Purpose of the study: In young adults, tibial wedge osteotomy performed for the best indications provides good results for about ten years. As these patients get older, knee arthroplasty may be necessary. The purpose of this work was to report operative difficulties and outcome after total knee arthroplasty performed in patients who had had a tibial osteotomy.

Material and methods: We reviewed 20 revision procedures where a posterior stabilised gliding total knee arthroplasty (TKA) was implanted after tibial osteotomy (closed wedge in general). There were 17 patients, mean age 71 years, sex-ratio 0.13; 82% of patients had cardiovascular histories and obesity was noted in 60%. The mean duration of the tibial osteotomy was 7 years. The mean IKS score was 31 and the mean function score 34. The patellofemoral joint presented signs of degeneration in all cases; the patella was low in 12 knees. Mean misalignment was 2 with > 10 varum in one knee and greater than 10 valgum in another. The anteromedial approach was used for 17 knees and the anterolateral approach for the other three. Osteotomy material was removed during the same procedure in five cases.

Results: There was one iatrogenic fracture of the tibial plateau with skin injury. At mean follow-up of 4 years (3–11 years), the mean IKS was 61 points and the mean function score 38. There was one aseptic loosening of the tibial plateau and one lat infection; there were 8 asymptomatic patellar subluxations and 14 low patellae.

Discussion: Tibial osteotomy with a closed lateral wedge for correction of major misalignment poses a difficult problem for subsequent prosthesis implantation. Difficulties include removal of the osteotomy material, the approach, ligament balance, and choice of the implant. Patellar complications can be avoiding by careful alignment of the height of the joint line and proper centring of the extensor system. The discordance between the function and joint score can be explained by the bilateral degenerative disease, by the cardiovascular history, and by the obesity noted in this series.

Conclusion: Tibial wedge osteotomy should be planned with the notion of possible future implantation of a total knee arthroplasty.

Purpose of the study: Echinococcosis is an anthropozoonosis with a predominantly muscular, more rarely osteoarticular, localisation. The purpose of this work was to describe the conditions of discovery, the diagnostic management, the serology and pathology findings, and the results of surgical treatment as well as potential complications.

Material and methods: We collected over a 16-year period, 14 cysts in eight women and six men. Mean age was 39 years (range 17–75) and delay to consultation was 36 months. The patients had an ultrasound (all 14 cases), computed tomography (n=7), MRI (n=7), hydatid serology (n=9) and pathology examination (n=10). All patients were treated surgically (7 complete resection); one patient was given associated medical treatment for a multiple localisation.

Results: Muscle hydatisosis occurred in all cases as a medium-sized tumour (mean 9 cm, range 5–16 cm) which was painful in half of the cases. One cyst was superinfected and one patient had a neurological complication. The most common site was the adductor compartment of the thigh (5 cases). Four patients had an associated visceral localization. At mean 4 years follow-up, one patient had a superinfection and two others recurrence at 7 and 10 months, with surgical revision and good outcome.

Discussion: The risk vascularisation of the thigh muscles explains these localisations. Ultrasound is a sensitive exploration which suggests the diagnosis in all cases. CT and MRI confirm the diagnosis and define the cyst relations. Pathology is needed for formal diagnosis. Total pericystectomy or wide resection is the best surgical technique, although not always readily achieved.

Conclusion: Muscle hydatidosis is rare. Treatment is surgical, different from the osteoarticular localisation, similar to the visceral foci. Recurrence is exceptional. Prevention remains the best treatment.

Purpose of the study: Transversal or «U» fractures of the sacrum are rare. Reported for the first time by Bonin in 1945, such fractures concern less than 1% of spinal fractures. Initially, these injuries were often missed despite their association with neurological disorders such as caudia equina syndrome. This late diagnosis is related to the context of multiple trauma and also to insufficient knowledge of this type of injury. The purpose of this study was to draw clinicians’ attention to this type of injury in order to favor early diagnosis and appropriate treatment.

Material and methods: This series included nine cases observed from 1999 to 2002. Mean age was 32 years, range 17–80. Female gender predominated (two-thirds of the patients). Six patients were fall victims, (suicide attempts or scaffold accidents). For eight patients, neurological signs involved a complete S1 or S2 caudia equina syndrome. L5 paralysis was noted in one patient due to a far-out syndrome. The diagnosis was established late in four patients, 2 to 45 days after trauma. Surgical treatment was instituted for six patients with neurological disorders diagnosed early. Treatment consisted in fracture reduction, posterior decompression and posterolateral stabilization. Intraoperative exploration revealed caudia equina contusion and compression in five of six patients with no loss of continuity. The sixth patient presented nearly complete root section.

Results: Eight of the nine patients were followed and reviewed at 2 years 4 months on average. The patient with a root section committed suicide four months postoperatively. Neurological recovery was complete for the five other patients who underwent surgery. Motor, sensorial and sphincter function and the urodynamic study were normal at last follow-up. L5 paralysis recovered last. For the two non-operated patients, only one achieved partial recovery.

Discussion: U fracture of the sacrum is a triple plane fracture which is difficult to explore with plain x-rays. In the context of a multiple trauma victim or attempted suicide, neurological complications are difficult to detect, further retarding the diagnosis of fracture. Roy Camille, Coutallier, Hessman report frequent misdiagnosis of the initial fracture and emphasize the contribution of computed tomography for correcting the diagnosis and establishing the surgical strategy. Surgery is the best option for improving prognosis, both in terms of neurological recovery and lumbopelvic stability.

Conclusion: Emergency physicians, neurosurgeons and orthopedist should be aware of U fractures of the sacrum, particularly in high-energy fall victims. A better clinical approach, particularly systematic examination of the perineum, is the key to successful diagnosis and proper orientation of the x-ray work-up to establish a positive diagnosis and improve the therapeutic approach.