A case of Caplan syndrome in a recently diagnosed patient with silicosis: A case report.

Rheumatoid pneumoconiosis, also known as Caplan's syndrome is defined as the association between silicosis and rheumatoid arthritis (RA). It is a rare and usually diagnosed in an advanced stage of RA course. It affects generally patients with long exposure to silica. In this article, we report a case of Caplan's syndrome.

Odontoideum Bone Revealed by c1-c2 Dislocation of the Cervical Spine during a Diving Accident.

INTRODUCTION: Odontoideum bone or the mobile odontoid process is one of the rarest malformations of the cervico-occipital hinge. It exposes to the atlo-axial instability and to the risk of bulbo-medullary compression threatening then the vital and functional prognosis. We report the case of a 16-year-old patient who was the victim of a raod accident resulting in acervical spine injury. Radiological investigation found an odontoideum bone malformation associated with C1C2 dislocation. CASE REPORT: A 16-year-old patient with no medical history had a road accident. Clinical evaluation found an incomplete tetraplegia.The imaging has revealed an atlo-axoidal dislocation with aspinal cord compression. Furthermore, radiological exams relvealed an odentoideum bone. A transcranial traction by a Gardner stirrup was set for 15 days to obtain a progressive reduction of the displacement. A full neurological recovery (FB-FD) was obtained.The patient was then operated to stabilize the reduction. A C1-C2 posterior zygapophyseal arthrodesis was performed. An autograft harvested from the iliac crest was used. Complementary open reduction and fixation of the cervico-occipital hinge was made using lamellar hooks and compression rods. At the 18-month follow-up, the clinical examination found no neurological deficiency and the plain radiography showed a complete fusion of the arthrodesis. CONCLUSION: Odontoideum bone is a rare and potentially life-threatening malformation. It is most often asymptomatic but symptoms could occur any time after a benign trauma. The prognosis mainly depends on the precocity of the management. Preventive surgery is recommended byseveral authorsin case ofinstability.

Cellulitis in aged persons: a neglected infection in the literature.

Cellulitis is a frequent soft tissue and skin infection. The lower limbs are affected in 70 to 80% of cases. Cellulitis in aged persons is not yet well described in literature. A retrospective descriptive study conducted in the Internal Medicine Department of Sahloul hospital in Sousse in Tunisia. It included patients whose age was up to 65 years old admitted into hospital for cellulitis of the legs, the arms or the face. One hundred fifty eight patients with a mean age of 73 years old (range: 65 to 94 years old) were included. Female to male sex ratio was 0.68. Among them, we noted diabetes mellitus in 81 cases (50.6%). The infection was located in the lower limbs in 155 cases (98%), in the face in two cases (1.3%) and in the upper limb in one case (0.7%). Twenty one patients (13.3%) presented with severe cellulitis and one presented with necrotizing fasciitis. All patients received intra venous antibiotic therapy. Surgical treatment was indicated in 14 cases. Cefazolin was prescribed in 77 cases (48%). Favorable evolution was noted in 144 patients (91.1%). Forty four patients (27.8%) received prophylactic antibiotics. Prevention of skin and soft tissue infection is a crucial step to preserve health in aged persons.

Treatment of high-energy pilon fractures using the ILIZAROV treatment.

The management of high-energy pilon fractures is still controversial. Open reduction and internal fixation are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. The aim of this retrospective study was to analyze the clinical and radiographic outcome of the ILIZAROV technique in patients with high-energy pilon fractures. Thirty cases of distal tibia epiphysis fractures (pilon fractures) were managed from 1999 to 2012. The study group included 5 cases of open fractures. The mean age was 47 years. According to Rüedi and Algower classification; 11 fractures were type II, and 19 type III. All fractures were a consequence of high-energy trauma. Fractures of the lower fibula were present in 28 of the patients. An external Fixator was applied for open fractures. Closed injuries were operated on 3 to 13 days after injury, with an average of 8 days. The mean follow-up was 48 months. All fractures united. The external fixator was removed after a mean of 22 weeks (10 - 28 weeks). Two patients with a type III fracture had a delayed union and were treated with corticotomy and dynamisation of the ILIZAROV fixator. Only one secondary displacement of a type III fracture was noted after two months and was treated by adjuction of 2 olive wires. There were no cases of osteomyelitis or deep infections. Pin-tract infections occurred in ten patients. We had not any case of nervous injury due to introduction of the pins. Using radiological criteria for assessement of reduction of the articular fragments, there was excellent and good restoration of articular structure in 24 cases. The average American Orthopeadic Foot and Ankle Society ankle-hind foot score was excellent in 16, good in 6, fair in 6 and poor in 2. Soft tissue healing occurred without need for plastic surgery in all cases. The movements of the ankle ranged from 0 to 20° of dorsiflexion and 5° to 40° of plantar flexion. Twenty patients had gone back to their preinjury profession. The ILIZAROV technique is a safe and a very effective treatment for severe pilon fractures with minimum complications and good healing results.

Septic arthritis of the pubis symphysis: clinical and therapeutic features.

Septic arthritis of the pubis symphysis is rare and difficult to diagnose. The objective of our study was to describe the biological, clinical, radiological and therapeutic aspects of this disease. This is a retrospective study of 4 cases of septic arthritis of the pubic symphysis collected in the Department of Rheumatology and Orthopaedics in Sousse in Tunisia over a period of 16 years (2000-2016). Our population consists of 3 women and one men. The mean age was 47 years (18-83). Clinical signs of appeal were inflammatory groin pain, pubic pain and fever. Symptoms appeared after forceps delivery in 2 cases, after surgery on the pelvis in one case and in a context of sepsis in one case. Radiographs showed pubic disjunction with irregular shoreline in all cases. CT performed in all patients and MRI in 2 patients showed erosions of the banks of the pubic symphysis with infiltration of the soft parts in all cases. The causative organisms were isolated in 3 cases by biopsy of soft tissue abscess under CT in 2 cases and vaginal swab in one case. Identified germs were staphylococcus aureus Méti-S (n=1), proteus mirabilis (n=1) and varied flora (n=1). The treatment consisted of appropriate antibiotics in all cases and surgical drainage of soft tissue abscess resistant to medical treatment in 2 cases. The outcome was favorable in all cases. Diagnosis of septic arthritis of the pubic symphysis is based on clinic supported by microbiologic culture results, image methods, and proteins augment during acute phase.

[Osteopecilia associated with psoriatic arthritis]. / Ostéopoécilie associée à un rhumatisme psoriasique.

Osteopecilia is a benign and rare condensing osteopathy. Its association with inflammatory rheumatism is very rare. We here report the case of a 25-year old patient with skin psoriasis, presenting with groin pain of inflammatory origin. Physical examination showed limitation of hip motions, lower limb-length inequality and pain on right sacroiliac mobilization. Laboratory tests showed inflammatory syndrome and negative immunological assessment. The radiograph of the pelvis revealed osteopecilia associated with destructive coxitis. CT scan of the pelvis showed coxitis and osteopecilia associated with bilateral sacroiliitis. The diagnosis of psoriatic arthritis associated with osteopecilia was retained. The patient was treated with methotrexate and NSAIDS. Osteopecilia usually is unexpectedly detected. Diagnostic radiology is essential to avoid unnecessary explorations and treatments.

[Giant cell tumors of the tendon sheaths of the hand: about 50 cases]. / Les tumeurs à cellules géantes des gaines synoviales de la main: à propos de 50 cas.

Giant cell tumors of the synovial tendon sheaths (GCTSTS) are a localized form of hemopigmented villonodular synovitis. They mainly affect the hands. This study aims to analyse the epidemiology, clinical and therapeutic characteristics of GCTSTS, to assess the results of surgical treatment and to identify risk factors for recurrences. We conducted a retrospective data collection from medical records of 50 patients with GCTSTS of the hand between 1992 and 2016 in the Department of Orthopaedics at the Hospital of Sahloul (Sousse-Tunisia). The clinical and epidemiological features of GCTSTS have been specified. The average age of patients was 33 years (9-69 years), the sex ratio was 0,6. Constant swelling (100%), joints inter-phalangeal mobilization trouble (6%) and digital pain (18%) were the most frequent reason for consultation. All tumors were located at the level of the digital region, especially at the level of the index (42%). It occurred on the palm of the hand in 66% of cases. All patients underwent surgery; macroscopically GCTTS appeared as an encapsulated polylobed and yellowish brown tumor, extending into the flexor tendons sheath(4 cases) and under the extensor tendon (2 cases). We noted a single case of recurrent cancer (2%) which was treated surgically. The functional results were good in all cases. The diagnosis of GCTTS should be evoked when there is evidence of digital swelling. Their management is based on surgery which is difficult and should be performed correctly to avoid recurrences.