[Congenital scaphotrapezial synostosis associated with a carpal tunnel syndrome: a case report]. / Synostose scaphotrapézienne associée à un syndrome du canal carpien chez une enfant de neuf ans : à propos d'un cas.

This report describes a case of congenital synostosis between two bones of the wrist scaphoid and trapezium in a nine-year-old girl who presented a severe tunnel carpal syndrome treated two years ago by open surgery. This association has not previously been described.

Traumatic lumbosacral dislocation: four cases and review of literature.

Diagnosis, physiopathology, and treatments of four patients with traumatic lumbosacral dislocations are described. This is a rare but severe lesion of the lumbosacral junction that usually occurs in patients with multiple trauma. It often is not thought of and the diagnosis may be missed. Evidence of lumbosacral dislocation should be examined and confirmed by computed tomography scans in patients with multiple fractures of transverse lumbar processes, asymmetric lumbosacral joints on frontal images, or slipping of L5 over S1 on lateral images. Treatment consists of reduction of the dislocated and fractured parts, lumbosacral arthrodesis, a posterolateral graft, and posterior instrumentation. Instrumentation may be short, extending from L5 to S1, or long, from L4 to S1, depending on the extension of the lesion. In some cases, reduction can be done intraoperatively, when the L4-S1 instrumentation is inserted, provided L5 transpedicle screws are pulled posteriorly. It usually is preferable to explore the vertebral canal to ensure that there is no disc lesion compressing the dura before proceeding with reduction. Compression of the dura could be avoided with a preoperative magnetic resonance imaging scan on which a lesion of the L5-S1 disc is sought. Additional interbody vertebral arthrodesis should be considered when the L5-S1 disc is affected severely. This lesion should be looked for preoperatively with a magnetic resonance imaging scan and intraoperatively by exploring the canal. This can be done at the time of the posterior surgery or during a second anterior surgical procedure.

[Epidemiological survey of wrist fractures in children]. / Les fractures du poignet de l'enfant: étude épidémiologique.

PURPOSE OF THE STUDY: The incidence of wrist fractures is increasing in children. We undertook an epidemiological survey in western France to determine characteristic features. MATERIAL AND METHODS: A prospective multicentric study was conducted over one year in five university hospital centers in western France. The survey included 839 wrist fractures in children aged 6 to 16 years. The following criteria were recorded: age and gender, date and energy of the trauma, side and description of the fracture. Displacement was measured on the AP and lateral radiographs. RESULTS: The boys were older than the girls at the time of the wrist fractures, generally during the summer season (May to October). The left wrist was involved in 55% of the fractures; 83% were metaphyseal fractures. Fractures with epiphyseal detachment were more frequent in adolescents and occurred after high-energy trauma. Metaphyseal fractures were more common in girls than in boys. Displacement was greater in older children, particularly in case of epiphyseal detachment. DISCUSSION: We did not observe the male predominance often reported in our country. The girls probably practice sports as much as boys.

[Non-traumatic myositis ossificans circumscripta]. / Myosite ossifiante circonscrite non traumatique.

BACKGROUND: Myositis ossificans circumscripta is a benign lesion with an acute course and may simulate a malignant tumor. It usually follows trauma to soft tissue. CASE REPORTS: Case n. 1. A 13 year-old girl was admitted because of a painful inflammatory tumour in the left thigh. Initial X-rays were normal. Ultrasound imaging showed a heterogeneous echogenic mass with several extending shadow cones in the distal part of the vastus medialis muscle resembling a calcifying hematoma. Twenty days later, X-rays showed a vague calcified peripheral rim in the medial distal part of the thigh. White blood count was normal, and blood sedimentation rate was 46 millimeters in the first hour. CT scan showed a transparent zone between the lesion and the adjacent bone and a lucent central area, surrounded by a dense outer area consistent with myositis ossificans. Histological examination of the excised mass confirmed myositis ossificans. Two years later, the patient was asymptomatic and X-rays showed no ossification. Case n. 2. A 14 year-old girl suffered from pain in the right anterior hip area since 10 days. She denied any trauma. A firm mass was palpable in the anterior superior iliac spine area and X-rays revealed a calcific density. CT scan showed a dense bony mass in the right gluteus medius muscle clearly separated from the adjacent bony pelvis by a soft tissue plane. Histological examination of the excised mass confirmed myositis ossificans. One year later, the patient was asymptomatic and X-rays of the pelvis showed no ossification. CONCLUSION: Myositis ossificans circumscripta is rare in children. CT scan suggests the benign nature of the lesion by demonstrating integrity of bony cortex and characteristic disposition of calcifications. The biopsy is not necessary if the diagnosis is certain. Surgery permits to reduce the evolution.

[Congenital dilatation of the prostatic utricle. Embryologic review, diagnosis and treatment. Apropos of 2 pseudo-tumoral cases, without hypospadias]. / La dilatation congénitale de l'utricule prostatique. Rappel embryologique, diagnostic et traitement. A propos de deux observations pseudo-tumorales, sans hypospadias.

The authors report two pediatric cases of congenitally dilated prostatic utricle. First a newborn with prenatal ultrasound diagnosis of abdomino-pelvic cystic mass and secondly a 4-year-old boy with urinary incontinence and lower abdominal mass. Unilateral renal hypoplasia was noted in both cases, but no hypospadias. The study of embryogenesis and pathogenesis shows that the anomaly happens before the 8th week of pregnancy. When hypospadias is associated, the anomaly develops later and has a hormonal cause. Prostatic utricle is not only an embryologic Müllerian remnant, but comes from the mesodermic and endodermic tissues. The first clinical signs are often urinary signs or an abdominopelvic mass. The prostatic implantation and the median localization of this cystic mass are both revealed by urethrography and ultrasonography. Computed tomography and especially Magnetic Resonance Imaging may be performed. MRI provides a detailed demonstration of the anatomy and a large field of view in all three planes. It helps to plan surgical therapy. The treatment of prostatic utricle may be percutaneous, endoscopic or surgical. The indications are based on the symptoms, but the risk of malignancy must be kept in mind. In our cases, the marked dilatation of the prostatic utricle led to surgical treatment and retrovesical excision was successful.

[Congenital cutaneous aplasia of the scalp. Apropos of 4 cases]. / Les aplasies cutanées congénitales du scalp. A propos de 4 observations.

Report of four cases of congenital defects of the scalp. In two of these cases, the skin defect was associated with a skull defect and in one, there were other cranial deformities. In each case, the lesion seemed isolated in otherwise normal children. This study contains a review of congenital scalp defects. The different aspects of this rare disease are presented and the treatment is discussed with reference to natural evolution. The authors differentiate between cases with isolated lesion and cases with associated malformations or abnormalities, malformation syndromes, as has been previously defined. In the case of skull defects, it is thought that immediate reparatory surgery must be performed, to prevent infection and hemorrhage of sagittal venous sinus, as it was the case in one of the four children. The covering of the defect can be realized with rotated skin flaps, which seem preferable to any form of plastic surgery, for cosmetic reasons, and for the secondary treatment of the skull defect, if this is necessary. When spontaneous closure of the bone defect, is not noted, which occurs generally in the case of large defects, it seems reasonable to close the latter by cranio-plasty, to protect the brain. In one of the four cases reported, this technical approach of the lesion was used, with a good result being reported, four years later.

Living conditions of serious chronic respiratory insufficiency patients treated at home on oxygen therapy or assisted ventilation.

A study on the living conditions of patients on long-term oxygen therapy or assisted ventilation at home was conducted in France in January 1988. At that date, 13,500 patients had been handled by 30 regional associations. Twenty-four regional associations (80%) representing 11,079 patients (82%) participated in the study. A total of 8,091 questionnaires were processed, accounting for 73% of patients interviewed and 60% of the population under treatment.

[The calcium bile syndrome in children]. / Le syndrome de la bile calcique chez l'enfant.

The "limy bile" is uncommon in adults and very exceptional in childhood. The authors report a new case of a 7 years old girl. The review of the literature since Churchman's description (1911) allowed to collect eleven other cases of children, less than fifteen old. The usual sexual distribution in biliary diseases with female predominance is not true for them: eight boys for four girls. The youngest was three years and six months old. All but one have presented mainly right upper abdominal pain and vomiting. The diagnosis was made by an abdominal plain film showing a spontaneous visualization of the gallbladder which contained a material made of carbonate of calcium. One was an operative detection. All presented a stone of neck of gallbladder or cystic duct. The origin of "limy bile" is unknown. Nine children have been operated (cholecystectomy) with good result. Spontaneous disappearance of "limy bile" was noted in three cases. It was marked by acute abdominal pain, inconstant jaundice or pancreatic reaction. No surgical care was brought with nor further problems or recurrence.

[One complication can mask another: chance discovery of a rare lesion during screening for arthritis of the hip]. / Une complication peut en cacher une autre: découverte fortuite d'une lésion rare au décours d'une surveillance pour arthrite de hanche.

The authors report the case of a new born baby in whom at the fourth day of life, a severe hypocalcemia was discovered. An umbilical arterial catheterization was performed. The evolution was characterized by a staphylococcic septicemia with hip arthritis and partial immune deficit. The mid term survey of the joint status, allowed the unexpected discovery, during an examination held under general anesthesia, of a probable mycotic aneurysm, by abdominal palpation. The lesion was localized on the right common iliac artery and was successfully treated by resection; arterial continuity was possible without venous patch nor prosthesis.

[Comparison of the therapeutic results at the end of growth of dislocation of the hips diagnosed at the time of walking and treated by slow reduction and correction of the axis of the femoral neck with or without arthrotomy (open reduction)]. / Comparaison des résultats thérapeutiques en fin de croissance de la luxation de hanche dépistée à l'âge de la marche traitée par réduction lente et correction d'axe du col fémoral avec ou sans arthrotomie (réduction sanglante).

The study concerns the results at the end of growth of an homogeneous series of congenital dislocation hips, treated by slow reduction, and secondary femoral neck osteotomy. Some of these hips were initially treated orthopaedically, others were operated for open reduction, more often, on account of a principle of treatment than due to necessity. The comparison of these two series allows the conclusion that the nocivity of the surgical procedure was demonstrated in most cases. The study demonstrated some harmful actions in the treatment of congenital dislocation hip at the age of walking. According to the authors, they aggravate the rate of deformities due to vascular lesions. The authors stress some therapeutic necessities, and describe their present attitude towards these hip dislocations. Their attitude is based upon a mild reduction, under progressive traction, abduction, and medial rotation. Tenotomies are, if necessary, performed previously. A plaster immobilization is then applied, until a sufficient penetration of the femoral head into covering acetabulum. In most cases, an abnormal femoral neck orientation was corrected by an osteotomy. An innominate osteotomy to improve the cover of the head was only performed when the centering of the head remained imperfect. By modifying an already ancient technique, which was proved by 84% good results in a series of 112 hips reviewed at the end of growth, the authors expect an actual decrease of the late trophic deformities.

[Results and developmental complications of congenital dislocation of the hip treated at walking age by progressive orthopedic reduction and corrective osteotomy of the femoral axes. Study of 112 hips at the end of their growth]. / Résultats et complications évolutives de la luxation congénitale de la hanche traitée à l'âge de la marche par réduction lente orthopédique et ostéotomie correctrice des axes fémoraux. Etude de 112 hanches en fin de croissance.

The authors have analysed the results of treatment of 112 congenitally dislocated hips at the end of growth. They had been treated at walking age by progressive reduction and femoral osteotomy. Any hips that required open reduction were excluded from the study. Over the years, the principles of treatment remain the same but the technique was improved. Most of the poor results were related to trophic or vascular complications. Satisfactory results were obtained in 84 p. 100 of cases. Improvements in technique suggest to the authors that better results may be expected in the future.