Devenir des mono-arthrites chroniques indéterminées : étude rétrospective de 46 cas

Objective. – To determine the natural history of undifferentiated monoarthritis of more than 3 months’ duration and to evaluate the usefulness of classic diagnostic tools for identifying factors associated with outcomes.Method. – Retrospective study of 46 patients with undifferentiated monoarthritis of more than 3 months’ duration.Results. – Full resolution was the outcome in 50% of cases. Rheumatoid arthritis and spondyloarthropathy were the most common diagnoses in the remaining patients. HLA-B27 status was the only significant predictor of outcome: progression to spondyloarthropathy was significantly more common (P = 0.05) among HLA-B27-positive patients. Mean time to full recovery was significantly shorter than mean time to disease progression (12 vs. 45 months, P = 0.0015). Intraarticular glucocorticoid injections were effective in over 50% of patients. Arthritis relief during the month following the injection was associated with self-limited disease. The role for magnetic resonance imaging in managing patients with undifferentiated monoarthritis remains unclear.Conclusion. – In patients with undifferentiated monoarthritis, the likelihood of a full recovery is 50%. The only significant predictor of outcome was positive HLA-B27 status, which was associated with progression to spondyloarthropathy.     

La dénervation totale du poignet : une étude rétrospective de 27 cas au recul moyen de 77 mois

ObjectivesComplete wrist denervation is a palliative operation, which yields still controversial outcomes. The aim of our study is to assess the late outcomes of complete wrist denervation.MethodsIn a retrospective continuous review of 27 complete and isolated denervations of the wrist joint performed by the same surgeon in 27 patients (15 men for 12 women) from 1995 to 2007, the pain (VAS), the function (Dash-score), the range of motion, the strength (Jamar) and the radiological changes were assessed at a mean follow-up period of 77 months (12 to 157).ResultsAt final follow-up, 12 patients (44%) were completely free of pain and 11 (41%) had little pain, four (15%) had moderate and severe pain. The average time to achieve the complete pain relief was 3 months and 3 weeks. Pain relief was stable over time in 89% of cases. There was a significant improvement in range of motion: 11° flexion/extension; 8° pronosupination. In average, the Jamar grip strength was 85% of the healthy side. The Dash-score was in average 30.4 (22 to 60). The extension of the osteoarthritic surface was observed in 14 patients (52%). Six complications were noted: one complex regional pain syndrome, five neuromas four of which resolved spontaneously. Two patients were re-operated. Eighteen patients were very satisfied (67%), six patients were satisfied (22%) and three patients were moderately satisfied (11%).ConclusionsComplete wrist denervation is an intervention with few complications indicated in chronic wrist pain of any aetiology.     

Le coude flottant : étude rétrospective et revue de la littérature

The floating elbow represents an uncommon combination of lesions in traumatology. Few studies have described this lesion especially in adults. Over a period of 6 years, 12 floating elbows were reviewed retrospectively. One osteoporotic elderly patient was treated conservatively. Reduction and internal fixation using different implants was performed in the other patients. Consolidation was obtained at the humerus at 3 months (2.5–3.5 months) on average, and 2.6 months (2–3 months) at forearm bones. According to the classification of Lange and Foster, our functional results were good in 67% of cases, fair in 17% and poor in 16% cases. Good functional prognosis of the upper limb requires rapid and adequate management of floating elbows. Internal fixation followed by early rehabilitation is recommended. The choice of surgical acts depends on the location of fractures. This strategy gave satisfactory results.     

La glomérulonéphrite aiguë post-streptococcique de l’enfant dans le sud tunisien : étude rétrospective de 12 ans

AimPost-streptococcal glomerulonephritis (PSGN) is a frequent cause of acute nephritis in children. This study aimed to describe the epidemiology, clinical characteristics and outcomes of PSGN and look for predictor's factors of severity.MethodsA 12-year retrospective review of case notes and laboratory data was conducted at a department of pediatrics, pediatric emergency and intensive care, Hedi Chaker Hospital.ResultsOne hundred seventy eight children were treated for PSGN with a mean age of 7.6 ans ± 3.43 ans. One hundred and forty-two patients (80%) had a history of a recent upper respiratory tract or skin infection. Streptococcal pharyngitis was the most common cause, identified in 113 patients (67.6%). Macroscopic hematuria and edema were noted in 135 (75.8%) and 114 cases (64%) respectively. Hypertension was present in 55 patients (31%). Oliguria was noted in 30 children (16.8%). Sixty-six subjects (37%) developed acute renal impairment (creatinine ≥ 70 micromoles/L). No correlation was demonstrated between acute renal impairment and age, sex, triggering infection, anemia and white blood cell count. Creatinine greater than 56.35 micromoles/L was associated with a high risk of developing high blood pressure. The mean length of admission was 5.8 days ± 4.44. Only one subject has ongoing renal dysfunction.ConclusionPSGN remains a common nephropathy in our region. The detection and effective treatment of any infection that may be involved can reduce the incidence of this disease.