[Hereditary neuropathy with liability to pressure palsy (HNPP): a diagnostic trap]. / Neuropathie héréditaire avec hypersensibilité à la pression: un piège diagnostique: à propos de deux cas.

The authors report two clinical cases of a rarely observed pathology in orthopedic surgery daily practice: hereditary neuropathy with liability to pressure palsy (HNPP), which leads to dysesthesiae, hypoesthesiae and regressive palsies. Onset, clinical signs and electromyographic abnormalities are described. Forensic consequences can occur in early postoperative period. Knowledge of this familial pathology allows precautionary measures at surgery and avoids unnecessary surgical revisions.

[Skin metastasis of lung carcinoma like Dupuytren's disease]. / Métastase cutanée d'un cancer pulmonaire simulant une maladie de Dupuytren.

Metastasis in the hand is uncommon. We report a case of metastasis of bronchial cancer to the hand mimicking Dupuytren's disease, which was operated using a skin graft with a good functional result. General prognosis is still very bad and the treatment should be palliative.

[Pseudoaneurysm of the superficial palmar arch, following endoscopic carpal tunnel release. A case report]. / Pseudo-anévrisme de l'arcade palmaire superficielle après chirurgie endoscopique du canal carpien. À propos d'une observation.

Pseudo-aneurysm of the superficial palmar arch following carpal tunnel release is exceptional and thus poorly reported. We present one observation, recorded on more than 1300 hands treated by endoscopic release using the "Chow" technique by a single surgeon. Ultra-sonography could be used in an attempt to locate the superficial palmar arch and thus prevent vascular damage at surgery.

[Spontaneous shoulder dislocation by posterior primary humeral notch: two case reports]. / Luxation spontanée de l'épaule par encoche postérieure humérale primitive: à propos de deux cas.

We report two cases of spontaneous anterior dislocation of the shoulder. Although the underlying etiology was different, both patients presented a posterior bone defect as the causal mechanism. Shoulder dislocation is explained by constitutional factors, which should include posterior bone defect.

[Abdominal complication of hip prosthesis: peritonitis]. / Une complication abdominale de la prothèse totale de hanche: la péritonite.

We report a case of rare complication of hip prosthesis: peritonitis. The bad influence of radiation therapy and corticotherapy is shown. A important outcome is necessary for this patients.

[Isolated fifth digit localization in Dupuytren's disease]. / L'atteinte isolée du cinquième rayon dans la maladie de Dupuytren.

Isolated fifth digit localisation in Dupuytren's disease has a bad reputation. A series of this injury is reported with a special attention on recurrences. This series is composed of 30 cases in 26 patients (four bilateral cases): the majority of patients were male and 53.5 y was the average age. Extension loss of MP and PIP joints were present in 25 cases, MP isolated extension loss in two cases and PIP in three cases. The treatment performed was a percutaneous needle technique in five cases, surgical fasciectomy in 24 cases using a zigzag palmodigital longitudinal fasciectomy approach in 18 cases, an open palm technique in six cases and one isolated laterodigital flap. Assessment of correction was based on Tubiana's classification. Average follow-up was 22 months. Postoperative course was uneventful except for one case of precarious vascularisation which leads to an amputation. For the digitopalmar localisations: 15 stage 0 or 1, 7 stage 2, 1 stage 3 and 1 stage 4. Improvement percentage was 0.60 in combined cases, 0.65 in cases with a MP loss and 0.46 in PIP loss. Five recurrences were noted. Literature on this topic is coherent with the fact that isolated involvement of the fifth digit carry a bad prognosis, mainly due to the high recurrence rate in our series as in other papers. In severe injuries, an imperfect result should be the aim to prevent vasculonervous complications.

[Aggressive osteoblastoma of the carpal scaphoid bone]. / Ostéoblastome agressif du scaphoïde carpien.

We report a case of aggressive osteoblastoma of the scaphoid bone and discuss the features of this tumor. The few reported cases emphazise the rarity of osteoblastoma in hand and wrist localizations. Pathological examination is mandatory before treatment due to lack of distinctive clinical and radiological features. In our case, the rapidiy aggressive progression, similar to a malignant tumor, required radical treatment with scaphoïdectomy.

[Anterior trans-scaphoid-lunate luxation of the wrist. Apropos of a case]. / Luxation trans-scapho-lunaire antérieure du carpe. A propos d'un cas.

About one uncommon case of anterior perilunate fracture-dislocation, the authors show the interest of posterior approach of the wrist to treat all the lesions. The scaphoïd is screwing proximally to distally and a pin is used to stabilise the pyramidolunare articulation. The clinical results are good on motion, on strength; the lunate doesn't present necrosis on radiology at 4 years.

[Anterior spinal fusion by thoracoscopy. A non-traumatic technique]. / La spondylodèse antérieure sous thoracoscopie: une technique atraumatique.

PURPOSE OF THE STUDY: Video assisted thoracic surgery (VATS) is a new modality which allows visualization of, and access to the intrathoracic organs without thoracotomy. Recently, this technique has been used for anterior thoracic spine approach to perform surgery which previously required standard postero-lateral thoracotomy. The authors report their initial experience of anterior spinal fusion using thoracoscopy and give a detailed description of their surgical procedure. MATERIAL AND METHODS: This technique, started on June 1993, was performed only in one level 1 in 10 patients who had thoracic spine trauma with fracture or luxation. The procedure was performed in the lateral decubitus position. The patient was prepared in the standard manner for a full thoracotomy. Surgical instruments that are needed for conversion to an open procedure must be in the operative room. Ventilation was stopped to the ipsilateral lung. Lung's collapse of the surgical side was obtained with a double lumen tube. Carbon dioxide (CO2) insufflation was used to further collapse. The first thoracoscopic portal was placed through the sixth or seventh intercostal space in the posterior axillary line, which was the safest place. All subsequent portals were placed under thoracoscopic visualization, in a triangular way as recommended by Landreneau (1992). Only open trocars were used to avoid complication of CO2 insufflation. Once the target level has been defined, a needle was placed into the disc space and roentgenographic confirmation obtained. The parietal pleura was then divided using monopolar electrocautery. Segmental vessels of the operation field lied transversely across the midportion of the vertebral body. They were mobilised and systematically ligated with endoscopic clip to simplify the procedure. Then the intervertebral space was opened and bone and disc were removed, restricted to the anterior and middle third. The graft was placed into the thoracic cavity by using a high density calcium hydroxyapatite ceramic block. Peroperative radiologic control ascertained the good position of the implant. At the end of the procedure a chest tube was placed through the lower trocar site and the lung re-expanded. A post operative CT Scan controlled good position of the graft and complete lung expansion. Contra-indications for VATS are previous surgical procedures or empyema causing extensive pleural adhesions. Procedures not appropriate for VATS approach are some that require anterior instrumentation for stabilisation, burst fracture, or fracture with posterior wall involved. RESULTS: The planned procedure was accomplished in all but one patient who required conversion to an open procedure because of segmental artery bleeding. Mean operative time was 1 h 45 mm, and mean estimated blood loss was 650 cc. There was no complication from CO2 insufflation neither postoperative complication. With an average of 2 years follow up, anterior grafting is as good as an open technique, radiologic evaluation according to Uchida (1990) showed good incorporation of each block without any radiolucent line or displacement. DISCUSSION: According to literature this technique was performed safely in 10 cases, especially without any respiratory complications and chronic pain (impairement of pulmonary function, re-expansion failure, incisional complications, rib fractures, chronic pain and malfunction of the chest wall, limitation of shoulder girdle motion) which are considered to be the main disadvantage of traditional thoracotomy. Many authors previously used VATS for multi level thoracic discectomy for correction of spinal deformities (Mack 1995), spinal reconstructive surgery (Mac Afee 1995) or removal of protrude thoracic disc (Rosenthal 1994). CONCLUSION: This original technique demonstrates that thoracoscopy for anterior thoracic surgery is better for the patients, reducing surgical trauma of the chest wall and to the lung parenchyma (in term of post operative comfort, sh

[Specific morbidity of substernal goiters. A comparative study with a matched series of cervical goiters]. / La morbidité spécifique des goitres plongeants. Etude comparative avec une série appariée de goitres cervicaux.

The operative morbidity rates in patients operated for substernal goiter (SG) vary from one series to another. The aim of this study was to reevaluate the morbidity using a matched technique. Each SG was matched to a cervical goiter for surgical technique, histology and thyroid function. There were 97 SG (75% of women), 43% with normal thyroid function, 28% with mild hyperthyroidism, 29% with hyperthyroidism. 87% of thyroidectomies were bilateral. Mean age was 66.5 +/- 11.5 years versus 55.8 +/- 11.9 years for cervical goiters (p < 0.001). The percentage of men was higher for SG than for cervical goiter (25% versus 10%, p < 0.01). Specimen weighed 166 +/- 109g versus 76 +/- 95g (p < 0.0001). Total volume of drainage was 164.0 +/- 68 ml versus 123.2 +/- 68 ml (p = 0.003). No operative death occurred. Early hypoparathyroidism rate was 3% versus 2% (p = 0.5), and late hypoparathyroidism was 1% versus 0% (p = 0.5). There was a 10 mg/l in serum calcium post-operative drop in both groups but no change in serum phosphate was noted (bilateral thyroidectomies). The early recurrent laryngeal nerve palsy rate was 4% versus 0% (p = 0.06) and 3% versus 0% one year later (p = 0.12). Early postoperative reoperation rate for hemostasis was 2% versus 1% respectively (p = 0.25). We conclude that there is no significant difference in surgical morbidity between thyroidectomies for SG and cervical goiters when patients are operated in specialized centers. Operative fears are not justified.