[Restrospective study of the first metatarsophalangeal joint arthrodesist: about 39 cases]

The first metatarsophalangeal joint arthrodesis is a fusion with optimal alignment of the first metatarsal and first phalanx which conferring indolence, strength and stability. The goal of this study was to evaluate the place of arthrodesis of the first metatarso-phalangeal joint in surgery of the fore foot. This work is based on analysis of records of 35 patients between 1995 and 2006. 39 first metatarsophalangeal joint arthrodesis were practice [3 were bilateral]. They had a follow up of from three to ten years. All patients were called for a complete exploration radiographic and clinical evaluation according to the criteria of KITAOKA. The average age of patients was 54 years. They were 28 women and 7 men. The indications were hallux rigidus in 51% cases and rheumatoid arthritis in 41% cases. The procedures used mostly a stable fixation with a compressive screw. The dorsal flexion recommended is between 20 and 30 [degree sign]. Ankylosis of the ankle or the inter-phalangeal joint was an against-indication for the first metatarsophalangeal joint arthrodesis. The study found a patient subjective satisfaction rate of 92 percent, there was no pain for 89 per cent of cases. It was noted 4 non-fusion cases paradoxically with satisfactory functional result. There was no pain of inter-phalangeal joint in all cases when X-rays showed arthritis in 4 cases. The first metatarsophalangeal joint arthrodesis, provided we respect a few simple principles, restores painless and satisfying function of foot

Corynebacterium propinquum isolated from a pus collection in a patient with an osteosynthesis of the elbow

Although non- diphtherial corynebacteria are ubiquitous in nature and commonly colonize the skin and mucous membranes of humans, they rarely account for clinical infections. Aim: we report a case of infection due to non- diphtherial corynebacteria, Corynebacterium propinquum. A Tunisian male patient of 67 years old was admitted to orthopedic surgery and traumatology ward of Charles Nicolle university hospital of Tunis [Tunisia] for a left elbow trauma. He was treated by osteosynthesis and received an antibioprophylactic therapy with amoxicilline-clavulanate and gentamicin association. No postoperative incident was noted. When he was readmitted a month later for the osteosynthesis material removal, clinical examination found a pus collection in the operated elbow. Specimen analysis showed a Gram positive stained bacilli identified as C.propinquum. The organism was resistant only to penicillin G and sulfamethoxazole-trimethoprim association. The patient was treated with ofloxacin [2g per day for 8 days] and gentamicin [160mg per day for 5 days] with clinical improvement. According to literature, infections due to C.propinquum are rare, occurring especially in patients with medical device or immunocompromised. Thus, this pathogen should be taken in consideration in such situations