[Pathological fracture of the femur in a patient with a venous malformation]. / Fracture pathologique du fémur sur malformation veineuse. A propos d'un cas.

We observed a pathological fracture of the femur in a 21-year-old woman with a venous malformation. Physical examination and plain x-rays disclosed a pathological bone. Biopsy revealed the venous malformation. The extent of the lesion that involved the entire quadriceps muscle was detailed with duplex-Doppler, computed tomography and arteriography. The patient was treated with an intramedullary nail. Intra-operative bleeding necessitated transfusion (packed cells and frozen plasma). Outcome was favorable. Bone healing was achieved at seven months.

[Tuberculosis of the wrist. Symptoms and outcome in eleven cases]. / Tuberculose du poignet. Symptômes et évolution de 11 cas.

PURPOSE OF THE STUDY: We present our experience with a rare localization of tuberculosis, the wrist, focusing on symptoms and outcome after treatment. MATERIAL AND METHODS: Our series included eleven patients, eight men and three women, mean age 42 Years, who presented tuberculosis of the wrist. Tuberculosis was known in four patients who were being treated and a context of tuberculosis was recognized in three others. One patient on long-term corticosteroid therapy was immunodepressed. Mean time from symptom onset to consultation was fifteen months indicating a slow and progressive disease process. An inflammatory syndrome was noted in nine patients. Based on the standard x-rays, the David-Chausse classification was: stage I n=1; stage II n=1; stage III n=3; stage IV n=4. The AP view of the wrist was normal in two patients. Diagnosis of tuberculosis was confirmed on the surgical biopsy specimen which revealed epithelio-gigantocellulary granuloma with caseous necrosis. In only five patients Koch bacilli developed in culture on Lowenstein-Jensen. Patients were given anti-tuberculous antibiotics and the wrist was immobilized in a plaster splint. RESULTS: Mean follow-up was two years. The disease course was blunted by the antituberculosis treatment. Surgical drainage was only required to clear abscesses. Wrist stiffness was frequent and had a significant functional impact. DISCUSSION: These eleven cases of a rare localization of tuberculosis illustrate the slow progressive course of clinical symptoms and radiological signs of tuberculosis, emphasizing the difficulties encountered in establishing early diagnosis of such isolated non-abscessed localizations. Anti-tuberculous treatment is effective but the functional outcome depends on early diagnosis before the development of radiological evidence of joint destruction.

[Posterior radiocarpal fracture-dislocation (eight case reports)]. / Les luxations-fractures radiocarpiennes postérieures (à propos de huit cas).

The Authors report a retrospective series of eight cases of posterior radiocarpal fracture-dislocation. Average age of patients was 32 years (23/54), with a male predominance (7 men and a woman). Injury was often due to a fall on the hand in extension from an elevated place (5/8). The wrist in back of fork is the characteristic deformity. Diagnosis was confirmed by AP and lateral views of the wrist. Radial styloïd fracture, posterior dislocation of the carpus and posterior rim avulsion were constant. Ulnar styloïd fracture was present in half of the cases and distal radio-ulnar dislocation in two cases. Four patients were treated conservatively and four surgically. Whatever the treatment choice, results are satisfactory at a short follow-up. The two patients presenting a distal radio-ulnar dislocation resulted in a bad result.

[Divergent dislocation of the elbow in an adolescent. A case report]. / Luxation divergente du coude chez l'adolescent. A propos d'un cas.

A case of simultaneous proximal radio ulnar joint divergent dislocation combined with a bone avulsion of the coronoid apophysis of the same elbow in a 16 years-old girl is presented. After a closed reduction and two weeks of plaster immobilization, normal function of the elbow was recovered within three months. There are only ten cases reported of such a divergent elbow dislocation in modern literature.

[False iatrogenic aneurysm complicating septic malunion of the femur]. / Faux anévrisme iatrogène compliquant une pseudarthrose septique du fémur.

We report a case of false iatrogenic aneurism of the femoral artery observed after external fixation for septic malunion of the femur subsequent to emergency plate fixation. This false aneurysm ruptured, requiring femoropopliteal arterial repair. In the septic context, the vascular sutures failed making it necessary to ligature the femoral artery. Vascularization was maintained by satisfactory collateral circulation.

[Necrotizing fasciitis of the upper limb. Apropos of 4 cases]. / La fasciite nécrosante du membre supérieur. A propos de quatre cas.

This article is based on the retrospective study of 4 cases of necrotic fasciitis of the upper extremity, in adult patients with a mean age of 57 years (range: 36 to 78 years) and with a male predominance (3 M/1 F). Presenting signs were variable: pain, febrile and inflammatory oedema, ecchymoses with inflammatory masses containing clear or haemorrhagic fluid. Treatment with antibiotics and anti-inflammatory drugs did not prevent progression to painless, necrotic ulcers. Rapid medical and surgical treatment constitutes an element essential of the prognosis and must include wide large debridement, antibiotics and intensive care.

[Transverse and T fractures with fracture of the posterior wall of the acetabulum. Results of orthopedic and surgical treatment. Apropos of 52 cases]. / Fractures transversales et en T avec fracture de la colonne postérieure du cotyle. Résultats des traitements orthopédique et chirurgical. A propos de 52 cas.

Fifty two cases of transverse and T fractures associated with a posterior wall fracture of the acetabulum were followed after conservative and surgical treatment. The mean follow-up was 3.5 years. There was marked displacement in 71% of cases, and a transverse fracture of the acetabular roof in 48% of case. There was no joint congruence in 50% of cases. The conservative and surgical results are the same without anatomical reduction, but the functional result seems better after surgical treatment with perfect reduction. However conservative management is necessary when anatomical reduction is impossible.

[Divergent dislocation of the elbow. Apropos of a case]. / La luxation divergente du coude. A propos d'un cas.

One case of divergent dislocation of the elbow is reported. It was associated with other lesions of the upper limb due to the violence of the initial trauma. The authors found 6 other cases reported in the literature. They discuss the mechanism, diagnosis and treatment of such lesions.