Traitement des fractures de la phalange proximale des doigts par brochage percutané en tour Eiffel. À propos de 45 cas

The authors report in the treatment of fractures of the proximal phalanx of the fingers, the use of Eiffel Tower pinning, a relatively simple method, fast and stable, associated to a protection and early rehabilitation. The objective of this method is to offer to the patient a pollici-digital grip. Our study is a retrospective study of 45 patients treated for fractures of the proximal phalanx of the fingers by percutaneous pinning according to Eiffel Tower method. We detail this simple and economic technique and examine the functional and radiological results of this series of patients. The amplitude of the active total motion of the proximal interphalangeal joint is on average 94.16° (78.5 % of the normal active mobility of the proximal interphalangeal joint), and the amplitude of the active total motion of the metacarpo-phalangeal joint is on average 90.05° (75 % of the normal active mobility of the metacarpo-phalangeal joint).     

Doppler spectrum analysis: a potentially useful diagnostic tool for planning the treatment of patients with Charcot arthropathy of the foot?

It is difficult to determine the safe timing of weight-bearing or reconstructive surgery in patients with Charcot arthropathy of the foot and ankle. In this study the Doppler spectrum of the first dorsal metatarsal artery was used to monitor the activity of the disease activity and served as a guideline for management. A total of 15 patients (seven men and eight women) with acute diabetic Charcot arthropathy of the foot and ankle were immobilised in a non-weight-bearing cast. They were followed at two-week intervals and bilateral Doppler spectra of the first dorsal metatarsal arteries were obtained using a 10 MHz linear ultrasound probe. The patients were allowed to start weight-bearing or undergo surgery after the Doppler spectrum had returned to normal pattern. The Doppler spectra in the unaffected limbs were triphasic in pattern, whereas those in limbs with active Charcot arthropathy showed monophasic forward flow. They returned to normal after a mean of 13.6?weeks (6 to 20) of immobilisation. Three patients underwent pan-talar arthrodesis to correct gross instability and deformity. Doppler spectrum analysis of the foot may reflect the activity of the disease in patients with Charcot arthropathy, and may be used as a guide to begin weight-bearing or undergo reconstructive surgery.     

The use of sacral neuromodulation for the treatment of non-obstructive urinary retention secondary to Guillain-Barré syndrome

Guillain-Barré syndrome, an acute autoimmune polyneuropathy and demyelinating disease, is characterized by weakness, sensory loss, areflexia, pain, autonomic dysfunction, and occasionally, micturition disturbances including voiding difficulty, urinary retention, nocturnal urinary frequency, and urge incontinence. Typically, urinary dysfunction resolves simultaneously with other neurologic deficits. We report the case of a 20-year-old woman with Guillain-Barré syndrome and persistent urinary retention 18 months following initial diagnosis. This patient is the first described in the literature to undergo successful treatment with sacral neuromodulation. Immediately following neuromodulator placement, the patient voided spontaneously and has had no voiding dysfunction or postvoid residual after 5 months of follow-up.     

Intraoperative three-dimensional navigation for surgical treatment of osteoid osteoma in the foot and ankle – A series of 14 cases

BackgroundThe surgical treatment for osteoid osteoma (OO) in the foot and ankle is challenging. It is difficult to locate the lesion and the anatomy is crowded by sensitive structures. The purpose of this study was to describe the outcomes of navigated mini open-intralesional curettage (NMIC) or navigated minimally invasive radiofrequency ablation (NMRFA) in treating these lesions.MethodsAll patients who underwent surgery for OO in the foot and ankle between 2015 and 2020 were included. O-arm navigation was used in All procedures. The choice of NMIC versus NMRFA was made by the surgeon according to the location of the lesion and its proximity to sensitive anatomic structures.ResultsFourteen patients were included. Ten were operated by NMRFA and 4 by NMIC. All patients’ symptoms related to OO resolved following a single procedure. Average AOFAS score increased by 18.7 (P < .001). Three patients had the following complications: pathologic fracture, superficial infection and transient deep peroneal nerve sensory loss.ConclusionNavigated surgical treatment of OO in the foot and ankle is accurate, efficient and safe.     

Long-term results and loosening analysis of de la Caffinière replacements of the trapeziometacarpal joint.

The results of 77 de la Caffinière arthroplasties for osteoarthritis of the thumb carpometacarpal joint were reviewed. The mean follow-up period was 8.5 years (range, 2-16 years). The survival rate at 16 years was 72%. Clinical and subjective scores were good in primary implants, reasonable in revisions, and poor in salvage procedures. The total loosening rate was 44%. Half of the loosening cases led to revision; the other half had good results. Loosening occurred significantly more often in men and younger women. The use of this prosthesis is only advised for women, preferably those older than 60 years.     

Facteurs d’irréductibilité des luxations sous-taliennes latérales. Étude de trois cas et revue de la littérature

Introduction

The subtalar dislocation is a rare injury especially in its lateral type. The urgency is to reduce dislocation to preserve the functional future of the foot. Some factors make this closed reduction impossible. The purpose of our work, through the study of three clinical cases and especially through an exhaustive review of the literature, is to study the different causes of irreducibility.

Observations

We report three cases of irreducible peritalar dislocation and have conducted a systematic review of the literature. We found that the most common cause of irreducibility was the interposition of the posterior tibial tendon (67%), followed by bone’s incarceration (21%) and other capsule and tendon elements (12%).

Conclusion

Several anatomical factors hinder the reduction of lateral subtalar dislocations. Their knowledge will allow a quick and effective management of this injury.

     

Intoxication aluminique en hémodialyse chronique. Un diagnostic rarement évoqué de nos jours. Illustration par un cas clinique et revue de la littérature

Aluminum intoxication in chronic hemodialysis patients has virtually vanished over the last decade. Therefore, the diagnosis is rarely advocated at present. Aluminum intoxication in dialysis patients associates to different degrees with dialysis encephalopathy, bone disorders and microcytic anemia. We report here the observation of a patient receiving intermittent hemodialysis therapy who presented with acute encephalopathy. It turned out to be caused by aluminum intoxication secondary to a defect in dialysis water treatment. Whatever the therapeutic approach, the prognosis of this dramatic complication in hemodialysis patients remains poor. In severe cases, only renal transplantation can be able to improve clinical outcome. Major sources of aluminum are tap water used for dialysis together with a defective water treatment system, and to a minor extent oral aluminum-containing phosphate binders and antacids. In the absence of a bone biopsy, the diagnosis can be made by measuring serum aluminum or better after a desferrioxamine test. Prevention of aluminum overload is of utmost importance. It is the responsibility of dialysis centers to provide aluminum-free water and dialysis fluid. In case of proven aluminum intoxication, the K/DOQI guidelines indicated how to best treat hemodialysis patients, based on long-term desferrioxamine infusions during the hemodialysis session. It is recommended to implement a stepwise increasing desferrioxamine dosage to prevent an acute decompensation with irreversible neurological lesions.     

Drainage percutané de l’abcès du psoas: Notre expérience et revue de la littérature. Percutaneous drainage of psoas abscess. Our experience and literature review

IntroductionPsoas abscess is a rare retroperitoneal infection and is often difficult to diagnose. It affects debilitated subjects. The aim of our study is to report our experience with percutaneous minimally-invasive drainage in the treatment of this condition.Patients and methodsWe report on a retrospective series of 22 patients followed at the Urology service, Military Hospital Moulay Ismail in Meknes (Morocco) over a period of seven years from January 2005 to January 2012. All patients underwent percutaneous drainage of the abscess under guidance of ultrasound or CT, together with appropriate antibiotics.ResultsAll patients had constitutional symptoms, 10 (45%) were diabetic. The postoperative course was consistently favorable. Recurrent abscess was noted in two patients (9%) and was favorably treated by percutaneous drainage. Diagnostic, clinical, biological and radiological characteristics of the disease are described.ConclusionPercutaneous drainage is an easy and reliable technique. It is minimally invasive, can be repeated if necessary, and is convenient in generally debilitated patients.