Dr BERNARD de DOMPSURE Régis

Objective: The aim of our study was to evaluate screw placement accuracy, safety, complications, and clinical outcomes including functional and pain score, in 32 patients treated with CT-guided pelvic ring fixation after high-energy trauma.

Materials and methods: Consecutive patients who were treated by CT-guided fixation of sacral or acetabular fractures after high-energy trauma were included. All procedures were performed under general anesthesia, with dual CT and fluoroscopic guidance, by interventional radiologists. Fractures were minimally displaced or reduced unstable posterior pelvic ring disruptions, with or without sacroiliac disjunction (Tile B or C) and minimally displaced acetabular fractures. The primary outcome evaluated was screw accuracy. Secondary outcomes included patient radiation exposure, duration of the procedure, complications, clinical functional score (Majeed score), and pain scale (VAS, visual analog scale) evaluation during a follow-up period from 4 to 30 months postoperatively.

Results: Thirty-two patients were included (mean age 46) and 62 screws were inserted. Screw placement was correct in 90.3% of patients (95% of screws). Mean procedure duration was 67 min and mean patient radiation exposure was 965 mGy cm. Mean follow-up was 13 months and no complications were observed. The mean Majeed score at final follow-up was 84/100 and the mean VAS was 1.6/10.

Conclusion: This technique is an effective and safe procedure in specific cases of pelvic ring and acetabulum fractures. It allows accurate screw placement in a minimally invasive manner, leading to effective management of poly-traumatized patients.

Key points: • CT-guided pelvic ring fixation, including sacroiliac and acetabular fractures, is an effective and safe procedure. • It allows accurate and minimally invasive screw placement, leading to effective management of poly-traumatized patients. • Multidisciplinary cooperation is essential to ensure efficiency and safety.

Clostridium indolis is an anaerobic spore-forming Gram-positive bacillus belonging to the Clostridium saccharolyticum group. Its clinical significance in human remains poorly known. We describe the first case of osteitis related to C. indolis, identified by MALDI-TOF mass spectrometry and provide a literature review of human infections related to C. saccharolyticum group species.

Introduction: Controversy continues around selecting the best strategy for managing nonunions of the humeral diaphysis. The objective of this retrospective study was to analyse the results of management of this complication using a uniform surgical technique.

Hypothesis: The rate of union obtained in the present series is comparable to the results reported in the literature.

Patients and methods: Twenty-one patients were surgically treated at the Geneva University Hospital for nonunion of the humeral diaphysis between 1995 and 2005 with a mean follow up of 50 months. Open reduction and internal fixation in compression using plates and screws with autologous bone graft enhancement was used. Eight cases were revisions of nonunions following a closed orthopaedic treatment and 13 cases were revisions following a failed surgical treatment.

Results: All the patients obtained union within a mean 4.5 months. The functional scores for the shoulder (Constant) and the elbow (Mayo) were 77 and 97 points (mean), respectively.Two patients developed transient paresis related to radial nerve and musculocutaneous nerve injuries and one had a recurring fracture. A single patient required a second intervention for delayed union.

Discussion: Of the surgical techniques for managing nonunion of the humerus, plate osteosynthesis is the most widely used. This simultaneously allows anatomic reduction, fracture compression, and osteogenesis stimulation. However, it can lead to infectious complications(although absent in our series) and neurological complications (10% transitory paresis in our patients).We report 95% rapid union in our series. Other techniques such as intramedullary nailing and external fixation do not provide equivalent results, and this is in agreement with the data found in the literature. We therefore recommend using compression plate fixation associated with autologous bone graft for the treatment of established nonunion of the humeral shaft.