Retrieval of the retracted flexor tendons for long fingers: New tip.

Zone II flexor tendon injuries continue to be a challenge for hand surgeons. During the injury event, the tendon ends may retract towards the palm. Retrieval of these lacerated ends can be problematic because the tendon sheath is unstretchable. This demanding surgery requires a precise repair technique where the tendon stumps are handled in an atraumatic manner. Microtrauma to the tendon sheath must be avoided as this can induce adhesions and lead to poor functional outcomes. Several retrieval methods for retracted tendon ends have been described in published studies. In this technical note, we will describe a technical variation that streamlines the surgical procedure and uses commonly available materials. This simple trick makes the procedure easier and avoids having to suture the tendon to the tubing.

[Luxatio erecta of the shoulder. Report of eight cases]. / Luxation erecta de l'épaule (à propos de huit cas).

The luxatio erecta is a rare form of shoulder dislocation frequently described in young patients. The purpose of our study is to review the mechanism of this affection as well as its clinical, radiographic and therapeutic features. We also report eight cases of luxatio erecta observed between 1995 and 2006. We report six males and two females with an average age of 40 years. The left shoulder was dislocated in seven cases and a direct mechanism was reported by two patients. All of our cases presented with the typical attitude described for this dislocation; an upper limb in fixed abduction with the hand raised and inability to bring the elbow back to the body. No neurovascular injury was reported in this study. Radiographic examination showed inferior dislocation of the humeral head and the axis of the shaft above the horizontal line in all of our cases. The treatment consisted of closed reduction under general anaesthesia followed by a Dujarier's bandage for three weeks. Luxatio erecta is the commonest type of inferior dislocation. Its mechanism is a fall on the upper limb in great abduction or antepulsion. The clinical diagnosis is easy, confirmed by an anteroposterior radiograph. The functional long-term prognosis is excellent.

[The floating forearm: elbow and perilunate dislocation]. / Avant-bras flottant: luxation périlunaire du carpe et luxation du coude.

To the five cases published in the literature concerning concomitant elbow and perilunate dislocation, the authors add a sixth case and discuss the epidemiologic, clinical and therapeutic characteristics of this complex injury.

[Chondrosarcoma of the hand. Diagnostic and therapeutic discussion (three case reports)]. / Le chondrosarcome de la main. Discussion diagnostique et thérapeutique (à propos de trois cas).

Chondrosarcoma of the hand is very rare. We report three observations which enable us to make a review of its pathology. There were two men and one woman aged 72, 38 and 63 years respectively. Localisation was phalangeal in two cases and metacarpal in one case. Two cases were central and one peripheral. Radiographs were characterised by the presence of lytic areas with intralesional calcifications and soft tissue extension. Histological diagnosis was made by biopsy in two cases and after amputation of the finger for lesional spread in one case. Treatment consisted of amputation of the finger in two cases. In the case of metacarpal localisation, wide resection of two rays was followed by recurrence after ten months which required amputation of the hand. We agree with other authors who believe that chondrosarcoma in the hand is due to malignant change in a pre-existing chondroma. Conservative treatment is difficult due to the small size of the hand which allows easy spread of the tumour from compartment to compartment.

[Solitary osteochondroma of the limbs. Clinical review of 76 cases and pathogenic hypothesis]. / L'exostose ostéogénique solitaire des membres. Revue clinique de 76 cas et hypothèse pathogénique.

The authors report a retrospective study of 76 solitary osteochondromas of the appendicular skeleton treated between 1981 and 1995. The ages of the patients ranged from 13 to 55 years with a mean of 21 years. The male/female-ratio was 1.37. Tumefaction with or without associated pain was the reason for consultation in 68 cases (89%). In 62 cases the osteochondroma was localized in the distal part of the femur or the proximal part of the tibia. All lesions were surgically resected; the resection was complete in all cases. Six patients were lost to follow-up; the other 70 were seen on a regular basis over a time period ranging from 1 to 12 years. The result from surgical treatment was assessed based on pain, joint motion, cosmetic consequences, nerve compression and recurrence of osteochondroma. The results were good in 68 cases and fair in two cases. Based on a review of previous experimental studies, the authors suggest a hypothesis to explain the rotation of a fragment of the growth plate which is needed for the development of osteochondroma. This rotation occurs as a result of the mechanical action from the periosteum under tension.

[Medullary osteoid osteoma. A pathogenic discussion]. / L'ostéome ostéoïde médullaire. Discussion pathogénique.

PURPOSE OF THE STUDY: Medullary osteoid osteoma is exceptional. We report one case. PATIENT: A 15-year-old patient presented osteoid osteoma localized in the medullary canal of the tibial shaft, associated with intense medullary and cortical hyperosteosis. DISCUSSION: The origin of the osteogenesis in medullary osteoid osteoma could be a localized hemodynamic change involving venous congestion with stimulation of periosteal venous drainage.

[Aneurysmal diaphyseal bone cyst. Etio-pathogenic hypothesis and review of the literature. A case report]. / Le kyste osseux anévrysmal diaphysaire. Hypothèse étiopathogénique et revue de la littérature. A propos d'un cas.

PURPOSE OF THE STUDY: Diaphyseal aneurysmal bone cyst is very rare. We report a case in a 20-year-old female. PATIENT AND METHOD: The clinical signs developed rapidly, within one month. The lesion was first curetted and grafted with cortico-cancellous bone. Recurrence was observed 6 months later. Complete excision and reconstruction with a free fibular vascularized grafted enabled healing. DISCUSSION: The pathogenesis of aneurysmal bone cysts is debated. We hypothesize that it is due to the opposed direction of periosteal and medullary blood circulation. This could explain the relative rarity of diaphyseal localizations compared with metaphyseal localizations.

Tuberculous osteitis in limbs. Twenty five case-reports.

Tuberculous osteitis is a rare condition that can be difficult to differentiate from bone tumor on X-ray films. The purpose of this retrospective study was to analyse the epidemiologic, diagnostic and therapeutic aspects of this disorder. Data from 25 patients (13 men; 12 women; mean age = 37) were collected between 1984 and 1993. The source of contagion was traced in 32% of the cases and 24% of patients were known as tuberculous. Patients searched medical attention because of pain in 84% of cases. The greater trochanter was involved in more than 50% of cases. The definite diagnosis was obtained by examination of a surgical biopsy and the anti-bacillary treatment led to recovery in all cases. This study highlights that tuberculosis must be considered when investigating a bone lacuna, all the more so when the greater trochanter is involved, in a country where tuberculosis is endemic.

[Isolated tuberculosis of popliteal cyst. Apropos of a case]. / La tuberculose isolée du kyste poplité. A propos d'un cas.

INTRODUCTION: Isolated localization of tuberculosis in the popliteal cyst is an exceptional affection. CASE REPORT: Mr. M.L., 18-year-old black moroccan, was admitted for a painful swelling of the left popliteal cyst, general state alteration and left thoracic pain. Clinical examination found a 5 cm on 3 cm oval tumefaction at the supero-medial part of the left popliteal hollow. No articular effusion was noted. Left knee X ray was normal, while ultrasound examination showed a modified popliteal cyst. Chest X ray showed a pleural effusion. Tuberculine skin test was positive (18 mm). A subtotal resection of the cyst was performed, evacuating 10 ml of thick pus. The histologic examination of the cyst confirmed its tuberculosis origin. In addition the left pleural biopsy confirmed the diagnosis of tuberculosis as well. The antibacillar treatment based on rifampicine, INH and pyrazinamide was given during 6 months. The evolution was favorable at 2 years of follow-up. DISCUSSION: Knee popliteal cyst is frequently an expression of an inflammatory or traumatic affection. The communication between the articular synovium and the serosa bursa of the lateral gastrocnemius is found in 50 per cent of cases, allowing an association of both localizations of tuberculosis. Hamabuchi described for the first time an isolated popliteal cyst tuberculosis in 1990. This case is similar to Hamabuchi's observation. Clinical and radiographical examinations were normal thus excluding a possible dissemination from the knee joint.

[Multifocal bone tuberculosis: apropos of a case]. / La tuberculose osseuse multifocale: à propos d'un cas.

INTRODUCTION: Tuberculosis of bone is rare (10 to 20 per cent of all skeletal tuberculosis). The multifocal form is exceptional even in endemic countries of tuberculosis. It constitutes less than 5 per cent of all osseous tuberculosis. CASE REPORT: O.H. 34 year-old, Moroccan woman of black race not vaccinated against tuberculosis, with a contagion, complained for a year from scapular pain and weight loss. She noticed that two masses had appeared six months ago. The patient was feverish (38 degrees). The physical exam showed a non inflammatory mass 10 cm wide located in front of the left sacroiliac joint and seeming to be a cold abscess. The radiologic assessment showed a lytic image of the humerus upper extremity, the right iliopubis branch, the left ischium and the left iliac wing. The surgical biopsy of the humerus showed an evolutive caseo-follicular tuberculosis. The nuclear scan of bone found two other localizations in the fourth lumbar vertebra and the ninth left rib. We concluded to a multifocal bone tuberculosis with seven localizations: The upper extremity of both humerus Right pubis Left ischium Left iliac wing 4th lumbar vertebra 9th left rib. The treatment consisted in a specific antibiotic therapy for 6 months associated to the evacuation of the cold abscess. DISCUSSION: Multifocal bone tuberculosis is more frequent in young adults of black race. The beginning of the disease is progressive and the fistulas are the main reason of consultation. The radiologic lesions are not specific and have a geodic shape rimmed with an osteocondensation. Multifocal bone tuberculosis in black african predominate in flat bones. Otherwise in the white race it is located in the long bones extremities. The diagnosis of certitude is based on histologic findings of the peripheric bone lesion. The specific antibiotic therapy leads to the recovery if given early. Short protocols (9 or 6 months) are recently more used with success.