[Supernumerary muscle on the dorsal surface of the hand. A case report]. / Muscle surnuméraire de la face dorsale de la main. A propos d'un cas.

The authors report a case of a painful wrist related to a "Manieux muscle" of the dorsal aspect of the hand. Manieux muscles are very rare supernumerary muscles first described by anatomists at the beginning of the 20th century. To our knowledge no symptoms related to this condition have been previously reported. In the present case, symptoms were limited to pain in the wrist with the presence of a fluctuant tumor. The putative diagnosis was synovial cyst. The abnormal muscle was revealed at operation. The operative findings confirmed the responsibility of the Manieux muscle for the patient's symptoms. The muscle was totally resected and pain completely disappeared without any functional impairment.

[The odontoid bone. Apropos of a surgically treated case]. / L'os odontoïde. A propos d'un cas opéré.

An odontoid bone was detected in an adult patient after injury to neck, with secondary appearance of disorders related to C1-C2 instability that disappeared after posterior C1-C2 arthrodesis. The odontoid bone is a rare anomaly of debatable origin. Current pathogenicity theories are discussed.

[Paraplegia caused by closed injury of the dorso-lumbar joint without apparent primary vertebral lesion]. / A propos des paraplégies par traumatisme fermé de la charnière dorso-lombaire sans lésion vertébrale primitivement apparente

Paraplegia due to closed trauma of the lumbo-dorsal junction, without bony lesions are exceptional. The author reports a case due to rupture of the posterior ligements, without vertebral displacement on the first films, but which became complicated secondarily by dislocation, which it was necessary to reduce by open operation. It thus seems that there occurred during this accident a marked vertebral displacement reponsible for paraplegia which became spontaneously reduced thanks to muscle contraction, but which recurred secondarily following muscular relaxation. This case illustrates the necessity for repeated X Rays in cases of marked lumbar trauma even if the initial films appear normal.

[Post-traumatic fat embolism. Apropos of 272 French cases]. / L'embolie graisseuse post-traumatique. A propos de 272 cas français

Pulmonary migration of fat globules form a fracture, although anatomically very frequent, rarely gives rise to clinical signs or symptoms. This pathological and clinical entity of fat embolism following trauma, remained for long undiagnosed in France, as the first published cases date from 1949 only; the syndrome is not, however, exceptional for, since 1949, 272 cases have been described including 42 which are published here. Clinical fat embolism affects, above all, adults with fracture of the femoral diaphysis placed in continuous extension. Continuous extension ensures only imperfect immobilisation and permits liberation of fat emboli from the focus whenever the patient moves. Early osteosynthesis is a generally effective means of prevention. The pathogenesis of fat embolism is still debated. It seems that in all cases the clinical signs are due to toxicity of fatty acids liberated from fat emboli. The usual acute neuro-respiratory form occurs after a free interval and associates four groups of symptoms: fever, dyspnea, coma and purpura. There exist forms with mainly neurological or respiratory symptoms, together with mild forms which may raise difficult diagnostic problems. Numerous further examinations have been proposed to permit this diagnosos. One should emphasize, in particular, the fundamental importance of abnormalities of the fundus oculi. The prognosis, which was very poor a few years ago, has been considerably improved with progress in resuscitation based mainly on maintenance of artificial respiration throughout the critical phase which is about 8 to 10 days. Further progress is, however, still possible for there is still a definite mortality.