Jean Claude Sané

Open Anterior Transverse (Divergent) Dislocation of the Elbow Joint

A divergent dislocation of the elbow joint is an unusual injury1. To the best of our knowledge, only sixty-nine cases have been reported in the literature since Warmont first described a case in 18542; these dislocations most commonly occurred in children. The upper ends of the radius and ulna dislocate from each other and from the humerus, and therefore diverge posteriorly and laterally (transverse divergence)1 or anteroposteriorly, with the radius diverging anteriorly and the ulna diverging posteriorly (anteroposterior divergence)3, or they converge with the radius posteromedially and the ulna posterolaterally (crossed divergence, radioulnar translocation)4. We report the case of a nine-year-old boy who sustained an open anterior divergent dislocation of the right elbow after a traffic accident. Open reduction and repair of the soft tissue was performed, and complete functional recovery had occurred at six months postinjury. To our knowledge, no other case of an anterior transverse dislocation of the elbow previously has been reported. The patient and his parents were informed that data concerning the case would be submitted for publication, and they provided consent. A nine-year-old right-hand-dominant boy presented to our Emergency Department with an open elbow injury following a traffic accident. He had been crossing the road when a truck struck his right upper limb. The exact mechanism remained undefined. On admission, the elbow joint was flexed and supinated. There was a large posterior wound with loss of soft tissue from the distal part of the arm to the wrist. The olecranon process and radial head were not palpable in their normal positions, and the distal part of the humerus had herniated through the triceps muscle (Fig. 1-A). Active motion of the elbow was not possible. Distally, the radial and ulnar pulses were palpable; the fingers were sensitive …

Fracture-décollement de l’épiphyse médiale de la clavicule: à propos de 6 cas et revue de la littérature

This study aims to describe the epidemiological characteristics and the different anatomo-clinical entities of the fracture-separation of the medial clavicular epiphysis but also to relate the morphological and functional results of bloody reduction followed by osteosuture using non absorbable thread. Five boys and one girl (mean age 14 years) showed a closed and isolated shoulder girdle trauma. Clinical examination and medical imaging, especially CT scan, allowed the diagnosis of epiphyseal separation and to classify the degree of medial clavicular epiphysiseal ossification indicating the direction of displacement as well as the nature of displacement according to the Salter-Harris classification. Bloody reduction followed by osteosuture using non absorbable thread (No. 1 decimal) was performed in 3 patients. One patient underwent cross-pinning the two younger patients were treated orthopedically. The displacement of the clavicle stump was anterior in 3 patients and retro-sternal in 3 patients. Posterior forms were complicated by odynophagia (n = 2) and asymptomatic compression of the subclavian vein (n = 1). One of the posterior forms was associated with an ipsilateral fracture of the medial one third of the clavicle. Consolidation was achieved in all patients with preservation of shoulder mobility. The fracture-separation of the medial end of the clavicle mimes clinically and radiologically the sternoclavicular dislocation. It can be serious because of the risk of visceral and vascular compression in its posterior form. Tomdensitometry is irreplaceable for an accurate diagnosis. Our preference is for bloody reduction followed by osteosuture using non metallic thread.Le but de ce travail est de décrire les caractéristiques épidémiologiques et les différentes entités anatomo-cliniques de la fracture-séparation de l’épiphyse claviculaire médiale mais également de rapporter les résultats morphologiques et fonctionnelsde de la réduction sanglante suivie de l’ostéo-suture au fil non résorbable. Cinq garçons et 1 fille âgés en moyenne de 14 ans ont présenté un traumatisme fermé et isolé de la ceinture scapulaire. L’examen clinique et l’imagerie médicale surtout la TDM ont permis de poser le diagnostic de décollement épiphysaire, de classer le degré d’ossification de l’épiphyse claviculaire médiale en précisant le sens du déplacement, ainsi que la nature du décollement selon Salter-Harris. Une réduction sanglante suivie d’une ostéo-suture au fil non résorbable décimale n°1 a été réalisées chez 3 patients. Un patient a bénéficié d’un embrochage croisé. Les deux plus jeunes ont été traités orthopédiquement. Le déplacement du moignon claviculaire était antérieur chez 3 patients et rétro-sternal chez les 3 autres. Les formes postérieures ont été compliquées d’une odynophagie (n=2) et d’une compression asymptomatique de la veine sous Clavière (n=1). L’une des formes postérieuresétait associée a une fracture ipsilatérale du 1 / 3 médial de la clavicule. La consolidation a été obtenue chez tous les malades avec une mobilité de l’épaule conservée. La fracture-décollement de l’extrémité médiale de la clavicule mime au plan clinico-radiologique la luxation sterno-claviculaire. Elle peut être grave en raison du risque de compression viscérale et vasculaire dans sa forme postérieure. La tomodensitométrie reste irremplaçable pour un diagnostic précis. Notre préférence va à la réduction sanglante suivie d’une ostéo-suture au fil non métallique.

The treatment of chronic laxities of the ankle by external ligament tension restoration

Chronic external laxities of ankle have long been treated by plasties with the short peroneal as stabilizer of the hindfoot. The restoration of the tension of the internal external capsule–ligament complex with a subastragalus flap is an interesting solution. Thirty-two sporting patients with an external instability of the ankle were treated surgically by restoration of the tension of the external lateral ligament using the Saragaglia technique and were re-examined with an average 5-year time lag. The instability and the anterior drawer were measured in pre and post-operative periods. If the intervention gives good results in severe external laxities, the result is definitely less good in laxities of low importance. The presence of a functional disorder of the forefoot constituted in the series a pejorative factor. The intervention makes it possible to correct external instability of the tibiotalar and subastragalus. The conservation of the axis of the hindfoot is useful for a good performance because an instability of the subastragalus deteriorates the result of the intervention.

Threatened Aortic Injury by Thoracic Pedicle Screw: A Case Report

Iatrogenic vascular injury during posterior spinal surgery is a rare but potentially serious complication with treatment challenges. We report the case of threatened aortic injury by pedicle screw impingement during posterior fixation of thoracic spine T7 - T8 fracture dislocation. The removal of the conflicting screws was done posteriorly after a visual control of the absence of adventitious break-in by a thoracotomy.

Arthrodèse talocrurale. Technique opératoire et retentissement sur les articulations sous-jacentes. À propos de 11 cas

RésuméLe but de ce travail est d’évaluer notre technique d’arthrodèse talocrurale et son retentissement sur les articulations sous-jacentes dans la prise en charge des arthroses de la cheville secondaire à un traumatisme négligé ou à une arthrite septique. De janvier 1996 à juin 1999, 26 arthrodèses talocrurales avaient été réalisées. Les critères d’inclusion étaient une étiologie arthrosique par traumatisme négligé ou séquellaire d’ostéoarthrite, une évaluation clinique et radiologique complète effective, une articulation sous-talienne normale, une fixation interne par vissage en X et un recul supérieur à six mois. La série présentait alors 11 cas avec une prédominance masculine (sept hommes pour quatre femmes) et un âge moyen de 46 ans à la date de l’arthrodèse. Le recul moyen était de 23 mois avec des extrêmes de 6 et 54 mois. Notre technique d’arthrodèse consistait, après un abord antérieur de la cheville, un avivement des surfaces articulaires, en une fixation par des vis à os spongieux croisées en X. La cheville était en position neutre dans les trois plans. Une contention plâtrée complétait cette synthèse pendant douze semaines. L’appui total était autorisé vers la dixième semaine. Nos patients avaient été évalués cliniquement selon la cotation de Duquennoy et radiologiquement sur la fusion osseuse et l’aspect de l’articulation sous-talienne. Nos résultats étaient bons dans 81,8 % des cas avec une fusion osseuse dans neuf cas dans un délai moyen de 12,4 semaines. Deux cas de pseudarthrodèse ont été observés. Nous avons observé au bout de 12 mois environ la survenue dans 45,4 % des cas d’une arthrose sous-talienne postérieure. L’arthrodèse talocrurale semble représenter, dans le cadre de la prise en charge de l’arthrose posttraumatique et postarthritique de la cheville, un traitement de choix malgré la survenue dans les suites lointaines d’une arthrose sous-talienne postérieure.AbstractThe aim of our work was to evaluate our tibiotalar arthrodesis technique and its effects on distal joints in treating ankle arthrosis secondary to a neglected injury or septic arthritis. From January 1996 to June 1999, we performed 26 tibiotalar arthrodeses. The inclusion criteria were arthrosis caused by a neglected injury or sequelae of osteoarthritis, a complete clinical and radiological evaluation, a normal subtalar joint, internal fixation by X cancellous bone screws and follow-up greater than six months. The series presented 11 cases (7 men and 4 women). The average age was 46. The average follow-up was 21 months (6 to 54 months). Using an anterior approach to the ankle, our arthrodesis technique consisted of joint surface resection and fixation by X cancellous bone screws. We maintained the ankle in neutral position. A plaster cast was applied for 12 weeks, with weight bearing allowed at week 10. Our patients were clinically evaluated according to the Duquennoy scoring system, the radiological determination of bone fusion and the appearance of the subtalar joint. The outcomes were good in 81.8% of the cases, with fusion in 9 cases obtained over on average period of 12.4 weeks. Two cases of pseudarthrodesis were observed. Posterior subtalar arthrosis occurred in 45.4% of the cases after an average of 12 months. Tibiotalar arthrodesis is a safe alternative for the treatment of neglected injuries and septic arthritis of the ankle after the occurrence of subtalar arthrosis in the long-term.