Relation entre le taux de 1,25-dihydroxycholécalciférol et le pronostic fonctionnel après une fracture de hanche chez les personnes âgées

The present treatment of a fracture must allow an anatomical consolidation and an ad integrum functional recuperation. An osteosynthesis giving immediate stability allows for an early rehabilitation, articular and muscular. However, it modifies the biological and mechanical conditions of the spontaneous bony consolidation and determines limits to the physiotherapy according to the type of the fracture, the type of the osteosynthesis and the degree of evolution. A poor osteosynthesis and/or a maladjusted rehabilitation exposes a pathological consolidation.

Évolution chirurgicale de la myélopathie thoracique secondaire à l'ossification des ligaments jaunes

Calcification of the cervical ligamentum flavum is a rare entity observed exclusively in Japanese people. We report a new case in a 65-year-old man from Tunisia who presented with symptoms of cervical myelopathy with mild tetra paresis, sensory abnormalities and dysuria. Magnetic resonance imaging (MRI) showed a posterior compression of the spinal cord at C3-C4. CT-scan showed a calcification of the ligamentum flavum at level C3-C4, compressing the left postero-lateral aspect of the spinal cord. C3-C4 laminectomy was performed with removal of abnormal ligamentum flavum tissue. The postoperative course was uneventful and all symptoms resolved.Calcification of the cervical ligamentum flavum is a rare entity; the diagnosis is easy but the pathogenesis remains unclear. Literature regarding this pathology is reviewed.

Démarche d’assurance qualité en chirurgie ambulatoire de la main

Postoperative rehabilitation is a multidisciplinary program that requires participation of anesthetists and surgeons. The development of laparoscopic surgery is one of the components of this program. Rehabilitation requires effective analgesia avoiding the administration of too much opiate because of their side effect on the digestive tract. Postoperative-epidural analgesia with local anesthetics significantly shortens postoperative ileus, but intravenous infusion of lidocaine should have the same effect. The main objectives are reduction in postoperative morbidity and shortening of hospital stay.