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STUDY QUESTION Can early pregnancies be accurately and cost-effectively diagnosed and managed using a new medical computerized tool? SUMMARY ANSWER Compared to the standard clinical approach, retrospective implementation of the new medical software in a gynaecological emergency unit was correlated with more accurate diagnosis and more cost-effective management. WHAT IS KNOWN ALREADY Early pregnancy complications are responsible for a large percentage of consultations, mostly in emergency units, with guidelines becoming complex and poorly known/misunderstood by practitioners. STUDY DESIGN, SIZE, DURATION A total of 780 gynaecological emergency consultations (446 patients), recorded between November 2018 and June 2019 in a tertiary university hospital, were retrospectively encoded in a new medical computerized tool. The inclusion criteria were a positive hCG test result, ultrasonographical visualization of gestational sac, and/or embryo corresponding to a gestational age of 14 weeks or less. Diagnosis and management suggested by the new computerized tool are named eDiagnoses, while those provided by a gynaecologist member of the emergency department staff are called medDiagnoses. PARTICIPANTS/MATERIALS, SETTING, METHODS Usability was the primary endpoint, with accuracy and cost reduction, respectively, as secondary and tertiary endpoints. Identical eDiagnoses/medDiagnoses were considered as accurate. During follow-up visits, if the updated eDiagnoses and medDiagnoses became both identical to a previously discrepant eDiagnosis or medDiagnosis, this previous eDiagnosis or medDiagnosis was also considered as correct. Four double-blinded experts reviewed persistent discrepancies, determining the accurate diagnoses. eDiagnoses/medDiagnoses accuracies were compared using McNemar’s Chi square test, sensitivity, specificity, and predictive values. MAIN RESULTS AND THE ROLE OF CHANCE Only 1 (0.1%) from 780 registered medical records lacked data for full encoding. Out of the 779 remaining consultations, 675 eDiagnoses were identical to the medDiagnoses (86.6%) and 104 were discrepant (13.4%). From these 104, 60 reached an agreement during follow-up consultations, with 59 medDiagnoses ultimately changing into the initial eDiagnoses (98%) and only one discrepant eDiagnosis turning later into the initial medDiagnosis (2%). Finally, 24 remained discrepant at all subsequent checks and 20 were not re-evaluated. Out of these 44, the majority of experts agreed on 38 eDiagnoses (86%) and 5 medDiagnoses (11%, including four twin pregnancies whose twinness was the only discrepancy). No majority was reached for one discrepant eDiagnosis/medDiagnosis (2%). In total, the accuracy of eDiagnoses was 99.1% (675 + 59 + 38 = 772 eDiagnoses out of 779), versus 87.4% (675 + 1 + 5 = 681) for medDiagnoses (P LIMITATIONS, REASONS FOR CAUTION The retrospective study design is a limitation. Some observed improvements with the medical software could derive from the encoding by a rested and/or more experienced physician who had a better ultrasound interpretation. This software cannot replace clinical and ultrasonographical skills but may improve the compliance to published guidelines. WIDER IMPLICATIONS OF THE FINDINGS This medical computerized tool is improving. A new version considers diagnosis and management of multiple pregnancies with their specificities (potentially multiple locations, chorioamnionicity). Prospective evaluations will be required. Further developmental steps are planned, including software incorporation into ultrasound devices and integration of previously published predictive/prognostic factors (e.g. serum progesterone, corpus luteum scoring). STUDY FUNDING/COMPETING INTEREST(S) No external funding was obtained for this study. F.B. and D.G. created the new medical software. TRIAL REGISTRATION NUMBER NCT03993015

Study question Can early pregnancies be accurately and cost-effectively diagnosed and managed using a new medical computerised tool, named “eDiagEPU”? Summary answer Compared to the standard clinical approach, the retrospective implementation of “eDiagEPU” in a gynaecological emergency unit was correlated with sharper diagnoses and more cost-effective managements. What is known already Early pregnancies complications are responsible for a large percentage of consultations, mostly in emergency units. Moreover, clinical guidelines updates for the management of Intrauterine Pregnancies of Uncertain Viability (IPUV) have become increasingly complex and seem to be unknown or misunderstood by several practitioners. Specifically, a recently published prospective multinational survey revealed a limited knowledge regarding early pregnancy guidelines, with 69.0% of the participants reporting incorrect managements of IPUV and 86.6% misinterpreting the evolution of serum human chorionic gonadotropin (hCG). In an attempt to aid practitioners with the diagnosis and management of early pregnancies, a software, named “eDiagEPU”, was developed. Study design, size, duration A total of 780 consultations, recorded between November 2018 and June 2019 in the gynaecological emergency unit of a tertiary university hospital, were retrospectively encoded in eDiagEPU. Positive hCG, ultrasonographical visualisation of gestational sac or/and embryo corresponding to a gestational age of 14 weeks gestation or less were the inclusion criteria. Diagnoses and managements suggested by eDiagEPU are named “eDiagnoses”. The ones provided by a gynaecologist member of the emergency department staff are called “medDiagnoses”. Participants/materials, setting, methods Identical eDiagnosis and medDiagnosis were considered as correct (gold standard). During follow-up examinations, if they became both identical to a previous discrepant eDiagnosis or medDiagnosis, this previous eDiagnosis/medDiagnosis was considered as correct. Persistent discrepancies were reviewed by four double-blinded experts whose majority defined the correct eDiagnosis/medDiagnosis. The accuracies of eDiagnoses/medDiagnoses were compared using McNemar’s Chi square test, computing diagnostic values (Sensitivity, Specificity, and predictive values) and 95% Confidence Intervals (CI). Cost reduction was also analysed. Main results and the role of chance Only one datum (0.1%) from 780 registered medical records was missing to process using “eDiagEPU”. Out of the 779 consultations that could be fully encoded until obtaining an eDiagnosis, 675 eDiagnoses were identical to the medDiagnoses (86.6%) and 104 discrepant (13.4%). From these 104, 60 reached an agreement during follow-up controls with 59 medDiagnoses finally changing into the initial eDiagnoses (98%) while only one discrepant eDiagnosis turning later into the initial medDiagnosis (2%). Finally, 24 remained discrepant at all subsequent checks and 20 were not reevaluated. Out of these 44 discrepancies without identical diagnoses/managements during follow-up controls, the double-blinded experts majority chose 38 eDiagnoses (86%) and 5 medDiagnoses (11%) including 4 twin pregnancies whose twinness was the only discrepancy. One discrepant eDiagnosis/medDiagnosis reached no majority (2%). In total, eDiagnoses accuracy was 99.1% (675 + 59 + 38=772 eDiagnoses out of 779 final diagnoses), vs 87.4% (675 + 1 + 5=681) for medDiagnoses accuracy (p Retrospectively, “eDiaEPU” was usable (99.9%), more accurate for each diagnosis except twinning report and more cost-effective than standard clinical approach. Limitations, reasons for caution The retrospective design is a limitation, as well as the quality of ultrasound interpretation. Some improvements could not derive exclusively from “eDiagEPU” but also from the encoding by a rested or more experienced physician. This software cannot replace clinical and ultrasonographical skills but can improve the diagnostic and therapeutic reasoning. Wider implications of the findings An improved “eDiagEPU” version, considering the diagnosis and management of multiple pregnancies with their specificities (potentially multiple locations, chorioamnionicity) has been developed. Prospective evaluations will be required. Further development steps are considered, including software incorporation into ultrasound devices and integration of previously published predictive/prognostic factors (serum progesterone, corpus luteum scoring...). Trial registration number NCT03993015

Le diagnostic anténatal par le contexte de prévision qu’il crée, tant du côté du bébé que de son environnement, est une situation expérimentale de résurgences émotionnelles en chaîne. C’est l’occasion d’analyser comment se réactivent des zones de mémoire pour faire face à l’anticipation des futures étapes de la grossesse, de la naissance et des premières années de vie de l’enfant. L’interdisciplinarité au sein du champ de l’obstétrique avait permis aux pédopsychiatres d’être attentifs à l’émergence de désordres émotionnels délétères dans la mise en place des relations parents– enfant : dysharmonie interactive, dépression du postpartum et troubles ultérieurs du développement. Les équipes découvrent leurs capacités à affiner le repérage des décalages émotionnels et le décodage des états de détresse parentale. Les dates anniversaires, qui scandent la vie psychique, avaient alerté depuis longtemps les psychothérapeutes qui en interprétaient les impacts dans l’après-coup. Le tournant que nous offre la démarche active d’anticipation du diagnostic anténatal est de permettre d’aménager le contexte de survenue d’une réactivation émotionnelle au moment où elle apparait, mobilisant ainsi le risque de répétition traumatique. Par une anamnèse fine, anticiper les dates à risque devient un enjeu de santé publique majeur concernant chaque professionnel impliqué dans le suivi obstétrical, à condition qu’il ne reste pas seul face à une situation familiale complexe. Les possibilités d’intervention du pédopsychiatre/psychologue en première et/ou en deuxième ligne permettent à l’ensemble des protagonistes du soin d’enrichir les axes de prévention dans une synergie d’action sans cesse en questionnement.

Resume Objectifs La prise en charge des patientes mauvaises repondeuses reste aujourd’hui un defi therapeutique que les equipes cliniques et biologiques d’assistance medicale a la procreation doivent relever. Les criteres de Bologne, etablis lors du consensus de l’ESHRE (2011), ont propose de standardiser la definition de mauvaise repondeuse afin d’uniformiser les pratiques. Le present travail dresse un etat des lieux des connaissances actuelles concernant les differentes solutions therapeutiques. Methodes Cette mise a jour des donnees actuelles concernant les mauvaises repondeuses a ete realisee a l’aide du moteur de recherche PubMed d’octobre 2000 a juin 2016. Resultats Il n’y a pas a ce jour de protocole ideal pour les patientes mauvaises repondeuses meme si le protocole antagoniste semble avoir la preference des cliniciens et des patientes, probablement en rapport avec une meilleure tolerance, une reduction de la consommation de gonadotrophines et de la duree de stimulation. Il semblerait qu’il n’y ait aucun interet a augmenter les doses de gonadotrophines au-dela de 300 UI/jour et qu’il n’existe pas de superiorite d’une gonadotrophine par rapport a une autre. A ce jour, il n’y a pas de preuve suffisante pour recommander l’utilisation de traitements adjuvants. Seule la DHEA semble apporter un benefice en termes de qualite embryonnaire et de naissances vivantes mais des etudes prospectives complementaires sont necessaires. Conclusion De nouvelles strategies, tel que le « banking ovocytaire » ou la double stimulation sur un meme cycle, offrent aujourd’hui de nouvelles perspectives pour la prise en charge des mauvaises repondeuses.

Background The primary objective was to evaluate correlations linking anatomical to functional outcomes after endoscopically assisted repair of acute acromioclavicular joint dislocation (ACJD). Hypothesis Combined acromioclavicular and coracoclavicular stabilisation improves radiological outcomes compared to coracoclavicular stabilisation alone. Material and methods A prospective multicentre study was performed. Clinical outcome measures were pain intensity on a visual analogue scale (VAS), subjective functional impairment (QuickDASH score), and Constant's score. Anatomical outcomes were assessed on standard radiographs (anteroposterior view of the acromioclavicular girdle and bilateral axillary views) obtained preoperatively and postoperatively and on postoperative dynamic radiographs taken as described by Tauber et al. Results Of 116 patients with acute ACJD included in the study, 48% had type III, 30% type IV, and 22% type V ACJD according to the Rockwood classification. Coracoclavicular stabilisation was achieved using a double endobutton in 93% of patients, and concomitant acromioclavicular stabilisation was performed in 50% of patients. The objective functional outcome was good, with an unweighted Constant's score ≥ 85/100 and a subjective QuickDASH functional disability score ≤ 10 in 75% of patients. The radiographic analysis showed significant improvements from the preoperative to the 1-year postoperative values in the vertical plane (decrease in the coracoclavicular ratio from 214 to 128%, p = 10−6) and in the horizontal plane (decrease in posterior displacement from 4 to 0 mm, p = 5 × 10−5). The anatomical outcome correlated significantly with the functional outcome (absolute R value = 0.19 and p = 0.045). We found no statistically significant differences across the various types of constructs used. Intra-operative control of the acromioclavicular joint did not improve the result. Implantation of a biological graft significantly improved both the anatomical outcome in the vertical plane (p = 0.04) and acromioclavicular stabilisation in the horizontal plane (p = 0.02). The coracoclavicular ratio on the anteroposterior radiograph was adversely affected by a longer time from injury to surgery (p = 0.02) and by a higher body mass index (BMI) (p = 0.006). High BMI also had a negative effect on the difference in the distance separating the anterior edge of the acromion from the anterior edge of the clavicle between the injured and uninjured sides, as assessed on the axillary views (p = 0.009). Conclusion This study demonstrates that acute ACJD requires stabilisation in both planes, i.e., at the coracoclavicular junction and at the acromioclavicular joint. Coracoclavicular stabilisation alone is not sufficient, regardless of the type of implant used. Implantation of a biological graft should be considered when the time from injury to surgery is longer than 10 days. The weight of the upper limb should be taken into account, with 6 weeks of immobilisation to unload the construct in patients who have high BMI values. Level of evidence II, prospective non-randomised comparative study.

Resume Le traitement des disjonctions acromio-claviculaires chroniques reste un sujet confidentiel et controverse. Face aux multiples options chirurgicales, il n’est pas toujours aise de choisir parmi les etapes indispensables. Methodologie de l’etude C’est une etude prospective multicentrique. Le suivi clinique et radiologique a comporte une analyse comparative entre les donnees preoperatoires et postoperatoires a 1 an : de la douleur (echelle visuelle analogique), de l’incapacite fonctionnelle subjective (QuickDash) et du score objectif de Constant, et une analyse comparative des deplacements vertical et horizontal mesures sur des radiographies simples. Resultats Issues d’une serie de 140 disjonctions acromio-claviculaires (DAC) operees, nous avons inclus 24 DAC au stade chronique. Le delai moyen avant chirurgie etait de 46 semaines (1 mois a 4 ans). L’âge moyen etait de 41 ans, avec une majorite d’hommes (75 %), 72 % avaient des activites sportives de loisir. Sur le plan professionnel, 40 % avaient un travail manuel. On denombrait 40 % de type III, 24 % de type IV et 36 % de type V selon la classification de Rockwood. Dans 92 % des cas, la stabilisation coraco-claviculaire sous controle endoscopique etait realisee avec un implant de type double bouton, renforce par une greffe biologique dans 88 % des cas. Dans 29 %, une resection millimetrique ou centimetrique de la clavicule distale etait realisee et une stabilisation acromio-claviculaire etait associee dans 54 %. Nous avons observe 33 % de complications. A 1 an postoperatoire, 21 patients ont ete revus cliniquement et radiologiquement (87,5 %). Seulement 35 % des patients etaient satisfaits ou tres satisfaits, alors que 100 % d’entre eux referaient l’intervention. La reprise du travail a temps complet etait possible dans 91 % des cas et la reprise de tous les sports etait possible dans 86 %. Le gain obtenu entre les valeurs pre- et postoperatoires a 1 an etait respectivement : score de Constant moyen passe de 61 a 87 ( p = 0,00002) ; score subjectif d’incapacite QuickDash passe de 41 a 9 ( p = 0,00002) ; reduction du deplacement vertical ( p −3 ) et horizontal ( p = 0,022). Conclusion Dans cette etude, les facteurs pronostiques favorables retrouves etaient : un delai preoperatoire court p = 0,02), une stabilisation acromio-claviculaire associee, une immobilisation postoperatoire type echarpe prolongee de 6 semaines. Par contre, la resection de la clavicule distale n’influencait pas le resultat final. Niveau de preuve Etude comparative prospective non randomisee.

Resume L’objectif principal etait de correler les resultats anatomiques et fonctionnels des reparations de DAC sous controle endoscopique et de demontrer la superiorite radiologique de l’association d’une fixation acromio-claviculaire a une stabilisation coraco-claviculaire. Materiel et methode Il s’agit d’une etude prospective multicentrique. Le suivi clinique a comporte une analyse de la douleur (echelle visuelle analogique), de l’incapacite fonctionnelle subjective (Quick Dash) et du score de Constant. L’evaluation anatomique a porte sur des radiographies simples (incidence de face en comparatif du cintre acromio-claviculaire et profil axillaire) en pre- et postoperatoire et des cliches dynamiques selon le protocole de Tauber. Resultats Parmi 116 cas de DAC au stade aigu, on demembrait 48 % de type III, 30 % de type IV et 22 % de type V selon la classification de Rockwood. Dans 93 % des cas, la stabilisation etait realisee avec un implant coraco-claviculaire (CC) de type double bouton et dans 50 % une stabilisation acromio-claviculaire etait associee. Quatre-vingt-deux pour cent des patients avaient un bon resultat fonctionnel (avec un score de Constant brut ≥ 85/100) et 75 % des patients avaient un score subjectif d’incapacite Quick Dash ≤ 10. L’analyse radiologique montre un gain significatif entre les valeurs preoperatoires et postoperatoires a 1 an dans le plan vertical (rapport CC passe de 214 % a 128 % avec p = 10 −6 ) et horizontal (deplacement posterieur passe de 4 mm a 0 mm avec p = 5·10 −5 ). Il existait une correlation entre le resultat anatomique et le resultat fonctionnel (IRI = 0,19 et p = 0,045). Nous n’avons pas observe de difference statistique entre les differents types de montages utilises, ni d’amelioration sur le resultat apres controle de l’articulation acromio-claviculaire en peroperatoire. La greffe biologique a ameliore le resultat anatomique dans le plan vertical ( p = 0,04) et la stabilisation acromio-claviculaire dans le plan horizontal ( p = 0,02). Le delai operatoire influencait negativement le resultat sur le rapport coraco-claviculaire sur le cliche de face ( p = 0,02) tout comme l’IMC ( p = 0,006) qui influencait aussi la differentielle entre bord anterieur de l’acromion et le bord anterieur de la clavicule sur le profil axillaire ( p = 0,009). Conclusion Cette etude a permis de montrer la necessite de stabiliser en 2 plans les DAC au stade aigu : coraco-claviculaire et acromio-claviculaire. La stabilisation coraco-claviculaire isolee ne suffit pas quel que soit l’implant utilise. Une greffe biologique doit se discuter sur des delais accident-chirurgie superieurs a 10 jours et il faut prendre en consideration le poids du bras (immobilisation pour soulager le montage pendant 6 semaines). Niveau de preuve II, etude comparative prospective non randomisee.

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Resume Introduction Le niveau d’activite des patients de plus de 70 ans tend a augmenter ainsi que leurs attentes en termes de recuperation de la fonction articulaire. Il n’est pas prouve que la cicatrisation d’une reparation de la coiffe soit satisfaisante chez les patients plus âges. Notre hypothese principale etait : la reparation des lesions du supra-epineux chez les patients de plus de 70 ans est fiable sur le plan du resultat clinique et de la cicatrisation. L’hypothese secondaire etait : la cicatrisation tendineuse est correlee significativement aux scores de Constant, ASES et SST ainsi qu’a l’âge, a la retraction tendineuse et a l’infiltration graisseuse. Patients et methodes Etude prospective multicentrique a propos de 145 patients de plus de 70 ans pour 135 patients revus a un an (93 %). L’âge moyen etait de 73,9 ans. Les lesions transfixiantes du supra-epineux etendues au maximum au tiers superieur de l’infra-epineux et de retraction limitee aux stades 1 et 2 de Patte ont ete incluses. L’evaluation clinique a ete effectuee suivant les scores de Constant, ASES et SST. La cicatrisation etait evaluee par echographie. Resultats On notait une amelioration significative des scores de Constant (44/76) +31,5 (p 0,0001) a un an de recul. Le taux de cicatrisation etait de 89 % avec 15 ruptures iteratives, dont neuf de stade 1 et six de stade 2. Le resultat clinique n’etait pas correle a l’âge du patient : Constant (p = 0,24), ASES (p = 0,38), SST (p = 0,83), ni au stade de retraction : Constant (p = 0,71), ASES (p = 0,35), SST (p = 0,69) ou au stade d’infiltration graisseuse (p > 0,7). La cicatrisation etait correlee a la qualite du resultat clinique (Constant p = 0,02, ASES p = 0,03), et a l’âge (p = 0,01), mais, n’etait pas correlee a la retraction ou au stade d’infiltration graisseuse (p > 0,3). Discussion/conclusion La reparation arthroscopique ameliore significativement les resultats cliniques meme apres 70 ans. Les resultats cliniques ne sont correles ni a l’âge (mais on ne note pas de degradation du resultat apres 75 ans), ni a la retraction frontale (mais retractions limitees aux stades 1 et 2). Le taux de cicatrisation est satisfaisant mais cette etude est limitee a de petites ruptures du supra-epineux et l’analyse postoperatoire par echographie est probablement moins performante que l’imagerie avec injection en coupe souvent prise en reference. Cette cicatrisation s’avere correlee a la qualite du resultat clinique et a l’âge du patient. Niveau de preuve Niveau II

Finding an efficient treatment for poor responders still poses a tremendous challenge for assisted reproductive technology. In 2011, an international consensus has been reached in Bologna on how to standardize the definition of poor ovarian response (POR) in a simple and reproducible manner. This article provides an objective assessment of the different treatment options currently available.A search of the database PUBMED was carried out for studies published in English between October 2000 and April 2016.There is no ideal protocol to manage poor responders even though the antagonist protocol seems to have an advantage of clinicians. This is thanks to better patient tolerance and reduced total dose of gonadotrophin as well as shorter time of stimulation. It seems that there is no benefit in increasing the gonadotrophin daily doses over 300IU nor using any specific type of gonadotrophin. Today, there is insufficient evidence to recommend any additional treatment for poor responders. Only dehydroepiandrosterone (DHEA) seems to increase embryonic quality and pregnancy rate, however further exploration and complementary prospective studies are necessary.New treatment strategies such as "oocyte banking" or double stimulation during the same cycle, could provide new prospects in poor responders management.

Introduction Treatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable. Methods This article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays. Results Based on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients’ mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 ( p = 0.00002); the subjective QuickDASH score decreased from 41 to 9 ( p = 0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane ( p −3 ) and the horizontal plane ( p = 0.022). Conclusion In this study, the favorable prognostic factors found were: time to surgery less than 3 months ( p = 0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result. Level of proof Level II prospective non-randomized comparative study.

Summary Introduction The level of activity of patients older than 70 years is tending to increase, as are their expectations in terms of joint function recuperation. It has not been proven that rotator cuff repair healing is satisfactory in the elderly. The main hypothesis of this study was: repair of supraspinous lesions in patients older than 70 years is reliable in terms of both clinical results and healing. The secondary hypothesis was: tendon healing is significantly correlated with the Constant, ASES, and SST scores as well as with age, tendon retraction, and fatty infiltration. Material and methods Multicenter prospective study on 145 patients older than 70 years, with 135 patients reviewed at 1 year (93%). The mean age was 73.9 years. Full-thickness tears of the supraspinatus extended at most to the upper third of the infraspinatus and retraction limited to Patte stages 1 and 2 were included. Clinical assessment was carried out in accordance with the Constant, ASES, and SST scores. Healing was evaluated with ultrasound. Results A significant improvement was noted in the Constant (44/76) +31.5 ( P P P > 0.0001) scores at 1 year of follow-up. The healing rate was 89% with 15 re-tears, nine of which were stage 1 and six stage 2. The clinical result was not correlated with patient age (Constant, P = 0.24; ASES, P = 0.38; SST, P = 0.83) nor with the retraction stage (Constant, P = 0.71; ASES, P = 0.35; SST, P = 0.69) or the stage of fatty infiltration ( P > 0.7). Healing was correlated with the quality of the clinical result (Constant, P = 0.02; ASES, P = 0.03) and age ( P = 0.01) but was not correlated with retraction or the fatty infiltration stage ( P > 0.3). Discussion/conclusion Arthroscopic repair significantly improves the clinical results, even in patients older than 70 years. The clinical results are not correlated with age (but deterioration of the result was not noted after 75 years) or frontal retraction (but the study only included retractions limited to stages 1 and 2). The healing rate is satisfactory, but this study is limited to small ruptures of the supraspinatus, and the postoperative ultrasound analysis probably inferior to CT imaging with contrast agent injection, often used as the reference. Healing proves to be correlated with the quality of the clinical result and patient age.

Resume Nous rapportons un cas d'osteome osteoide du trapezoide. Cette localisation carpienne est rare. C'est une synovite qui a ete le signe d'appel. Le diagnostic et l'orientation du geste therapeutique ont ete guides par les tomographies. L'exerese chirurgicale complete a apporte la guerison.

The present report describes a case of osteoid osteoma of the trapezoid. It'is an unusual localisation. Synovitis was the first clinical symptom. Tomograms allowed diagnosis and guided the treatment. Radical excision prevented recurrence.