[Malrotated kidney causing prenatal giant hydronephrosis]. / Anomalie de rotation rénale entraînant une hydronéphrose géante prénatale.

We report the case of a malrotated right kidney associated with giant prenatal hydronephrosis due to a non vascular extrinsic ureteropelvic compression. The kidney presented an hyper-rotation of 180° in relation to the original fetal position, with the renal hilum backward looking. At neonatal surgery we discover that the inferior pole of the kidney pushes laterally the ureteropelvic junction like a violin bridge. The simple uncrossing of the ureteropelvic junction from the inferior renal pole relieves the extrinsic ureteral obstacle and the giant hydronephrosis. The authors summarize the morphogenesis of the upper urinary tract which allowed to understand this rare anatomical variation.

Thermoregulation, hydration and performance over 6 days of trail running in the tropics.

The purpose of this study was to investigate thermal response, hydration and performance over a 6-day, 142-km trail running race in tropical conditions. 9 participants competed in the 2011 Gwadarun (30°C±2.4 °C and 82±4% RH). Data were collected on days 1, 4 and 6. Gastrointestinal temperature (Tgi) and heart rate (HR) were measured using portable telemetry units, whereas blood samples were collected for hematocrit, osmolarity, plasma concentrations, alkaline reserves and creatine phosphokinase. The performances expressed in speed were correlated with both total body water and body mass loss per hour (TBWL.h(-1) and ∆BM.h(-1)), HR and changes in Tgi per hour (∆Tgi.h(-1)): the more water and mass the participants lost, the higher the HR and the greater the Tgi change, and the better the performance. The ∆ Tgi.h(-1) was significantly correlated with ∆BM.h(-1), and the participants who lost the most mass had the greatest increases in Tgi. None of the blood parameters demonstrated significant changes. The present study showed that well-trained acclimated runners performing a 6-day trail race in a tropical environment and drinking ad libitum did not demonstrate heat-related illness or severe dehydration. Moreover, high performance was associated with increases in Tgi, TBW and BM losses per hour.

[Intra-articular distal radial fracture with lunate fossa rotated, about 4 cases: interest of surgical procedure by volar medial approach]. / Fracture articulaire du radius distal avec fragment de fossette lunarienne retourné, à propos de 4 cas : intérêt du traitement chirurgical par voie antéro-médiale.

INTRODUCTION: Intra-articular distal radial fractures in young subjects occur in severe trauma. Articular reduction needs to be anatomical. We report four cases with the particularity of having a 90° or 180° rotated lunate fossa. Our goal is to bring out the positive aspects of surgical procedure by volar medial approach and to assess long-term functionnal and radiological results. MATERIAL AND METHODS: Our study focused on four men whose average age was 27 (age range from 19 to 43). The fractures were type IV according to Melone's classification. The associated lesions included: one fracture of the base of the ulnar styloid, one fracture of the distal quarter of the ulnar diaphysis and one scapho-lunate diastasis. We used a volar medial approach between the flexors tendons and the ulnar bundle in order to pin the fragment of lunate fossa. The rest of the radial epiphysis was pinned after a 5mm skin incision. In two cases, this pinning was complemented with a brachial-antebrachial-palmar cast and in the other two cases with an external fixator. RESULTS: The follow-up period averaged 68.8 (18 to 115) months, all the patients were clinically examined through antero-posterior, lateral and dynamic X-rays. The objective results assessed according to Green and O'Brien's criteria, later modified by Cooney, were as follows: two very good, one good, one average. The X-rays showed consolidated fractures. According to Knirk and Jupiter's classification of arthritis, we had three grades 0, one of which showed a subchondral sclerosis of the lunate fossa, and one grade 3. DISCUSSION AND CONCLUSION: Imaging with simple radiographs is not sufficient and needs to be complemented with CT scan. Our approach allows for direct access to the fragment of the lunate fossa and easier visualization of the distal radioulnar, compared to Henry's approach, thereby avoiding excessive traction of the median nerve. TYPE D'ÉTUDE: Niveau IV.

Windsurfing hazard caused by needlefish.

Very amusing and entertaining for the traveler, marine activities in tropical countries can be dangerous. More and more trauma caused by hazardous marine animals have been reported in recent years in the world, after maritime accidents including water sports like windsurfing, kite surfing, swimming, diving, and injuries caused by sting or contact with a marine animal. Rays and stone-fish frequently cause trauma, but there are not many cases of injury by needlefish. This case reports a case of penetrating wound of the left foot caused by a Caribbean needlefish occurred during a session of windsurfing in Martinique.

Variation of the proximal insertion of the abductor digiti minimi muscle: correlation with Guyon's canal syndrome? Case report and literature review.

We describe the case of an original insertion and course of the abductor digiti minimi muscle on the medial part of the palmaris longus tendon. The anomalous muscle was only present on the left side. Various studies have reported the frequency of anomalous muscles in approximately 22 to 35% of hands and it was in majority an anomalous abductor digiti minimi muscle. The knowledge of this original insertion is important because it can sometimes be correlated with ulnar nerve compression at Guyon's canal. But Guyon's canal syndrome is less common than carpal tunnel syndrome, and the incidence of ulnar nerve compression in relation with anomalous muscle is approximately 2.9% of cases. It is possible to diagnose the anomalous muscle through ultrasound or MRI. This variation should be taken into consideration by surgeons during surgical procedures for ulnar nerve decompression at Guyon's canal and when performing anteromedial approach to the wrist between flexors tendons and ulnar bundle.

[Absence of the musculocutaneous nerve and its distribution from median nerve: About two cases and literature review]. / Absence du nerf musculocutané et distribution à partir du nerf médian : à propos de deux cas et revue de la littérature.

Musculocutaneous nerve arises mostly from the lateral cord of brachial plexus. Nevertheless, variations have been reported and, among them: the total absence of musculocutaneous nerve (from 1.4 to 15%), the absence of its passage through the coracobrachial muscle, its variable level of penetration as measured from the tip of the coracoid process, and its communicating branches with the median nerve. We report two cases of unilateral musculocutaneous nerve absence in a 66-year-old male and a 95-year-old female cadavers, on the right and the left side, respectively. The nerve fibers normally coming from musculocutaneous nerve emerged from the median nerve. The knowledge of this anatomical variation is important specially when performing plexus bloc or Latarjet's procedure.

Antero-medial approach to the wrist: anatomic basis and new application in cases of fracture of the lunate facet.

The Henry approach is the classical anterolateral surgical exposure of the volar aspect of the distal radius. This approach does not allow good access to the medial side of the volar distal radius (lunate facet) and the distal radio-ulnar joint, unless it is extended proximally, retracting the tendons and the median nerve medially, which can cause some trauma. The purpose of our study was to investigate the anatomic basis and to outline the advantages of the unusual anteromedial approach, reporting our experience in the treatment of 4 distal radius fractures, with a 90° or 180° twist of the lunate facet, and 10 wrist dissections on cadavers. The average follow-up was 68.8 months (range 18 to 115 months). In our series, this approach did not cause any nerve injuries or any sensory loss of the distal forearm and the palm. All the fractures of the lunate facet and of the radial styloid process healed. One patient with an ulnar styloid process fracture associated showed pseudarthrosis, but with no instability of the distal radio-ulnar joint or pain on the ulnar side. Using the criteria of Green and O'Brien, modified by Cooney, the results were: excellent in two cases, good in one case, and average in another. The evaluation of arthritis according to Knirk and Jupiter's classification showed grade 0 in three cases and grade 3 in one case with osteochondral sclerosis. We showed that the anteromedial approach is reliable and convenient in the case of fractures situated in the antero-medial portion of the radius, for the double objective of reducing the fracture under direct control and checking the congruence of the distal radio-ulnar joint.

Bilateral spontaneous tenodesis of the long head of the biceps at the bicipital groove with massive rotator cuff tear on a 103-year-old female cadaver: the natural evolution of the human shoulder?

During a dissection on a 103-year-old female cadaver, a bilateral spontaneous tenodesis of the long head of the biceps (LHB) with massive rotator cuff tear was discovered at the bicipital groove. Neer et al. have introduced the term of cuff-tear arthropathy to define severe disorganization of the glenohumeral joint with collapse of the humeral head that occurs following some massive tears of the rotator cuff, and we found this aspect during our dissection. The tendon of the LHB is a well-known source of shoulder pain, and the majority of degenerative changes in the LHB are associated with pathology of the rotator cuff. When there are complete rotator cuff tears and a rupture of the LHB, the ineluctable evolution of the shoulder is the ascension of the humeral head and the creation of a neoarticulation like in our case. This aspect is an acromial acetabulization as described roentgenographically by Hamada et al.

Irreducible Pipkin II femoral head fractures: Is transgluteal approach the best strategy?

UNLABELLED: Femoral head fracture-dislocations (FHFD) are rare, while irreducible cases are even less frequent. Truly irreducible fractures such as the two cases in this report must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. Opinions vary on the surgical approach to be used once the hip is reduced and the fragment of the femoral head yet remains to be stabilized. Reports in the literature do not usually take into account the specificity of irreducible lesions, which in our opinion should be treated by the transgluteal approach (TGA) while reducible forms can be treated by the Hueter approach. The transgluteal approach with the patient in the lateral decubitus position provides a direct anterior view of the antero-infero-medial fracture site as well as dorsal access via the injuries occasioned to dorsal soft tissues by the posterolateral dislocation. A lag screw can be used with this approach, which is the only way to stabilize the ligament teres femoris attachment. LEVEL OF EVIDENCE: Level IV retrospective historical study.

Tibial segmental bone defect reconstruction by Ilizarov type bone transport in an induced membrane.

The management of combined loss of skin coverage and bone substance in the lower third of the leg is problematic. A recommended sequential strategy associates removal of infected tissue and coverage followed by treatment of the bone defect. We report a technique without microsurgery, using Masquelet's induced membrane technique to manage the bone loss, associated to bone transport and coverage by a fasciocutaneous flap with distal pedicle. In a patient presenting with a 10 cm defect with bone exposure, this 2-step procedure allowed consolidation at 7 months without functional sequelae; the fixator was kept in place for 9 months. Neither microsurgery nor cancellous bone graft was required. Using a spacer to induce a membrane facilitated bone transport and distal consolidation.

Developments in injectable multiphasic biomaterials. The performance of microporous biphasic calcium phosphate granules and hydrogels.

Calcium phosphate bioceramic granules associated with hydrosoluble polymers were developed as bone substitutes for various maxillofacial and orthopaedic applications. These injectable bone substitutes, support and regenerate bone tissue and resorb after implantation. The efficiency of these multiphasic materials is due to the osteogenic and osteoconductive properties of the microporous biphasic calcium phosphate. The associated hydrosoluble polymers are considered as carriers in order to achieve the rheological properties of injectable bone substitutes (IBS). In this study, we used 2 semi synthetic hydrosoluble polymers of polysaccharidic origin. The hydroxy propyl methyl cellulose (HPMC), with and without silane, was combined with microporous BCP granules. The presence of silane induced considerable gelation of the suspension. The 2 IBS used (without gelation, IBS1, with gelation, IBS2) were implanted in critical size femoral epiphysis defects in rabbits. No foreign body reactions were observed in either sample. However, because of the higher density from gelation, cell colonisation followed by bone tissue ingrowth was delayed over time with IBS2 compared to the IBS1 without gelation. The results showed resorption of the BCP granule and bone ingrowth at the expense of both IBS with different kinetics. This study demonstrates that the hydrogel cannot be considered merely as a carrier. The gelation process delayed cell and tissue colonisation by slow degradation of the HPMC Si, compared to the faster release of HPMC with IBS1, in turn inducing faster permeability and spaces for tissue ingrowth between the BCP granules.

Lateral compression fractures of the superior pubic ramus with intra-articular extension.

A total of 30 patients with lateral compression fractures of the pelvis with intra-articular extension into the anterior column were followed for a mean of 4.2 years (2 to 6), using the validated functional outcome tools of the musculoskeletal function assessment and the short-form health survey (SF-36). The functional outcome was compared with that of a series of patients who had sustained type-B1 and type-C pelvic fractures. The lateral-compression group included 20 men and ten women with a mean age of 42.7 years (13 to 84) at the time of injury. Functional deficits were noted for the mental component summary score (p = 0.008) and in the social function domain (p < 0.05) of the SF-36. There was no evidence of degenerative arthritis in the lateral-compression group. However, they had high functional morbidity including greater emotional and psychological distress.

[Necrotizing fasciitis and cellulitis of the upper limb resulting from centipede bite: two case reports]. / Dermohypodermite bactérienne et phlegmon du membre supérieur par morsure de scolopendre: à propos de deux cas.

Centipede bites occurring in tropical countries are rare, however vigilance must be exercised during activities in the open air and dwellings should be checked in the event of rain. The bite is very painful and can be accompanied by generalised signs. An initial wound disinfection and a check of antitetanus vaccination status is all that is usually needed to ensure an uneventful outcome. There are however, rare cases where local toxicity and a bacterial super-infection, often with Gram+ cocci, can lead to a cellulitis or even necrotizing fasciitis of the hand. The diagnosis of a centipede bite can be made by the double marks made by the fangs. Wound debridement and antibiotics led to a good outcome in both our cases.

[Multilevel contiguous injuries of the lower cervical spine during flexion trauma with delayed diagnosis: a case report]. / Lésions étagées contiguës du rachis cervical inférieur lors d'un traumatisme en flexion de diagnostic retardé: à propos d'un cas.

The authors report a case of bilateral C4-C5 facet fracture dislocation associated with a severe sprain underlying C5-C6, which had occurred during an traffic accident. The diagnosis of severe sprain was raised on the 55 th day. The injury mechanism is studied. Contiguous multilevel injuries of the lower cervical spine should be suspected in case of high-energy trauma. MRI can provide an exhaust if diagnosis of possible multilevel injuries. After fixation of the obvious lesion, intraoperative dynamic fluoroscopy must be performed to demonstrate any instability in another area.

Thigh compartment syndrome after intramedullary femoral nailing: possible femoral nerve block influence on diagnosis timing.

We report a case of anterior thigh compartment syndrome (TCS), which occurred after a closed femoral fracture internal fixation using an intramedullary rod. A 20 ml ropivacaine hydrochloride single-injection femoral block had preceded general anaesthesia to conduct the surgical procedure. The compartment syndrome diagnosis was made the morning after surgery when the level of pain was interpreted as disproportionate to the treated lesion; in addition, compartment pressure measure had increased to 54 mmHg. A compartment fasciotomy was performed. Diagnostic delays have previously been observed and attributed to nerve blocks in cases of tibial fracture. This patient's report raises the question of whether a femoral block may be responsible for delays in diagnosing compartment syndrome, although no series have been published of such occurrences in large numbers. When nerve blocks are used, they should be more analgesic than anaesthetic. Careful patient monitoring remains important.

[Fracture of the glenoid cavity Goss-Ideberg type II with inferior dislocation of the shoulder]. / Fracture de la glène de la scapula type II de Goss-Ideberg associée à une luxation inférieure de l'épaule.

We report the case of a fracture of the glenoid, Goss-Ideberg type II, associated with an inferior dislocation of the shoulder, a combination that has not to our knowledge been previously reported. The injury had occurred after a fall of three metres. The radiological assessment included an anteroposterior view and a CT scan that guided the surgical approach by indicating that the fragment of the glenoid cavity was especially dorsal. We carried out a preoperative MRI to eliminate the possibility of a rotator cuff tear being present. The surgical treatment was carried out with the patient in lateral decubitus position and restored normal function to the shoulder.

Bilateral variation of the pectoralis minor muscle discovered during practical dissection.

We describe a case of an original insertion of the pectoralis minor on the coracohumeral ligament, supraspinatus tendon and the capsule of the glenohumeral joint. This variation has been described in anatomy textbooks since the nineteenth century. The peculiarity of this case is that the right shoulder presented type 2 and the left type 1 of the three varieties described by Le Double in 1897. Le Double (1843-1913) was a French anatomist who wrote a treaty on anatomical variations, in particular those of the muscle. Lately, only three publications have reported this variation in anatomic studies. Some authors have described the rotator cuff syndrome caused by this variation and an ultrasound study has demonstrated a frequency of 9.57% for the detection of this variation. It is possible to try and find this variation while investigating in order to diagnose impingement, through ultrasound, CT arthrography or MRI. We believe that this variation should be taken into consideration by surgeons during surgical procedures and arthroscopy.

[Acute carpal tunnel syndrome secondary to prolonged pressure on the wrist during enolic coma]. / Syndrome du canal carpien aigu après compression prolongée dans un contexte de coma éthylique.

We report a case of acute carpal tunnel syndrome caused by prolonged compression. A 40-year-old man was admitted for an acute carpal tunnel syndrome secondary to direct compression of the wrist which was blocked in supination under his thorax for ten hours during a period of alcoholic coma. Total sensorial anesthesia of the median nerve territory was noted. The emergency procedure consisted in simple opening of the carpal tunnel without nerve exploration due to the risk of bacterial contamination resulting from skin lesions, devascularization and postoperative fibrosis. Initially, the skin on the volar aspect of the wrist had the aspect of a second degree burn. The patient recovered nerve function the next day and the skin wound healed within 15 days. The patient was seen at consultation at 13 months and exhibited complete recovery of wrist and hand motion with normal thumb opposition and no signs of sensorial or motor deficit. The retinaculum of the flexor system must be opened to guarantee full nervous recovery.

[Traumatic rupture of the tibialis posterior tendon after ankle fracture: three cases and a review of the literature]. / Rupture du tendon du tibial postérieur lors des fractures de la cheville: à propos de trois cas et revue de la littérature.

We report three cases of complete traumatic tibialis posterior tendon rupture which occurred after ankle fracture. Diagnosis was established at surgery. Repair of the non-degenerative tendon was achieved during the procedure for osteosynthesis of the malleolar fracture. Fractures healed a few months after surgery. The posterior tibialis muscle tendon functioned plantar arch was normal, except in one patient with multiple injuries who died in intensive care thirteen days after the accident. Although exceptional, injury of the tibialis posterior tendon should not be overlooked after ankle fracture. These injuries become apparent only at surgery for the malleolar fracture since pain hinders clinical examination. Primary suture best guarantees a good functional outcome. Residual pain, deficit in active inversion of the foot, modified medial longitudinal arch, or progression to planovalgus are retrospective diagnostic signs.