Jacques A. Brunet

TRAUMATIC DISLOCATIONS OF THE LESSER TOES

Traumatic dislocations of lesser metatarsophalangeal joints (DLMTPJ) and lesser interphalangeal joints (DLIPJ) are very uncommon. A retrospective analysis of 31 cases and of the 16 reported cases was conducted to clarify our understanding of the pathomechanics, the role of associated injuries, recommended treatment, and outcome. Hyperextension with axial loading produces the injuries. Ipsilateral foot fractures or dislocations often occur and thus may compromise the outcome. Thirty percent of DLMTPJ and virtually all DLIPJ require open reduction; most often, the plantar plate prevents closed treatment of either DLMTPJ or DLIPJ. At follow-up, treated isolated DLMTPJ have few or no complaints; disability persists in patients who suffered concomitant displaced ipsilateral midfoot or forefoot fractures or dislocations. Neglected DLMTPJ remain symptomatic. All reduced DLIPJ are pain free.

Structural disorders at the insertion of the supraspinatus tendon: Relation to tensile strength

We examined macroscopically and microscopically 55 cadaver rotator-cuff tendons attached to their humeral heads to determine the distance between the edge of the articular cartilage and the tendon insertion of the supraspinatus (the width of the sulcus) and the score of regressive changes at the sulcus. In 33 specimens we measured the tensile strength. The width of the sulcus was correlated with the score of regressive changes and with the ultimate tensile strength of the supraspinatus tendon. The width of the sulcus correlated positively with the score of regressive changes (r = 0.66, p < 0.0001), but there was a negative correlation between the latter and the ultimate tensile strength (r = -0.81, p = 0.001) and between the width of the sulcus and the ultimate tensile strength (r = -0.74, p = 0.004). We believe that the width of the sulcus is a simple and useful clinical indicator of the integrity and the tensile strength of the supraspinatus tendon.

Pathomechanics of complex dislocations of the first metatarsophalangeal joint.

Because only 10 complex dislocations of the first metatarsophalangeal joint have been reported to date, a retrospective review was initiated to study the pathomechanics of 11 new cases (9 patients) and to report on the clinical and functional outcomes. Concomitant ipsilateral injuries were frequent: 6 tarsometatarsal joint partial disruptions and 8 cases with multiple midfoot or forefoot fractures or dislocations occurred. Clinical and radiographic assessments suggested that forefoot hyperextension combined with axial loading of the foot in a heel to toe or toe to heel direction produced all. Six cases required open reductions (5 were compound), and 5 cases were managed by closed methods. Associated tarsometatarsal joint disruptions facilitated closed management. The most common complaints at followup assessment (average, 7 years) were sensitive plantar wounds, partial joint ankylosis, and sesamoid sensitivity. All but 1 patient resumed the same or modified work. The data in this series suggest that most complex dislocations of the first metatarsophalangeal joint probably occur frequently with a concurrent tarsometatarsal joint sprain or disruption, and that the primary mechanism of injury is that of axial loading of the foot causing midfoot hyperflexion and forefoot hyperextension. Contrary to current opinion, not all complex dislocations of the first metatarsophalangeal joint are resistant to closed management.

A clinical study of quazepam in hospitalized patients with insomnia.

The efficacy of quazepam (Sch-16134) 15 mg capsules as a hypnotic has been compared with that of placebo in a 9-day study, using a parallel-group design. The physicians global evaluation numerically favoured quazepam 63% (nineteen of thirty) over placebo 50% (fifteen of thirty). Furthermore, it demonstrated greater improvement in Hypnotic Activity Index and Sleep Quality Index from baseline scores, and caused no adverse reactions.

Ultrastructure of the Fibrous Tissue Surrounding Internal Fixation Devices

The possible bursal nature of the fibrous tissue that develops like a capsule over internal fixation devices was studied ultrastructurally in 13 human and four canine cases. In both species, the basic structural pattern was similar. The capsule had two distinct zones. The superficial compact zone appeared as a pseudomembrane, and consisted of elongated fibro-cytes arranged transversely in a collagenous and microfilamentous matrix. In the deep zone, the cytoplasm and its constituents of connective tissue cells varied from meager to abundant. The structural organization of the capsule as well as its cellular characteristics did not conform to the specificities of an adventitious bursa. The capsular tissue did not appear to be affected by such host factors as age; implant alloy composition; the type of the underlying bone or its abnormalities; duration of implantation, or superficial or deep location of the metal device. Inflammation rarely occurred in the capsular soft tissue, including those cases where pain developed over the implants following an uneventful bone union. Because metal implants do not induce formation of adventitious bursa, pain over an uncomplicated implant is not likely to be due to a bursitis.

Fusion of the Chopart joint with screws

Objectives Arthrodesis of the Chopart joint. Should a malalignment exist, it must be corrected prior to fusion. Elimination of painful functional disturbances and reduced need for custommade shoes.

Intercondylar fibrotic lesion after retrograde intramedullary nailing of a femoral shaft fracture: a case report and review of the literature.

Retrograde intramedullary nailing is a largely successful technique for the treatment of femoral shaft fractures, although reports of knee pain after this procedure are not uncommon. Here we describe the case of a patient who developed a polyp-like fibrotic lesion of the intercondylar notch nearly 2 years after retrograde intramedullary nailing of a femoral shaft fracture as discovered by arthroscopic evaluation. This lesion caused pain and compromised our patients function; however, both of these measures were subjectively improved after the debridement of the lesion. This case emphasizes the necessity of long-term follow-up and further investigation into the cause and significance of postoperative knee pain in hopes of continuing to improve patient outcomes.