Interest of longitudinal patellar tunnels in reconstructing chronic patellar tendon rupture with semitendinosus autograft: A case report.

Treatment of chronic patellar tendon ruptures represents a real challenge for orthopaedic surgeons. The superior patellar migration and the pathological aspect of the tendon are the two conditions that aggravate the situation. Several reconstruction methods have been described in the literature. Hamstring tendon augmentation using horizontal patellar tunnel is widely used in such cases. However, underuse of longitudinal patellar tunnels, although they reproduce the native footprint of the patellar tendon insertion, highlights a missed opportunity in chronic patellar tendon rupture reconstruction. In the current article, we describe a semitendinosus tendon autograft reconstruction technique where the patellar tunnels are drilled longitudinally instead of being drilled transversely from medial to lateral. At 34 months follow-up, our patient claimed full active knee mobility with good quadriceps strength. Reproducing the native footprint of the patellar tendon insertion, through longitudinal patellar tunnels, leads to optimal outcomes after chronic patellar tendon rupture reconstruction with Semitendinosus Autograft.

Clinical and radiographic outcomes after paediatric supracondylar humeral fractures treated with combined intramedullary and lateral wire fixation: our experience in fifty-one cases.

PURPOSE: Displaced supracondylar humerus fractures in children are known for their high rate of complications and require urgent surgical treatment. Basically, there are two methods of fracture fixation: the lateral pin technique and the crossed pin technique. However, the best technique remains debated. The aim of this study was to evaluate the clinical and radiographic outcomes of our method of fixation using combined intramedullary and lateral wires for treatment of displaced supracondylar humeral fractures in paediatric patients. METHOD: Fifty-one paediatric patients were treated for displaced supracondylar humeral fractures. The method of fracture fixation used consists of two Kirschner wires inserted one intramedullary and the other laterally. Clinical and radiographic outcomes were assessed at last follow-up. RESULTS: According to Gartland's classification, 17 fractures (33%) were type 2 and 34 (67%) were type 3. The mean follow-up period was 7.8 months. Functional outcome according to Flynn's criteria was satisfactory in all cases with 92% graded as excellent or good. Cosmetic outcome according to Flynn's criteria was satisfactory in all cases. Radiologically, at last follow-up, the mean Baumann angle was 69° (63-82°) and the mean lateral capitellohumeral angle was 41° (32-50°). CONCLUSION: Patients managed with combined intramedullary and lateral wires experience satisfactory results. Moreover, this technique, without risk for the ulnar nerve, can be interesting in the treatment of infrafossal fractures and fractures with anterior displacement.

About a misleading calcified mass of the elbow: Soft tissue osteochondroma: A case report.

INTRODUCTION: Soft tissue osteochondromas are rare lesions, with a misleading radiology, that can present diagnostic dilemma. CASE PRESENTATION: We report the case of 16-year-old girl who presented an anterior swelling in his left elbow, slightly painful on palpation, with no signs of inflammation. Elbow mobility was normal. Standard radiographs showed a globular calcified mass. CT scan revealed a well-defined lobulated soft tissue mass with extensive flaky calcification. Magnetic resonance imaging (MRI) showed lobulated and intermuscular non-enhancing mass. The lesion had a low heterogeneous signal on T1 images, and a high heterogeneous signal on T2 FAT-SAT images, with low signal areas suggesting calcifications. There was no continuity to the adjacent ulna and radius. The patient first underwent image-guided core needle biopsy and histological examination concluded to chondroma. The tumour was then resected by anterior approach and the final histological diagnosis was osteochondroma of soft tissue. DISCUSSION: A diagnosis of extraskeletal osteochondroma should be considered when an ossified mass is localized in the soft tissue particularly on the elbow. Excision is the treatment of choice when the function is reduced and the nature of the tumour remain uncertain. CONCLUSION: Orthopedic surgeons should know about elbow localization of osteochondromas to help in accurate diagnosis and management of the tumour, to avoid overtreatment.