[Surgical treatment of proximal femur metastases]. / Traitement chirurgical des métastases du fémur proximal.

Aging of the population results in an increase of the incidence of cancer and bone metastases. The proximal femur is one of the most frequent locations of bone metastases. A pathological fracture has a major impact on the quality of life and potentially on survival. In case of impending fracture, prophylactic fixation is therefore strongly recommended. The management of metastases of the proximal femur depends on multiple parameters, life expectancy and fracture risk being the most important ones. If survival is estimated to be less than 6 weeks, surgery is generally not indicated. Beyond 6 weeks, surgical indication essentially depends on location of the metastases on the proximal femur and the presence of a fracture.

L'augmentation de l'espérance de vie s'accompagne d'une croissance de l'incidence des cancers et des métastases osseuses. Le fémur proximal est un des sites les plus fréquents de métastases osseuses. Une fracture pathologique dans cette localisation a un impact majeur sur la qualité de vie et potentiellement sur la survie du patient. Un traitement chirurgical prophylactique est ainsi recommandé en cas de risque de fracture imminente. La prise en charge des métastases fémorales proximales se décide en fonction de multiples paramètres, dont la survie théorique et le risque de fracture sont les plus importants. Si la survie est estimée à moins de 6 semaines, une chirurgie n'est en général pas indiquée. Au-delà, l'indication chirurgicale dépend essentiellement de la localisation des lésions et de la présence d'une fracture associée.

Reticular Perineurioma of the Hand: Diagnosis and Treatment of a Rare Case of Hand Mass.

Reticular perineurioma is a rare and recently delineated morphologic variant of benign perineurioma of skin and soft tissues. Because of its nonspecific gross appearance, varying histologic patterns, and potential range of cellularity, perineurioma of the hand is likely to be confused with more commonly encountered tumor or tumor-like conditions such as schwannoma, neurofibroma, fibromyxoid tumors, and giant tumor of tendon sheath. We report the case of a 20-year-old woman who presented with a slowly growing mass of the hand, which was eventually identified as a reticular perineurioma.

[Clavicle fracture : what's new in 2017?] / Fracture de clavicule : quoi de neuf en 2017 ?

Clavicle fracture is a common injury for the general practitioner, the accident and emergency department doctor and the orthopedic trauma surgeon. Historically, most clavicle fractures were treated conservatively. During the last two decades, clinical studies have shown higher rates of nonunion or symptomatic malunion than previously thought. These publications lead to an increase in surgical management of clavicle fractures. However, recent randomized controlled trials failed to confirm any strong clinical outcome improvement after surgical treatment. Based on recent literature, we present up-to-date recommendations and a treatment algorithm for clavicle fractures management.

Les fractures de clavicule représentent une lésion fréquemment rencontrée, aussi bien par le médecin généraliste, l'urgentiste que par le chirurgien orthopédiste. Leur prise en charge, historiquement principalement conservatrice, a connu un bouleversement majeur au cours des deux dernières décennies, suite à la publication d'études qui mettaient en avant des taux de pseudarthrose et de cal vicieux (raccourcissement cliniquement symptomatique) plus importants que ceux publiés par le passé. Ces travaux ont conduit à une augmentation des prises en charge chirurgicales initiales. Cependant, les récentes études contrôlées randomisées peinent à confirmer le bénéfice clinique de l'ostéosynthèse. En s'appuyant sur la littérature récente, nous présentons les recommandations actuelles, ainsi qu'un algorithme de prise en charge, pour les fractures de clavicule.

Thoracic spinous process nonunion as an unusual cause of back pain: a case report and review of the literature.

BACKGROUND: Purely isolated spinous processes fractures are rare and are usually treated conservatively, although a few authors have reported cases of nonunion that ultimately required surgical resection. CASE PRESENTATION: We present a case of an isolated T6 spinous process pseudoarthrosis that was treated by surgical resection of the tip of the spinous process. A 34-year-old Caucasian male patient was complaining of mid-thoracic back pain without neurologic impairment more than 2 years after an isolated spinous process fracture. Magnetic Resonance Imaging (MRI) and Single Photon Emission Computed Tomography (SPECT) revealed a nonunion. We performed a resection without further complication. CONCLUSION: Although spinous process nonunions may in some cases be well tolerated, surgical resection appears to be a reliable option in case of persistent symptoms. This illustrated case shows the description of an isolated thoracic spinous process nonunion and its surgical treatment.

C2 Odontoid Fracture Associated with C1-C2 Rotatory Dislocation: A Retrospective Analysis of 2 Surgical Techniques.

BACKGROUND: Odontoid fractures in association with a C1-C2 rotatory luxation reports are seldom found in the literature. The fusion between the lateral mass of C1 and C2 could be of interest to ensure adequate treatment in these particular cases. We report 23 cases where there was coexistence of an odontoid fracture and rotatory subluxation, which were treated surgically using cages between C1 and C2 or just traditional Goel-Harms technique. We evaluated the radiologic fusion rate, reoperation rate, and complications. METHODS: This was a single-center, retrospective, cohort study of patients with C2 fractures (mixed type and C1-C2 rotatory luxation according to the Fielding classification) who were treated surgically. Radiologic computed tomography scans were used to assess fusion (presence of bridging trabecular bone end plate or pseudoarthrosis) between 6 months and 1.5 years after the surgery. RESULTS: Twenty-three patients were diagnosed with C2 fractures and C1-C2 rotatory luxation that were treated surgically and were suitable for the analysis; 11 patients underwent C1-C2 fusion with intra-articular cages, and 12 underwent a classical Goel-Harms technique. The fusion rate at the C1-C2 joint was higher in the cages group. Only 12 patients exhibited fusion at the level of the odontoid fracture. CONCLUSIONS: C2 fractures associated with C1-C2 rotatory dislocation are rare. The fusion rate at the level of the odontoid in these patients appears to be lower than that reported in patients without rotatory dislocation. It may be of special interest to obtain a clear fusion at the C1-C2 joint, where this type of implant seems to offer an advantage.

Evolution of the Cross-Sectional Area of the Osseous Lumbar Spinal Canal across Decades: A CT Study with Reference Ranges in a Swiss Population.

Spinal canal dimensions may vary according to ethnicity as reported values differ among studies in European and Chinese populations. Here, we studied the change in the cross-sectional area (CSA) of the osseous lumbar spinal canal measured in subjects from three ethnic groups born 70 years apart and established reference values for our local population. This retrospective study included a total of 1050 subjects born between 1930 and 1999 stratified by birth decade. All subjects underwent lumbar spine computed tomography (CT) as a standardized imaging procedure following trauma. Three independent observers measured the CSA of the osseous lumbar spinal canal at the L2 and L4 pedicle levels. Lumbar spine CSA was smaller at both L2 and L4 in subjects born in later generations (p < 0.001; p = 0.001). This difference reached significance for patients born three to five decades apart. This was also true within two of the three ethnic subgroups. Patient height was very weakly correlated with the CSA at both L2 and L4 (r = 0.109, p = 0.005; r = 0.116, p = 0.002). The interobserver reliability of the measurements was good. This study confirms the decrease of osseous lumbar spinal canal dimensions across decades in our local population.

Isolated Femoral LCL Avulsion Fracture in the Adult Knee: Two Patient Cases and Literature Review.

Avulsion injuries of the LCL most commonly occur at the fibular insertion. Femoral LCL avulsion injuries have only been previously described in pediatric patients or as multiligament knee injury components among adults. This case series with comprehensive literature review describes for the first time 2 cases of isolated LCL femoral avulsion fractures in adults including conservative treatment outcomes. Both patients sustained a strong varus stress mechanism to their right knee, following sport injury or road traffic accident. For both patients, a complete radiographic evaluation including X-rays, MRI, and CT scan confirmed no other associated knee lesions. The femoral LCL avulsion fractures that were observed were minimally displaced and noncomminuted. Furthermore, imagery suggested preserved integrity at the superior lateral genicular artery, adjacent articular capsule, and IT band. Based on clinical and imaging evaluations, the decision was made to follow conservative treatment. By 10 weeks postinjury, both patients were asymptomatic with early radiological fracture healing evidence. Comparative varus stress radiographs at 20° knee flexion revealed no side-to-side differences and clinical exam showed no posterolateral rotatory instability. The second patient case presented with mild femoral LCL attachment calcification on follow-up CT-scan. Following a detailed analysis of anatomic injury characteristics, we suggest that patients with isolated femoral LCL avulsion fractures have low secondary displacement risk provided SLGA, articular capsule, and IT band integrity are present. In contrast to high-grade ligamentous and distal avulsion LCL injuries, we recommend conservative treatment for patients who sustain these lesions.

Entrapment of the Sciatic Nerve Over the Femoral Neck Stem After Closed Reduction of a Dislocated Total Hip Arthroplasty.

Sciatic nerve injury is a rare but potentially extremely disabling complication of posterior dislocated total hip arthroplasty. Initial closed reduction is recommended followed by a careful neurovascular examination. This procedure and the following stability testing are usually safe and typically associated with a very low complication rate. We report the case of sciatic nerve entrapment around the neck of the femoral stem after closed reduction of a posteriorly dislocated total hip arthroplasty. Immediate postreduction palsy led to surgical exploration, identification, neurolysis of the sciatic nerve and safe reduction was performed. Patient outcome was marked by complete sensitive sciatic nerve recovery, but complete loss of motor sciatic nerve function. This case highlights the importance of careful postreduction neurovascular assessment and prompt surgical exploration when indicated.