[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

[ neurogenic Paraosteoarthropathies from the hip]

The neurogenic paraosteoarthropaties of the hip is the ossifications ectopiques sitting around the coxo-femoral joint respecting the articular surfaces.We report seven cases of neurogenic paraosteoarthropaties of hip collected to the service of traumato-orthopedic in the UHC Ibn Rochd of Casablanca of the period 1992 until January 2002. These seven cases having in middle age of 28 years a sex-ratio of 0.75. All cases having like etiology the head injury with deep coma either. All cases have been operated for the hip, a three of then were operated for other localizations [2 elbows, 1 knee] according to the functional priority. For the seven cases operated for the hip intervention consisted in an arthrolyse of the hip with exerese of the osteoma. The ways were first the previous way in two cases, the postero-lateral way in three cases and the antero-external way.in two cases. Any case had a postoperative complications there. All these cases followed a rehabilitation of the postoperative with anti-inflammatory, in one case, the radiotherapy was used. The results according to the quotation of Merle d'Aubigne were excellent for 2 cases and good for the five other.The surgical treatment is obligatory when the osteoma is mature [scintigraphy, alkaline phosphatases] or in the case of compressive complications or great functional difficulty. On the other hand, the association of medical and surgical treatment in a pre and postoperative protocol is promising

[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

[Fractures of the tibial shaft [Report of 61 cases]]

Sixty one tibial pilon fractures have been collected at the department of orthopaedic and traumatologic surgery. The fracture of the tibial pilon represents 8% of the ankle traumatisms, it is the prerogative of the young person as the mean age of our patients was 36 years old with neat male predominance [71%]. The etiologic circumstances are dominated by the fall of a high place in 52%. The cutaneous lesions were present in 53% of cases. According to Vives classification, the complete complex fractures represent 46% of cases. The surgical treatment by internal osteosynthesis was practiced in 35 cases [57%], the osteosynthesis of the fibula fractures was systematic. The external fixator has been rise in 26 cases [22 Hoffman's type, 4 Ilizarov's type]. The functional results according to Lechevallier's criteria have been good in 30 cases [58%], medium in 11 cases [21%] and bad in 11 cases. We couldn't notice a correlation between functional results and radiological results; the latter's have been good in 20%, satisfactory in 46% and bad in 43%. The internal fixation proved its superiority in relationship with the external fixation

[Synovial osteochondromatosis of the shoulder. [Report of 3 cases]]

Synovial osteochondromatosis of shoulder is a rare affection, it becomes on the fourth place after the knee, elbow and hip. We report 3 cases in patients of more than 40 years old, the diagnosis suspected after radiologic study is confirmed by histologic study. All the patients benefited from open sky surgical treatment that permitted to make ablation of foreign bodies followed by a synovialectomy [cases n°l and n°2], a resection of the serous bursa with its synovial and a resection of the biceps tendon sheath for the case n°3. The results is affected by late diagnosis

[Carpometacarpal dislocation of long fingers. [Report of 2 cases]]

We report two cases of carpometacarpal dislocation of the fore long ringers. They were diagnosed in emergency and treated by closed reduction and immobilization in a plaster cast for the fist case, and by open reduction and stabilised by pins for the second case. They were followed for an average of 31 month. The results were rated good and two patients had a good function with no deformity, no instability

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

Bimalleolar fractures and their equivalents [about 200 cases]

Bimalleolar fractures rank third after lower radius fractures and above femur fractures. Those fractures gave post traumatic arthrosis in long term result. We reported retrospective analysis of 200 medical records after a follow up of eight years. The average age was 37.4 years with sex-ratio of 3/1. The road accident is the most frequent cause, the fall rank second. In Weber classification, the stage C was the most with 56%. 16% of patients have tibio-fibular diastasis, 28 patients have posterior fragment along. 16 patients have osteochondral depression, astragalo-tibial dislocation at 49 patients. 8 patients had polytraumatism, and 51% of patients with polyfractures. Open ankle fracture in 22%. The result after conservative treatment was satisfactory in 82%, the surgical result was good in 96% of patient at an average of four years and half. 15 patients present post traumtic arthrosis. Arthrosis was at patient with dislocation ankle fracture, osteochondral depression and open fractures. The result comparison with literature confirm the importance and interest of surgical treatment and orthopedic treatment must be reserved in management in this fractures