MRI evaluation of ATFL and CFL ligamentization after anatomical surgical reconstruction with a hamstring graft.

BACKGROUND: Chronic ankle instability is frequent complication following ankle sprains. Anatomical reconstruction of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) with a gracilis autograft is a validated reconstruction technique. The signal-to-noise quotient ankle (SNQA) score evaluates graft maturation with MRI and has been shown to be reproducible and reliable. The goal of this study was to evaluate the process of ligamentization of the anatomical reconstruction of the ankle using the SNQA. The hypothesis was that the SNQA signal of the ATFL and the CFL would decrease over time. METHODS: A prospective cohort of patients who underwent arthroscopic anatomical ATFL-CFL reconstruction was included. All patients underwent a follow-up MRI examination 3, 6. and 12 months after surgery and the SNQA score was determined. RESULTS: Twenty consecutive patients were included. The SNQA score decreased significantly over time for the ATFL (p = 0.001), the CFL (p < 0.001) and for the fibular bone tunnel-graft interface (p = 0.02). The SNQA scores of the ATFL were significantly higher than those of the CFL at 3 months (p = 0.01), 6 months (p = 0.003) and 12 months (p < 0.001), and then those of the fibular tunnel-graft interface at 12 months (p = 0.003). There was no difference in the SNQA score between the CFL and in the fibular graft-bone tunnel interface at any of the follow up periods. CONCLUSION: There is a process of graft maturation following anatomical ATFL and CFL reconstruction over time, which is faster for the CFL than for the ATFL during the first year. LEVEL OF EVIDENCE: II.

Lumbosacral plexus and pudendal nerve magnetic resonance tractography: A systematic review of the clinical applications for pudendal neuralgia.

Diffusion tensor imaging (DTI) is commonly used to establish three-dimensional mapping of white-matter bundles in the supraspinal central nervous system. DTI has also been the subject of many studies on cranial and peripheral nerves. This non-invasive imaging technique enables virtual dissection of nerves in vivo and provides specific measurements of microstructural integrity. Adverse effects on the lumbosacral plexus may be traumatic, compressive, tumoral, or malformative and thus require dedicated treatment. DTI could lead to new perspectives in pudendal neuralgia diagnosis and management. We performed a systematic review of all articles or posters reporting results and protocols for lumbosacral plexus mapping using the DTI technique between January 2011 and December 2023. Twenty-nine articles published were included. Ten studies with a total of 351 participants were able to track the lumbosacral plexus in a physiological context and 19 studies with a total of 402 subjects tracked lumbosacral plexus in a pathological context. Tractography was performed on a 1.5T or 3T MRI system. DTI applied to the lumbosacral plexus and pudendal nerve is feasible but no microstructural normative value has been proposed for the pudendal nerve. The most frequently tracking parameters used in our review are: 3T MRI, b-value of 800 s/mm2, 33 directions, 3 × 3 × 3 mm3, AF threshold of 0.1, minimum fiber length of 10 mm, bending angle of 30°, and 3DT2 TSE anatomical resolution. Increased use of DTI could lead to new perspectives in the management of pudendal neuralgia due to entrapment syndrome, whether at the diagnostic, prognostic, or preoperative planning level. Prospective studies of healthy subjects and patients with the optimal acquisition parameters described above are needed to establish the accuracy of MR tractography for diagnosing pudendal neuralgia and other intrapelvic nerve entrapments.

WALANT in hand surgery: Ischemic complications and their medicolegal implications in France: A systematic review of the literature and of French legal databases.

WALANT (Wide Awake Local Anesthesia No Tourniquet) presents a theoretical risk of digital ischemia due to the presence of epinephrine, associated to the local anesthetic. For this reason, in France, the market authorization prohibits the use of epinephrine in digital extremities. The main objective of the present study was to assess the risk of ischemic complications reported in literature, and then to analyze the medicolegal implications in France. A systematic literature review was performed by three independent readers, using the PubMed and Embase databases. Also, declarations of claims and legal proceedings between 2007 and 2020 in France were examined in the official national Légifrance and Doctrine databases. Eight of the 424 articles retrieved were selected. Only 3 cases of digital necrosis following local anesthesia with adrenalized lidocaine were reported. Adrenalized xylocaine may be considered in case of peripheral microcirculation disorder. From a medicolegal point of view, no complaints or medicolegal implications were associated with WALANT in France. It seems that the market authorization for adrenalized local anesthesia could be extended to use in the digital extremities. However, the lack of medical and legal data calls for caution. We therefore recommend the use of an institutional protocol specifying the cases of overdose and the patient's pathway, and training for practitioners wishing to use this technique.

Emergency department visits for pediatric traumatic injuries during general confinement: A single-center study in an urban setting.

BACKGROUND: The first case of SARS-CoV-2 was detected in France in January 2020 and the government decided on national confinement from March 17 to May 11, 2020. Our aim was to analyze the incidence of pediatric emergency department (ED) visits and hospitalizations for traumatic injuries during this period. METHODS: Any visit with an ICD-10 discharge diagnosis code of burn, fracture, traumatic wound, or sprain/bruise contusion was recorded within the 2 weeks before (weeks 10 and 11) and during the confinement (weeks 12 and 19). The visits with the same ICD-10 discharge diagnosis code during similar weeks of the previous 2 years were also included. For each of those visits, the number of hospitalizations was counted. RESULTS: The number of recorded visits between week 10 and 19 in 2018, 2019, and 2020 was, respectively, 2657, 2625, and 1106 children. The average number of visits per day during the confinement (13±5) was significantly different from the average number of visits per day during the same weeks in 2018 and 2019 (38±8 vs. 39±9, P<0.0001). The average number of visits per day was significantly lower during confinement compared with 2018/2019 for three categories of diagnoses (P<0.0001) but not for burns (1.7 vs. 1.8, P=0.23). The average number of hospitalizations per day was significantly lower during the confinement than during 2018/2019 (1.6±1.3 vs. 2.6±1.8, P<0.0001). CONCLUSION: Confining children in an urban setting appears to decrease the incidence of injuries, except for burns. These data may be useful in reorganizing caregiver supervision and hospital units. These results will need to be consolidated in a multicenter study.

Forearm reconstruction by induced-membrane technique after sarcoma resection in children: technique and functional outcome in three cases.

Forearm sarcoma is rare in children. Here, we report three cases. One child presented undifferentiated soft-tissue sarcoma involving the ulna, another had Ewing's sarcoma of the ulna, and the third had Ewing's sarcoma of the proximal radius. In the first case, there were episodes of iterative aseptic nonunion, treated surgically. At last follow-up (respectively 11, 9 and 8 years postoperatively), the mean Musculoskeletal Tumor Society (MSTS) score was 80%, 90% and 77% respectively, and all cases were in remission. The induced membrane technique to reconstruct bone defect after sarcoma resection in children is a possible limb-salvage strategy.

Six-week antibiotic therapy after one-stage replacement arthroplasty for hip and knee periprosthetic joint infection.

OBJECTIVES: One-stage replacement arthroplasty for treatment of periprosthetic joint infection (PJI) results in similar cure rate than two-stage (around 85-92%), but antibiotic therapy duration is not well established. The aim of this study was to evaluate the efficacy of a short six-week antibiotic course in periprosthetic joint infections after onstage exchange. PATIENTS AND METHODS: Retrospective, observational study conducted at Orthopaedic Department of Cochin Hospital, Paris, between 1st January 2010 and 31 December 2015. Patients with a microbiologically proven PJI, treated with one-stage replacement and 6 weeks (+/1week) of antimicrobial therapy were included. Pearson's-χ2 and Wilcoxon tests were used to compare categorical and continuous variables. RESULTS: Fifty patients with periprosthetic joint infections (42 hip, 8 knee PJI) treated with one-stage replacement arthroplasty were included. Median age was 69.3 years (IQR 24.5-97.4). Infections occurred after a mean of 36 months (IQR 1-216). Bone biopsy cultures were positive for Staphylococcus spp. in 29 patients (58%), Cutibacterium acnes in 19 (38%), Gram-negative bacilli in 6 (12%). Polymicrobial infections occurred in 12 (24%). Intravenous antibiotics were administered for a median of 11 days (IQR 4-45) and 46 patients (92%) were switched to an oral therapy. Medium follow-up was of 32 months (IQR 12-101). Overall remission rate was 90%. CONCLUSIONS: A six-week course of antibiotics in knee and hip PJIs treated with one-stage RA has a satisfactory remission rate in this open study.

Isolation from the serum of cancer patients and molecular structure determination of a ketone derivative of D3 vitamin.

In a previous article we have reported our finding of an unknown vitamin derivative in the serum of cancer patients and in rats transplanted by a malignant tumor. Analysis of this compound extracted from serum of cancer patients, was carried out by I.R., U.V., mass spectrography and nuclear magnetic resonance (N.M.R.) determination. This analysis led us to the conclusion that the compound was a ketone derivative of D3 vitamin: 1-ceto-24-methyl-25-hydroxycholecalciferol, provisionally designated D3C. Enzymatic pathways involved in the biosynthesis of this substance and its possible role in normal and pathological cell division are discussed.

Retinol, beta-carotene and alpha-tocopherol status in a French population of healthy subjects.

Serum concentrations of retinol, beta-carotene and alpha-tocopherol have been determined in an homogeneous French population of healthy subjects. The mean values retinol: 148 +/- 35 UI per deciliter; beta-carotene: 32 +/- 10 microgrammes per deciliter; alpha-tocopherol: 1 +/- 0.2 mg per deciliter and the frequency distribution of values do not dedicate the presence of nutritional deficiencies in such a population. However the 5% lowest and highest (and beyond) levels are taken into consideration in their possible correlation with other pathological states.

Presence in human serum, associated with cancer, of an abnormal cholecalciferol derivative, the 1-ceto-24-methyl-25-hydroxycholecalciferol. Preliminary results of a prospective study.

Using new techniques for micro-determinations of blood fat soluble vitamin concentrations, this study from a large population of cancer patients compared to healthy controls led to the finding, extraction and isolation of an abnormal cholecalciferol derivative the 1-ceto-24-methyl-25-hydroxycholecalciferol. This factor was shown to be present in serum from cancer patients and absent in most normal controls. A double blind study has confirmed the diagnostic value of this new marker of cancer. In the same time, an animal study was performed. The abnormal cholecalciferol derivative, absent in intact rats, was found in the blood of rats transplanted by the Ehrlich carcinoma. The compound, extracted from serum of human cancer patients, injected to transplanted rats significantly decreased their survival time. Injected to untransplanted rats it induced hypocalcemia. The genesis and the possible role of this factor in cancer development are discussed.

Fat soluble vitamins and cancer localization associated to an abnormal ketone derivative of D3 vitamin: carcinomedin.

Many investigations suggested relations between fat soluble vitamin levels in blood and incidence of cancer. These studies are concerning both therapeutical efficiency of vitamins intake, seric levels and cancer risk, and the supposed correlation between blood fat soluble vitamin levels and the cancer localization. The purpose of the present study was to investigate whether the alterations of fat soluble vitamin levels (A-vitamin, beta-carotene and alpha-tocopherol) were correlated not only to carcinogenic processes but also to the localizations of their developments. In a former article, we have found that an abnormal ketone derivative of D3 vitamin (1-keto-24-methyl-25-hydroxycholecalciferol) or carcinomedin was present in the serum of all cancer patients and absent in that of healthy control subjects. Serum levels of the four above substances were determined in 1068 subjects suffering from differently localized cancers and in 880 healthy subjects. A statistical multidimensional analysis of data led a separate five groups of cancer types (p less than 0.001). Within each group alterations of vitamin spectra, compared to controls, were identical; between groups they were significantly different. These groups were: anal and intestinal cancer; pancreatic, hepatic, oesophageal and gastric cancer; laryngeal and lung cancer; uro-genital and breast cancer; brain cancer. All these groups are statistically different from the reference one (p less than 0.001). This grouping roughly corresponds to the embryologic origin of affected organs. This suggests that carcinogenesis may alter fat soluble vitamin metabolism, specifically in various forms of cancer, or these alterations of vitamin metabolism are in some way involved in the carcinogenic process.

Serum levels of carcinomedin (1-keto-24-methyl-25-hydroxycholecalciferol) as an indicator of the progression of cancer. Preliminary results of a prospective study.

The serum levels of the cholesterol derivative 1-keto-24-methyl-25-hydroxycholecalciferol found in patients with cancer varies after surgical, chemical or radiotherapy treatments. The serum level associated with the vitamin profile has a predictive value for evaluating progress of the disease and therapeutic efficacy. The detection, identification and assay of a vitamin D3 derivative, 1-keto-24-methyl-25-hydroxycholecalciferol, named carcinomedin by us, in the serum of cancer patients was described in prior work. Also, the assay of carcinomedin, combined with those of serum levels of vitamin A, beta-carotene and alpha-tocopherol indicated a statistically significant correlation between these parameters and the localization of the primary neoplastic mass. In spite of the probable connection between carcinomedin and the presence of a neoplastic mass, several questions remain unanswered. In particular, it may be asked if the stage and progression of the tumor, surgical, chemotherapeutic or radiotherapeutic treatments may be related with any type of change in the serum levels of carcinomedin and fat soluble vitamins? To verify and respond to these questions, patients with various cancers (stomach, esophagus, breast, ovaries, uterus, etc.) were followed for three years. Clinical data were compared to analytical data supplied by assays of carcinomedin and the fat soluble vitamins.

[Four part valgus impacted fractures of the upper extremity of humerus: ilium graft reconstruction. Apropos of 8 cases]. / Fractures de l'extrémité supérieure de l'humérus à 4 fragments, impactées en valgus: relèvement par greffon iliaque. A propos de 8 cas.

PURPOSE OF THE STUDY: We present the results of an original technique for reconstruction of valgus-impacted humeral head using autologous iliac bone. MATERIAL AND METHODS: Between 1992 and 1993, 8 patients (average age 66 years, range 43 to 79 years) with four-part valgus impacted proximal humeral fractures were operated with the aim of preserving the humeral head. All fractures were treated with open reduction and were stabilized only with autologous bone. This procedure provided fixation without osteosynthesis. Using a deltopectoral approach the impacted segment of the humeral head was raised, the void was filled with autologous three-cortical iliac bone graft, and the tuberosities were relocated with the goal of anatomic reconstruction. The assessment included clinical examination including Constant's score, radiographic examination and MRI examination. Only one patient was not available for the review at follow-up evaluation (minimum 12 months, average 16 months). RESULTS: According to Constant's criteria, two results were excellent, two very good, one good, one fair and one patient were considered failure. Average Constant's score was 62; average score in comparison with the healthy side was 76 per cent. Radiographic findings showed in all cases healing and incorporation of the graft. MRI results showed only one asymptomatic partial avascular necrosis (14 per cent). DISCUSSION: This specific type of displaced four-part fracture of the proximal humerus which consists of valgus impaction of the head fragment without lateral displacement has a rate of avascular necrosis lower than that of other displaced four-part fractures. Blood supply of the articular segment is maintained via the periosteum extending to the medial part of the anatomic humeral neck. These data authorized the authors to propose a new conservative treatment for four-part valgus impacted proximal humeral fractures.

[Musculocutaneous island flap using the upper gluteus maximus muscle]. / Le lambeau musculo-cutané en îlot de faisceau supérieur de muscle grand fessier.

The authors report 24 cases treated with an gluteus maximus musculocutaneous flap. The gluteus maximus is generally used as a VY flap. Our technique uses the superior part of the muscle with the overlying skin as a rotation flap. The upper part of the muscle is supplied by the superior gluteal artery. A good knowledge of the anatomy makes this flap easy to perform. The skin part of the flap is drawn over the trochanter. It is generally a 8 cm diameter circle. We then create a subcutaneous tunnel to prepare the rotation. The muscle is then freed from its lateral origin. The separation from the gluteus medius is made by blunt dissection and the superior gluteal artery can then be seen. The myocutaneous flap can now be raised and transferred to the defect. This flap has, in our experience, many advantages especially in paraplegic patients: large skin defects can be covered with a single flap, the perisacral skin is free of any scar, the lower part of the muscle can still be used to cover ischial ulcers. Since 1987 we have treated 24 patients with good results. The reliability and the great technical simplicity makes us think that the superior gluteus maximus musculocutaneous island flap is optimal for the coverage of sacral pressure sores.

[Adjuvant treatment of patients with neoplastic lesions using the combination of a vitamin complex and an amino acid. Apropos of a series of 17 cases of epidermoid carcinoma of the upper aerodigestive tract]. / Traitement adjuvant de sujets atteints de lésions néoplasiques par l'association d'un complexe vitaminique et d'un acide aminé. A propos d'une série de 17 carcinomes épidermoïdes des voies aérodigestives supérieures.

The aim of the work reported here was to evaluate the effects of an adjuvant treatment composed of an association of vitamins with an amino acid: beta-alanine, in cancer patients. This adjuvant therapy has been given to 17 subjects with a squamous cell carcinoma of upper aerodigestive tract treated by radiotherapy most cases were T3 (according to the TNM-UICC). After a 63 months follow-up, 7 patients are alive and sterilized, 4 are alive but no sterilized, 2 died, 4 were excluded from the study. Besides a physical comfort improved in all our patients, we note a restoration of the immune defenses, both humoral and cellular, disturbed by radiotherapy. At last, we note an increase of survival in the patients treated by the adjuvant therapy, compared to a reference population of patients with squamous cell carcinoma of upper aerodigestive tract. Despite the limits of the study, it was interesting to report the positive effects of the therapeutical association, vitamins and beta-alanine, after a combined radio-surgical treatment of patients with squamous cell carcinoma of upper aerodigestive tract.

Bilateral slipped capital femoral epiphysis occuring in an adult with acromegalic gigantism.

The etiology of slipped capital femoral epiphysis is still unknown. Traumatic, endocrine, toxic, and mechanical causes have all been hypothesized. It is well documented that the highest incidence occurs during the adolescent growth spurt, suggesting the role of an endocrine abnormality. We report a case that supports this hypothesis.

MR imaging of posteromedial and posterolateral stabilisers of the knee: anatomic basis and patterns of lesions in knee injuries.

The angular points are the ligamentous and tendinous structures that reinforce the posteromedial and posterolateral capsule of the knee and share in fixation of the posterior horns of the menisci. They are often damaged in acute injuries and this is usually associated with ruptures of the cruciate and collateral ligaments and may add to the degree of laxity. We describe the normal appearance of these structures in terms of the sectional anatomy, correlated with the lesional appearances of complete and incomplete ruptures and associated meniscal detachments as shown by clinical testing and arthrotomy findings.