[Acute osteomyelitis of the clavicle in the newborn infant: a case report]. / L'ostéomyélite aiguë de la clavicule chez le nouveau-né : à propos d'un cas.

Acute osteomyelitis of the clavicle accounts for less than 3% of osteomyelitis cases, with its usual location in the middle third. It may be hematogenous, due to contiguity, or secondary to catheterization of the subclavian vein or neck surgery. The diagnosis is often delayed, and clinical symptoms may simulate obstetric brachial plexus palsy in young children. We report a new case of osteomyelitis of the clavicle in a 30-day-old newborn.

Coracoid fracture combined with distal clavicle fracture without coracoclavicular ligament rupture: A case report.

Distal clavicle fracture accompanied by coracoid process one is a rare injury. Surgical and/or conservative treatments are proposed. We report the case of a 49-year-old woman presenting a distal clavicle fracture associated with a coracoid process one due to a fall on the left shoulder. Both injuries are treated surgically. Per operatively, and through an anterior "strap" approach, the coracoclavicular ligament was seen intact. The distal clavicle fracture was fixed with K-wires and cerclage and the coracoid process was secured by a screw. Active-assisted rehabilitation of the shoulder was initiated 3 weeks after surgery. At the last follow-up of twelve months, the patient had painless full shoulder functions and X-rays show bony union. Early recovery to normal life is possible with surgical treatment in patients with distal clavicle fracture combined with coracoid fracture.

Congenital infantile fibrosarcoma of the forearm.

Congenital infantile fibrosarcoma is a rare soft tissue neoplasm in the infant of which only a few cases are reported as congenital. This tumor has a rapid growth and extensive local invasion, but metastasis rarely occurs. Distal extremities involvement is more common and metastasis are rare. We report a case of a congenital infantile fibrosarcoma of the forearm, which was initially confused with a hemangioma, treated successfully by surgical resection.

Ganglion cyst of the carpal navicular. A case report and review of the literature.

Intraosseous ganglion (IOG) cyst of the scaphoid is an infrequent cause of hand and wrist pain. Intraosseous ganglia located in the scaphoid have rarely been described in the literature. We report the case of a 30-year-old right-handed woman who presented with a more than 24-month history of progressive right-wrist pain. No history of trauma was reported.Conservative treatment with anti-inflammatory medications before referral was unsuccessful. Examination revealed a small palpable mass in the carpal navicular region with no limitation of normal wrist motion. An IOG cyst of the scaphoid was found on standard radiograph and CT-scan of the wrist. Treatment consisted in curettage of the cyst followed by packing of the defect with autologous cancellous bone graft harvested in the distal end of the radial metaphysis. Satisfactory functional recovery was achieved. The clinical, radiographic and therapeutic aspects of this rare condition are discussed by the authors.

Bilateral posterior fracture dislocation of the shoulder.

The authors report a case of shoulder bilateral posterior fracture dislocation in a 42-year-old man with osteogenesis imperfecta history. The importance of the communition, the large size of articular surface involved and the poor quality of the bone indicate a bilateral total shoulder arthroplasty. At midterm outcome, a good range of motion of both shoulders was registered.

[Iliopsoas abscess: a rare complication of pyogenic sacroiliitis in a child]. / Abcès du muscle iliopsoas : complication rare de la sacro-iliite à pyogène chez l'enfant.

Pyogenic sacroiliitis is a rare entity in children. Diagnosis is often delayed because of its variable clinical presentation, low suspicion by the examining physician, and rare findings on radiographs. Delayed diagnosis, however, results in complications such as iliopsoas abscess. We report the case of a 12-year-old girl hospitalized with a 21-day history of fever, pain in the left iliac fossa, and flexion contracture of the hip. On examination, she had fever (38.9 degrees C), psoitis, localized tenderness at the left sacroiliac joint, and pain elicited by lateral compression of the pelvis. The abdominal examination was normal. The erythrocyte sedimentation rate was 130 mm in the first hour, C-reactive protein was 186 mg/l, and the white blood cell count was 18,400/mm(3), with 79% neutrophils. Urinalysis was normal. Blood cultures were negative. Radiographs of the pelvis showed irregular left sacroiliac borders. The CT scan provided the diagnosis of sacroiliitis complicated by an ilioapsoas abcsess. Treatment was based on antibiotic therapy associated with surgical drainage. Bacteriologic investigation revealed Staphylococcus aureus. The patient's temperature returned to normal on the second day. Antibiotics were continued for 3 months, leading to full recovery.

Acute hematogenous osteomyelitis of the scapula in children.

PURPOSE OF THE STUDY: Osteomyelitis of the scapula is uncommon, often with a misleading clinical presentation. We report four cases of osteomyelitis of the scapula to illustrate the particular clinical imaging findings and treatment related to this location. CASE REPORTS: Between 1996 and 2006, four children were treated for osteomyelitis of the scapula, three boys and one girl, with a mean age of 8 years (range, 5-11 years). The time from symptom onset to hospitalization was 2 days. Pain was noted for all patients and total functional incapacity of the upper extremity was noted for three patients. The diagnosis of osteomyelitis of the scapula was established on the basis of imaging (ultrasound and CT scan). All patients were given medical treatment and underwent surgery. A positive bacteriology was noted in all patients. The bacterium isolated from blood cultures (two cases) and local samples obtained at the surgical site (four cases) were Meti-S Staphylococcus aureus. RESULTS: The results were analyzed by studying the anatomic and functional outcome at a mean follow-up of 36 months (range, 16-60 months). The patients were pain-free and had full range of motion in their shoulders. There were no complications. DISCUSSION: Few reports are available in the literature on osteomyelitis of the scapula. We discuss the specific clinical and imaging features as well as the treatment for this location.

Elderly patient's mortality and morbidity following trochanteric fracture. A prospective study of 100 cases.

BACKGROUND: Trochanteric fractures are a major source of mortality, morbidity and functional impairment in the elderly. Morbidity is closely related to the degree of instability and comminution and is substantially influenced by the quality of reduction and internal fixation. Advanced age and associated co-morbidities are two decisive factors of mortality secondary to trochanteric fracture. OBJECTIVES: This prospective study examined the epidemiological profile of trochanteric fractures and assessed mortality and morbidity with the aim of establishing management guidelines and improving prevention strategies. MATERIAL AND METHODS: One hundred patients were included; 60% were male. Mean age was 76 years (range, 60-96 yrs). One, or more than one, co-morbidities were present in 68% of cases. The fractures were caused by a simple fall in 90% of cases. Fractures were classified according to the criteria of Ramadier and the ones of Ender. Sixty-five percent of these fractures were unstable. A dynamic hip screw was systematically used as the standard means of internal fixation. RESULTS: Anatomic and functional results were analyzed in 82 patients (18 had died within the first year following fracture occurrence). Mean follow-up period was 24 months (range, 12-36 months). Bone healing was achieved in 96% of cases. There were numerous postoperative complications (four cases of thromboembolism, fourteen immobility-related complications, two infections, six secondary displacement combined to loss of fixation, four non-unions, and nine malunions). At 2 years follow-up, 28 patients had died. Mortality was strongly correlated with older age (over 90 years), associated co-morbidity and fracture instability. Good functional outcomes (72%) correlated with younger age (60-74 years), fracture stability, adequate reduction and internal fixation. DISCUSSION: In stable trochanteric fractures, osteosynthesis by dynamic screw-plate is more effective than alternative techniques (blade-plate, nail-plate, Ender nail or even trochanteric nail). In unstable trochanteric fractures, delayed weight-bearing should be preferred to avoid mechanical complications. In fractures that are unstable or extend far below the lesser trochanter, trochanteric nailing is indicated since providing enhanced stability, but sometimes at the cost of insufficient reduction. The treatment objective should be the complete resumption of weight-bearing as early as possible with the fewest possible complications. Prevention consists in detecting and treating osteoporosis and countering the causes of falls in elderly subjects (muscular reinforcement and correction of neurosensory deficit). LEVEL OF EVIDENCE: Level III: Prospective diagnostic study.

[Palmar dislocation of the metacarpophalangeal joint. A case report]. / Luxation palmaire de l'articulation métacarpophalangienne des doigts longs: à propos d'un cas.

Palmar dislocation of the metacarpophalangeal joint of the long finger is a rare injury. The authors report a case of palmar dislocation of the metacarpophalangeal joint of the ring finger. The presumed mechanism is a combination of active flexion and forceful hyperextension. The dislocation was treated successfully by closed reduction shortly after injury. Closed reduction should be attempted in all cases of this injury.

["Floating fifth metacarpal". A Case report]. / "Un cinquième métacarpien flottant". A propos d'un cas.

We present the case of a patient with a fracture-dislocation of the fifth metacarpal and a dislocation of the metacarpophalangeal joint (floating fifth metacarpal) combined with a fracture of the fourth metacarpal. The mechanism of injury and management of this uncommon injury is reported. The "floating fifth metacarpal" and the fourth metacarpal fracture were reduced by closed techniques with percutaneous fixation. Twelve months later, the patient had a full range of wrist and finger movement, he was pain-free and without any residual disability.

[An unusual localisation of osteochondroma. A single case report]. / Une localisation exceptionnelle d'un ostéochondrome. A propos d'un cas.

Solitary osteochondroma is a rare benign tumour of the hand arising from the cortical surface. The important differential diagnoses, which should be considered, are Nora's lesion, florid reactive periostitis and Turret exostosis. The authors report an unusual case of osteochondroma of the metacarpal bone with a deficit of extension. The diagnosis was made using imaging techniques and confirmed by histological examination. The treatment is surgical, namely complete excision.

An unusual complication of pubic exostosis.

We report the case of a left superior pubic ramus osteochondroma occurring in a 29-year-old man. The patient consulted for a multiple exostoses disease revealed by a painful induration at the base of his penis. This induration was increasing in volume and causing discomfort during sexual intercourse and when sitting for a prolonged period of time. CT-scan examination showed a pedunculated osteochondroma of the left superior pubic ramus compressing the urethra. Surgical resection of the tumor confirmed the diagnosis of osteochondroma. At a 2-year follow-up delay, all symptoms had regressed with no evidence of recurrence.

[Combined fracture of the distal radius and scaphoid in children. Report of two cases]. / Fracture du scaphoïde carpien associée à une fracture de l'extrémité inférieure du radius chez l'enfant. A propos de deux cas.

The authors report two cases of concomitant scaphoid and distal radial fractures, a rare combination of lesions in children. The first case was in a 14-year-old boy who presented a midscaphoid fracture associated with a distal forearm fracture. The second case concerned a 13-year-old boy who presented a midscaphoid fracture associated with a Salter type II distal radial fracture. Both fractures were reduced under general anaesthesia. The total period of immobilisation was 3 months, using a large arm thumb cast. Associated scaphoid fractures should be suspected with all types of distal forearm injuries in children. Reduction of the radius fracture should be done carefully to avoid possible displacement of the scaphoid fracture.

[Impaction posterior wedge osteotomy for the treatment of postsurgical flatback: 22 cases]. / Ostéotomie de fermeture postérieure par impaction intracorporéale pour dos plat postopératoire: à propos d'une série de 22 cas.

PURPOSE OF THE STUDY: There is increasing interest in sagittal balance as an important element when planning treatment of spinal deformations. Posture disorders, particularly flatback, can be observed after surgical treatment of scoliosis. The frequency of flat back syndrome has increased with the development of spinal surgery. MATERIAL AND METHODS: Posterior osteotomy is designed to resolve these problems. Two techniques are used: the Smith-Petersen procedure and transpedicular subtraction osteotomy. We adopted the second procedure, adding two technical modifications: installation on an orthopaedic table and intracorporeal cancellous impaction. We performed closed posterior osteotomy by intracorporeal impaction and report here our results in a series of 22 patients with postoperative flat back treated between July 1999 and June 2002. Mean age at surgery was 52 years. There were sixteen women and six men. All patients had a history of spinal surgery with fusion. They had had 2.1 spinal operations on average with a maximum of seven. All patients complained of severe postural pain. They had difficulty bending forward and standing back up. Radiographically, we noted altered spinal and pelvic angles and an abnormal plumb line from C7 to the promontory. RESULTS: We analyzed outcome at 21 months on average. Preoperatively five patients had 12 levels of non-union. Osteotomy was performed at L4 in nineteen patients and L3 in three. A rigid instrumentation was used in all cases. Osteosynthesis material was implanted after correction of the deformation with no particular problem for spinal stability or reduction. Mean operative time was 180 minutes and mean blood loss was 1680 ml. A complementary anterior approach was required in one patient. Intraoperative complications were dominated by dural breaches in five patients, high paraplegia not directly related to the osteotomy in one patient, regressive S1 paresia occurred in one patient and transient cruralgia which regressed in 4 to 6 months in four patients. We also observed functional intestinal obstruction in one patient and severe depression in another. There were no infections or deaths. We also observed two cases of predominant correction at the discal level and not the vertebral level. All operated patients felt their posture was improved and were able to maintain the upright position for prolonged periods. Flexion of the lower limbs was improved. Mean correction of lumbar lordosis was 25.1 degrees (range 12-39). Mean sacral slope was 33 degrees . Mean correction of the position of C7 on the promontory plumb line was 72 mm. This variable was highly altered preoperatively (95.6 mm) and was improved after osteotomy in all patients. At last follow-up, there was one case of nonunion which had been successfully revised. DISCUSSION: The literature on osteotomy for the treatment of flat back is sparse. Our series of subtraction osteotomy is the largest reported to date. Preoperative and intraoperative planning remain a topic of debate and require further study.