Atteintes osseuses multiples d'une syphilis congénitale précoce : à propos d'un cas

Introduction. Nous décrivons un cas d'agénésies dentaire multiples associées à une ectopie bilatérale des troisièmes molaires ainsi de la deuxième prémolaire mandibulaire gauche. Cas clinique: Une patiente de 30ans était référée par son médecin gastroentérologue pour une prise en charge odontologique. La patiente décrit de ne jamais avoir bénéficié d'avulsion dentaire et ne souffrait d'aucun douleur ou gène au niveau orofacial. Une exploration clinique suivie d'examens radiologiques était réalisé. L'examen clinique révèle l'absence de plusieurs dents. La radiographie panoramique avait permis de confirmer le diagnostic d'agénésies multiples de huit dents. Les deux troisièmes molaires mandibulaires incluses en position verticale au niveau de la branche mandibulaire. La 35 aussi incluse en position apicale de la 38. L'examen CBCT montre une déhiscence des corticales des faces interne et externe du ramus en regarde des couronnes des troisièmes molaires. Discussion. L'oligodontie associée à une inclusion dentaire multiple reste un cas rare. Les éléments de l'examen clinique associés à la radiographie panoramique permettent de confirmer le diagnostic d'agénésie et d'ectopie dentaires. La radiologie tri dimensionnelle est capitale dans la prise de décision thérapeutique des dents ectopiques en position condy lienne.Conclusion. Sans symptomatologie clinique et radiologique, la décision thérapeutique était de s'abstenir de traitement chirurgical et de surveiller

[Treatment of proximal humeral fractures by Telegraph nail: prospective study of 34 cases]. / Traitement des fractures de l'extrémité proximale de l'humérus par clou Télégraph: étude prospective de 34 cas.

PURPOSE OF THE STUDY: Many developments have been devoted to improving osteosynthesis of proximal humeral fractures, but indications remain controversial. Anterograde nailing using a locked self-stabilizing nail is an attractive conception which has provided promising results. The purpose of this study was to assess the early results observed in a series of patients treated with a first-intention Telegraph nail. MATERIAL AND METHOD: Thirty-four patients were reviewed for a prospective clinical and radiological assessment. Mean follow-up was 13.6 months (range 3-34 months). Mean age at the time of the accident was 68 years (20-90 years). There were 24 women and 10 men: the left shoulder was fractured in 22 patients. All fractures healed within 1 to 4 months. Groups for statistical analysis were determined by type of fracture using the Neer and Duparc classifications. Qualitative functional analysis used the Constant score in comparison with the opposite side. Anatomic analysis of fracture reduction after healing was based on plain x-rays (ap view in neutral rotation) by measuring the angle of inclination of the head in relation to the diaphyseal axis (alphaF). Normal was 45 degrees; reduction was considered adequate for an alphaF angle between 30 degrees and 60 degrees. The lateral view was used to search for posterior or anterior tilt of the humeral head. RESULTS: Necrosis of the humeral head was observed in four shoulders (11.8%). Three of them after displaced joint fractures. These cases were retained for the analysis. Considering all patients in the study, the raw mean Constant score was 62 points and the age- and sex-weighted score was 82.5%. For two- and three-fragment extra-articular fractures, the mean Constant score was 82.3% (21 shoulders); it was 89% for simple joint fractures (5 shoulders) and 79% for complex joint fractures (8 shoulders). The differential Constant scores, comparing the healthy side with the operated shoulder, showed a difference of 20 points on average (range 0-43 points). 52.9% of patients reviewed displayed mild deficit, 20.6% moderate deficit, and 26.5% major deficit. The mean alphaF angle was 38 degrees (range 0-80 degrees). Reduction was considered good in 18 shoulders with a mean Constant score of 88.7%. Reduction was considered poor in 16 shoulders with a mean Constant score of 75.6%. Four shoulders exhibited posterior tilt of the humeral head, all associated with healing in a valgus position. DISCUSSION: The Telegraph nail provides reliable fixation for the treatment of extra-articular and simple articular fractures of the proximal humerus. Dislocated fractures are classical indications for arthroplasty, with acceptable results for a only slightly invasive procedure. The risk of osteonecrosis does not necessarily deteriorate shoulder function and secondary revision for insertion of a prosthesis is still possible. The radio-clinical correlations show the importance of reduction quality to obtain a good final clinical result. Among the nine cases of poor outcome, six were related to a misaligned callus with persistent valgus deviation of the head (alpha F<30 degrees ) and in some cases, excessive posterior tilt. The solidity and stability achieved with the Telegraph nail enabled healing in all cases of fracture in this series with immediate postoperative reduction in most. The stability being related to the quality of bone stock, primary arthroplasty remains an important indication when it appears that a solid osteosynthesis cannot be achieved.

[Scaphoid fracture associated with displaced fracture of the distal end of the radius in children. Apropos of a case]. / Fracture du scaphoïde associée à une fracture déplacé de l'extrémité inférieure du radius chez l'enfant. A propos d'un cas.

A child of 13 years, victim of a fall on his wrist at dorsal flexion position; he presented a scaphoid fracture associated with a displaced fracture of the distal end of the radius. The radius fracture was reduced under general anesthesia, by external manoeuvre; the consolidation was obtained after 10 weeks of plaster cast immobilization. The follow-up was of two years, with a good clinical and radiological result in spite of a non union of the Ulnar-styloid. It is important to remember this exceptionnel association in children not to forget the scaphoid fracture.