[Aesthetic rehabilitation of a case of maxillary fibrous dysplasia in a child]. / Réhabilitation esthétique d'un cas de dysplasie fibreuse maxillaire chez l'enfant.

Fibrous dysplasia (FD) is a rare, congenital, benign bone disorder in which healthy bone tissue is replaced by abnormal scar-like (fibrous) connective tissue. The lesions may affect one or more bones, including the jawbones. A 13-year-old girl visited the dentist for failed eruption of her left maxillary permanent teeth and facial asymmetry. Radiological analysis revealed impactions of the permanent teeth in hypertrophic, hyperdense, weakly trabeculated bone tissue. To restore the aesthetics of the smile, a treatment combining decoronation and bonded restorations was performed. FD enlargement would slow down after puberty, allowing for long-term therapies. But there is no information about implantology in this type of bone lesion. The aesthetic and functional consequences of a maxillary FD should be managed as soon as possible. Treatment involves a multidisciplinary team and follow-up care into adulthood.

Trapeziectomy and suspension ligamentoplasty for surgical revision of trapeziometacarpal joint arthrodesis failure: two cases.

Trapeziometacarpal joint osteoarthritis is a common degenerative disease. Arthrodesis is a widespread historical surgical technique to treat this pathology, providing pain relief and stability and strength of the thumb. Nevertheless, pantrapezial arthritis and non-union are not uncommon complications, leading in some cases to revision surgery. No gold-standard procedure has been described for revision of trapeziometacarpal arthrodesis failure. We describe two cases of failed arthrodesis treated with trapeziectomy and suspension ligamentoplasty, a well-known, biological, low-cost, successful, and easy-to-perform procedure.

[Evaluation of the success of medical abortion by a plasma hCG control threshold]. / Évaluation du succès de l'interruption volontaire de grossesse médicamenteuse par un seuil d'hCG sérique.

OBJECTIVES: In France, monitoring of the success of medical abortion is recommended 2 to 3 weeks after the procedure. However, there is no clear consensus on the modalities of this monitoring. The main objective of this study is to identify a threshold of serum hCG (human chorionic gonadotropin) control for medical abortions ≤7 weeks of gestation below which success can be confirmed without recourse to pelvic ultrasound. METHODS: This is a retrospective multicenter study conducted over a 14-month period. The serum hCG level, measured between the 15th and 25th day following the abortion, was compared with the results of the pelvic ultrasound performed at the follow-up visit. Ultrasound failure was defined as retention or persistent pregnancy. RESULTS: Among the 624 women included, the failure rate was 22.3%, including 86.3% of retentions, 8.6% of pregnancies stopped and 5% of pregnancies progressed. Using a ROC curve, the threshold value of hCG found to exclude failure at 95% was 253 IU/l (AUC=0.9202, sensitivity=84.17%, specificity=85.95% and positive predictive value [PPV]=63%). CONCLUSIONS: A serum hCG level ≤253 IU/l is sufficient to affirm the efficacy of medical abortion. However, since PPV is only 63% for this threshold, ultrasound should be reserved for women with high hCG levels.

[How to proceed after a failed vacuum delivery]. / Quelle voie d'accouchement choisir après échec d'extraction par ventouse.

OBJECTIVES: Compare maternal and neonatal morbidity in patients delivered by a second instrument versus cesarean section after failed vacuum. METHODS: We performed a retrospective study between January 2006 and December 2014. Case notes of 172 failed vacuum deliveries were studied. The studied parameters were blood loss, perineal tears, pH, Apgar score, neonatal reanimation and length of stay in neonatology. RESULTS: The frequency of vacuum failure was 8.7%. The use of the second instrument (77.9%) was associated with a higher prevalence of third degree perineal tears (13.4% vs. 0%; P=0.017) and more episiotomy (72.2% vs. 0%; P<0.0001). There was no significant difference regarding post partum hemorrhage between cesarean section and second instrument delivery. There was no significant difference regarding neonatal morbidity between cesarean section and second instrument delivery after failed vacuum. When an attempted second instrument delivery failed, the risk of adverse neonatal outcome was increased: newborns had a significantly longer stay in a neonatal unit (2.4 versus 0.6 days; P=0.026), lower pH (P=0.017), lower Apgar scores (7.4 versus 8.8; P=0.0373), needed intubation (P=0.0471) and had seizures (P=0.04) more often. CONCLUSION: Compared to cesarean section, the use of the second instrument increased maternal morbidity but doesn't seem to increase neonatal morbidity. If the second instrument fails, neonatal morbidity is significantly increased.

Thumb CMC total exchange arthroplasty with the ARPE implant.

We present two case reports of successful total exchange arthroplasty at the carpometacarpal joint of the thumb using an ARPE implant. In one patient (62-year-old female), a primary MOJE prosthesis had been implanted two years previous. In the second patient (48-year-old female), a primary ELEKTRA prosthesis had been implanted one year previous. At a follow-up of two and three years respectively, there were no changes in position of both ARPE implants and no signs of loosening. All clinical parameters (DASH score, pain through VAS, grip strength) had improved.