Giant cells tumor recurrence at the third lumbar vertebra.

Giant cell tumors (GCT) of the spine are rare. We report a case of (GCT) of the third lumbar vertebra revealed by left lumbar radiculopathic thigh pain in a 47 year old man. Imaging showed an osteolytic process invading the vertebral body, the posterior arch and compressing the dural sac left side. Neurological decompression was first performed including stabilization by an instrumented postero-lateral graft. A surgical biopsy was obtained at the same time to confirm the diagnosis. A secondary L2-L4 tumor curettage and graft procedure did not prevent, 5 years later, tumor recurrence. We believe that the simple tumor curettage is insufficient to prevent giant cell tumors recurrence.

Distal femoral varus osteotomy outcome: Is associated femoropatellar osteoarthritis consequential?

INTRODUCTION: Distal femoral varus osteotomy (FVO) can be indicated for young active patients who have lateral unicompartmental osteoarthritis in a valgus knee originating in the femur. However, its indication remains controversial when associated patellofemoral osteoarthrosis is present. HYPOTHESIS: Associated patellofemoral osteoarthrosis influences the results of osteotomy in cases of lateral tibiofemoral osteoarthrosis. METHODS: Twenty patients (22 knees) underwent opening wedge FVO for lateral tibiofemoral osteoarthrosis of a valgus knee. The osteoarthrosis was lateral and unicompartmental in 11 cases, associated with patellofemoral osteoarthrosis in nine cases, and global in two cases. The osteotomy site was fixed with a 95° blade plate in all cases. At a mean follow-up of 54 months, all the patients were evaluated using the International Knee Society (IKS) score. RESULTS: Eighteen knees had good or excellent results (80%), two had fair results (9.5%), and two had poor results (9.5%). One female patient underwent total knee replacement revision at 8 years and three others are awaiting total knee replacement. The mean preoperative IKS score increased from 49.28 (range, 14-70) to 74.23 (range, 41-92) at the last follow-up. The mean preoperative functional score increased from 50.68 (range, 30-80) to 72.85 (range, 40-90) at the last follow-up (p=0.001). The 8-year survival rate was 91% (confidence interval, 69-100%). We noted improvement in patellofemoral syndrome and recentering of the patella in seven cases out of nine with severe patellofemoral osteoarthrosis. CONCLUSION: Distal femoral varus osteotomy, with lateral opening wedge and fixation can be a good alternative to treatment of lateral tibiofemoral osteoarthritis associated with a valgus knee originating in the femur. The association of patellofemoral osteoarthritis does not affect the functional results. LEVEL OF EVIDENCE: Level IV. Retrospective study.

Pelvic bone hydatidosis.

Bone hydatid disease is a rare pathology, characterized by its long clinical latency, the absence of radiological specificity as well as its challenging surgical treatment. We report an observation of pelvic bone hydatidosis in a 28-year-old patient, appearing with pain and stiffness of the hip as well as a degenerative aspect on the coxofemoral joint on X-ray. The treatment consisted of an extensive hemipelvectomy with femoro pelvic arthrodesis, completed by medical treatment. The functional result was excellent in spite of a break in the fixation material, which allowed a certain mobility at the proximal end of the femur. Hydatid disease of bone is infiltrating,diffuse, slow, and progressive, all characteristics explaining the often-delayed diagnosis. Medical imaging provides accurate analysis for planning a broad surgical resection. The quality of surgical resection is determined according to the risk of recurrence. Pelvic locations are particularly difficult to treat. After an enlarged and difficult surgical resection, reconstruction remains aleatory and poses many technical problems.

[Osteoid osteoma of the coccyx: a case report]. / Ostéome ostéoïde du coccyx: à propos d'un cas.

The spine is a rare localization of osteoid osteoma and the coccyx even more exceptional. We report a case of osteoid osteoma of the coccyx in a young man who consulted for sacrococcygeal pain partially relieved with salicylates. Computed tomography of the region demonstrated a typical osteoid osteoma lesion. CT-guided localization enabled complete resection of the nidus as demonstrated by the CT of the operative specimen Pathology confirmed the diagnosis of osteoid osteoma. Outcome has been quite favorable at two years.

[Low-grade central chondrosarcoma: difficult diagnosis in an adolescent girl]. / Chondrosarcome central de bas grade: un diagnostic difficile: à propos d'un cas.

Central chondrosarcoma of the tibia is exceptional, particularly in young patients. Low-grade tumors raise difficult problems for histological distinction with enchondroma. We report a case of grade 1 chondrosarcoma located in the upper portion of the tibia in a 17-year-old girl. After radical surgery, outcome was favorable with no recurrence or metastasis at three years follow-up. The distinction between low-grade central chondrosarcoma and enchondroma is one of the most difficult challenges in bone pathology. Clinical, radiographic and pathological data must be considered together to reach certain diagnosis.

[Transverse fracture of the sacrum: value of imaging. A case report]. / Fracture transversale du sacrum: place de l'imagerie. A propos d'un cas.

Transverse fractures of the sacrum with major displacement are rare and often misdiagnosed. A case of transverse fracture of the sacrum with cauda equina injury is reported. The diagnosis was not recognized initially. Conventional radiographs of the pelvis failed to demonstrate the fracture. True lateral sacral views and CT scan with reconstructions allowed analysis of the different sagittal fracture lines to facilitate surgical planning. These examinations should be considered in all patients with history of high energy trauma and clinical signs indicating lumbosacral injury.