Les ostéotomies de varisation

Summary During the retrospective study of a series of 81 observations, the principles and technique of the osteotomy of varisation of the superior end of the femur are recalled. It appears that, considering the results of this work, the indication for varisation osteotomy is reserved nowadays to subjects who are less than 50 years old, presenting primary coxarthrosis or mild dysplasia, satisfying different criteria of good radiologic recentering. It appears, on the other hand, necessary to do this osteotomy with no Mac Murray effect.

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Les ostéotomies de varisation

Résumé A l'occasion de l'étude rétrospective d'une série de 81 observations, les principes et la technique de l'ostéotomie de varisation de l'extrémité supérieure du fémur sont rappelés. D'après les résultats de ce travail, l'indication d'ostéotomie de varisation doit être réservée de nos jours, semble-t-il, à des sujets de moins de 50 ans, présentant une coxarthrose primitive ou une dysplasie peu évoluée, satisfaisant aux différents critères d'un bon recentrage radiologique. Il apparaît d'autre part nécessaire de réaliser cette ostéotomie sans « effet Mac Murray ».

     

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.     

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.