Atteintes osseuses multiples d'une syphilis congénitale précoce : à propos d'un cas

Introduction. Nous décrivons un cas d'agénésies dentaire multiples associées à une ectopie bilatérale des troisièmes molaires ainsi de la deuxième prémolaire mandibulaire gauche. Cas clinique: Une patiente de 30ans était référée par son médecin gastroentérologue pour une prise en charge odontologique. La patiente décrit de ne jamais avoir bénéficié d'avulsion dentaire et ne souffrait d'aucun douleur ou gène au niveau orofacial. Une exploration clinique suivie d'examens radiologiques était réalisé. L'examen clinique révèle l'absence de plusieurs dents. La radiographie panoramique avait permis de confirmer le diagnostic d'agénésies multiples de huit dents. Les deux troisièmes molaires mandibulaires incluses en position verticale au niveau de la branche mandibulaire. La 35 aussi incluse en position apicale de la 38. L'examen CBCT montre une déhiscence des corticales des faces interne et externe du ramus en regarde des couronnes des troisièmes molaires. Discussion. L'oligodontie associée à une inclusion dentaire multiple reste un cas rare. Les éléments de l'examen clinique associés à la radiographie panoramique permettent de confirmer le diagnostic d'agénésie et d'ectopie dentaires. La radiologie tri dimensionnelle est capitale dans la prise de décision thérapeutique des dents ectopiques en position condy lienne.Conclusion. Sans symptomatologie clinique et radiologique, la décision thérapeutique était de s'abstenir de traitement chirurgical et de surveiller

[Use of the vascularized upper tibial crest at the wrist and hand]. / Utilisation de la crête tibiale vascularisée au poignet et à la main.

The choice of a technique for reconstruction of bone loss to the lower end of the forearm is often difficult, especially in cases of nonunion. Vascularized bone is essential in these indications. We present cases of post-traumatic hand and wrist reconstruction with upper tibial corticocancellous transfer. It is a reliable reconstructive procedure for forearm bone loss to cover limited size bone defects, leaving no complication to the donor site.

[Treatment of proximal humeral fractures by Telegraph nail: prospective study of 34 cases]. / Traitement des fractures de l'extrémité proximale de l'humérus par clou Télégraph: étude prospective de 34 cas.

PURPOSE OF THE STUDY: Many developments have been devoted to improving osteosynthesis of proximal humeral fractures, but indications remain controversial. Anterograde nailing using a locked self-stabilizing nail is an attractive conception which has provided promising results. The purpose of this study was to assess the early results observed in a series of patients treated with a first-intention Telegraph nail. MATERIAL AND METHOD: Thirty-four patients were reviewed for a prospective clinical and radiological assessment. Mean follow-up was 13.6 months (range 3-34 months). Mean age at the time of the accident was 68 years (20-90 years). There were 24 women and 10 men: the left shoulder was fractured in 22 patients. All fractures healed within 1 to 4 months. Groups for statistical analysis were determined by type of fracture using the Neer and Duparc classifications. Qualitative functional analysis used the Constant score in comparison with the opposite side. Anatomic analysis of fracture reduction after healing was based on plain x-rays (ap view in neutral rotation) by measuring the angle of inclination of the head in relation to the diaphyseal axis (alphaF). Normal was 45 degrees; reduction was considered adequate for an alphaF angle between 30 degrees and 60 degrees. The lateral view was used to search for posterior or anterior tilt of the humeral head. RESULTS: Necrosis of the humeral head was observed in four shoulders (11.8%). Three of them after displaced joint fractures. These cases were retained for the analysis. Considering all patients in the study, the raw mean Constant score was 62 points and the age- and sex-weighted score was 82.5%. For two- and three-fragment extra-articular fractures, the mean Constant score was 82.3% (21 shoulders); it was 89% for simple joint fractures (5 shoulders) and 79% for complex joint fractures (8 shoulders). The differential Constant scores, comparing the healthy side with the operated shoulder, showed a difference of 20 points on average (range 0-43 points). 52.9% of patients reviewed displayed mild deficit, 20.6% moderate deficit, and 26.5% major deficit. The mean alphaF angle was 38 degrees (range 0-80 degrees). Reduction was considered good in 18 shoulders with a mean Constant score of 88.7%. Reduction was considered poor in 16 shoulders with a mean Constant score of 75.6%. Four shoulders exhibited posterior tilt of the humeral head, all associated with healing in a valgus position. DISCUSSION: The Telegraph nail provides reliable fixation for the treatment of extra-articular and simple articular fractures of the proximal humerus. Dislocated fractures are classical indications for arthroplasty, with acceptable results for a only slightly invasive procedure. The risk of osteonecrosis does not necessarily deteriorate shoulder function and secondary revision for insertion of a prosthesis is still possible. The radio-clinical correlations show the importance of reduction quality to obtain a good final clinical result. Among the nine cases of poor outcome, six were related to a misaligned callus with persistent valgus deviation of the head (alpha F<30 degrees ) and in some cases, excessive posterior tilt. The solidity and stability achieved with the Telegraph nail enabled healing in all cases of fracture in this series with immediate postoperative reduction in most. The stability being related to the quality of bone stock, primary arthroplasty remains an important indication when it appears that a solid osteosynthesis cannot be achieved.

An anatomical study of the relationship between excursion of the flexor tendons and digital mobility: proposition of an intraoperative test for flexor tendon tenolysis.

The excursion of the flexor tendons of the thumb and fingers was studied in ten fresh cadaveric upper limbs. For each centimetre of tendon movement, obtained by traction of the flexor tendons at the wrist, the angular changes of the digital articulations were measured; movement started at extension and proceeded to maximum flexion. A further five upper limbs were used to evaluate the effect of pressure over the musculotendinous area of the flexor tendons of the fingers and thumb. Pressure on the muscle bellies in the forearm causes movement of the tendons, different for each finger, with the accompanying digital flexion depends on the magnitude of the movement. On the basis of this anatomical study a test is described which may be beneficial in the diagnosis of pathology and trauma of the flexor tendons and, particularly, in the intraoperative evaluation of the quality of motion obtained during tenolysis.

Upper tibial corticocancellous flap anatomy study (19.2.93).

A cortico-cancellous flap from the anterolateral aspect of the upper third of the tibia was presented. Sixty lower limbs of "fresh" cadavers were dissected. The vascular bundle includes the anterior tibial artery and its recurrent collateral branches and recurrent and musculoperiosteal arteries. The flap is harvested with the interosseous membrane and can be used either free or predicled. We used this flap for two patients suffering from pseudarthrosis. Long range clinical and radiological results are good.

[Fracture of the femoral shaft in children. Ascending or descending medullary nailing? A choice of principle or necessity?]. / Fracture de la diaphyse fémorale chez l'enfant. Embrochage centro-médullaire ascendant ou descendant? Un choix de principe ou de nécessité?

Over a period of 4 years, 40 children between the ages of 6 and 14 years (mean: 10 years) were treated for a fracture of the femoral shaft (39 closed fractures and 1 Cauchoix type I open fracture) by flexible medullary nailing, either ascending (5 cases) or descending (35 cases). Although it is classical to use the ascending route described by the Nancy team, the sub-trochanteric descending route was preferred for its simplicity; non-involvement of the knee by the insertion of the nail allows earlier autonomy in children. The results have been found to be satisfactory; no complications related to the method were observed. The biomechanical principles are also conserved.

[Fracture of the femoral diaphysis in children. Ascending or descending centro-medullary nailing? A choice of principle or of necessity?]. / Fracture de la diaphyse fémorale chez l'enfant. Embrochage centro-médullaire ascendant ou descendant? Un choix de principe ou de nécessité?

Over a period of 4 years, 40 children between the ages of 6 and 14 years (mean: 10 years) were treated for a fracture of the femoral shaft (39 closed fractures and 1 Cauchoix type I open fracture) by flexible medullary nailing, either ascending (5 cases) or descending (35 cases). Although it is classical to use the ascending route described by the Nancy team, the sub-trochanteric descending route was preferred for its simplicity; non-involvement of the knee by the insertion of the nail allows earlier autonomy in children. The results have been found to be satisfactory; no complications related to the method were observed. The biomechanical principles are also conserved.