[Bipolar dislocation of the forearm]. / Luxation bipolaire de l'avant-bras: luxation du coude et luxation transcapholunaire du carpe. A propos d'un cas.

The authors report the case of a 23 year old patient, who presented the following combination of injuries after a fall, namely a divergent dislocation of the elbow, a fracture of the radial head, a fracture of the ulna and a perilunate dislocation with scaphoid fracture. The entire injury thus represented a bipolar dislocation of the forearm. The emergency management consisted of a closed reduction of the elbow together with osteosynthesis of the ulna, internal fixation of the scaphoid with a compression screw, and scaphocapitate K wiring. After 26 months, the function of the elbow was satisfactory, and the range of motion of the wrist was from 50 degrees of flexion to 40 degrees of extension. Satisfactory healing of the scaphoid was observed. This combination of injuries has only rarely been reported in the literature.

[Ewing's sarcoma of the hand: a case report]. / Sarcome d'Ewing de la main: a propos d'un cas.

Ewing's sarcoma of the hand is rare. This tumor was first described in 1921, since then, only a few cases with hand involvement have been reported. We report a case of Ewing's sarcoma of the left hand, presenting as a swelling of the hand gradually enlarging over six months. Plain radiographs showed marked osteolysis of the second, third and fourth metacarpals. Histological confirmation was made following biopsy. Despite amputation and post-operative chemotherapy, death occurred two months later due marrow aplasia.

[Aseptic osteonecrosis of the femoral head in thalassemia minor: a case report]. / Ostéonécrose aseptique de la tête du fémur dans la thalassémie mineure: á propos d'un cas.

We report a case of aseptic necrosis of the femoral head in a 14-year-old black adolescent with thalassemia minor disclosed by physical examination and blood tests. No other anomaly could be identified. Despite the very probably secondary nature of the aseptic osteonecrosis of the femoral head and the absence of any other etiology, it is highly difficult to demonstrate the causal effect of thalassemia minor. We reviewed the literature and discuss the pathogenesis of this association.

[Total carpometacarpal dislocation. Case report]. / La luxation carpométacarpienne antérieure complète des doigts. A propos d'un cas.

Anterior carpometacarpal dislocation are rare injuries. The anterior type is exceptional. Mr A.T 18 years old, male, student, right-handed, without pathological medical history. He was admitted in emergency after a fall of a motorbike (unknown mechanism) for a closed left hand injury; examination revealed a total impaired mobility and an important swelling of the hand without vasculonervous disorders. X-ray revealed a pure anterior dislocation of the five carpometacarpal joints. The patient was operated on in emergency using both anterior and posterior approach, which allowed to reduce the dislocation. It was maintained by K-wires. An antebrachiopalmar cast was applied for six weeks. One year later, the result obtained was considered excellent.

[Hand trauma from table saw: best prevention]. / La main traumatique par toupie: pour une meilleure prévention.

OBJECTIVE: Trauma to the hand from a circular saw table is a common occurrence in developing countries. It tends to occur in young people, leading to psychologic- and socio-economic disability and loss. METHOD AND RESULTS: In this series of 834 patients. The mean age was 25 years. The left hand was involved in 88%. The authors report on the epidemiologic features of these lesions. These accidents are correlated with postprandial somnolence. The most frequent causes are absence of security systems and heterogeneity of the wood. DISCUSSION: The authors emphasize the importance of information for workers, using consciousness raising campaigns. They also stress the necessity of improvement of the conditions of work. Professional formation must be mandatory for young woodworkers and the laws concerning utilization of dangerous machines must be rigorously enforced, in order to lower the incidence of these accidents.

[Cubital tunnel syndrome and heterotopic ossification. Eight case reports]. / Syndrome du tunnel cubital et paraostéoarthropathie neurogène. A propos de huit cas.

INTRODUCTION: The occurrence of cubital tunnel syndrome during heterotopic ossification is infrequent. Entrapment of the nerve requires early decompression whereas definitive elbow release is often delayed to reduce the risk of recurrence of periarticular ossification. The pathophysiology and treatment of these two conditions are discussed. METHOD: The authors report a retrospective study of eight men (average age 37 years), all with previous head injury. The nerve entrapment was severe in two cases, moderate in four and mild in two. The elbow was ankylosed with a mean flexion deformity of 96 degrees (77 degrees-123 degrees). Management consisted of early decompression and neurolysis with anterior transposition of the ulnar nerve. In four cases elbow release was postponed until maturation of the ossification. RESULTS: The neurolysis results were assessed according to the score of KLEIMAN modified by TEOH. They were excellent in two cases, good in five and bad in one. DISCUSSION: Entrapment of the ulnar nerve in the context of heterotopic ossification seems related to compression and tension on the ulnar nerve. The compression may be due to prolonged pressure of the medial edge of the elbow on the bed of the nerve, or to a periarticular bony bridge and the initial inflammatory reaction of the heterotopic ossification. Ulnar nerve tension seems to be due to prolonged flexion of the elbow joint and to movements of the shoulder and the wrist, on either side of the ankyrozed elbow. Treatment should be by early decompression of the nerve and we recommend, in addition, anterior transposition to reduce the tension on the nerve. The elbow release can be combined with the neurolysis or delayed according to the state of activity of the heterotopic ossification.

[Lateral dislocation of the elbow: pathophysiological and therapeutic analysis]. / Luxation pure latérale du coude. Approche physiopathologique et thérapeutique.

Lateral dislocation of the elbow is exceptional, and its pure form even more so. We report a case of lateral dislocation of the elbow observed in a 65-year-old woman following a fall on the medial aspect of the elbow in the flexion position. Reduction could not be achieved because of the anconeus muscle interposition. Analysis of the mechanism involved and the displacements observed enabled to propose a reduction manoeuvre using gentle traction on the elbow with extension and progressive supination of the forearm, pushing the olecranon backward then pulling it medialy. This enabled avoiding incarceration of the nerve bundle or capsulo-ligamentary structures.

[Ossifying parosteal lipoma of the rib: a case report]. / Lipome para-ostéal ossifiant costal: à propos d'un cas.

Ossifying parosteal lipoma is an uncommon form of parosteal lipoma. We report an exceptional rib localization where hyperosteosis probably arose from contact between the lipoma and the periosteum. Foci of metaplastic cartilage undergoing chondral ossification within the adipose tissue suggest a possible mixed origin.

[Primary malignant non-Hodgkin skeletal muscle lymphoma: a case report]. / Lymphome malin non-hodgkinien primitif du muscle squelettique: à propos d'un cas.

BACKGROUND: Malignant non-Hodgkin lymphoma (NHL) is rarely encountered in soft tissue. The differential diagnosis with other soft tissue tumors, particularly sarcoma, is difficult. CASE REPORT: A 70-year-old woman presented an increase in the volume of the right thigh. Ultrasonography visualized a hypoechogenic mass with irregular contours. At computed tomography, the mass measured 17x14x7 cm and was situated in the biceps femoris. Enhancement was heterogeneous after intravenous contrast injection with discrete infiltration of the subcutaneous fat. Tumor biopsy demonstrated diffuse malignant small B-cell lymphomatous-plasma cell proliferation. The diagnosis was primary NHL of the biceps femoris. Search for extension was negative. Wide resection was followed by chemotherapy. The patient was free of recurrence at 10 months follow-up. DISCUSSION: Primary NHL of skeletal muscle is usually observed in elderly subjects, principally in thigh muscles. Magnetic resonance imaging and computed tomography visualize characteristic features. Diagnosis is formally established by pathology.

[Chondrosarcoma of the hand. Diagnostic and therapeutic discussion (three case reports)]. / Le chondrosarcome de la main. Discussion diagnostique et thérapeutique (à propos de trois cas).

Chondrosarcoma of the hand is very rare. We report three observations which enable us to make a review of its pathology. There were two men and one woman aged 72, 38 and 63 years respectively. Localisation was phalangeal in two cases and metacarpal in one case. Two cases were central and one peripheral. Radiographs were characterised by the presence of lytic areas with intralesional calcifications and soft tissue extension. Histological diagnosis was made by biopsy in two cases and after amputation of the finger for lesional spread in one case. Treatment consisted of amputation of the finger in two cases. In the case of metacarpal localisation, wide resection of two rays was followed by recurrence after ten months which required amputation of the hand. We agree with other authors who believe that chondrosarcoma in the hand is due to malignant change in a pre-existing chondroma. Conservative treatment is difficult due to the small size of the hand which allows easy spread of the tumour from compartment to compartment.

[Solitary osteochondroma of the limbs. Clinical review of 76 cases and pathogenic hypothesis]. / L'exostose ostéogénique solitaire des membres. Revue clinique de 76 cas et hypothèse pathogénique.

The authors report a retrospective study of 76 solitary osteochondromas of the appendicular skeleton treated between 1981 and 1995. The ages of the patients ranged from 13 to 55 years with a mean of 21 years. The male/female-ratio was 1.37. Tumefaction with or without associated pain was the reason for consultation in 68 cases (89%). In 62 cases the osteochondroma was localized in the distal part of the femur or the proximal part of the tibia. All lesions were surgically resected; the resection was complete in all cases. Six patients were lost to follow-up; the other 70 were seen on a regular basis over a time period ranging from 1 to 12 years. The result from surgical treatment was assessed based on pain, joint motion, cosmetic consequences, nerve compression and recurrence of osteochondroma. The results were good in 68 cases and fair in two cases. Based on a review of previous experimental studies, the authors suggest a hypothesis to explain the rotation of a fragment of the growth plate which is needed for the development of osteochondroma. This rotation occurs as a result of the mechanical action from the periosteum under tension.

[Posterior shoulder instability in athletes: surgical treatment with iliac bone block. Apropos of 6 case reports]. / Instabilité postérieure de l'épaule chez le sportif traitée par butée iliaque. A propos de 6 observations.

PURPOSE OF THE STUDY: Sports activities requiring antepulsion, adduction and medial rotation can favor the development of posterior instability of the shoulder. Conservative treatment is indicated, but many techniques have been proposed in case of failure. All do not allow recovery of the same sports level. We report our experience with six cases of posterior shoulder instability treated with a Gosset posterior bone block. MATERIAL AND METHODS: We retrospectively reviewed cases treated between 1974 and 1995. Six athletes, aged 17 to 34 years (mean 25 years) underwent posterior bone block surgery using the Gosset procedure on their dominant shoulder. Three of the patients had experienced involuntary dislocation and three others involuntary and voluntary dislocation. One patient had a multidirectional hyperlaxity. Five patients had participated in rehabilitation programs for at least five months. Two patients had undergone unsuccessful bone block surgery in another unit. RESULTS: Stability and pain relief were achieved in all cases. Three patients recovered complete mobility. In the three others, mean limitation of mobility for the different sectors was 15 degrees. There has been no sign of osteoarthrosis at three years follow-up. All patients have resumed their sports activities, three at the same level. DISCUSSION: In our experience, most surgical techniques proposed for the treatment of posterior shoulder instability are unsuccessful. The Gosset iliac bone block prolongs the articular surface. After consolidation, it allows sports activities requiring shoulder force and provides satisfactory mobility.

[Medullary osteoid osteoma. A pathogenic discussion]. / L'ostéome ostéoïde médullaire. Discussion pathogénique.

PURPOSE OF THE STUDY: Medullary osteoid osteoma is exceptional. We report one case. PATIENT: A 15-year-old patient presented osteoid osteoma localized in the medullary canal of the tibial shaft, associated with intense medullary and cortical hyperosteosis. DISCUSSION: The origin of the osteogenesis in medullary osteoid osteoma could be a localized hemodynamic change involving venous congestion with stimulation of periosteal venous drainage.

[Aneurysmal diaphyseal bone cyst. Etio-pathogenic hypothesis and review of the literature. A case report]. / Le kyste osseux anévrysmal diaphysaire. Hypothèse étiopathogénique et revue de la littérature. A propos d'un cas.

PURPOSE OF THE STUDY: Diaphyseal aneurysmal bone cyst is very rare. We report a case in a 20-year-old female. PATIENT AND METHOD: The clinical signs developed rapidly, within one month. The lesion was first curetted and grafted with cortico-cancellous bone. Recurrence was observed 6 months later. Complete excision and reconstruction with a free fibular vascularized grafted enabled healing. DISCUSSION: The pathogenesis of aneurysmal bone cysts is debated. We hypothesize that it is due to the opposed direction of periosteal and medullary blood circulation. This could explain the relative rarity of diaphyseal localizations compared with metaphyseal localizations.

Tuberculous osteitis in limbs. Twenty five case-reports.

Tuberculous osteitis is a rare condition that can be difficult to differentiate from bone tumor on X-ray films. The purpose of this retrospective study was to analyse the epidemiologic, diagnostic and therapeutic aspects of this disorder. Data from 25 patients (13 men; 12 women; mean age = 37) were collected between 1984 and 1993. The source of contagion was traced in 32% of the cases and 24% of patients were known as tuberculous. Patients searched medical attention because of pain in 84% of cases. The greater trochanter was involved in more than 50% of cases. The definite diagnosis was obtained by examination of a surgical biopsy and the anti-bacillary treatment led to recovery in all cases. This study highlights that tuberculosis must be considered when investigating a bone lacuna, all the more so when the greater trochanter is involved, in a country where tuberculosis is endemic.

[Isolated tuberculosis of popliteal cyst. Apropos of a case]. / La tuberculose isolée du kyste poplité. A propos d'un cas.

INTRODUCTION: Isolated localization of tuberculosis in the popliteal cyst is an exceptional affection. CASE REPORT: Mr. M.L., 18-year-old black moroccan, was admitted for a painful swelling of the left popliteal cyst, general state alteration and left thoracic pain. Clinical examination found a 5 cm on 3 cm oval tumefaction at the supero-medial part of the left popliteal hollow. No articular effusion was noted. Left knee X ray was normal, while ultrasound examination showed a modified popliteal cyst. Chest X ray showed a pleural effusion. Tuberculine skin test was positive (18 mm). A subtotal resection of the cyst was performed, evacuating 10 ml of thick pus. The histologic examination of the cyst confirmed its tuberculosis origin. In addition the left pleural biopsy confirmed the diagnosis of tuberculosis as well. The antibacillar treatment based on rifampicine, INH and pyrazinamide was given during 6 months. The evolution was favorable at 2 years of follow-up. DISCUSSION: Knee popliteal cyst is frequently an expression of an inflammatory or traumatic affection. The communication between the articular synovium and the serosa bursa of the lateral gastrocnemius is found in 50 per cent of cases, allowing an association of both localizations of tuberculosis. Hamabuchi described for the first time an isolated popliteal cyst tuberculosis in 1990. This case is similar to Hamabuchi's observation. Clinical and radiographical examinations were normal thus excluding a possible dissemination from the knee joint.

[Multifocal bone tuberculosis: apropos of a case]. / La tuberculose osseuse multifocale: à propos d'un cas.

INTRODUCTION: Tuberculosis of bone is rare (10 to 20 per cent of all skeletal tuberculosis). The multifocal form is exceptional even in endemic countries of tuberculosis. It constitutes less than 5 per cent of all osseous tuberculosis. CASE REPORT: O.H. 34 year-old, Moroccan woman of black race not vaccinated against tuberculosis, with a contagion, complained for a year from scapular pain and weight loss. She noticed that two masses had appeared six months ago. The patient was feverish (38 degrees). The physical exam showed a non inflammatory mass 10 cm wide located in front of the left sacroiliac joint and seeming to be a cold abscess. The radiologic assessment showed a lytic image of the humerus upper extremity, the right iliopubis branch, the left ischium and the left iliac wing. The surgical biopsy of the humerus showed an evolutive caseo-follicular tuberculosis. The nuclear scan of bone found two other localizations in the fourth lumbar vertebra and the ninth left rib. We concluded to a multifocal bone tuberculosis with seven localizations: The upper extremity of both humerus Right pubis Left ischium Left iliac wing 4th lumbar vertebra 9th left rib. The treatment consisted in a specific antibiotic therapy for 6 months associated to the evacuation of the cold abscess. DISCUSSION: Multifocal bone tuberculosis is more frequent in young adults of black race. The beginning of the disease is progressive and the fistulas are the main reason of consultation. The radiologic lesions are not specific and have a geodic shape rimmed with an osteocondensation. Multifocal bone tuberculosis in black african predominate in flat bones. Otherwise in the white race it is located in the long bones extremities. The diagnosis of certitude is based on histologic findings of the peripheric bone lesion. The specific antibiotic therapy leads to the recovery if given early. Short protocols (9 or 6 months) are recently more used with success.

[Triquetro-lunar instability. The role of the radio-styloidian index]. / Les instabilités pyramido-lunaires. Rôle de l'indice radio-styloïdien.

Based on a series of 13 isolated triquetro-lunar instabilities, the authors underline the excess of the radio styloidian index measured radiologically. They found a significant difference (p < 0.001) when comparing this series with a group of 100 normal wrists. A similar comparative study of 13 triquetro-lunar instabilities secondary to perilunar dislocations and of a series of 16 hyperlax wrists did not reveal any significant difference. The same applies to a similar parallel study of the ulnar variance index measurements when comparing the various groups with the control group. After reviewing the mechanism of lesions, and disorders of the wrist's axial forces, caused by changes in the ulnar lengths, ulnar styloid overshooting is designated as a risk factor for isolated triquetro-lunar instabilities. Finally, the authors insist on the necessity of proper reduction of radial low end fractures and detachments, and on the shortening of the long ulna, as a "complementary" procedure when treating isolated triquetro-lunar instabilities.

[Carpal perilunar dislocation. Clinical study (apropos of 39 cases)]. / Luxations péri-lunaires du carpe. Etude clinique (à propos de 39 cas).

Carpal perilunar dislocations are hidden lesions with uncertain outcome and treatment which is not yet standardized. This retrospective study including 39 cases of carpal perilunar dislocations helps clarify these issues. For fresh dislocations, the diagnosis was established in 66%. Surgical treatment was performed in 26 cases. Anatomic results showed nonunion, necrosis and residual instability. Function was always decreased and was worse in open forms or after orthopedic treatment. Scaphoid screwing results were better than those from pinning. Lateral wrist x rays must always be ordered in cases of wrist trauma to avoid delayed diagnosis. Surgical treatment must systematically use a palmar incision; it permits precise repair of bones and ligamentous lesions and reduces the risk of arthritis.

[Arthrolysis of the elbow--apropos of 70 cases]. / L'arthrolyse du coude--à propos de 70 cas.

This retrospective review covers 70 cases of elbow stiffness treated by arthrolysis. The average age was 27 years. Eighty percent had a posttraumatic origin; 53.6% were old dislocations. In 67.1% the range of movement was reduced for flexion and extension; 80% were severe to very severe cases. Physiotherapy was passive and active from the third postoperative day, except for the old dislocations, treated for 2 weeks by fixation of the radial condyle, because of instability. For 51.4% the range of movement was -30 degrees extension up to 130 degrees flexion, intra-operatively; for 21.4% it was a long-term result. The results were related to the damage to the joint space, the large number of old dislocations and insufficient rehabilitation.