[McGregor's flap: a salvage technique: about a case, clinical features and outcome]. / Lambeau de Mac Gregor, solution de sauvetage: à propos d'un cas, clinique et résultat.

Inguinal flap is a distant axial pediculated flap. This flap is reliable in covering large losses of substance of the upper limb. Its major drawback is that it requires two-step surgery. Inguinal flap is the elective method in the arsenal of emergency left hand surgery or in common left hand surgery. This is due to its greasy thickness and its short small pedicle, with frequent anatomical variations. The purpose of this study was to show its role imbalance out its advantages and its disadvantages. We report the case of a 33-year female patient presenting with severe deformation with closure of the anterior commissure and first metacarpophalangeal joint ankylosis after complex open trauma of the hand. The patient underwent two-step surgery with opening the first commissure and trapezio-M1 arthrodesis stabilized by plug insertion followed by immediate skin coverage by McGregor's inguinal flap and after 21days by weaning and donor site suture. Anatomical and functional outcome was good. The patient was satisfied with the scar at the donor site, which could be easily covered with clothing, by the functionality and aesthetics of the hand. McGregor's flap is an attractive solution for coverage with significant advantages from a functional and aesthetic point of view. Its role should be enhanced in the therapeutic armamentarium of flaps for limb coverage.

Are painDETECT scores in musculoskeletal disorders associated with duration of daily pain and time elapsed since current pain onset?

OBJECTIVES: We aimed to compare painDETECT scores in outpatients seen in a rheumatology department over a 1-month period and search for correlations between painDETECT scores and the estimated duration of daily pain and time elapsed since the onset of current pain. PATIENTS AND METHODS: A total of 529 of 738 outpatients agreed to complete a set of questionnaires, including painDETECT. RESULTS: The mean painDETECT score was 14.14 ± 7.59, and 31% of the patients had painDETECT scores of >18. Fibromyalgia ranked first (21.2 ± 6.0), followed by osteoarthritis of the lower limbs (17.8 ± 8.2), back pain and radiculopathies (16.1 ± 6.8), osteoarthritis of the upper limbs (15.7 ± 8.1), spondylarthrosis (15.1 ± 7.2), entrapment neuropathies (14.1 ± 2.4), rheumatoid arthritis (13.8 ± 7.1), miscellaneous conditions (13.8 ± 8.2), tendinitis (13.4 ± 7.9), connectivitis (11.5 ± 6.7), and osteoporosis (8.5 ± 6.9). The duration of daily pain was much longer in patients with painDETECT scores of >18 (12.41 ± 8.45 vs 6.53 ± 7.45 hours) (t = 0.0000), but very similar painDETECT scores were observed for patients suffering from pain for less than 1 week (13.7 ± 8.2; 38% > 18), for 1 month (14.5 ± 8.2; 25% > 18), several months (12.7 ± 7.3; 23% > 18), 1 year (13.8 ± 7.7; 29% > 18), or several years (14.7 ± 7.4; 33% > 18). CONCLUSION: PainDETECT scores differed little depending on the musculoskeletal condition, strongly correlated with the duration of daily pain, and appeared to be as high in patients with recent pain as in those suffering for years.

IMSYC immunologic synovitis score: A new score for synovial membrane characterization in inflammatory and non-inflammatory arthritis.

OBJECTIVES: Krenn synovitis Score has been developed by Krenn et al. in order to assess synovitis severity and is used in synovial research. Cell signature of synovial tissue can be studied using immunohistochemistry and is of interest as a biomarker for both prognosis and prediction of response to treatment. However, no synovitis score including immunohistochemistry exists yet. In order to answer this unmet need, we propose a new Immunologic Synovitis score (IMSYC) adding 5 components to the Krenn score: CD68, CD3, CD20, CD31 and Ki67 immunostaining. In this study, we aimed to validate this new IMSYC by studying its diagnostic performances in a well-defined collection of synovial samples. METHODS: Synovial samples from patients were obtained during surgical procedures. CD68, CD3, CD20, CD31 and KI67 immunohistochemistry were performed. RESULTS: In total, 77 patients were included. In total, 45 were females, mean age was 63.1 years. Forty had inflammatory arthritis, mainly rheumatoid arthritis (31/40). Non inflammatory arthritis group included 35 patients with mainly osteoarthritis. Mean Krenn score and IMSYC were significantly higher in the inflammatory group (P<0.001). ROC analysis of diagnostic performances determined the score of 13.5 out of 24 as the cut-off that gave the best ratio for discrimination between inflammatory and non-inflammatory arthritis with a sensitivity of 71.8% and specificity of 98%. CONCLUSION: We propose a new synovitis score including immunohistochemistry. This score has a better sensitivity and specificity than the Krenn score and represents a more functional synovitis evaluation. IMSYC could be further used in better categorizing synovial tissue phenotype and give a basis for tissue driven therapy.

[Clubfoot in adult patients treated with tibiocalcaneal arthrodesis: about two cases (3 feet)]. / Pied varus équin de l'adulte traité par arthrodèse tibiocalcanéenne: à propos de deux cas (3 pieds).

Inveterate clubfoot (inveterate talipes equinovarus, ITEV) is a vicious attitude of the foot which doesn't rest on the floor through its normal base of support but weight is thrown to the outer side of the foot and to the foot point. When this vicious attitude persists a long time, it results in severe osteoarticular deformities in adults. Fixed ITEV is a good indication for tibiocalcaneal arthrodesis. In the majority of cases this provides painless and stable plantigrade foot. This study aims to assess the clinical and radiological outcomes of astragalectomy with tibiocalcaneal fusion. This case series involves 2 adult patients undergoing tibiocalcaneal arthrodesis due to severe and annoying equinovarus rearfoot deformity. Outcome was satisfactory with painless and stable plantigrade foot. At 90-day follow-up the patient with bilateral clubfoot had no inequality while the patient with unilateral clubfoot had a shortening of 2 cm compensated by right sole. In the majority of cases with severe and fixed deformities of the ankle and of the ITEV, tibiocalcaneal arthrodesis allows for painless and stable plantigrade foot, without vascular or cutaneous risk.

Osteoporosis-Pseudoglioma in a Mauritanian Child due to a Novel Mutation in LRP5.

Osteoporosis-pseudoglioma (OPPG) syndrome is a very rare autosomal recessive disorder, caused by mutations in the low-density lipoprotein receptor-related protein 5 (LRP5) gene. It manifests by severe juvenile osteoporosis with congenital or infancy-onset visual loss. We describe a case of OPPG due to novel mutation in LRP5 gene, occurring in a female Mauritanian child. This 10-year-old female child was born blind, and after then multiple fragility fractures appeared. PCR amplification and sequencing revealed a novel homozygous nonsense mutation in exon 10 of the LRP5 gene (c.2270G>A; pTrP757(⁎)); this mutation leads to the production of a truncated protein containing 757 amino acids instead of 1615, located in the third ß-propeller domain of the LRP5 protein. Both parents were heterozygous for the mutation. This is the first case of the OPPG described in black Africans, which broadens the spectrum of LRP5 gene mutations in OPPG.