Ostéome ostéoïde à localisation multifocale et récurrente du carpe

The autors report a case of osteoid osteoma located simultaneously at the right carpitate and at the proximal part of the right third metacarpian. A 31 years old man presented in 1997 an osteoid osteoma involving the right capitate. One year after the surgical excision of the tumor, a second osteoid osteoma reappears to the same place requiring a 2nd intervention. A 3rd osteoid osteoma  was discovered 16 months later at the proximal part of the right third metacarpian. After every excision, the pathological aspect was compatible with a nidus of osteoid osteoma. Osteoid osteoma of capitate are very rare. Multifocal forms are exceptional. If relapses of the tumor are sometimes explained by the incomplete excision of the nidus, the pathogenis of the true recurrence remains unclear.     

Traitement d’une fracture-luxation chronique de l’interphalangienne proximale par un greffon d’hémi-hamatum

Fracture-dislocations of the proximal interphalangeal (PIP) joint are complex and challenging to manage once they become chronic. We report a case of PIP joint fracture-dislocation treated by hemi-hamate arthroplasty. An 18-year-old male polytrauma patient presented with a neglected PIP joint fracture-dislocation in the third finger of the left hand. After four months of follow-up, he remained disabled due to clinodactyly and stiffness. After performing a cadaver study to evaluate the feasibility of grafting, we resurfaced the bone-cartilage defect with a hemi-hamate arthroplasty. The range of motion at the last follow-up was 65° without pain; the DASH score was 2.27. The patient was able to return to heavy manual labour work at 5 months postoperative.     

Ostéite chronique multifocale récurrente : évolution à 5 ans de 14 cas pédiatriques

Objective. To determine the clinical presentation and outcomes of chronic recurrent multifocal osteomyelitis (CRMO) in pediatric patients. Patients and methods. Ten girls and four boys were followed up between 1993 and 1999 for CRMO diagnosed on the basis of radiographic bone lesions with, at the same sites, increased radionuclide uptake, negative microbiological specimens, and histological evidence of nonspecific osteomyelitis. Results. Mean age at CRMO was 9.6 ± 3.4 years, mean disease duration was 5.3 ± 2.5 years, and mean number of flares per patient was 5.9 ± 3.7. Thirty-four per cent of lesions were in the metaphyses of the lower limb bones, 14% in the pelvis, and 13% in the chest wall (with clavicular lesions in four patients). Three patients had skin lesions (psoriasis in two and palmoplantar pustulosis in one). Eight patients received antibiotic therapy, for two months at the most, to no advantage in the short term. Nonsteroidal antiinflammatory drugs were used in all 14 patients and glucocorticoid therapy in four. Sulfasalazine was used in five patients, to good effect in four. Mean follow-up was 5.3 ± 2.5 years. At last follow-up, eight patients had active disease, including one with synovitis and one with Takayasu disease. Conclusion. As compared to SAPHO syndrome, skin lesions and chest wall involvement are less common in CRMO. The long-term prognosis is guarded: in our study only six of 14 patients were in remission at last follow-up.     

Traitement de l’ostéoporose postménopausique par les agents anaboliques

The main efficacy criterion for drugs against osteoporosis is protection against fractures. Many resorption-inhibiting agents meet this criterion, including estrogens, alendronate, risedronate, raloxifene, calcitonin, and calcium-vitamin D supplements). Conversely, among anabolic agents, only parathyroid hormone (PTH) is known to reduce the fracture risk, the mechanism being increased bone matrix production by osteoblasts with no alterations in the mechanical properties of bone. Although fluoride salts induce a marked increase in bone mineral density (BMD), there is no evidence that this protects against vertebral or peripheral fractures. Growth hormone, IGF-I, statins, and strontium ranelate are under investigation. A recent controlled clinical trial in 1637 women with osteoporosis showed that daily subcutaneous injections of PTH (1-34) (20 or 40 μg) for 21 months reduced the fracture risk. With 20 μg/day, the reductions were 65 % for vertebral fractures and 57% for extravertebral fractures, 11% of patients had moderate postinjection hypercalcemia, and BMD increased by 9 % at the lumbar spine and by 3 % at the femoral neck. These findings open up the exciting possibility that PTH used alone or in combination with resorption-inhibiting agents may be helpful. To date, PTH is the only anabolic agent that has proved capable of reducing the risk of vertebral and extravertebral fractures in women with established postmenopausal osteoporosis.     

Arthrite de l’arrière-pied révélatrice d’un ostéome ostéoïde intra-articulaire. À propos de deux cas

Osteoid osteoma is a tumour, commonly found in the long bones. The intra-articular presentation in the hindfoot is very rare. We are reporting on two cases of intraarticular osteoid osteoma of the subtalar joint located on the calcaneus. Atypical clinical symptomatology was the reason for the delayed diagnosis. In both cases, a CAT scan of the ankle enabled a diagnosis of osteoid osteoma to be made. Open surgical resection enabled a full recovery to be achieved, with all pain being alleviated. Through these two case studies, clinical, paraclinical and therapeutic aspects of the intra-articular presentation of osteoid osteoma in the foot and ankle will be discussed.     

Angiodysplasie colique et hémodialyse chronique. Traitement par coagulation au plasma argon. À propos d’un cas

IntroductionGastrointestinal angiodysplasia is a very common cause of digestive haemorrhage among patients with chronic renal insufficiency. It is well known that bleeding from angiodysplasias can be a difficult therapeutic problem since therapeutic possibilities are scarce and surgery is scolded with high mortality rate. Endoscopic argon plasma ablation therapy is a new, effective and safe treatment in the management of gastrointestinal angiodysplasia.Case reportWe reported a case of a female haemodialysis patient aged 40 years. She was haemodialysed since 6 years in our center from unknown nephropathy. In March 2006, she complained of black stools and melena, and developed severe anaemia (Haemoglobin at 4 g/dL). Exploratory endoscope examination of the digestive tract showed the presence of bleeding from angiodysplastic lesions of the right colon. The patient had severe clinical picture extension of angiodysplastic lesions and frequent bleeding episodes. Bleeding arrest was observed after argon plasma coagulation, with a significant decrease of blood transfusions and improvement of anaemia.ConclusionGastrointestinal angiodysplasia was reported to be an important complication in dialysis patients and was recognized as an important cause of erythropoietin-resistant anaemia. It can worsen vital prognosis. Argon plasma coagulation is an effective treatment in these patients.     

Traitement des sténoses de l’urètre par urétrotomie interne endoscopique: résultats anatomiques et fonctionnels d’une série de 244 cas

Objective

To evaluate the results of a homogeneous series of urethral strictures treated exclusively by endoscopic internal urethrotomy and to determine the factors that may predict the outcome.

Patients and Methods

Between 1989 and 2007, 244 patients were treated for urethral stricture. All of them were subjected to endoscopic direct vision internal urethrotomy (DVIU).

Results

34.3% of good results were achieved after the first DVIU. Mean follow-up was 3.5 years. No mortality was encountered, while the rate of morbidity was 5%. Better results were achieved in patients with short (< 2 cm) and single strictures in the proximal urethra. Mean post-operative catheterization was 2 days; a further extension of the catheterization time did not yield any significant improvement. Unsatisfactory results (65.5%) were found in patients with large urethral strictures located in the distal urethra or in elderly patients. 62.5% of the patients showed a satisfactory outcome after a second urethrotomy, while the other patients required urethral dilatation or urethroplasty.

Conclusion

DVIU is a simple procedure which does not have a high rate of morbidity and requires short hospitalization. With a steady success rate of around 75.4% after a follow-up of 3.5 years we feel that DVIU can be recommended as treatment of choice for all short, single and proximal urethral strictures, preferably in young patients without previous interventions on the urethra     

Traitement chirurgical de l’hallux valgus par ostéotomie métatarsienne : à propos de 85 pieds

Introduction

The authors present the results of surgery for hallux valgus in 69 patients (85 feet) by metatarsal osteotomy (Scarf or chevron osteotomy) associated with phalangeal osteotomy, in 2004 and 2005.

Material and methods

In this retrospective study of 58 female and 11 male middle-aged patients (mean age: 57 years), the hallux valgus was 33° on average and the metatarsus varus 15°. All the patients suffered pain on the bunion and had difficulty wearing shoes. The patients were reviewed with X-rays of both feet with weight bearing and a Guntz view of the sesamoid bones. This enabled measurement of the metatarsus varus, the hallux valgus, the distal metatarsal articular angle (DMAA), the distal articular angle of M1 in relation to M2 (DM2AA), the proximal phalangeal articular angle (PPAA) and evaluation of the position of the sesamoid bones. The clinical evaluation was based on the Groulier scoring system.

Results

In the average follow-up time of 21 months, 81% of the patients were satisfied or very satisfied. The objective result was good or very good in 83.6%. There was a connection between the clinical results and the correction of the metatarsal phalangeal angle (M1P1), the intermetatarsal angle (M1M2), the DMAA, the DM2AA and the PPAA. Fifteen percent of patients had complications (insufficient correction, hematoma and superficial sepsis). Two patients were reoperated for an iatrogenic hallux varus. The poor anatomic results and the Groulier score correlated with subjective results.

Discussion

Our results are comparable with those described in the literature. The Groulier scoring system gives a good objective evaluation of the results since it takes into account radiological anatomical data that affects the final result in cases of insufficiency or loss of correction. The correction of DM2AA is essential to achieve a good anatomical result.

Conclusion

Operative correction of hallux valgus must remain a functional and not aesthetic operation. In addition, distortion of the remainder of the forefoot must be taken into consideration when planning treatment, as this impacts on the final result.