Short-term and mid-term outcome of total ankle replacement in haemophilic patients.

BACKGROUND: Ankle arthropathy is very frequent in haemophilic patients. Prostheses are valuable alternatives to arthrodesis in non-haemophilic patients. We report the experience of a single centre in France on the use of prostheses in haemophilic patients. METHODS: Retrospective study of 21 patients with haemarthropathy who underwent ankle arthroplasty (32 ankles), with additional surgery, if needed, from July 2002 to September 2009 (mean follow-up 4.4±1.7 years). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale was used to evaluate pain, function, ankle mobility and alignment. RESULTS: The overall AOFAS score improved from 40.2±19.4 (pre-surgery) to 85.3±11.4 (post-surgery). The function score increased from 23.6±7.7 to 35.9±6.7 and dorsiflexion from 0.3°±5.0° to 10.3°±4.4°. Two patients underwent further ankle arthrodesis. On X-ray, both tibial and talar components were stable and correctly placed in all ankles. Alignment was good. CONCLUSION: Ankle arthroplasty is a promising alternative to arthrodesis in haemophilic patients.

[Prognostic elements at early stapes of severe spinal cord injuries (value of pain sensitivity]. / Eléments de pronostic à la phase précoce des traumatismes vertébro-médullaires graves (valeur de la sensibilité à la douleur

The prognosis in serious spinal cord injury remains difficult. The neurologist has a large number of elements at his disposal, but their reliability is uncertain. Clinical information, experimental work and recent data on medullar vascularization makes it possible to isolate diagramatically in the spinal cord a medium layer which contains the pyramidal and spino-thalamic tracts. The neighbourhood of these two fasciculi confers them a similar vulnerability to severe injury. Thus when an injured tetraplegic or paraplegic patient recovers his sensitivity to pain, he finally must recover his motor function and on the contrary, the recovery of motility is impossible without a return of pain sens. Clinical observation is in consequence of major importance as it shows that the recovery of sensitivity to pain, in the case of a patient with a serious spinal cord injury, is an argument for a favourable prognosis, whereas the recovery of an isolated tact perception does not in itself makes it possible to hope for eventual recovery of motor power.

[Epiphyseal detachment of the proximal end of the tibia in a child with a vascular lesion. Apropos of a case]. / Décollement épiphysaire de l'extrémité supérieure du tibia chez l'enfant avec lésion vasculaire. A propos d'un cas.

The authors report a case of lesion of the popliteal artery associated with a fracture involving separation of the upper end of the tibia in a child following a serious accident. This lesion was treated by resection-vein graft after reduction of the fracture and immobilisation by two pins. In the light of this case, the authors undertake a review of the world literature, then assess the mechanism and the bone and vascular lesions, the various pathological classifications and the aetiologies. Finally, they emphasize the difficulty in diagnosing the bone lesion and, above all, the vascular lesion. Arteriography is indicated where there is the slightest doubt.

Thirty cases of duplication of the thumb. Operative results.

Thirty cases of duplication of the thumb have been seen during a period of 8 years. Twenty-four children underwent surgery for a total of 25 operations, and these are reviewed after a follow-up of at least a year. Wassel's type IV was the most frequent type, occurring in 14 cases. There were 23 primary operations, and 2 reoperations for frontal deviation, which were secondary to operations done elsewhere. The average age at the time of operation was 16 months, the mean follow-up is 4 years (1 to 8 years). The results are analyzed according to Wassel's criteria. Regardless of the location of the duplication, function is unaffected, the structure of the thumb is good, and the parents are satisfied. However, examination revealed some loss of mobility in 10 cases, shortening of the thumb in 5 cases, instability of the collateral ligament in 3 cases and axis deviation in 10 cases. Six of these were clinodactyly at the IP, 1 a clinodactyly at the MP and 3 Z-shaped deformities at the IP and MP. The two reoperations were done to correct a significant loss of alignment, and in each the result was upgraded from "poor" to "fair". It seems that the end results are determined at the original operation which should be done before the 18th month. The thumb with the least function, usually on the radial side, is resected and the remaining component reconstructured. This includes centralization of the insertions of the extrinsic muscles, and reinsertion of the thenar muscles. Immobilization by pinning is usually done due to the need for an osteotomy during the surgery for realignment of the axis of the thumb. It must, however, always be remembered that this surgery is cosmetic rather than functional.