[Radiation protection in orthopedic theatre in Tunisian Charles Nicolle hospital]

Orthopaedic theatre personnel [OTP] are exposed to ionizing radiation by the use of Image intensification in the operating room. The aims of this study are to determine OTP knowledge about ionizing radiation risks and the availability of radiation protection clothes, to propose appropriate corrective measures. This descriptive study was performed during an orthopaedic operating theatre equipped with a mobile Image intensifier unit in Charles Nicolle hospital, in March 2010. We have performed an orthopaedic theatre visit to identify the availability of radiation protection clothes. We used a questionnaire in order to identity OTP knowledge about ionizing radiation. We established a global score of knowledge to classify our population. We identified 65 professionals exposed to ionizing radiation. 54 of them [83%] responded to our questionnaire. 65% were men and sex ratio was 0,54. The median of the age was 32 years [23-51]. Orthopaedic theatre personnel were 35% surgeons, 32% nurses, 20% superior technicians and 13% service workers. The mean of the Global score of knowledge was 8,4 /20 [3,6 -15,2]. The Kruskal-Wallis test showed that this score increases significantly with grade. Because availability of lead aprons, they were worn by 67% of the staff. In the present study, the results indicate insufficiency in OTP knowledge and in radioprotection tools availability. In order to minimize all unnecessary radiation, attempts should be made to increase orthopaedic theatre personnel knowledge about radiation protection. Safety culture is a referral method to reduce radiation exposure as low as possible

[Pott's disease of the upper cervical spine [three cases and literature review]]

Sub-occipital Pott's disease is rare, but dangerous. To recall diagnostic aspects and spatially the neuroradiological ones of sub-occipital Pott's disease. We describe three patients with sub-occipital Pott's disease followed in our department from 2002 to 2007. there were two women and one man [mean age at onset: 48 years]. The early clinical picture was non specific. Exploration, in addition to standard radiographies included a computerized Tomography [CT] [n=2] and MRI [n=1 and n=3]. The diagnosis was confirmed histologically on a biopsy of the abscess [n=1], a bacteriological evidence [n=2] and retained thanks to argument presumption [n=3]. The treatment was based on quadruple antituberculous chemotherapy with external traction [n=2 and n=3] associated with urgent surgery [n=1] because of the worsening of the neurological complications. The evolution was fatal [n=1] and positive [n=2 and n=3]. Tuberculosis should be suspected in patients with chronic torticollis and residing in an area when tuberculosis is endemic. Medical treatment is based on a quadruple antituberculosis chemotherapy with fraction in the presence of atlanto-axial instability. Surgery is reserved in case of neurological worsening or persistent instability

[Restrospective study of the first metatarsophalangeal joint arthrodesist: about 39 cases]

The first metatarsophalangeal joint arthrodesis is a fusion with optimal alignment of the first metatarsal and first phalanx which conferring indolence, strength and stability. The goal of this study was to evaluate the place of arthrodesis of the first metatarso-phalangeal joint in surgery of the fore foot. This work is based on analysis of records of 35 patients between 1995 and 2006. 39 first metatarsophalangeal joint arthrodesis were practice [3 were bilateral]. They had a follow up of from three to ten years. All patients were called for a complete exploration radiographic and clinical evaluation according to the criteria of KITAOKA. The average age of patients was 54 years. They were 28 women and 7 men. The indications were hallux rigidus in 51% cases and rheumatoid arthritis in 41% cases. The procedures used mostly a stable fixation with a compressive screw. The dorsal flexion recommended is between 20 and 30 [degree sign]. Ankylosis of the ankle or the inter-phalangeal joint was an against-indication for the first metatarsophalangeal joint arthrodesis. The study found a patient subjective satisfaction rate of 92 percent, there was no pain for 89 per cent of cases. It was noted 4 non-fusion cases paradoxically with satisfactory functional result. There was no pain of inter-phalangeal joint in all cases when X-rays showed arthritis in 4 cases. The first metatarsophalangeal joint arthrodesis, provided we respect a few simple principles, restores painless and satisfying function of foot