[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.

[Sub-trochanteric fractures. A comparative study between gamma nail and angular osteosynthesis with lateral cortical support]. / Fractures sous trochantériennes. Etude comparative entre le clou gamma et les ostéosynthèses angulaires à appui cortical externe.

PURPOSE OF THE STUDY: Treatment and outcome of sub-trochanteric fractures are at the origin of many problems. The aim of this study was to evaluate the superiority of the "Gamma Nail". MATERIAL AND METHODS: Two homogenous groups of patients were studied. Each group had 40 patients. The osteosynthesis performed in the first group (Group I) was an "angular" type with lateral cortical support (Nail plate, blade plate, dynamic screw). The second group (Group II) received the "Gamma Nail" implant. The 4 criteria employed to compare the 2 groups were: operatory (duration, blood loss, support-free walking); clinical (walking, pain, anatomy); radiological (reduction and healing); and finally complications and failures. RESULTS: The average operative duration in group I was 3 hrs vs 1 hr in group II. 90 per cent of group I received transfusions with 3 bloods units vs 40 per cent of group II, received 1 blood unit. Support-free walking was authorized 3 months later in group I, and immediately in group II. The results were identical for clinical criteria. The average time for radiological bone healing was 3.5 months in group 1 and 2 months in Group II. 12 complications occurred in group I and 3 in group II: 7 cases of dismantling, 4 non unions and 1 serious deep infection in Group I. In group II: 2 cases of dismantling and a diaphysis fracture beneath the nail. These complications were found in the beginning of our experience with the Gamma Nail. DISCUSSION: 30 per cent of patients in Group I were affected by complications vs 7.5 per cent in group II (with p = 0.01). The duration of surgery, blood loss, and support-free walking delay demonstrated the superiority of the Gamma nail technique. CONCLUSION: This study confirms the superiority of the Gamma nail for the treatment of sub-trochanteric fractures.

Influence of timing on the analgesic effect of intravenous ketorolac after orthopedic surgery.

This study evaluated the pre-emptive analgesic effect of intravenous (i.v.) ketorolac (KET) for total hip replacement (THR). Sixty patients who underwent surgery for THR under general anesthesia were randomly allocated to 3 groups. Two i.v. injections were administered: one before induction and one after surgery. The patients were studied prospectively in a double-blind manner. The control group (CONT; n = 20) received 2 ml of normal saline (NS) for both injections. The pre-operative KET group (PRE; n = 20) received 60 mg of KET and then 2 ml of NS. The postoperative KET group (POST; n = 20) received 2 ml of NS and then 60 mg of KET. General anesthesia was standardized with a intra-operative cumulated dose of fentanyl limited to 4 micrograms/kg. In the recovery room (RR), pain was controlled with an i.v. tritration of morphine; thereafter, on the surgical ward, patients used a patient-controlled analgesia (PCA) pump (Abbott). Pain was evaluated with a visual analogue scale (VAS) at rest and movement in the RR, then every hour for 6 h and every 6 h for 5 days. The side effects monitored were: sedation, respiratory depression, nausea, perioperative bleeding. The patients and surgery were similar for the 3 groups. Upon arrival in the RR, VAS scores taken at rest and at movement were lower for the PRE group than for the CONT and POST groups. Otherwise, VAS scores were similar in all 3 groups. The cumulative dose of morphine in the PRE group was lower than that for the CONT and POST groups from 0 to 6 h.(ABSTRACT TRUNCATED AT 250 WORDS)

[Locking of the metacarpophalangeal joint of articular origin. Review of the literature and case report]. / Blocages de la métacarpo-phalangienne d'origine articulaire. Revue de la littérature à propos d'un cas.

We report a case and review concerning literature of intrinsic locking of the metacarpophalangeal joint. These lockings are usually due commonly to degenerative arthritis of the joint, rarely to an abnormal shape of the head of metacarpal or intraarticular loose bodies. They should be differentiated from the extension lag of proximal interphalangeal joint usually encountered in "trigger finger" due to stenosing tenosynovitis. Conservative treatment must be careful and may fail or be complicated. Surgical treatment is effective, best done via an anatomical approach depending on the pathologic findings and the metacarpophalangeal joint locking etiology.

[Strictly epidermotropic "Ketron Goodman"-type lymphoma. Immunohistochemical and ultrastructural analysis of a case]. / Lymphome purement épidermotrope type "Ketron Goodman". Analyse immunohistochimique et ultrastructurale d'un cas.

We report a case of T cell lymphoma which was exclusively located within the epidermis. The T cells of this lymphoma were all of suppressor-cytotoxic phenotype. They did not express the CD7 antigen and a molecular biology study showed T cell type genotypic rearrangements. Both immunohistochemical and ultrastructural studies showed close contacts between lymphoma and Langerhans cells.

[Partial or total enucleation of the talus. Value of conservative treatment. Apropos of 8 cases]. / Les énucléations partielles ou totales de l'astragale. Intérêt du traitement conservateur. A propos de 8 cas.

Eight cases of talus enucleations are reported. The patients ranged in age from 18 to 62 years. The follow-up period in this study extended from one year to 12 years. The talus was reduced in six cases and usually fixed with a trans-plantar pin. The main problem in the conservative treatment was represented by early infection which required a calcaneo-tibial arthrodesis. On the other hand, necrosis of the talus, although unavoidable, is usually well tolerated. That may be explained by the fact that the necrosis is dense and congruous and does not lead to severe arthritic changes. Among 5 cases of necrosis of the talus, fusion of the ankle and of the sub-talar joint was indicated in only one patient. The authors conclude that the conservative treatment should be systematically tempted and that arthrodesis should be indicated only for the infections, that usually appear early or the osteoarthritic changes which appear later.

[Recent fractures of the humeral diaphysis in adults. Comparison of orthopedic and surgical treatment. Apropos of 252 cases]. / Les fractures récentes de la diaphyse humérale de l'adulte. Comparaison du traitement orthopédique et des traitements chirurgicaux. A propos de 252 cas.

Two hundred and fifty two cases of fracture of the humeral shaft have been treated by the authors, half conservatively by mobilisation against the chest wall and half surgically. The main surgical procedures were plating, nailing without reaming, fascicular intramedullary pinning, or external fixation. Conservative treatment gave satisfactory results without iatrogenic complications. However, significant limitation of movement was seen in 61 cases and was severe in 14. Eight non-unions occurred. The best surgical fixation was either by intramedullary nailing or fascicular intramedullary pinning in fractures of the upper third or the middle third of the humeral shaft. These techniques resulted in very few post operative radial palsies. Plating is indicated in unstable fractures of the lower third of the humerus. Conservative treatment or blind intramedullary nailing or pinning is indicated in cases of initial radial palsy, the nerve being explored only after three to six months in the absence of recovery.

[Subtalar dislocations with medial or lateral displacement (author's transl)]. / Les luxations sous-astragaliennes internes et externes. A propos de 20 cas.

The authors have observed 20 cases of subtalar dislocation, 16 with medial displacement and 4 with lateral displacement. The treatment given and the results are described. An experimental study has also been made which confirms that in medial dislocations the talo-navicular joint dislocates first whilst in lateral dislocations the talo-navicular joint dislocates last. The severity of assoicated lesions is emphasised. It is concluded that in severe displacement with complete extrusion of the talus, tibio-calcaneal arthrodesis gave better results than excision of the talus.

The surgical treatment of fractures of the upper end of the humerus by blind pinning (author's transl). / Traitement par embrochage à foyer fermé des fractures del'extrémité supérieure de l'humérus.

During a period of five years, the authors have treated 250 fractures of the upper end of the humerus. Fifty-one were treated by blind pinning. Six to eight Kirschner wires are passed up to the head of the humerus under X-ray control through a hole made on the posterior aspect of the lower end of the humerus just above the olecranon fossa. The functional results were satisfactory in 70% of cases. The indications for pinning were for severely displaced fractures, comminuted fractures, either impacted or not, or slipping of the upper humeral epiphysis. The results were less satisfactory in cases with an elevated greater tuberosity. The technique cannot be applied to fracture-dislocations.

[Congenital nodular fibromatosis: report of six personal cases (author's transl)]. / A propos de la fibromatose nodulaire congénitale (d'après 6 observations).

Six personal cases of nodular congenital fibromatosis are reported: one fibromatosis colli, two fibromas of the fingers one multiple fibromas of the toes and sole associated with osteoporosis and underlying bone lacunes, one recurrent plantar fibromatosis, one disseminated fibromatosis with multiple bone lesions. Such varieties of fibromatosis are very uncommon. Few are isolated such as fibromatosis colli or the fibroma of the fingers. The prognosis is generally good except for the generalized multinodular form which associates a very large visceral involvement. Aetiology is completely unknown. Only few arguments are in favour of an hereditary dominant autosomal transmission of the diffuse multinodular form.