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.

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.

[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.

[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.

[The use of the B.A.S.K. total prosthesis for the reconstruction of the proximal femur after tumour excision (author's transl)]. / Prothèse B.A.S.K. de reconstruction après exérèse de l'extrémité supérieure du fémur pour tumeur.

The authors have used an original model of total hip prosthesis (B.A.S.K. Prosthesis) which allows for repair of bone losses up to 13 cm. The length of the femoral device is adjustable and it articulates with a mobile cup. It has been used in 15 cases, 13 of which were bone metastases. Three died after operation. The others were able to walk and leave hospital. No dislocation or infection occurred. One prosthesis fractured after one year. The authors believe that this type of prosthesis is worth-while in cases with a limited expectation of survival.

[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.

[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).

[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.

[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.

[Upper brachial plexus palsy. Seven cases treated by muscle transplantation (author's transl)]. / Paralysie radiculaire supérieure du plexus brachial. Traitement par transpositions musculaires associées. Résultat de sept cas.

Seven cases of upper brachial plexus palsy, have been treated by associated transplantation of pectoralis major for flexion, and of teres major and latissimus dorsi for external rotation. Operation was performed eighteen months at least after injury, during which period rehabilitation was necessary to prevent atrophy of the pectoralis major and contracture in internal rotation. The strength of flexion was improved by alterations of the original Clark's operation. The whole muscle was transplanted: its humeral tendon was fixed to the coracoid process; its thoracic extremity lengthened by an aponevrotic flap from rectus anterior was pulled through a posterior anti-brachial incision, holding the arm in anteposition and the forearm in supination. A strong tension was obtained in this way. Transplantation of teres major and latissimus dorsi tendons behind the humerus was done in the same stage. Results are in favor of these improvements: all seven patients, including two hard-workers, obtained a strong and large flexion. The useful part of external rotation was restored. All went back to their former occupations.

[The first Zancolli procedure in the treatment of cubital and mediocubital claw hand. Apropos of 32 cases]. / L'intervention de Zancolli première manière dans le traitement des griffes cubitales et médio-cubitales. A propos de 32 cas.

The authors have reviewed 32 cases of claw hand due to lesions of the ulnar nerve only in 25 cases or associated lesions of the ulnar and median nerve in 7 cases treated by the first Zancolli procedure. This procedure consists of advancement of the pulleys and anterior capsulorraphy of the metacarpo-phalangeal joints. One case had to be operated on twice. In 25 instances there was a complete division of the nerve. One 17 occasions the procedure was done on the ring and little fingers only and on 12 occasions on the other finger. The results were excellent or good in 23 cases. An associated tendon transfer in the thumb was done in all cases in which there was an associated median lesion.

[Treatment of acute pyogenic arthritis of major joints of the limbs]. / Traitement des arthrites aiguës à pyogènes des grosses articulations des membres.

The authors have treated 52 cases of septic arthritis of major joints. When aspiration contain an opaque fluid, conservative treatment with antibiotic therapy and immobilisation obtained healing in half of the patients. Surgical lavage of the joint was needed on 21 occasions with healing in 15. Synovectomy was performed in 8 cases and was indicated only at the stage of pyogenic synovitis before the development of pyogenic arthritis. When the latter stage was reached, arthrodesis was indicated. It was performed primarily on 6 occasions and secondarily once. Seven patients died. The average age was seventy years. The importance of early treatment is stressed.

[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.

[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.

[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.

[The peroperative isotopic location of osteoid osteomas and other lesions exhibiting increased uptake on scintigraphy]. / Le repérage isotopique per-opératoire des ostéomes ostéoïdes et autres lésions hyperfixantes à la scintigraphie.

The technique, advantages and pitfalls of the isotopic localization and control during operation in orthopaedic surgery were evaluated throughout 28 interventions on lesions, which exhibited an increased uptake of a radioactive bone-seeker: the dimethyl-aminodiphosphonate, provisionally designated SF44 (Laboratoires Solabco, Coutras, France). For bone scanning, following the injection of this radiopharmaceutical that increased by 25% the lesion to normal bone ratio compared to the data for the diphosphonates in current use, the localization of lesions at surgical sites was carried out with the use of a sterilisable small radiation probe of a circular cross section 2 mm in diameter (Quartz et Silice, Paris, France). The probe was connected to a portable electronic device that converted the rates of radioactive disintegration into an acoustic signal, which increased with increasing radioactivity (Novelec, Meylan, France). The method was atraumatic and has proved to be useful at various times of the operation. More often, it was used to locate the lesion on the exposed bone. It enabled monitoring the progress of excisions and allowed to shorten their dimensions. The method was of great value at the end of the intervention for ensuring a complete excision as indicated by the lack of any residual focus of increased uptake detectable on the periphery of the operative site. Isotopic control during an operation is fully efficient to locate osteoid osteomas and other circumscribed lesions of the skeleton that give rise to an increased uptake of radioactivity.

[Comparative study of 4 types of polyester arterial prostheses]. / Etude comparative de 4 types de prothèses artérielles en polyester

The authors report a comparative study of 4 types of arterial prosthesis made of polyester. After implantation in the dog, the superiority of unfolded Rhodergon velvet prostheses was shown. They have excellent qualities for tissue reconstruction owing to presence of histological structures characteristic of large caliber arteries and absence of histological changes and hemorrhagic suffusion after the 12 th month following insertion.

[Post-traumatic discoligamentous lesions of the lower cervical spine : delayed diagnosis of a second lesion (author's transl)]. / Lésions disco-ligamentaires étagées d'origine traumatique du rachis cervical inférieur. A propos d'une observation.

Unilateral luxation of the lower cervical spine was diagnosed following injury in a patient, an associated severe subjacent ligamentous sprain remaining undetected until a later date. The reasons for the delay in making the second diagnosis are exposed. The possibility of employing peridurography in order to treat these discoligamentous lesions simultaneously, is discussed.

[Tarsal tunnel syndrome caused by granulomatous arteritis of an artery supplying the posterior tibial nerve. Apropos of a case]. / Syndrome du canal tarsien par artérite granulomateuse de l'artère nourricière du nerf tibial postérieur. A propos d'un cas.

A patient presented with a tarsal tunnel syndrome due to granulomatous arteritis of the artery supplying the tibial nerve. The pathogenicity of these types of lesion is discussed based on findings during operation, and a logical therapeutic attitude established: early opening of the tarsal tunnel with interfascicular neurolysis of the tibial nerve.