long as one year. The technique of retrograde scaphoid fixation with two Herbert screws is described, evaluated from the biomechanical point of view, and compared to other methods of fixation. In contrast to a single screw, two Herbert screws give complete stability of fixation, and guarantee a good clinical result provided the correct indications have been selected. This technique has advantages as an alternative procedure, especially in fractures that present after a significant delay, and enables one to avoid having to bone graft.

Conservative surgery of primary bone tumors, which has become possible owing to the progress made by chemotherapy, must be carcinological, and it is therefore based on a thorough assessment of local tumor extension. CT and MRI have proven their great value for this assessment. While CT clearly shows the calcified tissue and the extension into soft tissue, MRI is more effective to delineate the tumoral and intraosseous margins and, more importantly, for the exploration within bone, for which it has the advantage of making a study in all planes possible. The anatomical substrate and exact meaning of the MR signal of pathological tissue still remains to be specified. However, MRI already appears to be the essential examination for the assessment of local bone tumor extension. If it did not have contraindications, it could replace CT within the next few years.

The reconstruction of massive pelvic defects following resection for tumour or damage from major trauma presents great technical difficulty. We have used cryopreserved allografts in patients to restore the normal anatomy and avoid major resection, such as a hemipelvectomy. This method avoids major limb shortening and impairment of function which occurs after trochantero-iliac or trochantero-sacral arthrodesis. Resection of tumour must be meticulous and complete in order to achieve a sound bed for the allograft. No problems were encountered in reattaching muscle insertions to the allograft, and skin healing was achieved without difficulty in all cases but one. In 2 patients involvement of nerve roots by tumour required their resection, with paralysis of the affected limb, but the overall function was satisfactory. In 10 patients removal of the hip joint was needed, and a total replacement was undertaken with cementing of the acetabular component into the allograft. Only one patient required a further operation because of partial necrosis of the allograft. Demineralisation was noted in some parts of the allograft between 18-20 months, but did not appear to affect function.