A rare polydactyly of the forefoot with partial duplication of the 5th metatarsal and supernumerary digit: A case report.

INTRODUCTION: Polydactyly of the foot is a congenital anomaly characterized by the appearance of all or part of one or more additional rays. Adult cases are more rare, and surgical management of the deformity is still debated. PRESENTATION OF CASE: A 49-year-old black patient with this condition might complain of an abnormal cosmetic appearance or difficulty with footwear. DISCUSSION: Only a few cases of postaxial polydactyly with a partial duplication of the fifth metatarsal without a supernumerary digit have been reported. CONCLUSION: The surgical indication is always retained in front of the aesthetic discomfort of the patient associated with footwear. The surgical technique must be individualized according to the deformity encountered, either by open or percutaneous approach; we find it interesting to share this unusual case in order to classify it later as a foot deformity.

Aseptic nonunion of the tibia treated by plating and bone grafting: retrospective study about 40 cases.

OBJECTIVE: The objective of this study was to evaluate the clinical and radiological results of the treatment of aseptic nonunion of the tibia by plating and bone grafting. MATERIAL AND METHODS: This retrospective study included 40 patients with aseptic nonunion of the tibia, treated in the Trauma-Orthopedic department B4 of CHU Hassan II in Fez-Morocco. The average age was 41 years (range 25-60 years). The initial fractures were in the middle third of the tibia for the majority of our patients. We used the ASAMI criteria to assess the results. RESULTS: We found 45 patients with aseptic nonunion of the tibia who were treated by the same surgical team and followed in postoperative consultation for a fixed period of 10 months. Three patients lost to follow-up and two patients refused the treatment. In 37 patients (92.5%), union was obtained after a mean delay of 4.3 months (range 3-7 months). The average time from initial treatment to treatment for nonunion was eight months (range 6-10 months). According to the ASAMI classification, bone results were excellent in 26, good in 8, fair in 3 and poor in 3; functional results were excellent in 10, good in 16, fair in 11 and poor in 3. CONCLUSIONS: Our study suggests that the combination of screwed plate and autograft in the treatment of aseptic nonunion of the tibia has provided satisfactory results. A well-codified management of the initial fracture remains the gold key to prevent the occurrence of pseudarthrosis.

[Emergency coverage of post-traumatic losses of cutaneous substances of the anterior face of the knee using proximally based sural fasciocutaneous flap: about 4 cases of articular wounds]. / La couverture en urgence des pertes de substances cutanées d'origine traumatique de la face antérieure du genou par lambeau fascio-cutané sural à pédicule proximal: à propos de 4 cas de plaies articulaires.

Our study reports 4 cases of male patients with wounds on the anterior face of the knee loosing cutaneous substance after motorcycle accident. The patients had undergone surgery involving the debridement and the application of four proximally based sural fasciocutaneous flaps since 2012. The average age of patients ranged from 28 to 42 years. The highest loss of cutaneous substance measured 14 x 10 cm. The average pedicle length was 14 cm. The post-operative suites were uneventful with a satisfactory wound healing. From a functional point of view the knee and the ankle were completely mobile. This study shows the effectiveness and reliability of proximally based sural fasciocutaneous flap in the coverage of post-traumatic losses of cutaneous substances of the anterior face of the knee, and allows for limit the indications for heads of the gastrocnemius muscle flaps.

[Total knee replacement without patellar resurfacing: about 60 cases]. / Prothèse totale du genou sans resurfaçage de la rotule: à propos de 60 cas.

During total knee replacement, one of the main problems of surgeon is to choose between preservation of the patella or resurfacing with prosthetic replacement of patellar cartilage. This issue continues to be a subject of controversy within the orthopaedic community. There is no clear consensus on the optimal approach to the patella during total knee arthroplasty (TKA). We conducted a retrospective study of 60 patients undergoing total knee replacement without resurfacing of the patella. These procedures were performed in the Department of Orthopedics and Trauma-Surgery (B) at the University Hospital Hassan II, Fez, since January 2009 to December 2015. The average age of patients was 58 years, ranging between 20 years and 80 years. Female prevalence was clear (41 women, 72% and 16 men, 28%). Clinically, the majority of patients had mechanical pain and all patients underwent clinical and radiological examination. The IKS score was used to assess knee condition before and after surgery. The surgical procedure was based on total knee arthroplasty without patellar resurfacing. Post-operative complications included 7 cases of anterior knee pain, 2 cases of infection of superficial skin treated with appropriate antibiotic therapy and 3 cases of stiffness. No cases of hematoma, phlebitis or sepsis were reported. Clinical results after a follow-up period of 18 months were satisfactory. Given these results, the preservation of the patella allowed for very satisfactory middle term results regarding pain relief and restoration of function. In addition, potential complications of patella prosthesis were avoided. One limitation of these replacements without resurfacing is the occurrence, or sometimes the persistence, of anterior knee pain; hence the need for secondary resurfacing. Current data from the literature show that there is no consensus on the approach to the patella during total knee replacement. Finally, patella resurfacing is an approach that the surgeon should choose on the basis of current data. This said, the debate can continue focusing on a single issue: which approach should be used to the patella.

[Triplane fracture of the proximal end of the tibia: a rare lesion (case study and literature review)]. / Fracture triplane de l'extrémité supérieure du tibia: une lésion rare (étude d'un cas et revue de la littérature).

We here report the case of a 16-year old patient with triplane fracture of the proximal end of the tibia due to a sporting accident occurred during a cycling race. CT scan (CT) was performed to assess the fracture with a high level of accuracy. After identification of all fragments requiring osteosynthesis, closed reduction was performed with fixation of fracture fragments using cannulated screws. At the last follow-up visit, radiological and functional results were excellent.

Hoffa's fat pad tumours like: results of the arthroscopic resection.

We performed a retrospective cohort study to increase awareness in orthopaedic community of this rare but interesting disease which is often misdiagnosed as meniscal pathology and to analyze present results of arthroscopic resection in seven patients. we retrospectively reviewed records from 2008-2012 and identified 7 patients with symptomatic Hoffa's fat pad impingement. The diagnosis was made by clinical exam, MRI imaging and verified arthroscopically. Of the 7 patients 2 were excluded due to receiving open resection. The remaining five underwent arthroscopic resection. Lysholm and American knee society scores were obtained pre and post operative and at final follow up. There was a significant improvement in their symptoms and function after the surgery at an average follow-up of 14 months. The one poor result was because of paresthesia over the distribution of the infrapatellar branch of the saphenous nerve after open resection. tumours like of the fat pad should be treated by arthroscopic resection because of less residual pain and less complication was found using arthroscopy. In case of high volume of tumours only open excision can provide complete excision.