MR imaging of hemophilic arthropathy of the knee: classification and evolution of the subchondral cysts.

Magnetic resonance imaging was performed to assess the subchondral bone of the knee in 64 patients with severe hemophilia A. Using this method, subchondral cysts could be detected and evaluated. We separated the cysts into four classes (LL, LH, HH, C) depending on their signal intensities on T1- and T2-weighted images. Follow-up studies, performed on 25 patients during a period of 10-30 mo after the initial examination, suggest that these four classes of cysts correspond to four successive stages. Morphological changes within a class of cysts were also observed. Although histological confirmation was not possible, this study demonstrated that magnetic resonance imaging allows a better understanding of the pathophysiology and the natural evolution of the subchondral cysts in hemophilic arthropathy.

Synovectomy of the elbow in young hemophilic patients.

Synovectomy of twenty-three elbows was done in eighteen patients, eight to twenty-five years old, who had severe hemophilia and were followed for eighteen to seventy months. Episodes of bleeding recurred in four elbows, and moderate pain persisted in three. A significant improvement in mobility was observed for pronation-supination in nine elbows and for flexion-extension in fourteen. No radiographic evidence of arthritis was seen. Synovectomy of the elbow, performed through a single lateral incision, appears to be a valuable surgical procedure in hemophiliacs in whom non-operative treatment has failed, and resection of the radial head should be done in adults when there is moderate or severe damage to the cartilage of the radial head.

[Nontraumatic aseptic osteonecrosis of the femoral head. Etiopathogenic, developmental and therapeutic considerations: review of the literature]. / Ostéonécrose aseptique non traumatique de la tête fémorale. Considérations étiopathogéniques, évolutives et thérapeutiques: revue de la littérature.

Aseptic non-traumatic necrosis of the femoral head occurs in patients with very unusual general state of health. Despite the fact that the metabolic abnormalities are better known today, many problems with regard to prognosis and treatment remain. According to the author's experience and, review of the literature, the authors consider that the production of tissue repair with hypervascularity is an aggravating factor. Disturbance of lipoproteins plays a major aetiological role. Decompressive forage should be reserved for the early stages. Secondary degenerative arthritis is almost constant after conservative surgery in cases that have been assessed. The authors obtained good results after Luck's adjusted cups and they consider that this is a reliable procedure. They have observed a high level of septic complications after total prosthesis. It is thought that this is related to the general condition of the patient.

[Trichorhinophalangeal syndrome. Apropos of 4 cases discovered in adults]. / Syndrome tricho-rhino-phalangien. A propos de quatre cas découverts chez l'adulte.

Of four adult patients with the trichorhinophalangeal syndrome, 3 were from one family, one had associated major femoral trochlear dysplasia and bilateral mandibular condyle dysplasia, and another a bilateral coxa plana.

[Plate fixation in fractures of the tibial plateau (author's transl)]. / Ostéosynthèse par plaque épiphysaire dans les fractures des plateaux tibiaux. A propos de 111 cas.

The authors have reviewed 100 cases of fracture of the upper end of the tibia with separation of a tibial plateau with some degree of depression. These cases were treated operatively with reduction of the depression and the use of an iliac bone graft to fill the bone defect and fixation with an epiphyseal plate. The results were satisfactory in 86 cases. The conclusions were that surgery should be avoided in patients with poor general condition or with poor local vitality of the limb. In these cases the possibility of delayed operation should be considered or minimum fixation obtained with an external fixator or conservative treatment using traction.