Traumatic lumbosacral dislocation: four cases and review of literature.

Diagnosis, physiopathology, and treatments of four patients with traumatic lumbosacral dislocations are described. This is a rare but severe lesion of the lumbosacral junction that usually occurs in patients with multiple trauma. It often is not thought of and the diagnosis may be missed. Evidence of lumbosacral dislocation should be examined and confirmed by computed tomography scans in patients with multiple fractures of transverse lumbar processes, asymmetric lumbosacral joints on frontal images, or slipping of L5 over S1 on lateral images. Treatment consists of reduction of the dislocated and fractured parts, lumbosacral arthrodesis, a posterolateral graft, and posterior instrumentation. Instrumentation may be short, extending from L5 to S1, or long, from L4 to S1, depending on the extension of the lesion. In some cases, reduction can be done intraoperatively, when the L4-S1 instrumentation is inserted, provided L5 transpedicle screws are pulled posteriorly. It usually is preferable to explore the vertebral canal to ensure that there is no disc lesion compressing the dura before proceeding with reduction. Compression of the dura could be avoided with a preoperative magnetic resonance imaging scan on which a lesion of the L5-S1 disc is sought. Additional interbody vertebral arthrodesis should be considered when the L5-S1 disc is affected severely. This lesion should be looked for preoperatively with a magnetic resonance imaging scan and intraoperatively by exploring the canal. This can be done at the time of the posterior surgery or during a second anterior surgical procedure.

[Synovial cyst of the intercondylar fossa of the knee: three symptomatic cases and a review of the literature]. / Kyste synovial de la tente des croisés: A propos de trois cas symptomatiques et revue de la littérature.

Synovial cyst of the intercondylar fossa of the knee or cyst of the "cruciate tentorium" is an uncommon finding. Most of the reports in the literature were made after the advent of magnetic resonance imaging. Most cysts are asymptomatic and discovered fortuitously. We report our experience with three cases of symptomatic cysts, describing the diagnostic and therapeutic approaches used. Clinical manifestations of symptomatic cysts are variable and non-specific. Pain is commonly observed with limitation of knee amplitudes. If their is no other suspected meniscal or osteochondral disease after clinical and MRI assessment, surgical treatment is only indicated in case of functional impairment. Medical care may be sufficient in certain cases, associating puncture and infiltration. In others surgical treatment, generally via an arthroscopic approach, is needed.

[Chronic stress-related compartment syndrome of the forearm]. / Le syndrome d'effort chronique des loges antérieures de l'avant-bras.

The chronic anterior compartment syndrome of the forearm is a rare pathology (3 cases have been already published), and of new knowledge. Three new cases on 2 patients (one on both sides) are described here. The authors describe recent advances about physiopathology, exploration and surgical treatment. It is due to strenuous activity using flexor muscles of the forearm without any release period (here motor cyclist competition). The symptom was pain at the anterior forearm similar to cramp. The most important for diagnosis was to measure the pressure after activity. The threshold level read after activity was up to 30 mm of Hg, with a very slow coming back to normal value. The isotopic scanner with hydroxyl methylene di-phosphonate (HMDP), after activity, showed a delay of arrival of the tracer and a stasis. RMI seems to give abnormal modification of the signal. The only treatment was surgical and an open fasciotomy of superficial and deep fascia must be done, with opening of the muscle's perimysium. The patients became painfree and resumed their sport after surgical treatment.

[Treatment of posterior instability of the shoulder joint using an acromial stop with a pediculated deltoid flap]. / Le traitement des instabilités postérieures de l'épaule par butée acromiale pédiculée à un lambeau deltoïdien.

Our purpose has been to describe an original surgical technique without describing all the problems concerning the posterior instability. The original technique has a double effect: active with the muscular flap and passively mechanic, if necessary, by the bone graft. Five patients have been treated with this technique with a follow-up of one year and a half. 4 females and 1 male with an average age of 32 years 1/2. 2 were recurrent posterior instability, one unintentional and 2 intentional subluxations. 2 were epileptics. In all cases, the disparition of the instability was obtained. Full range of movement and sport were resumed at the former level. On X-rays, the humeral head was centered. By its double mechanism, active with the muscular flap and possibly passive with the bone graft, this technic is reliable to treat the majority of posterior instability. It combines the way of action searched in physiotherapy and capsulomyoplasties to center the humeral head and this one by the bone graft in case of posterior glenoid fracture or dysplasia. It doesn't have the insufficiencies of physiotherapy or capsulomyoplasties in posterior traumatic instabilities, nor from the classical bone graft over the glenoid posterior wall, cause of osteoarthritis and pain.

[Supernumerary muscle on the dorsal surface of the hand. A case report]. / Muscle surnuméraire de la face dorsale de la main. A propos d'un cas.

The authors report a case of a painful wrist related to a "Manieux muscle" of the dorsal aspect of the hand. Manieux muscles are very rare supernumerary muscles first described by anatomists at the beginning of the 20th century. To our knowledge no symptoms related to this condition have been previously reported. In the present case, symptoms were limited to pain in the wrist with the presence of a fluctuant tumor. The putative diagnosis was synovial cyst. The abnormal muscle was revealed at operation. The operative findings confirmed the responsibility of the Manieux muscle for the patient's symptoms. The muscle was totally resected and pain completely disappeared without any functional impairment.

[Muscular conflict in the peroneal retinaculum caused by supernumerary muscular fascicles of the peroneus brevis. Apropos of 2 cases]. / Conflit musculaire dans la gouttière rétro-malléolaire par faisceaux musculaires surnuméraires du court péronier latéral (peroneus brevis). A propos de deux cas.

The authors describe two cases of muscular conflict in the peroneus retinaculum due to supernumerary muscular fascicules initiating a dislocation of the peroneal tendons. Removing the extra muscular portion brought about complete recovery in both cases.