Tibial segmental bone defect reconstruction by Ilizarov type bone transport in an induced membrane.

The management of combined loss of skin coverage and bone substance in the lower third of the leg is problematic. A recommended sequential strategy associates removal of infected tissue and coverage followed by treatment of the bone defect. We report a technique without microsurgery, using Masquelet's induced membrane technique to manage the bone loss, associated to bone transport and coverage by a fasciocutaneous flap with distal pedicle. In a patient presenting with a 10 cm defect with bone exposure, this 2-step procedure allowed consolidation at 7 months without functional sequelae; the fixator was kept in place for 9 months. Neither microsurgery nor cancellous bone graft was required. Using a spacer to induce a membrane facilitated bone transport and distal consolidation.

[Acute carpal tunnel syndrome secondary to prolonged pressure on the wrist during enolic coma]. / Syndrome du canal carpien aigu après compression prolongée dans un contexte de coma éthylique.

We report a case of acute carpal tunnel syndrome caused by prolonged compression. A 40-year-old man was admitted for an acute carpal tunnel syndrome secondary to direct compression of the wrist which was blocked in supination under his thorax for ten hours during a period of alcoholic coma. Total sensorial anesthesia of the median nerve territory was noted. The emergency procedure consisted in simple opening of the carpal tunnel without nerve exploration due to the risk of bacterial contamination resulting from skin lesions, devascularization and postoperative fibrosis. Initially, the skin on the volar aspect of the wrist had the aspect of a second degree burn. The patient recovered nerve function the next day and the skin wound healed within 15 days. The patient was seen at consultation at 13 months and exhibited complete recovery of wrist and hand motion with normal thumb opposition and no signs of sensorial or motor deficit. The retinaculum of the flexor system must be opened to guarantee full nervous recovery.

[Idiopathic tumoral calcinosis: two cases and review of the literature]. / Calcinose tumorale idiopathique: A propos de deux cas et revue de la litterature.

Two black patients from Africa presented idiopathic tumoral calcinosis. This rare disease, defined by the presence of calcified deposits in peri-articular tissues remains poorly elucidated. Pathogenesis is still hypothetical. The diagnosis can be established with careful physical examination and appropriate complementary exams, allowing early complete surgical resection without biopsy. Pathology examination is required for formal differential diagnosis. The present tumors were particularly large, but did not produce signs of compression. In the first patient, the tumor developed after pregnancy in the zone of antibiotic injections. The second patient presented multiple bilateral symmetrical localizations with bone invasion. Histology confirmed the nature of the lesions and revealed bony metaplasie in the first patient, an element rarely described. Prognosis is excellent with early treatment. Recurrence is the rule in the event of incomplete resection. We discuss the appropriate diagnostic and therapeutic management.

[Surgical treatment of a femoral agenesis: a case report]. / Traitement chirurgical d'une agénésie fémorale sévère chez l'adulte: à propos d'un cas.

We report a case of severe femoral agenesia in an adult and propose a new surgical approach facilitating prosthesis fitting. The procedure involves insertion of a total hip arthroplasty, arthrodesis of the knee and amputation of the foot. The final prosthesis fits on the crural area with weight bearing on the ischiatic region, the lesser pelvis, and the articulated knee. Outcome was satisfactory at one year in our patient. Other surgical alternatives are presented.

[Anterior subtalar dislocation associated with a fracture of the calcaneus: a case report and review of the literature]. / Luxation antérieure sous talienne associée à une fracture du calcanéum. A propos d'un cas et revue de la littérature.

A new case of uncommon anterior subtalar dislocation associated with a fracture of the calcaneus is reported. Mechanism of production is described with a review of literature. The criteria of radiologic diagnosis are mentioned. Closed reduction with stabilisation by Kirschner wire were undergone. Prolonged physiotherapy following 6 weeks of immobilisation allowed good result. A decreased subtalar motion without pain was found at the last check up.