[Home environment and acute propylene glycol intoxication in a two-year old. An unusual case report]. / Environnement domestique et intoxication aiguë au propylène glycol chez un nourrisson de deux ans. A propos d'une observation inhabituelle.

BACKGROUND: Acute propylene glycol intoxication in a two-year-old toddler underlines the potentially serious toxicity in children of this chemical agent present as a diluent in many drugs and environmental products such as cosmetics, diapers, cleansing towels, despite a common consideration of safety and lack of toxicity. CASE REPORT: A two-years-old boy previously healthy was found in the morning by his parents in his cradle, lethargic, responsive only to sharp pain. On admission, vital signs were: temperature 38.5 degrees C, lethargy, polypnea; propylene glycol intoxication through disposable cleansing towels chewing was ascertained by anamnesis and blood urine analyses which revealed metabolic acidosis and serum propylene glycol peak. CONCLUSION: Environmental acute propylene glycol intoxication must be considered and searched for in front of a metabolic acidosis case of unknown origin in children.

[Experimental study of compression by Herbert screw in carpal scaphoid fracture]. / Fracture du scaphoïde carpien traitée par vis de Herbert.

PURPOSE OF THE STUDY: The purpose of this experimental work was to obtain a radiographical assessment of the effect of the compression achieved with the Herbert screw due to its different thread diameters by comparing the real and expected reduction of interfragment gap (IFG) on cadaver bones. To better understand and define the limits of this "self-compressing" effect and to study the usefulness of screw sizes smaller than the scaphoid, we measured the maximal and mean reduction of IFG without using the instrumentation. MATERIAL AND METHODS: Twelve scaphoids were obtained from fresh cadavers. The scaphoid holes were drilled and tapped in the largest axis of the scaphoid, in a central position parallel to an anti-rotation wire. A transverse osteotomy was made in the mid third of the scaphoid to simulate a Schernberg grade III fracture. The real IFG reduction was defined as the difference between the gap measured before and after screwing. The expected IFG reduction was defined by multiplying the number of screw turns by the pitch height per turn. RESULTS: On the reduction average, a Herbert screw produced a 1.1 mm IFG reduction. The maximal reduction IFG measured was 1.5 mm. For 7 cases, the real IFG reduction was larger than expected, for 4 cases it was smaller than expected and for 1 case the difference was considered negligible. The Fisher test did not demonstrate any significant statistical difference between the real and expected IFG reduction for all scaphoids. The operator perceived a subjective sensation of compression after one screw turn that continued up through the last turn. DISCUSSION: The Herbert screw develops maximal compression force when all the screw threads are totally anchored in the bone. The interfragment gap closes linearly, bringing the two bone fragments together. However, failure can result if the gap is too wide (>2 mm), the screw is poorly positioned, or there is an inappropriate correspondence between screw length and diameter and scaphoid size. Unlike spongy bone screws, the Herbert screw has a round non-conical tip thread and a shallow thread that do not bring the bone fragments together. The perception of compression corresponds to the passage of the screw through the spongy bone and not to real narrowing of the gap between the fragments. In clinical practice, because of the use of instrumentation for open surgery in carpal scaphoid fracture, it is not necessary to rely on these data, but they can be useful for percutaneous screw insertion without a guidewire and without prior compression or for another localization. Peroperative radiographs should be obtained to assess the quality of the screw position and check reduction and the reality of the compression.

[Primary intraosseous rhabdomyosarcoma]. / Rhabdomyosarcome intra osseux primitif.

We report a case of primary intraosseous pleiomorphic rhabdomyosarcoma located in the pelvis of a 21-year-old woman followed for 4 years. The lytic tumor involved the acetabulum and the isthma with moderate extension to soft tissue. First line chemotherapy was unable to arrest tumor progression. Hemipelvectomy with saddle prosthesis reconstruction was performed, but septic complications dictated a secondary inter-ilio-abdominal amputation. Recurrence-free remission was achieved for 4 years, suggesting this was indeed a primary tumor. Primary intraosseous rhabdomyosarcomas are exceptional. Bone localizations generally suggest metastasis from a primary tumor often situated in an intraperitoneal localization. When search for a primary tumor is negative, intraosseous lesions can be considered as primary tumors warranting curative treatment. Radical surgical resection is recommended within the framework of a multidiscipinary management protocol associating radiotherapy and chemotherapy to improve prognosis.

[Angulation deformity of a finger after local radiotherapy]. / Déformation angulaire d'un doigt après radiothérapie locale.

The authors report a case of a third finger angulation deformity. This radial deviation deformity is owed to a local radiation for verrucae vulgaris at 16 years old. The treatment by corrective osteotomy of the phalange was performed with satisfactory correction and full restoration of function.

[Kinematics of the healthy and arthritic hip joint during walking. A study of 136 subjects]. / Cinématique de la coxofémorale saine et arthrosique durant la marche. Etude de 136 sujets.

PURPOSE OF THE STUDY: The study aimed to analyze the spatiotemporal parameters and 3-dimensional pelvic and hip kinematic components during gait in two groups: patients with a primitive osteoarthritis of the hip and control normal subjects. MATERIAL: The study included 51 patients, ranged from 42 to 81 years, and 86 normal subjects. METHOD: Gait analysis was performed using the optoelectronic system VICON with 5 cameras in free-speed conditions. Functional grading of the patients was assessed by Lequesne's score. Thickness of the hip cartilage was measured on pelvis AP radiograph. A preliminary study was performed to measure reliability of the data on 11 patients. RESULTS: At the initial stage of osteoarthritis, speed, cadence, stride length and hip flexion-extension motion appeared as very close to normal data. After this initial stage, there was a statistical relationship between these parameters and arthritis functional grading. Pelvis rotation around the vertical axis did not change according to severity of functional grading. The mean value of this component of pelvis motion was 10 degrees in the pathological group, whereas it was 8 degrees in the female normal group, and 7 degrees in the male group. There were no significant relationship between radiographical thickness of hip cartilage and functional grading of patients or gait parameters. DISCUSSION: This study demonstrates that spatiotemporal gait parameters and kinematic data appear as quantitative index which could be used in future studies. It also shows that pelvic rotation is greater in pathological group than in normal subjects, even in the extreme beginning of the hip osteoarthritis. This particularity can be explained as a very early consequence of the arthritis or, in the opposite, as risk factor.

Anatomical basis of the variable aspects of injuries of the axillary nerve (excluding the terminal branches in the deltoid muscle).

The course of the axillary n. is complex with three points of angulation that may be used to delineate four segments and a fifth segment that corresponds to the intramuscular ending of the nerve in the deltoid m. The purpose of this study was to determine the precise anatomy of the nerve and of its branches, and some morphologic features for each segment. Thirty-two shoulders from embalmed adult cadavers have been studied. The axillary n. was divided in five segments: 1) from its origin to the inferior border of the subscapularis m., 2) from the subscapularis m. to the anterolateral border of the tendon of the long head of the triceps brachii m., 3) from the triceps to the posteromedial part of the surgical neck of the humerus, 4) from the humerus to the entry into the deltoid m., 5) the intramuscular distribution of the nerve in the deltoid m. In each segment from 1 to 4 were noted the origins of the branches to the subscapularis and teres minor mm. and to the scapulohumeral joint, and the origins of the lateral cutaneous branchial n. and of the terminal motor branches to the deltoid m. The length and the diameter of the nerve in the segments and the distance from the segment S1 to the musculotendinous junction of the subscapularis m. were measured. The results showed that the mean diameters were about 4.1 mm in segment 1, 4.1 mm in segment 2 and 3.4 mm in segment 3. The mean distance to the musculotendinous junction was 7.7 mm. Many variations in the levels of origin of the different muscular, articular or cutaneous branches were found without symmetry between the right and left sides. The lateral cutaneous brachial n. was absent in four cases. The results are compared with those in the literature. The division into five segments is proposed to radiologists and surgeons for evaluation or operative procedures on the axillary n., and to provide a hypothesis about the variable aspects of injuries of the nerve.

Quantitative assessment of cortical bone remodelling from routine radiographs of total hip arthroplasty.

In orthopaedic clinical studies, quantitative X-ray bone densitometric analysis could provide precise means of detecting alterations within the bone. With duel-energy X-ray absorptiometry and diphotonic absorptiometry precise and reproducible measures are possible, but they require a specific and costly examination. The use of routine and past available radiographs could facilitate long-term follow-up retrospective studies, but when femoral X-ray bone density is assessed by the naked eye on conventional radiographs, the percentage of errors may be very high (80%). The advantage of a method using conventional radiographs has led us to look for an original technology to estimate X-ray bone density from routine radiographs using both soft tissues and prostheses as X-ray absorptiometric phantoms. In theory, this calculation requires several approximations. An experimental study based on 40 subjects aimed at determining the rate of error due to these approximations. Three radiographs were made for every subject with very different exposure settings. They were computerized by a CCD camera to measure the grey levels (256 scale) of soft tissue and prosthesis, as well as variations in contrast. The statistical analysis showed that when comparing X-ray bone density on different routine radiographs, the percentage of error could be lower than 10% but only under these conditions: (a) grey levels of soft tissue > 26; (b) grey levels of prosthesis < 212; (c) variation of contrast between radiographs > 0.79; (d) radiographs made with the same incidence, and (e) weight of the subject remaining constant during the whole period. It therefore seems possible to compare retrospectively the cortical X-ray bone density from routine radiographs, and to quantify bone remodelling around total hip arthroplasty, but only for the same subject.