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Aujourd’hui, revisionner une série via les plateformes de vidéo à la demande (VàD) est une pratique de plus en plus populaire. L’objectif de cette recherche est de cerner la façon dont les jeunes adultes réécoutent les séries ainsi que les significations qu’ils construisent autour de cette pratique. S’appuyant sur des entretiens semi-dirigés réalisés auprès de 20 jeunes Québécois âgés de 18 à 34 ans, les résultats mettent en évidence une diversité de pratiques de revisionnement connecté, le plus souvent individuelles, et de significations qui s’y rapportent. Ils montrent le rôle important que joue le dispositif de visionnement connecté dans leur mise en place : les stratégies de mise en marché des séries des services de VàD et l’interface des plateformes offrent à la fois des incitatifs à reprendre le visionnement d’une série et des possibilités de contrôle accru pour les usagers sur le texte sériel et le contexte de visionnement., Rewatching a series using video-on-demand (VOD) platforms is becoming increasingly popular. Based on semi-structured interviews with 20 Quebecers aged 18 to 34, this study aims at investigating young adults rewatching practices and their meaning. The results highlight a variety of rewatching practices, most often individual, which are reinforced by the use of connected viewing devices. Marketing strategies of VoD providers as well as platform interfaces offer several incentives to rewatch series and provide users with increased opportunity to control serial text and viewing context.

Advanced glycation end products (AGEs) play an important role in oxidative stress and inflammation, processes implicated in the development and progression of kidney dysfunction. In the present study, we investigated the participation of the pro-oxidant protein thioredoxin-interacting protein (TXNIP) and of epigenetic mechanisms on kidney tissue (in vivo, in non-diabetic rats) and on terminally differentiated glomerular podocytes (in vitro) chronically exposed to AGEs. AGEs induced total kidney and glomerular TXNIP expression and decreased H3K27me3 content. Concomitant treatment with the antioxidant N-acetyl-cysteine (NAC) reversed only the increased TXNIP expression. TXNIP expression positively correlated with proteinuria and negatively correlated with H3K27me3 content. In vitro studies in podocytes showed that 72 h exposure to AGEs decreased nephrin expression and increased Txnip, Nox4, Col4a1, and epithelial-to-mesenchymal transition (EMT) markers (Acta2, Snail1, and Tgfb1). Podocytes treatment with NAC reversed Nox4, Col4a1, Acta2, and Tgfb1 increased expression but did not abrogate the reduced expression of nephrin. MiR-29a expression was downregulated by AGEs in vivo, but not in vitro. In conclusion, treatment of non-diabetic rats with AGEs induced TXNIP expression and decreased the contents of the repressive epigenetic mark H3K27me3 and of miR-29a, potentially driving injury to glomerular filtration barrier and podocytes dysfunction.

Because of the paucity of information regarding metabolic effects of advanced glycation end products (AGEs) on liver, we evaluated effects of AGEs chronic administration in (1) insulin sensitivity; (2) hepatic expression of genes involved in AGEs, glucose and fat metabolism, oxidative stress and inflammation and; (3) hepatic morphology and glycogen content. Rats received intraperitoneally albumin modified (AlbAGE) or not by advanced glycation for 12 weeks. AlbAGE induced whole-body insulin resistance concomitantly with increased hepatic insulin sensitivity, evidenced by activation of AKT, inactivation of GSK3, increased hepatic glycogen content, and decreased expression of gluconeogenesis genes. Additionally there was reduction in hepatic fat content, in expression of lipogenic, pro-inflamatory and pro-oxidative genes and increase in reactive oxygen species and in nuclear expression of NRF2, a transcription factor essential to cytoprotective response. Although considered toxic, AGEs become protective when administered chronically, stimulating AKT signaling, which is involved in cellular defense and insulin sensitivity.

Made available in DSpace on 2018-11-26T22:38:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-05-25 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Little is known about advanced glycation end products (AGEs) participation in glucose homeostasis, a process in which skeletal muscle glucose transporter GLUT4 (Scl2 alpha 4 gene) plays a key role. This study investigated (1) the in vivo and in vitro effects of AGEs on Slc2 alpha 4/GLUT4 expression in skeletal muscle of healthy rats, and (2) the potential involvement of endoplasmic reticulum and inflammatory stress in the observed regulations. For in vivo analysis, rats were treated with advanced glycated rat albumin (AGE-albumin) for 12 weeks; for in vitro analysis, soleus muscles from normal rats were incubated with bovine AGE-albumin for 2.5 to 7.5 hours. In vivo, AGE-albumin induced whole-body insulin resistance; decreased (similar to 30%) Slc2 alpha 4 mRNA and GLUT4 protein content; and increased (similar to 30%) the nuclear content of nuclear factor NF-kappa-B p50 subunit (NFKB1), and cellular content of 78 kDa glucose-regulated protein (GRP78). In vitro, incubation with AGE-albumin decreased (similar to 50%) the Slc2 alpha 4/GLUT4 content; and increased cellular content of GRP78/94, phosphorylated-IKK-alpha/beta, nuclear content of NFKB1 and RELA, and the nuclear protein binding into Slc2 alpha 4 promoter NFKB-binding site. The data reveal that AGEs impair glucose homeostasis in non-diabetic states of increased AGEs concentration; an effect that involves activation of endoplasmic reticulum-and inflammatory-stress and repression of Slc2 alpha 4/GLUT4 expression. Univ Sao Paulo, Inst Biomed Sci, Dept Physiol & Biophys, Sao Paulo, Brazil Univ Sao Paulo, Fac Med, Hosp Clin HCFMUSP, Lab Carboidrato & Radioimunoensaio LIM 18, Sao Paulo, Brazil Univ Sao Paulo, Fac Med, Hosp Clin HCFMUSP, Lab Lipides LIM 10, Sao Paulo, SP, Brazil Univ Estadual Paulista, Fac Sci & Technol, Dept Physiotherapy, Sao Paulo, Brazil Univ Nove Julho UNINOVE, Programa Posgrad Med, Sao Paulo, Brazil Univ Estadual Paulista, Fac Sci & Technol, Dept Physiotherapy, Sao Paulo, Brazil FAPESP: 2012/20432-0 FAPESP: 2016/25155-5 FAPESP: 2012/18724-2 FAPESP: 2013/00713-7 FAPESP: 2014/17251-9 CNPq: 2016/15603-0

The aim of this study was to investigate three methods of prediction of the bone quality of the distal humerus: dual-energy X-ray absorptiometry (DEXA), Ct-Scan and plain radiographs.The bone mineral density (BMD) of 21 cadaveric distal humerus was determined using DEXA at two levels. Then a CT-scan and anteroposterior radiographs were taken. The cancellous density was estimated with the CT-scan. The cortico-medullar index (CMI) was calculated as cortical thickness divided by total bone thickness on AP views.A significant positive correlation was found between the BMD of the epiphysis and the CMI of r = 0.61. The mean BMD of the distal humerus was 0.559 g/cm(2). Male specimens showed a significantly higher BMD than females. The mean CMI of diaphysis was 1.431 and the mean BMD of the metaphysis region was 0.444 g/cm(2).More than a direct evaluation of the bone density with a CT-scan, the CMI of the distal humerus diaphysis is a predictor of the bone quality of the distal humerus. This should be of great help for the surgeon's decision making in case of fracture of the distal humerus, as open Reduction and Internal Fixation (ORIF) of fractures of the distal humerus can lead to failure due to poor bone quality.Basic Science Study, Anatomic Cadaver Study.

The TASER(®) is a self-defense weapon whose use has now become commonplace among law enforcement agencies. Electronic control weapons were first used in the USA in the 1990s and then adopted in Europe and France. We report a case of an 18-year-old male who presented a penetrating lesion of the middle phalanx of the left index finger. To the best of our knowledge, this is the first complex finger injury due to the TASER(®). It highlights the potential major risks to finger vitality and function with use of this electrical weapon.

Carpal coronal fractures are rare. We report the case of a 15 year-old male who fell from a balcony and suffered a displaced coronal fracture of the capitate, hamate and triquetrum. The diagnosis, which was initially made based on the X-rays, was confirmed by CT scan. Open reduction and internal fixation using Herbert screws was performed. To the best of our knowledge, this is the first published case of a coronal fracture of these three bones. The patient returned to normal activities after six months.

Defects on the palmar surface of the fingers are an important part of hand emergencies, especially fingertip wounds. Luckily, many coverage methods are available. We will review the anatomy of this area and the thought process for treating these defects. We will also propose an algorithm that can be used to select the best technique based on the type of injury present.

Los traumatismos del plexo braquial son los mas graves de todas las lesiones de los nervios perifericos, pero en los ultimos 30 anos se han producido avances considerables en su tratamiento. El objetivo principal es establecer un diagnostico exacto para despues tratar de mejorar el pronostico. La violencia del traumatismo, asi como la estimacion de la fuerza aplicada sobre el miembro son especialmente importantes. La probabilidad de que exista una lesion del plexo braquial puede determinarse durante la exploracion del paciente en urgencias; una exploracion detallada del plexo puede efectuarse en pocos minutos en un paciente consciente y colaborador. El examen mediante resonancia magnetica (RM) es indispensable. Los pacientes que no muestran signos de recuperacion durante los primeros 2 meses son candidatos a la exploracion quirurgica. Si los fasciculos estan lesionados e indurados, es necesaria su reseccion y restablecer su continuidad mediante un injerto; la neurotizacion esta indicada en las avulsiones superiores para restaurar la funcion del hombro y del codo. En las paralisis completas, se efectua un injerto a partir del neuroma proximal o se utilizan transferencias de los nervios intercostales En las paralisis superiores C5-C6, la neurotizaciones son el procedimiento estandar. En las paralisis de larga evolucion, la perdida de la flexion y extension del codo se trata por medio de musculos libres reinervados por nervios intercostales o por el nervio espinal accesorio. Varias innovaciones recientes proporcionan opciones quirurgicas de reconstruccion, con la posibilidad de mejorar el resultado funcional. La cirugia secundaria a los 2 anos suele ser necesaria una vez que el paciente ha recuperado la flexion del codo.

Resume Hypothese Les fractures distales de l’humerus sont difficiles a caracteriser et a classer selon l’AO. Le but de notre etude etait de montrer l’interet de l’imagerie par tomodensitometrie (TDM) et d’evaluer sur une etude multicentrique, sa reproductibilite intra- et inter-observateur en fonction de leur experience. Materiel et methodes A partir d’une enquete en ligne sur un cas clinique de fracture de l’humerus distal, la classification de la fracture selon l’AO a ete etudiee sur des radiographies et a ete reevaluee sur des scanners. Seize observateurs issus de cinq centres differents ont evalue 26 dossiers radiologiques. La classification AO et les principales caracteristiques de la fracture ont ete evaluees. Une premiere serie de lecture avec l’imagerie radiographique et le scanner 2D etait repetee 15 jours plus tard avec en plus les images scanner 3D. A distance une seconde serie de lecture identique a la premiere permettait la comparaison. Resultats Avec le scanner, 95 % des chirurgiens classaient correctement la fracture contre seulement 73 % avec la radiographie. Le scanner corrigeait le diagnostic et l’attitude therapeutique dans respectivement 90 et 25 %. La reproductibilite inter-observateur etait faible pour la classification AO et les caracteristiques de la fracture avec l’imagerie radiographique et scanner 2D mais aussi avec l’imagerie 3D en plus. La reproductibilite intra-observateur etait amelioree par l’imagerie 3D. L’experience des observateurs, contrairement a la qualite de l’imagerie ou a l’origine geographique, n’influait pas sur l’accord des reponses. Conclusion Une imagerie scanner ameliore la precision du diagnostic et peut modifier la prise en charge chirurgicale. L’imagerie scanner n’ameliore pas l’accord inter-observateur avec un nombre d’observateurs eleves pour les variables etudiees. L’imagerie 3D augmente l’accord intra-observateur a la difference de l’imagerie 2D. L’experience en annees de pratique des observateurs contrairement a la qualite des images, l’habilete a manier l’outil informatique et surtout l’observation et l’interpretation de l’imagerie n’influe pas sur les resultats. Niveau de preuve III.

BACKGROUND: Activation of hepatic stellate cells (HSCs) is a key event in the initiation of liver fibrosis. CD4 T cells can modulate positively or negatively this process. Briefly, Th1 cells despite their pro-inflammatory properties have anti-fibrogenic properties in contrast to Th2 cells. We and others have demonstrated that IL-17A produced by Th17 cells has pro-fibrogenic properties as it promotes activation of HSCs via different mechanisms. Th17 cells also produce IL-22, an enigmatic cytokine with proinflammatory and hepatoprotective properties. In addition, IL-10 produced by regulatory T cells (Treg) negatively modulates activation of HSCs. AIMS: We hypothesized that liver fibrosis progression results from an alteration in the Th17/Treg ratio leading to an imbalance in the pro-fibrotic cytokine profile within the liver. METHODS: We examined ex vivo the frequency of Th17 and Treg populations and the cytokine profile of intrahepatic lymphocytes isolated from liver biopsy samples (n=32). We validated these cytokines profiles using in vivo model of fibrosis in transgenic mice and primary human HSCs. RESULTS: We observed increased Th17/Treg ratio in advanced (F4, Metavir) as compared to moderate or non-fibrosis (F0-F2). Furthermore, we observed a bias towards Th17/Th9 cytokine profile in fibrotic livers with viral-hepatitis, whereas the cytokine profile was Th17/Th2 in non-viral hepatitis. All biopsies exhibited a 5-fold increase in IL-22 in fibrotic livers (p=0.0082) irrespective of aetiology. In vivo, lack of IL-22 signaling protects against thioacetamide-induced fibrosis. IL-22RA1 Knockout mice have reduced collagen deposition measured by picro-sirius red staining (p=0.0009) and pro-fibrotic genes expression (ACTA2, LOXL2, TIMP-I, TGFb1, COL1A1) in comparison to wild-type littermates. In vitro stimulation of primary human HSCs with IL-22 sensitized them to suboptimal doses of TGF-b. RNA-seq analysis demonstrated activation of p38 in HSCs in response to IL-22 and chemical inhibition of p38 suppressed the pro-fibrogenic effect of IL-22. CONCLUSIONS: Our results suggest a dysregulated Th17/Treg ratio in advanced fibrosis coupled with distinct cytokine profile dependant on the aetiology of liver disease. Finally, we have identified IL-22 as a common factor in advanced liver fibrosis acting through sensitization of HSCs to TGF-b in a p38-dependent manner. FUNDING AGENCIES: CIHR

Summary Introduction Fractures of the distal humerus in patients over the age of 65 remain a therapeutic challenge. Treatment options include conservative treatment, internal fixation or total elbow arthroplasty. The complications of these different treatment options were evaluated in a multicentre study. Materials and methods Four hundred and ninety-seven medical records were evaluated. A retrospective study was performed in 410 cases: 34 received conservative treatment, 289 internal fixation and 87 underwent total elbow arthroplasty. A prospective study was performed in 87 cases: 22 received conservative treatment, 53 internal fixation, and 12 underwent total elbow arthroplasty. Patients were evaluated after at least 6 months follow-up. Results The rate of complications was 30% in the retrospective study and 29% in the prospective study. The rate of complications in the conservative treatment group was 60%, and the main complication was essentially malunion. The rate of complications was 44% in the internal fixation group and included neuropathies, mechanical failure or wound dehiscence. Although complications only developed in 23% of total elbow arthroplasties, they were often more severe than those following other treatments. Discussion Complications develop in one out of three patients over 65 with distal humerus fractures. Three main types of complications were identified. Neuropathies especially of the ulnar nerve, especially during arthroplasty, must always be identified, the nerve requiring isolation and transposition. Bone complications, due principally to mechanical failure, were found following internal fixation. Despite technical progress, care must be taken not to favor excessive utilization of this treatment option in complex fractures on fragile bone. Although there were relatively fewer complications with total elbow arthroplasty they were more difficult to treat. Ossifications were frequent whatever the surgical option and can jeopardize the functional outcome. Level of evidence Level IV.

Resume Introduction Les fractures de la palette humerale du sujet de plus de 65 ans representent un challenge therapeutique. Les moyens therapeutiques varient entre le traitement orthopedique, les osteosyntheses ou la prothese totale de coude. A travers une etude multicentrique, les complications de ces differents traitements ont ete evaluees. Materiel et methode Quatre cent quatre-vingt-dix-sept dossiers ont pu etre evalues. L’etude retrospective a permis d’analyser 410 dossiers dont 34 ont beneficie d’un traitement orthopedique, 289 d’osteosyntheses, et 87 d’une prothese totale de coude. L’etude prospective a permis de valider 87 dossiers dont 22 traitements orthopediques, 53 osteosyntheses et 12 protheses totales de coude. Les patients ont pu etre evalues avec un recul minimum de 6 mois. Resultats Dans la serie retrospective, le taux de complications etait de 30 % et de 29 % dans la serie prospective. Ce taux etait de 60 % pour le traitement orthopedique essentiellement des cals vicieux. Il etait de 44 % pour les osteosyntheses notamment des lesions nerveuses, des demontages, et des conflits cutanes. Il etait de 23 % pour les protheses totales de coude, mais souvent plus complexes a resoudre que pour les autres traitements. Discussion Un patient sur trois, victime d’une fracture de l’humerus distal apres 65 ans, va presenter une complication. Trois grands types de complications ont ete retrouves dans ces situations. Des complications nerveuses surtout ou niveau du nerf ulnaire qu’il faut toujours reperer et isoler et transposer surtout en cas de prothese. Des complications osseuses a type de faillite de materiel sont surtout vues dans les osteosyntheses. Malgre les avancees techniques, il faut rester prudent et savoir ne pas pousser une indication devant une fracture complexe sur un os fragile. Les protheses ont moins de complications mais elles sont plus difficiles a traiter. Les ossifications sont frequentes quel que soit le traitement chirurgical et peuvent minorer les resultats fonctionnels. Niveau de preuve IV.

Resume Introduction Le traitement orthopedique reste un traitement d’exception des fractures de l’extremite distale de l’humerus du sujet de plus de 65 ans. Cependant, dans une population selectionnee, ce traitement peut etre une option therapeutique seduisante. Patients et methode Une etude prospective et une etude retrospective ont permis d’inclure 56 patients d’âge moyen 84,7 ans (68–100) dans cette serie. Tous les patients ont ete traites par immobilisation brachio-ante-brachio-palmaire pendant 6 a 8 semaines sans reduction de la fracture. Il s’agissait de fracture de type A selon l’AO dans 18 cas, de type B dans 8 cas, et de type C dans 30 cas. Resultats Au recul moyen de 20,2 mois dans la serie retrospective et de 8,6 mois dans la serie prospective, le score MEPS etait de 83 points avec 75 % de resultats satisfaisants, et de 86 points avec 83 % de resultats satisfaisants respectivement. Le Quick-DASH etaient de 31,3 et de 34,4 points respectivement. Une pseudarthrose a ete constatee dans 3 cas. Soixante-dix pour cent des patients presentaient un cal vicieux extra-articulaire, et 65 % un cal vicieux articulaire dans la serie retrospective contre 16 % dans la serie prospective. L’arthrose augmentait avec le recul avec plus de 50 % des patients presentant une arthrose de stade 2 ou 3 dans la serie retrospective au recul. Trois complications etaient notees : 2 hematomes et 1 lesion cutanee (escarre localisee). Dans 3 cas, il a ete constate un deplacement de la fracture qui n’a pas necessite de changement de traitement. Discussion Le traitement orthopedique des fractures de l’humerus distal chez le sujet de plus de 65 ans reste une therapeutique d’exception. Il permet de conserver une autonomie de vie et donne un resultat clinique satisfaisant, avec l’absence d’enraidissement important articulaire ou d’instabilite du coude. Cependant, il faut savoir accepter d’avoir une radiographie non anatomique. Niveau de preuve IV.

Background and purpose There is little published data on the diagnostic and therapeutic management of lower-limb stump infections (excluding toe and forefoot amputations). Patients and methods We made a retrospective observational study of 72 patients having undergone a major lower-limb amputation for a vascular or traumatic reason, complicated by post-surgical stump infection, between January 1, 2000 and December 31, 2009. Results Stump infection was diagnosed more than 6weeks after amputation in half of the patients. Staphylococcus was the most frequently isolated bacterium. Ultrasonography and CT scan combined with fistulography were useful to confirm the diagnosis and to determine the extension of infection. Thirty-two patients (44%) needed surgical revision in addition to antibiotic treatment. Patients diagnosed with bone infection more frequently required complementary surgery than those with soft tissue infection (P Conclusion The optimal management of this type of infection requires obtaining reliable bacteriological documentation (abscess aspiration in case of soft tissue infection or bone biopsy in case of osteomyelitis) to adapt to the antibiotic treatment. The management should be multidisciplinary (orthopedic or vascular surgeons, rehabilitation specialists, and infectious diseases physicians). Most patients may use prosthesis once the infection is treated.

Resume Introduction La prise en charge des fractures de l’extremite distale de l’humerus (FEDH) chez le sujet âge demeure, malgre les progres therapeutiques, un des grands challenges de la chirurgie traumatologique. Ces fractures, relativement rares, appartiennent aux fractures osteoporotiques et comme telles ont une incidence croissante. Patients et methodes Grâce a une etude retrospective colligeant 410 patients sur une periode de 10 ans et une etude prospective totalisant 87 patients durant un an et demi, les auteurs ont analyse l’epidemiologie des FEDH du sujet âge de plus de 64 ans dans 19 centres francais. L’ensemble des patients retenus a ete revu, en dehors d’un sujet de l’etude retrospective decede mais dont les donnees etaient exploitables. Resultats Les fractures sont dominees par le type C de la classification de l’AO et se produisent dans plus de 80 % des cas chez une femme, de plus de 80 ans dans pres d’un cas sur deux. Une forte majorite des patients a un bon niveau d’autonomie et vit a domicile. Contrairement a d’autres localisations fracturaires du membre superieur, pres de 90 % des patients ont necessite une intervention. Une etude du role de differents facteurs sur la prise en charge, les complications et le resultat a mis en evidence l’intervention primordiale de l’osteoporose. Conclusion Les auteurs insistent sur l’importance du statut fonctionnel dans les indications therapeutiques, beaucoup plus adapte que l’âge chronologique pour cette population. Niveau de preuve IV.

Resume Introduction Les fractures de l’extremite distale de l’humerus du sujet âge sont souvent complexes et difficiles a prendre en charge. Le but de cette etude est de rapporter les resultats d’une serie multicentrique d’osteosyntheses de fracture de la palette humerale du sujet âge de type A-B et C de la classification de l’AO, pour identifier les benefices et pieges des differents types de montage. Patients et methodes Deux etudes ont ete menees : une etude multicentrique prospective qui a permis d’inclure 53 patients et une etude multicentrique retrospective avec 289 patients, tous âges de plus de 65 ans avec une fracture recente de la palette humerale. Les patients ont ete evalues cliniquement (antecedents, etat general, amplitudes articulaires, le Mayo Elbow Performance Score (MEPS), et radiologiquement (type de fracture, consolidation ou non de la fracture, presence d’un cal vicieux ou non, status du materiel). Resultats Les resultats cliniques et fonctionnels evalues a l’aide du MEPS sont relativement satisfaisants : avec une moyenne a 92 points pour les type A, 82 points pour les type B et 88 points pour les type C. Dans les deux series, ce sont les fractures de type B qui ont ete les plus difficiles a traiter et qui ont donne les moins bons resultats cliniques, fonctionnels et radiologiques. Les complications etaient surtout liees aux fractures de type C ; il s’agissait principalement de lesions neurologiques et de demontages/pseudarthrose. Discussion Bien qu’il s’agisse de fractures difficiles a traiter avec un taux de complication non negligeable, la recuperation fonctionnelle s’est fait de facon assez satisfaisante. Il s’agit d’une chirurgie difficile dont l’une des composantes majeures reste le niveau d’osteoporose des patients qu’il convient d’analyser finement pour poser eventuellement l’indication d’une arthorplastie totale de coude. Niveau de preuve IV.

INTRODUCTION: Despite recent treatment advances, management of distal humerus fractures in the elderly remains one of the most challenging aspects of trauma surgery. Although these fractures are relatively rare, they fall under the umbrella of osteoporotic fractures, which themselves are increasing in frequency. MATERIAL AND METHODS: Two studies were performed: one retrospective study of 410 patients over a 10-year period and one prospective study of 87 patients over a 1.5-year period. This allowed us to analyse the epidemiology of distal humerus fractures in subjects above 64years of age in 19 different French hospitals. All of the included patients were reviewed, except for one subject in the retrospective study who had died, but whose data was still used. RESULTS: Most of the fractures were AO type C, occurred in women in more than 80%, and occurred in nearly one of two persons above 80 years of age. Most of the patients had a high level of autonomy and lived at home. Unlike other upper limb fracture sites, nearly 90% of patients required surgical treatment. The presence of osteoporosis was found to have a tremendous impact on fracture care, complications and results. CONCLUSION: Functional status is more important than chronological age in this patient population; the former must be taken into account when determining treatment indications. LEVEL OF EVIDENCE: Level IV. Language: en

Resume Introduction Les fractures de l’humerus distal representent 5 % des fractures osteoporotiques des sujets de plus de 60 ans. Le terrain osteoporotique, les co-morbidites, et les comminutions articulaires rendent difficile leur prise en charge. Hypothese La prothese totale de coude represente une solution therapeutique fiable chez les sujets de plus de 65 ans presentant une fracture de la palette humerale. Patients et methode Quatre-vingt sept patients (80 femmes et 7 hommes) de 79 ans de moyenne d’âge (65–93) ont beneficie de la mise en place d’une prothese totale de coude pour le traitement d’une fracture de type A selon la classification de l’AO dans 9 cas, de type B dans 8, et de type C dans 70. Resultats Au recul moyen de 37,5 mois (extremes, 6 et 106) le MEPS atteignait 86 ± 14 points avec un score quick-DASH de 24 ± 19 points, et un stade de Katz a 5 ± 1,5 points. Le MEPS etait d’autant meilleur que le patient venait de son domicile, avec un stade de Katz preoperatoire eleve, et un antecedent de rhumatisme inflammatoire. Cinquante-cinq patients (63 %) presentaient un coude incolore et 20 (24 %) qu’une douleur minime. L’arc d’extension-flexion etait de 97 ± 22 et 48 % presentaient un arc superieur ou egal a 100°. Soixante-neuf patients presentaient une fonction normale. Des complications ont ete retrouvees dans 20 cas (23 %) avec une reprise chirurgicale necessaire dans 8 cas (9 %). Deux protheses ont du etre changees, l’une pour fracture de la tige humerale, et l’autre pour descellement. Une seule infection est a deplorer dans cette serie. Conclusion Les protheses totales de coude ont permis d’obtenir des resultats immediats satisfaisants permettant de redonner aux patients un coude indolore, stable et fonctionnel. Ces resultats semblent reproductibles et durables avec le temps. Le taux de complication n’est pas negligeable avec un taux de reprise chirurgicale autour de 10 %. Niveau de preuve IV.

El tratamiento de las fracturas proximales de los dos huesos del antebrazo debe integrarse dentro del tratamiento global de las posibles lesiones asociadas de la articulacion del codo. El conocimiento de la anatomia y de la biomecanica del codo permitira una mejor adaptacion del tratamiento. El extremo proximal del cubito participa en la estabilidad anteroposterior por medio del gancho olecranocoracoideo, pero tambien en la estabilidad frontal en varo por la intermediacion de la faceta anteromedial de la apofisis coronoides. Esta apofisis funciona de forma sinergica con la cabeza del radio y las estructuras capsuloligamentarias lateral y medial. El tratamiento debe basarse en un analisis completo de las lesiones que afectan al cubito proximal, investigando la posible presencia de una afectacion del olecranon, de la coronoides y, en ocasiones, una extension metafisaria. Es necesario identificar las lesiones asociadas de la cabeza radial y analizar las relaciones de las articulaciones radiocapitelar y radiocubital proximal. En las fracturas aisladas de olecranon, la osteosintesis mediante obenque en las fracturas simples o mediante placa en el caso de las fracturas conminutas ofrece por lo general buenos resultados. Cuando la fractura presenta una extension metafisaria o existen lesiones asociadas, se recomienda una osteosintesis mediante placa. En las lesiones de la apofisis coronoides es necesario, en caso de inestabilidad, realizar una osteosintesis del complejo coronoides-braquial anterior; la presencia de una fractura asociada de la cabeza radial no siempre es indicacion de su extirpacion. Sera necesario realizar la osteosintesis o una sustitucion protesica para garantizar la estabilizacion externa de la articulacion. La reparacion de los elementos ligamentarios y musculares del epicondilo lateral permite garantizar la estabilidad posterolateral. Si en este estadio persiste la inestabilidad, estaria indicada la utilizacion de un fijador externo articulado para garantizar la estabilidad del codo; la reparacion del ligamento colateral medial es controvertida. Si se respeta este esquema de tratamiento quirurgico, se puede llevar a cabo rapidamente la movilizacion postoperatoria de una articulacion estable con el objetivo de conseguir resultados funcionales satisfactorios y reducir el riesgo de complicaciones.

Aim: To assess the renal effects of chronic exposure to advanced glycation end-products (AGEs) in the absence of diabetes and the potential impact of concomitant treatment with the antioxidant N-acetyl cysteine (NAC). Methods: Wistar rats received intraperitoneally 20 mg/kg/day of albumin modified (AlbAGE) or not (AlbC) by advanced glycation for 12 weeks and oral NAC (600mg/L; AlbAGE+NAC and AlbC+NAC, respectively). Biochemical, urinary and renal morphological analyses; carboxymethyl-lysine (CML, an AGE), CD68 (macrophage infiltration), and 4-hydroxynonenal (4-HNE, marker of oxidative stress) immunostaining; intrarenal mRNA expression of genes belonging to pathways related to AGEs (Ager, Ddost, Nfkb1), renin-angiotensin system (Agt, Ren, Ace), fibrosis (Tgfb1, Col4a1), oxidative stress (Nox4, Txnip), and apoptosis (Bax, Bcl2); and reactive oxidative species (ROS) content were performed. Results: AlbAGE significantly increased urine protein-to-creatinine ratio; glomerular area; renal CML content and macrophage infiltration; expression of Ager, Nfkb1, Agt, Ren, Tgfb1, Col4a1, Txnip, Bax/Bcl2 ratio; and 4-HNE and ROS contents. Some of these effects were attenuated by NAC concomitant treatment. Conclusion: Because AGEs are highly consumed in modern diets and implicated in the progression of different kidney diseases, NAC could be a therapeutic intervention to decrease renal damage, considering that long-term restriction of dietary AGEs is difficult to achieve in practice.

This study reports several clinical cases for orthopaedic bone regeneration using an injectable bone substitute (MBCP Gel ® ) to demonstrate its safe use and efficiency in clinical applications. The biomaterial is a composite of microporous bioceramic hydroxyapatite granules that are associated with beta tricalcium phosphate (MBCP) and a synthetic hydrosoluble polysaccharide hydrogel (CE mark 123 and FDA dental domain registered). The present exploratory study demonstrated the generative osseous performance of this injectable bioceramic for filling various orthopaedic bone defects. The clinical cases showed bone ingrowth into the cavities created by drilling when removing the aseptic osteonecrosis of the femoral head during biopsy taking. Furthermore, bone reconstruction was seen after filling large cystic defects, at the time of the revision surgery of the hip prosthesis. Resorption and bone ingrowth with trabecular bone architecture were observed in defects created in long bones (femur and tibia). Patients were followed during 5 months to 1 year. The overall results demonstrated the safe use and the clinical performance of this injectable bioceramic in orthopaedics.

L’objectif de cette etude est de decrire la reconstruction des articulations metacarpophalangiennes (MCP) post-traumatiques par arthroplastie en pyrocarbone type pyrosphere. Nous avons realise quatre reconstructions articulaires des MCP chez deux patients. Il s’agissait des hommes, travailleurs de force, victime d’un traumatisme par scie circulaire sur la face dorsale de la main dominante. Le delabrement cutane et de l’appareil extenseur etaient majeurs, ainsi que la destruction cartilagineuse et osseuse des MCP, ouverte, avec perte osseuse peri-articulaire. Il n’y avait pas de devascularisation. Les reconstructions articulaires MCP post-traumatismes ouverts ont necessite deux temps operatoires, utilisant la technique de la membrane induite. En urgence, on realise un Masquelet arme au ciment antibiotique + l’appareil extenseur est suture en direct ou reconstruit. Une antibiotherapie preventive a ete realisee en postoperatoire. Trois mois apres, on realise le 2e temps par ablation du ciment en respectant la membrane induite peri-articulaire, prelevements bacteriologiques, tenolyse de l’appareil extenseur et mise en place d’implant prothetique, en pyrocarbone (pyrosphere-3S Ortho). Un patient a beneficie une antibiotherapie postoperatoire de 6 semaines, sans depose du materiel pour prelevements bacteriologiques osseux peroperatoires positifs. Les suites ont necessite une kinesitherapie longue pour recuperation des amplitudes articulaires et renforcement musculaires. La douleur etait controlee. Les implants etaient stables cliniquement et radiologiquement. Les traumatismes ouverts des articulations MCP sont difficiles a traiter et engendre douleur, arthrose, raideur et instabilite. Les options therapeutiques actuellement decrites sont l’arthrodese, l’arthroplastie totale (pyrocarbone ou silicone), le transfert articulaire ou l’amputation. Cette arthroplastie offre une alternative interessante chez le sujet actif et manuel, victime d’une destruction traumatique ouverte des MCP, ou l’importance de la perte osseuse ne permet pas la pose d’une arthroplastie totale standard. Cette arthroplastie MCP pourrait etre une option therapeutique interessante chez le travailleur de force. Davantage de recul serait neanmoins necessaire.

Resume Nous rapportons trois cas de patients ayant presente une lesion pseudotumorale dans les suites d’une arthroplastie totale de hanche avec deux presentations macroscopiques differentes : (1) la presentation classique sous forme d’un granulome inflammatoire, (2) la survenue d’un hematome collecte en rapport avec des lesions des vaisseaux gluteaux, probablement atteints par le processus pseudotumoral est rapportee pour un cas. Le diagnostic de ce type de lesion est radiologique, tandis que la tomodensitometrie permet la confirmation et surtout montre l’extension et les rapports de la lesion lorsqu’elle est extensive. Une arteriographie est necessaire en cas de lesion de nature liquidienne et la biopsie est a discuter en fonction du contexte clinique. Dans les trois cas, il a ete observe une histologie typique de lesions granulomateuses. Une fois le diagnostic etabli, la prise en charge therapeutique reste similaire pour les deux presentations avec une reprise chirurgicale, qui doit etre la plus precoce possible lorsque l’os cortical est atteint afin d’eviter une fracture pathologique.

Background The purpose of this study was to evaluate the long-term outcome (>20 years) of patients who underwent an open Bankart procedure, many of them contact athletes, in terms of shoulder stability, return to sport, and the development of osteoarthritis. Methods We retrospectively reviewed 49 patients (50 shoulders) who underwent an open Bankart procedure for recurrent shoulder instability. There were 36 contact athletes (73%) in this cohort. Mean follow-up was 28 years (25-32). Clinical examination was performed by an independent reviewer, with standard shoulder radiographs obtained. Results Eight patients had recurrence of dislocation after a new traumatic episode, in six cases while playing rugby, with two of them requiring re-operation. Forty (82%) patients returned to their previous level of sports activities, including all 31 rugby players. No statistically significant loss of motion occurred in this group, although there was slight loss of flexion (6°) and external rotation (9°). The mean Rowe score at final follow-up was 82 (25-97), and all but two patients considered themselves satisfied with the results of the surgery. Thirty-four (69%) patients showed signs of osteoarthritis at follow-up, as follows: Stage 1 –18, Stage 2 – 5, Stage 3 – 5, and Stage 4 – 1. Conclusion At long-term follow-up, patients undergoing an open Bankart procedure for recurrent shoulder instability obtained a high percentage of shoulder stability, and reliably returned to high-level sports activities. However, 69% did show radiographic signs of osteoarthritis.

La aparicion de una metastasis osea marca un cambio en la evolucion del paciente con cancer. Excepto en el caso de tumores primitivos muy peculiares, las posibilidades de curacion practicamente han desaparecido y el tratamiento esta orientado esencialmente hacia la mejoria de la calidad de vida del paciente. Esto hace surgir la necesidad de una estrecha colaboracion entre medicos y personal de enfermeria, cada una de las especialidades al servicio de la otra para aumentar su eficacia y limitar al maximo las complicaciones para el paciente. Se detallan sobre todo las estrategias quirurgicas y las asociaciones de tecnicas susceptibles de responder a las necesidades del paciente, sin volver a las tecnicas de base pero precisando intervenciones especificas en funcion de la localizacion.

Los traumatismos del plexo braquial son lesiones conocidas historicamente y son las mas severas de todas las lesiones de los nervios perifericos. Sin embargo, en los ultimos 30 anos se han producido avances considerables en su tratamiento. El objetivo principal es establecer un diagnostico exacto para despues tratar de mejorar el pronostico. La violencia del traumatismo, asi como la estimacion de la fuerza aplicada al miembro son especialmente importantes. La presencia de una lesion del plexo braquial puede descubrirse durante la exploracion del paciente en urgencias despues de un traumatismo de la cintura escapular; un examen detallado del plexo y de sus ramas puede efectuarse en pocos minutos en un paciente consciente y colaborador. El examen mediante RM y el diagnostico electrofisiologico resultan indispensables despues de las 3 semanas. Los pacientes que no muestran signos de recuperacion durante los 2 primeros meses son candidatos a la exploracion quirurgica. Si los fasciculos estan lesionados, indurados y fibrosados, es necesaria una reseccion de los mismos y restablecer su continuidad mediante injerto; la neurotizacion se indica en las avulsiones superiores para restaurar la funcion del hombro, del codo e incluso de la muneca. En las lesiones postraumaticas del plexo del adulto, las reparaciones suelen requerir diversos injertos nerviosos y neurotizaciones: en las paralisis completas, se efectua un injerto a partir del neuroma proximal o se utilizan transferencias con los nervios intercostales o con la porcion distal del nervio espinal accesorio; esto proporciona una flexion del codo en el 75% de los casos, y una abduccion y rotacion externa del hombro en el 50% de los casos. En las paralisis superiores C5 C6, la transferencia cubital-biceps es el procedimiento estandar si las raices C5 C6 estan avulsionadas. El injerto a partir de una raiz cervical afectada, si esta disponible, se utiliza para restaurar la funcion del codo; en las paralisis C5 C6 (C7), la extension de la muneca y de los dedos se consigue con transferencias tendinosas. En las paralisis antiguas, la perdida de la flexion y extension del codo se trata por medio de musculos libres reinervados por nervios intercostales o por el nervio espinal accesorio prolongado por un injerto. Innovaciones recientes han aportado nuevas opciones de reconstruccion quirurgica, lo que puede mejorar el resultado funcional. La cirugia secundaria suele ser necesaria una vez el paciente ha recuperado la flexion del codo: artrodesis de hombro, osteotomia de desrotacion humeral, artrodesis estetica de muneca en pronacion.

Las compresiones nerviosas del pie y del tobillo son infrecuentes. Los nervios afectados son sobre todo los de tipo sensitivo. El conocimiento de la anatomia es indispensable para sospechar este tipo de lesion, que suele pasar desapercibida debido a que su diagnostico es dificil de establecer. El dolor sigue siendo el sintoma revelador. Su localizacion es caracteristica y depende del nervio afectado. Puede que se manifieste tan solo durante el esfuerzo y, por tanto, afectar una poblacion de personas deportistas. A veces, puede acompanarse de trastornos de la sensibilidad y, en muchos menos casos, de trastornos motores. El descubrimiento de un signo de Tinel al realizar la percusion es un elemento clinico de orientacion destacado, pero su ausencia no excluye el diagnostico. Las exploraciones complementarias distinguen entre los diagnosticos diferenciales, y pueden poner de manifiesto las causas que favorecen la expresion de los sindromes neuropaticos por atrapamiento o del tunel. El electromiograma realizado en buenas condiciones, de forma bilateral y comparativa, puede demostrar una disminucion de las velocidades de conduccion sensitivas y una disminucion de la amplitud de los potenciales sensitivos. El sindrome del tunel sigue siendo la etiologia mas habitual de estas compresiones nerviosas. A menudo se encuentra una causa favorecedora. Puede tratarse de una inestabilidad del tobillo, trastornos de la estatica del pie, secuelas de fracturas, quistes sinoviales o hernias musculares. En ocasiones no se encuentra ninguna causa favorecedora y el sindrome del tunel se considera idiopatico. Ademas, la etiologia puede ser una intervencion quirurgica previa. El tratamiento medico conservador, basado en la interrupcion de las actividades desencadenantes, la correccion ortotica de un trastorno estatico y la rehabilitacion deben proponerse en una primera fase. Las infiltraciones locales pueden ser de utilidad diagnostica y terapeutica. Si fracasan estos tratamientos, se propone una intervencion quirurgica. Se realiza una neurolisis liberando el nervio afectado de cualquier elemento compresivo, ya se trate de una arcada aponeurotica o de bandas fibrosas. Debe identificarse y suprimirse cualquier causa favorecedora. En algunos casos, si en la intervencion se encuentra un seudoneuroma, un nervio demasiado distendido o si fracasa una neurolisis previa, se realiza una neurectomia proximal en estos nervios sensitivos. Los resultados de las intervenciones quirurgicas suelen ser favorables, sobre todo si se ha identificado y suprimido la causa de la compresion. En caso contrario, pueden persistir secuelas dolorosas.

Surgical treatment of lateral femoral cutaneous neuropathy (LFCN) is performed only after failure of conservative management. We reexamined 167 cases (7 bilateral) of LFCN of various etiologies (idiopathic, abdominal surgery, iliac crest bone grafting, trauma, and total hip arthroplasty) operated on between 1987 and 2003. Average follow-up was 98 months (20-212). The intervention was performed under local anesthesia in 139 cases (83%). Surgical release of the nerve was performed in 153 cases (92%) and transection in 14 cases (8%). Surgical treatment of LFCN led to improvement and patient satisfaction in 130 cases (78%). The results depended on several factors, especially the underlying etiology, duration of symptoms before intervention, and integrity of the nerve. Nerve release remains the first-line surgical technique, improving painful symptoms in many cases while preserving sensation of the thigh. It can be performed under local anesthesia by an experienced surgeon.

The aim of this study was to report the epidemiological characteristics and the experience of 5 departments of trauma, in France, in the management of fractures of the proximal ulna. 163 patients with fractures of the proximal ulna with a mean age of 49.9 years (range 16-97) were managed. The most common mode of injury was a motor vehicle collision (48%). 18% sustained associated injuries to the ipsilateral limb. Open fractures were present in 42 patients (25%). A total of 109 patients had a fracture of the olecranon, with the Mayo 2A and B types most frequently seen (66%). The patients were invited for clinical examination at a mean duration of 16 months, retrospectively. Validated patient-oriented assessment scores involving the Mayo Elbow Performance Index (MEPI) and the Broberg and Morrey score were evaluated. All patients had follow-up radiographs. The mean arc of elbow motion was 130° (70-150°). The mean MEPI was 91 (20-100) with good results in 23% and excellent results in 52% of the patients. The mean Broberg and Morrey score was 90 after isolated olecranon fracture, and decreased with the complexity of the lesion. 117 fractures (72%) healed with ulnohumeral congruity. 9 fracture non-unions occurred (6%). Although the fracture of the proximal ulna can be described in several classifications, none of them accommodate it satisfactorily, because of the complexity of the lesion. The coronoid process is the keystone for the stability of the elbow. It forms the anterior buttress with the radial head. Tension band wire fixation is by far the commonest technique of internal fixation used for the treatment of non-comminuted olecranon fractures. Dorsal plate fixation is a useful option by providing improved fixation of complex comminuted fractures and fracture-dislocations. The radiocapitellar joint has to be restored appropriately, preserving the radial head when possible and replacing it with a prosthesis otherwise. The lateral collateral ligament complex is commonly disrupted and usually can be reattached to its origin from the lateral epicondyle. In addition, a brief period of hinged external fixation should be considered.

Axillary nerve injuries still go undiagnosed far too often despite their frequency. However the quality of the outcome depends on expert management and prompt surgery. To optimise the latter, we re-examined 83 operated cases of traumatic lesions of the axillary nerve. We analysed the neurological and functional recovery of these patients by means of a follow-up evaluation at 6 years postop. The results were classified by age, mechanism of injury, delay to surgery and the presence or otherwise of associated neurological or osteo-articular lesions. We highlighted that a high index of suspicion ought to exist in all cases of trauma to the shoulder in a patient aged more than 40, any injury associated with palsy of the long head of triceps and in the case of an osteo-articular lesion due to high-velocity trauma. A complete lack of shoulder abduction must always prompt a search for a lesion of the axillary nerve as well as a suprascapular nerve palsy or rotator cuff lesion. There are few literature reports of surgical management of this particular nerve injury. An early MRI scan as part of the management should improve results by a reduction in the delay before surgery. As a result of our investigation we conclude that a lesion of the axillary nerve without signs of recovery at 3 months should be referred to a centre specialized in peripheral nerve surgery.

Les tumeurs nerveuses peripheriques de type schwannome sont rares. Il existe dans une partie des cas une association avec une maladie de Recklinghausen. Nous rapportons le cas d’une patiente de 63 ans, retraitee, decrivant une histoire douloureuse evoluant sur un an, sans deficit sensitivomoteur. L’IRM a permis de diagnostiquer un schwannome isole au niveau du premier espace intermetatarsien envahissant le premier metatarsien sans complication fracturaire associee. Ce diagnostic fut confirme par une biopsie preoperatoire. La patiente beneficia d’une exerese chirurgicale, d’un curetage osseux et d’un traitement adjuvant a l’azote liquide sans comblement osseux. L’analyse finale de la piece operatoire a confirme le diagnostic de schwannome. Au dernier recul, aucune recidive n’a ete detectee ni sur le plan clinique ni sur l’imagerie. Ce cas est seulement le troisieme schwannome intraosseux rapporte au niveau d’un metatarsien.

Resume Introduction Le but de cette etude est d’evaluer les resultats d’une serie prospective de 138 cas de syndromes du canal carpien, operes par une technique percutanee. Methode Les 129 patients (108 femmes et 21 hommes, de 49 ans et 9 mois de moyenne d’âge) ont ete evalues en preoperatoire par un questionnaire, un examen clinique (Weber, boucle, test de Kapandji, test de Tinel, test de Phalen, test de Vainio et prise de la force de poigne). La particularite de la technique operatoire est l’utilisation d’une sonde cannelee introduite dans le canal carpien afin de guider la lame au cours de la section du ligament annulaire. Resultats Les resultats ont ete evalues lors de trois consultations (premier, troisieme et sixieme mois). Nous obtenons 98,5 % de tres bons et bons resultats (criteres de Kelly), deux patients ont presente un syndrome algodystrophique. Nous n’avons pas releve de complications vasculaires, tendineuses ou neurologiques et nous n’avons jamais converti l’intervention par une technique a ciel ouvert. Discussion Les principaux avantages de cette technique sont une reprise rapide de la fonction de la main avec une duree de reprise moyenne du travail de 22,6 jours, un taux de complication faible et un materiel simple.

We retrospectively analyzed the charts of 13 athletes (18 limbs) who had sural nerve entrapment localized in the passage of the nerve through the superficial sural aponeurosis. There were 11 men and 2 women (average age, 43 years; range, 31 to 59). All patients reported chronic calf pain that was exacerbated during physical exertion. Delay to diagnosis averaged 9 months (range, 5 to 24). Tenderness in the calf was identified along the course of the sural nerve in all cases. In 10 patients (15 limbs) electrodiagnostic testing before surgery was positive. After failure of nonoperative treatment, surgery was conducted under local anesthesia. Neurolysis was performed by incising the superficial sural aponeurosis and the fibrous band in it through which the nerve passes. The results of the operation were evaluated in terms of residual symptoms, ability to return to the former sport, and degree of patient satisfaction. A final follow-up examination was performed an average of 14 months (range, 6 to 30) after the operation. The final result was excellent in 9 limbs (2 bilateral), good in 8 limbs (2 bilateral), and fair in 1 case. The differential diagnosis of sural nerve entrapment in athletes is discussed. Increase in sural muscle mass or development of local fibrous scar tissue compromised the sural nerve in its course through the unyielding and inextensible superficial sural aponeurosis.

Flow cytometry was used to quantify apoptotic and necrotic polymorphonuclear (PMN) cells in an exudate generated by biomaterials, and the results were compared with determinations of spontaneous apoptosis and necrosis in PMN cells from the bloodstream. The exudate formed inside cylindrical tubes subcutaneously implanted in the dorsal region of rats was collected over a 1-week period. A rapid and simple staining procedure based on the spectral properties of the bisbenzemide Hoechst 33342 was used to identify apoptotic PMN cells. Quantification of permeabilized PMN cells stained by propidium iodide was possible in the same unfixed specimens. The percentages of apoptotic and permeabilized PMN cells in peripheral rat blood were low (1.8 ±0 0.5% and 1.7 ± 0.7%, respectively), similar to results found in humans. In exudates generated by polyvinyl chloride (PVC), the percentages of apoptotic and permeabilized PMN cells were higher than in the blood. The percentage of PMN cells undergoing apoptosis progressively increased with time and reached a maximum at day 2 (27% ± 6%). The percentage of permeabilized cells progressively increased with time and was much higher than the percentage of apoptotic cells on days 4 and 8. Apoptosis and necrosis of PMN cells at day 2 were inhibited when tubes were filled with 10% serum. Selective inhibition of apoptosis with a caspase inhibitor in vivo indicated that apoptosis and necrosis are two separate pathways leading to the death of PMN cells in the exudate. At day 2, polyurethane (PU) was associated with a lower rate of apoptosis than PVC or a random copolymer of trimethylene carbonate (TMC) and ϵcaprolactone (ECL). Apoptosis was interpreted as an organized cell removal process that limits inflammation. Apoptosis was the natural route of PMN cell death at the early stage of inflammation. © 1999 John Wiley & Sons, Inc. J Biomed Mater Res, 44, 429–435, 1999.

Flow cytometry was used to quantify an inflammatory reaction in vivo as a new approach to evaluating the biocompatibility of biomaterials. The exudate formed inside cylindrical tubes composed of polyvinyl chloride (PVC), silicone elastomer (SIL), or polyurethane (PU) implanted subcutaneously in the dorsal region of rats was collected over a 3-week period. The volume, number of cells, and concentration of fibrinogen were determined in the exudate for the three biomaterials. The exudate was analyzed using a flow cytometry technique after labeling of the leukocytes with a monoclonal anti-CD45 antibody. Fibrinogen rose progressively over the 3-week period for the three polymers. After the different leukocyte lines were identified in rat blood samples, their determination in the exudate revealed differences among the three biomaterials. At day 2, PVC induced a predominantly neutrophilic inflammatory reaction whereas PU and SIL gave a mixture of monocytes and neutrophils. At day 9, the aspect of the cytograms was different, but the identification of the subpopulations was still possible. At day 23, the number of cell events became too low to distinguish the subpopulations. An even more detailed approach might be possible using specific labeling for each leukocyte line to establish a comparison among the three biomaterials. Flow cytometry associated with histomorphometric assessment might provide a precise quantitative in vivo test for determining the biocompatibility of materials.

Sixty patients (sixty-two limbs) who had entrapment of the peroneal nerve were managed with operative decompression, and the results were evaluated after an average duration of follow-up of forty-two months (range, twenty-five to 162 months). The entrapment was postural in five patients, dynamic in two (one of whom had bilateral entrapment), and idiopathic in fifty-three (one of whom had bilateral entrapment). Fifty-eight patients (including the two who had bilateral entrapment) had a positive Tinel sign. Twenty-two patients (including the two who had bilateral entrapment) had sensory symptoms only, and thirty-eight had both sensory and motor symptoms. Electrophysiological studies were performed for all patients in order to confirm the diagnosis. Sensory deficits were confirmed on the basis of a marked decrease in the amplitude of sensory potentials, and motor deficits were confirmed on the basis of decreased nerve-conduction velocities. The common peroneal nerve was decompressed by division of both edges of the fibular fibrous arch. The average time from the onset of symptoms to the operation was fourteen months (range, one to 120 months), primarily because of delayed referrals. Twelve of the twenty-two patients who had had only sensory symptoms preoperatively had complete recovery by the time of the latest follow-up. The average delay from the onset of symptoms to the operation was thirty months (range, six to eighty-six months) for the ten patients (eleven limbs) who did not have full recovery compared with nine months (range, four to thirty-six months) for the twelve patients (thirteen limbs) who did. The postoperative recovery of motor function, as determined with use of the grading system of the Medical Research Council, was good for thirty-three (87 per cent) of the thirty-eight patients who had had both sensory and motor symptoms preoperatively. All seven patients who had peroneal nerve entrapment of known etiology had improvement postoperatively. We recommend operative decompression when symptoms persist or recovery remains incomplete for three to four months, provided that the diagnosis has been confirmed with electrophysiological studies.

SummaryWe report three cases of pseudotumoral lesion secondary to total hip replacement using metal on polyethylene bearings, presenting two distinct macroscopic aspects: (a) classic inflammatory granuloma and, in one case, (b) onset of hematoma associated with gluteal vessel lesions, probably affected by the pseudotumoral process. Diagnosis was radiographic, with CT-scan serving to confirm and, more importantly, to reveal extension and analyze surrounding tissue. Arteriography is needed when the lesion is liquid, and biopsy may be envisaged depending upon the clinical situation. In all three cases, histology was typically that of granulomatous lesions related to wear debris. Once diagnosis could be established, treatment was similar in both presentations, with surgical revision, which should be as early as possible in case of cortical bone involvement, to prevent pathologic fracture.

L’osteome osteoide, tumeur benigne intra-osseuse bien connue, reste de localisation rare aux os du carpe. Il se manifeste par des douleurs mal systematisees, souvent d’horaire inflammatoire mais parfois avec une composante mecanique trompeuse. Nous presentons le cas d’une patiente de 19 ans, droitiere, se plaignant de douleurs d’apparition brutale du poignet droit, d’horaire mixte, sans facteur declenchant retrouve, et evoluant depuis plus d’un an. La patiente est partiellement soulagee par le port d’une orthese thermoformee prenant le poignet. Le bilan radiologique initial ne retrouve pas de lesion osseuse ni des parties molles. L’IRM realisee en suivant conclut a une necrose du scaphoide devant un hypo-signal en sequence T1, plutot localise au pole proximal et la tomodensitometrie montre une legere condensation du pole proximal du scaphoide + la pathologie est rapidement etiquetee maladie de Preiser. Le tableau clinique et scanographique reste stable durant la periode de surveillance et d’investigations, mais le diagnostic n’est pas remis en question. La patiente decide de changer d’orientation professionnelle car toute activite de force lui est contre-indiquee. Par la suite une greffe osseuse vascularisee est programmee mais la patiente demande un deuxieme avis qui conduit a une reunion de concertation multidisciplinaire. A la relecture de l’IRM, celle-ci montre en fait un hyper-signal en sequence T2, infirmant definitivement une necrose osseuse avasculaire. Le diagnostic d’osteome osteoide est evoque devant la composante inflammatoire predominante de ses douleurs, et devant la presence d’une lesion douteuse (aspect de nidus difficile a affirmer) visible sur les coupes scanographiques au pole proximal du scaphoide. Il sera confirme par une angio-IRM. Un traitement en radiologie interventionnelle a ete propose par laser ou radiofrequence. La patiente a ete amelioree par la prise d’aspirine entre temps. La localisation d’un osteome osteoide au carpe est peu frequente, la symptomatologie et l’aspect IRM parfois trompeurs en l’absence d’images scanographies typiques. A notre connaissance, seul un cas similaire d’osteome osteoide mimant une necrose avasculaire du triquetrum a ete decrit dans la litterature. Il s’agit donc d’un diagnostic rare, difficile, avec un pronostic fonctionnel tres defavorable en cas de prise en charge retardee, et dont la presentation dans ce cas est tres atypique.

Axillary nerve injuries still go undiagnosed far too often despite their frequency. However the quality of the outcome depends on expert management and prompt surgery. To optimise the latter, we re-examined 83 operated cases of traumatic lesions of the axillary nerve. We analysed the neurological and functional recovery of these patients by means of a follow-up evaluation at 6 years postop. The results were classified by age, mechanism of injury, delay to surgery and the presence or otherwise of associated neurological or osteo-articular lesions. We highlighted that a high index of suspicion ought to exist in all cases of trauma to the shoulder in a patient aged more than 40, any injury associated with palsy of the long head of triceps and in the case of an osteo-articular lesion due to high-velocity trauma. A complete lack of shoulder abduction must always prompt a search for a lesion of the axillary nerve as well as a suprascapular nerve palsy or rotator cuff lesion. There are few literature reports of surgical management of this particular nerve injury. An early MRI scan as part of the management should improve results by a reduction in the delay before surgery. As a result of our investigation we conclude that a lesion of the axillary nerve without signs of recovery at 3 months should be referred to a centre specialized in peripheral nerve surgery.