[Glomus tumor of forearm: a case report]. / Tumeur glomique de l'avant-bras: a propos d'un cas.

The authors report a case of a glomus tumor of the soft-tissues of the forearm in a 23 year old woman. The diagnosis was suspected on MRI, and confirmed by a biopsy. The result after surgical resection was excellent, just like other cases in the literature.

[Effect of arthroscopic fluid inflow on the femoro-patellar tracking. Comparative study of the dry and fluid filled knee]. / Effet du remplissage liquidien arthroscopique sur l'engagement fémoro-patellaire. Etude comparative du genou sec et liquidien.

INTRODUCTION: The dynamic study of the patello-femoral joint is of outstanding interest in unexplained anterior knee pain syndrome. Nevertheless, the accuracy of information regarding this particular point by means of video-arthroscopy is of concern, due to the surgical conditions of the procedure. The aim of this study was to appreciate the effect of serum inflow on the visual evaluation of the patello-femoral tracking during conventional knee arthroscopy. MATERIAL AND METHODS: The study group included 100 knees in 68 male and 32 female patients. Mean age at surgery was 36 years (range, 13 to 69 years). Indication for knee arthroscopy was: meniscal and/or ligament injury in 77 knees (group I), patello-femoral pain in 13 knees (group II), tibial tuberosity screw removal in 7 knees (group III) and "mysterious" painful knee in 3 patients (group IV). Arthroscopic technique was conventional; general anaesthesia, pneumatic tourniquet, single antero-lateral portal and serum inflow by simple gravity. We measured the minimum flexion angle that was necessary to obtain de visu a perfect centralization of the patella dome into the trochlear groove in two situations: before inflating the knee ("dry" angle) and after serum inflow ("serum" angle). RESULTS: The average value of the flexion angle providing perfect centralization (FAC) in the "dry" situation and in the "serum" situation was 31 degrees (range, 10 to 75 degrees) and 38 degrees (range, 20 to 85 degrees), respectively. Of the 100 studied knees, the average difference between the "serum" and the "dry" FAC was about 7 degrees (6 degrees 45', standard deviation: 3 degrees 56') and was superior to 10 degrees in only one occasion; this difference is significative (T-test; p < 0.0001). Conversely, there was no significant difference between the average differential FAC figure noted in each group of patients (ANOVA; p = 0.28). DISCUSSION: The role, if any, of the tourniquet inflated around the proximal thigh is more or less constrictive, thus restricting the natural patellar tendency to shift laterally. Moreover, the absence of active quadriceps muscle contraction under general anaesthesia acts also in the same way. CONCLUSION: By comparison with the more natural "dry" situation, in nearly all occasions serum inflow by simple gravity induced less than 10 degrees of knee flexion overcourse until the obtention of a perfect patello-trochlear centralization. This data must be taken to consideration during arthroscopic examination of the patello-femoral tracking in the diagnosis of anterior knee pain that would remain unexplained after conventional imaging procedures.

[New radiologic data on the trapezo-metacarpal joint. The results of 330 cases]. / Nouvelles données radiologiques sur la trapézo-métacarpienne. Résultats sur 330 dossiers.

Systematic x-rays in specific views and maximal amplitude of 330 trapezo-metacarpal joints in patients presenting with hand lesions has enabled us to define some original radiological parameters: the angle of the trapezium, the slope angle of the trapezium in anteversion and retroversion, trapezium mobility, the subluxation coefficient and the contact arc of the first metacarpal (M1) on the trapezium, defective reintegration of the base of the first metacarpal into the curve of the trapezium on AP and lateral views and the length of the intermetacarpal ligament. Statistical analysis, using analysis of variance, Chi-square test and correlation tests have demonstrated some correlations between all of these parameters allowing us to propose a pathophysiological hypothesis. In particular, this study emphasised the important role of a failure of the intermetacarpal ligament in the pathogenesis of proximal osteoarthritis of the thumb. Long before the onset of the well known signs of osteoarthritis, narrowing of the joint line and osteophytes, precursor radiological signs can be detected: loosening of the intermetacarpal ligament, excessive mobility of the trapezium, and poor reintegration of the base of M1 in the trapezium curve on AP and lateral films should now allow the early diagnosis and the proposal of preventive operations, such as intermetacarpal ligamentoplasty, reorientation osteotomies of the trapezium facet when the trapezium angle is too wide or new surgical techniques on the abductor carpi radialis, an almost constant expansion of the abductor pollicis longus on the trapezium.

[Digital flap autografts for pulp coverage in distal amputations of the fingers. 68 flaps]. / Les lambeaux homodigitaux de couverture de la pulpe dans les amputations distales des doigts. A propos de soixante-huit lambeaux.

Sixty-one patients underwent 68 digital pulp amputations involving the distal phalanx (Zone 2 and 3). 46 unipedicular Vankataswami-Subramanian island flaps (VS flap) and 22 bipedicular Moberg-O'Brien flaps (MOB flap) were performed. All distal thumb amputations were treated by MOB flap, whereas all lateral finger distal amputations of the long digits were treated by VS flap. Both flaps were used for the other types of amputation. Four digits developed complications and needed a delayed regularisation. The mean follow-up for the 46 flaps was two years. Pulp reconstruction was satisfactory in all flaps. Sensation was normal or slightly decreased in 66%. Nail dystrophy was considered to be poor in 56% and was attributed to initial trauma and the distal phalanx shortening. 20 degrees of extension deficit was found in 8 patients. We obtained 61 excellent and good results justifying our indications: MOB flap for all types of distal amputation of thumb in zone 2 and 3, VS flap for lateral distal amputations of the long fingers. In transverse amputation of the long fingers, MOB flaps seem to give better results than VS flaps.