[Bifocal avulsion of the patellar tendon in an adult: a case report]. / Avulsion osseuse bifocale du tendon rotulien chez un adulte: à propos d'un cas.

PURPOSE OF THE STUDY: Bifocal proximal and distal avulsion of the patellar tendon is a rare event in adults with, to our knowledge, no previous report in the literature. Exceptional bifocal avulsion of the patellar tendon is generally related to an underlying bone or systemic disease. We report the case of a 90-year-old diabetic patient who developed simultaneous avulsions of the patellar and tibial insertions. CASE REPORT: A 90-year-old woman with noninsulin-dependent diabetes mellitus fell on her left knee and was subsequently unable to extend the knee despite normal quadriceps contraction. Radiographically, the knee joint showed a transverse fracture of the lower third of the patella and a fracture of the anterior tibial tuberosity, evidencing rupture of the quadriceps tendon. Signs of osteoarthritis were minimal. The patient underwent surgery for osteosynthesis of the patella with two vertical pins and a figure-eight wire cerclage in addition to fixation of the anterior tuberosity of the tibia with 3 staples and wire cerclage. The patient recovered well and was walking six months later. DISCUSSION: Bifocal disruption of the extensor system is a rare event in adults. It is usually associated with an underlying bone disease (Paget's disease, osteomalacia, osteitis deformans) or systemic disease (lupus erythematosus, rheumatoid arthritis, hyperparathyroidism, Wilson's disease), but bilateral spontaneous disruption may occur. There have been two reports of patellar full-thickness tendon tears in diabetic patients but no case of a bipolar avulsion involving both insertions. Concurrent forces applied to the ligament were probably the cause of this unique type of patellar tendon avulsion. CONCLUSION: This is the first report of a bifocal disruption of the patellar tendon. Different underlying diseases may be involved. Treatment consists in double fixation.

Humeral retrotorsion and glenohumeral relationship in the normal shoulder and in recurrent anterior dislocation (scapulometry).

The authors' roentgenographic technique provides precise assessment of the glenohumeral relationship on the basis of two-plane examination. A group of 50 normal male subjects serve as the basis for determining normal values for the following angles or lines: projected and corrected cephalodiaphyseal angle, projected and corrected humeral retrotorsion, glenoid inclination, angle of attack, glenoid retroversion, dimension of glenoid, width of humeral head, and contact index. Two groups of patients suffering from recurrent anterior dislocation (RAD) are compared with the normal group. The shoulders with RAD do not differ significantly from the normal ones. Humeral retrotorsion, in particular, is identical. Significant differences are found between affected and unaffected sides in unilateral RAD. The diameter of the glenoid and the contact index are smaller on the dislocated side. Because the projected values seldom differ by more than 10 degrees from the calculated values, if the authors' roentgenographic technique is used, the figures can generally be accepted without correction.

Metatarsalgia due to insufficient support by the first ray.

Sixty-five feet with metatarsalgia due to inadequate support by the first ray are presented. A classification of different types of deficient anteromedial support is proposed in relation to the morphology of the first ray. When there is deficient anteromedial support and the first ray is normal, the ray is elevated and may or may not be associated with supination of the forefoot. When there is elevation of the first ray alone, operations are proposed which restore normal anteromedial support. The decision for choosing a particular type of operation is determined by an analysis of the cause of the elevation. There operations can be on the soft tissues, bone or both. When loss of anteromedial support is the consequence of complete supination of the forefoot, this has been corrected by a tarsal derotation osteotomy. Supination of the forefoot may be accompanied by elevation of the first ray. In there cases, the derotation osteotomy has been complemented by one of the operations described in the case of simple elevation of the first ray. The different indications of these surgical procedure are described as well as the results. In the case of deficient anteromedial support with an abnormal first ray, the treatment was conservative or surgical. The results of different operations performed to restore the normal loading under the forefoot are described.

[Soft tissue sarcoma of the limbs]. / Les sarcomes des parties molles des membres.

24 cases of soft tissue tumors treated during the last 10 years are analysed. Therapeutical results and a review of the literature are presented. Survival of patients with these types of tumors is very limited. Two points have to be emphasized. --Exact histological diagnosis, large surgical resection at distance of the neoplasm, done by an experienced surgeon give the best chances of good results. In many cases this means heavy surgery and severe functional loss. --The future will surely bring better treatment for these still poorly known tumors. Perfect knowledge of the topography of the neoplasm is necessary to perform surgery in best conditions. Chemotherapy and radiotherapy should be tested on larger series of cases to prove their efficiency.

[Sarmiento functional bracing of tibial fractures (author's transl)]. / La méthode de sarmiento dans le traitement des fractures de jambe.

The functional bracing advocated by Sarmiento was used in the conservative treatment of 74 recent tibial fractures (6) adults, 13 children) and in 12 fractures with delayed union. The leg was immobilized in an Orthoplast below-the-knee functional brace with patellar tendon bearing. A flexible plastic insert fitted on the heel allowed the use of sock and shoe. Knee and ankle motion were possible and early weight-bearing was allowed. The results of this method of treatment in recent fractures was excellent since healing occured without delay and function restoration was rapid. In delayed union of tibial fractures this method gave promising results. It is the authors' opinion that Sarmiento's functional bracing is a highly satisfactory method of conservative treatment of tibial fractures.

[Conservative treatment of tibial fractures using Sarmiento's functional technic]. / Le traitement conservateur des fractures de jambe par la méthode fonctionnelle de Sarmiento.

A conservative functional technique of treatment of tibial fractures is described. This method allows the mobilization of knee and ankle joints and early weight-bearing. The leg is fitted into an Orthoplast orthosis fixed to a plastic sole which permits the wearing of shoe and sock. The experience in 56 patients is described. Excellent function results obtained after a relatively short time recommend this type of treatment.

[Essential bone cyst and its therapy]. / Le kyste essentiel de l'os et son traitement.

Twenty-nine cases of unicameral bone cyst treated surgically are reported. The literature is reviewed and different methods of treatment are discussed. Important factors contributory to the risk of recurrence are identified and stressed.

[Standing and walking with walking aids - an electromyokinesigraphic examination (author's transl)]. / Stehen und Gehen mit Gehhilfen. Eine elektromyokinesigraphische Untersuchung.

Study of the variations of the automatic electrical activity of the shoulder, trunk and lower extremities muscles with different types of walking aids (Cane, elbow-crutches, shoulder-crutches, tricycle). Electromyocinesigraphic recordings have been made in 10 normal men and women age 24 to 35. The variations of their posture and walking pattern according to the weightbearing with different types of aids have been studied and are discussed.

[Paralysis of the trapezius muscle]. / Les paralysies du trapèze.

Four cases of paralysis of the trapezius muscle occurring during the last 15 years are reported. The characteristics of this lesion, which is usually of iatrogenic origin, are outlined. Among the alternatives in treatment, Eden's operation is the method of choice. Major handicaps are usually corrected from both an esthetic and functional point of view.