[New varieties of lateral metatarsophalangeal dislocations of the great toe]. / Nouvelles variétés de luxations métatarso-phalangiennes du gros orteil: les luxations latérales.

PURPOSE OF THE STUDY: We report seven cases of traumatic dislocation of the great toe, detailing the anatomy, the mechanism of injury and the radiographic diagnosis. We propose an additional classification based on three hereto unreported cases. MATERIAL AND METHODS: Between october 1994 and october 1997, we treated seven patients with traumatic dislocation of the first metatarso-phalangeal joint of the great toe. There were six men and one woman, mean age 35 years (range 24 - 44 years). Dislocation was caused by motor vehicle accidents in four cases and by falls in three. Diagnosis was made on anteroposterior, lateral and medial oblique radiographs. According to Jahss' classification, there was one type I and three type IIB dislocations. There was also one open lateral dislocation and two dorsomedial dislocations. Only these dorsomedial dislocations required open reduction, done via a dorsal approach. Mean follow-up was 17.5 months (range 9 - 24 months) in six cases. One patient was lost to follow-up. The outcome was good in six cases and poor in one (dorsomedial dislocation). DISCUSSION: Dislocation of the first metatarso-phalangeal joint of the great toe is an uncommon injury. In 1980, Jahss reported two cases and reviewed three others described in the literature. He proposed three types of dislocation based on the feasibility of closed reduction (type I, II and IIB). In 1991, Copeland and Kanat reported a unique case in which there was an association of IIA and IIB lesions. They proposed an addition to the classification (type IIC). In 1994, Garcia Mata et al. reported another case which had not been described by Jahss and proposed another addition. All dislocations reported to date have been sagittal dislocations. Pathological alteration of the collateral ligaments has not been previously reported. In our experience, we have seen one case of open lateral dislocation due, at surgical exploration, to medial ligament rupture and two cases of dorsomedial dislocation due, at surgical exploration, to lateral ligament rupture. CONCLUSION: We propose another additional classification with pure lateral dislocation (type III) and dorso-lateral dislocation (type IL or IIL+), which are related to the formerly described variants.

[Fractures of the trapezium]. / Les fractures du trapèze.

The authors report a retrospective study of eight cases of trapezium fractures. There were seven male and one female patient aged 21 to 48 years. The presumed mechanism of injury was established in only four cases. Clinical trapeziometacarpal abnormality was always present. The diagnosis was made on standard radiographs in seven cases, computed tomography was used in one case. The fracture was simple, vertical and lateral in five cases, complex in one case and consisted in a lateral avulsion in two cases. An associated Bennett's fracture was present in five cases. The treatment was conservative in two cases. Internal fixation was performed in four cases (3 using a lag screw, 1 using a Kirschner wire) and transosseous reinsertion in two cases. With an average follow-up of 3 years (1 year-6 years), open reduction and internal fixation appears to be simple and to give good or excellent results.

[Fractures of the coronoid process]. / Les fractures de l'apophyse coronoïde.

INTRODUCTION: A retrospective study has been made of a series of 22 cases, and the classification and treatment of fractures of the coronoid process of the ulna have been discussed. MATERIAL, METHODS AND RESULTS: A report has been made of 22 cases of coronoid process fracture (18 males and four females). The mean age was 26 years (range: 19-47 years). According to the Reagan and Morrey Classification, there were 11 type I (avulsion of the tip of the bone), seven type II (a fragment of less than 50% that was detatched from the coronoid process), and four type III cases (a fragment of more than 50% that was detatched from the coronoid process). Elbow dislocation was present in 16 cases, and a radial head fracture was associated in four cases. All type I fractures were treated by immobilization of the elbow in a plaster cast for ten to 15 days, with eight excellent and three good results. In type II fractures, open reduction, internal fixation with antero-posterior lag-screw and early post-operative movement in three patients gave better results than immobilization for three weeks, which was the procedure used in four cases (after transosseous reinsertion in one case). In type III fractures, good results were obtained following open reduction and internal fixation with antero-posterior lag-screw in three patients. The result was average in the fourth case, with immobilization for four weeks. CONCLUSION: The Reagan and Morrey classification is most useful for the classification of coronoid process fractures. If there is no comminution of the detatched fragment, open reduction and internal fixation with antero-posterior lag-screw is the treatment of choice in type I and II fractures. In type I fractures, immobilization for about two weeks gives good results.

[Metacarpophalangeal dislocation of the index finger. Apropos of 7 operated cases]. / Les luxations métacarpo-phalangiennes de l'index. A propos de sept cas opérés.

Complex dislocation of the metacarpophalangeal joint of the index finger is an uncommon injury. The authors report seven cases, including three neglected dislocations, two with associated osteochondral fractures and one with sesamoid entrapment. Open reduction was necessary in each of the seven cases. In recent dislocations (four cases), both approaches were successful in obtaining reduction and normal finger movements were obtained. The dorsal approach was simple and safe, while the palmar approach was difficult and had many disadvantages. In the case with sesamoid entrapment, the sesamoid had to be removed to achieve reduction. In neglected dislocations (three cases), the dorsal approach was successful in one case (three weeks), two incisions were necessary in one case (seven months), and one case was treated by Swanson prothesis (two years). None of these patients regained normal mobility postoperatively.

[Acute pancreatitis in the post-partum period. Apropos of 3 cases]. / Les pancréatites aiguës du post-partum. A propos de trois cas.

Acute pancreatitis and pregnancy is a rare and serious combination that poses difficult diagnostic and therapeutic problems. Three cases of acute pancreatitis occurred in the post-partum period. Based on these cases and a literature review, we analyzed the different aspects of this interesting association. Biliary origin is particularly evident. Acute pancreatitis after delivery is a serious problem compared to other forms of acute pancreatitis. Late diagnosis caused by circumstances of happening contribute to the severity at least partially.

[Role of surgery in the treatment of Pott's disease in adults. Apropos of 29 cases]. / Place de la chirurgie dans le traitement du mal de Pott de l'adulte. A propos de 29 cas.

PURPOSE: The management of tuberculous spondylitis remains much debated in countries with great tuberculous prevalence; the attitude in front of vertebral focus is divided between exclusive conservative treatment versus surgical treatment. The authors report their experience about surgical treatment of tuberculous spondylitis. MATERIAL AND METHODS: Twenty nine out of thirty one adults underwent surgery for tuberculous spondylitis, between january 1988 and july 1994. The average age was 29 years (range 18 to 65 years). Five patients presented radicular syndrome. The operative indications were mechanical in 20 cases, neurologic and mechanical in 5 cases, etiological and mechanical in 4 cases. Anterior approach was performed in 26 cases, posterior approach in 3 cases. A disc sequestrectomy and/or resection associated to pus evacuation and skeletal graft was performed in 24 cases. Fixation of the graft by screwed plate was used in 3 cases. Antituberculous treatment was instituted in all cases. RESULTS: The average duration of time spent in hospital was 29 days. The average follow-up was 15.61 months (range: 8 months to 5 years). Short and mean-term outcome was marked by a fistula in 3 cases. These patients underwent a second procedure; they had a good evolution. The long term outcome showed that all patients were considered as cured (functional and neurological results were satisfactory); all patients obtained fusion. Stability was achieved after 3 to 5 months. DISCUSSION: In our context, we prefer surgical treatment. Spine tuberculous is usually seen at an advanced anatomical and clinical stage with major destruction of several vertebras. CONCLUSION: Surgery allows to assert the diagnosis, to treat a compression, to evacuate pus, to treat or at less to avoid worsening of a deformation, and to reduce treatment duration.

[Tuberculosis of the patella. An unusual localization apropos of 2 cases]. / La tuberculose de la rotule. Une localisation exceptionnelle à propos de 2 cas.

Tuberculosis in an isolated localization in the patella is rarely reported. Five cases were found in the literature. Two new cases together with the radiographic work-up to be performed in case of a "painful" knee are presented. Histology of the curetage specimen is required to reach certain diagnosis and develop an adapted management strategy to protect the functional future of the knee.

[Septic diaphyseal pseudarthrosis. Practice during war and peace time. Apropos of 130 cases]. / Les pseudarthroses septiques diaphysaires. Pratique de guerre et pratique civile. A propos de 130 cas.

130 septic diaphyseal pseudoarthroses (SDP) were treated over a period of 10 years, 58 in the context of a war situation and 72 in civilian practice. The two etiologies differed in that the size of the initial associated cutaneous lesion was much greater in battle injuries. A staged treatment procedure was applied in 110 cases: treatment of the infection, followed by osteogenic grafts and depending on the case, stabilisation of the assembly or replacement of internal by external fixation materials. More recently, the use of muscular or musculocutaneous pedicle flaps has enabled, in a single procedure, the eradication of osteitis and the implantation of cortico-trabecular bone in 20 SDP producing 19 consolidations and 2 cases of residual osteitis.

[Duodenal tuberculosis associated with lymph node tuberculosis (apropos of a surgical case)]. / Tuberculose duodénale associée à une tuberculose ganglionnaire (à propos d'un cas chirurgical).

The authors report a case of duodenum tuberculosis associated to a lymph gland tuberculosis. Diagnosis has been made possible only with an exploratory laparotomy justified by an almost total duodenum stenosis. They review the different aspects (pathogenic, anatomopathologic, clinical, radiological, therapeutic) of a disease non frequent but not exceptional, especially in the african countries.

[Isolated retroperitoneal hydatid cyst. Apropos of 2 new cases]. / Le kyste hydatique rétropéritonéal isolé. A propos de deux nouveaux cas.

Hydatid disease in endemic countries is common but an isolated retroperitoneal localisation is rare. After a review of the aetiopathogenesis and clinical aspects, the authors express the opinion that safe, rapid and reliable technique of echotomography is the key investigation in obtaining a positive diagnosis. In terms of its course, the histopathological appearances are those of a locally malignant tumour which as a preferential and severe effect on renal function. Surgery is the only valid method for eradication of the parasite and freeing the urinary tract.