Long-term result of a pure tibiotalar dislocation in a child.

Pure ankle dislocation without fracture is a very rare injury in children. We report the case of a 9-year-old patient who sustained open medial dislocation of the tibiotalar joint without fracture. The management, contributive factors, and long-term results are reported with a review of the literature.

Primary unconstrained shoulder arthroplasty in patients with a fixed anterior glenohumeral dislocation.

BACKGROUND: Reports of shoulder arthroplasty for the treatment of fixed glenohumeral dislocation are rare. The purpose of this study was to analyze the results following shoulder arthroplasty in patients with a fixed anterior shoulder dislocation. METHODS: Eleven patients were evaluated at a minimum of twenty-four months after they underwent an arthroplasty for the treatment of a fixed anterior shoulder dislocation. Four patients underwent a total shoulder arthroplasty, and the remainder were treated with a hemiarthroplasty. Four shoulders had osseous reconstruction of the anterior aspect of the glenoid. The patients were evaluated with use of the Constant score, measurement of active anterior elevation and external rotation, the patient's subjective grading of the result, and a radiographic examination. RESULTS: The mean Constant score improved from 21.1 points preoperatively to 46.0 points following the arthroplasty, and the mean active anterior elevation improved from 48.6 degrees to 90.0 degrees . The pain component of the Constant score was the most reliably improved parameter, increasing from a mean of 4.8 points preoperatively to a mean of 11.0 points postoperatively. Eight patients reported that the result was excellent or good, and the remaining three considered it to be fair. We observed seven complications in five patients, including four cases of anterior instability of the shoulder. Two of the four patients treated with a total shoulder replacement were seen to have definite loosening of the glenoid component on follow-up radiographs. CONCLUSIONS: Shoulder arthroplasty in patients with a fixed anterior shoulder dislocation is fraught with difficulties and complications. Although arthroplasty reliably relieved shoulder pain in this population, limited functional results should be expected.

[Shoulder arthroplasty for osteoarthritis after prior surgery for anterior instability: a report of 27 cases]. / Prothèse d'épaule sur omarthrose secondaire à une instabilité antérieure opérée: à propos d'une série de 27 cas.

PURPOSE OF THE STUDY: The purpose of this study was to analyze the natural history of shoulder osteoarthritis secondary to prior surgery for anterior instability, to evaluate clinical and radiological results of shoulder prosthesis, and to compare results with reports in the literature. MATERIAL AND METHODS: Twenty-seven shoulder prostheses (Aequalis) were implanted in patients with osteoarthritis of the shoulder after prior instability surgery. These shoulders were reviewed retrospectively at a mean follow-up of 46 months (range 24-48). Prior surgery had been performed with coracoid block in two-thirds of the shoulders and with soft-tissue procedures in one-third. Twenty-four shoulders had had one instability procedure, several procedures had been performed in three. The Constant score was used to assess clinical status preoperatively and at last follow-up. Male gender predominated (16/27), and mean age at first dislocation was 31.6 years (4 patients experienced their first dislocation after the age of 60 years). The patients had a mean 18.2 dislocations. The natural history of osteoarthritis was long: 24.2 years on the average. Mean age at arthroplasty was 55.8 years. The preoperative images demonstrated an iatrogenic factor in 5 shoulders and constructive osteoarthitis in 24. Posterior glenoid wear was observed in 24% of the cases, fatty degeneration of the subscapularis in 45% and full-thickness tears of the supraspinatus in 4 cases. The anterior scar tissue was released and implants were positioned anatomically in 26 cases. Total arthroplasty was used for 21 shoulders and a humeral prosthesis for 6. RESULTS: There were five complications including three anterior prosthetic instability, all three in patients who were over 60 years of age at their first instability surgery (one of these three patients required revision arthroplasty). Outcome was good or excellent in 56% of the shoulder with a mean weighted Constant score of 83%: mean gain in pain score=8.3 points, in anterior elevation=51 degrees, in external rotation=33.5 degrees. The type of prior instability surgery and preoperative active external rotation had no determining effect on outcome. Factors correlated significantly with outcome were fatty degeneration of the rotator cuff muscles, particularly the subscapularis. DISCUSSION: Osteoarthritis of the shoulder has a long natural history, 26 years in our patients excepting those whose first dislocation occurred after the age of 60 years. Posterior glenoid wear, described by others, was only found in 24% of the shoulders in this series. Surgical dissection and release of anterior scar tissue was difficult. The overall results of arthroplasty were good and were correlated with fatty degeneration of the rotator cuff muscles, particularly the subscapularis, but not with the type of instability surgery. These results were less satisfactory than reported in series of arthroplasty for primary centred osteoarthritis: complications occurred in 18% of the shoulders with three cases of anterior dislocation. Unlike reports of arthroplasty after instability surgery where many of the patients had several operations, overall results in our series were not compromised by a large number of multiple interventions.

Shoulder arthroplasty in patients with a prior anterior shoulder dislocation. Results of a multicenter study.

BACKGROUND: Prior reports of shoulder arthroplasty performed for dislocation-induced arthropathy have included only patients who had had a prior stabilizing procedure. The purpose of this study was to report the results of shoulder arthroplasty in all patients with a prior anterior shoulder dislocation, including both those previously treated operatively and those previously treated nonoperatively. METHODS: Fifty-five shoulders undergoing arthroplasty for arthritis following a prior anterior shoulder dislocation were evaluated. Twenty-seven of the shoulders had undergone a prior anterior stabilization procedure. The measures used to evaluate the shoulders included the Constant score, adjusted Constant score, active mobility, subjective satisfaction, radiographic result, and complications. RESULTS: The shoulders were evaluated at a mean of 45.0 months. The Constant score improved from a mean of 30.8 points preoperatively to a mean of 65.8 points at the time of follow-up. The adjusted Constant score improved from a mean of 38.2% to a mean of 79.8%. Active forward flexion improved from a mean of 82.1 degrees to a mean of 138.9 degrees. Active external rotation improved from a mean of 4.0 degrees to a mean of 38.6 degrees. Fifty patients rated the result as good or excellent. Negative prognosticators included an older age at the time of the initial dislocation and a rotator cuff tear. No significant differences in demographic factors, pre-arthroplasty function, post-arthroplasty function, pre-arthroplasty radiographic findings, post-arthroplasty radiographic findings, complication rate, or reoperation rate were noted between the patients treated with a prior operation for the anterior instability and those treated nonoperatively. CONCLUSIONS: This investigation documented the good results obtainable with shoulder arthroplasty for the treatment of arthritis following anterior shoulder instability. In addition, our findings suggest that capsulorrhaphy-induced arthropathy may be indistinguishable from arthritis following nonoperatively treated anterior shoulder instability.

[Shoulder arthroplasty for non-operated anterior shoulder instability with secondary osteoarthritis]. / Prothèse d'épaule sur omarthrose secondaire à une instabilité antérieure non opérée: à propos d'une série de 28 cas.

PURPOSE OF THE STUDY: The purpose of this study was to analyze the natural history of osteoarthritis of the shoulder joint secondary to non-operated anterior instability, to evaluate the clinical and radiological outcome after arthroplasty for this indication, and to compare results with data reported in the literature. MATERIAL AND METHODS: Twenty-eight Aequalis shoulder arthroplasties were performed for osteoarthritis secondary to anterior shoulder instability in patients who had not undergone any prior stabilizing surgical procedure. This multicentric series was reviewed retrospectively at a mean follow-up of 44 months (range 24-87 month). Preoperative and last follow-up clinical status was compared using the Constant score. Standard operative technique was used and anatomic position of the implants was achieved in 27 patients. Total shoulder arthroplasty was performed in eighteen patients and simple humeral implantation in ten. Patients were divided into two sub-groups for analysis of outcome (age at first dislocation > or < 40 years). RESULTS: There were four complications including one early loosening that required revision arthroplasty. Outcome was excellent or good in 54% of the cases. Group 1 (age at first dislocation < 40 years) included 17 patients and exhibited male predominance (13/17), young age at first dislocation (mean 28.5 years), high number of dislocations (mean 13), and a long natural history of osteoarthritis (mean 28 years). In this sub-group, imaging disclosed constructive osteoarthritis reflecting a long history. There was one case with a full-thickness tear of the supraspinatus. Outcome was excellent or good in 64% of these 17 patients (14 underwent total shoulder arthroplasty). The sub-group of 11 patients whose first dislocation occurred after the age of 40 years exhibited female predominance (9/11), a small number of dislocations (mean 1.3), and a short natural history of osteoarthritis (mean 6 years). In this sub-group, imaging disclosed six cases of basically chondrolytic osteoarthritis reflecting a short evolution. There were seven cases of full-thickness tears of the supraspinatus. Outcome was excellent or good in 36% of these 11 patients (4 underwent total shoulder arthroplasty). DISCUSSION: The forty-year age cutoff allowed us to distinguish two populations. The first population of patients whose first dislocation had occurred before the age of 40 years was predominantly male, with a long history of constructive osteoarthritis without rotator cuff tears. Most of these patients were treated with total shoulder arthroplasty which gave results similar to those obtained with arthroplasty for primary centered osteoarthritis. The second sub-group of patients aged over 40 years at the time of the first dislocation were predominantly female with a short history of minimally constructive osteoarthritis and frequent rotator cuff tears. Humeral implants were used for most of these patients and gave less favorable results than in the former sub-group, probably due to the high rate of rotator cuff tears.

[Prosthetic hip joint infection caused by Listeria monocytogenes]. / Infection d'une prothèse totale de hanche par Listeria monocytogenes.

The authors report an unusual case of prosthetic hip joint infection caused by Listeria monocytogenes. The patient, an 87-year-old lady who had undergone a right total hip replacement 10 years previously, presented with pain and restriction of hip motion three weeks after an episode of abdominal pain. Aspiration of the joint yielded a dark fluid, from which Listeria Monocytogenes type 4-b was isolated. Blood cultures remained negative. After prolonged antibiotic therapy, symptoms gradually resolved. A few months later, pain recurred with radiological signs of loosening of the femoral component. One-stage revision arthroplasty was performed combined with antibiotic treatment. The patient remains asymptomatic at one year follow-up. Laboratory data and x-ray control are normal. Prosthetic hip joint infection with Listeria monocytogenes is uncommon; few cases have been reported. The literature review shows that prolonged antibiotic therapy alone may be used in patients for whom removal of the prosthesis is not desirable, although revision arthroplasty or prosthesis removal remains necessary in the other cases.

[Traumatic axial separation of the radial mid carpal joint. Case report and review of the literature]. / Séparation traumatique axiale de la médiocarpienne radiale. A propos d'un cas avec revue de la littérature.

The authors report a case of traumatic axial disruption of the radial mid carpal joint. This unusual type of scaphotrapezo-trapezoïdal dislocation occurred after a motorcycle accident. Open reduction and pinning was performed. At three years and six months follow up, clinical exam showed less power thumb pinch than the other side. Arthritic changes were noted on X-rays control, but a good range of motion was preserved. Radial mid carpal disruption is uncommon. It includes the separation of the trapezium, trapezoïdal, first and second metacarpal bones from the remaining wrist. Only 13 other similar cases were reported in literature for the last three decades. Mechanism of the injury and treatment are discussed.

[Compression of the anterior interosseous nerve by Gantzer's muscle]. / Compression du nerf interosseux antérieur par le muscle de Gantzer.

The authors report a case of incomplete anterior interosseous nerve syndrome due to mechanical compression by Gantzer's muscle. This accessory muscle induced an isolated paralysis of the flexor pollicis longus with a characteristic pinch attitude. No improvement was shown after six weeks of medical treatment. Recovery was rapid and complete following surgical relief of compression. Anatomical considerations, clinical features, and treatment are discussed.

[Anterior subtalar dislocation associated with a fracture of the calcaneus: a case report and review of the literature]. / Luxation antérieure sous talienne associée à une fracture du calcanéum. A propos d'un cas et revue de la littérature.

A new case of uncommon anterior subtalar dislocation associated with a fracture of the calcaneus is reported. Mechanism of production is described with a review of literature. The criteria of radiologic diagnosis are mentioned. Closed reduction with stabilisation by Kirschner wire were undergone. Prolonged physiotherapy following 6 weeks of immobilisation allowed good result. A decreased subtalar motion without pain was found at the last check up.

[Arthroscopic meniscectomy with Ho-Yag laser versus mechanical meniscectomy. Mid-term results of a randomized prospective study of 80 meniscectomies]. / Méniscectomie arthroscopique au laser Ho-Yag versus méniscectomie mécanique. Résultats à moyen terme d'une étude prospective randomisée à propos de 80 méniscectomies.

INTRODUCTION: The theoretical advantages of the Ho-Yag laser make it the ideal instrument for current use in arthroscopic meniscectomy. Short term results showed less patient discomfort, rapid recovery and less post operative pain and swelling. The purpose of this single blind prospective randomized study was to compare the results of arthroscopic meniscectomy performed mechanically to those obtained with the Ho-Yag laser, with a minimum follow up of one year. MATERIALS AND METHODS: Eighty meniscectomies in 76 patients were included with a mean follow up of 19.5 months (extremes 12-35 months). The mean age was 42.5 years (extremes 18-65 years). The laser group included 39 patients while the mechanical group included 37 patients. In the Ho-Yag laser group, energy never exceeded 30 watts. During arthroscopic meniscectomy, no other surgical procedure was allowed i.e. chondroplasty, ligament surgery. Prior to arthroscopy, all patients underwent a clinical evaluation including: Pain and Lysholm score assessment. This was repeated in the post operative period at the 10th, 30th day and at last follow up. 37 patients also had a standard X ray at last follow up (anterior-posterior, lateral, and schuss views). RESULTS: No statistically significant difference was observed in global clinical results between both techniques. Even if mechanical meniscectomy showed better results, the laser remained best when used in degenerative medial meniscal tears with minimal cartilaginous lesions. In degenerative medial meniscal tears with severe cartilaginous lesions, mechanical meniscectomy showed significantly better results (p = 0.048). X ray control was normal in 47 p. 100 of the laser group and in 80 p. 100 of the mechanical group. The difference was statistically significant (p = 0.038). Narrowing of the joint space was observed in 45 p. 100 of laser group and in 18 p. 100 of mechanical group. Iterative arthroscopy was necessary in 4 cases (3 laser and 1 mechanical) for residual pain. Severe chondrolysis was present in 2 cases following laser meniscectomy. In the 2 other cases a complement of meniscectomy for residual lesions allowed good results. No bony necrosis was observed after laser meniscectomy. CONCLUSION: According to the results of this study and the high cost of the laser, we do not recommend the laser as a routine technique for arthroscopic meniscectomy.

[Simultaneous traumatic dislocations of the index finger. Apropos of a case with review of the literature]. / Luxation étagée traumatique de l'index. A propos d'un cas avec revue de la littérature.

A new case of simultaneous dislocation of the proximal and distal interphalangeal joints on the same digit is reported. This injury is uncommon in the index. The forces were applied to the finger tip in hyperextension position. Closed treatment provided a good result with full range of motion. Therapeutic options are discussed.

Callus response to micromovement during elongation in the rabbit.

The purpose of this investigation was to determine whether induced micromovement during the elongation period could improve the consolidation of diaphyseal elongation obtained by callus distraction. Two series of paired rabbit hindlimbs were studied. The surgical procedure and the waiting period were identical. During elongation, one hindlimb was stimulated, and the other was the control. The consolidation period was 2 days. Reproducible tibial osteotomy and lengthening of the two tibiae was confirmed radiographically. The mineralized callus was quantified by dual-beam x-ray absorptiometry. The callus diameters were measured. Bones were axially compressed to failure. Callus volume, mineral quantity, mineral density, and resistance to failure were not different on the stimulated side compared with the unstimulated side, so micromovement applied during elongation had no effect on bone consolidation. For all tibiae, resistance to failure of the callus was significantly correlated to callus volume, to callus mineral content, and to callus mineral density.

Callus response to micromovement after elongation in the rabbit.

The purpose of this investigation was to determine whether induced micromovement could improve the consolidation of diaphyseal elongation by callus distraction. Two series of paired rabbit hindlimbs were studied. The surgical procedure, waiting period, and elongation period were identical. One hindlimb was then left under neutralization conditions, but the other limb was stimulated by axial micromovements. Reproducible tibial osteotomy and lengthening of the two tibiae were confirmed radiographically. The mineralized callus was quantified by dual-beam x-ray absorptiometry. The anteroposterior and lateral diameters of the callus were measured. A semiquantitative histologic study allowed the ratio between fibrous or cartilaginous callus or both and mineralized callus to be determined. Bones were axially compressed to failure. Callus volume, callus mineral content, callus mineral density, and mechanical forces required to failure were significantly superior on the stimulated side compared with the neutralized side, so micromovements applied after the end of elongation were beneficial for bone healing. Mechanical forces required to failure were significantly correlated to callus volume and callus mineral density.

[Primary acute osteomyelitis of the sternum associated with anterior mediastinitis]. / Ostéomyélite aiguë primitive du sternum associée à une médiastinite antérieure.

In a 14-year-old adolescent, primary acute osteomyelitis in a rare localization, the sternum, was associated with anterior mediastinitis. Antibiotic therapy and partial sternectomy together with emptying the mediastinal abscess was successful. Therapeutic management of such cases is presented in a review of the literature.

[Transverse fracture of the body of C2. Apropos of a case]. / Fracture séparation sagittale transcorporéale de C2. A propos d'un cas.

INTRODUCTION: A new fracture of the body of C2 is described. The mechanism is an axial compression producing a body sagittal fracture spreading to the posterior arch with a separation effect. CASE REPORT: A 29 years old female fell from the second floor. Examination showed a head injury and upper neck stiffness. Specific radiological signs was reported on the standard X-ray. The fracture involved the body and the lamina of C2 with a sagittal separation. No neurological abnormality was detected. CT scan provided additional information and allowed the survey of bone healing. Non operative treatment was undertaken by minerva jacket for four months carying complete recovery. DISCUSSION: The mechanism of this fracture seems to be similar to Jefferson's fracture. Review of the literature showed that fractures of the body of C2 are uncommon. Their different types are discussed.

[Atlanto-axial Pott's disease. Apropos of a case with review of the literature]. / Mal de Pott atloïdo-axoidien. A propos d'un cas avec revue de la littérature.

INTRODUCTION: A new case of sub-occipital Potts disease is reported. CASE REPORT: A 26 years old female from Senegal was admitted for cervical pain of three months duration, neck stiffness and left nasal obstruction with Arnold neuralgia. Radiological studies found a C1-C2 rotatory subluxation with an osteolytic erosion of the lateral mass of the atlas and destruction of the left atlanto-axial joint. CT scan and magnetic resonance imaging provided important diagnostic clues. Culture of sinus biopsies showed a mycobacterium tuberculosis. Progressive reduction of the dislocation and immobilization by minerva jacket for six months with prolonged antituberculous chemotherapy provided successful end result. DISCUSSION: A review of the literature found 95 cases reported since the beginning of this century. The mean age was 20-30 years old. A finding of acid resistant bacilli is necessary for diagnosis and requires culture of gastric secretion, expectoration, retro pharyngeal mass puncture and other upper respiratory tract foci. Radiological signs are discussed. Chemotherapy is the mainstay of treatment with immobilization following reduction of the dislocation when present. The removal of abscess is discussed as well as bone grafting by an anterior or more commonly by posterior approach in case of instability.

[Bipolar luxation of the 5th metacarpal bone]. / Luxation bipolaire du cinquième métacarpien.

A case of post-traumatic double dislocation of the fifth metacarpal is reported. No reference has been found in the literature. Both were dorsal dislocations, mechanism appears as an axial compression on the metacarpal distal extremity, as first phalanx is hyperextended. Only the carpo-metacarpal-joint was reduced by close technic with percutaneous fixation; the metacarpo-phalangeal dislocation required surgery using a palmar approach. Normal function of the joint was recovered three months later.

[Giant cell chondroma of soft tissues. Apropos of a case and review of the literature]. / Chondrome à cellules géantes des tissus mous. A propos d'un cas avec revue de la littérature.

Soft tissue chondroma is a benign cartilaginous tumour most often located at the extremity of the upper limbs. We report a very unusual case of soft tissue chondroma due to its location in the sole of the foot resulting in delayed diagnosis. Diagnosis of soft tissue chondroma was confirmed by microscopic examination and by immunohistochemistry showing S 100 protein in the cells of mature and immature areas. The presence of numerous giant cells is exceptional. Labelling of the giant cells by KP 1 protein in the present case suggest that they are derived from macrophages.