[Diagnosis and treatment of brodie's abcess in adults: about twenty cases]

Background: Brodie's abscess is a bone abscess described as a localized primary purulent collection with sclerotic wall. Since the first report of Sir Benjamin Brodie in 1832, many papers described different clinical and treatment aspects. Pathogeny and therapy still remain not clearly elucidated

Aim: The aim of our study is to describe clinical aspect and to study the result of treatment including surgery and antibiotics

Methods: Our study is retrospective including 20 patients admitted to the author's institution for isolated bone abscess. The mean age of these patients is 30 years old [14 up to 46 years] with male predominance. Symptoms were chronic including localized pain with no systemic illness. The erythrocyte sedimentation rate was elevated in 2/3 of the cases. Roentegenogram was typical in 18 cases showing metaphysic cyst with sclerotic wall. Tibia was the most involved bone, 14 among 20 cases. Bacteriological study of the abscess pus isolated staphylococcus in 12 cases and pseudomonas in two cases. No organism was identified in the six remaining cases. Histopathological study showed chronic osteomyelitis with granulation including lymphocytes and plasma cells in all cases. Surgery and antibiotics were adequate for treatment in all cases. Our approach consisted in curettage without primary skin closure, cast immobilisation and antibiotics

Results: Our patients were followed up over a median period of six years [8 months to 10 years]. Overall, the results of treatment were good and in the long-term the abscess disappeared in all cases without recurrence. The erythrocyte sedimentation rate was normalized in 10 weeks and roentegenologically, the abscess disappeared progressively without oesteomyelitis complication

Conclusion: According to our study, we believe that surgical treatment based on total excision of the bone collection and the sclerotic wall is the best method of therapy. As a matter of fact, healing was obtained without grafting in all cases and in the long-term follow up, abscess disappeared without recurrence and fistulisation

Intraligamentous ganglion cyst of the anterior cruciate ligament [about a case]

Unknowlogement: Ganglion cysts have been reported in all joints, with varying frequency in location. A few cases have been described concerning ganglia of the anterior cruciate ligament [ACL] particularly intraligamentous cysts

Aim: The aim of the study is to report specific particularities of intraligamentous ganglion cyst of the ACL

Case: We report a new case of intraligamentous ganglion cyst of the anterior cruciate ligament treated successfully with arthroscopic aspiration followed by partial excision of the cyst wall after MRI examination. The MR findings, clinical features and arthroscopic findings were evaluated comparatively. Diagnosis was confirmed by means of histological study after arthroscopic excision. The cyst was fluid-filled, with low T1-weighted signal intensity and high T2- weighted signal intensity. Pain was the most frequent clinical sign without any history of trauma. Postarthroscopy outcome was painless. Histologic diagnosis corresponded to ganglion cyst

Conclusion: An intraligamentous ganglion cyst of the ACR is extremely rare and suggests some diagnostic and therapeutic particularities

Arthroscopy of the shoulder technics and indications. about 64 cases

Arthroscopic surgery replaced at present more and more conventional articular surgery because its anatomic character, its less morbidity and its more simple post-poerative care. After knee, the shoulder is considere as the articulation witch benefit of the progress of arthroscopic technics. Autors reported their experience in shoulder arthroscopy witch is introduced in the service since 1999. The gol of this study is to describe the technic of the shoulder arthroscopy and to precise its main indications

Results of unicondylar femoral fractures: a review of 28 patients

Unicondylar femoral fractures are rare. They form a particular entity of the femoral lower extremity fractures. The purpose of this work was to evaluate the anatomical and functional results of unicondylar femoral fractures on pain, mobility, walking and stability of the knee. We reviewed, retrospectively, 28 patients presenting unicondylar femoral fracture. There were 19 men and 9 women, with average age of 54 years [22 - 87 years], victims essentially of domestic accident. The fracture was alone in 65% of cases. According to Nordin's classification, the fracture was of type I in 3% of cases, type II in 35% of cases, type III in 20% of cases and type IV in 42% of cases. Twenty five patients had a surgical treatment after a median period of 7 days post-accident, 3 patients were treated orthopedically. After 3 years follow up, results were noted according to MEGY's score which takes into account walking, mobility, pain and the stability. Clinically, we noted 26 good and very good results and 2 moderate results. Anatomically, we obtained 75% of satisfactory reductions. Unicondylar femoral fractures remain rare. It is important to recognize them and to make the exact diagnosis of their type. Surgical treatment exposes old subjects to risk of dismantling anatomical osteosynthesis because of osteoporoses