[Soft-tissue chondroma of the hand: a case report and analysis of diagnostic procedures for extra-osseous cartilaginous lesions of the hand]. / Chondrome des parties molles de la main: diagnostic des lésions cartilagineuses extra-osseuses à la main (à propos d'un cas).

We report a case of a chondroma found in the soft tissues of the hand. Reports in the literature show that this cartilaginous tumor is a rare slowly-evolving benign tumor. Diagnosis is difficult as standard x-rays show variable images depending on the degree of calcification. Magnetic resonance imaging is helpful in orienting the diagnosis and delimiting the tumor but is not always useful in determining its exact origin. Positive diagnosis is provided by the pathology examination, but confirmation may be difficult to establish. We stress the importance of repeated microtrauma in the development of soft-tissue chondroma. Surgical treatment is the only successful solution but recurrence is not exceptional.

[En bloc resection of the hip via a simultaneous double approach]. / Résection monobloc de hanche par double abord simultané

The pelvis is not an uncommon localization for primary or secondary tumors. Progress in chemotherapy has reduced the risk of metastasis and advances in reconstruction surgery using prostheses or allografts has made it possible to preserve a functional limb. We describe our method for en bloc resection of the hip. We use a double simultaneous approach for en bloc resection of the hip. The posterior Kocher-Langenbeck approach is associated with a anterior iliocrural approach. Each approach is performed by a separate team. We analyzed the advantages and disadvantages of this method, describing three recent cases. The double-simultaneous approach allowed greater safety for en bloc carcinological resection of the hip for patients with malignant tumors or aggressive intra-articular extension. Reconstruction was achieved with a total hip arthroplasty, reducing the duration of the operation and in theory, blood loss and risk of secondary infection. This method would not be indicated for patients without pelvic involvement nor for patients with a small-sized tumor (<5 cm).

[MRI appearance of a primary leiomyosarcoma of bone with epiphyseal involvement]. / Aspect IRM d'un cas de léiomyosarcome osseux primitif de localisation épiphysaire.

Primary leiomyosarcoma of bone is a rarely reported tumor of elderly subjects. It usually shows an aggressive osteolytic pattern on plain radiographs and involves predominantly the metaphyses of long bones. We report a case of primary leiomyosarcoma of bone, which is atypical by its epiphyseal location, a non-aggressive pattern on plain radiographs and its MR imaging features.

[Posterior shoulder instability in athletes: surgical treatment with iliac bone block. Apropos of 6 case reports]. / Instabilité postérieure de l'épaule chez le sportif traitée par butée iliaque. A propos de 6 observations.

PURPOSE OF THE STUDY: Sports activities requiring antepulsion, adduction and medial rotation can favor the development of posterior instability of the shoulder. Conservative treatment is indicated, but many techniques have been proposed in case of failure. All do not allow recovery of the same sports level. We report our experience with six cases of posterior shoulder instability treated with a Gosset posterior bone block. MATERIAL AND METHODS: We retrospectively reviewed cases treated between 1974 and 1995. Six athletes, aged 17 to 34 years (mean 25 years) underwent posterior bone block surgery using the Gosset procedure on their dominant shoulder. Three of the patients had experienced involuntary dislocation and three others involuntary and voluntary dislocation. One patient had a multidirectional hyperlaxity. Five patients had participated in rehabilitation programs for at least five months. Two patients had undergone unsuccessful bone block surgery in another unit. RESULTS: Stability and pain relief were achieved in all cases. Three patients recovered complete mobility. In the three others, mean limitation of mobility for the different sectors was 15 degrees. There has been no sign of osteoarthrosis at three years follow-up. All patients have resumed their sports activities, three at the same level. DISCUSSION: In our experience, most surgical techniques proposed for the treatment of posterior shoulder instability are unsuccessful. The Gosset iliac bone block prolongs the articular surface. After consolidation, it allows sports activities requiring shoulder force and provides satisfactory mobility.

Rotator interval lesions and their relation to coracoid impingement syndrome.

In the last 10 years we have found impingement of the coracoid process on the rotator interval in 12 patients (14 shoulders). Seven of these patients were women and 5 were men; the average patient age was 48.5 years. One patient had a calcified coracohumeral ligament, another patient had an anterior tear of a repaired deltoid flap, and a third had an aberrant pectoralis minor tendon inserted into the rotator interval. Eleven patients had a weak rotator interval, and in 4 cases the rotator interval had a small tear. We closed the rotator interval in all 12 patients. We also performed a coracoidoplasty in 5 of the patients. The condition of all shoulders improved clinically after operation; the average follow-up was 4.2 years. Three patients (4 shoulders) still had moderate pain, and 7 patients (9 shoulders) lacked strength. Internal rotation was the only shoulder movement that remained limited. Although impingement seemed obvious during surgery, experimental studies have reported contradictory findings.

Total shoulder replacement by magnetic arthroplasty.

Permanent magnets offer a novel solution to the problem of shoulder implant instability when the rotator cuff has been destroyed. We report a case of their use in a 66-year-old patient with a large proximal humerol breast cancer metastasis. Humerol resection was below the deltoid insertion. The polyacetal device had samarium-cobalt magnets in the humeral head. The glenoid component (the keeper in the magnetic circuit) was made of titanium nitride-coated F17 stainless steel. The system's breakaway force was ca. 40 N. At 24 months the shoulder was free of pain and stable, with an active range of movement of 30 degrees flexion, 45 degrees external rotation, and internal rotation to T8. The patient could perform household tasks and drive an automatic car. Radiography showed no implant loosening or upward humeral head dislocation. Subsequently, the patient's condition deteriorated; at 33 months she was bedridden, and radiography showed dislocation of the humeral component.

[Primary leiomyosarcoma of bone: a clinico-pathologic and immunohistochemical study of 3 cases]. / Léiomyosarcomes primitifs de l'os: étude anatomo-clinique et immunohistochimique de 3 observations.

Primary leiomyosarcoma of bone is rare. Herein we describe 3 cases with immunohistochemical study. All 3 cases were positive for smooth muscle actin and/or desmin. None was positive for cytokeratin. Differential diagnosis includes metastatic spindle cell carcinoma, other sarcoma (fibrosarcoma, malignant fibrous histiocytoma) and metastatic extra-osseous leiomyosarcoma, mostly from uterus or digestive tract.

[Fractures of the distal radius with dorsal displacement: a comparative study of the predictive value of 6 classifications]. / Fractures de l'extrémité inférieure du radius à déplacement dorsal: comparaison de la valeur prédictive de 6 classifications.

PURPOSE OF THE STUDY: The authors compare six classifications in a prospective study of distal radius fractures surgical treatment. Classifications included Castaing's, Frykman's, Gartland's, Older's, Lindström's and Jenkins'. MATERIAL: 96 patients presenting a distal radius fracture were included in a protocol comparing two surgical treatments. 42 were treated with styloid pinning and immobilization while 54 with intra-focal pinning and immediate mobilization according to Kapandji's technique. METHODS: Each patient was graded initially according to each six classifications. Patients were reviewed at 6 weeks, 3, 6, 12, and 24 months. Clinical and radiographical evaluation were performed. Clinical and radiological results were compared according to each group of classification. RESULTS: None of the six classifications appeared to have any utility to predict functional or radiological results. None was able to distinguish treatment option. DISCUSSION: The six classifications did not permit to predict clinical or radiological outcome of distal radius fractures treated by radial styloid pinning or Kapandji's technique. All those classifications have been described for conservative treatment rarely performed in France for displaced fractures. CONCLUSION: The six classifications tested showed no predictive value in K-wire treatment of dorsally displaced distal radius fractures.

[Rupture of the flexor tendon of the hand caused by tuberculosis]. / Rupture à la paume des tendons fléchisseurs d'origine tuberculeuse.

A 47 years-old man presented an atraumatic, spontaneous index flexor tendons rupture. This patient has been treated two years ago for a pulmonary tuberculosis. At surgery, the flexor tendons were infiltrated by a granuloma. Histologic examination was compatible with tuberculosis sequelae. According to literature review, this is the second reported case of a tendon rupture due to tuberculosis granuloma.

Fracture of the distal radius. A prospective comparison between trans-styloid and Kapandji fixations.

We performed a prospective study on 96 patients with extra-articular or intra-articular fractures of the distal radius with a dorsally displaced posteromedial fragment. After closed reduction, we compared trans-styloid fixation and immobilisation with Kapandji fixation and early mobilisation. Forty-two patients of mean age 57.1 years +/- 18.1 (SD) were treated by trans-styloid K-wire fixation and 45 days of short-arm cast immobilisation. Fifty-four patients of mean age 57.7 years +/- 18.7 (SD) had Kapandji fixation and immediate mobilisation according to the originator. All the patients had clinical and radiological review at about six weeks and at 3, 6, 12 and 24 months after the operation. Pain, range of movement and grip strength were tested clinically, and changes in dorsal tilt, radial tilt, ulnar variance, and radial shortening were assessed radiologically. Statistical analysis was applied to comparisons with the normal opposite wrist. Pain and reflex sympathetic dystrophy were more frequent after Kapandji fixation and early mobilisation, but the range of motion was better although this became statistically insignificant after six weeks. The radiological reduction was better soon after Kapandji fixation, but there was some loss of reduction and increased radial shortening during the first three postoperative months. The clinical result at two years was similar in both groups.

Acromioclavicular dislocations: treatment by coracoacromial ligamentoplasty.

We did a retrospective review of 32 patients who had undergone acute treatment for acromioclavicular joint dislocation (mean follow-up period 46 months) and 24 patients who had undergone surgery for chronic joint dislocation (mean follow-up period 51 months). All patients had a ligamentoplasty performed using the coracoacromial ligament. With the shoulder functional score described by Patte, we obtained 81% satisfactory results for the patients who underwent acute treatment and 79% satisfactory results for those who underwent late treatment. Because results in both groups were similar, we now treat only the more severe form of acute dislocation with surgery. Delayed surgery is indicated in those patients who have an unsatisfactory result after functional treatment.

Entrapment and compartment syndromes of the upper limb in haemophilia.

17 patients with haemophilia have been treated for a neurological deficit of the upper limb. Four of the five entrapment neuropathies have been operated upon, and only two patients recovered completely. Only two of the 12 patients with a compartment syndrome have been operated upon, and only two had sequelae. Clotting factor replacement is always indicated as primary treatment. Surgical release is indicated if the condition fails to improve. Late treatment was responsible for incomplete recovery, whatever the cause of the nerve compression.

Case report 728: Desmoplastic fibroma.

A 69-year-old woman with a 25-year history of recurrent sciatica presented with an expanding lytic lesion of the right side of the first sacral vertebra. Histological examination proved the lesion to be a DF. DF is usually diagnosed in young patients and is very rarely located in the spine and sacrum. The growth rate of the tumor was presumed to be very low because it had not progressed from radiological studies performed 9 years previously. The clinical, radiological, and pathological features of DF are described, and the differential diagnoses are discussed. The most difficult problem is to distinguish DF from a low-grade fibrosarcoma or chordoma.

[Antero-internal impingement of the shoulder]. / Le conflit antéro-interne de l'épaule.

Anteromedial conflicts of the shoulder are situated in the subcoracoid or coracohumeral space, in the anterior part of the acromio-coracoid vault. The authors describe a first fibrous band connecting the anterolateral border of the acromio-coracoid ligament to the coraco-biceps tendon (Apoil) and a second deeper band between the superior border of the subscapularis and the insertion of the long head of biceps onto the labrum (Patte). The role of the vault varies according to constitution (length and direction of the coracoid process) and acquired factors (iatrogenic or traumatic); the role of the floor depends on numerous elements: traumatic sequelae (malunion), eccentricity of the humeral pivot, lesion of the rotator interval, variant of insertion of the anterior capsule, floating glenoid labra, anomalies of insertion of pectoralis minor. There are no pathognomonic signs, but Gerber's, Hawkin's and Yocum's signs are generally observed. Computed tomography and CT arthrography are currently the most reliable complementary investigations to demonstrate this type of conflict. This regional pathology is situated at the crossroads between pure conflictual mechanisms and hyperlaxity phenomena associated with subluxations.

[Bipolar prosthesis in femoral neck fractures. Results and long-term acetabular tolerance of 36 bipolar arthroplasties]. / La prothèse intermédiaire dans les fractures du col du fémur. Résultats et tolérance cotyloïdienne à long terme de 36 arthroplasties intermédiaires.

The authors present the long-term results of 36 SEM cemented bipolar hip prostheses for femoral neck fractures with a mean observation time of 7.4 years. The objective was to study the acetabular tolerance of these prostheses comparing with Moore's and Thompson's conventional hemiarthroplasties. The average age of the patients was of 69 years. According to the Merle d'Aubigné's classification, clinical results were better than those results reported in the literature with conventional hemiarthroplasties. At long term, acetabular deteriorations were nevertheless frequent (41.6 per cent pinchings and 25 per cent protrusions), but with no clinical significative correlation. They seem to be favoured by technical errors (drilling, size of the cups) and acetabular morphology. The part of the intermediary joint's mobility is difficult to demonstrate and is far being univocal. The authors conclude, to the superiority of the bipolar hip prosthesis actually totalizable (long term clinical results and middle term acetabular tolerance) in comparison with the conventional hemiarthroplasties, and recommend the use of those implants in sub-capital displaced femoral neck fractures for elderly patients with no arthrosis.

[Compression of the deep branch of the ulnar nerve as it exits the pisiform-unciform hiatus: report of an anomaly not yet described]. / Compression de la branche profonde du nerf ulnaire à la sortie du hiatus piso-unciformien. A propos d'une anomalie non encore décrite.

We observed a case of compression of the deep branch of the ulnar nerve distal to the piso-hamate hiatus due to an aberrant fibrous band arising from the hamulus ossi hamatum and ending in the flexor digiti minimi muscle. An anatomical study of eleven fresh cadaver hands revealed that between the piso-hamate hiatus and the palm, the nerve passes through an osteo-fibrous tunnel in which multiple anomalies can occur. The authors think that ulnar nerve neurolysis at the wrist must always extend up to the palm.

[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.