[Simple puncture versus trocar puncture biopsy for the bacterial diagnostic evaluation of osteoarticular infections. A prospective study of 54 cases]. / Ponction simple contre ponction biopsie au trocart pour le bilan diagnostique bactériologique des infections ostéo-articulaires. Etude prospective sur 54 cas.

PURPOSE OF THE STUDY: We have performed a prospective study in 54 patients with suspected osteoarticular deep infection. The purpose of the study was to compare notch needle-biopsy versus simple punction in term of bacteriological efficiency. MATERIAL AND METHODS: Among 54 patients (32 males, 22 females), 16 cases of deep infections were proven. There was 29 hips, 17 knees, 6 ankles, 2 elbows and 1 shoulder. Each patient was investigated with simple punction and notch needle-biopsy. Diagnostic value of both methods were evaluated by comparison with results of surgical prelevement which was the gold standard for evaluating both tests. The study was made using usual diagnostic test criteria: sensitivity, specificity, positive predictive value, negative predictive value and also likelihood ratio method. RESULTS: Sensibility for the simple punction was 31.25 per cent and sensibility for notch needle-biopsy was 69 per cent. Specificity for simple punction was 97 per cent but for notch needle-biopsy it was 100 per cent. Positive predictive value was respectively 83.33 per cent for simple punction and 100 per cent for notch needle-biopsy. Negative predictive value was 0.71 per cent for simple punction and 0.31 per cent for notch needle-biopsy. Likelihood ratios for simple punction was 11.87 and likelihood ratios for notch needle-biopsy was infinite. DISCUSSION: Sensibility for notch needle-biopsy of 69 per cent is two time superior to sensibility of simple punction. Notch needle-biopsy had no false positive. It is a completely specific test. Methodology was valuable because all patients who had negative result of non invasive test had no preoperative antibiotherapy, and underwent surgery for bacteriological diagnostic only. CONCLUSION: Notch needle-biopsy is always superior to simple punction. This study leads us to modify our practice. From now on we will never use again simple punction but we will only perform notch needle-biopsy which diagnostical efficiency is superior.

[Old Monteggia lesions in children. Apropos of 14 cases]. / Lésions de Monteggia anciennes chez l'enfant. A propos de 14 observations.

Fourteen patients between the ages of 3.5 years and 11 years, with an old Monteggia lesion were managed in the Orthopaedics department between 1968 and 1997. Dislocation of the radial head was not diagnosed at the time of the initial trauma in 9 out of 14 cases and the diagnosis was made an average of 14 months after the trauma (range: 5 weeks to 84 months). Twelve of the 14 patients underwent surgical reduction of chronic dislocation of the radial head, mostly associated with proximal ulnar osteotomy and/or a procedure on the extensor retinaculum. The mean follow-up is 4 years 9 months. There were 66% excellent and good results, 25% of moderate results and 9% of poor results. Due to the difficulty of surgery of neglected lesions, the authors report their experience and emphasize the importance of the initial diagnosis.

Congenital dislocation of the patella. Part II: orthopaedic management.

Five patients (eight knees) with diagnosed congenital dislocation of the patella and well-documented charts were reviewed. Age at diagnosis ranged from 4 days to 6 years. A flexion contracture of the knee and femorotibial rotatory dislocation of varying degrees were present in all the cases. The quadriceps was active in all the cases, producing knee flexion in four cases. Foot deformity was associated in all the cases (clubfoot, calcaneovalgus, or congenital vertical talus). Gradual correction of knee flexion contracture with serial casting was attempted in five cases leading to an almost complete extension in two cases. Treatment of patellar dislocation was surgical in all the cases, consisting in extensive quadriceps release (seven knees) or V-Y lengthening (one knee), division of lateral soft tissues, and reefing of the medial retinaculum and capsule. Intraoperative anomalies were recorded. At an average follow-up of 6.9 years, all the patients are able to walk on their operated limb, and the patella is centered in the trochlea in all the cases. Knee mobility, rotatory dislocation, and daily function were improved in seven cases.

Congenital dislocation of the patella. Part I: pathologic anatomy.

There has been considerable confusion between true congenital dislocation of the patella and other patellar instabilities. Only very few papers describing the anatomical features of congenital dislocation of the patella are found in the literature. The purpose of this paper was to describe the anatomical anomalies found in two cadaver specimens of a true permanent and irreducible congenital patellar dislocation. The quadriceps femoris is short and displaced laterally and acts as a knee flexor. The patella is small, articulating with the outer aspect of the lateral condyle, with no possibility of medial reduction onto the trochlea. Many other anomalies involving the bones, muscles, and nervous structures were found. Congenital dislocation of the patella must be distinguished from other patellar dislocations in children. The severity of structural anomalies is mainly owing to its prenatal onset. Congenital