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ABSTRACT: Morse tapers are frequently used in total hip replacement to achieve precise adjustment of lengths and femoral offset. Mechanically, they do not raise any specific problems so long as strict positioning requirements are observed and elements from different manufacturers are not mixed together. We report a case in which the implant induced unexplained pain at 2 years, in relation to a defective fit between the metallic head and the Morse taper. Asymmetric partial fit of the head onto the taper was detected on control X-ray and was implicated as causing metallosis due to excessive release of metal debris from the Morse taper. Revision required femoral stem exchange because of the damage to the Morse taper as well as replacing the cup with new metal-metal bearings. Evolution was favorable at 3 years' follow-up. Most hip replacements include a Morse taper; the present clinical case is a reminder that strict positioning rules are to be respected, without which corrosion and wear may lead to mechanical failure.
Orthopaedics & Traumatology Surgery & Research 02/2012; 98(2):247-50. · 0.94 Impact Factor
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ABSTRACT: The authors present a case of a distal radius fracture associated with a comminutive fracture of the ulna head, treated by volar locking plate for the radius fracture and ulnar head resection. We obtain an early good objective and subjective functional result, whereas this type of fracture is classically associated with bad results in the series published with other treatments. This result needs to be confirmed by a more exhaustive series.
Chirurgie de la Main 11/2010; 30(1):69-72. · 0.53 Impact Factor
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ABSTRACT: We report the rare case of a patient with an avascular necrosis of the proximal part of the capitate, with a review of the literature. The patient was treated by a resurfacing prosthesis of the proximal part of the capitate. At 22 month of follow up, the patient had a good functional result. Resurfacing prosthesis is a good therapeutic option in case of proximal capitate avascular necrosis when there is no more place for conservative surgery.
Chirurgie de la Main 06/2010; 29(3):203-6. · 0.53 Impact Factor
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ABSTRACT: The authors report two cases of complete dorsal carpometacarpal dislocations associated with lesions of the hand and the two bones of forearm. These dislocations are rare, and their clinical and radiological diagnosis is difficult. These cases are original through the association of carpometacarpal dislocation with lesions of the two bones of forearm. They demonstrate the need to stress the importance of a complete evaluation of the patient. Treatment must be immediate and begin with the osteosynthesis of the proximal lesions to avoid any irreducibility. These elements will determine the functional outcome.
Chirurgie de la Main 06/2009; 28(4):250-4. · 0.53 Impact Factor
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ABSTRACT: A retrospective radiologic analysis of Paget's disease of the spine.
The prevalence, anatomic distribution, mechanisms of formation of Pagetic vertebral ankylosis (PVA) and the possibility of a relationship to diffuse idiopathic skeletal hyperostosis (DISH) were assessed in a large population of persons with Paget's disease.
Acquired vertebral ankylosis is not a common feature of the Paget's disease of the spine and its mechanisms of formation remain unknown. In some reports, PVA was associated with radiographic signs of DISH.
Of 337 Pagetic patients monitored in the Division of Rheumatology from 1961 to 1990, all 245 who had entire spine radiographs were selected for study. Radiographs were studied for signs of Pagetic vertebral lesions and for spinal lesions of DISH.
The study group contained 156 men with a mean age of 68 years (range 37-92) and 89 women with a mean age of 71 years (range 50-89). Fourteen PVA were observed on the radiographs of 11 men (mean age 68 years; range 60-76). One PVA was cervical, eight were thoracic, one thoracolumbar, three lumbar, and one lumbosacral. Eighty of the two hundred forty-five patients (32.6%) had characteristic features of DISH. Eight out of the eleven patients with PVA also had evidence of spinal lesions of DISH and radiographic features of DISH were observed contiguous to ten of the fourteen PVA.
The scarcity of PVA reported in the literature and in our study (4.4% of 245 patients) suggests that constant progression of the disease from one vertebra to another by invasion of intervertebral disc space is rare. However, the higher incidence of PVA in men, their preferential location at the thoracic spine and their association with lesions of DISH suggest that progression of Pagetic lesions by invasion of bridging osteophytes may be an important mechanism for the intervertebral spread of Paget's disease.
Spine 03/1995; 20(4):454-9. · 2.08 Impact Factor
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ABSTRACT: Vertebral bridging occurs in approximately 10% of patients with spinal pagetic lesions. Diffuse idiopathic skeletal hyperostosis has been reported in patients with pagetic block vertebras and may facilitate vertebral fusion and extension of pagetic lesions. High prevalences of diffuse idiopathic skeletal hyperostosis have been found in patients with Paget's disease. To determine how pagetic block vertebras develop and to investigate relationships between Paget's disease and diffuse idiopathic skeletal hyperostosis, 244 patients with Paget's disease were studied retrospectively. Diagnostic criteria for diffuse idiopathic skeletal hyperostosis were the presence of flowing ossification along the anterolateral aspect of at least three contiguous vertebral bodies or presence of at least two anterolateral intervertebral bony bridges in the same spinal segment. Eight (33%) of the 244 patients had diffuse idiopathic skeletal hyperostosis. Two-thirds of patients with both conditions were male. There was no statistically significant association between presence of diffuse idiopathic skeletal hyperostosis and spinal involvement by Paget's disease. Fourteen pagetic block vertebras were identified in 11 male patients. Eight of these 11 patients had involvement of the fused vertebras or adjacent vertebras with diffuse idiopathic skeletal hyperostosis. Our findings confirm that diffuse idiopathic skeletal hyperostosis is common in patients with Paget's disease. The statistically significant association between diffuse idiopathic skeletal hyperostosis and pagetic vertebral fusion in the same site suggests that the former condition may be a risk factor for pagetic vertebral bridging.
Revue du Rhumatisme 03/1994; 61(2):100-8.
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ABSTRACT: Five cases of insufficiency fracture of the sacrum in women aged over 60 are reported. The elements of diagnosis and causative factors are reviewed. In all cases the diagnosis was confirmed by technetium bone scintigraphy and computerized tomography of the sacrum. Bone tissue evaluation in search of a bone-wasting disease, the principal cause of this type of fracture, was conducted in all 5 patients, using photon absorptiometry and/or double energy computerized tomography and histomorphometry. These examinations provided detailed information on disorders of mineralization in the genesis of these insufficiency fractures.
La Presse Médicale 01/1989; 17(44):2335-8. · 0.67 Impact Factor
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Revue du rhumatisme et des maladies ostéo-articulaires 12/1988; 55(11):915-8.
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Revue du rhumatisme et des maladies ostéo-articulaires 05/1986; 53(4):255-60.
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Revue du rhumatisme et des maladies ostéo-articulaires 56(8-9):597-600.
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ABSTRACT: Fourteen osteoporotic women who had been under treatment with fluoride (23 mg/day of fluorine ions) for 12 months on average developed periarticular pain in the lower limbs or pelvis, corresponding to 21 fractures due to bone insufficiency. Six of these fractures were revealed only by radionuclide uptake in the painful areas, whereas the remaining 15 fractures, including 2 of the sacrum, were visible at radiography. Four patients had a past history of hyperthyroidism or were in a state of active hyperthyroidism detected by hormonal assays and iliac bone biopsy when the fractures were diagnosed. The decalcification associated with hyperthyroidism facilitates the occurrence of bone insufficiency fractures, as do treatments with high doses of fluoride, inadequate calcium supplement intake (observed in 5 cases) or the presence before treatment of renal impairment or disorders of bone mineralization, sometimes detected only by iliac bone biopsy. Repeated measurements of blood and urinary fluoride levels during treatment make it possible to adjust fluoride dosage, and lower doses (14 mg/day of fluorine ions) might reduce the incidence of the adverse effects of fluoride on bone.
La Revue de Médecine Interne 10(2):118-26. · 0.61 Impact Factor
