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ABSTRACT: We present our experience with a rare localization of tuberculosis, the wrist, focusing on symptoms and outcome after treatment.
Our series included eleven patients, eight men and three women, mean age 42 Years, who presented tuberculosis of the wrist. Tuberculosis was known in four patients who were being treated and a context of tuberculosis was recognized in three others. One patient on long-term corticosteroid therapy was immunodepressed. Mean time from symptom onset to consultation was fifteen months indicating a slow and progressive disease process. An inflammatory syndrome was noted in nine patients. Based on the standard x-rays, the David-Chausse classification was: stage I n=1; stage II n=1; stage III n=3; stage IV n=4. The AP view of the wrist was normal in two patients. Diagnosis of tuberculosis was confirmed on the surgical biopsy specimen which revealed epithelio-gigantocellulary granuloma with caseous necrosis. In only five patients Koch bacilli developed in culture on Lowenstein-Jensen. Patients were given anti-tuberculous antibiotics and the wrist was immobilized in a plaster splint.
Mean follow-up was two years. The disease course was blunted by the antituberculosis treatment. Surgical drainage was only required to clear abscesses. Wrist stiffness was frequent and had a significant functional impact.
These eleven cases of a rare localization of tuberculosis illustrate the slow progressive course of clinical symptoms and radiological signs of tuberculosis, emphasizing the difficulties encountered in establishing early diagnosis of such isolated non-abscessed localizations. Anti-tuberculous treatment is effective but the functional outcome depends on early diagnosis before the development of radiological evidence of joint destruction.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 07/2004; 90(4):337-45. · 0.37 Impact Factor
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ABSTRACT: We observed a pathological fracture of the femur in a 21-year-old woman with a venous malformation. Physical examination and plain x-rays disclosed a pathological bone. Biopsy revealed the venous malformation. The extent of the lesion that involved the entire quadriceps muscle was detailed with duplex-Doppler, computed tomography and arteriography. The patient was treated with an intramedullary nail. Intra-operative bleeding necessitated transfusion (packed cells and frozen plasma). Outcome was favorable. Bone healing was achieved at seven months.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 06/2004; 90(3):280-4. · 0.37 Impact Factor
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ABSTRACT: One case of divergent dislocation of the elbow is reported. It was associated with other lesions of the upper limb due to the violence of the initial trauma. The authors found 6 other cases reported in the literature. They discuss the mechanism, diagnosis and treatment of such lesions.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 02/1994; 80(2):150-2. · 0.37 Impact Factor
