[POEMS syndrome with plasmocytoma lytic bone lesion]. / POEMS syndrome avec plasmocytome ostéolytique.

INTRODUCTION: Crow-Fukase or Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, and Skin changes syndrome (POEMS) is a rare multisystemic affection with incompletely elucidated etiopathogenesis. CASE REPORT: We report a case of POEMS syndrome in a 48-year-old adult revealed four months before admission by areflexic flask tetraparesis prevalent on the lower limbs in connection with demyelinating and axonal CIDP "like" sensoriomotor neuropathy of the four limbs electroneuromyographically. The patient presented elevated protein level in the CSF with monoclonal standard IgG gammapathy associated with a narrow band lambda, suggesting POEMS syndrome. Further explorations revealed skin lesions with glomeruloid angiomas, edematous vasomotor disorders as well as erythrocyanose, hypogonadism, papillar edema and a lytic bone lesion of the left scapula. Radiotherapy was associated with corticosteroids and plasma exchanges. Outcome was good with resolution of the symptoms and stabilization of the neuropathy. DISCUSSION: POEMS syndrome is rare; the diagnosis is based on necessary criteria, the presence of a demyelinating and axonal polyneuropathy associated with an IgA or IgG monoclonal gammapathy, the light chain being almost entirely lambda, associated to other characteristic elements, in particular glomeruloid angiomas, endocrinopathy, sclerosing plasmocytoma which must be carefully required. Treatment is based on surgical cure or radiotherapy for bone lesion and non specific treatments such as corticosteroid therapy, plasma exchanges and IVIG.

[Peroneal nerve schwannoma presenting with a peroneal palsy]. / Syndrome de paralysie péronière révélant un schwannome du sciatique poplité externe au col du péroné

Peroneal nerve injury in the lateral aspect of the knee is frequent, commonly dominated by traumatic or compressive etiologies. Tumors, generally synovial cysts, are exceptional causes. We report a case of a 70-year-old women referred for assessment of peroneal palsy syndrome found to be related to peroneal schwannoma in the lateral aspect of the knee. Schwannoma is the most frequent peripheral nerve benign tumor. It is commonly limited to cranial and upper limb nerves. Localization on the lower limbs (sciatic nerve) has been reported in 1 percent of cases. The peroneal nerve localizaton has not been reported to date. We underline difficulties of diagnosis inherent to this particular localization.

[Irreducible traumatic dislocation of the hip caused by labral and capsular entrapment with a buttonhole effect]. / Luxation traumatique de hanche irréductible par incarcération d'une capsule et du labrum entraînant un effet de boutonnière.

Irreducible hip dislocation following capsular and labral entrapment is a rare condition. We report a case of irreducible posterior traumatic pure hip dislocation where reduction was successfully achieved only with open surgery. An analysis of this case in the light of the published literature recalls the different etiologies of irreducible traumatic dislocation of the hip and the requirement for open surgery.

[Snake bite poisoning and compartment syndrome. A report of two cases]. / Envenimations par morsure de serpents et syndrome de loge. A propos de deux observations.

Snakebite poisonings are frequent In Morocco, because of the delay in treatment, they can be very serious even lethal. Treatment has two components: firstly correction of the systemic hemodynamic, respiratory and haematological disturbances and secondly administration of specific antivenom. Envenomation of a limb can lead to cutaneous necrosis, compartment syndrome and even necrotising fascitis. Early diagnosis and prompt treatment is needed to prevent these complications. We report two cases of compartment syndrome of which one was combined with systemic manifestations and the other caused residual pathology in the limb.

[Neglected fracture-dislocation of the elbow: surgical reduction with enlarging osteoplasty of the trochlear notch. Case report]. / Fracture-luxation négligée du coude : réduction chirurgicale avec plastie d'agrandissement de la grande cavité sigmoïde (a propos d'un cas).

Elbow dislocations in the infant are not very frequent and are associated to the fractures. Their management must be urgent and rigorous if complications are to be avoided. We report the case of a child aged 12 who presented with a fracture-dislocation of the right elbow, after falling from a tree. The patient was treated in a standard manner for one month. Four months later, the patient presented again, this time complaining of stiffness of the elbow. Physical examination confirmed the reduced range of movement of the elbow (flexion 80 degrees, extension -30 degrees) without associated neurovascular complication. Radiography of the elbow showed a posterior dislocation with remodelling of the humeral contours. Surgical exploration revealed normal articular cartilage, a pseudoarthrosis of the epitrochlea, a dislocation of the radial head and the sigmoid fossa of small size in relation to the trochlea. A reduction was only possible after an "enlargement plasty" of the trochlear notch. The patient was seen after an interval of six months. The elbow was stable with no vasculo-nervous complication.and had flexion of 110 degrees with extension of -30 degrees.

[Isolated dislocation of the radial head in an adult (case report and literature review)]. / Luxation isolée de la tête radiale chez un adulte (a propos d'un cas et revue de la littérature).

The authors report a case of isolated anterior dislocation of the radial head in a 28-years-old woman without functional disorders. After a literature review, they discute traumatic and congenital etiology of this injury.

[Lesions of the distal radio-ulnar joint associated with isolated fractures of the radial shaft]. / Les lésions de l'articulation radio-cubitale distale associées aux fractures isolées de la diaphyse du radius.

The authors have performed a retrospective study of 49 Galeazzi fractures treated between 1990 and 1998. This lesion is considered rare because it is often misdiagnosed as an isolated fracture of the radius. The mean age of the patients was 31 years. There was a male predominance with a sex ratio of 4/1. Road traffic accidents were the main etiology (45%). Galeazzi fracture type III in Mansat's classification represented 53%, followed by type II (33%), type I (8%) and equivalents of Galeazzi fracture (6%). The treatment was surgical in all cases. The radial fracture was internally fixed with a plate. Reduction of the distal radio-ulnar instability, achieved by manipulation, was maintained with radio-ulnar pin fixation in 53% and with plaster cast immobilization 45%. The results, evaluated according to Mikic's criteria were excellent in 87%. The prognosis of Galeazzi's fracture depends mainly on the initial treatment of the lesions of the distal radio-ulnar joint, which require for their diagnosis a meticulous clinical evaluation and a good radiological analysis.

[Carpal perilunar dislocation. Clinical study (apropos of 39 cases)]. / Luxations péri-lunaires du carpe. Etude clinique (à propos de 39 cas).

Carpal perilunar dislocations are hidden lesions with uncertain outcome and treatment which is not yet standardized. This retrospective study including 39 cases of carpal perilunar dislocations helps clarify these issues. For fresh dislocations, the diagnosis was established in 66%. Surgical treatment was performed in 26 cases. Anatomic results showed nonunion, necrosis and residual instability. Function was always decreased and was worse in open forms or after orthopedic treatment. Scaphoid screwing results were better than those from pinning. Lateral wrist x rays must always be ordered in cases of wrist trauma to avoid delayed diagnosis. Surgical treatment must systematically use a palmar incision; it permits precise repair of bones and ligamentous lesions and reduces the risk of arthritis.

[Direct communication between the lower urinary tract and the hip joint complicating acetabular fracture. A case report]. / Communication directe entre les voies urinaires basses et l'articulation coxo-fémorale compliquant une fracture de l'acétabulum. A propos d'un cas.

INTRODUCTION: Urinary complications are rare in acetabular fractures (3.5 p. 100). They can lead to immediate, secondary or late complications. CASE REPORT: The authors report the case of an uretro-acetabular fistula in a complex acetabular fracture. Intravenous urography showed the fistula with opacification of the hip joint. Surgical treatment of the fracture was contra-indicated due to the septic risk. Post traumatic degenerative joint disease appeared in our patient and a total hip arthroplasty was performed at 18 months post injury. At 6 months follow-up, clinical biological and radiographical status was good. DISCUSSION AND CONCLUSION: Hip joint contamination with urines due to uretroacetabular fistula could be responsible for septic hip arthritis and late joint deterioration. Urine drainage using a cystocatheter as in our observation is recommended. Primary and secondary treatment of the acetabular fracture remains difficult.

[Femoral neck fracture in osteopoikilosis]. / Fracture du col de fémur sur ostéopoecilie.

Osteopoikilosis was discovered in a 53-year-old patient who suffered a fracture of the right femoral neck. Plain X-rays demonstrated symmetrical bilateral stippling of variable size. No images were seen in the skull and spine. The fracture of the femoral neck was treated by total hip replacement. At surgery, the joint cartilage of the femoral head and the acetabulum had a normal aspect. Pathology examination of the femoral head demonstrated regular thick dense lamellae. Functional outcome at ten months was good (Postel-Merle-d'Aubigné score). Osteopoikilosis is an uncommon clinically latent condensing bone disease which can be revealed by bone fracture.

[Tuberculous infection after dynamic-hip screw osteosynthesis: a case report]. / Infection tuberculeuse de hanche après ostéosynthèse par vis plaque: à propos d'un cas.

We report the case of a 72-year-old woman who developed osteoarticular tuberculosis after dynamic hip screw osteosynthesis for a pertrocanteric fracture. Necrosis of the head and disassembly of the prosthetic material ensued. This patient had no history of pulmonary or extra-pulmonary tuberculosis. Certain diagnosis was established on the basis of pathology findings and successful antibiotic treatment associated with surgery: ablation of the implant, head-neck resection, total hip arthroplasty. Two hypothetical pathogenic mechanisms can be put forward: hematogenic dissemination from another focus and reactivation of latent local infection.

[Open post-traumatic anterior luxation of the hip in children. Apropos of a case and review of the literature]. / Luxation antérieure ouverte post-traumatique de la hanche chez l'enfant. A propos d'un cas et revue de la littérature.

INTRODUCTION: Anterior open traumatic dislocation of the hip in children is rare. MATERIALS AND METHODS: We report the case of a child aged 9 years, who presented following a motor vehicle accident an anterior open dislocation of the left hip associated with a fracture separation of the trochanter, a fracture of the homolateral humerus and a fracture of the contralateral femur. He was treated by open reduction of the dislocation and pinning of the various fractures. RESULTS: After 15 months functional result of the hip was good. The radiograms showed early signs of necrosis of the femoral head. DISCUSSION: The treatment consisted of emergency reduction of the dislocation. Despite this treatment, a review of the literature showed that necrosis of the femoral head is still frequent. CONCLUSION: Anterior open dislocation of the hip is a severe disease in the child and its prognosis becomes severe with the opening and the association with a fracture.

[Pure posterior luxation of the elbow in adults: immobilization or early mobilization. A randomized prospective study of 50 cases]. / Luxation postérieure pure du coude chez l'adulte: immobilisation ou mobilisation précoce. Etude prospective randomisée sur 50 cas.

INTRODUCTION: Pure posterior dislocation of the elbow is frequent in young subjects. The objective of treatment must be to reduce the dislocation and avoid complications, the most frequent being stiffness, but also elbow instability. The objective of this prospective study was to evaluate the functional and anatomical characteristics of two treatment modalities: plaster immobilization and early mobilization. MATERIAL AND METHODS: 50 cases of pure posterior dislocation of the elbow were included in a prospective study and randomized to two groups: Group I: twenty six cases were treated by reduction under general anaesthesia and plaster immobilization for three weeks, followed by rehabilitation. Group II: twenty four cases were treated by reduction under general anaesthesia, followed by early mobilization. RESULTS: We evaluated our results in terms of loss of amplitude of elbow movement (particularly extension), stiffness, instability, relapses, pain and ossification. This study demonstrated better recovery of elbow function in patients treated by early mobilization: 96% of good results with recovery of normal extension in group II versus 81% of cases in group I. Stiffness was observed in 19% of patients in group I versus 4% in group II; this difference was very significant. Comparison of pain revealed no significant difference and no relapses, instability or ossifications were observed in either of the two groups. DISCUSSION AND CONCLUSION: Early mobilization is superior to plaster immobilization, as it allows recovery of better quality elbow function without inducing instability or recurrence.

[Giant cell tenosynovial tumor, spread in the forearm soft tissues. A case report]. / Tumeur ténosynoviale à cellules géantes, diffuse des parties molles de l'avant-bras. A propos d'un cas.

Giant cell tumor of the tendon sheath (GCTTS), tenosynovial giant cell tumor are a group of rare proliferative disorders which involves synovial joints and tendon sheaths. Considerable confusion exists about the surgical treatment and diagnosis of these disorders. We report an exceptional case of a tenosynovial giant cell tumor of the forearm. It concerns a 23 years old woman presenting multiple tumors of the forearm and wrist. Result of the primary biopsy concluded to an eosinophilic granuloma. Magnetic resonance imaging demonstrated a richly vascularized tissular lesion involving the extensor carpi radialis and extensor pollicis longus. Surgical excision of the tumor was performed. Macroscopic, histologic and immunohistochimic findings confirmed the diagnosis of tenosynovial giant cell tumor. This diffused form is rare compared with the nodular one involving fingers. Optimal treatment is surgical resection. The only risk is recurrence.

[Antelunar dislocation of the wrist. Apropos of 3 cases]. / Les luxations antélunaires du carpe. A propos de trois cas.

Volar perilunar dislocation of the carpus is rare. We report three cases here. The patients were 18, 23 and 31 years of age. The etiology was a traffic accident in all cases and palmar hyperflexion of the wrist was noted in all three. Palmar dislocation was associated with a scaphoid fracture in two cases. In the third case, there was an associated fracture of the radial styloid and capitate. The patients were operated on after a delay of 48 h in two cases and four weeks in one. The dorsal approach was used in two cases and the palmar approach in the other. Reduction, fracture osteosynthesis and intracarpal temporary arthrodesis were the main lines of treatment. The functional result evaluated after a minimum of eight months' follow-up was good in two cases, and acceptable in one (Green and O'Brien score). Volar perilunar dislocation is often associated with fracture of a carpal bone, mainly the scaphoid. It occurs in young men, after a violent injury. Polytrauma is often associated. Closed reduction is attempted first but open reduction is often needed because of instability of the lesion. The functional result is good if the treatment restores carpal bone congruence.

[Juvenile aponeurotic fibroma. A case report with a review of the literature]. / Fibrome aponévrotique juvénile. A propos d'un cas, avec revue de la littérature.

Juvenile aponeurotic fibroma is a rare benign tumour which occurs mainly in young patients under 20 years of age and especially during childhood. Clinical presentation is a unique, hard and painless tumour of the palm or sole. The treatment commonly accepted for this locally recurrent tumour is complete excision with function preservation. In this paper, we report on a case of juvenile aponeurotic fibroma of the thenar area with a thickening of the first metacarpal bone shaft. Bone involvement in juvenile aponeurotic fibroma is a very rare condition. We only found one report of a comparable case in literature.

[Radial nerve paralysis after lateral dislocation of the elbow]. / Paralysie radiale au cours d'une luxation externe du coude.

Nerve injuries complicating elbow dislocation reported in literature involve ulnar and median nerve. A case of radial nerve paralysis after lateral dislocation of the elbow is reported.

[Giant cell tumor of the third metacarpal bone: a case report]. / Tumeur à cellules géantes du troisième métacarpien: à propos d'un cas.

A case of giant-cell tumor of the third metacarpal bone is reported, treated with resection and reconstruction by iliac graft. At a 5 years follow-up, the cosmetic and functional results of the hand are good.

[Results of primary median nerve repair at the wrist: report of 24 cases]. / Résultats de la réparation primaire des plaies du nerf médian au niveau du poignet: à propos de 24 cas.

INTRODUCTION: Nerve injuries of the upper limb can cause serious damage: primary repair has improved the results but the prognosis for recovery remains uncertain. We present the results of primary repair of 24 median nerve injuries at the level of the wrist. MATERIALS AND METHODS: Between 1990-1998, we repaired 57 median nerve injuries at the wrist. Only 24 patients were included in this retrospective study. The average age of the patients was 25 years (range: 18-60 years). Seventeen patients were men and seven were women. All the patients were operated within 12 h after the accident. In all the cases, epiperineural suture was performed followed by immobilisation in a cast for 3 weeks. No specific rehabilitation programme was employed. RESULTS: At review with a mean follow-up of 3 years, 46% of the patients obtained good or very good results according to Chanson's scoring system. The sensory recovery was between S4-S2 with the Weber test in 75% of patients. Fifty-eight percent of patients recovered a motor function between M3-M2. DISCUSSION: In most papers, very good and good results averaged 60%. The results in our series did not achieve this level. We believe that this is due to two factors: firstly, the age distribution of our patients and secondly the lack of a specific program of sensory rehabilitation.

[An uncommon occupational accident: tuberculous tenosynovitis of the extensor tendons of the hand]. / Accident de travail inhabituel: ténosynovite tuberculeuse des tendons extenseurs de la main.

We present a case of tuberculous tenosynovitis of the extensor tendons of the hand. Our patient was a young doctor working in the respiratory medicine department. He was injured on the dorsal aspect of the hand with a needle used for pleural aspiration. The clinical features consisted of gradually swelling, mild pain and stiffness of the metacarpophalangeal joint. The diagnosis was made after synovectomy. Histological and bacteriological examinations revealed tuberculosis. Treatment consisted of synovectomy and appropriate antibiotics. The clinical course was excellent after one year follow-up. Tuberculous tenosynovitis of the hand is a rare manifestation of extrapulmonary tuberculosis occurring in fewer than 5% of all cases of skeletal tuberculosis. Thickening of the tendon or synovial sheath and local accumulation of fluid are the characteristic manifestations. The diagnosis must be confirmed by surgical biopsy. Antibiotics and synovectomy achieve a good functional result.