Total hip revision using a cup design with a peg to treat severe pelvic bone defects

When dealing with severe bone loss during acetabular revision of a total hip arthroplasty, it can be difficult to find a reliable anatomical structure to ensure high-quality primary fixation of the cup. Since 2003, we have been using an implant with a long peg that is anchored into the iliac isthmus. This structure is usually intact, even in the most severe situations of bone loss. The use of this specially designed component provides satisfactory mechanical reconstruction in cases that can be quite challenging (Paprosky and SOFCOT stage 3). The length and postoperative care for the procedure remain the same and early weight bearing is possible. The specific principles applying to this procedure, along with the anatomical features of the iliac isthmus, the implantation technique and our initial results are described in detail.

Rupture of the flexor tendons of the little finger in fractures of the hook of the hamate bone. Report of two cases

Two cases of rupture of the flexor tendons of the little finger associated with a fracture of the hook of the hamate bone are presented. The preoperative diagnosis had not been made. Excision of the fractured hook and repair of the tendons by a short graft from the palmaris longus in one case and by the transfer of the superficial flexor of the ring finger in the other case gave a good final result. The authors remark on the rarity of reports of this fracture in the literature, the frequent occurrence of nonunion and the two complications which are exceptional; rupture of the flexor tendons and compression of the deep branch of the ulnar nerve. The fracture is mainly encountered in sports that require the grasping of a handle (tennis, golf, hockey, squash). The diagnosis is often missed at the onset because of not using the correct X-ray positioning: special incidence for the carpal tunnel view and a 3/4 view with the wrist in 45 degrees of supination and forced radial deviation.

Swanson trapezial implant in the treatment of peritrapezial arthrosis. A study of eighty cases

Eighty cases of peritrapezial arthritis of the thumb treated by Swanson's trapezial implant have been reviewed by the authors. They advocate a slightly modified technique and emphasize the importance of "varisation" of the implant and of correct resection of the greater multangular bone. Follow-up was at least one year in all cases, maximum 10 years, the mean being 3 1/2 years. Results were judged as very good in 75% of the cases, fair in 20% and poor in 5%. This study emphasized the cases of failure by implant instability and its causes. In 8 cases, abnormal wear of the implant or of the scaphoid bone raises the question of long-term tolerance of silicone implants.

[Surgical treatment of recent severe sprains of the knee. Does the anterior cruciate ligament of the knee merit suturing?]

The authors have reviewed 62 cases of acute ligamentous injury of the knee, all surgically treated. They emphasize the importance of good co-ordination of muscles and ligaments in the function of the knee. The menisci should be preserved wherever possible. Direct suture of the anterior cruciate ligament gives poor results (20 per cent successful). They recommend immediate transplantation of a hamstring (semi-tendinosus) tendon by the Lindeman's technique. They conclude that the anterior cruciate ligament should not be sutured. In three cases it was resected with good results.