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Measure the effect of the strategy to fight the Covid-19 pandemic, based on containment, on the practice of orthopedic and trauma surgery in Tunisia.This is a comparative study, concerning the impact of Covid-19 on the flow of patients, operated in orthopedic surgery and trauma departments, during the containment period from March 12, 2020 to April 30, 2020, comparing it to the same period of the year 2019, in the Central-East region of Tunisia (Kairouan, Sousse, Mahdia, Monastir).A significant decrease of 27% in the flow of patients admitted to orthopedic surgery departments in central-eastern Tunisia, during the 2020 containment period, compared to the same period of the previous year was documented. This decrease was generally widespread, notified in three orthopedic departments: Sousse (39%; p10-3), Monastir (29%; p10-3) and Mahdia (27%; p10-3). It focused on the following three groups: infections (45%; p10-3), wounds (30%; p10-2), and fractures (20%; p10-3).The collateral effects of the strategy to fight the Covid-19 pandemic, are "obvious" in orthopedic surgical practice. A health crisis management plan (including disasters and pandemics) should be better prepared in orthopedic surgery departments.

Background: The aim of this study was to assess the oncologic outcome of pelvic bone sarcomas (PBS) and to identify prognosis factors.Methods: We report a multicentric cohort of patients treated for a PBS from 2000 to 2020. Data from 12 hospitals were analysed. Patients treated for primary PBS were included. Alive patients with less than 6 months of follow up were excluded. The primary outcome was survival.Results: One hundred and fourteen patients (67 males and 48 females) were reviewed with a mean follow up of 32±46,5 (1 to 216) months. The mean patient and doctor diagnosis delays were respectively 8,5±10,2 (1 to 60) and 3±4,3 (0 to 24) months. Sixty-eight patients (59,6%) died after a mean time from diagnosis of 15,9±22,8 (1 to 120) months. The overall survival rates at 5 and 10 years were respectively 38,4% and 27,6%. Chondrosarcoma histological type (HR=3,64), metastasis (HR=3,55) and surgery (HR=0,12) were identified as significant survival factors. Surgery was also associated to a decreased risk of metastasis (OR=0,03, 95% CI: 0,01 – 0,1). Among the 76 patients (66,7%) who underwent surgery, local recurrence was observed in 19 patients (25%) with a mean time from surgery to onset of 11,05 (±17,5) months. Conclusions: This nation-wide20-year-cohort study shows that surgery is the most effective treatment option in PBS regardless the histological type of the tumour. Efforts have to be done to decrease the diagnosis delay in order to start treatment when surgery is still feasible.

Primary musculoskeletal echinococcosis is rare and accounts for 2-3% of the patients with hydatid disease. We report a case of giant primary hydatid cysts of the thigh and the gluteal region in an 82-year-old female, who presented with a painful multiple palpable mass. The diagnosis was confirmed by imaging and serology. Total resection was performed through an extended lateral approach of the thigh and intraoperative findings revealed infected giant hydatid cysts. The postoperative outcome was uneventful. Albendazole drug (400mg per day) was given for the next 3 months. At 6 months follow-up, the patient was satisfied with no complications or recurrence.

Various plating systems are available to fix distal radius fractures, each with a specific design. The purpose of this study was to compare radiological outcome and complications of the Variable Angle LCP Plate 2.4-mm (DePuy Synthes) with the VariAx volar locking plate (Stryker). One hundred patients (103 wrists) operated on for a distal radius fracture were retrospectively reviewed with a mean follow-up of 3.5 years. Seventy-three wrists were treated with a DePuy Synthes plate and 30 with a VariAx plate. The overall complication rate was 32%. Nineteen cases underwent revision surgery, 18 had malunion and 3 complex regional pain syndrome. Complicaton rate was 43% with DePuy Synthes plates and 27% with Variax plates, but the difference was not significant.

Report the results of a participatory approach in Tunisian orthopedic surgery, for the development of a consensus of experts, on the identification of the list of pathologies to always be considered as non-postponable emergencies, during the COVID-19 pandemic.This descriptive study of the opinions of Tunisian experts covered all orthopedic morbidities classified into three homogeneous groups: trauma, infections and tumors of the musculoskeletal system. The attitudes of the interviewees were collected using the "Delphi" method, using a "Google-Form" questionnaire, sent by email to all of the Tunisian university orthopedic surgeons in practice, and registered at the SOTCOT. Consensus has been established for an item, if validated by at least 80% of the experts. The analysis of the results focused on the first 30 responses to this "online" form.Tunisian experts agreed on the continuity of the urgency of taking in charge all the items of orthopedic morbidity during the COVID-19 pandemic, apart from the following affections: aseptic nonunions in the upper and lower limbs, aggressive giant cell tumors, and hyperalgesic disc herniations, where agreement rates were only at 8%, 12%, 58% and 77%.Relative to its disciplinary and professional specificities, the majority the of orthopedic conditions were still considered as emergencies, during the COVID-19 pandemic, which did not lend to postponement of the surgery. However, their management should obey to the recommendations of "Sorting" and the " COVID-19 Patient Pathway ", established by national authorities.

Introduction Les fractures comminutives de la tete radiale peuvent compromettre la fonction et la stabilite du coude. La tete radiale represente un element de stabilite secondaire apres le ligament lateral medial du coude. La reconstruction du pilier lateral peut resoudre le probleme d’instabilite. L’objectif de ce travail est d’evaluer les resultats cliniques, radiologiques et fonctionnels des protheses de la tete radiale (PTR) en pyrocarbone a moyen terme. Patients et methodes Il s’agit d’une serie prospective de 10 patients traites pour fracture comminutive de la tete radiale et ayant eu une mise en place d’une PTR en pyrocarbone. L’âge moyen etait de 36 ans, le sexe ratio F/H etait de 1/4. Parmi ces 10 fractures, 7 etaient dans le cadre d’une fracture-luxation du coude et 3 etaient isolees. Le delai operatoire etait entre 3 semaines et 5 ans par rapport au traumatisme initial. Les gestes associes a la mise en place de la PTR etaient 4 plasties du ligament annulaire, 2 arthrolyses du coude, 1 osteosynthese de l’olecrane, 1 osteosynthese du processus coronoide et 4 ablations de corps etrangers intra-articulaires. Resultats Au recul moyen de 37 mois, et selon le Mayo Evaluation Prognostic Score, nous avons obtenu 80 % de tres bons et bons resultats et 20 % de resultats moyens. Concernant les complications, nous n’avons note aucun descellement et aucune luxation de la prothese. Nous avons note 2 cas d’osteolyse autour de la tige (stress shilding) et un cas de raideur du coude. Deux patients presentant initialement des lesions osteo-chondrale du capitulum ont eu une usure de celui-ci. Discussion Nos resultats anatomo-fonctionnels sont satisfaisants mais restent legerement au-deca des resultats rapportes dans la litterature. Toutefois, le faible nombre de patients ne permet pas de comparer les populations de chaque etude surtout en termes de lesions associees. A la revue de la litterature, la prothese en pyrocarbone donne de bons resultats. Grace aux proprietes biomecaniques du pyrocarbone, et la bonne congruence articulaire, elle cause beaucoup moins d’usure du capitulum. Dans notre serie, nous rapportons une usure du capitulum dans 2 cas qui seraient plutot en rapport avec des lesions osteo-chondrales prealablement existantes. Conclusion Les PTR figurent actuellement parmi les moyens pertinents dans l’arsenal therapeutique devant une fracture complexe de la tete radiale. Certaines complications decrites peuvent etre evitees par une bonne technique de pose. L’utilisation de pyrocarbone a encore ameliore les resultats.