[Poland'syndrome and hand's malformations: about a clinic series of 37 patients]. / Syndrome de Poland et malformations de la main: à propos d'une série clinique de 37 patients.

INTRODUCTION: Poland's syndrome is a rare malformation which associates thoracic anomalies and anomalies of homolateral upper end. We wish to know the frequency of hand's malformations in this syndrome in our clinical experience. MATERIAL AND METHODS: We have revised 37 patients who were seen initially for a thoracomammary anomaly. This clinical series from plastic surgery service of Toulouse has been revised to know the importance of hand's malformations. RESULTS: Hand's malformations in Poland's syndrome are rare in your study, they touch only 12% patients. We find only 4 malformations in 33 patients, four were lost. They were only females, we find three brachymesophalangies and a major form. DISCUSSION: Hand's malformations in Poland's syndrome are less frequent than classically. There is no parallelism between gravity of thoracic malformation and that one of upper end. In this series, we find only one case with syndactyly; originally, Poland's syndrome was named << Poland's syndactyly >>. Finally, we think that we can talk about Poland's syndrome without anomaly of homolateral upper end, the major element is musculary agenesia of sternocostal pectoralis major. The search of homolateral upper end has to be systematic in front of suspicious of Poland's syndrome.

[Poland's syndrome: clinic series and thoraco-mammary reconstruction. Report of 27 cases]. / Syndrome de Poland: série clinique de reconstructions thoraco-mammaires. A propos de 27 patients opérés.

The authors evaluate the quality of thoraco-mammary reconstructions in Poland's syndrome. There was 34 patients in our serie, and 27 were operating between 1982 and 2001. There was 19 women and 8 men; the mean age was 19 years (9-40 years). Because of the clinical variability, the authors propose a classification of the malformation's importance in 3 degrees. In our serie, there is 35% of degree I, 53% of degree II and 12% of degree III. Each patient had an average of 2 general anaesthesias (1-6). For the first operation time, men had translation of the homolateral latissimus dorsi muscle flap in 25%, and a thoracic prosthese in 75%. Women had mammary prosthese in 50%, expansion prosthese in 20%, mammary prosthese and thoracic prosthese in 20%, muscle flap in 10%. The same person analysed the results in terms: good, middle or bad. The results are good in 67%, middle in 22%, poor in 11%. In degree 1, the results are always good; in degree II, they are good in 59%, middle in 29% and poor in 12%; in degree III, the results are good, middle and poor in 33%.

[Funnel chest: filling technique with deep custom made implant]. / Pectus excavatum: technique de comblement par endoprothèse profonde sur mesure.

Through 97 patients over 9 years, the authors present a surgical treatment for "funnel chest" using custom-made silicone elastomer prothesis which are deeply placed, behind muscle and aponevroses. They justify the choice of this simple and non invasive technique, by the fact that this deformation is only morphological in most cases or even only inaesthetic with exceptional cardiac or pulmonary consequences. Patient's motivation being mainly due to psychological disconfort, the non invasive aspect of the technique leads them to choose surgery, particularly as results are good and complications seldom.

[About an uncommon case of post-irradiation sarcoma of the chest wall]. / A propos d'un cas rare de sarcome radio-induit du sein.

A case of postirradiation leiyomyosarcoma of the chest wall is presented. The tumor occurred after 4 episodes of radiotherapy over a period of 12 years. Criterious to define the radiation-induced sarcoma are discussed. The location of the leiomyosarcoma in comparison with the different irradiated fields shows that the tumor occurred in the border line of the differents fields called "zone of penumbra".

[Tibial fracture with intact fibula treated by reamed nailing]. / Fracture de jambe à fibula intacte: intérêts de l'enclouage centromédullaire.

PURPOSE OF THE STUDY: The main difficulties encountered in the orthopedic treatment of leg fractures with intact fibula are reduction of the tibial and an unusually high rate of varus unions and non-unions. The aim of this retrospective study was to assess the outcome after reamed nailing of tibial fractures with an intact fibula. MATERIAL AND METHOD: Between 1986 and 1997, 38 fractures of the tibia with an intact fibula were treated by first intention centromedullar nailing. There were 28 men and 10 women, mean age 28 years, with a single fracture in 25 cases. There were 25 motor vehicle accidents (17 two-wheel, 8 four-wheel), 5 sports accidents, 2 home falls, and 6 others. Fracture of the tibial diaphysis was associated with a homolateral femoral fracture in 7 cases, 7 fractures were open (7 type 1, 2 type 2, 1 type 3), 7 fractures were associated with abrasive skin lesions. Using the AO classification, the tibial fracture was type A in 26 cases, type B in 11, and type C in 1. The fracture was in the middle third of the tibia in 21 cases, the distal third in 15 and in the proximal third. Grosse and Kempf nails were used exclusively. Static nailing was used in 27 cases, dynamic nailing in 8, and the nail was not locked in 3 cases. Nails of diameter 9 to 13 were implanted after reaming 1 mm more. RESULTS: The fracture gap increased during the reaming in 5 patients; 2 patients had to undergo a secondary aponeurectomy due to a postoperative compartment syndrome and had no further sequela. Consolidation was achieved after the first intention treatment in 30 patients, after dynamization in 6. A non-union in 2 patients was also successfully managed with new nailing and dynamization. Delay to consolidation was a mean 175 days (range 60 - 480). Transverse fractures consolidated more rapidly (mean 122 days). At last follow-up (minimum 1 year), active knee and ankle mobility were normal in all patients. Nineteen patients complained of pain at the site of the nail insertion, evaluated at 1 on a 10-point analogie scale by 10 of them and at 2 by the 9 others. Eight out of 10 patients felt cure had been achieved 5 months postoperatively. DISCUSSION: These rapidly obtained clinical results and the relatively low rate of non-union (5 p. 100) should be attributed to the reamed nailing technique. We discuss the frequency of tibial fractures with intact fibula and the underlying circumstances. The lack of patent fibular fracture does not signify the fibula is intact. Trauma-induced tibio-fibular dislocation (1 case in our series) can occur. A review of the literature emphasizes the frequency of non unions and misalignment after orthopedic treatment. The most widely used surgical technique is reamed nailing. This technique has the inconvenience of possible pain at the insertion site which usually disappears after ablation of the nail and also a compartment syndrome where reaming is a possible aggravating factor. CONCLUSION: Nailing is a reliable technique for the treatment of tibial fractures with an intact fibula. Weight bearing should be encouraged as early as possible. The indication for a locked nail depends on the anatomic type of the tibial fracture and its localization. Immediate weight bearing should be recommended. Strict surveillance allows dynamization with fibulotomy in case of late consolidation. Prospective randomized studies comparing nailing with other therapeutic methods are needed to confirm these data.