[Interscapholunate carpal axial dislocation: a case report]. / Luxation axiale du carpe inter-scapho-lunaire. A propos d'un cas.

We present a case of a patient presenting a right wrist injury due to a motor vehicule accident. X-rays and CT Scan showed transcapholunate axial dislocation with the capitate impacted between the scaphoid and the lunate without perilunate dislocation. This injury was associated to a fracture of radial styloid process, trapezium, triquetrum, hamate, and a pisotriquetral and intermetacarpal dissociation. We did not find any similar case in French or English litterature. Treatment associated closed reduction and percutaneous pinning. At one year follow-up the wrist was painless with a normal range of motion. This lesion contributes to the understanding of carpal injuries mechanism. Capitate ascension within the scapholunar joint due to an important compression force is a pathogenic factor of scapholunate dissociation.

[Knee arthrodesis using tibio-femoral rods following ablation of the septic total prosthesis]. / Arthrodèse du genou par tiges tibio-fémorales après ablation de prothèses totales septiques.

A technique of knee arthrodesis is described, using a fixation by medullary tibio-femoral rods introduced in the supra-malleolar region of the tibia. This procedure has been used with success as a salvage procedure after removal of four septic total prostheses of the knee. It allowed an early weight bearing and was indicated in cases where external fixator had failed or was contra-indicated.

[X-ray computed tomography in the study of fractures of the calcaneus]. / Apport de la tomodensitométrie dans l'étude des fractures du calcanéum.

In a series of 28 calcaneal fractures, computed tomography scanning has shown axial deformities in the coronal and horizontal (plantar) planes not previously recognized. Two-thirds of the fractures investigated showed a deformity in at least two planes. A combination of dorsiflexion, valgus and adduction was present in one-third of the cases. This examination allowed a precise measure to be made of the enlargement of the calcaneus which very frequently occurs and was greater than 25 per cent in two-thirds of the cases. It makes it possible to visualize subtalar and calcaneocuboid incongruence with great precision and, in particular, to determine the size of the incongruous surface and its severity. Computed tomography scanning showed the existence of subtalar incongruity without depression of the thalamus, which is a concept which is not well recognized. It shows incongruity which is not evident on normal radiographs or, conversely, which may be falsely interpreted from deceptive pictures. The results of this study indicate that the usual classifications based on radiological examination are inadequate and need to be revised. The accuracy of this examination leads to the hope of more precise indications for treatment in the future.

[Streptococcal gangrene. A report on 9 cases (author's transl)]. / La cellulite gangréneuse streptococcique. 9 cas siégeant aux membres.

The authors have treated 9 cases of streptococcal gangrene of the limbs. They describe the clinical features:local oedema, erythema, and cyanotic spots. In 7 of the cases the infected general condition was very severe. At operation, the subcutaneous soft tissues were grey-green without pus. The authors have reviewed the literature and consider that treatment should be based on early excision of the skin and subcutaneous tissues. Antibiotics are of great help but are not sufficient by themselves. Nine patients reached a stable state but sequelae have been severe with one disarticulation of the shoulder, one ankylosis of the wrist, one ankylosis of the knee and one generalised stiffness of the hand. Only five patients have been completely cured.