The authors have reviewed 194 malleolar fractures. 164 cases were treated conservatively. Less of half of them led to satisfactory results. 44 cases were operated on either primitively or after failure of conservative treatment. 29 satisfactory results were noted on 33 cases reviewed after a one year (or more) follow-up. Both foci were systematically approached, including the cases where a ruptured fragment existed in place of the malleolar fracture. Important third posterior fragments were fixed by a postero-lateral approach in prone position. Usually the lateral malleoli were fixed by screwing or plating or wiring. Medial malleoli were fixed by screwing or wiring. In some cases, collapse of the tibial roof had to be treated by grafting. The authors emphasize the importance of a fair repair of such lesions which should be recognized by tomographs. Indications are detailed. In any case, treatment should be applied in emergency for avoiding early blisters.

Adult↗

PubMedDate not supplied

[Severe fractures of the lower end of the humerus in adults (author's transl)].

The authors have treated sixty six cases of severe comminuted fracture of the lower end of the humerus. Five main types have been distinguished: 1. Supracondylar fractures. 2. T-shaped fractures. 3. Trans-condylar fractures in which the fracture line is distal, detaching only the articular surfaces. 4. Diaphyso-epiphysial fractures. 5. Trans-columnar fractures similar to transcondylar fractures but with additional fractures detaching a fragment of lateral or medial epicondyle and a fracture through the trochlea separating the articular surface into two parts. Fifty-four patients were operated on to apply internal fixation. Analysis of the results based on critical criteria shows 53 p. 100 of satisfactory results. The authors emphasise the frequency and severity of damage to the ulnar nerve. They conclude that the results are better after surgical treatment than with conservative treatment which should be reserved for distal and comminuted fractures. A new type of plate has been designed to be applied and fixed to the lateral aspect of the bone.

Adolescent↗