[Chronic fistula of the forefoot in a Moroccan man: bone chromomycosis due to Phialophora verrucosa]. / Fistule chronique de l'avant pied chez un marocain: chromomycose osseuse à Phialophora verrucosa.

Chromomycosis is a chronic infection caused by various fungi. Bone involvement is exceptional. The purpose of this report is to describe a case of chromoblastomycosis localized on the tarsal bone in a 27-year-old man from southern Morocco. The patient was a former barefoot long-distance runner. He presented with thickening of the skin with a cutaneous fistula on the left forefoot. These manifestations had been ongoing for 2 years. Imaging demonstrated scattered lytic lesions involving tarsal bone and the base of the third metatarsus. Definitive diagnosis was based on direct mycological examination and anatomopathology. Medical and surgical treatment led to stabilization of the lesions. No recurrence was observed during follow-up examination two years later.

[Fractures of the trapezium]. / Les fractures du trapèze.

The authors report a retrospective study of eight cases of trapezium fractures. There were seven male and one female patient aged 21 to 48 years. The presumed mechanism of injury was established in only four cases. Clinical trapeziometacarpal abnormality was always present. The diagnosis was made on standard radiographs in seven cases, computed tomography was used in one case. The fracture was simple, vertical and lateral in five cases, complex in one case and consisted in a lateral avulsion in two cases. An associated Bennett's fracture was present in five cases. The treatment was conservative in two cases. Internal fixation was performed in four cases (3 using a lag screw, 1 using a Kirschner wire) and transosseous reinsertion in two cases. With an average follow-up of 3 years (1 year-6 years), open reduction and internal fixation appears to be simple and to give good or excellent results.

[New varieties of lateral metatarsophalangeal dislocations of the great toe]. / Nouvelles variétés de luxations métatarso-phalangiennes du gros orteil: les luxations latérales.

PURPOSE OF THE STUDY: We report seven cases of traumatic dislocation of the great toe, detailing the anatomy, the mechanism of injury and the radiographic diagnosis. We propose an additional classification based on three hereto unreported cases. MATERIAL AND METHODS: Between october 1994 and october 1997, we treated seven patients with traumatic dislocation of the first metatarso-phalangeal joint of the great toe. There were six men and one woman, mean age 35 years (range 24 - 44 years). Dislocation was caused by motor vehicle accidents in four cases and by falls in three. Diagnosis was made on anteroposterior, lateral and medial oblique radiographs. According to Jahss' classification, there was one type I and three type IIB dislocations. There was also one open lateral dislocation and two dorsomedial dislocations. Only these dorsomedial dislocations required open reduction, done via a dorsal approach. Mean follow-up was 17.5 months (range 9 - 24 months) in six cases. One patient was lost to follow-up. The outcome was good in six cases and poor in one (dorsomedial dislocation). DISCUSSION: Dislocation of the first metatarso-phalangeal joint of the great toe is an uncommon injury. In 1980, Jahss reported two cases and reviewed three others described in the literature. He proposed three types of dislocation based on the feasibility of closed reduction (type I, II and IIB). In 1991, Copeland and Kanat reported a unique case in which there was an association of IIA and IIB lesions. They proposed an addition to the classification (type IIC). In 1994, Garcia Mata et al. reported another case which had not been described by Jahss and proposed another addition. All dislocations reported to date have been sagittal dislocations. Pathological alteration of the collateral ligaments has not been previously reported. In our experience, we have seen one case of open lateral dislocation due, at surgical exploration, to medial ligament rupture and two cases of dorsomedial dislocation due, at surgical exploration, to lateral ligament rupture. CONCLUSION: We propose another additional classification with pure lateral dislocation (type III) and dorso-lateral dislocation (type IL or IIL+), which are related to the formerly described variants.

[Fractures of the coronoid process]. / Les fractures de l'apophyse coronoïde.

INTRODUCTION: A retrospective study has been made of a series of 22 cases, and the classification and treatment of fractures of the coronoid process of the ulna have been discussed. MATERIAL, METHODS AND RESULTS: A report has been made of 22 cases of coronoid process fracture (18 males and four females). The mean age was 26 years (range: 19-47 years). According to the Reagan and Morrey Classification, there were 11 type I (avulsion of the tip of the bone), seven type II (a fragment of less than 50% that was detatched from the coronoid process), and four type III cases (a fragment of more than 50% that was detatched from the coronoid process). Elbow dislocation was present in 16 cases, and a radial head fracture was associated in four cases. All type I fractures were treated by immobilization of the elbow in a plaster cast for ten to 15 days, with eight excellent and three good results. In type II fractures, open reduction, internal fixation with antero-posterior lag-screw and early post-operative movement in three patients gave better results than immobilization for three weeks, which was the procedure used in four cases (after transosseous reinsertion in one case). In type III fractures, good results were obtained following open reduction and internal fixation with antero-posterior lag-screw in three patients. The result was average in the fourth case, with immobilization for four weeks. CONCLUSION: The Reagan and Morrey classification is most useful for the classification of coronoid process fractures. If there is no comminution of the detatched fragment, open reduction and internal fixation with antero-posterior lag-screw is the treatment of choice in type I and II fractures. In type I fractures, immobilization for about two weeks gives good results.

[Metacarpophalangeal dislocation of the index finger. Apropos of 7 operated cases]. / Les luxations métacarpo-phalangiennes de l'index. A propos de sept cas opérés.

Complex dislocation of the metacarpophalangeal joint of the index finger is an uncommon injury. The authors report seven cases, including three neglected dislocations, two with associated osteochondral fractures and one with sesamoid entrapment. Open reduction was necessary in each of the seven cases. In recent dislocations (four cases), both approaches were successful in obtaining reduction and normal finger movements were obtained. The dorsal approach was simple and safe, while the palmar approach was difficult and had many disadvantages. In the case with sesamoid entrapment, the sesamoid had to be removed to achieve reduction. In neglected dislocations (three cases), the dorsal approach was successful in one case (three weeks), two incisions were necessary in one case (seven months), and one case was treated by Swanson prothesis (two years). None of these patients regained normal mobility postoperatively.

[Aneurysmal bone cyst of all humeral diaphysis (a case report)]. / Kyste osseux anévrismal pandiaphysaire de l'humérus (à propos d'un cas).

Aneurysmal bone cyst (ABC) is a benign osteolytic lesion usually occurring in the metaphysis of long bones. Authors report a case of a 21-year-old man with an expanding aneurysmal bone cyst in the entire humeral diaphysis and both metaphyses, discovered incidentally. Authors present the therapeutic difficulties encountered and discuss theepidemiology, diagnosis and management of ABCs.