[Isokinetic comparative study at the third postoperative month after surgery of the anterior cruciate ligament with arthroscopy or after mini-arthrotomy]. / Etude comparative isocinétique au troisième mois post-opératoire après plastie du ligament croisé antérieur sous arthroscopie ou après mini-arthrotomie.

PURPOSE: A double blind prospective study was performed in 64 patients with a clinical and isokinetic assessment three months after anterior cruciate ligament (A.C.L.) reconstruction. MATERIAL AND METHODS: This work included 64 patients (47 males and 17 females), divided in two groups: 41 patients had an arthroscopically assisted bone-tendon-bone A.C.L. reconstruction, 17 had an open procedure. The isokinetic records concerned peak torque and muscular work at two different speeds. RESULTS: Three months after surgery there was no significant difference between both groups particularly what concerns the isokinetic assessment in muscular performances. Peak torque in hamstring averaged 151.4 Nm in the open procedure group and 149.2 Nm in the arthroscopically assisted group (p = 0.7), in quadriceps 156.10 Nm vs 149.3 Nm (p = 0.47). DISCUSSION: The advantages of arthroscopy in early muscular recovery are rarely admitted in medical literature. CONCLUSIONS: The favorable opinion of the authors to the arthroscopically assisted A.C.L. reconstruction concerning its rapid muscular recovery abilities is only based on subjective criterions.

Ambulatory treatment of multidrug-resistant Staphylococcus-infected orthopedic implants with high-dose oral co-trimoxazole (trimethoprim-sulfamethoxazole).

We examined the effectiveness and safety of high-dose oral co-trimoxazole (trimethoprim-sulfamethoxazole) for the treatment of orthopedic implants infected with multidrug-resistant Staphylococcus species. The prospective study was conducted between 1989 and 1997 in a university medical center with ambulatory-care services. Patients eligible for the study consisted of those from whom multidrug-resistant Staphylococcus spp. organisms susceptible only to glycopeptides and co-trimoxazole were isolated from their orthopedic implants and for whom there was no contraindication to the treatment. All patients were treated orally with high-dose co-trimoxazole (trimethoprim, 20 mg/kg of body weight/day; sulfamethoxazole, 100 mg/kg/day). Patients with prosthetic hip infections were treated for 6 months, with removal of any unstable prosthesis after 5 months of treatment; patients with prosthetic knee infections were treated for 9 months, with removal of any unstable prosthesis after 6 months of treatment; and patients with infected osteosynthetic devices were treated for 6 months, with removal of the device after 3 months of treatment, if necessary. Monthly clinical evaluations were conducted until the completion of the treatment, and follow-up examinations were conducted regularly for up to 6 years. The overall treatment success rate was 66.7% (26 of 39 patients), with success rates of 62.5% for patients with prosthetic knee infections, 50% for those with prosthetic hip infections, and 78.9% for those with other device infections. Seventeen of the 28 (60.7%) patients who did not have any orthopedic material removed were cured. Eight patients stopped the treatment because of side effects, and one patient was not compliant. In three patients treatment failed because of the appearance of a resistant bacterium. Long-term oral ambulatory treatment with co-trimoxazole appears to be an effective alternative to the conventional medicosurgical treatment of chronic multidrug-resistant Staphylococcus-infected orthopedic implants which includes long-term intravenous antibiotic therapy combined with surgical debridement and removal of foreign material or its subsequent one- or two-stage replacement.

[Retrospective analysis of 78 surgically repaired fractures of the radial head]. / Analyse rétrospective d'une série de 78 fractures de la tête radiale opérées.

The authors present a analysis of 78 cases of radial head fracture operated in the same department. 16 cases were added to the first study of 62 cases operated between 1967 and 1988 and published in 1991. According to the Mason classification modified by Morrey, there were 22 type II, 24 type III and 32 type IV. Surgical treatment consisted in an osteosynthesis in 35 cases, a fracture fragment excision in 9 cases, a resection of the head in 24 cases, a silastic prosthesis in 10 cases. The results have been studied on a functional and radiological basis with follow-up from 2 to 23 years (mean 5 years). The authors noted the good results of the type II fractures which had an osteosynthesis, the satisfactory results in more than 50% of the cases with resection of the radial head. The comparison of both series established the absence of prosthesis in the recent one. The poor results of the comminutive fractures with elbow dislocation lead the authors to consider the prothesis in these fractures, as a possible indication.

[Tuberculosis of the greater trochanter. Apropos of 2 cases]. / Trochantérite tuberculeuse: A propos de deux cas.

INTRODUCTION: The authors report two cases of tuberculosis of the greater trochanter as an uncommon localization in osseous tuberculosis. MATERIAL AND METHODS: 1st case: A 77 year old male presented with hip pain and swelling. Laboratory studies revealed an increased erythrocyte sedimentation rate. The patient had a positive skin test reaction for tuberculosis. Radiographs showed greater trochanter remodeling. M.R.I. demonstrated a bilobed abscess. There were enough arguments to initiate medical treatment, before surgery: excision of the abscess and partial trochanteric resection. 2nd case: In a 51 year old male, a large lytic lesion of the whole greater trochanter suggesting benign bone tumors was found an radiographs after a traumatism. Curettage and grafting were undertaken. The final diagnosis was made with the results of the intra-operative samples culture of and led to appropriate medical treatment. RESULTS: The outcome was good in both cases with four years follow-up for the first case, and two years for the second one. DISCUSSION: Trochanteritis Tuberculosis occurs in 1.8 per cent of bony tuberculosis cases. Local symptoms are discrete and the diagnosis is belatedly made when the tuberculous abscess appears. Radiographs and CT scan show the bony lesions: unevenness of the contours of the trochanter and several gaps in it. MRI shows the abscess and its spread. The microbiological test (when antibiotic therapy has not been initiated) and anatomo-pathological tests confirm the diagnosis. General treatment is based on a six month long specific antibiotic therapy. Local treatment concerns the abscess and the bony lesions. As the case may be; careful curettage is undertaken, or wide excision is performed.

[Metastatic localization in the buccal cavity. Case report and literature review]. / Localisations métastatiques au niveau de la cavité buccale. Observation d'un cas et revue de la littérature.

Metastatic tumors of oral cavity are uncommon. Mandibular localisation is the most frequent. Microscopic diagnosis and other metastatic localisations help the diagnosis we are reporting on. The report is on a case with prostatic and lung primitive tumors associated with gingivo-maxillary, femur and cutaneous metastasis.

[The role of condylectomy in the treatment of mandibular laterognathism in children]. / Place de la condylectomie dans le traitement des latérognathies mandibulaires de l'enfant.

In 7 cases of mandibular laterognathia caused by condylar hypertrophy, the authors specify the clinical and teleradiological features in adolescents. They emphasize the inadequacy of lateral teleradiography and of its measurements, and the need for three-dimensional investigation. In adolescents, secondary deformations, either spontaneous or therapeutic, are rare, and the treatment preferred is condylectomy based on the study of casts. The immediate results of this techniques are satisfactory. The long-term consequences on growth and temporomandibular pathology have been studied.