Anatomical and radiological study applied to distal radius surgery.

PURPOSE: The purpose of this study was to determine, during anterior plating of the distal radius, the length of a screw above which there is a risk for the extensor tendons and the optimal shape of an anterior plate. It was also to determine the projection of the axis of the distal third of the radius on the distal articular surface in case of wrist arthroplasty in order to simplify the procedure. METHODS: We studied 74 dry radii from adult cadavers. Each one underwent a CT scan. We measured the thickness of each radius at the dorsal tubercle level, at the second compartment level and at the third compartment level. We calculated the metaphyseal-epiphyseal angles of the lateral column and of the intermediate column (Rikli and Regazzoni in J Bone Joint Surg (Br) 78(4):588-592, 1996). We also calculated the projection of the longitudinal axis of the most distal 7 cm of the radius on the distal carpal surface of the radius. RESULTS: Mean thickness at the dorsal tubercle level was 22.1 mm (18-26.1). The mean slope of the lateral column was 155° (143-167) while that of the intermediate column was 145° (134-153). We have found a statistically significant difference (p < 0.0001) between these two slopes. The axis of the distal radius was projected on the posterior-lateral quadrant of the distal articular surface. CONCLUSIONS: The emergence of new implants needs a precise evaluation of a fractured, an arthritic or a reconstructed distal radius. The double slope of the distal radius complicates the manufacturing of an "anatomical" plate. The optimal shape is between these two slopes. Moreover, ancillaries for wrist replacement are still approximations, which means that it is important to know the projection of the radial axis on the articular surface of the distal radius.

[Rotator cuff tears: value of 3.0T MRI]. / Perforations de la coiffe des rotateurs: intérêt de l'IRM 3,0T.

PURPOSE: To demonstrate the value of 3.0T MR imaging for the detection of rotator cuff tendon tears and surgical planning by correlating imaging findings to surgical findings. Materials and methods. Prospective follow-up of patients who underwent 3.0T MR imaging of the shoulder in our department between November 2005 and June 2007. Surgical findings were correlated to imaging findings for 48 patients who underwent surgery: detection, size, partial thickness or complete, and tendon edges. RESULTS: In this patient group, the positive predictive value of MRI for detecting surgical tears was 100% (100% of complete tears and 92% of partial thickness tears). No change in surgical management was recorded when arthroscopy was performed based on MRI findings (size of tear). CONCLUSION: 3.0 T MRI is valuable for the detection of small tears, especially for partial thickness tears due to increased spatial resolution. The identification of surgical candidates and surgical planning are improved due to more accurate measurements of tear size and quality of the tendon edges.

[Evaluation of the efficacy of CT-guided epidural and transforaminal steroid injections in patients with diskogenic radiculopathy]. / Evaluation de l'efficacité des infiltrations canalaires et foraminales de corticoïdes guidées par TDM dans le traitement des radiculalgies par conflit disco radiculaire.

PURPOSE: To evaluate the efficacy of CT-guided epidural and transforaminal steroid injections in patients with diskogenic radiculopathy. MATERIALS AND METHODS: Seventy patients underwent CT guided injections after failure of medical management. Only patients with minimal degenerative changes and diskogenic monoradicular symptoms were treated. Only two patients with fibrosis were included. RESULTS: 78.6% of patients experienced persistent symptomatic improvement. No difference was noted between lumbar segments and there was no more failures with epidural injections compared to transforaminal injections. Cervical disk herniations responded better than lumbar disk herniations. Good results were obtained in younger patients (M=46.25 years), symptomatic for 3-4 months or less, and with clear radicular symptoms and clinical neurological deficits (hypoesthesia, absent DTR) without motor deficit. No patient with severe spinal stenosis (S-) was included and the disk herniations were small (b1, b2, c1, c2 or d1, d2). Only a single injection was needed. Cortivazol provided superior results compared to dexamethasone. CONCLUSION: CT-guided injections should be included in the therapeutic armamentarium after standard medical management, with cure as the goal.

[Combined bipolar radiofrequency and cementoplasty of bone metastases]. / Radiofréquence bipolaire et cimentoplastie dans le traitement des métastases osseuses.

Bone metastases are the most common cause of pain in cancer patients. Pain management in cancer patients, often revealing the disease and always present at advanced stages, is an important and difficult task. Pain is not always properly controlled by high doses of specific medication, radiation therapy or chemotherapy. When these therapies do not provide adequate pain relief, percutaneous neurolysis, infiltrations, alcoholizations and cementoplasty may be considered. More recently RF ablation has been proposed. On weight-bearing bones, RF can be combined with acrylic cement injection. The authors present here this very effective new technique which is complementary to classical pain management techniques.

[Ganglion cyst rupture in the retro-femoral fat: a report of two cases]. / Rupture de kyste mucoïde dans la graisse rétro-fémorale: à propos de deux cas.

Ganglion cysts are ubiquitous cystic lesions without synovial wall and inconstant communication with the articular cavity. The later must nonetheless always be carefully looked for. We report two cases of ganglion cyst rupture in the retrofemoral fat simulating phlebitis with thigh cellulitis. To the best of our knowledge, this has not been previously reported in the literature. Familiarity with this entity ensures adequate medical diagnosis and management, avoiding unnecessary imaging and laboratory work-up and inappropriate use of anticoagulant and antibiotic.

[Pain management in bone metastasis of pulmonary origin: new interventional and metabolic techniques]. / Nouvelles techniques interventionnelles et métaboliques dans la prise en charge des métastases osseuses.

Invasion of bone by a metastatic lesion is the most common cause of pain in cancer patients. Pain management in these patients is an important and difficult task. The pain is not always properly controlled by high doses of specific medication, radiation therapy or chemotherapy. When these therapies do not provide adequate pain relief, percutaneous vertebroplasty, cementoplasty, radiofrequency ablation and internal radiotherapy appear to be elegant and efficient complementary alternative pain control methods.

[Lipoma of the spermatic cord. Description of a case and review of the literature]. / Lipome du cordon spermatique. Description d'un cas et revue de la littérature.

The authors analyse a case of fibrolipoma of the spermatic cord. It is the most common entity in the non testicular tumors. Ultrasound imaging has proven his utility. Lipoma is homogeneous, a little hyperechoic compared with the next testicle. But surgically exploration of all solid tumors of the cord is appropriated.

[Chondrosarcoma of the femur neck simulating a normal variant. A difficult diagnostic pitfall]. / Chondrosarcome du col fémoral simulant une variante de la normale. Un redoutable piège diagnostique.

We report a case of chondrosarcoma of the femoral neck wrongly considered as a normal variant during a long time due to the initial aspect on the plain films and its location. Precise radiological criteria must allow the differential diagnosis and will be detailed.

[Diagnosis of ivory vertebra. Bibliographic study, report of 2 cases of pagetic ivory vertebra]. / Diagnostic d'une vertèbre d'ivoire. Etude bibliographique, rapport de 2 cas de vertèbre d'ivoire pagétique.

Two cases are reported of ivory vertebra, an isolated lesion difficult to diagnose clinically or radiologically. Tomographic and if necessary computed tomographic analysis should provide a precise diagnosis of a Paget's disease origin, biopsy being reserved for cases for which a doubt exists.

[Fluid-fluid level in an intra-osseous ganglion cyst of the talus]. / Niveau liquide-liquide dans un kyste mucoïde intra-osseux du talus.

The author report a very rare case of fluid-fluid level in an intra-osseous ganglion cyst of the talus that was detected on CT and MR imaging. Pre-operative diagnosis was suggested by the presence of a communication between the talo-cuboid joint and the cyst, as shown at MR Arthrography.

[True isolated atherosclerotic aneurysm of the axillary artery]. / Anévrisme vrai isolé d'origine athéromateuse de l'artère axillaire.

The true atherosclerotic aneurysm of the axillary artery is a rare condition. It either presents as a pulsatile axillary mass or arterial emboli in the hand and fingers. We report the case of a 70-year-old man with a 5 cm aneurysm of the axillary artery presenting with embolic disease to the hand. Angiography is helpful and provides valuable preoperative anatomic details. Surgery remains the treatment of choice but endovascular treatment can also be considered.

[Comparison between iopamidol and ioxaglate in digital arteriography of the lower limbs]. / Comparison du iopamidol et du ioxaglate en artériographie numérisée des membres inférieurs.

This prospective study concerning 100 subtraction angiographies of the lower limbs compared two iodine concentrations of iopamidol (300 and 370 mg l/l) and ioxaglate (320 and 350 mg l/l). More pain and movements disturbed the subtraction with iopamidol 370 in comparison with ionic contrast media (p < 0.005). The quality of the contrast was better with ioxaglate 350 (p = 0.05) than with the others. This one appears to be a good compromise for this type of examination.

[Dense intracerebral cholesteatoma in computed x-ray tomography. Apropos of a case]. / Cholestéatome intra-cérébral hyperdense en tomodensitométrie. A propos d'un case.

The authors report a case of cholesteatoma which is uncommon on account of its dense appearance on the C.T. scan and its temporal localization.

[Craniopharyngioma with intraventricular development. Apropos of 2 cases. X-ray computed tomographic aspect]. / Craniopharyngiomes à développement intra-ventriculaire. A propos de deux observations. Aspect tomodensitométrique.

We report two cases of craniopharyngioma developed within the third ventricle. In this occasion we present the different C. T. findings of these tumors.

[Fungal mycotic aneurysms and multiple cerebral abscesses caused by Scedosporium apiospermum. Apropos of a case with review of the literature]. / Anévrysmes mycotiques et abcès cérébraux multiples à Scedosporium apiospermum. A propos d'une observation avec revue de la littérature.

The authors report a case of intracranial fungal aneurysm and brain abscesses. The compromised host was a young drowned woman. Scedosporium Apiospermum was isolated in fungal culture from abscess. Radiological and clinical pictures are typical of the hyphal form.

[Subperiosteal (juxtacortical) chondroma of the hand. Apropos of 2 cases. Review of the literature]. / Chondrome sous-périosté (juxta-cortical) de la main. A propos de 2 observations. Revue de la littérature.

Subperiosteal chondroma (juxta-cortical) is unusual benign cartilaginous neoplasm with characteristic radiographic features. We report two cases occurring in uncommon location: the hand. Radiologic differential diagnosis with others bone tumors is easy but it could be difficult with some soft-tissue tumors, especially chondrosarcoma and extraarticular chondromatosis.

[Spondylodiscitis after embolization of an extramedullary intraspinal arteriovenous fistula]. / Spondylodiscite après embolisation d'une fistule artérioveineuse intra-canalaire extra-médullaire.

The authors report a case of spondylitis Th11-Th12 occurred 1 month after embolization of an intraspinal extramedullary arteriovenous fistulae; this fistulae was fed by 11th left intercostal artery. The infecting organism isolated from the affected intervertebral disc was streptococcus sanguis a common agent of dental abscess.

[Bilateral traumatic carotid-cavernous fistula treated using an inflatable and detachable balloon]. / Fistule carotido-caverneuse traumatique bilatérale traitée par ballonnet gonflable et largable.

The authors report a case of traumatic bilateral carotid-cavernous fistula successfully treated by inflatable and detachable balloon.

[Dorsal spinal cord compression caused by vertebral subperiosteal chondroma. Apropos of 2 cases]. / Compression médullaire dorsale par chondrome sous-périosté vertébral. A propos de 2 observations.

The authors report 2 cases of vertebral subperiosteal chondroma causing thoracic spinal cord compression. Total excision of this benign cartilaginous neoplasm is usually sufficient treatment.

[Subperiosteal chondroma. Diagnostic contribution of x-ray computed tomography. Apropos of 2 cases]. / Chondrome sous-périosté. Contribution diagnostique de la tomodensitométrie. A propos de 2 observations.

Results of CT scan exploration are reported in two cases of subperiosteal chondroma, one in a 4 year old child affecting the anterior tibial tuberosity the other in a 9 year old child involving the upper end of humerus. Data from CT scan imaging were undoubtedly superior to those of conventional radiography and appear to be characteristic of this benign cartilaginous tumor, greatly facilitating correlation between clinical, radiological and pathologic findings. The scanner should allow certain situations to be dedramatized and the surgical attitude adapted when the functional prognosis is involved.