[Acromelic arthritis: a new entity]. / L'acropolyarthrite rhumatoïde.

PURPOSE OF THE STUDY: Few patients with rheumatoid arthritis present isolated acromelic bone and joint destructions. Concerned joints are wrist, MP, PIP, DIP and forefoot. The aim of the current study is to describe and evaluate the long-term results of wrist, hand and forefoot surgery in an acromelic arthritis group. MATERIAL AND METHODS: 93 patients with acromelic arthritis were included in the study. 202 surgical procedures were performed between 1981 and 2001 in addition to medical treatment. 93 procedures concerned dorsal wrist surgery. The mean follow-up of this group was 7 years (24 months-20 years). 78 synovectomies of radio-carpal and medio-carpal joints with a Sauvé-Kapandji procedure were performed and 10 with a radio-lunate arthrodesis and 5 with other surgeries. The main indication for surgery was severe pain. RESULTS: Functional results and radiographic evolution (Larsen X-ray classification) were studied. All patients were satisfied or very satisfied and pain was significantly reduced. Radiographic lesions progressed but Larsen's stage remained unchanged in 73% of patients. All patients with forefoot surgery recovered total walk autonomy. DISCUSSION: Acromelic arthritis is a particular form of rheumatoid arthritis that progresses very slowly. Surgery should be indicated earlier, for a better joint function stabilisation.

[Syringomyelia and associated bone and joint diseases]. / Syringomyélie et pathologies ostéo-articulaires associées.

Syringomyelia can occur in patients presenting bone and joint diseases of various origins. When joint destruction of the shoulder or elbow produces little pain, a neurological cause might be involved. In this case, the disease history can be of utmost importance because an initial diagnosis of rheumatoid polyarthritis, polyosteoarthritis, or destructive joint disease can be misleading before the syringomyelic origin of the bone and joint disease becomes patent. We report two cases illustrating this association and the diagnostic pitfalls which can delay recognition of the syringomyelia. Better awareness of the prevalence of this condition should be helpful in establishing the diagnosis and in selecting patients who can benefit from neurosurgical treatment. The two cases presented here suggest that syringomyelia could be underdiagnosed in certain patients with an initially atypical presentation. A review of the current knowledge of syringomyelia suggests that arthroplasty is generally not advisable for destroyed dislocated syringomyelic joints.

[Merkel cell carcinoma of the skin: two case reports located at the hand, with a review of litterature]. / Le carcinome cutané de Merkel: revue de la littérature à propos de deux localisations à la main.

The Merkel cell carcinoma of the skin are rare neuroendocrine tumours, with a dermal location. Their severity and metastatic potential are higher than cutaneous melanomas'. Two cases are reported at the hand. A review of literature displays the pejorative prognosis of these tumours. Hand surgeons must be aware of them, in order to fasten the diagnosis and include the patient among a multidisciplinary medical team.

[Jaccoud's arthropathy. Surgical results of 41 hands]. / La main de Jaccoud. A propos de 41 mains opérées.

Jaccoud's arthropathy, which was first described in 1869, is a rare syndrome that is characterized by a painless or relatively painless deformity of the digits II, II, IV and V with a dislocation of the extensor tendons into the metacarpal valley. When the thumb is affected, a Z deformity is observed. The present analysis was based on 40 patients (56 hands, 41 of which were operated on over the period 1989 to 2001). A distinction should be made between Jaccoud's disease following a known inflammatory arthropathy (23 hands; average patient age 55 years) and the idiopathic form of the disease (18 hands, average patient age 70 years). From a clinical point of view, a classification of the deformities is needed so that appropriate surgical treatment can be determined. In the present study, four groups were therefore proposed, in groups I and III the realignment to centre of the extensor tendons of the metacarpophalangeal joint and joint stabilization yielded 83% positive results. In groups II and IV the results were only 66% good after Swanson implant. The pathogenesis of Jaccoud's disease has not yet been determined, but now that more information has become available and a better analysis can be made of its various clinical and anatomopathological charasteristics, these should assist in defining precise surgical indications.

[Resection of the first row of carpal bones: post-traumatic wrist and Kienbock's disease]. / La résection de la première rangée des os du carpe: poignet post-traumatique et maladie de Kienböck.

This study reports the outcomes of 27 proximal row carpectomies for stage II (Watson) scapholunate--(10 Slac) and scaphoid non union--(8 Snac) advanced collapse and stage III (Lichtman) Kienböck's disease (9 cases) followed for an average of respectively 72 and 50 months. Following surgical treatment, more than 80% of patients in both groups were pain free. The total arc of motion averaged 67 degrees (unchanged), for the post-traumatic arthritis, and 59 degrees for Kienböck's, a decrease of 17%. Grip strength averaged a 17% increase in comparison to the opposite size for both groups. Proximal row carpectomy showed a high degree of patient satisfaction and is a motion-preserving and grip-preserving procedure used in stage II post-traumatic arthritis but Lichtman III stage in Kienböck's disease had a comparatively poor result. Proximal row carpectomy simplifies the structure of the radiocarpal joint. When the cartilage on the capitate head and the radial lunate facet are not worn, this procedure provides a good result with respect to pain, range of motion and strength which is stable with time.

[Voluntary bilateral dislocation of the hip in children: a case report and review of the literature]. / Luxation volontaire de la hanche chez l'enfant: à propos d'une cas et revue de la littérature.

Voluntary bilateral dislocation of the hip was discovered in a three-year-old girl. Dislocation was documented by arthrography and computed tomography. After failure of a capsuloraphy, successful treatment was achieved with bilateral femoral varus oseotomy. Stability has been good after six years follow-up. Clinical and radiological signs as well as the underlying causes and treatment are discussed in light of this case and fifteen others reported in the literature.

Wrist arthroscopy and dislocation of the radiocarpal joint without fracture.

The authors report a rare case of dorsal dislocation of the radiocarpal joint without any bony lesion associated. The traumatic cause was a high energy motorbike accident. Fractures of the other limbs were associated. The authors report the clinical, radiological, and arthroscopic features. Wrist arthroscopy showed a complete tear of all the extrinsic ligaments, a radial avulsion of the triangular fibrocartilage complex, and the integrity of the intracarpal ligaments, which guided the treatment. The dislocation was treated by closed reduction and radiocarpal pinning. The authors propose wrist arthroscopy in radiocarpal dislocation for diagnosis of soft tissue and cartilaginous lesions to guide the treatment (close or open).

[Fibrous frame of the rotator cuff. The concept of fibrous lock]. / Le squelette fibreux de la coiffe des rotateurs. La notion de verrou fibreux.

MRI assessment of shoulder suggests the presence of a strong fibrous structure in the depth of the supra spinatus muscle. An anatomical study has been performed in 20 fresh human shoulders. There was a very strong fibrous frame within the anterior part of the supra spinatus m. and within the upper part of the sub scapularis. The upper part of the infra spinatus m. contained a significant fibrous reinforcement too so as in the teres minor m. The authors describe fibrous structures around the rotator interval, which constitute an antero-superior Fibrous Lock of the scapulo humeral joint and may help the repair of the full thickness tears of the rotator cuff.