[Double dislocation of the fifth metacarpal]. / Luxation bipolaire du cinquième métacarpien.

A case of simultaneous dorsal dislocation of the metacarpophalangeal and carpometacarpal joints in the little finger is presented. The patient required an open reduction of the metacarpophalangeal joint, the carpometacarpal joint was reduced simultaneously. Thirty month post-operatively there was no subluxation of either joint.

[Hand trauma from table saw: best prevention]. / La main traumatique par toupie: pour une meilleure prévention.

OBJECTIVE: Trauma to the hand from a circular saw table is a common occurrence in developing countries. It tends to occur in young people, leading to psychologic- and socio-economic disability and loss. METHOD AND RESULTS: In this series of 834 patients. The mean age was 25 years. The left hand was involved in 88%. The authors report on the epidemiologic features of these lesions. These accidents are correlated with postprandial somnolence. The most frequent causes are absence of security systems and heterogeneity of the wood. DISCUSSION: The authors emphasize the importance of information for workers, using consciousness raising campaigns. They also stress the necessity of improvement of the conditions of work. Professional formation must be mandatory for young woodworkers and the laws concerning utilization of dangerous machines must be rigorously enforced, in order to lower the incidence of these accidents.

[Anterior luxation of the elbow. A case report]. / La luxation antérieure pure du coude. A propos d'un cas.

We report in this work a case of anterior pur dislocation of elbow in a patient of 45 years, with antecedent of elbow trauma in childhood, occurred after a direct trauma on bent elbow. The diagnosis is obvious and represented by a pseudarthrosis of the epitrochlea. The treatment consisted of a reduction practiced immediately of the dislocation and contention by a posterior plaster for two weeks. The consequences are good without recidivism with a latenesis over one and half year.

[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.

[Epiphyseal detachment of the upper end of the tibia]. / Décollement épiphysaire de l'éxtremité supérieure du tibia.

In this study, we report 3 cases of fractures involving separation of the upper end of the tibia in young adolescent. These are fairly rare injuries that usually treated by plaster immobilisation. Our aim, through this work is to show the uncommon characteristic of this injuries, possibility of local complications and the difficult of choice of treatment: conservative or surgical treatment.

[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.

[Subungual exostoses. A retrospective study of a series of 28 cases]. / Les exostoses sous-unguéales. Etude rétrospective d'une série de 28 cas.

Subungual exostosis represents an uncommon osteocartilaginous benign proliferation with a trend towards recurrence. The authors report on a retrospective series of 28 cases of subungual exostosis of the first toe with histologic confirmation. There were 20 male and 8 female patients, with a mean age of 18 years. A history of trauma or repetitive microtrauma was noted in 21 cases. Surgical treatment was performed using the most direct approach. The tumor was widely excised and the ungual apparatus was reconstructed under optic magnification. All patients were reviewed after 14 to 96 months. Tumor recurrence was observed in 4 cases, treated secondarily with success. No malignant transformation was seen.

[Local digital anesthesia using lidocaine with or without bicarbonate. A comparative randomized study]. / Anesthésie locale digitale par lidocaïne avec et sans bicarbonate. Etude comparative randomisée.

PURPOSE OF THE STUDY: Local anesthesia with lidocaine is widely used in surgery of the extremities, particularly for fingers. Injection causes pain. In order to minimize this discomfort, addition of bicarbonate has been used by many authors. Results were however contradictory in relation with the difference of approaches. Our study is based on a randomized comparative series with and without lidocaine alcalinization. MATERIAL AND METHODS: Sixty patients presenting multidigital trauma concerning at least two fingers. For each patient, one finger was anesthetized by lidocaine 2 per cent alone and one by lidocaine 2 per cent plus bicarbonate 8.4 per cent respectively in proportion of 4/5 and 1/5. We compared the intensity of pain during injection by a scale ranging from 0 to 10. RESULTS: Significant difference was found between both groups (p < 0.001), alcalinization appearing to decrease discomfort during injection. DISCUSSION: Mechanism of pain decrease by alcalinization is unclear. It appears that intracellular passage of non ionic form of lidocaine is facilitated by alcalinization. This allows the decrease of latence of lidocaine and relieve pain more rapidly by pain receptors blockade. CONCLUSION: Diminution of pain during anesthetic injection has major advantage in out-patient surgery of extremities, in ligamentar testing of digital articulations and in steroid injection.

[Metaphysis fracture of the distal radius: Kapandji's or Py's pinning?]. / Fractures métaphysaires du radius distal: embrochage de Kapandji ou de Py?

The authors report a prospective and randomized study comparing two pinning techniques for fractures of the distal radius. The series compared 42 patients treated by Kapandji's intrafocal pinning (Group I) and 46 patients treated by Py's isoelastic pinning (Group II). Secondary displacement was observed in 7 patients in group I and in 2 patients in Group II. Secondary displacement of K-wire was observed in 6 patients in group I and in no patient in group II. Functional results were analysed according to jakim's criteria. A significant difference was observed between the two groups, for global scores, objectives scores and radiological scores, with better results for Py's pinning. No significant difference was observed for subjective scores advantages of Py's pinning were: stability of isoelastic wires preventing posterior comminution and no need for radioscopic control. Kapandji's pinning is proposed in cases of lower and unstable fractures in teenagers without focal comminution and in T fractures. In the other cases of metaphyseal fractures with posterior displacement, Py's pinning could be proposed.

[Primary muscular echinococcosis. Apropos of 2 cases]. / L'échinococcose musculaire primitive. A propos de deux cas.

We report 2 cases of primary muscular hydatosis of the thigh in a 30-year-woman and a 75-year-man. The clinical picture was a benign soft tissue tumor. The ultrasound and C.T. scan exams confirmed the diagnosis and showed precisely the intimacy of the lesion with the femoral vascular axe. Preoperative diagnosis of this affection is mandatory in order to prevent any rupture of the cyst so as to avoid anaphylactic shock and local recurrence. Percystectomy is the treatment of choice for this lesion.

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.

[Tetraplegia in fat embolism]. / Tétraplégie au cours de l'embolie graisseuse.

This is a report of two cases of tetraplegia complicating fat embolism after fracture of long bones. In the first case, a 26 year-old male sustained fractures of femur and tibia. One day after admission, the patient became comatose (Glasgow coma score = 6) with dyspnaea and petechiae present on the anterior chest wall. In second case, a 22 year-old man with a fracture of tibia and humerus, suffered two days after admission from similar signs of fat embolism (dyspnaea, Glasgow score coma = 6, petechiae). A tetraplegia occurred after 7 days in the first patient and 6 days in the second. No lesions were visible on brain CT scan. Magnetic resonance imaging showed relative high-intensity areas on T2 weighted views. The outcome at three weeks was favourable, without neurologic sequelae.

[Primary hydatidosis of the peripheral muscles. 7 case reports]. / L'hydatidose primitive des muscles périphériques. A propos de 7 cas.

The authors reviewed a series of 7 cases of isolated and primitive hydatid cyst in the peripheral muscles. The disease was mainly diagnosed in young (average age 29.3 years) women of rural origin (87.7%), who consulted for a soft tissue tumor, evolving over at least 6 months, without alteration of the general condition. In 5 of the 7 patients, the tumor was located in the thigh and in 3 cases in the adductors compartment. The diagnosis was highly suspect on sonography. The surgical treatment consisted in a complete resection of the hydatic cyst with surrounding muscle tissue in 6 of the 7 cases, and in a subtotal removal of the surrounding tissues in one case which had adhesions of the surrounding tissues with the femoral vessels. With a follow-up of 19 months, neither clinical nor serological examination showed any recurrence or new sites.

[An osteoid osteoma of the os capitatum]. / L'ostéome ostéoïde du grand os.

We report a hyperalgic form of an osteoid osteoma of the capitatum, wich had evolved since 14 months. The diagnosis was done by roentgenography. Complete surgical excision of the lesion led to the cure.