[The anterior interosseous nerve syndrome. A rare lesion of a median nerve branch in the forearm. A case]

Apparently spontaneous and isolated lesions of the anterior interosseous nerve--a purely motor branch of the median nerve in the forearm--are extremely rare. Their clinical manifestations are fairly stereotyped, consisting of paralysis restricted to the long flexor muscle of the thumb, the deep flexor muscle of the index finger and the quadrate pronator muscle, without sensory disorders. The diagnosis is confirmed by electromyography. The syndrome may caused by traumas of the forearm or may develop spontaneously, although underlying anatomical abnormalities which may act as predisposing factors are not infrequently found in this case. The natural outcome may be favourable, but surgery may be required to release the nerve.

[Spinal injuries without neurologic complications]

Instability of the injured spine may be bony, which allows only limited displacement, or osteo-disco-ligamentous where the potentiality for displacement is unlimited. A reasonable degree of purely bony displacement can be accepted in the spine, and only when the deformity is considerable is closed or open reduction necessary. However, osteo-disco-ligamentous instability requires operative stabilisation. There is a risk of post operative medullary complications, which can be lessened by sound surgical technique, but this has to be judged against the possibility of secondary cord damage in an unstable injury. Properly performed operations should allow the same degree of correction to be obtained in the spine as is customary in long bones. This will lessen the aesthetic and functional problems which occur secondary to the spinal deformity, and lessen the risk of onset of neurological damage arising as a result of acquired spinal stenosis.

[Recent fractures of the odontoid. Prognostic factors]

A review of 92 recent fractures of the odontoid process suggests that they can be divided into two groups: stable fractures requiring no more than orthopedic treatment, and unstable fractures requiring surgery. Basing themselves on four main prognostic factors (direction and level of the fracture, distance between the fragments and age of the patients), the authors propose three types of surgical treatment differing in complexity and functional results: posterior C1-C2 arthrodesis, simple lacing with nylon threads and, quite recently, direct screwing by the antero-lateral approach.

[Recent injuries of the last 5 cervical vertebrae in the adult (with and without neurologic complications)]

Traumatic lesions of the lower cervical spine give rise to two main problems - injury to the bones or ligaments leading to possible instability, and the presence or absence of damage to the spinal cord or nerve roots. After discussing the pathological anatomy and describing the clinical signs of the lesions, the authors explain their treatment programme which is based on seventeen years of practical experience. All unstable lesions involving the lower five cervical vertebrae are treated surgically, especially if there is partial or total tetraplegia. Instability can be rectified by reduction of the lesion and fixation by means of plates screwed into the articular masses, and this procedure has the additional advantage of improving the recovery of the neurological lesion. The nursing of the tetraplegic patient is also facilitated.

[Atloaxoid dislocation with basilar pressure and spinal cord symptoms in rheumatoid arthritis. A case of occipitocervical arthrodesis followed by resection of the odontoid]

The authors report a case of atlanto-axial dislocation in a patient with rheumatoid arthritis. There was some neurological impairment with upper limb pain and hyperreflexia. As a first stage, a cranio-cervical fusion was performed through a posterior approach. Three weeks later the axis was excised through an antero-lateral approach, together with its odontoid process. The patient's condition was much improved and the neurological lesions disappeared.

[Prospects for conservative excision procedures in osteosarcomas in 1981]

On the tenth anniversary of the Bone Tumor Study Group (BTSG) the authors report on their overall experience of the surgical management of osteogenic osteosarcomas. Current data from the medical literature is analyzed. The authors believe that every time a resection-reconstruction procedure is possible it should be preferred to systematic amputation. This policy is warranted by the continuing advances in medical management, particularly in chemotherapy. However, when dealing with osteosarcomas, the therapist's fore-most concern is the danger to life rather than functional considerations. Attention is drawn to recent technical developments enabling total excision of vertebral and costovertebral osteosarcomas, that should lead to considerable improvement of the prognosis of such tumors which was hopeless until now.

[Aseptic osteonecrosis during corticosteroid treatment of Behçet's disease (author's transl)]

Four patients with Behçet's disease (a 42-year-old woman and 3 men aged 24, 32 and 39 respectively), who had received high doses of prednisone (0.5 to 1 mg/kg/day) during a mean period of 21 months developed aseptic osteonecrosis of the femoral heads and condyles which obliged to reduce steroid dosage and to introduce additional drugs. Corticosteroids are useful in Behçet's disease, as in other systemic diseases, but they probably act also on the underlying immune vascularitis. The occurrence of pain in weight-bearing joints during treatment should suggest osteonecrosis and in such cases, beside radiography, scintigraphy with technetium and/or phlebography with pressure measurement might provide an early diagnosis.

[Recovery of a complete cervical spinal cord injury with tetraplegia (author's transl)]

The prognosis of a complete cervical spinal cord injury is based on an accurate initial diagnosis and on immediate treatment in order to release the medullary compression and stabilise the spine. The diagnosis of a complete traumatic quadriplegia depends upon a thorough neurological examination, particularly noting sensation and motor power of the sacral segments, looking for a sacral sparing which is a sign of a better prognosis. The authors analysed a well documented case of progressive recovery obtained after nearly immediate open reduction and synthesis of a C1 C2 fracture-dislocation with complete quadriplegia.

[Total excision of thoracic vertebrae (author's transl)]

The authors believe that it is not possible to remove a thoracic vertebra completely by a lateral transthoracic approach. They have operated on three patients in which a thoracic vertebra has been removed completely using an extended posterior approach. The technique described utilizes an extra-pleural bilateral thoracotomy through a single posterior incision. The posterior mediastinum is mobilised and the vertebral bodies freed. The technique is indicated in tumours of the spine compressing or threatening the spinal cord, especially primary local malignant tumours or where adjuvant treatment such as radiotherapy, chemotherapy or radio active drugs are effective. Benign but recurrent tumours such as giant cell tumours or aneurysmal bone cysts are also good indications for this method.

[Factors of severity in the fractures of the odontoid process (author's transl)]

The authors think that the prognosis in fractures of the odontoid process could be based on an evaluation of the stability and on the direction of the fracture line. The stability depends on the integrity of the common posterior spinal ligament. When it is disrupted, the spine should be surgically fixed. When it is intact, conservative treatment is indicated. The stability should be appreciated on dynamic X rays 15 days after the trauma. The fracture lines oblique anteriorly are more stable than the fracture lines oblique posteriorly. The comminuted type, like "English policeman's hat" are very unstable.

[Odontoid process fractures associated with fractures of the pedicles of the axis (author's transl)]

The authors report their experience concerning eleven cases of that original and frequent association of fractures. The ligamentous lesions associated with those fractures are considered, justifying the necessary dynamic X rays. The eleven cases are reviewed and a classification supported by an iconography is given, according to the unstability of the odontoid or of the pedicles. The complications after orthopaedic or surgical treatment are analysed and the authors give their conclusions. The proposed treatment is conservative when the fractures are neither displaced nor unstable, and surgical when one of the two fractures is unstable. The best procedure is bi-pedicular screwing associated with C1/C2 wiring.

[Severe strains of the cervical spine operated on by a posterior approach (author's transl)]

The authors have operated on 18 cases of severe strain of the cervical spine (six cases of C1-C2 and 12 cases of level cervical spine). They point out the difficulty of an accurate diagnosis in emergency. They emphasize the importance of flexion-extension X-rays when conventional X-rays are not strictly normal. After an analysis of the results they suggest that recent cases should be treated by posterior grafting at the level of C1 and C2, posterior plating at lower levels. Old and irreducible cases should be treated by osteotomy and anterior grafting: banding with grafting at C1 and C2, posterior screwed plating at the inferior cervical level.

[Treatment of hypercorrection after surgical procedure on hallux valgus. Medial osteoplastic ridge (author's transl)]

Hallux varus hypercorrection is reduced and maintained by a medial osteoplastic ridge fixed by screws in the head of the first metacarpal bone. It can be indicated to associate an extensor Hallucis longus lengthening.

[The treatment of diaphyso-epiphyseal tumours by local resection with the preservation of joint movement. A report of four cases (author's transl)]

Four cases of epiphyseal tumours were treated by the authors by local resection. In two cases, there was a giant-cell tumour of the lower end of the femur, in one case a giant-cell tumour of the lower end of the radius and in one case a juxta-cortical sarcoma of the lower end of the radius. In the two cases involving the knees, resection preserved the articular surface and the subchondral bone. Reconstruction was achieved by a cortical autograft. In all cases, painless joint movement was preserved with satisfactory muscle power.