PLAN
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
9 9 99 <1 <1 9 99 &&'- &&'- "# <( <( 9&+D 9&+D <( <( $9&0 9&0 << << 9&:%& 9&:%& <= <= 9& 9& &%&'#.&# <= <= &&%&%- %!"# %!"# =, =, 9&*%&%- 9&*%&%- %!"# %!"# =, =, $ $9&&% 9&&% = = #. # #%& = = )&&.# =) =) %%&2 %# % =) =) &&! %#"# "# = = 9&%.'+%5 9&%.'+%5 ' = = $9&-% 9&-% *&!E =7 =7 9&- 9&- %& = = &2# = = )# %! = = %.#0 =1 7#'%! =1 =1 %'# =( =( / / #%2&&& =< =< 9 == == 9 9,, 8; $$8; $$8;,, ) )
INTRODUCTION 1
[2] [21]! " # $# [16; 34; 46] % &'(') *+*! # [26] 2
RAPPEL ANATOMIQUE 3
Vue superficielle du pli du coude Vue superficielle de la région olécranienne 1- Saillie bicipitale. 2- Saillie épitrochléenne. 3- Saillie épicondylienne. 4- Olécrane. 5- Epitrochlée. 6- Epicondyle. 7- Gouttière olécranienne externe. 4
1,' - $ $. $.-[8] (figure 1) # " / / 0 # 1 " 2" - 3 "! 4!!! 4/5 6! 4 6 7#6 2"8-9 "!4 4 6 4 6 6 :! -. - ;! 0< 4 06 "4 6- & # 5
=>2$?)2@32>@2 =>2$?)2@32>@2 =>29'&)2@32>@2 =>29'&)2@32>@2 "/ / ) A 2"B 2" C ( "D ( ï + ( $ $ 46 6 6
; $ - -[7]! A - A -! E -4/6 4/6! - 2 A - # )- 2 B,C 5 "! 2 4 06 - & F " G!F! H # 406-2 F 7
4/6 8
! - 04 6-2 0! H 046-2 - F! "! F! - 2 "+I "! & 4 6 F # 406 9
/,. "-4A6[7] $ - (!F F 2#- %7 - # " %7-0 # %7 - F H! ; - "! "0 0 F! H A - 9. "!F 10
/. A. B. C )D 90 4A6 11
! A! 0 " 0 " -! F A!- ( - " 0 ( "- " 0 /! ( - # "! "- @H! "!- $ -! 0 9-3- 12
A, -[32]. - -4B6 3 A- > "- # - ; ; > - C!- >- @ J 9 >!#- > "- B -!# 13
2 " # K # K " # K # K! #! -4C6 & - L"! F L!!- " L!!! 14
FIGURE 4 : VUE ANTERIEURE. FIGURE 5 : VUE POSTERIEURE. 1- Muscle biceps brachial. 2- Muscle long supinateur. 3- Muscles épitrochléens (grand palmaire, petit palmaire, cubital antérieur). 4 Rond pronateur. 5- Veine céphalique. 6- Veine basilique. 7- Muscle triceps. 8- Olécrane. 9- Epitrochlée. 10- Nerf cubital. Les rapports musculaires de la région du coude 15
/ =!-4(D+I 4(D+I*6 *6 % - % # - M # - ( F #! # # M - M- # #! 0 % # - 9 # $ H! - - #! 16
=>2$?)2@32>@24(D6 =>2$?)2@32>@24(D6 =>2. 2%3$24(+6./. A?B B $ # C $ #D = +? I. * 'N 2! 17
=>2$)2@$2 =>2$)2@$24(I6 4(I6 =>2$)2@$24( =>2$)2@$24(*6 *6./. A? B? C.! 18
! 19
ETUDE BIOMECANIQUE 20
$ 3 - # #! F - ; ; -[29] - "!! "!! - - "! :" DN F F!! $! H! & H! # H $!! F # 21
/!!, -!! -! "! # "+N!!# F #! 2 #! F! " 0!! # $!! CO! H! CO -! H H! DOFNO! 22
( -[29]!! M& - 7 H # H!# 4C 6 0 FDC M& - & - F CC F*NO! AN! :! F+NO 2 ANO!.$!# H # H.$ H " & - -!!!0 2 H 23
$! 4 "! "! 6 & -! & - 2 "! & - - H 3 DN P H % - [29]!-! - -! - 7! #! H -!& 24
! - -! F " - 25
EPIDEMIOLOGIE 26
$,$ - F 1 [21 ; 46; 37]!- /N AN F - - # CN IN P1 ;,&!-!!,7-3 7 %,. - - F "!- " " -7"0Q R 1. [37] S & ANO! H "< 27
ETUDE ANATOMPATHOLOGIQUE 28
$,3 - " # F" # # 2 " " # - @ @ ' )$ 4$$'&6. T $UV $' ;, @ @ -4 "6[24] (figure 10) )"3- )"33- )"333- )"3=- 2 $$'& "- )"3- )"33-, )"333-29
)"3- )"33- )"333- )"3=- @ @4N6 [4] 30
46,. T $UV4$'6-[13]46 46,(! 4 "$6- $ $- " $/ $/- " $A $A- " /,( "4 ";6- ;- "4 6 ;/ ;/- " 4 6 ;A- 4 6 A,( "4 "6- - WXYW)Y / /- " A A-, 31
Fracture A1 Fracture A2 Fracture A3 Fractures extra-articulaires ( type A) fracture B1 fracture B2 fracture B3 Fractures unicondylienne ( type B). T $UV46 [13] 32
Différents types de fracture B3 Fracture C1 Fracture C2 Fracture C3 Fractures sus et inter-condyliennes ( type C ). T $UV46 6 [13] 33
%,? G-[10] (Figure 12) 2( &'(')*+*2 - - &E" & " F - (! 4" 6 (! 4"6 ( 4" 6 ( 4"6 F - ( ( 0 4S& 6 ( "4Z6 34
Fracture supra-condylienne fracture du condyle latéral et du condyle médial. sus et inter- fracture sus et inter- fracture diaphyso-epiphysaire. Condylienne simple. condylienne comminutive. &'(')4/6 [10] 35
Fracture dia-columnaire de face et profil. Fracture dia-condylienne de Kocher de face et profil. Fracture de Hahn-Steinthal de face et profil. Fracture du capitellum de face et profil. &'(')4/6 [10] 36
2,.. -[40] (figure 13) "- ( W)Y ( W)Y ( WXY ( WSY ( ( $. T $UV4$'6 P F! H 37
Fracture haute en T. Fracture basse en T. Fracture en Y. Fracture en H. Fracture en lambda Fracture en lambda latérale. médiale... (figure 13) [10] 38
ETUDE CLINIQUE ET RADIOLOGIE 39
3,2 -[22 ; 18],3 - E$! ES - [) F 4 6- [ - 1 E9 7 E& - [% " 7 # " E& F S /,2!",2!"- E- - [!!& # #!E" 1?! #! E!4(B<C6 % #! < E - [ " H 40
'# 4B B6 [18] $ #!?! #!4 #!4C C6 [22] 41
H 2! [' 4 "! 6 EJ- J- 3 F 33,2 -[15] 3 " 4(D6 3! " % F 3!! 42
Figure 13: Incidence de face. A. Position. B. Résultat. Figure 16 : Incidence de profil. A. Position. B. Résultat [15] 43
TRAITEMENT 44
3,3 - #!! # " #! & " # 33,; - @ ' " # 333,. "- - $,) -[35],3 1 - & 1 F*N5! D2! " " 1 2! 45
/,@ -[4] 11 D - " ;,) -,,3 -[17] (Figure 17) #2 *N5 F # F " H %! - /,=-[17]! " /,=,= -[17; 38; 10] " # 2 ' - - 46
3 3 3 3 " 4+ +6[17] 47
! - L9-4 6 L9! /,= -4(I6 4(I6 2 2 F! / / /,= -4(*6 4(*6 2 2 F 2! / A,= - 3 " " " # 48
= 4I6 4I6 = 4*6 4*6[17] 49
P! H " # " # / B,= - 2 H FF % F W! "Y #! # &" % F4Z6;". "#! $! F # # 3 / C,= -4(/N6 4(/N6 H 2 4 6! 4 6 50
= - 4/N6 4/N6 = - 4/N 51 /N6[17]
/ D,= - -4(///6 4(///6 H =>!&" / +,= -4(/A6 4(/A6 9 - # / I,=! -4(/B6 4(/B6!! "!!! 2 / *,= -4(/C6 4(/C6 F F 4 0 6 H F 52
) =4/ /6 & 4// //6 6 = 4/A6[17] 53
= =! 4/B6 = 4/C6[17] 54
/ N, -!! ACBDC+ Tableau : Avantages et inconvénients des grandes voies d abords postérieurs du coude. [17] 55
/ /,= /,= -[17; 38] (Figures 26, 27, 28,29) 2 H F" 2 H - "4 6 #4 6-2!! 4Z6! F " 2! 4 6 $4;"6 2! F F A,=-[17; 33] (Figures 30, 31, 32) / A,= 2 -! - " "! 56
3 4/D6 6 [17] = 4/+6 4/+6 = = 4/I6 =;"4/*6 =;"4/*6 57
=\ 4 6 58
> 59
3 4AN 4AN6 6 % 4A A6 6 = "4A/6[17] 60
/ B,= B,= -[17; 38] (Figures 33, 34, 35)!!!! ) - = S" = = / C,!-[13; 17] ) " F! ) F! - = = " = 61
3 4AA6 [17] = 4AB6 =S"4AC6 =S"4AC6 62
A,@ " #- - 3! " # A,2- [10]4(A*6 Z F! " # 1 2 "" H " FH! A /,' " # /,' " #-[49] (Figure 40) =F # H "!. # C/" H A A,' " # A,' " #-[34 ; 36 ; 48] (Figures 36, 37, 38) 9XWY 9 " - 2 # & # F!! ",A 63
9 4,A 6-2 H F! 9% $'-F F H F A B,3 -[10] 9 " "! 9 "" 9 4 Z6 "S " # 9 # 9! " " #F "!!!![12] 64
Figure 36: Plaque pré-moulée de Lecestre- Dupont. [30] Figure 36: Mise en place d une plaque Lecestre lors d un abord postérieur. [30] 65
(A+ (A+-9-9 [2] Figure 38: F H F H [30] Figure 39: Embrochage [20] Figure 40 : Vissage [20] 66
B,@ -[28 ; 39 ; 41]! " # F"!, F" F H "! " #)!F]")F C,$ -[3] & # F., -[47] ] # " # 2 B # # # 2!! )! 2 " AFB 1 67
EVOLUTION ET COMPLICATIONS 68
$,2 - BCFDN 3 "- ) ;, -, -, -[50] 33 333! %] # " /,- [50] 2! # P A,- [50] 2 22&)@2 [35] H "! 69
B, - H "! "! H [11 ; 37] /, - /,J- #- -[13] 3 H %# " H # 3 G / /, -[10] 9 F F " 496! F!! 70
#- / A, -[10] % / B,% - 2 ' " # # ] 4 B 6 A, - A,@-[1] 2 2 H -[9] )" - " 1 > ] )" - "! "! 71
' - 3 H " FG ". "-!! <NNO[6] A /,9 -[26] # " " > % " " # "F % 1 # H A A,!-[13] 3!!W Y!! "3 F! A B,JH -[13] 2 2 H. 72
PATIENTS ET METHODES 73
! "##$! "##%& ' ' ( ) &* +),-. '/ 0 12 ( & *$ (!3456& ) 78 9 7 0:) 0 ' 0; 0 < 9 = 74
4-0>0"0?>?"? >" * * + )9, : * * 4 9 ;. 4-- : 0 6 4 6 4.? '- ' 75
RESULTATS 76
9 ( 00 0 *@ >%A# -. >B &* - @ CBA> "DA> & *. E @&+>, >6 F@ nombre de patients 16 14 12 10 8 6 4 2 0 17-26 26-35 35-44 44-53 53-62 62-71 71-80 Age 77
?:) :) "" >> &+", Hommes Femmes 33% 67% " )& 3 D%G G & < *< <DCG&+, Gauche Droit 36% 64% < & 78
9 *( %HG0;>"G HG&+C, Chute AVP Agréssion 12% 9% 79% C 6 5 ( ( 0 0I '/& 4- ( 7. ( 4-0) >> &CG 4-? H "%&"%G 4- - > H&HG I - ( H&HG - &CG ( ("%&"%G& 79
?0 ( ( Type anatomopathologique 9 8 7 6 5 4 3 2 1 0 A1 A2 A3 B1 B2 B2 C1 C2 C3 I ( - ( - %& * >* * * ( ) )( )& * )9& 5 >> +&G, :B& :D& 80
"* 7 >->.& * * 7 > - J& ) "& & *) C- - 4 @ >& 4 4 09 * >">E - D&CE& K$ +-,&?4-4- * & ;. ;. * "C 0 >D& 5)A& * H& I (. %"&%"G& 81
9'- '- - : '- 7. ( (*55:465 D >A&>AG (*55:465L (*55:465L. 5. ; 5.L (*55:465L. L D >A&>AG " D&#DG ># #&#G H&#HG B >B&>DG > &#G *- ) (*55:465 +., CB&CBG. #&#G ( (H&#HG & * (*55:465 ( - %&G((. M B#G C#G.& 82
4-4-0 4-? 4- (*55:465 C >> 5. C B > ; > " 5.+ " " > 4.'- - (& 5: >: : *.-) - ( & 3?0? & "6 6 9. " & ; ; > 9.>& " ". & 9 D>A&>AG& C) ) I )& 83
;6 6 0 ;. $. ) ) &7! 4. & 9) <>B8& ) >>"#8&? N(& 9) <#8& ) >>>#8& 0. 9$& 9) <CB8& ) >>##8& ' ' 9LLL 9) >CB8& ) <>##8& 84
?6 6 * J(" ># & :". 5 7. ( 4. B ">&%CG? % #&CG 0. C >%&C#G ' % #&CG I ( ( #&CG K & 85
DISCUSSION 86
9 ( 0: : @ : 7. 0 -. 6IN35:OCD CDP B# C% 0!06757OC" C"P "> CC&C 5*0=5O"# "#P BB CC&% 60==0?OC CP "H > *099O> O>P B# "A&AD 7 &>B *@ -.$ @ - & )( @ - DB (BG ( >BDC DG ()(@ -.E & 87
?: : ) : 7. +G, +G, +G, +G, 0!06757OC"P "> A&>#G D#&H#G 56I7O">P BH BH&"G C#&DAG 6IN35:OCDP B# BDG CCG 60==0?OC CP "H %B&ADG "C&>CG *099O> O>P B# A"G >AG 7 D%G G 7 ( & M ))( & 9 D%G&9 J 60==0?A"G%B&ADG*099&JK $ +0;,( ( EE ) & 88
: : < : 7. <+G, <+G, '0735993O%P # BD&DDG C&CG 0!06757OC" C"P "> C"&ADG B%&>CG 60==0?OC CP "H %"&C>G "%&BHG *099O> O>P B# D#G C#G 7 DCG DG * <& I ) & 5 < ( ( ( ()<& 9: : 7. 5 0;0 5*0=5O"# "#P BB " "H 56I7O">P BH B "C 60==0?OC OCP "H >% B D *099O> O>P B# >" B 7 "D C 89
5 ( $& ( ( & 9 ( ( 0: : - ( ( : 7. 4-0 4-? 4-9306O>H O>HP >"&>"G D&I%G A>&A>G?6OBP C B&AAG "D&CAG D%&DCG 60==0?OC OCP "H >&#G "%&BAG C>&%G *099O> O>P B# "#G "G CDG 7 &CG "%&"%G H&HG I ( - +-, ( - +- 0,+-?,& 0 ) - H&HG. - &CG ( "%&"%G& 90
?: : >I I : 7. I (?6OB OBP C B >BG 0!06757O OC" C"P "> H CG 56I7O"> O">P BH >D "%G 60==0?OC OCP "H " %G *099O> O>P B# C AG 7 >> &G * ( ) )( )&5 -(- )( & I ( ) & J)( 56I7 0!06757( 0;" 60==0? K$0;& 9 0;+C, +,( "D ( C& 91
"* * : 7. 0 0!06757OC" OC"P "> 56I7O"> O">P BH B 60==0?OC OCP "H > *099O> O>P B# > 4- > ". >. >. > >. > 7 " >. *. K $ (( ) - & 7E ) ( " ).& 4. & * * : 7. 0 ( 67=OCBP "> >C&"G 56I7O"> O">P BH C D&A#G 60==0?OC OCP "H >> AG *099O> O>P B# A >DG 7 ># &G 92
I ( E ( $ ( ( &. J)(. & 9 ( 0: :. : 7. *( 5*0=5O"#P BB HA&>AG 56I7O"> O">P BH AH&AG 60==0?OC OCP "H H>&DDG *099O> O>P B# DCG 7 %"&%"G (. & *) K$.. & 93
?: : - : 7. ( * 5. 5.+ '0735993 5993 O%P # DD&DDG "B&H"G %&CG >>&>>G 60::OCC OCCP D ">&>G "D&""G C&C"G >A&#G 60==0? OCP "H C>&DDG "H&>DG >"&BG A&G *099O> O>P B# C#G >CG DG >#G 7 CB&CBG #&#G H&#HG >B&>DG 5 - $ ) J. ( & ( * E( & ) ( *55:465+., CB&CBG.#&#G( ( H&#HG& 94
: : > : 7. 7. ( 0!06757OC" OC"P "> > C&%DG 5*0=5O"# O"#P BB B H&#HG 60=0??OC OCP "H >#&CG *099O> O>P B# C AG 7 > &#G I. & JK!3456O"%P*0::5O>CP (- + ( - (,& 7 ). & "7 7 * (.( ". 5*0=5O"#P A.67=OCBPB.& * 60==0? *099 & *.$ (. &*.& * - $.& 95
) ) 7 60==0? *099 67=5*0=5 )& ( ( ( (& C : 7. 67=OCB OCBP "> # 5*0=5O"# O"#P BB " 60==0?OC OCP "H I *099 99O> O>P B# > 7 # *.. & 3. & 0 & 96
B6 6 : 7. 7. ( 67=OCB OCBP "> # 5*0=5O"# O"#P BB > "&DG 6IN35:OCD OCDP B# A >DG 60==0?OC OCP "H # *099O> O>P B# C AG 7 D >A&>AG * ( E. D ( >A&>AG( ( & * (. &O"#P 97
;* : 7. 4-6 6 ) Q. '- Q 0!06757 OC"P ">! BB&DG CC&CG '0407 O"BP >%. A"&BG >%&DBG 6IN35:OCDP B# '- DBG BG 56I7O">P BH! %"&HG "%&>G 60==0?OCP "A '- D#&%>G H&"HG *099O> >P >" * AG >%G 7 "! B"&>%G C%&AG -.& 9. DH&B% G ( J (.. & * ( #&CG ( & 98
CONCLUSION 99
* (.( & * - ( & ' F ( ) (.F( &*. F. (.. F.$ & 100
RESUME
! " #$$%! &'()**+,()**-++. / ++ 01-"2* 34 5 6-7 4-87! %9:; <*7 /# <=7 #>! =)7 (?&> 012734@ 0+734@0+73 0+73 5 4,
%A > @// > / B& B ; BC @ /"/#$$%! &' (/)**+(/)**-++ > ++/ 01-"2*/ 34 5 6-7 4 B / -87 ; %9:; / B<*7 # > B B<=7 /#> : B /B=)7/ (?&> > / B012734 0+730+73 0+73 > B /B// >BC B4/ @B
"! # $%&'()*+,'+ -.*! /% 0 12 34 "56-78 0,.%9: ;9 -. <=%> 9?@2 16 > E$ F>G H' F.*$%7 AB) CD- '+7 "KK IJJL-/*%IJJK-/H H VUL T+G @ > S/9 RJQPLO /9 KK M+*D-7 H9 N9% "VL_/ 9HWX%YZ>7 '[\]:'^7. ^7. H VcJ F6bEb^>Y4.9 -a[ -7 `/%! "]:' HVcfF6-%9'$ e]:'df6f-.34d7%9 "]:' W.gW.<=%/HVfI/<=%>F-.34&/ "-%g-h \ VK#-0 (!\ VPR / 56-7 8 ]$7*+ H72 "VK/]/$%VK/i>j (! -HH07!F-.34jkl /];7/.=%>>! "+(%W-0d2mW!1+#n 0;%g4--q =rxp!2@2/+7o2! "l /*! /%9
ICONOGRAPHIE 105
Fracture sus et inter-condylienne en «Y» Traitement par plaque pré-moulée type LECESTRE 106
Fracture sus et inter-condylienne en «Y» Traitement par plaque pré-moulée de type LECESTRE + embrochage. 107
Fracture de l épitrochlée. Traitement par vissage + embrochage. 108
Fracture du condyle latéral incluant le capitellum. Traitement par vissage + embrochage. 109
Fracture sus et inter-condylienne en «Y» avec communition supra-condylienne. Traitement par plaque type LECESTRE. 110
Fracture supra-condylienne simple. Traitement par plaque LECESTRE+vissage 111
BIBLIOGRAPHIE 112
!"##$"%$&#' (!) *)+ *,-. // "(00"(1 &2,2+ +324 3"(00" #$(0'555 6 / 72)!! 8*98)9: *: 8 /;6 6/6 6 -. #$<"%7<1 12)= +*:89>::-28=9> )!=?5// /?@/; 2"2 "(00 <2!: ) @. "77&(#"(00( '2:: *=A) 8+*-!)B:? "(0 $2=! *)! 8 C/"?6"% (&#(1 #2) * A) *:: 9*)! /. "70&10"##("(1(<0 113
09! 2*9A )*!> = 8 ;6 6/6 6%. "(00&"77&(( ::9*D9:,.! /@@// ; @E!"(00( (=:!! *)2)! -*=::!* :!: 6F/;; / 6% (&/; "( &7#"(00( &=:!! *> A) - 6. "(00<"7070"%7 7 +)*, +=*!:9) 8*9E 8*9B:: /@ 6G% 60(?C #$":H#"'0&' 1!A *2).*))2)2)?6%?""C?. "&0&&00"(007 <9!). +*2.) /;6 6 6 +###"%&$ '9). 9*> A) -*=:!! * :!: A?. "! "77&(0"(00&"7 114
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