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Abstract: The carpal collapse is defined as a loss of carpal height. It corresponds to a disorganization of carpal bone pieces that switch between them against each other resulting in dysfunction of the dynamics of carp responsible for progressive cartilage wear. Osteoarthritis causes pain and stiffness of the wrist with a “bloated” pattern. We distinguish two main groups of carpal collapse : those resulting from an anomaly starting intracarpal whether malunion, a nonunion, a microcrystalline arthritis or a ligament injury and those resulting from disorientation radiocarpal following a malunion of the radius is called “adaptive carpal collapse”. The latter changes the orientation of the articular surface of the radius at which the carp adapts by shifting with a loss of height. Once the stage of collapse is present, it is important to identify its cause to best adapt the therapeutic management and prognosis assessment. This retrospective diagnosis requires knowing some anatomical features of bone structure carpal ligaments and method of analysis of radiological guidance and carpal height. Outcome of osteoarthritis secondary to carpal collapse is so predictable and stereotyped according to their causes and different treatments are possible depending on staging. Initial treatment of the lesion causing collapse remains the most likely to avoid the use of palliative treatment usually only possible with advanced stages. [Copyright &y& Elsevier]

Résumé: L’arthrose est la maladie articulaire la plus fréquente. Sa physiopathologie est complexe, multifactorielle et reste mal élucidée. À ce jour, il n’a pas été découvert d’agent pharmacologique susceptible de modifier le cours évolutif de l’arthrose. La calcification du cartilage articulaire est une caractéristique de l’arthrose et des données suggèrent que cet élément contribue directement à la destruction articulaire. Les cristaux de calcium sont retrouvés fréquemment dans le liquide articulaire au cours de l’arthrose mais leur rôle exact reste mal élucidé. Les cristaux de phosphate de calcium basique (PCB) sont les principaux cristaux mis en évidence dans l’arthrose et des données récentes sont en faveur de leur rôle pathogène dans le processus arthrosique. Toutefois, les informations concernant leur fréquence exacte et leur localisation sont très variables dans la mesure où il n’existe pas de méthode de détection simple et fiable de ces cristaux. Le but de cette revue est de décrire les méthodes actuellement disponibles pour détecter les cristaux de PCB, en mettant en lumière leurs avantages et leurs inconvénients. Nous présentons également les nouvelles données disponibles dans ce domaine, tout particulièrement dans l’optique de possibles applications en pratique clinique. L’amélioration des méthodes de détection des cristaux de PCB pourrait apporter une aide au diagnostic de l’arthrose et au développement de nouvelles thérapeutiques. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: L’arthrose (OA) et l’ostéoporose (OP) sont deux maladies fréquentes qui ont un impact sur la qualité de vie des personnes âgées. Depuis des dizaines d’années, il existe une controverse sur la relation inverse qui existerait entre l’OA et l’OP. L’objectif de cet article était de comparer les propriétés structurales du cartilage articulaire calcifié (CAC) et de l’os sous-chondral entre les femmes ménopausées avec OA et OP. Méthodes: Huit têtes fémorales ont été prélevées chez des femmes ménopausées au cours de leur traitement chirurgical par prothèse de hanche pour OA primitive. Elles ont été comparées à neuf têtes fémorales prélevées de femmes ostéoporotiques et appariées selon l’âge, au cours de leur hémiarthroplastie de hanche suite à une fracture ostéoporotique du fémur proximal. Deux coupes dimensionnelles histomorphométriques ont été effectuées pour mesurer l’épaisseur du CAC et les paramètres osseux histomorphométriques. Le rapport CAC sur cartilage articulaire total (CAT) a également été calculé chez tous les spécimens osseux. Résultats: Les donneurs arthrosiques avaient un CAC et rapport CAC/CAT plus élevé (CAC : 117,69±28,16μm vs 97,88±16,79μm, p =0,041 ; rapport CAC sur CAT : 15,74 % vs 10,51 %, p =0,023). La fraction osseuse (BV/TV), l’épaisseur des travées (Tb.Th), le nombre de travées (Tb.N) et le rapport nœuds-extrémités libres (Nd/Tm) étaient plus faibles chez les donneurs ostéoporotiques (BV/TV : 21,55±3,41 % vs 16,64±2,26 %, p =0,003 ; Tb.Th : 121,33±16,11μm vs 98,59±18,56μm, p =0,017 ; Tb.N : 2,41±0,73mm−1 vs 1,37±0,31mm−1, p =0,001 ; Nd/Tm : 0,78±0,22 vs 0,50±0,14, p =0,007). Cependant, l’espacement des travées (Tb.Sp) était augmenté chez les patients ostéoporotiques (Tb.Sp : 345,49±106,18μm vs 652,09±159,71μm, p =0,0004). Conclusions: Les propriétés différentes du CAC et de la microstructure osseuse sous-chondrale influencent la physiopathologie de l’OA et de l’OP. Les propriétés structurales de l’os minéralisé sous-chondral confirment la relation inverse qui existe chez les femmes ménopausées entre OA et OP. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose of this study was to evaluate the results and complications of locked palmar plating in patients with articular fracture of the distal radius. Methods: Twenty-two patients were reviewed retrospectively. The average age was 68 years. All fractures were classified as Type C according to the AO classification. Clinical and functional examination including range of motion, grip strength, pain and return to previous activities were assessed. Loss of radial height, radial inclination, palmar tilt and ulnar variance were evaluated with preoperative and postoperative radiographs. Results: At an average follow-up of 10 months, the range of motion was 124° in flexion and extension and 178° in pronation and supination. Grip strength was 80% of the opposite side. Fifteen patients were free of pain. Three patients suffered tenosynovitis of the extensor tendons. Radiographic measurements averaged 11mm radial height, 21° radial inclination, 4° palmar tilt and 1mm ulnar variance. Conclusions: The result of this study showed that locked palmar plating of articular distal radius fractures is effective even in cases of metaphyseal comminution with a low rate of complications. [Copyright &y& Elsevier]

Abstract: Articular cartilage is essential for the motion of the skeleton. However, this tissue is unable to spontaneously repair once injured, since it is avascular and aneural. Numerous repair strategies are developed, but they do not lead to a functional tissue and research into cartilage repair focuses now on tissue engineering technics. Adult mesenchymal stem cells (MSC), present in various tissues, have the potential to differentiate into chondrocytes in vitro in response to specific growth factors. The members of the transforming growth factor β, among them the bone morphogenetic protein (BMP)-2, appear very promising inducers in this context. BMP-2 favours chondrogenic expression, in particular expression of type IIB collagen, the cartilage-specific isoform of this collagen. Therefore, collagen type IIB is a good indicator of the differentiation state of MSC. However, since BMP-2 has also osteogenic properties, it is critical to differentially control chondrogenic and osteogenic properties of BMP-2 when used with MSC. Strategies for this control are presented in this review. Most likely, this is the combination of growth factors such as BMP-2 with biomaterials that will lead to the successful use of MSC for cartilage repair. [Copyright &y& Elsevier]

Abstract: Elbow dislocations in the infant are not very frequent and are associated to the fractures. Their management must be urgent and rigorous if complications are to be avoided. We report the case of a child aged 12 who presented with a fracture-dislocation of the right elbow, after falling from a tree. The patient was treated in a standard manner for one month. Four months later, the patient presented again, this time complaining of stiffness of the elbow. Physical examination confirmed the reduced range of movement of the elbow (flexion 80°, extension –30°) without associated neurovascular complication. Radiography of the elbow showed a posterior dislocation with remodelling of the humeral contours. Surgical exploration revealed normal articular cartilage, a pseudoarthrosis of the epitrochlea, a dislocation of the radial head and the sigmoid fossa of small size in relation to the trochlea. A reduction was only possible after an "enlargement plasty" of the trochlear notch. The patient was seen after an interval of six months. The elbow was stable with no vasculo-nervous complication.and had flexion of 110° with extension of –30°. [Copyright &y& Elsevier]

Abstract: Apart from clinical parallels, similarities in the pathogenesis of arterial and articular cartilage calcification have come to light in recent years. These include the roles of aging, of chronic low-grade inflammation and of genetic and acquired dysregulation of inorganic pyrophosphate (PPi) metabolism. This review focuses on recent developments in understanding the pathogenesis of artery calcification pertinent to interpretation of the mechanistic basis for articular cartilage calcification in aging and osteoarthritis. [Copyright &y& Elsevier]

During the last decade, articular ultrasonography (US) has been found effective in evaluating inflammatory, degenerative, and traumatic abnormalities of articular and periarticular tissues. In clinical practice, US used in combination with a thorough clinical evaluation can help rheumatologists to confirm or to refute diagnostic hypotheses. US is safer than computed tomography (CT), an advantage shared by magnetic resonance imaging (MRI). As compared to CT and MRI, US is less expensive ; in addition, it can be performed immediately, for several joints, as often as needed. Furthermore, US allows dynamic studies. Several articles published in rheumatology journals emphasize the value of US in patients with musculoskeletal diseases. The present review article discusses the indications, efficacy, and limitations of articular US. [ABSTRACT FROM AUTHOR]

Abstract: Surgical management of the rare thrue articular fractures of the elbow remain difficult: the surgeon must achieve anatomical reconstruction with a reliable fixation allowing mobilisation of the joint for early rehabilitation. Arthroscopic treatment of elbow fractures (capitellum, coronoid, olecranous and radial head) gives an excellent intra articular view with few soft tissue damage. Cartilage damage, intra articular loose bodies and capsulolabral injuries are then well adressed. Arthroscopic management of elbow fracture is potentially dangerous for the neuro-vascular structures and requiere good knowleges in elbow arthroscopic technique. We routinely use lateral approach, trying to avoid the medial approach in traumatology. This article relates the differents surgical techniques. A preoperative computed tomography is needed to select the eligible fractures for those techniques. [Copyright &y& Elsevier]