[Infection of a tophaceous nodule of the middle finger]. / Infection d'un tophus goutteux de la main.

Gouty involvement of the hand is uncommon and the complications the most described are bony destruction, digital joint instability, tenosynovitis and double ipsilateral tunnel syndrome of the median and ulnar nerves at the wrist. Septic complications, such as infection of a tophaceous nodule, are a rare entity. The authors report a case of an infection of a tophaceous nodule of the middle finger in a 67-year-old man. The diagnosis was suspected on physical examination and radiological findings but final diagnosis is provided by bacteriological examination. This case is presented to heighten awareness of this rare entity and to provide a setting for a discussion of management.

Giant cells tumor recurrence at the third lumbar vertebra.

Giant cell tumors (GCT) of the spine are rare. We report a case of (GCT) of the third lumbar vertebra revealed by left lumbar radiculopathic thigh pain in a 47 year old man. Imaging showed an osteolytic process invading the vertebral body, the posterior arch and compressing the dural sac left side. Neurological decompression was first performed including stabilization by an instrumented postero-lateral graft. A surgical biopsy was obtained at the same time to confirm the diagnosis. A secondary L2-L4 tumor curettage and graft procedure did not prevent, 5 years later, tumor recurrence. We believe that the simple tumor curettage is insufficient to prevent giant cell tumors recurrence.

Distal femoral varus osteotomy outcome: Is associated femoropatellar osteoarthritis consequential?

INTRODUCTION: Distal femoral varus osteotomy (FVO) can be indicated for young active patients who have lateral unicompartmental osteoarthritis in a valgus knee originating in the femur. However, its indication remains controversial when associated patellofemoral osteoarthrosis is present. HYPOTHESIS: Associated patellofemoral osteoarthrosis influences the results of osteotomy in cases of lateral tibiofemoral osteoarthrosis. METHODS: Twenty patients (22 knees) underwent opening wedge FVO for lateral tibiofemoral osteoarthrosis of a valgus knee. The osteoarthrosis was lateral and unicompartmental in 11 cases, associated with patellofemoral osteoarthrosis in nine cases, and global in two cases. The osteotomy site was fixed with a 95° blade plate in all cases. At a mean follow-up of 54 months, all the patients were evaluated using the International Knee Society (IKS) score. RESULTS: Eighteen knees had good or excellent results (80%), two had fair results (9.5%), and two had poor results (9.5%). One female patient underwent total knee replacement revision at 8 years and three others are awaiting total knee replacement. The mean preoperative IKS score increased from 49.28 (range, 14-70) to 74.23 (range, 41-92) at the last follow-up. The mean preoperative functional score increased from 50.68 (range, 30-80) to 72.85 (range, 40-90) at the last follow-up (p=0.001). The 8-year survival rate was 91% (confidence interval, 69-100%). We noted improvement in patellofemoral syndrome and recentering of the patella in seven cases out of nine with severe patellofemoral osteoarthrosis. CONCLUSION: Distal femoral varus osteotomy, with lateral opening wedge and fixation can be a good alternative to treatment of lateral tibiofemoral osteoarthritis associated with a valgus knee originating in the femur. The association of patellofemoral osteoarthritis does not affect the functional results. LEVEL OF EVIDENCE: Level IV. Retrospective study.

[From diagnosis to treatment of gluteus medius tendon tear of the hip: a case report]. / Du diagnostic au traitement de la rupture de la coiffe de hanche: à propos d'un cas.

OBJECTIVE: To report a case of spontaneous gluteus medius tear repaired surgically in a 42-year-old woman patient without any other antecedent other than diabetes. PATIENT AND METHODS-RESULTS: Trochanteric pain evolving for 7 months led to scintigraphy objectifying a hyperfixation of the trochanter and ultrasonography showing an inflammatory gluteus medius tendon. These examinations were supplemented by magnetic resonance imaging and tomodensitometry visualising the tendon rupture but no marked fat degeneration of the muscle despite atrophy of this one. Surgical exploration confirmed the presence of a major rupture of the gluteus medius tendon, which was reinserted through an osseous trench. Rehabilitation involved protecting the tendon, by an installation of the member in abduction and passive mobilization from the third postoperative day, with a move to partial support on day 45. The result after 16 months was excellent, the patient returning to work 8 months after the surgery without any residual pain. CONCLUSION: The spontaneous rupture of the gluteus medius, often ignored, can occur in young subjects and induce limited function, often well corrected by reinsertion surgery.

[Melitococcal psoas abscesses: study of three cases and review of the literature]. / Les abcès mélitococciques du psoas: etude de 3 cas et revue de la litterature.

Vertebral involvement is a common complication of brucellosis in adults. However psoas abscess related to brucellar spondylitis have rarely reported. The purpose of this report is to describe three cases of bilateral psoas abscess identified during workup for brucellar spondylitis. Medical imaging was helpful in confirming diagnosis of these fluid collections. Epidemiological, clinical, radiological and serological findings were consistent with melitococcal etiology. Treatment was based on a combination of antibiotics (rifampicine-doxycycline) and abscess evacuation by percutaneous drainage, needle aspiration or open surgery. Outcome was favourable. Brucellar psoas abscess is uncommon. Most caseare discovered coincidentally during investigation of melitococcal spondylitis. Management usually consists of fluid drainage and appropriate antibrucellar therapy. Prognosis is favourable.

Hydatid cyst of bone: diagnosis and treatment.

Osseous hydatidosis is a rare occurrence of hydatid disease. Anatomoclinical changes are, however, peculiar to this localization. From the anatomopathologic standpoint, this localization marks the torpid, insidious progression of the parasite into bone tissue, leading to an immediate diffuse, extensive, invasion process, so complete surgical eradication is rarely possible. From the clinical standpoint, whatever the localization may be, we are surprised by the latency of this affection, the patient being treated at an advanced stage, when radiologic lesions are already extensive, and the complications, especially in the spinal area, are severe. Owing to the poor biologic findings, the diagnosis of osseous hydatidosis is still primarily based on roentgenographic findings. Sometimes, however, the diagnosis is established only after surgery. Treatment of osseous hydatidosis is closer to oncologic therapy than to the usual surgical treatment of visceral hydatid cysts. Because of the poor results with medical treatment, osseous hydatidosis must be treated by a radical operation with wide excision, adapted to each localization. In the main, the prognosis of osseous hydatidosis remains poor, especially with spinal and pelvic localizations, which are the most frequent ones. The prognosis and treatment of osseous hydatidosis belong in the same category as a locally malignant lesion.

[Cold parapharyngeal abscess in spondylodiscitis]. / Les abcès froids parapharyngés sur spondylodiscite.

BACKGROUND: The principle danger of pharyngeal abscess is the risk of rupture overflow into the upper respiratory track. Pyogenic abscesses are the most frequent and tuberculosis is rare. We report two cases of retro and parapharyngeal abscesses with tuberculous spondylodiscitis. CASE REPORTS: The first case occurred in a 54-year-old woman, the second in a 19-year-old man. Both had a laterocervical swelling associated with a oropharyneal bulge that progressed over several months. Computed tomography showed abscess formation and spinal disease in both cases. Drainage of the abscess led to the distological diagnosis of tuberculosis. Medical management was successful with resolution of the abscess and spinal lesions. DISCUSSION: Spinal tuberculosis should be suspected in patients with a parapharyngeal abscess without detectable portal that progresses slowly. A biopsy specimen is required for diagnosis. Magnetic resonance imaging can provide early evidence of spondylodiscities. Medical treatment is indicated.

[Lipoma arborescens of the knee: contribution of x-ray computed tomography. Apropos of a new case]. / Le lipome arborescent du genou: apport de la tomodensitométrie. A propos d'un nouveau cas.

The authors report a case of a synovial lipoma of the knee in a 40 years old man who suffered from chronic instability of the right knee associated to an extensive joint swelling and recurrent hydarthrosis. Ultrasonography and arthrography showed a synovial process and the computerized tomography showed an inhomogeneous low density due to its fat content suggesting a synovial lipoma arborescens of the knee. Final diagnosis was confirmed by histological examination of the arthroscopic biopsy. The authors discuss, through out their case and a review of the literature, modern investigation findings and indication for surgical treatment of this disease.

[Value of false profile of the pelvis in the monitoring of total hip prosthesis]. / Intérêt du faux profil du bassin dans la surveillance des prothèses totales de hanche.

The authors used a retrospective series of cases of total hip replacement with a follow-up of between 6 and 12 years, including 10 undergoing reoperation for slipping of the prosthesis, to define the value of the false lateral view of the pelvis in the monitoring of such patients. This view provides earlier detection than AP views of wearing of polyethylene which manifests itself by penetration of the femoral head into the acetabular implant. This penetration, which can be measured radiologically, is better visualised in the false lateral view of the pelvis for simple reasons of radiological incidences. The false lateral view of the pelvis has another use in the monitoring of total hip replacements. It enables visualisation of the posterior part of the acetabulum which is generally the site of first appearance of the earliest signs of slipping in the form of a thin line.

[Anterior approach to the high thoracic spine by the subscapular route]. / Abord antérieur du rachis dorsal haut par voie sous-scapulaire.

The authors report their experience of the approach of the high thoracic spine (from T1 to T3), with the help of a thoracic flap resected under the location of the scapula. This approach has only given few functional disorders after the operation: besides, it offers the possibility to widen towards the low thoracic spine or the cervical spine.

[Anatomy of the trochleo-condylar junction and its consequences on the femoro-patellar joint in single-compartment prostheses]. / Anatomie de la jonction trochléo-condylienne et ses conséquences sur l'articulation fémoro-patellaire des prothèses unicompartimentales.

A search was made for impingement of the femoral part upon the patella on femoropatellar axial views made at a 90 degree angle of flexion in 81 cases of unicondylar arthroplasty (46 medial and 35 lateral). The patients were followed up during a period ranging from 5 to 10 years. 16 cases of impingement between the condyle part and the patella were found. Radiologically, this resulted in a notch on the patella. Clinical symptoms were usually moderate. The anomaly most often found at the onset of this complication was faulty positioning of the condyle part. The complication was more frequently observed in lateral femorotibial arthroplasty (10 cases out of 35) than in medial one-compartment arthroplasty (6 cases out of 46). This variation can be explained on the basis of morphological differences between the medial and lateral sides of the trochleocondylar junction. A study carried out using anatomical specimens, X-rays and scanner sections was used to define the differences.

[Contribution of echography in the course and treatment of acute osteomyelitis]. / Apport de l'échographie dans l'évolution et le traitement de l'ostéomyélite aiguë.

In a series of 43 cases of acute hematogenous osteomyelitis, the ultra sound (US) allowed the diagnosis and the accurate localisation of the sub periosteal abscess. The early surgical treatment of the sub periosteal abscess since its nascent or, at least, before its rupture into the soft parts, changes completely the development of the illness and reduces considerably the chronicity forms. This early surgical treatment allows also to isolate rapidly the germ and to test its sensitiveness to antibiotics, which insures a better effectiveness to the medical treatment.