Search

L´instabilité antérieure de l´épaule suite à une luxation traumatique chez l´adulte jeune est une complication fréquente. La procédure de Latarjet est la technique la plus utilisée pour traiter cette instabilité, consiste à réaliser une butée coracoïdienne au niveau du bord antérieur de la glène. Cependant, l´exposition articulaire au cours de cette technique est souvent limitée et rend le positionnement de la butée difficile. Pour évaluer l´effet de la position de la butée coracoïdienne sur la qualité du résultat fonctionnelle à court et moyen termes. Nous avons étudié chez 70 patients la position de la butée coracoïdienne sur la radiographie standard post-opératoire et le résultat fonctionnel par le score du duplay et le taux de satisfaction. L´âge moyen été de 25 ans et demi, le sexe-ratio était de neuf et le recul moyen était de 6,5 ans. L´étude radiologique a montré que la butée coracoïdienne était en position sus équatoriale ou non affleurante du rebord glénoïdien antérieur (trop interne ou saillante en intra-articulaire) dans 20% des cas. Ce groupe a présenté une baisse du score moyen de stabilité par 7,68 points, de la douleur par 10,04 points et du score global de Duplay par 13,3 points, ainsi qu´une augmentation significative du taux d´arthrose gléno-humérale. Ainsi, une butée coracoïdienne en position sus équatoriale ou non affleurante a un effet délétère sur la qualité des résultats fonctionnels de la technique de Latarjet.

Introduction: Bone and joint infections are rare localizations of tuberculosis, and its diagnosis is challenging. The atypical clinical presentation may lead to delayed diagnosis and severe complications., Case Presentation: We report the case of a 72-year-old female diagnosed with tuberculosis of the knee. She was complaining of progressive right knee pain and swelling without systemic signs. She was misdiagnosed as having a flare-up of osteoarthritis, which led to a delayed diagnosis and a septic subluxation of the knee. We performed a knee arthrotomy, lavage, and stabilization with an external fixator. The microbiologic tests did not isolate any germs. However, a histological examination confirmed the diagnosis by revealing a caseating granuloma surrounded by epithelioid cells. The patient treated with anti-tuberculosis therapy had a good evolution. Three months post-surgery, the external fixator was replaced with a removable knee brace., Discussion: Osteoarticular tuberculosis is often caused by the hematogenous route. The lack of specificity in clinical and radiological signs makes the diagnosis difficult, especially at the early stage, leading to delays in diagnosis and complications. Nevertheless, the recognition of predisposing factors to tuberculosis, with persisting symptoms despite treatment, should draw the intention of further investigation. The treatment of osteoarticular tuberculosis is primary medical with antituberculosis chemotherapy. However, surgical treatment is reserved for specific indications and mostly to treat complications., Conclusion: The lack of specificity in clinical and radiological signs in osteoarticular tuberculosis may mislead the physician. Nevertheless, focusing on predisposing factors, especially in endemic areas, may guide diagnosis and avoid complications., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: The authors declare no conflict of interest.

Introduction: Bone hydatidosis is a rare disease. It is characterised by discreet and nonspecific symptomatology that makes the diagnosis late and the treatment difficult to manage., Presentation of Case: We report the case of a 29-year-old woman hospitalised for right hip pain with a lytic image well limited in the upper extremity of the right femur. We retained the diagnosis of a unicameral bone cyst which weakens the cortical bone. Osteosynthesis with a Gamma nailing was indicated to prevent fractures. At five years of follow up, the patient presented a pain recurrence. Radiographs showed almost a destruction of the upper extremity of the femur and a loosening of osteosynthesis material. Thus, we indicated the removal of the osteosynthesis material and a bone biopsy were performed. Histopathological examination leads to an osseous hydatid cyst diagnosis. We decide to carry out a carcinological resection and reconstruction with a mega prosthesis. The clinical results were excellent and no recurrence for three years follow-up., Discussion: Bone hydatidosis is challenging to diagnose at an early stage, mainly when it simulates a bone cyst. Moreover, the consequence of a late or misdiagnosed bone hydatidosis is devastating. Because of its diffuse and infiltrative character, it gradually invades the whole bone, which makes it more complicated to manage., Conclusion: Bone hydatidosis is a rare disease that can simulate other pathologies like a bone cyst in our case. In these situations, the anamnesis has a primordial place to guide the diagnosis and investigations., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Neurogenic paraosteoarthropathies are ectopic ossifications which develop near the joints. They are a process of neo-ectopic osteogenesis occurring after central or peripheral neurological lesions, in some types of comas (oxygen carbon intoxication, prolonged sedation) and following peripheral traumas including burns. They inolve almost exclusively the large proximal joints of the limbs. Elbow is the second area of involvment. The purpose of our study was to analyze the results of surgical arthrolysis in 37 patients with elbow stiffness due to neurogenic osteoarthropathy of the elbow. We conducted a retrospective study of 35 patients and 37 elbows over a 25-year period. Preoperative assessment included clinical and radiological examination. Since 2003 the patients had undergone systematic elbow arthroscopy. The gold standard surgical treatment was arthrolysis. All patients underwent functional rehabilitation protocol. Outcomes were analyzed after a mean 5-year follow-up period (6 months - 10 years). Neurogenic paraosteoarthropathy was caused by head injury with coma in 58.8% of cases. Preoperative assessment showed bending stiffness in the majority of cases (88%), severe or very severe in 64.7% of cases. Intraoperatively functional elbow range of motion from -30° to 130° was obtained in 61.7% of cases and in 41% of cases in the long term. Ulnar nerve liberation was satisfactory in 92% of cases. No postoperative instability of the elbow was reported. Two patients with definitive neurological lesions had osteoma recurrence. The results were equivalent regardless surgical delay. Surgical arthrolysis is an effective treatment for neurogenic osteomas of the elbow., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts., (© Khaled Khelil et al.)

Several surgical procedures, including mosaic arthroplasty, can be used to treat patients with cartilage loss in the femoral condyles. This study aims to assess mid-term clinical and radiological results as well as the main prognostics elements. We conducted a retrospective epidemiological study over a period of 15 years. During the study period we collected data from 35 workable medical records of patients with osteochondritis dissecans of the femoral condyles treated by mosaic arthroplasty, with an average follow-up of 24 months. The level of complaints as well as preoperative knee function were evaluated and compared with the healthy knee according to the International Cartilage Repair Society (ICRS) score, the International Knee Documentation Committee (IKDC) score and visual analogue scale (VAS). It was less than 60% in 27 patients. During the follow-up period, the results were analyzed according to Hughston's functional and radiological criteria. After an average follow-up of 24 months, algoneurodystrophy was reported in 5 cases with a single case of haemarthrosis. A net ICRS score improvement was observed with a mean increasing from 54% to 74% on the follow-up visit. Most of patients were satisfied or very satisfied (82.9%). The elements of good prognosis recognized in our study included: a mean time between symptom onset and surgery of less of 18 months, having deep lesions with a diameter less than 02 cm and having lesions in the internal condyle. The treatment of cartilage loss is necessarily based on the correction of its direct and indirect causes namely the morphotype, the laxity and meniscus capital. No consensus in the decision-making was reached and no one could confirm the superiority of a technique in relation to the other but we can say that cartilage defect which sizes from 2 to 4 cm² may be the best indication for mosaic arthroplasty., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.

We conducted a retrospective study of 35 patients with subungual exostosis of the hallux, also known as Turrett's exostosis, in the Department of Orthopedics and Traumatology at the Senior Military Hospital of Instruction of Tunis over the period between 1995 and 2015. We here summarize the outcomes of patients treated for this disease. The average age of patients was 29 years, with a sex ratio of 1.7. The median consultation time was six months. This delay in consultation was caused by a diagnostic error due to clinical picture resemblance with ingrown nail. Diagnosis was always confirmed by frontal and profile X-ray of the involved hallux. Treatment was based on total resection of the exostosis either through large ungual window or by latero-ungual approach. Anatomo-pathological examination was performed systematically. It allowed to confirm the benignity of the disease in all cases. All patients recovered and returned to their previous activity, on average, in 2 months. No patient had a recurrence.

Aim: Was to evaluate the results of deltoid flap for the treatment of massive rotator cuff tears., Methods: This retrospective study included 20 shoulders in 20 patients with a painful massive, irreparable rotator cuff tears. The average patient age was 54 years. They were all treated with acromioplasty and a deltoid flap according to Augereau technique. Follow-up averaged 6 years 3 months (range 18 months - 11 years 4 months). Clinical and radiologic evaluations were done before and after surgery. Function was evaluated according to Constant's score., Results: The Constant's score increased from 24.6/100 to 54.45/100. Eighty five per cent of patients were satisfied. Results on pain were good, with an average of Constant's score of 11/15. However, improvement strength or motion was not significative, with an average of 7.1/25 and 22.8/40 respectively., Conclusion: This study concludes that, this technique is a simple surgical procedure and their results on pain were good. Therefore, we conceder it is an excellent indication for the treatment of massive rotator cuff tears in adults after medical treatment failure.

Background: Physical exercise has beneficial effects on a number of physiologic systems, including the skeleton. However, combined with potential risk factors, unwise training practises may harm theses systems. A stress fracture represents one from of breakdown in the skeletal system., Aim: Assess the usefulness of MRI and kinesitherapy., Methods: 14 patients in military circles had a stress facture. Most of the fractures are located at the upper metaphysis of the tibia., Results: The radiography was poor, the MRI was the investigation of choice. The images show a FREDERICSON grade 4 lesion. Treatment is mainly non or partially weight bearing until consolidation., Conclusion: Although stress fracture results from unbalance between the bone and the forces applied, the injury occurs as a result of summation of various extrinsic and intrinsic factors at a given point in time.

Multicentric giant cell tumors of bone are rare; they represent less than 1% of all giant cell tumors. We report the case of a 35-year-old right-handed man, who presented in 1985 with a giant cell tumor of the upper end of the right humerus. After failure of conservative treatment (curettage and bone grafting), resection-arthrodesis of the shoulder with a free vascularized fibular autograft was performed. Three years later, the patient developed an osteolytic lesion of the lower end of the ipsilateral radius, involving the soft tissues and the wrist joint. He was treated with resection-arthrodesis of the wrist with a free vascularized fibular graft. The histologic study confirmed the diagnosis of giant cell tumor of similar grade. After 13 years follow-up, the patient had a satisfactory function of the limb and no recurrence of the tumor was noted.

An avascular necrosis of the femoral head occurred after intra-medullary nailing of a femoral diaphyseal fracture. This complication may be related to the posterior situation of the proximal insertion hole just posterior to the trochanteric notch and piriformis fossa as demonstrated by the CT scan. This situation of the nail may cause injury to posterior branch of the circonflex artery at the time of rod insertion. Even if it appears exceptional in adult patients with intra-medullary nailing, this potential complication and the anatomy of the superior extremity of the femur should be known.