[Diagnosis of tuberculous arthritis : a sometimes long and winding road]. / Arthrite tuberculeuse : un diagnostic parfois long et semé d'embûches.

Extraspinal tuberculous arthritis is a rare entity in developed countries, mostly found in populations of migrants. We describe a case of foot osteoarthritis in a young migrant, with an arduous diagnostic process. The sequence of the diagnostic studies (imaging, articular tap, bone biopsy together with cultures and molecular biology) must follow a logic based on clinical suspicion and on the knowledge of the diagnostic values of different tests. The diagnosis of tuberculous arthritis, a slowly progressing infection with a low bacteriologic burden, is difficult. The reported case emphases the need for perseverance. It shows the value of diagnostic procedures, their limits and the need for their integration to the clinical judgement.

L'arthrite tuberculeuse non rachidienne est rare dans les pays occidentaux où elle touche avant tout les populations de migrants. Nous décrivons un cas d'ostéoarthrite du pied, dont le processus diagnostique s'est révélé ardu. La succession des examens pratiqués (radiologie, ponction puis biopsie avec les cultures et la biologie moléculaire) doit s'inscrire dans une logique dictée par la suspicion clinique et la connaissance des performances diagnostiques des différents tests. Le diagnostic d'arthrite tuberculeuse, une infection d'évolution lente, pauvre en charge bactérienne, est difficile. Le cas présenté révèle le besoin de persévérer et permet de discuter la valeur des procédures diagnostiques, leurs limites et leur intégration dans le raisonnement clinique.

Pronator teres selective neurectomy in children with cerebral palsy.

The objective of this study was to evaluate the results after selective pronator teres (PT) neurectomy in children with spastic hemiplegia. Patients with PT spasticity without contracture and an active supination improvement after PT botulinum toxin injection were included. Hand function and deformities were evaluated with the House score, Gschwind and Tonkin pronation deformity classification and Zancolli's classification. Twenty-two patients (mean age 11.6 years) were included in this study. The average follow-up was 32.6 months. All but one patient improved their supination with a preoperative mean active supination of 5° (range -80-70°) and postoperative of 48° (range 10-90°). Active pronation was always maintained at the last follow-up. PT selective neurectomy appears to improve active and passive forearm supination and should be included in a global strategy of treatments to improve upper limb function in children with cerebral palsy. LEVEL OF EVIDENCE: IV.

Shoulder bony landmarks location using the EOS low-dose stereoradiography system: a reproducibility study.

PURPOSE: To investigate the reproducibility of shoulder bony landmarks location using the EOS low-dose stereoradiography system, in order to validate this new tool for the study of gleno-humeral pseudo-kinematics. METHODS: An inter and intraobserver reproducibility study of shoulder bony landmarks location concerning 22 healthy volunteers. This study concerned the neutral position, arm at rest. Humerus and scapula were modeled with simple geometric shapes using specific software. Those shapes were positioned on A-P and lateral x-rays views. Images analysis of the 22 subjects was carried out three times (n(r) = 3), by two observers (n(o) = 2), for a total of n(tot) = 132 analyses. RESULTS: We obtained a very good reproducibility for the humeral head center and the diaphysis axis with 95% confidence interval (IC95%) inferior to 1.09 mm and 0.41 degrees, respectively. The uncertainty was higher for the lateral and medial epicondyles. Regarding the scapular bony landmarks, we observed a good reproducibility for the tip of the coracoid process, the inferior glenoid rim, and the axillar border with a 95% confidence interval lower than 2.13, 2.91 mm, and 3.67 degrees, respectively. The uncertainty was higher for the most postero-lateral point of the acromion and the superior glenoid rim. CONCLUSION: Our analysis of the x-rays obtained with the EOS low-dose stereoradiography system assessed the location reliability and reproducibility of specific scapular and humeral bony landmarks. This work opens the way to gleno-humeral pseudo-kinematics analysis using EOS imaging system.