[Surgical treatment of acetabulum fractures [Report of 52 cases]]

This piece of work consists of a study of 52 cases of acetrabular fractures treated with open reduction and internal fixation in the service of Traumatology Orthopedics of the H.U.C Ibn Rochd of Casablance from 1994 to 2004. The average patient age was 37 years. A road traffic accident was the most involved causative mechanism [90%]. The left side was the most affected [60%]. The Judet and Letournel views confronted to the computed tomography data lead to establish diagnosis, to make classification by Judet and Letournel classification and to appreciate congruency by the Duquennoy-Senegas classification. The Kocher-Langenbeck approach was use in 88% of the cases. We have used plates to fix fractures. Screw were use in association with plates in 73%. The functional outcome is assessing according to the Postel Merle D'aubigne score and the results were excellent to good in 65%, fair in 25% and poor in 10% of the cases. We have won 47% on the both vertical and horizontal congruency TT3 and TC3. As complication, we noted 12 cases of osteoarthritis [30%], 9 cases of heterotopic ossifications [23%] and one case of osteonecrosis of femoral head [2.5%]

[Extra-articular malunion of distal radius. [Report of 20 cases]]

Malunion remains the most common complication following fracture of the distal radius. The consequences of the deformities on the wrist function are analysed and a therapeutic strategy is suggested. The authors report 20 cases of non-articular malunion of the distal radius. Preoperative evaluation requires a comparative analysis with clinical and radiological assessment. Corrective posterior osteotomy is performed on the radius in 47% of the cases, an anterior open osteotomy in 37% of the cases, a lateral osteotomy with a closing osteotomy in 10% of the cases, and in one case; an osteotomy of radius lengthening. The bone graft is associated in 50% the cases. At three years follow-up, the functional results are been studied following the lilloise school quotation. Also, the good results became of 0 to 30% and the bad results of 60 to 10%. The non-articular malunions are usually caused by an insufficient initial treatment. Also, the re-orientation osteotomies with bone graft make good results in long term

[Total hip prostheses in osteonecrosis of the femoral head [about 46 cases]]

The authors report a retrospective study about 50 THP realized at the department of the orthopedic-traumatism wing 32 in UHC Ibn Rochd of Casablanca between January 1992 and December 2001. The group includes 22 men [47,8%] and 24 women [52.2%]. The right hip hs been operated on in 30 cases [60%] and the left hip in 20 cases. 20 patients presented an aseptic osteonecrosis caused by a corticotheraphy, 7 patients suffered from ethylism and 5 patients had already been operated on. Postel and Merle d'Aubigne's quotation was used to value the state the hip before and after the operation. The postero-external tract of Moore was used in 47 cases [94%] and Harding in 3 cases [6%]. The THP were cimented in 34 cases [68%] and not cemented in 14 cases [28%]. After a recession of 4,7 years, we noticed as complications: 4 detachments [8%], 4 cases of the hip stiffness and 3 cases of periarticular ossifications, and accords DMA quotation, the results were satisfactory in 32 cases [64%], medium in 12 cases [24%] and bad in 6 cases [12%]. The THP is a choice method in the treatment of femoral head aseptic osteonecrosis, the success of the intervention depends on the respect of the indication and to correct realization of the operation

[Autogenous bone graft reconstruction and Kerboull ring aseptic acetabular loosening]

62 cases of acetabulum reconstruction by Kerboull cross were performed from 1998 to 2003. This reconstruction was realized in 62 cases of acetabulum loosening with bone defect : type III or IV of the SOFCOT classification. The mean follow up was 4 years. We note an increase of PMA score in 92% and 1 losening due to infection. Reconstruction of the acetabulum. Its fixation, the reconstruction of the acetabulum with Kerboull cross is a good alternative to bone defect in acetabulum. Its fixation, the reconstruction of the acetabulum by the bone grafting and the automatic centralization of the hip seems to be the major points of this technique

Actinomycosis of the psoas iliac muscle: concerning a case

Actinomycosis are bacterial infections considered non contagious, caused by Actinomyces, gram positive filamentous bacilli, mucuous buccal digestive saprophytes. The abdominal or pelvic locations are rare, and may stimulate a neoplasic affection by causing delicate diagnosis problems. We here report a case of actinomycosis of the right ilio-psoas muscle in a fifty-year old patient with a tumor syndrome of the right iliac fossa, with no abdominal pelvic compression. We did not notice any entrance. The actinomycosis diagnosis was led thanks to anatomo-pathologic exam. The treatment consisted of a tumor resection with betalactamine based antibiotherapy. The pelvic actinomycosis is a rare affection with a difficult diagnosis because of the failure to recognize it as well as its presentation that is similar to a neoplasic process

Traumatic avulsion of the triceps tendon with fracture dislocation of the elbow. a case report

The distal traumatic avulsion of the triceps muscle is an exceptional lesion. The clinical presentation is associated with an intense sudden pain of the posterior side of the elbow with loss of active extension of the fore-arm and the palpation of a depression above the olecranon. The presence of small avulsed bone fragment of the olecranon over a lateral X-ray view of the elbow confirms the diagnosis. The antero-posterior and lateral views of the elbow also help to investigate for any bone lesion, particularly a fracture of the radial head. The trans-osseous and periosteal reinsertion often yield good results. The related observation is remarkable. In fact, it is to our knowledge, that this is the first case of traumatic avulsion of the tricipital brachial tendon associated with a fracture-laxation of the right elbow with a fracture of the radial head and a postero-lateral sublaxation of the elbow

[ dislocation-fracture of the Hip [correlation between the type of injury, therapeutic process and the anatomo functional evolution]]

In this retrospective study of 44 cases collected between 1982 and 1992, we try to analyse the lesional relation ship of the luxations - fractures of the hip, the therapeutic processes and the anatomic and functional evolution of this articulation. The mean age of our patients is 35 years old, the extreems are 13 and 70 years. The highway accident is the most fruquent etiology. In 77% of the cases, the luxation has been associated to the fracture of the posterior panes. The lesional association was varied [cranial traumatism, sciatic lesion]. The treatment was orthopedic especially and consisted in the reduction of the luxation emergently and the traction. The surgical treatment of the fracture depended on the result of the reduction, the articular congruence, the fracture type and the residual displacement. The delay was 1 to 10 years, we noticed 24% of bad result, the cephalic necrosis is more frequent in the luxation -fracture than in pure luxations. The risk of arthrosis is important in relation ship with the fractures of isolate socket, we noticed a non neglectable frequency of the periarticular ossifications. We insist on the rigorous pathologic complete physical examination, the emergent treatment, the accurate value of the state of articular congruence [roof theed, socket head] in order to diminish the risk of complications [necrosis, senile coxarthritis]

[Tuberculosis and acquired immunodeficiency syndrome]

From January 1987 to July 1990, 16,2% of patients followed with Human Immunodeficiency Virus [HIV] infection, of which six were ill [all with AIDS], had tuberculosis. Pulmonary tuberculosis was present in four patients [66,6%], and extrapulmonary tuberculosis in six. The extrapulmonary infections were located in the mediastinal lymph nodes in two cases, the peripheral lymph nodes in two cases, and in the pleura in two cases. Pulmonary infection was multilobar in four cases with cavitary infiltrates in one case. An intradermal skin test, using 10 TU PPD, was positive in only one case. The diagnosis of tuberculosis was confirmed by evidence of Mycobacterium Tuberculosis [MT] in direct examination in three cases, by cultures in the same three cases, and histology in four cases. Preliminary results of antibacterial treatment were favorable in five patients. However, these five patients died within an average of twelve months after diagnosis of tuberculosis, corresponding with the CDC which includes extrapulmonary tuberculosis in their case definition of AIDS. A study of a larger series would allow clarification of the epidemiological aspects of tuberculosis associated with HIV infection in Morocco