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.

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.

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.

Rare case of Malign Peripheral Nerve Sheath Tumor complicating a solitary giant neurofibroma of the thigh.

INTRODUCTION AND IMPORTANCE: Malign Peripheral Nerve Sheath Tumor is rare and can occur on a solitary neurofibroma or as part of neurofibromatosis type 1. The occurrence of a giant solitary neurofibroma in the thigh is rare and its complication in MPNST is much rarer. The diagnosis is based on a combination of radiological, histological and immunohistochemical evidence. CASE PRESENTATION: We present the case of a 55 years old woman who presented a mass of the posterior aspect of the thigh without any other abnormality on systemic examination. MRI showed a T1 hyposignal and a T2 hypersignal and the biopsy performed was in favor of a neurofibroma. After surgical resection, the histological study of the surgical specimen revealed an MPNST developing on a pre-existing neurofibroma. After 5 months, the patient had moderate knee stiffness with thigh amyotrophy. CLINICAL DISCUSSION: The occurrence of MPNST on a giant solitary neurofibroma of the thigh is extremely rare. MRI allows evoking the diagnosis but radiologists are confronted with a problem of differential diagnosis. Histological examination supports the diagnosis in addition to immunohistochemical examination. Only surgical treatment can give hope for a cure. Recurrences remain frequent with a 5-year survival of 50 %. CONCLUSION: Early diagnosis is essential to prevent the evolution of the tumor and the occurrence of poor prognostic factors compromising the management, increasing the risk of recurrence and affecting the overall survival of patients.

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.