Osteosynthesis of an intertrochanteric fracture on osteopetrosis A case report

INTRODUCTION

Osteopetrosis is a rare hereditary disease that can be transmitted in an autosomal recessive or autosomal dominant.

CASE REPORT

Here, we report a case of trochanteric fracture in an 18-year-old boy with an anatomical plate. At the last follow-up, 24 months after surgery, the fracture had healed well, and the patient was not restricted in his activities.

DISCUSSION

Osteopetrosis is a rare bone disease that is mainly caused by osteoclast dysfunction. It results from a remodelling defect that leads to hypermineralization of the skeleton, resulting in bone fragility. Both surgical and nonsurgical management have advantages and disadvantages. Thus, open reduction and anatomic plate fixation remain effective management modalities for trochanteric fractures in osteopetrosis patients.

CONCLUSION

For our patient and as described in the literature, the complication rate decreases as some principles are respected with better consolidation of the osteoporotic fracture.

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.

"Growth plate fracture of the proximal tibia in a young adult with an unfused growth plate: A case report"

INTRODUCTION

Tibial plateau fractures are recognized as one of the most challenging orthopedic injuries, especially when encountered in adults with unfused growth plates. The rarity of such cases makes them significant for study and discussion.

IMPORTANCE

The presence of an open growth plate in adult patients can significantly influence both treatment decisions and outcomes. Understanding these unique cases is vital, as they offer insights into managing similar future cases and advancing orthopedic care.

CASE PRESENTATION

A 23-year-old male, following a car accident, presented with a closed knee injury. Radiographic evaluations, including a hand X-ray to determine skeletal age, were employed. The findings confirmed a Salter and Harris type 4 fracture of the proximal tibia and indicated a skeletal age of approximately 15 years ±6 months. Treatment involved open reduction and internal fixation, specifically tailored to account for the patient's preserved growth plate.

CLINICAL DISCUSSION

Managing such fractures necessitates a specialized approach, ensuring the growth plate is not jeopardized during treatment. The patient's age, combined with the presence of an unfused growth plate, added complexity to the treatment plan. The emphasis on accurate classification of the fracture, the selected surgical technique, and post-operative care played a pivotal role in the successful recovery.

CONCLUSION

This case underscores the importance of a holistic, multidisciplinary approach in managing rare orthopedic presentations. Ensuring the preservation of growth potential while achieving functional recovery is paramount. Such cases enrich the orthopedic literature, guiding future treatments and interventions.

Post-traumatic missing medial malleolus: case report with a one-year follow-up

INTRODUCTION AND IMPORTANCE

Ankle fractures result from a wide variety of mechanisms the biomechanics of this articulation make any fracture altering the contact of the articulation surface lead to increased stresses and an inevitable evolution to tibiotalar arthritis.

CASE PRESENTATION

We report the case of a 56-year-old patient admitted for open fracture dislocation of the ankle with a missing medial malleolus. He was treated by external fixation k-wiring and periosteal repair of the deltoid ligament. The one-year follow-up shows a good functional outcome with the patient's satisfaction.

CLINICAL DISCUSSION

In ankle fractures, some authors report no need for fixation of the medial malleolus. Furthermore, the absence of the medial malleolus is not necessarily accompanied by instability of the ankle; however, it inevitably leads to ankle osteoarthritis.

CONCLUSION

Our patient admitted for a bimalleolar fracture with missing medial malleolus, as described in the literature, had a favorable evolution with a functional score that was judged fair.

Diagnosis and treatment of osteo-articular tuberculosis of the foot and ankle (a five case series)

INTRODUCTION

Osteo-articular tuberculosis is a rare manifestation of this disease, often posing diagnostic challenges that necessitate additional diagnostic imaging modalities such as radiography, CT, and MRI. This article presents a series of five cases involving tuberculosis affecting the bones of the foot and ankle, diagnosed at various stages. The patients received appropriate anti-tuberculosis medical treatment following national protocols, along with surgical interventions when necessary.

CASE STUDIES

In this series, we describe the clinical characteristics and management of five cases of foot and ankle bone tuberculosis. These cases were diagnosed at different stages, and all patients received standard anti-tuberculosis medical therapy according to national treatment guidelines. Surgical interventions were performed when deemed necessary to optimize patient outcomes.

DISCUSSION

The diagnosis of bone tuberculosis should be considered in any clinical scenario that presents with uncertain features, persistent symptoms, or resistance to conventional treatment approaches. It is crucial to employ a multidisciplinary approach involving medical and surgical management to effectively address this challenging disease. However, it is important to note that surgical intervention cannot replace the necessity of proper medical treatment.

CONCLUSION

Tuberculosis involving the bones of the foot and ankle remains an infrequent occurrence. However, considering the endemic context, prompt therapeutic interventions are essential to prevent significant osteoarticular damage. Early diagnosis, adherence to established treatment protocols, and a comprehensive approach encompassing both medical and surgical modalities are crucial for successful management of this rare entity.

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.

[Esophageal foreign body revealed by respiratory distress]

Ingestion of a foreign body is usually accidental in children. Respiratory symptoms, often favored by the persistence of the foreign body in the esophagus, can be revealing, but rarely respiratory distress as a method telling. We report a case of unrecognized esophageal foreign body revealed by respiratory distress.

Mycetoma (Madura foot): A case report

INTRODUCTION

Mycetoma is a chronic disease, which is endemic in tropical and subtropical countries. We report a rare case of mycetoma located on the foot of a patient living in a temperate-climate country followed by a short discussion.

OBSERVATION

A 50-year-old woman with painless swelling in her left foot. The swelling started after a banal penetrating injury on the sole of her left foot 23 years ago. X-rays images showed multiple osteolytic lesions of the tarsus. The histological analyses identified the fungus madurella mycetomatis. The treatment was radical surgery (amputation). The patient had a tibial prosthesis and recovered an autonomous gait.

DISCUSSION

Mycetoma is a chronic granulomatous inflammatory response often with sinus tract formations due to fungal or bacterial organisms. The infection of the forefoot is quite typical. It is a slowly progressing disease affecting the deep dermis and subcutaneous tissues that can extent to the underlying bones.

CONCLUSION

If it is not diagnosed early on, mycetoma can cause functional and esthetical impairments.

[Celiac disease and ischemic stroke]

INTRODUCTION

Neurological manifestations of celiac disease are various. An association with ischemic stroke is not common and has not been well documented. We report two cases.

OBSERVATIONS

The first patient had experienced several transient ischemic strokes in the past 2 years and then had an acute ischemic stroke involving the territory of the right posterior cerebral artery. Investigations revealed celiac disease with no other recognizable etiology. The clinical course was marked by persistent visual aftereffects, but no new vascular event. The second patient had been followed since 1998 for celiac disease confirmed by pathology and serology tests. She was on a gluten-free diet. The patient had an ischemic stroke involving the territory of the left middle cerebral artery. Apart from a positive serology for celiac disease and iron deficiency anemia, the etiological work-up was negative.

DISCUSSION

The mechanisms of vascular involvement in celiac disease are controversial. The most widely incriminated factor is autoimmune central nervous system vasculitis, in which tissue transglutaminase, the main auto-antigen contributing to maintaining the integrity of endothelium tissue, plays a major role. Other mechanisms are still debated, mainly vitamin deficiency.

CONCLUSION

Being a potentially treatable cause of ischemic stroke, celiac disease must be considered as a potential etiology of stroke of unknown cause, particularly in young patients, and even without gastrointestinal manifestations.

[POEMS syndrome with plasmocytoma lytic bone lesion]

INTRODUCTION

Crow-Fukase or Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, and Skin changes syndrome (POEMS) is a rare multisystemic affection with incompletely elucidated etiopathogenesis.

CASE REPORT

We report a case of POEMS syndrome in a 48-year-old adult revealed four months before admission by areflexic flask tetraparesis prevalent on the lower limbs in connection with demyelinating and axonal CIDP "like" sensoriomotor neuropathy of the four limbs electroneuromyographically. The patient presented elevated protein level in the CSF with monoclonal standard IgG gammapathy associated with a narrow band lambda, suggesting POEMS syndrome. Further explorations revealed skin lesions with glomeruloid angiomas, edematous vasomotor disorders as well as erythrocyanose, hypogonadism, papillar edema and a lytic bone lesion of the left scapula. Radiotherapy was associated with corticosteroids and plasma exchanges. Outcome was good with resolution of the symptoms and stabilization of the neuropathy.

DISCUSSION

POEMS syndrome is rare; the diagnosis is based on necessary criteria, the presence of a demyelinating and axonal polyneuropathy associated with an IgA or IgG monoclonal gammapathy, the light chain being almost entirely lambda, associated to other characteristic elements, in particular glomeruloid angiomas, endocrinopathy, sclerosing plasmocytoma which must be carefully required. Treatment is based on surgical cure or radiotherapy for bone lesion and non specific treatments such as corticosteroid therapy, plasma exchanges and IVIG.

Les tumeurs à cellules géantes des gaines synoviales de la main: à propos de 32 cas

Giant cell tumors of tendon sheath (GCTTS) represent a localised form of pigmented villonodular synovitis. They are usually found in the hand (80% of cases) where it represents the second most common tumor of the soft parts after the ganglion cyst. Its surgical treatment is sometimes difficult because of local extension and the invasion of vital digital structures. We report a retrospective study over 10 years of 32 cases of GCTTS with an average age of 35 years and a sex-ratio of 1. The reason for consultation was the presence of a digital mass, associated with an impairment of finger flexion in 43,7% of patients. A palmar localisation was found in 56,2%, especially in the fifth ray (62,5%) and at the level of the distal phalanx (68,7%). Radiological changes were observed in 4 cases. All patients were treated surgically. Macroscopically the lesion presented as an encapsulated tumor, polylobulated and yellow-brownish which invaded the skin (1 case), extended into the sheath of the flexor tendons (3 cases) and under the extensor tendon (4 cases). In the post operative follow up we noted one case of hypoaesthesia of the pulp and three cases of stiffness of the proximal interphalangeal joint. No skin necrosis was found. With a 4 year average follow up (10 months - 9 years), we noted three reccurrences (9,3%) which were all surgically managed. After analysis of the literature, the authors will describe the clinical aspects and the therapeutic difficulties of this condition.

Syndrome de paralysie péronière révélant un schwannome du sciatique poplité externe au col du péroné

Peroneal nerve injury in the lateral aspect of the knee is frequent, commonly dominated by traumatic or compressive etiologies. Tumors, generally synovial cysts, are exceptional causes. We report a case of a 70-year-old women referred for assessment of peroneal palsy syndrome found to be related to peroneal schwannoma in the lateral aspect of the knee. Schwannoma is the most frequent peripheral nerve benign tumor. It is commonly limited to cranial and upper limb nerves. Localization on the lower limbs (sciatic nerve) has been reported in 1 percent of cases. The peroneal nerve localizaton has not been reported to date. We underline difficulties of diagnosis inherent to this particular localization.

[A case of neglected shoulder anterior dislocation with preservation of joint function]

Shoulder neglected anterior dislocation is a rare event and intolerated in young patients. We report a case of shoulder antero-medial dislocation among 15 years. It was a woman aged 35, who had a left shoulder trauma with an unnoticed antero-medial dislocation. Fifteen years later, the patient presented an inesthetic deformity with presevating function. The Rowe and Zarsins score was good. The radiographs showed the humeral neack in a neo-cavity of the joint associated to Malgaine lesion with an advanced arthrosis of the joint.

[Neglected fracture-dislocation of the elbow: surgical reduction with enlarging osteoplasty of the trochlear notch. Case report]

Elbow dislocations in the infant are not very frequent and are associated to the fractures. Their management must be urgent and rigorous if complications are to be avoided. We report the case of a child aged 12 who presented with a fracture-dislocation of the right elbow, after falling from a tree. The patient was treated in a standard manner for one month. Four months later, the patient presented again, this time complaining of stiffness of the elbow. Physical examination confirmed the reduced range of movement of the elbow (flexion 80 degrees, extension -30 degrees) without associated neurovascular complication. Radiography of the elbow showed a posterior dislocation with remodelling of the humeral contours. Surgical exploration revealed normal articular cartilage, a pseudoarthrosis of the epitrochlea, a dislocation of the radial head and the sigmoid fossa of small size in relation to the trochlea. A reduction was only possible after an "enlargement plasty" of the trochlear notch. The patient was seen after an interval of six months. The elbow was stable with no vasculo-nervous complication.and had flexion of 110 degrees with extension of -30 degrees.

Luxation isolée de la tête radiale chez un adulte (à propos d'un cas et revue de la littérature)

The authors report a case of isolated anterior dislocation of the radial head in a 28-years-old woman without functional disorders. After a literature review, they discute traumatic and congenital etiology of this injury.

Les tumeurs desmoïdes du creux sus-claviculaire (à propos de trois cas)

The authors report three cases of desmoid tumors of the shoulder-girdle. Through these observations and a review of the literature, they underline the specific characteristics of the desmoid tumors: the frequency and the seriousness of the localisations at the member roots and the great difficulties of the exeresis.

Traitement chirurgical des fractures du capitellum chez l'adulte. À propos de huit cas

Fracture of the capitellum is a rare intra-articular fracture and presents a frontal fracture line. It occurs in adolescents after the age of 13 years and in adults. We report a series of eight patients treated between 1992 and 2002. There were five females and three males with a mean age of 25 years (range: 20-34 years). According to the classification of Bryan and Morrey, three fractures were classified as type I, three as type II and two as type III. All patients were operated on within the first week after injury. The fixation techniques used were screw fixation in five cases and Kirschner wire fixation in three cases. Seven patients had excellent results and one patient had some limitation of range of movement. There were no instances of infection or avascular necrosis. Diagnosis of this fracture is often missed. Poor results of treatment are observed after imperfect reduction, delayed treatment or resection of the capitellum. We report in this study the results of surgical treatment.

[Lesions of the distal radio-ulnar joint associated with isolated fractures of the radial shaft]

The authors have performed a retrospective study of 49 Galeazzi fractures treated between 1990 and 1998. This lesion is considered rare because it is often misdiagnosed as an isolated fracture of the radius. The mean age of the patients was 31 years. There was a male predominance with a sex ratio of 4/1. Road traffic accidents were the main etiology (45%). Galeazzi fracture type III in Mansat's classification represented 53%, followed by type II (33%), type I (8%) and equivalents of Galeazzi fracture (6%). The treatment was surgical in all cases. The radial fracture was internally fixed with a plate. Reduction of the distal radio-ulnar instability, achieved by manipulation, was maintained with radio-ulnar pin fixation in 53% and with plaster cast immobilization 45%. The results, evaluated according to Mikic's criteria were excellent in 87%. The prognosis of Galeazzi's fracture depends mainly on the initial treatment of the lesions of the distal radio-ulnar joint, which require for their diagnosis a meticulous clinical evaluation and a good radiological analysis.

[Femoral neck fracture in osteopoikilosis]

Osteopoikilosis was discovered in a 53-year-old patient who suffered a fracture of the right femoral neck. Plain X-rays demonstrated symmetrical bilateral stippling of variable size. No images were seen in the skull and spine. The fracture of the femoral neck was treated by total hip replacement. At surgery, the joint cartilage of the femoral head and the acetabulum had a normal aspect. Pathology examination of the femoral head demonstrated regular thick dense lamellae. Functional outcome at ten months was good (Postel-Merle-d'Aubigné score). Osteopoikilosis is an uncommon clinically latent condensing bone disease which can be revealed by bone fracture.

[Pure posterior luxation of the elbow in adults: immobilization or early mobilization. A randomized prospective study of 50 cases]

INTRODUCTION

Pure posterior dislocation of the elbow is frequent in young subjects. The objective of treatment must be to reduce the dislocation and avoid complications, the most frequent being stiffness, but also elbow instability. The objective of this prospective study was to evaluate the functional and anatomical characteristics of two treatment modalities: plaster immobilization and early mobilization.

MATERIAL AND METHODS

50 cases of pure posterior dislocation of the elbow were included in a prospective study and randomized to two groups: Group I: twenty six cases were treated by reduction under general anaesthesia and plaster immobilization for three weeks, followed by rehabilitation. Group II: twenty four cases were treated by reduction under general anaesthesia, followed by early mobilization.

RESULTS

We evaluated our results in terms of loss of amplitude of elbow movement (particularly extension), stiffness, instability, relapses, pain and ossification. This study demonstrated better recovery of elbow function in patients treated by early mobilization: 96% of good results with recovery of normal extension in group II versus 81% of cases in group I. Stiffness was observed in 19% of patients in group I versus 4% in group II; this difference was very significant. Comparison of pain revealed no significant difference and no relapses, instability or ossifications were observed in either of the two groups.

DISCUSSION AND CONCLUSION

Early mobilization is superior to plaster immobilization, as it allows recovery of better quality elbow function without inducing instability or recurrence.

[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.

[An uncommon occupational accident: tuberculous tenosynovitis of the extensor tendons of the hand]

We present a case of tuberculous tenosynovitis of the extensor tendons of the hand. Our patient was a young doctor working in the respiratory medicine department. He was injured on the dorsal aspect of the hand with a needle used for pleural aspiration. The clinical features consisted of gradually swelling, mild pain and stiffness of the metacarpophalangeal joint. The diagnosis was made after synovectomy. Histological and bacteriological examinations revealed tuberculosis. Treatment consisted of synovectomy and appropriate antibiotics. The clinical course was excellent after one year follow-up. Tuberculous tenosynovitis of the hand is a rare manifestation of extrapulmonary tuberculosis occurring in fewer than 5% of all cases of skeletal tuberculosis. Thickening of the tendon or synovial sheath and local accumulation of fluid are the characteristic manifestations. The diagnosis must be confirmed by surgical biopsy. Antibiotics and synovectomy achieve a good functional result.