Stepping into the Unknown: Unveiling the Rarity of PCL Fracture-Avulsions.

Tears of the posterior cruciate ligament (PCL) are rare, and avulsion fracture of the tibial attachment of the posterior cruciate ligament is even rarer. These injuries usually occur in accidents such as car crashes, causing acute pain, swelling as well as total functional impotence of the knee. Studies on the incidence of these injuries show variable results, but there appears to be an upward trend. The surgical management of PCL avulsion fracture is not clearly established, although arthroscopic techniques are becoming more popular due to their potential benefits. However, some medical centers may have limited access to these methods, thus preferring open surgery options. A case of LCP avulsion fracture in a 36-year-old female patient was reported, and surgery was successfully performed, leading to full recovery after six months with full knee mobility and posterior stability.

Surgical treatment of Hahn-Steinthal fracture using Herbert screws.

Hahn-Steinthal fractures are rare and often neglected. Their initial management should be early, given the relatively high complication rate. We report eight cases of type I capitellum fractures treated by Herbert screw fixation. Between 2019 and 2022, we selected eight patients (six men and two women) with a mean age of 25 years (18-40 years). The mean follow-up was 2 years (1-3 years). Clinical results were assessed using the Mayo Clinic Elbow Performance Score (MEPS). The mean arc of mobilitý was 135° (105°-150°) for flexion/extension and 161° (150°-175°) for pronosupination. The mean MEPS was 90.6 points, with seven excellent results and one good result. The aim of this study was to highlight the good results of Herbert screw fixation technique in the management of Hahn-Steinthal fractures.

Fracture of the two forearm bones and congenital radioulnar synostosis: A case report and review of literature.

Congenital proximal radioulnar synostosis limits prono-supination and is often well tolerated. Only one publication in the literature describes a fracture associated with this malformation. We report a case of radius and ulna shaft fractures in a 35-year-old patient with well-tolerated bilateral proximal congenital proximal radioulnar synostosis.

Severe pure open dislocation of the ankle and flexor digitorum longus tendon tear a case report.

Proximal avulsion rupture of the flexor digitorum longus (FDL) tendon associated with an ankle dislocation is extremely rare. We report a case of a 29 years old patient presenting a severe open ankle dislocation with flexor digitorum longus tendon tear after a motorcycle accident. We performed wound debridement, ankle reduction, tendon repair and stabilization with external fixation. At our last follow-up 17 months after the operation, the patient had good functional outcome and returned to work. This report is noticeable as it is, to the best of our knowledge, the third study reporting a case with simultaneous open ankle dislocation and proximal avulsion rupture of the FDL tendon.

Anterior cruciate ligament cysts: About a rare condition.

The purpose of this study was to provide information on cysts of the anterior cruciate ligament (ACL) of the knee. This included an anatomical and radio-anatomical reminder of the cruciate ligaments of the knee, along with details of the epidemiology, etiopathogenesis, anatomical risk factors, clinical presentation, differential diagnosis, and treatment of ACL cysts. A retrospective analysis was conducted, involving the review of 7 radioclinical records from the medical imaging department of Ibn Sina University Hospital in Rabat, covering a period of 3 years (2018-2020), during which 7 cases of ACL cysts were diagnosed. The results revealed that ACL cysts are a rare condition, frequently detected incidentally during the assessment of meniscal lesions. Symptoms commonly include knee pain and limited mobility, and MRI is considered the diagnostic modality of for distinguishing between simple fluid-filled cysts and infiltrative cysts, as well as for ruling out other differential diagnoses. Treatment options include radio-guided infiltration puncture and arthroscopic resection.

Osseous hydatid disease: A mimic of other skeletal pathologies.

Hydatid disease is still endemic in several regions worldwide including Morocco, and is caused in most cases by the larval form of 2 species of the tapeworm Echinococcus: E. granulosus and E. multilocularis. Primary hydatid disease of the bone without systemic involvement is rare. The disease has a silent clinical evolution until it reaches complicated stages. Complications may include pathological fracture, neural deficit, infection, and fistulization of the abscess. Preoperative diagnosis is based on clinical history, imaging findings, and serological tests, which lack high sensitivity and specificity. Although the interpretation of imaging studies can prove to be very confusing because the bone changes evolve with time, and the nonspecificity of these findings often leads to a mistaken diagnosis. The diagnosis requires a high index of suspicion, especially in patients who reside in or travel to sheep-raising areas where hydatid disease is endemic. A high index of suspicion is necessary for the diagnosis, especially in patients that live in or travel to sheep-raising areas where hydatid disease is endemic. The treatment of choice remains surgical, following the principles of a locally malignant lesion. Chemotherapy (albendazole alone or in combination with praziquantel) is indicated when surgery is not possible or as an adjuvant treatment. The prognosis is often poor. We report the case of a 28-year-old woman with long-standing pain in the left hip joint in which the imaging findings were thought of as being either tuberculous or neoplastic. The result of a CT-guided biopsy concurred with an unexpected diagnosis of a hydatid cyst. This case highlights that in the absence of a high index of suspicion for echinococcal infection, the semblance of imaging findings of hydatid disease in the bone to those of other skeletal pathologies can lead to misinterpretation.

About a rare ankle injury in adults: Case report of a Tillaux fracture in adult.

Introduction and importance: Tillaux fracture occurs as a result of a forced external rotation mechanism involving the anterolateral tibial plafond. The occurrence of this fracture in adults is rare because the ligament usually disrupts before causing bone avulsion. Case presentation: We report the case of a 31-year-old man who, following a trauma in a foot-ball game, was admitted for management of an isolated anterolateral tibial plafond fracture. The diagnosis was made by X-ray, supported by CT scan, which investigated the fracture and excluded other associated injuries. Management was based on open reduction and direct screw fixation. After a 12-month follow-up, we obtained an excellent result. Clinical discussion: Tillaux fracture occurs most often in adolescents, more rarely in adults. The balance between ligament strength and bone strength explains the occurrence of this fracture in children, and the decrease in its incidence with the closure of the conjugation cartilage. Diagnosis is based on a complete radiological workup with standard radiographs and possibly a CT scan. Treatment is most often surgical using either direct screw fixation or plate osteosynthesis. Conclusion: Avulsion of the anterolateral distal tibia, called Tillaux fracture, is a rare entity requiring careful examination and a complete assessment in order to make the diagnosis and to eliminate other associated injuries. Although the literature reports single cases, management is often surgical.

Fracture of the greater trochanter with occult intertrochanteric fracture in an adult treated by percutaneous screw fixation: Case report of an often missed injury.

INTRODUCTION AND IMPORTANCE: Fractures of the greater trochanter with occult intertrochanteric extension are rare and difficult to diagnose. This type of fracture is not identified on standard radiographs and is considered to be an isolated fracture of the greater trochanter that is not subject to surgery. MRI is used to make the diagnosis or, failing that, CT. These fractures are most often surgically fixed to avoid further displacement, prevent complications of bed rest and allow early rehabilitation. CASE PRESENTATION: We present the case of a patient who was diagnosed with a fracture of the greater trochanter with an occult intertrochanteric fracture based on CT, treated by percutaneous screw fixation with full recovery of hip mobility and consolidation after 3 months. CLINICAL DISCUSSION: Isolated fractures of the greater trochanter are most often associated with an occult intertrochanteric fracture found on MRI. This diagnosis changes the prognosis and management since an isolated greater trochanter fracture is usually treated conservatively whereas an intertrochanteric extension most likely requires surgical fixation. Various approaches have been used to fix this type of fracture. In our case, we opted for percutaneous screw fixation with good results. CONCLUSION: Isolated fractures of the greater trochanter with an occult intertrochanteric fracture are a rare entity that most often go unnoticed. MRI or, alternatively, CT should be systematically requested in the presence of an isolated fracture of the greater trochanter on standard radiographs. Surgical management can avoid complications and early management while restoring gluteal muscle function.

Pertrochanteric fracture of an ankylosed hip with protrusio acetabuli treated by PFNA nail: A case report of a rare case.

INTRODUCTION: Hip fractures are the cause of significant morbidity and mortality, aggravated by the existence of an underlying hip pathology. The association of a pertrochanteric fracture with an ankylosed hip and acetabular protrusion is extremely rare. It has not been reported in the literature and the optimal management remains unknown. The surgical treatment indicated for trochanteric fractures allows patients to restore their autonomy quickly while avoiding complications. CASE PRESENTATION: We present the case of a 45-year-old patient who was followed for multiple myeloma and treated with chemotherapy. Following a fall on the pelvis, we found a pertrochanteric fracture with an ankylosed hip and acetabular protrusion. The patient was treated with a PFNA nail based on some principles to improve stabilization, with good results. CLINICAL DISCUSSION: The combination of acetabular protrusion and hip ankylosis alters the biomechanics of this joint by displacing the center of rotation inward and decreasing abductor muscle tension while increasing the lever arm. Several surgical approaches have been reported on case reports with different results. No consensus has been reached for this entity because of its rarity and the absence of a large sample. The result reported for our patient could make cephalomedullary nailing a good option since it allows preservation of the gluteal musculature, early management of the patient and recovery of the pre-morbid state. CONCLUSION: The lack of consensus and the changes caused by this hip condition are a challenge for orthopedists. We treated our patient with a PFNA nail based on a few principles necessary to optimize stability with a satisfactory result.

Minimally Invasive Technique in the Management of Tibial Pilon Fractures: New Approach and Promising Results.

Background: Comminuted tibial pilon fractures are induced by high-energy mechanisms and are often associated with soft tissue injuries. Their surgical approach is problematic due to postoperative complications. Minimally invasive management of these fractures has a considerable advantage in preserving the soft tissue and the fracture hematoma. Materials and Methods: We conducted a retrospective study of a series of 28 cases treated at the Orthopedic and Traumatological Surgery Department of the CHU Ibn Sina in Rabat over a period of 3 years and 9 months, from January 2018 to September 2022. Results: After a mean follow-up of 16 months, 26 cases had good clinical results according to the Biga SOFCOT criteria and 24 cases had good radiological results according to the Ovadia and Beals criteria. No cases of osteoarthritis were observed. No skin complications were reported. Conclusion: This study highlights a new approach that deserves to be considered for this type of fracture as long as no consensus has been given.

Primary muscular hydadit cyst: Case report.

Primary hydatid disease of the skeletal muscle without systemic involvement is rare. Since the infection appears on clinical examination to be a soft-tissue tumor. It is important to have a preoperative radiological evaluation, particularly with magnetic resonance imaging (MRI) to avoid biopsy or improper cyst management during surgery. We present a unique case of a primary hydatid cyst manifesting as an expanding soft-tissue mass in a 31-year-old woman's left thigh with magnetic resonance imaging revealed a very suggestive aspect of hydatid cyst in the adductor muscles and shows the interaction between cysts and nearby structures. The cyst was surgically removed, and macroscopic and microscopic histopathological examinations confirmed the diagnosis of muscular hydatidosis.

Corrigendum: Schwannome bénin du nerf grand sciatique, à propos de 2 cas.

[This corrects the article DOI: 10.11604/pamj.2014.18.252.4684.].

Corrigendum: Abcès tuberculeux de la face postérieure de la cuisse: à propos d'un cas.

[This corrects the article DOI: 10.11604/pamj.2014.19.50.4683.].

[Osteoblastoma of the ankle: an uncommon location]. / L'ostéoblastome de la cheville: une localisation exceptionnelle.

Osteoblastoma is a rare benign bone tumor occurring in adults younger than 30 years, with a clear predominance in men. It mainly occurs at the level of the spine and of the diaphysis in long bones. It occurs exceptionally in the ankle. We here report the case of an adult patient with osteoblastoma of the left ankle revealed by localized pain and partial functional disability. Standard radiographic evaluation was normal. Given the persistence of complaints CT scan was performed, but findings resulted in a misdiagnosis of osteochondritis. Anatomo-pathological examination of the surgical specimen allowed to adjust the diagnosis. Patient' s outcome was simple with very satisfactory functional result. Our case study is important due to the uncommon age of occurrence of the disease (patient older than 30 years) and to its unusual location at the level of the ankle. Even if aggressive forms have been reported in the literature, the prognosis of osteoblastoma is good and recurrences can be avoided by adequate surgical treatment.

Divergent dislocation of the carpometacarpal joints: a case report.

BACKGROUND: Divergent carpometacarpal joint dislocations of the fingers are very rare. Due to severe swelling and overlapping of bones on a radiograph of the wrist and hand, dislocations are missed. The purpose of this clinical case report is to highlight this unusual injury to avoid missing diagnosis. CASE PRESENTATION: We report a case of a 24-year-old Moroccan man, an athlete, who presented divergent carpometacarpal joint fracture-dislocations of the ulnar four fingers after a fall during a national cycling competition. Radiographs showed divergent dislocation and associated fractures. He underwent open reduction and fixation with percutaneous Kirschner wires followed by 6 weeks of immobilization. Active physiotherapy was started and the results were satisfactory after a 2-year follow-up. CONCLUSIONS: Divergent carpometacarpal joint dislocations of the fingers are exceptional; their diagnosis is sometimes difficult and may go unnoticed especially in a patient with polytrauma. The functional prognosis depends on the precocity of diagnosis and the quality of the reduction and rehabilitation.

[Post-traumatic pure dislocation of the elbow: what is the outcome?] / La luxation pure du coude post traumatique: quels résultats?

Elbow dislocations are very frequent. We conducted a retrospective study of 40 patients with dislocations of the elbow whose data were collected between 2013 and 2015. All patients underwent emergency reduction under sedation or under general anesthesia. Treatment was completed with antalgic immobilization for about ten days followed by active mobilization. After a mean follow-up period of 24 months, flexion and extension mobility greater than 100ο was obtained in more than 80% of patients and only two cases had severe stiffness. Overall outcomes assessed using Mayo Elbow Performance Score ranged from good to very good in 35 patients, they were medium in three patients and bad only in two cases.

[The role of the retrograde nailing in distal femur fractures: about 7 cases]. / Intérêt du clou rétrograde dans les fractures du fémur distal: à propos de 07 cas.

We report a series of seven cases of fractures of the distal end of the femur treated by retrograde centro-medullary nailing in the Orthopedic-Trauma Department at the Hospital Ibn Sina over the period 30/05/2010 - 30/04/2015. The average age of patients was 54 years, with a slight male predominance (57,1%). Road traffic accidents were the main cause of these fractures (71.4%) and they mostly affected the right side of body (57,1%). From a surgical point of view, the mean time between symptom onset and treatment initiation was 2 days. Spinal anesthesia was performed in five cases. The average length of stay in hospital was 5 days. The mean time of consolidation was 4 months in all patients, there was only one case of delayed consolidation (6 months). Patients had good functional outcomes with mean knee flexion 120°, with only one case of limited flexion 90°. There was one case of consolidation delay and one case of pseudarthrosis. No deaths, or superficial or deep sepsis, or thromboembolic complications or fat embolism were registered. In general we had satisfactory outcomes. Our study highlights that retrograde femoral nailing is an essential osteosynthesis technique for the surgical treatment of the distal femur fractures.

[Role of Trauma Damage Control Orthopaedic in polytraumas: a case of pelvic disjunction associated with hip dislocation with vascular injury]. / L'intérêt du trauma damage control orthopédique dans les polytraumatismes : un cas de disjonction du bassin associée à une luxation de la hanche avec atteinte vasculaire.

The knowledge of the pathophysiology of patients with severe trauma and the hemodynamic and inflammatory consequences of initial surgical management has led many surgeons to change their approach to the treatment of patients with severe polytraumas associated with lesions of the pelvis or of limbs by integrating the principles of sequential treatment or Trauma Damage Control Orthopaedic (TDCO). We report the case of a patient involved in a public road accident, admitted to hospital in a state of shock with pelvic disjunction and hip dislocation complicated by vascular injury in the same limb. Our approach was based on TDCO concepts by favoring external fixation of the pelvis after hip dislocation reduction. The timeliness of our apprach allowed early limb revascularization while avoiding the hemodynamic and inflammatory complications of open surgery.

[Pure internal subtalar dislocation: about a case]. / Luxation sous-talienne interne pure: à propos d'un cas.

Pure subtalar dislocation is a rare condition. We here report the case of a young patient presenting with pure internal subtalar dislocation as a result of a sport accident. He underwent orthopedic therapy achieving a good functional outcome.

[Chase's amputation in a patient with melanoma on the index finger: about a case]. / L'amputation de Chase dans un mélanome de l'index: à propos d'un cas.

We report the case of a 40-year old patient referred by the Depatment of Dermatology at the Ibn Sina Hospital in Rabat for amputation of the index finger as a result of a melanoma diagnosed by biopsy. The amputation was performed according to Chase's method. Aesthetic and functional outcome was very good six months following surgical treatment.