[Long-term results of midtarsal arthrodesis for flatfoot in adults]. / Résultats à long terme du traitement du pied plat valgus de l'adulte par arthrodèse médiotarsienne.

PURPOSE OF THE STUDY: Arthrodesis proposed for the surgical treatment of reducible pes planovalgus (flatfoot) in adults is designed to relieve pain and correct the deformity. The purpose of this work was to present the radiological and clinical results obtained with midtarsal arthrodesis performed in 22 cases of pes planovalgus. MATERIAL AND METHODS: This study concerned 22 cases of reducible flatfoot (Johnson grade 2) in 19 patients (11 males, 8 females, mean age 43 years, age range 15-75 years). Clinical outcome was assessed in terms of pain, function and motion using the AOFAS and Mann classifications. Radiological assessment (loaded anteroposterior and lateral views with Méary cerclage) noted the Djian angle, talometatarsal alignment, talar slope, calcaneal slope, calcaneal valgus, and osteoarthritis stage in adjacent joints. RESULTS: Mean follow-up was 7 years 4 months (range 6 months-20 years 3 months). Two nonunions resolved favorable after cancellous grafting. The Kitaoka score was 73.5/100 points (range 53-94). Pain and function improved from 2.8 to 1.1 points (/4 points) and from 3.45 to 1.6 points (/4) on the Mann scale. Flexion-extension remained unchanged. The foot was aligned correctly in 68% of cases. The mean talar slope and the talocalcaneal divergence were normal at last follow-up but there was a persistent undercorrection of the Djian angle in 68% of the feet and a break in the Méary line in 41%. Calcaneal valgus was reduced 6.6 degrees (16.6 to 10 degrees ) but the podoscope footprint was still the flatfoot type in 86% of the feet. For 50%, the neighboring joints presented progressive osteoarthritic degeneration. Subjectively the patients were very satisfied or satisfied with minor reservations for 73%. None of the patients was disappointed with the results. The objective outcome was excellent or good in 68% of the feet. DISCUSSION AND CONCLUSION: The results in terms of pain relief, function, motion, complications, and rate of satisfaction were comparable with results presented in the literature. Midtarsal arthrodesis provides effective pain relief and satisfactory functional recovery without creating any morbidity greater than simple talonavicular fusion. Nevertheless, it was noted that while correct alignment is achieved in the majority of cases, the clinical and radiological restoration of plantar cavum is limited. Furthermore compensatory hypermobility of the adjacent joints leads to the development of moderate osteoarthritic remodeling which remains asymptomatic more than seven years after the operation.

[Hydroxyapatite-coated Esop modular femoral stem: three to ten year outcome in 155 cases]. / La prothèse fémorale Esop revêtue d'hydroxyapatite à modularité métaphysodiaphysaire: résultats à 5 ans de recul moyen d'une cohorte de 155 implants.

PURPOSE OF THE STUDY: Primary and secondary stability of the Esop prosthesis depends exclusively on cementless metaphyseal anchoring. This modular implant is composed of an hydroxyapatite-coated metaphysis on which a diaphyseal piece is added intraoperoperatively simply to act as a centering device. The purpose of this retrospective analysis of a consecutive series was to assess primary and secondary stability of the Esop implant by measuring axial migration over time. MATERIAL AND METHODS: Between 1995 and 2001, 172 primary total hip arthroplasties (THAs) were performed with the Esop femoral implant and the Atlas III acetabular implant. Six patients lost to follow-up and eleven patients who died were excluded from the analysis. The review thus concerned 155 THA in 128 patients (66 women and 32 men), mean age 57 years (age range 28-77 years), 53% with an occupational activity at the time of surgery. Degenerative hip disease and aseptic osteonecrosis were present in 87% of patients. Imagika, a dedicated software, was used to measure axial migration and overall offset of the THA at four distinct times: on the immediate pre- and postoperative films, after introduction of weight-bearing, and at last follow-up (mean 61 months, range 35-114 months). Survival and clinical and radiographic outcome were also assessed with the Postel-Merle-d'Aubigné (PMA) score. RESULTS: THA survival was 98%, all causes of failure included. The PMA score showed 97% excellent, very good or good outcome. Axial migration greater than 5 mm was demonstrated in ten hips (6.4%). Among these ten, seven exhibited migration during the first month than did not move further up to last follow-up. Comparison between the pre- and postoperative images revealed a 10 mm reduction in offset in 38% of hips, showing that the hip rotation center was medialized. DISCUSSION: Migration observed in ten implants corresponded to restablization at weight-bearing in seven. There was no correlation with the clinical outcome or poor radiological osteointegration. CONCLUSION: Primary and secondary stabilization of the Esop implant is satisfactory. In this series, the rotation center of the hip was globally medialized so that it would be useful to have available lateralized implants.

[Clinical results of resection arthroplasty for infected shoulder arthroplasty]. / Résultats de la résection arthroplastique dans les arthroplasties d'épaule infectée.

PURPOSE OF THE STUDY: Infection is a rare complication of shoulder arthroplasty. Various therapeutic solutions have been proposed: antibiotics alone, one-stage or two-stage reimplantation, surgical or arthroscopic cleaning without prosthesis removal, scapulohumeral arthrodesis or simple arthroscopic resection. We evaluated the mid-term clinical outcome after resection arthroplasty for the treatment of infected shoulder arthroplasty. MATERIAL AND METHODS: The series included ten infected arthroplasties in ten patients. Mean duration of implantation was two years seven months (range nine months to five years). Bacteriological diagnosis was established from intraoperative articular samples or systematic samples taken during surgical revision procedures: meti-S Staphylococcus aureus strains (n=4), coagulase-negative Staphylococcus (n=5 including three S. epidermidis) Streptococcus mitis (n=1) and Citrobacter koseri (n=1). The mean Constant score before revision was 58 (range 23-77). Subjective patient satisfaction before surgical revision was rated good in six cases, fair in one and poor in three. Surgery associated removal of the implant, complete resection of the cement, resection of the fistular tracts, wide debridement of infected tissues and total synovectomy. RESULTS: Patients were seen at an average follow-up of three years eight months. The objective functional outcome measured with the Constant score was only fair, 28 points (range 20.6-36), and corresponded to a loss of 29 points compared with the preoperative score. This was explained mainly by lower scores for joint motion, function and muscle force but with persistently satisfactory scores for pain. All patients remained pain-free (daytime and nighttime). Patient satisfaction was rated good for two, fair for five and mediocre for three. Clinical and biological proof of eradicated infection was obtained in all patients. DISCUSSION: Infection remains a serious devastating problem for shoulder arthroplasty with an important functional impact. Resection only has a modest clinical effect. Precise identification of the causal germ with institution of adapted antibiotic therapy is required for eradication of the infection. Early diagnosis is probably the most important parameter affecting clinical outcome and surgical options. Functional results after resection arthroplasty are modest. This procedure should be reserved for patients with reduced functional demands. Improved management of the infectious load and reduction of diagnostic delay should help improve functional outcome and favor use of stow-stage procedures for reinsertion.

[Clinical results of arthroscopic tenotomy of the long head of the biceps brachii in full thickness tears of the rotator cuff without repair: 40 cases]. / Résultats de la ténotomie arthroscopique du chef long du biceps brachial dans les ruptures transfixiantes de la coiffe des rotateurs non réparées: a propos de 40 cas.

PURPOSE OF THE STUDY: Appropriate treatment of irreparable rotator cuff tears in patients without osteoarthritic shoulder joints remains a subject of debate. Medical treatment, a substitution muscle flap, and palliative arthroscopic treatment have been proposed. Arthroscopic tenotomy of the long head of the biceps brachii is warranted because this tendon is often the cause of part or all of the pain. If there is a full thickness tear of the rotator cuff, the exposed tendon of the long head of the biceps brachii can, because of its anterosuperior position, become impinged against the acromial vault during forward flexion. The purpose of this work was to evaluate the mid-term clinical and radiological results of arthroscopic tenotomy of the long head of the biceps brachii during treatment of full thickness tears of the rotator cuff. MATERIAL AND METHODS: The series included 40 shoulders operated on for tenotomy alone (n=32) or in combination with acromioplasty (n=8). The long head of the biceps brachii was in place in 23 shoulders (58%), displaced in seven and subluxed in five. The position was not determined in five. At last follow-up, the mean rough Constant score was 58 points, giving a gain of 20 points. The gain for pain was +7.1 points, +6.4 points for activity, and +6.6 points for motion. After the operation, muscle force for elbow flexion-supination was decreased 40% compared with an age-, sex- and dominance-matched control group. 86% of the patients were satisfied with the outcome and only two patients were disappointed by the asymmetry of arm muscle volume. Radiographically, at last follow-up there were no signs of superior excentration of the humeral head and the subacromial space, which measured 7.38 mm preoperatively was 7.19 mm postoperatively. Likewise only two shoulders progressed to excentered osteoarthritis at 41 and 72 months. DISCUSSION: Mid-term results of arthroscopic tenotomy of the long head of the biceps brachii are satisfactory. The technique is simple and has limited functional consequences. The procedure has an undeniable impact on pain and has allowed a 34 degree gain in anterior flexion of the shoulder. Complementary acromioplasty was not found to provide a supplementary benefit in this series. Nevertheless, the degradation of the result in one female patient at six years suggests we should be prudent concerning the long-term benefit of this procedure which should be reserved for irreparable tears in patients with minimal functional demands.

Function of subscapularis after surgical treatment for recurrent instability of the shoulder using a bone-block procedure.

We compared the long-term function of subscapularis after the Latarjet procedure using two surgical approaches. We treated 102 patients (106 shoulders) with a mean age of 26.8 years (15 to 51) with involuntary unidirectional recurrent instability. The operation was carried out through an L-shaped incision with trans-section of the upper two-thirds of the muscle in 69 cases and with a subscapularis split in 37. All clinical results were assessed by the Rowe and the Duplay scores and the function of subscapularis by evaluating the distance and strength at the lift-off position. Bilateral CT was performed in 77 patients for assessment of fatty degeneration. The mean follow-up was 7.5 years (2 to 15) and 18% of cases were lost to follow-up. The mean Duplay score was 82 of 100 for the L-shaped incision group and 90 of 100 for those with a subscapularis split (p = 0.02). The mean fatty degeneration score was 1.18 after an L-shaped incision compared with 0.12 after subscapularis split (p = 0.001). The subscapularis split approach is therefore recommended.

[Radiocarpal dislocation: twelve cases and a review of the literature]. / Luxation radio-carpienne: à propos d'une série de 12 cas et revue de la littérature.

PURPOSE OF THE STUDY: Radiocarpal dislocation is an uncommon entity in traumatology. Proper management depends on the type of dislocation and the presence of concomitant injury. The purpose of this study was to detail the pathogenesis of radiocarpal dislocation and describe its complications and treatment. MATERIAL AND METHODS: Twelve radiocarpal dislocations were reviewed retrospectively. Nine were associated with multiple trauma. For this review, physical examination was performed to determine the functional status, presence of pain, joint motion, and grip force. The Green and O'Brien score as modified by Cooney was used to assess function. Grip force was measured with a Jamar dynamometer and weighted by the non-dominant/dominant ratio. Dumontier and Moneim classifications were used to define different types of radiocarpal dislocation. Radiological evaluation was based on anteroposterior (ulnar and radial inclination) and lateral views of the wrist. RESULTS: Dorsal displacement was observed for nine dislocations. All were associated with fractures (eleven fractures of the lateral cuneal process and eight fractures of the styloid process). Other associated injuries were distal radioulnar dislocation and intracarpal sprains (two scapholunate and two lunotriquetral). There were three median nerve compressions which all regressed without sequelae. Ten patients were treated by styloradial osteosynthesis alone and two patients by capsule-ligament suture via an anterior approach. Pinning was used to stabilize the two lunotriquetral injuries and the one neglected radioulnar dislocation. RESULTS: At last follow-up (mean 46.2 months), the overall functional outcome was satisfactory. The Green and O'Brien (modified by Cooney) score was excellent for one patient, fair for eight, and mediocre for three (75% satisfactory results). Distal radioulnar degeneration developed in the patient who had a neglected radioulnar dislocation. Three cases of radiocarpal degeneration were observed in patients with neglected scapholunate sprains whose wrist was symptomatic at last follow-up. DISCUSSION: Radiocarpal dislocation is associated with intracarpal fracture and/or injury. Intracarpal injury must be treated in order to limit the risk of future degeneration. Pure radiocarpal dislocation (or in association with a minimal fracture of the styloid) should be treated surgically, irrespective of the approach, in order to achieve capsule-ligament suture. Other radiocarpal dislocations can be simply reduced with osteosynthesis of associated fractures. Intracarpal and/or distal radioulnar lesions must be stabilized. Osteosynthesis or capsule-ligament suture must be achieved to obtain a satisfactory clinical result.

The communicating branches between the sural and superficial peroneal nerves in the foot: a review of 55 cases.

The rich sensory innervation of the ankle and foot is manifest through the numerous communicating branches linking the neural trunks, particularly the superficial peroneal and sural nerves on the anterolateral aspect of the hindfoot. The 35 communicating branches seen in 55 dissections (58%) were proximal in half of the cases, lying in the malleolar and lateral tarsal regions, and distal in the other half, in the metatarsal region. The communicating branch was straight in 25 cases and curved in 11. The average distances of the communicating branch from the crest of the lateral malleolus and the tubercle of the 5th metatarsal was 4.7 and 4.1 cm, but there was a wide range of values. We believe that stretching of the proximal communicating branch during forced inversion of the ankle and/or foot or during fractures of the calcaneus or direct injury in surgical approaches or arthroscopy of the ankle may lead to unexplained pre- and submalleolar pain. Advances in modern imaging may allow recognition of these branches and guidance of infiltration and even neurolysis in cases of failure of conservative treatment.

[Correction of acquired metatarsus elevatus and hallux flexus: technique used in nine cases]. / Technique de correction du metatarsus elevatus acquis avec hallux flexus. A propos de 9 cas.

Nine cases of acquired metatarus elevatus or horizontalization of the first metatarsal with hallux flexus (dorsal bunion) were treated surgically associating: plantar wedge resection of the base of the first metatarsal or the first cuneiform; distal disinsertion of the long hallux flexor which was then positioned under the base of the first metatarsal and finally fixed on the distal dorsal segment of the metatarsophalangeal capsule; distal disinsertion of the anterior tibial tendon and tenodesis of the posterior tibial tendon. Weight bearing was allowed after pinning for one Month to position the axis of the first ray. Morphological results, recorded at 11 Years follow-up (mean) were satisfactory. There were no recurrent deformations and no residual instability of the first ray. The only observation was a minimal stiffness of the metatarsophalangeal joint with no tendency to degeneration.

[High incidence of total hip arthroplasty aseptic loosening with ion-coated titanium femoral heads]. / Fréquence élevée des descellements prothétiques aseptiques après utilisation d'un couple titane implanté-polyéthylène.

PURPOSE OF THE STUDY: The purpose of this study was to determine the frequency of aseptic loosening among a series of total hip arthroplasties evaluated at 84 months and to search for the cause. Two types of acetabular cups had been implanted. It was hypothesized that the ion coating of the titanium head could be involved in the deterioration of titanium/polyethylene implants. MATERIAL AND METHODS: Two non-cemented acetabular cups differing only by the presence or not of a hypoxyapatite coating were studied. Different types of femoral heads (stainless steal, chromium-cobalt, alumina, zincrona, nitrurated titanium, ion-coated titanium) and femoral stems (with or without cement) were implanted. Sixty-two ion-coated titanium heads were implanted and 47 patients with 52 heads were reviewed. Clinical outcome was assessed with the Postel-Merle-d'Aubigné score and the Livermoore method was used for radiological assessment of the bone-implant interface and polyethylene wear. The physico-chemical properties of one titanium head explanted after aseptic loosening were also studied. RESULTS: At 84 months follow-up, the mean clinical score was 15.8/18 points. Mean polyethylene wear was 0.18 mm/year. There were 13 revisions for aseptic loosening: two bipolar, nine acetabular and two femoral. Mean wear for the explanted implants was 0.34 mm/year. Metallosis was observed in eight cases. Arthroplasties with the same types of femoral stem and acetabular implants but with other types of heads (stainless steal, chromium-cobalt, alumina, zincrona, nitrurated titanium) led to only one case of aseptic loosening among 118 implantations. Electron microscopy demonstrated the presence of scratch lines, disappearance of the nitrogen ion layer, decreased hardness, and increased roughness of the titanium head. DISCUSSION: The poor friction properties of titanium are well known. To improve performance, ion coating has been proposed. This technique consists in projecting nitrogen ions onto the surface of the head to form a surface coating measuring about one micron. The high incidence of aseptic loosening, polyethylene wear, metallosis, and modifications of the head surface (disappearance of the nitrogen ion layer, scratch marks, etc.) suggest ion-coated titanium heads could be the cause of these aseptic loosenings. CONCLUSION: Ion-coating has not provided good protection of the titanium head. Patients with this type of head should be followed carefully in order to detect aseptic loosening or metallosis early.

The fibrocartilaginous sesamoid: a cause of size and signal variation in the normal distal posterior tibial tendon.

The aim of this study was to investigate the presence of fibrocartilage within the distal posterior tibial tendon (PTT) before its division correlating with size and signal variation on MR images through a radio-anatomic and pathologic study. Eight fresh cadaveric feet underwent MR imaging were cut into 4-mm slices in the axial plane. The PTT specimens were harvested at the tendon distal portion before its division and sent to pathology. Thirty-three asymptomatic subjects underwent axial double-echo turbo-spin-echo MR imaging. Proximal and distal PTT signal and diameter were evaluated. In cadavers, every PTT flared distally. Intratendinous fibrocartilage and ossified sesamoid were found in, respectively, 87.5 and 12.5% of the cases. Distal PTT flaring was demonstrated in 100% of the asymptomatic subjects (mean diameter 8 mm). An intratendinous high signal intensity on proton-density-weighted images and sesamoid bone were evidenced in, respectively, 36 and 33% of the cases. Proximally, PTT presented a 4-mm mean diameter and was hypointense in 100% of the cases. Only one accessory navicular bone was detected. Laterally off-centered increased intratendinous signal intensity as well as PTT distal widening with otherwise normal MR imaging features are related to an intratendinous fibrocartilage.

A study of reproducibility of an original method of CT measurement of the lateralization of the intertubercular groove and humeral retroversion.

An original method of CT measurement of the lateralization of the humeral intertubercular groove is described based on geometric construction following Thales theorem. A study of intra- and interobserver reproducibility was done of this measurement and humeral retroversion on 32 healthy volunteers. The results show good reproducibility of these measurements. The average value of humeral retroversion was lower than the average values found in the literature: 11.71 degrees on average on the dominant side and 7.03 degrees on average on the non-dominant side with a large spread of values. The reasons for these differences are discussed. The average values of lateralization of the intertubercular groove were 114.97 degrees on the dominant side and 121.9 degrees on the non-dominant side. These CT measurements are important to consider in the pathophysiology of chronic anterior instability of the shoulder.

Multi-fasciculated anterior talo-fibular ligament: reassessment of normal findings.

The aims of this study were to (a) provide an accurate description of the anterior talo-fibular ligament (ATFL) multifasciculated feature by means of cadaver study, and (b) to further delineate contour and signal variations on MR images related to this feature in a group of asymptomatic subjects. After MR imaging, three cadaveric feet were frozen and cut in the coronal plane. The ATFL were harvested and sent to pathology. Another cadaveric foot was dissected. The MR imaging was performed in 3 healthy volunteers and 19 patients without pathology of the ATFL. For both cadaveric feet and subjects, MR imaging protocol consisted of axial and coronal proton-density (PD) and T2-weighted turbo-spin-echo (TSE) sequences (TR/TE: 3500 ms/17-119 ms). On MR images, ATFL signal and fascicle numbers were assessed, respectively, in the axial and coronal planes. Gross anatomy and pathology confirmed the ATFL bifasciculated aspect. On cadaveric coronal MR images, 3 of 4 ATFLs were bifasciculated and one of four was striated. On patients' coronal MR images, 2 of 22 of the ATFL were monofasciculated, 12 of 22 bifasciculated, and 8 of 22 striated. On axial MR images, 16 of 22 of the ATFL demonstrated a low signal intensity and 8 of 22 an intraligamentous subtle increased signal intensity. Two of 22 of the ATFL had contour irregularities. Isolated anterior talo-fibular intraligamentous signal abnormalities or contour irregularities on axial PD and T2-weighted MR images with an otherwise normal ATFL aspect on coronal MR images and no other MRI criteria for ankle sprain may reflect normal anatomy.

[Clinical and computed tomography results of 106 Latarjet-Patte procedures at mean 7.5 year follow-up]. / Résultats cliniques et tomodensitométriques d'une série continue de 106 butées de Latarjet-Patte au recul moyen de 7,5 ans.

PURPOSE OF THE STUDY: We reviewed, at a mean follow-up of 7.5 years, overall functional outcome, bony architecture of the humerus predisposing to anterior instability, and treatment failure after 106 Latarjet-Patte procedures performed in 102 patients (mean age 34 years). MATERIAL AND METHODS: The reproducibility of computed tomographic findings was validated prior to analysis. There were 5 men for 1 woman in this series. The initial injury, occurring at the age of 22 years on the average, was caused by trauma in 87% of the patients and generally involved the dominant upper limb. Ninety-seven patients practiced sports activities, a high risk sport for 48%. Clinical outcome was assessed with the Duplay score. Standard x-rays were also obtained, with bilateral computed tomography in 80 patients. RESULTS: The osteosynthesis screw had to be removed in 6% of the cases due to posterior pain. The Latarjet-Patte procedure yielded 76.4% excellent or good results according to the Duplay scoring system. Sixty percent of the competition-level athletes like amateur athletes resumed their former sports activities at the same level. Seventy-percent of the patients were pain free. At last follow-up, complaints of pain, generally minor pain, were related to age of onset of instability, preoperative pain, and presence of joint degeneration. Loss of rotation was less than 11 degrees (mean). There was one case of recurrence subsequent to secondary trauma and 13.2% of the patients experienced residual apprehension. This lack of perfect stability was not related to a technical error but rather to a functional section of the head cartilage which remained in an overly anterior position because of a Malgaigne notch extending to the surface. Grade 2 or 3 joint degeneration was observed in 15% of the patients. It was related to duration of follow-up, patient age, mode of instability, and overlap of the bone block. Standard x-rays underestimated the incidence and degree of joint degeneration since the computed tomographic analysis revealed 17.5% of joint space narrowing (overall or posterior). Single cortex screwing led to nonunion, observed in 7% of the cases. Advanced osteolysis led to pain with altered overall function. DISCUSSION: Operated patients appear to have a constitutional morphology predisposing to anterior instability due to more marked bicipital lateralization than seen in controls. The differences concerning humeral version are less pronounced. There was a difference in version, independently of the presence of a notch, between the unstable and the healthy side. Conversely, in comparison with controls, a more anterior sector of the head cartilage (secondary anteversion) was only seen in patients with a notch. CONCLUSION: We consider that preoperative measurement of humeral retroversion and lateralization of the bicipital gutter can be helpful in establishing a precise therapeutic indication. Rather than searching for a constitutionally anomalous retroversion, we advocate searching for a more anterior functional section of the head cartilage (aggravated anteversion) caused by the presence of a Malgaigne notch on the unstable side (retroversion< or =0 degrees ). When this anomaly is present, we prefer associating a derotation retroversing osteotomy of the humerus with the classical technique. This should avoid persistent residual apprehension.

[Reproducibility of CT scan evaluation of muscular fatty degeneration. Intra- and interobserver analysis of 56 shoulders presenting with a ruptured rotator cuff muscles]. / Reproductibilité de l'évaluation tomodensitométrique de la dégénérescence graisseuse des muscles. Analyse intra- et inter-observateurs sur 56 épaules présentant une rupture de la coiffe des rotateurs.

PURPOSE OF THE STUDY: This study was undertaken to determine the reproducibility of measurements of fatty degeneration of the rotator cuff using computed tomography (CT). MATERIAL AND METHODS: Fifty-six patients who had undergone surgery for rotator cuff tear were included in this retrospective study. The extent of fatty infiltration was evaluated on CT scans with soft tissue windows in all 56 shoulders using a five-stage scoring system described by Goutallier. Five independent observers made the assessments. The same operation was repeated one month later to test intraobserver agreement. Four parameters were recorded: fatty infiltration of three muscles (supraspinatus, infraspinatus, subscapularis), and overall fatty infiltration grading. Interobserver variability was determined for each parameter using the intercorrelation coefficient (a test of reproducibility of quantitative measurements). RESULTS: The most reproducible measurement was the overall fatty infiltration grade. For this parameter, interobserver agreement was good with an intercorrelation coefficient of 0.75. The interval of confidence was +/- 0.5. Intraobserver agreement depended on the observer's level of experience. It was good for overall fatty infiltration grade assess by three senior observers (r=0.78) and moderate for two junior observers. CONCLUSION: The overall fatty infiltration grade is a reproducible parameter that should be used to evaluate the degree of fatty infiltration as the safety margin of this value (graded 0 to 4) is about 0.5. Fatty infiltration of a torn cuff would not be the only criterion to improve indications for treatment of rotator cuff tears.

Accessory coracobrachialis muscle as a cause of anterior impingement syndrome of the rotator cuff in an athlete.

Subcoracoid impingement is a rare but well-know cause of anterior shoulder pain in throwing and overhead athletics. Bulging of the walls or the contents of the coracohumeral space may hamper the smooth gliding of soft tissue between the coracoid process and glenohumeral joint, especially in forward elevation and internal rotation of the arm. Following is a case report of subcoracoid impingement caused by an accessory coracobrachialis muscle in an alpinist treated by resection of the muscular supernumerary slip.

Gas phase infrared spectroscopy of selectively prepared ions.

The first example of direct structural characterization of polyaromatic ions by coupling a Fourier transform ion cyclotron resonance mass spectrometer with an infrared free-electron laser is presented. Measurement of the IR spectra of selectively prepared ionic reactive intermediates is allowed by the association of the high peak power and wide tunability of the laser with the flexibility of the spectrometer, where several mass selection and ion reaction steps can be combined, as demonstrated in the case of iron cation complexes of hydrocarbons. The present experimental setup opens the way to understanding chemical reaction paths.

[Ulnar nerve compression and pseudoarthrosis of the medial metacarpal bases]. / Compression du nerf ulnaire et pseudarthrose des bases métacarpiennes médiales.

A case of compression of the deep branch of the ulnar nerve associated with pseudarthrosis of the base of the fifth metacarpal and the upper shaft of the fourth metacarpal is reported. The delayed procedure consisted in volar decompression of the ulnar nerve by dividing the pisi-hamate ligament and plating and grafting of both fractures. The patient achieved marked improvement four weeks post-operatively and had complete functional recovery at follow-up of 16 years after injury without narrowing of the hamato-metacarpal joint despite synostosis of the bases of the medial metacarpals.

[Osteoid osteoma of the radial bicipital tuberosity: report of 2 cases]. / Ostéome ostéoïde de la tubérosité bicipitale du radius: a propos de deux cas.

We report two cases of osteoid osteoma located in the bicipital tuberosity of the radius. This unusual localization illustrates the clinical polymorphism frequently observed in osteoid osteomas of the elbow and consequently the tendency to late diagnosis. Resistant contraction of the brachial biceps, in forearm pronation, suggests the need for complementary exams, particularly computed tomography. Surgical resection via anterior access can control pain and prevent recurrence.

[Relationship between the tendon of the long head of the biceps brachii muscle and the glenoid labrum]. / Etude des rapports entre le tendon du chef long du biceps brachial et le labrum glénoïdal.

For many authors, the insertion of the long head of the biceps brachii muscle is exclusively or mainly located on the supraglenoid tubercle. The aim of this work was to study the insertion of the long head of the biceps brachii at macroscopic and microscopic examinations. 31 shoulders of macerated cadavers of both sex (age range: 52-92 years) were dissected by a posterior approach in order to study the glenoid labrum and the origin of the long head of the biceps brachii muscle. At macroscopic examination two types of the proximal part of the long head of the biceps brachii were demonstrated: a flattened shape in 84% of the cases and a hemicylindrical shape in 16% of the cases. Four types of origin were demonstrated at dissection: in 64.5% of the cases the tendon inserted mainly on the postero-superior part of the labrum, in 19.4% of the cases the tendon inserted both on the postero-superior and postero-anterior labrum, in 6.4% of the cases it inserted only on the supraglenoid tubercle and in three cases the tendon inserted on the intertubercular groove. The histologic examination performed on 6 superior part of the bicipitolabral complex have all shown that the tendinous fibers blended with the glenoid labrum. The examination performed on an complete labrum demonstrated tendinous fibers within the glenoid labrum up to the junction between the postero-superior and postero-inferior part of the labrum.

[Long term results of the surgical treatment of bicondylar fractures of the distal humerus extremity in adults]. / Résultats à long terme du traitement chirurgical des fractures bicondyliennes de l'extrémité distale de l'humérus chez l'adulte.

PURPOSE OF THE STUDY: In intra-articular fractures of the distal humerus, full functional recovery is difficult to obtain. An osteosynthesis by plate is the treatment of choice, but location and type of plate always remain open for debate. We present a consecutive series of intra-articular fractures of the distal humerus treated by osteosynthesis. The aim of the study is to determine and to compare the results of various types of osteosynthesis. MATERIALS AND METHODS: We reviewed 55 patients at an average of 108 months after early internal fixation for intraarticular displaced fractures of the distal humerus type C according to the A.O. classification. Intraarticular osteotomy of olecranon was used in 37 subjects (67.27%). The osteosynthesis has been achieved with a precasted lateral plate for 31 patients, with two posterior plates in 18 subjects, with a screwing on triangulation in four patients and with pins in two patients. RESULTS: The osteosynthesis with two posterior plates obtained a good result between 78.57% and 92.86% of cases, whereas the osteosynthesis with a precasted lateral plate gave a good result between 73.68% and 76.32% of cases according to the score used for estimation. In the aggregate, the functional estimate has a good result in the most of the cases whatever the score of estimate. At follow up we observed an average range of motion of 103 degrees. This value is quite good because it corresponds to the sector of the useful functional mobility. DISCUSSION: The review of our cases and the literature prompt us to follow the way of the osteosynthesis in adjusting indications to the type of fracture and in using a well-codifed technology. As it is already the case, a minimal osteosynthesis by screwing or by pins must be left except for peculiar cases in osteopenic elderly patients and if they have a very poor health. Contrary to other studies, the osteosynthesis with two posterior plates has given us better results provided that it has been systematically associated with a triangulation screwing in order to increase the strength of fitting in the sagittal plan. The precasted lateral plate gives a stable fitting too, nevertheless it is well advised to associate it to an osteosynthesis of medium column especially when the fracture is type C3. We have statistically proved that the age is not contraindication for osteosynthesis. CONCLUSION: This surgery is difficult and entails complications. The dismantling of the synthesis always gives poor results particularly if it is succeeded by an immobilization in plaster. The poor reduction, origin of arthrosis, of loss of bony substance and of calcifications worsen the functional prognosis. Last but not least, a good result can be obtained in the most of the cases however the types of fractures.