Partial sterno-costo-claviculectomy for Ewing's sarcoma of the medial clavicle (case report)

INTRODUCTION

Primary clavicle tumors are uncommon and account for <1 % of primary bone tumors. The majority of primary clavicle tumors are malignant. Approximately 1.4 % of all cases of Ewing's sarcoma occur in the clavicle.

CASE PRESENTATION

Here, we report the case of a patient diagnosed with Ewing's sarcoma who received neoadjuvant chemotherapy and had an important reduction in the tumoral volume; second, the patient had undergone partial resection of the medial clavicle, first rib, and the sternum.

DISCUSSION

The survival rate of patients with nonmetastatic lesions is 56-79 %. The clavicle is connected to major anatomical structures, which makes surgery challenging. Even if there is little morbidity after resection, these studies did not show the superiority of reconstruction.

CONCLUSION

The location of Ewing's sarcoma in our patient indicated that the surgical approach was needed for large resection. The functional outcomes were excellent, with no signs of recurrence at the 2-year follow-up.

Bifocal rupture of the patellar tendon in TKA: Case report and review of the literature

INTRODUCTION AND IMPORTANCE

Rupture of the extensor apparatus is a serious complication that can occur in a prosthetic knee. Bifocal extensor ruptures are rare and even more uncommon in adults.

CASE PRESENTATION

We report the case of an obese, diabetic, and hypertensive patient who underwent total knee arthroplasty two weeks previously and was admitted following a fall from her height for a rupture of the patellar tendon with release of the sutures. An investigation revealed bifocal avulsion of the patellar tendon from its patellar and tibial insertion. The patient was treated with double lacing and anchoring at the patellar and tibial levels with wire cerclage.

CLINICAL DISCUSSION

Several factors contribute to tendon fragility: degenerative changes linked to age, general or local conditions, and surgical approaches for TKA. These abnormalities also affect the tendon's ability to heal and should suggest the inadequacy of simple repair without tendon augmentation using a plasty, an autograft, or an allograft.

CONCLUSION

The prognosis for patients with extensor tendon ruptures in the TKA (total knee arthroplasty) remains unclear, and in our case, this was exacerbated by the delay between prosthesis insertion and the incident and by the open nature of the lesion.

Variant of the terrible triad of the elbow, a CASE report with a review of the literature

INTRODUCTION

The terrible triad described by Hotchkiss in 1996 is a complex lesion of the elbow, following a trauma combining forced valgus and external rotation. It is a lesion that puts the elbow at risk of developing complications such as instability, stiffness, or synostosis of the proximal radio-cubital joint.

CASE REPORT

We report the case of a patient who suffered a closed trauma to the right elbow following a fall onto the palm of the hand with a valgus lateral rotation mechanism. The lesion assessment showed a B2 fracture of the distal humerus (AO classification) with a line splitting the capitulum in the frontal plane, a type 3 coronoid process fracture (Morrey/Odriscoll classification), and a posterolateral elbow dislocation. The surgical treatment followed the same principles as for the terrible triad, with a reconstruction of the lateral column by osteosynthesis of the humeral palate, followed by an internal approach for osteosynthesis of the coronoid process, with the restoration of a stable elbow without laxity in the frontal plane.

DISCUSSION

On the basis of the lesion mechanism, column theory, and the schematization of the constituent elements of elbow stability in a ring, certain lesions can be placed in the same box as the terrible triad of the elbow, which also complies with the same therapeutic implications.

CONCLUSION

Our observation underlines the possibility of the existence of lesions other than those described by Hotchkiss, which would have the same consequences: an unstable elbow with the risk of evolving into chronic instability or stiffness and whose management accepts the same management.

Long-term functional outcomes after primary surgical repair of acute and chronic patellar tendon rupture: Series of 25 patients

OBJECTIVE

We aimed to evaluate the clinical outcomes after surgical repair of patellar tendon rupture (PTR) and compare the evolution of 2 types of rupture (acute and chronic) after the same rehabilitation protocol.

METHODS

This was a prospective cohort study of patients with PTR treated between January 2006 and January 2014 in the department of trauma surgery, Ibn Rochd university hospital, Casablanca.

RESULTS

We evaluated 25 patients (21 men) after a median follow-up of 75 months (range 29-120). The mean age was 34.7±8.59 years. Overall, 17 patients had acute rupture and 8 chronic rupture. Fifteen healthy volunteers (13 men) were recruited as a control group. Mean Knee Society Score (KSS) knee score was significantly higher after than before surgery (82.28±12.297 vs 20.64±7.6; P<0.0001) as was KSS function score (88.40±17.483 vs 23.40±8.98; P<0.0001). Pain measured on a visual analog scale was significantly lower after than before surgery (1.96±1.24 vs 6.60±1.26; P<0.0001). ROM and KSS knee and function scores were significantly lower on the operated than non-operated side after surgery. For both types of PTR, only knee extensor muscle strength was significantly lower on the operated than non-operated side and as compared with healthy volunteer knees.

CONCLUSIONS

Surgical repair of PTR with reinforcement and an early rehabilitation program demonstrate good results after a long follow-up. However, chronic PTR may need longer or a different rehabilitation protocol of the knee-extensor apparatus.

[Juvenile aponeurotic fibroma. A case report with a review of the literature]

Juvenile aponeurotic fibroma is a rare benign tumour which occurs mainly in young patients under 20 years of age and especially during childhood. Clinical presentation is a unique, hard and painless tumour of the palm or sole. The treatment commonly accepted for this locally recurrent tumour is complete excision with function preservation. In this paper, we report on a case of juvenile aponeurotic fibroma of the thenar area with a thickening of the first metacarpal bone shaft. Bone involvement in juvenile aponeurotic fibroma is a very rare condition. We only found one report of a comparable case in literature.

[Direct communication between the lower urinary tract and the hip joint complicating acetabular fracture. A case report]

INTRODUCTION

Urinary complications are rare in acetabular fractures (3.5 p. 100). They can lead to immediate, secondary or late complications.

CASE REPORT

The authors report the case of an uretro-acetabular fistula in a complex acetabular fracture. Intravenous urography showed the fistula with opacification of the hip joint. Surgical treatment of the fracture was contra-indicated due to the septic risk. Post traumatic degenerative joint disease appeared in our patient and a total hip arthroplasty was performed at 18 months post injury. At 6 months follow-up, clinical biological and radiographical status was good.

DISCUSSION AND CONCLUSION

Hip joint contamination with urines due to uretroacetabular fistula could be responsible for septic hip arthritis and late joint deterioration. Urine drainage using a cystocatheter as in our observation is recommended. Primary and secondary treatment of the acetabular fracture remains difficult.

[Ulnar nerve hemangioma associated with hemangioma of the epitrochlean muscles. A case report]

Peripheral nerve haemangiomas are rare and their association with muscular haemangiomas is exceptional. We report a case of haemangioma of antebrachial flexor muscles in a 19-year-old patient. The diagnosis was established during a Scaglietti-Page type of release operation.

[Finger fibrosarcoma. A case report]

The hand is a rare site of fibrosarcoma. We report one case in a fifty two year old female patient, presenting with a two-year history of an ulcerated tumor of the palmar aspect of the right index finger. The X Ray showed severe erosion of the 2nd phalanx. Because of the large volume of the tumor, a proximal amputation of the 2nd finger was performed. Histological examination concluded on a fibrosarcoma which was completely resected. No signs of recurrence or distant metastasis were seen after 8 months. The frequency of fibrosarcoma in the hand is 2.7 to 5.3%. These tumors are rarely located in the soft tissues of the hand. The treatment is essentially surgical based on a carcinological resection, which represents the only way to avoid recurrence, which is evaluated to be 12% after amputation.