Nonunion of the scaphoid treated by anterior vascularized bone graft: a review of 26 cases.

OBJECTIVE: To evaluate the clinical and radiological outcome of anterior vascularized bone graft in the treatment of primitive nonunion of the scaphoid. METHODS: This is a retrospective study of 26 scaphoid nonunion cases treated by this technique between 2004 and 2009. The mean age was 38 years. Nonunion was of types IIA and IIB according to the Alnot's classification and only one case showed a proximal pole necrosis (type IV). The fixation was ensured by K-wire. The mean immobilization period was 9 weeks. RESULTS: At mean 19 months follow-up, the bone union rate was 88.5%. Failure was noted in three cases. No significant complications secondary to this technique were observed. The mobility in extension and flexion had an average recovery of 18 degree Nineteen patients (73%) were free of pain, and the others had occasional pain. CONCLUSIONS: It is a meticulous surgical technique that provides better union rates than those of conventional scaphoid graft. This technique is first adopted in cases of failure of conventional grafts in the treatment of scaphoid nonunion but the encouraging results suggest expanding indications to primitive nonunion.

An unusual Monteggia type I equivalent fracture: a case report.

We report an unusual case of a type I Monteggia equivalent lesion in a 6-year-old girl consisting of fracture of the ulnar diaphysis and fracture of the neck of the radius without dislocation of the radial head. Manual reduction and immobilization in a plaster cast were performed. At 10 years of follow-up, the patient had regained full flexion and extension of the elbow, and nearly full pronation and supination. In the literature, this lesion has been reported only in two paediatric patients indicating that this is an extremely rare trauma.

[Pott's disease of the upper cervical spine (three cases and literature review)]. / Mal de Pott du rachis cervical supérieur (à propos de 3 cas).

BACKGROUND: Sub-occipital Pott's disease is rare, but dangerous. AIM: To recall diagnostic aspects and spatially the neuroradiological ones of sub-occipital Pott's disease. METHODS: We describe three patients with sub-occipital Pott's disease followed in our department from 2002 to 2007. RESULTS: There were two women and one man (mean age at onset: 48 years). The early clinical picture was non specific. Exploration, in addition to standard radiographies included a computerized Tomography (CT) (n=2) and MRI (n=1 and n=3). The diagnosis was confirmed histologically on a biopsy of the abscess (n=1), a bacteriological evidence (n=2) and retained thanks to argument presumption (n=3). The treatment was based on quadruple antituberculous chemotherapy with external traction (n=2 and n=3) associated with urgent surgery (n=1) because of the worsening of the neurological complications. The evolution was fatal (n=1) and positive (n=2 and n=3). CONCLUSION: Tuberculosis should be suspected in patients with chronic torticollis and residing in an area when tuberculosis is endemic. Medical treatment is based on a quadruple antituberculosis chemotherapy with traction in the presence of atlanto-axial instability. Surgery is reserved in case of neurological worsening or persistent instability.

Synergistic effect of starch on the antibacterial activity of honey.

The role of amylase present in honey in enhancing its antibacterial activity was evaluated in the presence and absence of starch. Two strains of pathogenic bacteria have been used: Staphylococcus aureus and Escherichia coli. For S. aureus, the minimum inhibitory concentration (MIC) for the three varieties of honey tested without starch was 11%, 24%, and 29% (vol/vol), respectively. When starch was added with honey to the media the MIC obtained was 5%, 19%, and 25% (vol/vol), respectively. For E. coli, the MIC for the three varieties without starch was 23%, 28%, and 25% (vol/vol), respectively. When starch was added with honey to media, the MIC was 19%, 26%, and 23% (vol/vol), respectively. It is speculated that the amylase present in honey hydrolyzed the starch chains to randomly produce dextrin and maltose and that this increased the osmotic effect of the media, which consequently increased the antibacterial activity.