Purpose: Van Den Bosch reported diminished quality of sexual intercourse in 40% of the patients victims of pelvic fractures. Using the Rosen self-administered questionnaire, five aspects of sexual activity were analysed: erectile function and orgasm, sexual desire, satisfaction with sexual intercourse and overall satisfaction. This retrospective series included patients with pelvic ring fractures in 1999.

Material and methods: The situation of 46 patients, aged 30 to 70 years was assessed with the International Index of Erectile Function self-administered questionnaire and a questionnaire concerning the patient’s status. The radiographic analysis included the Tyle classification. Associated injury to the membranous urethra were noted. Students t test was used to compare the IIEF scores in the study population and in a control population constituted for validation of the questionnaire.

Results: Forty-six patients responded (60.1%). None of the patients complained of disorders before the accident. Thirty-seven patients had sexual activities during the four weeks before responding including 11 (29.7%) with variable degrees of dyserection. Pubic dysfunction was the only factor associated with impaired sexual activity, leading to lower satisfaction and erectile function. There was no relationship between the five IIEF items and age, duration of follow-up, Tyle classification, branch fractures.

Discussion: This study is the first using the IIEF score to ascertain the degree of male sexual dysfunction after pelvic fractures. This self-administered questionnaire provides a tool adapted to the patient’s needs. Compared with the control group, we noted a prevalence of erectile dysfunction to the order of 30% with a significant diminution of overall satisfaction (p < 0.05). There was no significant correlation between male sexual sequelae, type of fracture and the notion of urethra injury. Pubic dysjunction is regularly correlated with decreased erectile function and overall satisfaction, probably in relation with injury to the cavernous bodies. Impaired sexual function, found long after the trauma (mean follow-up 26.8 years) suggests a permanent injury.

Conclusion: The IIEF self-administered questionnaire is interesting for young male patients victims of pelvic trauma, particularly in case of pubic dysjunction. Used during rehabilitation, it can identify patients with sexual sequelae (erectile function) in an overall medical and medicolegal management scheme.

Purpose: Prevention of post-trauma infections is basically aimed at streptococcal, staphylococcal and anaerobic germs. An increasing number of open fractures are however contaminated with Bacillus cereus leading to a multidisciplinary discussion involving infectious disease specialists, orthopaedic surgeons, and bacteriologists concerning the appropriate management. Bacillus is an ubiquitous genus of sporulated telluric Gram positive germs found in soil and plants. B. cereus can lead to local wound infection. This environmental (including hospital) bacterium is often a temporary host of the skin flora and its isolation can be taken as a simple contamination with no therapeutic consequence. B. cereus is sensitive to fluoroquinolones.

Material and methods: Between August 1995 and December 2000, B. cereus was isolated in 41 patients from surgical specimens taken from deep muscle and bone tissues. Ordinary medium was used for culture. Genomic analysis was used to type the Bacillus. Statistical analysis was conducted in cooperation with the epidemiology unit.

Results: In our unit, isolation of B. cereus was significantly associated with severe open leg fractures (Gustilo grades IIA and IIIB) with soil contamination. Samples were taken due to fever, wound discharge, elevation of C reactive protein despite antibiotic prophylaxis beyond 48 hours using the standard protocol of aminopenicillin + betalactamase inhibitor, constantly inactive against B. cereus. The strains identified presented different genomic types ruling out nosocomial contramination. One amputation, one chronic osteitis and one anteriolateral leg compartment necrosis resulted from B. cereus infection in this series.

Conclusion: Arguments developed here allow us to recall the importance of careful surgical debridement of open fractures and to emphasise the requirement for bacteriological samples and appropriate antibiotic therapy for 48 hours, combining, in agreement with the 1998 Consensus Conference, aminopenicillin + betalactamase inhibitor and gentamycin which is active against B. cereus. Severe open leg fractures which follow an unfavourable course should suggest possible B. cereus infection requiring early antibiotic therapy using a regimen with good bone diffusion including a fluoroquinolone which is always active against B. cereus.

Purpose: Bone remodelling and osteolysis around total hip arthroplasty (THA) is a highly debated subject in the medical literature. Such bone behaviour is poorly understood around femoral stems used in revision THA. The main problem is to obtain an objective assessment of bone remodelling and bone reconstruction over time, reconstruction techniques being very variable. Conventional radiology is insufficient, but dual energy x-ray absorptiometry (DEXA) provides a means of following changes in the bone around first intention femoral stems.

Material and methods: We studied bone behaviour around revision femoral stems using the non-cemented “P.P. system”. This type of femoral stem is implanted after trochanter osteotomy to facilitate access and stimulate reconstruction. The series included 31 patients who underwent revision total hip arthroplasty. Follow-up examinations included standard radiographs and DEXA of the operated hips, the contralateral hip and the lumbar spine. Periprosthetic zones defined by Grüen were compared with the same zones in the contra-lateral femur. Mean follow-up was six years.

Results: The standard radiographs did not demonstrate any significant change in periprosthetic cortical thickness. The DEXA demonstrated a significant an average 19.97% reduction in bone density in zones 2, 3, 4, 5 and 6. There was no significant difference in zone 7 and an increase in zone 1 (torchanter osteotomy). These figures are to be compared with the variable thickness observed for first intention pros-theses even shortly after implantation.

Discussion: Our results are the first to our knowledge demonstrating the behaviour of bone around revision femoral stems.

Conclusion: Digastric trochanterotomy appears to be an effective means of stimulating reconstruction of the proximal femur. At equivalent follow-up, the quadrangular section of the revision P.P. stem is more favourable in terms of bone loss compared with first intention stems.