Thomas Le Corroller

La fracture ostéoporotique du col fémoral et la coxarthrose constituent aujourd'hui deux enjeux majeurs de santé publique chez les sujets âgés. L'ostéoporose est définie par une diminution de la masse osseuse et une altération de la structure osseuse. La coxarthrose d'autre part associe la perte progressive du cartilage d'encroûtement articulaire, une sclérose osseuse sous-chondrale, des géodes sous-chondrales, et des ostéophytes marginaux. Bien qu'une masse osseuse élevée semble prédisposer à l'arthrose, les relations métaboliques et biomécaniques entre ostéoporose et coxarthrose sont complexes. L'évaluation de l'architecture osseuse de l'extrémité proximale du fémur est un des enjeux majeurs de recherche actuels visant à la caractérisation des modifications du tissu osseux liées au vieillissement. Notre travail de thèse s'est inscrit dans un projet pluridisciplinaire de recherche sur les altérations de la structure osseuse de l'extrémité proximale du fémur, reposant sur une analyse en imagerie médicale et une étude biomécanique de cette région anatomique fondamentale.

Ultrasound-guided intervention of peripheral nerves is a new and promising branch of sonography. It offers minimally invasive therapeutic solutions with relatively little effort and has thus become an alternative to surgical procedures for managing entrapment neuropathies. It has shown considerable success in treating carpal tunnel syndrome, as well as other neuropathies caused by compression or focal strangulations. Sonosurgery, in particular, has become established as a validated reliable alternative to both open and endoscopic surgery. This review article critically examines the historical development of peripheral nerve ultrasound-guided intervention, leading ultimately to sonosurgery, and describes potential future uses.

A 51-year-old man with a history of ankylosing spondylitis presented with gradually increasing right hip pain. Computed tomography and magnetic resonance imaging demonstrated a large lytic lesion of the right iliac bone. Percutaneous bone biopsy was performed, followed by a diagnosis of an aggressive bone hemangioma. After a multidisciplinary meeting, sequential interventional treatment combining arterial embolization, percutaneous cryoablation, and cementoplasty was proposed and performed under imaging guidance, resulting in a complete resolution of symptoms. The patient presented a local recurrence at 4 years posttreatment, managed successfully with percutaneous cementoplasty under computed tomography guidance.

Image-guided percutaneous cryoablation plays an increasingly important role in managing bone and soft tissue tumors. Well-established indications include the treatment of osteoid osteoma, palliation of painful skeletal metastases, and local control of oligometastatic disease. Emerging indications are now a variety of painful benign bone tumors beyond osteoid osteoma, symptomatic soft tissue lesions (such as desmoid fibromatosis, vascular anomalies, abdominal wall endometriosis), as well as local recurrences of bone and soft tissue sarcoma. This state-of-the-art review describes the percutaneous cryoablation technique including current strategies to prevent complications. We also discuss the expanding range of clinical indications, as well as future directions of this promising technology in the musculoskeletal system.

Both benign and malignant tumors, including metastases, commonly occur in the bones around the knee. During the past few decades, image-guided percutaneous treatments have proved effective for the management of osteoid osteoma as well as for palliation of painful bone metastases. The advent of interventional oncology has led to less invasive and less morbid treatment options when compared with surgery. Clinical indications have therefore been expanded to a variety of painful benign bone tumors beyond osteoid osteoma. In addition, bone metastases and bone sarcoma recurrence in selected patients can now be treated percutaneously with a curative intent. This article aims at providing a unique interdisciplinary perspective on image-guided percutaneous interventions for both benign and malignant bone tumors around the knee, including thermal ablation, intralesional injections, as well as bone consolidation techniques. The expanding range of clinical indications and future directions are herein discussed with an emphasis on the challenges encountered specific to this anatomic region.

Whipple disease is a rare chronic infection caused by the Gram-positive intracellular bacterium Tropheryma whipplei. The classic clinical presentation includes digestive symptoms, weight loss, and polyarthralgia, with diagnosis requiring histological examination of duodenal biopsies and polymerase chain reaction (PCR). Localized forms of T. whipplei infection can significantly delay diagnosis. Spondylodiscitis is an extremely rare manifestation of Whipple disease with few cases reported in the literature. We present a case of subacute spondylodiscitis, assessed by MRI, in an 82-year-old patient with a previous history of seronegative rheumatoid arthritis unresponsive to treatment. Detection of the bacteria was confirmed through PCR on disco-vertebral biopsies while duodenal biopsies were normal. Symptoms rapidly improved with doxycycline and hydroxychloroquine treatment. This case highlights an atypical presentation of bone and joint manifestations in T. whipplei infection and the crucial role of specific PCR testing on biopsy material from affected tissues in the diagnostic process.

Percutaneous bone consolidation is increasingly used for the management of bone pain resulting from benign and malignant conditions. Percutaneous vertebrop

Peripheral nerve disorders refer to any condition that damages the peripheral nervous system with variable presentations and numerous causes. The diagnosis is usually suspected clinically and then confirmed using electrophysiology. Yet electrodiagnostic studies lack precise anatomical delineation and often cannot determine the underlying cause of the peripheral neuropathy. However, thanks to recent technological advances, high-resolution ultrasound (HRUS) and magnetic resonance (MR) imaging have emerged as exceptional modalities to identify the exact site of pathology and demonstrate the underlying etiology. These developments have led to a multimodality approach to peripheral nerve disorders. Imaging provides anatomical and morphological information while functional evaluation remains derived from electrodiagnostic study. This article reviews the HRUS features of common as well as less frequent peripheral nerve disorders: entrapment neuropathies, traumatic injuries, neuralgic amyotrophy, polyneuropathies, and nerve tumors.