EMC - Rhumatologie-Orthopédie最新文献

{"title":"Gelures","authors":"E. Cauchy (Praticien hospitalier urgentiste),&nbsp;J. Foray (Chirurgien, membre de l'Académie de chirurgie)","doi":"10.1016/j.emcrho.2005.06.001","DOIUrl":"https://doi.org/10.1016/j.emcrho.2005.06.001","url":null,"abstract":"<div><p>Frostbite is a localised lesion caused by a direct freezing action on tissues. It is characterised by a gradual onset and a local numbness that may delay its medical management. The pathophysiology of frostbite is peripheral vasoconstriction secondary to a drop in core body temperature. The mainstay of primary medical treatment is a rapid re-warming, and the use of peripheral vasodilators. New management guidelines aim to reduce progression of frostbite to progressive secondary necrosis. A recent classification based on initial lesion involvement and bone scanning data defines four stages which correlate with long-term prognosis and have useful prognostic implications. At the stages III and IV, a risk of bony amputation is associated. Late surgical treatment aims to be maximally conservative and is discussed with plastic surgeons. But in case of uncontrolled sepsis emergency surgical treatment may be needed.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 5","pages":"Pages 470-478"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.06.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136602923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chirurgie reconstructive après amputation traumatique du pouce","authors":"G. Foucher ,&nbsp;J. Medina","doi":"10.1016/j.emcrho.2005.07.004","DOIUrl":"https://doi.org/10.1016/j.emcrho.2005.07.004","url":null,"abstract":"<div><p>Secondary thumb reconstruction after traumatic amputation has largely evolved owing to the development of numerous techniques. Conventional techniques remain important and indicated, including the rejuvenated osteoplastic reconstruction with composite forearm island flaps and the progressive lengthening by distraction. Pollicization remains sometimes indicated, in case of associated mutilated finger. Microsurgery has been added to the armamentum through free vascularized toe transfers. Even in this field, improvements are observed, both for the recipient and the donor sites.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 5","pages":"Pages 552-572"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.07.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136602990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Échographie en rhumatologie","authors":"B. Lecoq ,&nbsp;L. Fournier ,&nbsp;M. Carteni ,&nbsp;F. Morin ,&nbsp;C. Marcelli","doi":"10.1016/j.emcrho.2005.07.002","DOIUrl":"10.1016/j.emcrho.2005.07.002","url":null,"abstract":"<div><p>The importance of ultrasonography in rheumatology has increased dramatically. Its use is likely to significantly modify rheumatology practice. Rheumatologists may perform this examination themselves, provided they have been correctly trained for it (about 2 years). Technical advances (high- and multi-frequency transducers) allow accurate ultrasonographic analysis of tendon, muscle and joint structures. Ultrasonography constitutes a direct prolongation of the clinical examination, which provides further arguments to the rheumatologist's diagnosis and helps for more accuracy in the therapeutic management. The numerous potential applications of ultrasonography for musculoskeletal diseases are currently under evaluation by clinical research teams. The clinical knowledge of the rheumatologist enhances the potentialities of ultrasound examinations. The actual less expensive cost of ultrasound devices allow rheumatologists to use this technique in their daily practice, both in the hospital context or in a private practice.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 5","pages":"Pages 443-469"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82734697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manifestations rhumatologiques paranéoplasiques en dehors de l'ostéoarthropathie hypertrophiante","authors":"C. Masson (Praticien rhumatologue hospitalier),&nbsp;B. Bouvard (Interne),&nbsp;M. Audran (Professeur, chef de service)","doi":"10.1016/j.emcrho.2005.03.003","DOIUrl":"10.1016/j.emcrho.2005.03.003","url":null,"abstract":"<div><p>Paraneoplastic rheumatic syndromes (PRS), as any paraneoplastic syndrome, induce signs or symptoms related to a known or an unrecognized tumour, cancer, or haemopathy, often malignant but not always. The chronologic relationship between the neoplastic process and the symptomatology is essential. PRS is not due to a tumour-induced compression or a synovial or bone peri-articular metastatic invasion. They differ from pre-neoplastic systemic rheumatic conditions. They disappear when the patient may benefit from a radical treatment. The best rheumatologic example is the hypertrophic pneumogenic osteoarthropathy described elsewhere in this work. Here we review the other PRS conditions: the palmar fasciitis syndrome; the ovary (but not exclusively) polyarthritis and cancer; the paraneoplastic muscular syndromes induced by a dermatomyositis, polymyositis, Lambert-Eaton myasthenia syndrome, and stiff man syndrome; inflammatory rheumatisms (polyarthritis, pseudo Still's disease, benign oedematous acute polyarthritis of the elderly, rhizomelic pseudoarthritis) in their rare paraneoplastic presentations; the vascular lesions (erythromelalgia, Raynaud's disease, digital necrosis, vascularitis) in their paraneoplastic presentations; other potentially paraneoplastic systemic rheumatic conditions (atrophic polychondritis, multicentric reticuloendotheliosis, panniculitis-arthritis syndrome, and amyloid arthropathy); paraneoplastic hypercalcemias, in particular those related to the parathormone-related peptide; and oncogenous osteomalacia. Clinical and paraclinical orientations are considered, according to these different situations, particularly for the presented tumoural and haematological diseases.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 5","pages":"Pages 501-509"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.03.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86461793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumeurs malignes osseuses du genou : exérèse et reconstruction","authors":"F. Langlais,&nbsp;N. Belot,&nbsp;H. Thomazeau,&nbsp;D. Huten,&nbsp;J.-C. Lambotte,&nbsp;T. Dreano","doi":"10.1016/j.emcrho.2005.03.002","DOIUrl":"https://doi.org/10.1016/j.emcrho.2005.03.002","url":null,"abstract":"<div><p>Both the distal femur and the proximal tibia are the preferential site of primitive malignant bone tumours, particularly adolescents' osteosarcomas. Total knee replacement is the gold standard when the tumour spreads to the epiphysis, when it is aggressive and extracompartimental. The prosthesis used in such case is the cemented press-fit of which the long centromedullar stems rest onto the healthy side of the isthmus. The joint is a hinge which may be rotational or not. In femoral lesions without joint invasion, in case of subtotal excision of the quadriceps, an extensor mechanism must be reconstructed, by transfer of the ischii and leg muscles. Surgery by antero-medial access allows controlling the vasculonervous pedicle. In tibial tumours, special attention must be paid to soft tissues, for the front prosthesis coverage (made using a medial gastrocnemius flap) and the extensor kinematization as well. If a part of the patellar ligament has been preserved, it is sutured on the biceps tendon after transferring both the osteotomized fibula and the medial gastrocnemius. If full excision of the patellar ligament has been performed, a combined composite prosthesis is used, that permits re-inserting the patient's extensor mechanism on the extensor mechanism of the allograft. In case of joint invasion, arthrectomy is necessary, using a total composite prosthesis with extensor allografting. After two decades of such reconstructive prostheses use, their long-lasting and satisfactory functional results following extensor reconstruction are confirmed and allow considering this therapeutic procedure even in young and active subjects. Biological reconstruction is recommended in patients with preserved epiphysis and joint (chondrosarcomas, metaphysis limited osteosarcomas). In femoral tumours, medial vascularized fibulas are used for reconstruction, with complementary lateral allografting. Plating is used for osteosynthesis. In tibial tumours, maintaining the allograft by a fixed nail may be effective. Arthrodeses are limited to some rare cases such as athletes, hard-working subjects, or major infectious risk. Today, prostheses are far more frequently used than arthrodeses. Owing to long-lasting effects, biological therapy is recommended provided it is compatible with satisfactory carcinologic excision. Such exeresis and reconstruction surgical procedures showed good oncologic and functional results, but interventions were complex, necessitating frequent resumptions. This surgery can be undertaken only by trained surgical teams, familiar with this type of prostheses, flap use, and vascularized bone transfers.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 4","pages":"Pages 335-354"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91973896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Résections-reconstructions pour tumeurs osseuses malignes du membre supérieur","authors":"P. Anract (Professeur des Universités, praticien hospitalier),&nbsp;B. Tomeno (Professeur des Universités, praticien hospitalier)","doi":"10.1016/j.emcrho.2005.04.002","DOIUrl":"https://doi.org/10.1016/j.emcrho.2005.04.002","url":null,"abstract":"<div><p>Malignant bone and soft-tissue tumours are less common in the upper limb than in the lower limb (ratio 1:2). They mainly affect the shoulder, particularly the proximal humerus. Limb-sparing surgery may be considered in about 80% of patients with malignant shoulder tumours. In contrast, in patients with more distal malignancies (at the elbow level, or below) that involve extraosseous tissue, amputation is frequently required. A biopsy must be performed prior to treatment of the tumour, together with investigations aimed at assessing the tumour extension in the bone and soft tissues, the relationships between the tumour and the joints, vessels and nerves, the regional spread, and potential metastatic disease. After scapulectomy, the proximal humerus is suspended to the clavicle or ribs. Massive scapular prostheses or allografts are rarely used. When the proximal humerus can be resected without removing the deltoid muscle, reconstruction can be achieved using a composite inversed Delta prosthesis, a massive allograft, or a composite humeral prosthesis. When deltoid excision is required, scapulohumeral arthrodesis with allogeneic and autologous grafting is performed. After resection of the humeral diaphysis, reconstruction relies on allogeneic and autologous graft implantation with internal fixation. For elbow reconstruction, arthrodesis, massive prosthesis, or massive allograft is generally used. For reconstruction of the distal radius, we usually perform arthrodesis of the distal radius to the first row of carpal bones. Alternatives include implantation of a vascularized fibular graft and massive allografting for arthrodesis or arthroplasty. After resection of the distal ulna, reconstruction is not necessary. Primary bone malignancies of the hand are more rare; they usually involve metacarpal bones. Conservative resection is rarely feasible, and most patients require complete or partial hand amputation to obtain tumour-free margins.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 4","pages":"Pages 355-375"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.04.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91973897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fractures diaphysaires de l'adulte (fractures pathologiques exclues)","authors":"P. Bonnevialle","doi":"10.1016/j.emcrho.2005.04.001","DOIUrl":"10.1016/j.emcrho.2005.04.001","url":null,"abstract":"<div><p>Diaphyseal fractures are characterized by specific anatomical, biomechanical and histological features. Bone lesions are classified according to the type of lesion and their location. Soft tissue injuries are analysed, leading to a classification of diaphyseal fractures in closed and open lesions. Basic principles are proposed, for the diagnosis and the therapy. Early complications and non union events are described. Non operative treatment and osteosynthesis – external fixation, nailing, plating – are studied.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 4","pages":"Pages 394-410"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91175311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manifestations ostéoarticulaires des anémies","authors":"Ph. Collet (Rhumatologue, médecin des Hôpitaux)","doi":"10.1016/j.emcrho.2005.03.005","DOIUrl":"10.1016/j.emcrho.2005.03.005","url":null,"abstract":"<div><p>Osteoarticular manifestations due to haemolytic anaemia are not rare. Generally, they appear early in childhood but they may remain causing great problems of management in adulthood and, thus, concern the rheumatologist. During the management of thalassaemia, various painful bone or joint manifestations may be encountered. Osteoporosis has become a more frequent disorder due to the lengthening of survival that has resulted from an improved therapeutic management. Biophosphonates have shown efficacy in significantly increasing the bone mass. The principal complication of beta-thalassaemias is the vaso-occlusive attack that, at the bone level, may be responsible for bone infarct or aseptic osteonecrosis. Other painful manifestations may be observed, such as septic arthritis or aseptic arthropathies. In such cases also, multidisciplinary management allowed reducing mortality and improving survival.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 4","pages":"Pages 376-393"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.03.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79977061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Instabilités du genou","authors":"S. Dojcinovic (Chef de clinique),&nbsp;E. Servien (Assistant chef de clinique),&nbsp;T. Aït Si Selmi (Praticien hospitalier),&nbsp;C. Bussière (Chef de clinique),&nbsp;P. Neyret (Professeur, chef de service)","doi":"10.1016/j.emcrho.2005.04.003","DOIUrl":"10.1016/j.emcrho.2005.04.003","url":null,"abstract":"<div><p>Knee instability is a subjective symptom that encompasses many anatomo-clinical situations. Patient's declarations, clinical examination, and x-ray pictures allow, most of the time, establishing precise diagnosis. More sophisticated investigations may be necessary secondarily, in the pre-operating context. When analysing the symptoms and for the determination of the lesion diagnosis, the practitioner has to put the instability in clinical context (patient questioning, clinical and paraclinical examination). The main diagnostic contexts that will be considered in the present chapter are those instabilities of ligament and meniscus origin and those of patellofemoral origin.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 4","pages":"Pages 411-442"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.04.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72853323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blessures des membres et du rachis par projectiles","authors":"G. Versier (Professeur agrégé du Val de Grâce, chef de service),&nbsp;D. Ollat (Assistant des Hôpitaux des Armées)","doi":"10.1016/j.emcrho.2005.01.001","DOIUrl":"10.1016/j.emcrho.2005.01.001","url":null,"abstract":"<div><p>Gunshot wounds include multi-tissular and heterogeneous lesions. Responsible agents are various: firearms, attack guns, hunting rifles, mines and terrorist machines. The management of patients with such wounds is no longer the matter of the sole military practitioners; since the emergence of terrorism and crime in the cities, the civil community is more and more often concerned. Such lesions have to be managed according to specific rules of which doctors should be aware because sometimes they differ from usual traumatology. Dressing is the main step in the surgical management. It allows fighting efficiently the omnipresent infection. Vascular lesions are frequent and necessitate sometimes urgent revascularization. Except in particular cases, bone stabilization is performed using external fixation. Cutaneous suture is delayed. Most of the time, recovery induces reiterative dressings and secondary reconstructive surgery. Despite great improvements, sequelae remain important and emergency or secondary amputation is still frequent.</p></div>","PeriodicalId":100448,"journal":{"name":"EMC - Rhumatologie-Orthopédie","volume":"2 3","pages":"Pages 262-275"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emcrho.2005.01.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74209078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}