Osteoid osteoma of the phalanx and metacarpal bone: report of 17 cases.

BACKGROUND: Osteoid osteoma (OO) is a slowly progressing benign osteoblastic tumour. In the hand, this tumour is rare. We propose a review of seventeen cases of OO of the phalanx and metacarpal bone. PATIENTS AND METHODS: During the period, between 1998 and 2011, a total of seventeen OO in the hand were confirmed by the pathological examination. They were 10 women and 7 men with an average age of 29 years (age range 17-76). The most common site of the tumour was the proximal phalanx in ten cases, followed by middle phalanx in four cases and metacarpal bone in three cases. The diagnosis of OO was highly required by clinical history. Standard radiographs showed variable images, but computed tomography, and it was useful to facilitate diagnosis and pre-operative planning. All patients underwent surgery (the tumour resection and autogenous bone grafting). In post-operative, there was an immediate pain relief with complete resolution of all symptoms. No recurrence was observed during the last follow-up period of 4 years and 2 months. CONCLUSION: The diagnosis of OO of the hand can be difficult, and it should be considered with bony pain or bony swelling, especially when the history is a chronic one. The CT scan allows visualisation and precise localisation of such benign tumour of the hand. The care should be taken to make the excision complete in order to avoid recurrence.

Posterior interosseous nerve syndrome due to intramuscular lipoma.

Lipomas are extremely common benign soft tissue tumors that are usually subcutaneous and asymptomatic. However, an intramuscular lipoma, occurring adjacent to the proximal radius, may easily cause paralysis of the posterior interosseous nerve because of a specific anatomical relationship of these structures in that area. In this report, we describe an unusual case of a 48-year-old-woman with a posterior interosseous nerve syndrome due to an intramuscular lipoma. The patient had good recovery after surgery and rehabilitation physiotherapy.

[Idiopathic ulnar nerve entrapment at the elbow: report of 20 cases]. / Le syndrome canalaire du nerf ulnaire au coude d'origine idiopathique : à propos de 20 cas.

We report a retrospective study of 20 patients treated for idiopathic cubital tunnel syndrome in a period of 10 years (2002-2011). The average age was 46 years. A profession at risk was present in the majority of cases. The treatment was surgical in all the cases. The indication for surgery was related to the importance of sensory-motor deficit, the long duration of symptoms, and the failure of conservative treatment. Two surgical techniques were used in this work: isolated neurolysis and neurolysis with anterior transposition of the ulnar nerve. There were no complications or recurrence of symptoms. After a mean follow-up of 12 months, our results evaluated thanks to the classification of Bishop were considered as excellent or good in 85% of cases and fair in 15% of cases. Prognosis factors were advanced age (more than 60 years), severity of the disease, and duration of symptoms (more than one year). The management of this affection must go through a better knowledge of the disease, for early diagnosis and appropriate treatment, only guarantees for a good result.

Obturator dislocation of the hip with ipsilateral femoral neck fracture: A case report.

Obturator dislocation of the hip associated with ipsilateral femoral neck fracture is an unusual injury. We report a case of a 40-year-old man with such a combination of injuries which was treated with an open reduction and internal fixation. He has a good follow-up result. There was no evidence of avascular necrosis on radiographs after 3 years.

Coracoid fracture combined with distal clavicle fracture without coracoclavicular ligament rupture: A case report.

Distal clavicle fracture accompanied by coracoid process one is a rare injury. Surgical and/or conservative treatments are proposed. We report the case of a 49-year-old woman presenting a distal clavicle fracture associated with a coracoid process one due to a fall on the left shoulder. Both injuries are treated surgically. Per operatively, and through an anterior "strap" approach, the coracoclavicular ligament was seen intact. The distal clavicle fracture was fixed with K-wires and cerclage and the coracoid process was secured by a screw. Active-assisted rehabilitation of the shoulder was initiated 3 weeks after surgery. At the last follow-up of twelve months, the patient had painless full shoulder functions and X-rays show bony union. Early recovery to normal life is possible with surgical treatment in patients with distal clavicle fracture combined with coracoid fracture.

Osteochondritis dissecans of the capitellum: autologous osteochondral mosaicplasty: a case report.

The etiology of osteochondritis dissecans (OCD) of the capitellum is unknown but has generally been attributed to repetitive microtrauma or ischemia. We present a case report of a handball player with OCD of the capitellum. Preoperatively, he complained of elbow pain. CT imaging showed the injury. This patient was treated with mosaicplasty harvested from the lateral femoral condyle. He returned to his full former sports activities within 6months of surgery. The continuity of the cartilage layer between the osteochondral graft and the capitellum was shown on CT arthrogram images at 12months after surgery. We believe that mosaicplasty gives successful results with end-stage OCD of the capitellum.

Ewing's sarcoma of the finger: report of two cases and literature review.

Ewing's sarcoma of the finger is extremely rare. Pain and swelling of the affected finger are the most frequent presenting features. We report two cases of Ewing's sarcoma located at ring finger and the thumb in two children aged 14 and 10 years. The first patient died of generalised metastases despite surgery, chemotherapy and radiation therapy. The second had no localised recurrence or metastases after surgery and chemotherapy at last follow-up of 4.5 years after tumour resection. The tumour's surgical accessibility, chemotherapy, and radiation therapy improve the prognosis of this tumour.

The scaphocapitate fracture syndrome: report of a case and a review of the literature.

The Fenton's syndrome or scaphocapitate fracture syndrome has been described since 1950. This severe and uncommon injury occurs after a high-energy trauma of the wrist. This syndrome associated the fractures of the scaphoid and capitate, with a rotation of 90° or 180° of the proximal fragment of the capitate. The diagnosis is determined by careful physical and radiological examinations, including conventional radiographs. Computed tomography can be helpful in detecting such lesions. We report one case of Fenton's syndrome that occurred after a high-energy trauma in a 22-year-old male. We discuss the mechanisms of the injury and the results of treatment.

Giant cell tumour of the flexor tendon sheath of the hand: analysis of 27 cases.

Giant cell tumour of the tendon sheath (GCTTS) is a slowly progressing benign tumour arising from synovial cells of tendon sheaths. It is one of the most common soft tissue tumours in the hand. We report a retrospective study of 27 proven GCTTS of the hand. The mean length of follow-up was 4.5 years (17 months-8.5 years). Radiographic findings are useful and may prove of great diagnostic value. The positive diagnosis was provided by the pathology examination after complete excision that was performed in all patients. The recurrence was noted in two surgically managed cases. The excision should be meticulous and complete in order to avoid recurrence.

[Advancement fingertip homodigital neurovascular island flaps of long fingers. About 32 cases]. / Les lambeaux d'avancement en ilot pulpaire homodactyle des doigts longs. À propos de 32 cas.

AIM: Evaluation of reconstruction results using a homodigital neurovascular island flap so as to recover long fingers loss fingertip. PATIENTS AND METHODS: This was a retrospective study of 32 fingertip-flaps of long fingers practiced on 31 patients. They were young people (mean age: 28 years), often male (77.5%), and manual workers in 55%. The loss fingertip was traumatic in 87%. The fingertip reconstruction has been urgently assured, except in three initially-treated whitlow cases. RESULTS: Four criteria value were used to value the results of coverage: Aesthetic, sensitive, functional, and socio-professional. We obtained good results in 72%. CONCLUSION: The homodigital neurovascular island flap is a simple and reproducible technique. It's an excellent method for fingertip reconstruction in Allen type II and III. Despite of some complications, in touch with the initial trauma, this surgery gives back a useful sensitivity and a good aesthetic aspect of the fingertip.

[Ulnar nerve compression at the elbow and heterotopic ossification: a report of five cases]. / Compression du nerf ulnaire au coude et paraostéoarthropathie neurogène: à propos de cinq cas.

AIM: Heterotopic ossification (HO) is common in head-injured patients. Ulnar nerve compression by HO at the elbow is rare. The purpose of this study was to establish a strategy for the management of ulnar nerve compression secondary to HO at the elbow. PATIENTS AND METHODS: The authors report a retrospective study (2000-2008) of five cases of ulnar nerve compression at the elbow secondary to HO. All patients were male (mean age, 33 years). The HO was secondary to head injury (four cases) and severe burn (one case). According to the Dellon's classification, the ulnar nerve entrapment was severe in two cases and moderate in three. The elbow was ankylosed; the flexion deformity ranged from 60 degrees to 120 degrees. Only in one case was nerve decompression performed before HO maturation. In the other cases, elbow release and nerve decompression were done at the same time, when maturation of HO was achieved. Postoperative outcome assessment was based on the Kleiman and Bishop's score. RESULTS: At 4 years of follow-up, the neurolysis result was excellent in one case, good in three cases, and poor in one. CONCLUSION: It seems that HO is not the direct cause of ulnar nerve compression, but its impairment may be increased by the nerve tension and elbow fixation that it causes. When HO is mature, neurolysis can be combined with elbow release. However, when HO maturation is not achieved early neurolysis associated with anterior transposition should be done without elbow release.

[The reversed homodigital island flap: 28 cases]. / Le lambeau en îlot homodigital à contre-courant : à propos de 28 cas.

AIMS: The purpose of the study is to evaluate the coverage of the distal tissue defect of long fingers using reversed homodigital island flap and comparison with other flaps. PATIENTS AND METHOD: It was a retrospective study of 28 cases of reversed homodigital island flap practiced in 28 patients to cover skin finger distal loss. The mean age was 29 years, the sex ratio was 0.17. The variety of à pédicule exclusivement vasculaire was the most used (89%). Partial necrosis of the flap was noticed only in two cases (7%). Six criteria were used to evaluate this coverage: the quality of the flap, the donor site, the neuroma formation, the cold intolerance, the mobility of the finger, and the satisfaction of the patient. A final score for every case was attributed. RESULTS: At the middle last follow-up, the results were good in 89% and average in 11%. CONCLUSION: The reversed homodigital island flap is a safe method offering multiple advantages and constitutes an interesting alternative in front of the distal tissue defect of the long finger.

Primary hydatid cyst of the biceps femoris.

Echinococciasis is a zoonotic infestation, which generally involves the liver and the lungs. Primary muscle hydatidosis is an uncommon finding. The authors report a case of primary hydatid cyst localized in the right long head of the biceps femoris of a 25-year-old woman. A wide excision of the cyst with a safety margin was performed. No recurrence has been detected after a 3-year follow-up period. The authors review the literature and discuss the MRI findings. The diagnosis of muscular hydatid cyst is done using clinical and radiological findings in endemic context.

[Pseudarthrosis of the coracoid process after dislocation of the shoulder]. / Pseudarthrose du processus coracoïde après luxation antérieure de l'épaule.

PURPOSE OF THE STUDY: The aim of this study is to present an unusual lesion combining instability of the shoulder with a fracture of the coracoid process. MATERIAL AND METHODS: The authors have treated one case of recurrent anterior dislocation of the shoulder associated with pseudarthrosis of the coracoid process. The shoulder was stabilised by surgery using the Latarjet procedure. DISCUSSION: The association of an anterior dislocation of the shoulder and pseudarthrosis of the coracoid process is very unusual. It is often unrecognized because of poor knowledge of this lesion or poor quality of the radiographs performed in the emergency room. The most likely mecanism is a direct impact of the humeral head against the coracoid process during the dislocation. The diagnosis requires good quality radiographs. When the shoulder is painful or unstable, surgical treatment is performed and the Latarjet procedure takes care of both the pseudarthrosis and the instability of the shoulder.

Shoulder arthritis as a lung metastatic carcinoma revealer. A case report.

Joint metastasis is very rare. It usually presents as a monoarthritis. It is generally located in the knee and secondary to lung cancer. Prognosis is poor, with a mean survival term of less than six months. We report the case of a right shoulder joint metastasis from a bronchopulmonary squamous cell carcinoma in a 55-year-old male smoker. The patient presented with an atypical chronic post-traumatic arthritis, not improved by symptomatic treatment. The diagnosis was based on synovial biopsy performed during open surgery. The primitive lung cancer was confirmed by chest CT scan and bronchial biopsy.

[Acute carpal tunnel syndrome after trauma: a series of 26 cases]. / Le syndrome aigu du canal carpien post-traumatique: à propos de 26 cas.

The aim of the study is to evaluate the results of the median nerve release at wrist as a part of acute carpal tunnel syndrome. This is a retrospective study about 26 cases of acute carpal tunnel syndrome following isolated injury of the wrist. Clinical evaluation of the median nerve function was performed before and after release. A classical median nerve release was performed in emergency eventually associated with stabilization of bone lesions. The population included was young, the mean age was 26 (range 4-52) years, frequently male (sex-ratio 3.5:1). The wrist trauma was direct in 75% of all cases and oftentimes with high velocity. The median nerve was deficient in the first examination. The average time from injury to surgery range from three hours to five days. The release was performed in emergency. The latest follow-up showed a complete recovery of the nerve's function in 85% and an incomplete in the rest (15%).The mean prognosis factor was the release time. Wrist trauma particularly with high velocity should lead to evaluation of median nerve function and to an emergency release when acute median neuropathy appeared.

[Combined fracture of the distal radius and scaphoid in children. Report of two cases]. / Fracture du scaphoïde carpien associée à une fracture de l'extrémité inférieure du radius chez l'enfant. A propos de deux cas.

The authors report two cases of concomitant scaphoid and distal radial fractures, a rare combination of lesions in children. The first case was in a 14-year-old boy who presented a midscaphoid fracture associated with a distal forearm fracture. The second case concerned a 13-year-old boy who presented a midscaphoid fracture associated with a Salter type II distal radial fracture. Both fractures were reduced under general anaesthesia. The total period of immobilisation was 3 months, using a large arm thumb cast. Associated scaphoid fractures should be suspected with all types of distal forearm injuries in children. Reduction of the radius fracture should be done carefully to avoid possible displacement of the scaphoid fracture.