Avulsion of flexor digitorum profundus secondary to enchondroma of the distal phalanx. Case report and literature review.

We report an unusual case of avulsion of the flexor digitorum profundus tendon of the ring finger at its insertion, in combination with a pathological fracture of the distal phalanx due to enchondroma. The bone lesion was curetted and grafted using autogenous bone. The FDP tendon was reattached to the distal phalanx using the pullout technique. We describe this case in detail and discuss the surgical management through a review of literature.

[Comminuted intra-articular fractures of the distal humerus in elderly patients]. / Fractures articulaires complexes de l'extrémité distale de l'humérus chez le sujet âgé

Treatment of comminuted intra-articular fractures of the distal humerus in elderly patients remains a challenge in trauma surgery. These fractures are rare, but their frequency increases. Our multicenter studies collected 238 cases of comminuted intra-articular fractures of the distal humerus in patients older than 65: two hundred and five cases for the retrospective study, 33 for the prospective study with a minimum follow-up of six months. The following criterias were studied: age, sex, state of health (with ASA score), functional scores (with Katz score), osteoporosis by the OST score and dual X-ray absorptiometry. The results were evaluated according to the Mayo Elbow Performance Score (Morrey) and the Quick DASH. X-ray studies were performed in order to assess both results for prosthesis and osteosynthesis. The following criteria were studied: bone healing, quality of reduction, signs of arthritis (Broberg-Morrey), prosthetic position, mechanical complications, prosthesis fixation. There were 80% of women in good health according to the ASA score (more than 70% of ASA 1 or 2). Most of them (80%) were self-governing and living at home. Hundred and seventy-two patients had an osteosynthesis and 44 had a prosthetic reconstruction (like Coonrad-Morrey prosthesis). Patients treated with osteosynthesis were younger (mean age was 77) than those treated with prosthetic reconstruction (mean age 81). Mean follow-up was 32 months. Results of osteosynthesis were good and excellent for 77% of the patients. Complications occurred for 20% of patients with a reoperation rate of 13%. Results of prosthetic reconstruction were good and excellent for 83% of the patients with 14% of complications and 6% of reoperation. Prosthetic reconstruction seemed to be better than osteosynthesis according to the Mayo Clinic score (84 points versus 77 points for the retrospective study and 95 points versus 75 points for the prospective study). However, the statistical analysis was not significant. Treatment of these fractures must be discussed according to the physiological status of the patient and the fracture patterns (scan evaluation). In conclusion, osteosynthesis remains the standard treatment when stable fixation is feasible. However, prosthetic reconstruction should be discussed for dependant patients or with comorbidity factors, bad bone quality leading to poor osteosynthesis or complex fracture.

Human telomerase is regulated by erythropoietin and transforming growth factor-beta in human erythroid progenitor cells.

Telomerase catalytic subunit (hTERT) exerts important cellular functions including telomere homeostasis, genetic stability, cell survival and perhaps differentiation. However, the nature of external or internal signals, which regulate hTERT expression in tissues, remains poorly understood. Thus, whereas it has been described that hTERT gene is regulated along the differentiation of primitive myeloid progenitors, the effect of specific cytokines on telomerase expression in each myeloid lineage is currently unknown. Based on these considerations, we have investigated hTERT expression in erythroid cells treated with erythropoietin (EPO) and transforming growth factor beta (TGFbeta), as putative positive and negative regulators, respectively. We describe here that EPO activates hTERT gene transcription in in vitro-expanded primary erythroid precursors as well as in UT7 erythroleukemia cells. In UT7 cells, this study shows also that EPO acts through a JAK2/STAT5/c-myc axis. In contrast, TGFbeta blocks EPO signaling downstream of c-myc induction through a Smad3-dependent mechanism. Finally, hTERT appears to be efficiently regulated by EPO and TGFbeta in an opposite way in erythropoietic cells, arguing for a role of telomerase in red blood cell production.

[Partial trapezectomy with suspension and interposition tendinoplasty for trapezometacarpal osteoarthritis: 5 years results]. / Trapézectomie partielle avec tendinoplastie de suspension et d'interposition dans le traitement de la rhizarthrose: résultats à cinq ans.

OBJECTIVES: Partial trapezectomy with suspension and interposition tendinoplasty is an alternative to total trapezectomy or trapezometacarpal arthroplasty for the treatment of trapezometacarpal osteoarthritis. This technique preserves the thumb length allowing good motion and satisfactory pollicidigital strength. The purpose of the present study is to report our experience with this procedure reviewing a continuous monocentric series of 41 thumbs with an averaged follow-up of 5 years. Surgical technique, clinical and radiographic results, and indications are discussed. METHODS: Thirty-three patients (41 thumbs) of 57.4 years average age underwent this procedure. According to Dell classification there were 23 stage II, 15 stage III, and 3 stage IV. No sign of osteoarthritis of the scapho-trapezo-trapezoidal joint were noted. Clinical and radiographic evaluations were available for all the patients. Pollicidigital strength was measured with a dynamometer. RESULTS: At 57 months average follow-up, 71% of the patients had no pain. Average opposition was 9.56 out of 10 according to Kapandji, the key pinch was equal to 6.51 kg, and M1M2 space was 34 degrees . Trapezometacarpal space was 2.52 mm on average. There were only 3 complications related to a reflex sympathetic dystrophy. CONCLUSION: Partial trapezectomy with tendinoplasty gives satisfactory functional results which is maintained with follow-up. It allows recovery of a functional pollicidigital strength by limiting thumb shortening. It is a reliable procedure with a low rate of complication indicated for isolated thumb trapezometacarpal joint osteoarthritis without scapho-trapezo-trapezoidal joint involvement.

[Segmental tibia fractures: a critical retrospective analysis of 49 cases]. / Fractures bifocales de jambe. Etude critique d'une série de 49 cas.

PURPOSE OF THE STUDY: Segmental tibia fracture is defined by the presence of two distinct fracture lines separating the cortical and completely isolating an intermediary segment of the tibia. Little work has been published on this clinical entity. We report a retrospective analysis of 49 patients treated in one center for segmental tibia fracture in order to determine more precisely the indications for three surgical techniques: locked intramedullary nailing with or without reaming, and external fixation. MATERIAL AND METHODS: The series included 34 men and 15 women, mean age 40.8 years. All patients had traffic accident: 25 had multiple fractures, 17 had multiple organ injury, and 9 had floating knees. There were 30 open fractures; 2 patients developed compartment syndrome. The segments were: distal-proximal metaphyso-metaphyseal (n=1), proximal diaphyso-metaphyseal (n=17), diaphyso-diaphyseal (n=27), and distal diaphyso-metaphyseal (n=4). The mean length of the intermediary segment was 14.1 cm. The emergency procedure involved intramedullary nailing with reaming (Grosse-Kempf nail) in 32 patients, intramedullary nailing without reaming in 7 patients (Collin nail in 5 and UTN in 2) and external fixation with non-transfixing pins in 10 patients (Orthofix). External fixation was converted early to intramedullary nailing in three patients (Grosse-Kempf nail in 2 and Collin nail in 1). RESULTS: Three patients were excluded: 2 underwent amputation after failure of vessel repair and 1 developed septic necrosis of a free latissimus dorsi flap; 1 patient died from multiple organ failure. Outcome at at least 18 months was known for 42 patients (4 patients lost to follow-up). There were 4 cases of post-nailing compartment syndrome; one case of deep infection on a Grosse-Kempf nail was treated by external fixation. Among the 27 patients with segment tibia fractures finally stabilized with a Grosse-Kempf nail, nonunion developed in 8; mean time to bone healing was 10 +/- 4.8 months (with dynamization in 13 patients). For the 7 external fixations, nonunion developed in 2; mean time to bone healing was 9.2 +/- 2.9 months. For the 8 nailings without reaming, nonunion developed in 2; mean time to bone healing was 9.5 +/- 2.5 months. Bone healing was not simultaneous in the two foci in more than half of patients. Two patients developed clinical sequelae of their compartment syndrome with deficient knee flexion in two. The 12 cases of aseptic nonunion were successfully treated by nailing with reaming and early weight bearing. DISCUSSION: Comparing our results with the therapeutic modalities used in published reports on segmentary tibia fractures showed that time to bone healing and the rate of nonunion were generally greater than in our series. A critical analysis of these results allows us to propose a more interventionalistic attitude before the development of late healing. We also propose a classification of segmental tibia fractures and a decisional tree for choosing between the three techniques based on the presence of soft tissue damage, the presence of compartment syndrome (nailing without reaming), and the presence of proximal or distal metaphyseal fractures (distal locked nail). Nailing with moderate reaming remains the preferred method.