[The rotator interval: hidden lesions?]. / L'intervalle des rotateurs: des lésions cachées?

The rotator interval corresponds to a defined triangular shaped anatomical region at the anterosuperior portion of the shoulder where specific pathological processes may occur. First, the morphological and functional anatomy of the region will be reviewed. Then, the role of different imaging modalities will be described along with pathological imaging features. Normal structures of the rotator interval may be imaged with modern techniques, including MR and CT arthrography. On the other hand, clinical evaluation of rotator interval pathology remains difficult; and no consensus exists concerning their management. Imaging characterization of rotator interval pathology could be a key factor for pre-therapeutic work-up.

[Elbow arthroscopy]. / L'arthroscopie du coude.

This symposium of the French Arthroscopic Society is the 2005 state of the art of elbow arthrosocpy in France. A survey reports 499 cases during 2 years with a rate of complication higher than the arthroscopies of other joints (6% of minor and 1% of major complications). The main indication is the removal of loose bodies. They can come from arthritis, chondromatosis, osteochondritis or fracture. The most accurate radiologic examination is an arthroCTscan. The main pronostic factor is the cartilage status. Arthrolysis is the second indication. We performed a retrospective and a prospective studies to compare open and arthroscopic surgery. Results are almost similar with a significant higher improvement in flexion (7 degrees ) in the open group. Open surgery seems more efficient but with a franck loss of motion in the postoperative course. However, in this group elbows were preoperatively stiffer in relation with a trauma event instead of sport related microtrauma in the arthroscopically treated group. Removal of necrotic fragment combined with abrasion in osteochondritis of the capitulum yields to good results with 82% of patients resuming to sports. Long term prognosis is unknown as the joint line is narrowed at a 3 years follow up. Arthroscopy is usefull in synovial diseases as resection of synovial folds or removal of tumors like villonodular synovitis. In the treatment of epicondylitis, the results of our retrospective study are not so good as those reported in the literature. But in our comparative study the results are similar to the open surgery group. The numerous procedures and the different follow up in these two groups did not allow to give statistical analysis. Elbow arthroscopy is a hyper specialty with more and more advanced procedures.

[Focused lithotripsy in the treatment of tendinosis calcarea of the shoulder: results at 2 months and one year]. / La lithotritie focalisée dans le traitement des tendinopathies calcifiantes de l'epaule. Résultats a 2 mois et un an.

OBJECTIVE: The authors report their experience with extracorporeal lithotripsy in 30 patients with calcific tendinosis of the rotator cuff. MATERIALS AND METHOD: This technique is based upon the utilization of high-energy shockwaves (6000 shocks in 3 sessions Day 1, D8, D30) under continuous ultrasound localization of the lesion (EPOS Ultra1). Calcification were evaluated at plain film, US and CT to characterize their length and features. RESULTS: Complete or partial resorption of calcifying deposits within 2 months and one year was observed in 27.5% and 25% of cases respectively. Clinical improvement results are encouraging at two months (50%), but reduced at one year (28.5%), consistent with the rate of resorption of calcifications. CONCLUSION: This painful, long, and expensive technique seems to be disappointing in the treatment of the calcific tendinosis.

Anatomical basis of latissimus dorsi and teres major transfers in rotator cuff tear surgery with particular reference to the neurovascular pedicles.

Musculotendinous transfers (MTT) of latissimus dorsi (LD) and teres major (TM), either in isolation or combination, have recently been advocated to treat irreparable rotator cuff tears. The purpose of this study was to (1) review the anatomy of the LD and TM neurovascular pedicles, and (2) undertake experimental MTT to humeral insertions of either supraspinatus or infraspinatus to evaluate tension on their nutrient arteries in six positions of the arm. Twenty-six shoulders were studied, 22 of which had previously been injected with red latex. Gross dissection, using 4.3 x magnification when necessary, was followed by one MTT for each shoulder (11 LD, 6 TM, 9 combined). The anatomy of the LD and TM neurovascular pedicles was consistent with classic descriptions in 85% of cases; "medialisation" of the thoracodorsal artery was observed in 4 specimens. Tension on the teres major artery was not observed in 15 isolated or combined MTTs, while tension on the thoracodorsal artery in at least one arm position was observed in 60% of 20 isolated or combined MTTs. Three factors were found to be associated with tension: medialisation of the thoracodorsal artery, fixation onto the supraspinatus insertion, and 90 degrees abduction combined with internal rotation. The results suggest that tension on the thoracodorsal artery is possible under certain circumstances when an isolated LD or combined MTT is performed to treat irreparable rotator cuff tear.

Lipoma arborescens of the elbow: a case report.

A 76-year-old woman with a longstanding history of right elbow swelling and recurrent joint effusion presented for consultation. There was no history of trauma and conventional radiographs were negative. Computed tomography (CT) and magnetic resonance imaging were performed and showed a frond-like fatty synovial mass and joint effusion. Arthrotomy disclosed a lipoma arborescens of the right elbow.

Indications for surgery in so-called "regular" thoracic and thoracolumbar kyphosis.

Idiopathic thoracic, thoracolumbar, and Scheuermann's kyphosis do not figure in the same global entity. We propose a classification for so-called "regular" kyphosis. This classification is based on the location of the most rigid curvature segment. Segmental kyphosis may be short, in which case we can distinguish between four types: high kyphosis (type I), middle kyphosis (type II), low or thoracolumbar kyphosis (type III), and segmental kyphosis, which can extend along the entire thoracic spine (type IV). The symptomatology and therapeutic indications are different for each type. We report a series of 15 patients (6 female, 9 male), aged between 18 and 33 years (average age 24 years). The mean kyphosis angle (Cobb angle) in type I patients (n = 3) was 75 degrees in type II patients (n = 3) it was 82 degrees, and in type III patients (n = 9) it was 78 degrees. The pain was greater in type III patients. All patients were operated on using a double approach. As the first step, we performed an anterior approach, disc excision, and bone graft. Ten days later, a posterior approach with CD instrumentation was carried out on ten levels. The mean follow-up is 4 years (range 9 months in 7 years). We noticed no neurological complications and one case of late sepsis. Mean angular loss of correction was 6 degrees. The correction obtained depended on the type of kyphosis. We obtained a mean postoperative Cobb angle of 63 degrees in type I curves, 55 degrees in type II, and 45 degrees in type III. The new classification allows a better understanding of regular kyphosis and helps to define clinical and therapeutic approaches. An analysis of the resulting surgical correction can also be made by comparing homogeneous groups of patients.

[Secondary internal osteosynthesis after external fixation for recent or old open fracture of the lower limb]. / Ostéosynthèse interne secondaire après fixation externe pour fracture ouverte, récente ou ancienne, du membre inférieur.

PURPOSE: The purpose of our study is to analyse the indications, results and limits of secondary internal fixation after external fixation for open fracture of the lower limb. MATERIAL: Our series covered 21 patients treated between 1991 and 1994. There were 17 men and 4 women. Tibia was affected 17 times and femur 5 times (one bifocal fracture). In Gustilo's classification, we had 1 case of type 1, 12 of type II and 8 of type III. METHODS: We used 15 times the FESSA External Fixator and 6 times a monotube external fixator in emergency. We have done secondary 11 intra medullary nailing and 11 patients were treated by plating (one patient had both) 13 patients had a bone graft (cortico-cancellous graft). In the first group of patients (10 cases), the initial treatment gave us good results for both skin and bone healing. The external fixation was replaced by an internal one in order to accelerate bone consolidation and to allow an early weight-bearing. Removal of the external fixation was made at an average of 4 months postoperative. In the Second group (11 cases) the internal fixation was proposed because of an insufficiency of the external fixation leading to complications as: non union, mal union and bone defects. External fixation was removed in a mean time of 8 months. Internal fixation was completed by local bone autograft. RESULTS: 17 patients have been reviewed. Consolidation occurred with an average of 6 months after internal fixation 1 to 24 months. We had no deep infection but only 2 superficial ones. DISCUSSION: We chose 2 types of indication, and we called them programmed and for necessity. The first group of 10 patients whose stain was moderate and whose initial setting up had permitted a perfect anatomic reduction with a rapid wound healing. Internal fixation was performed after a short duration of external fixator. An early weight bearing was allowed so that the functional recovery could be obtained quickly. The second group is represented by patients whose internal fixation was done for non union, malunion or bone defect. In such a case autogenous cancellous graft was used to fill the defect.

[The styloid bone and carpal protuberance]. / Os styloïdeum et carpe bossu.

Dorsal carpal protuberance of the wrist is frequently caused by the presence of a styloideum bone. We report a case illustrating this pathophysiological hypothesis. This pathology is often confused with synovial cyst emphasizing the importance of a lateral view of the hand in 30 degrees supination. Computed tomography sections are also helpful showing the exact nature of the protuberance. A cuneiform resections of the joint line can leave to complete symptom relief.