Trans-scaphoid trans-lunate trans-triquetral volar perilunate dislocation: A case report.

Introduction: Translunate volar perilunate dislocations are extremely rare, with few documented cases. Only eight instances of volar translunate perilunate dislocation have been described in the literature. This report presents a successfully treated case using early reduction and internal fixation that led to a very satisfying outcome at 9 months follow-up. Case report: A 20-year-old man presented with left wrist pain and swelling after a fall from a vehicle at 50 km/h, landing on an outstretched right hand. Radiographs and a CT scan identified scaphoid, lunate, and triquetral fractures, along with a volar perilunate dislocation. Surgical treatment was performed with a dorsal approach, including scaphoid and lunate fracture fixation, triquetral avulsion repair, and lunate stabilization with K-wires. The wrist was immobilized for 6 weeks, intense physical therapy started after K-wires removal. At 9 months follow-up, positive results were seen clinically and radiologically. Discussion: A perilunate fracture-dislocation includes dislocation of the carpus from the lunate. Johnson divided these injuries into lesser arc (pure ligamentous) and greater arc (fracture-related). Bain introduced the translunate arc concept in a case series of three patients, depicting a path through the lunate causing lunate fracture alongside perilunate injury. Treatment focuses on lunate reduction and fixation, combined with addressing greater and lesser arc injuries. Achieving successful lunate realignment and fixation is challenging. However, early diagnosis, prompt reduction, rigid fixation, and repair of both arc injuries can lead to optimal functional recovery.

Traumatic obturator dislocation of the hip joint: About 2 cases and review of the literature.

INTRODUCTION: Traumatic dislocation of the hip is a serious lesion, and its obturator variety is rarely reported. It always reflects a high-energy trauma and represents a therapeutic emergency that requires a reduction in less than 6 h due to the risk of aseptic necrosis of the femoral head in the long term. CASE REPORT: We reported 2 cases of hip obturator dislocation in patients aged 21 and 45 years respectively, which occurred following a road accident, received for pain and functional impairment of the hip, and in a typical attitude with hip flexion, abduction, rotation and knee flexion with no downstream limb vascular-nervous injury. The emergency reduction in <6 h, in two cases, followed by functional treatment by offloading for 8 weeks and support of the limb with the resumption of walking had been authorized at 3 months with a return to sport at 16 weeks; made it possible to obtain satisfactory results at 18 months of follow-up, with an absence of a functional gene, stiffness and without signs of necrosis of the femoral head. DISCUSSION AND CONCLUSION: Traumatic obturator dislocation of the hip constitutes serious lesions and requires early and appropriate management, reduced to closed focus, treated functionally give excellent results in the medium term. The patient must be carefully monitored over the long term and be warned of the risks he runs.

Quadriceps tendon repair using double row suture anchor fixation: Case reports and review of the literature.

INTRODUCTION: Traumatic rupture of the quadricipital tendon is rare and disabling. The traditional repair technique involving transpatellar tunnels is still relevant, but this technique seems to be superseded for the technique using anchors. This study aimed to present the place of the anchors in quadriceps tendon tears, and assess the functional results after a means follow-up of 18.66 months. CASE REPORTS: We report 03 cases of acute rupture of the quadricipital tendon collected in the Trauma Surgery and Orthopaedics Department. The average age was 53.66 years, all patients were male, the rupture occurred after a sporting accident in one case, and in 2 cases concerning minimal trauma from a fall in 2 patients followed for renal failure. The average consultation time was 48 h. The right knee was affected in 2. The clinical presentation was identical in all patients with the deficit of active extension of the leg. All patients were treated surgically with the use of double row anchors. The technique used consisted of insertion of two 5.0 mm anchors at the base of the patella, and the proximal part of the quadricipital tendon was sutured with heavy absorbable sutures using Krakow suture. RESULTS: At a mean follow-up of 18.66 months, no infectious complications were noted, no active extension deficit and the active flexion average was 123.33°. CONCLUSION: The rupture of the quadricipital tendon is a rare injury. Surgical treatment by double row anchors gives excellent results with a satisfactory medium-term functional recovery and allow early rehabilitation.

Pseudarthrosis of distal radial growth plate treated with Blount clip: A case report.

INTRODUCTION AND IMPORTANCE: Epiphyseal detachement of distal radius are frequent, the richness of the vascular supply at this level favors rapid consolidation, but with the possibility of long-term complications which vary according to the classification of Salter and Harris. In the literature they are dominated by the epiphysiodesis, however, Pseudarthrosis of the growth plate is exceptional. Through this case presentation, we will explain contributing factors of its occurrence and its care management. CASE PRESENTATION: We report a case of a pseudarthrosis of distal radial growth plate (GP) due to an epiphyseal detachement type I of Salter and Harris in a 16-years-old patient who presented with a right wrist trauma at the age of 8, treated by a traditional immobilization (Moroccan Jbira) and who kept a painful deformity of the right wrist in hand ulnar boot. Face and profile radiography of the right wrist found a pseudarthrosis of distal radial growth plate, the patient had surgery to attach pseudarthrosis spot using a Blount clip, and at the same time, creating a partial epiphysiodesis in the lateral side, resulting in the correction of the wrist malalignment. After 5 years, we had a consolidation of the pseudarthrosis spot, without modification of angular deviation. CLINICAL DISCUSSION: GP's traumas care management is based on an urgent and anatomical reduction because it is a very fragile area and is more affected by mechanical stress, however in our context Patients consult usually after late complications such as deformations and functional abnormalities. Blount clip was our surgical team choice because it is the best way of osteosynthesis in our case, it allows a solid fixation thanks to its biomechanical characteristics. Pseudarthrosis of distal radial growth plate is exceptional in the literature that's why we cannot compare our results. CONCLUSION: This complication would have been prevented with initial adequate care management, prevention about avoiding traditional traitements.

[Madura foot: a rare pathology in Morocco (about 15 cases)]. / Le pied de Madura: pathologie rare au Maroc (à propos de 15 cas).

Mycetoma is a rare disease in Morocco. The purpose of this work is to increase the awareness of this infection that is still not diagnosed in our context by Moroccan practitioners, as well as to show the medical treatment limits in Madura foot disease. This is a retrospective study of 15 patients with an average age of 34 years. All patients presented classic lesions: swelling fistulizing of slow evolution, with elective foot localization. In spite of the identification of pathogenic agents, the delay of diagnosis and the osseous infringement imposed amputations for 14 patients. After a 3-year follow-up, all patients with amputation had a good evolution with the help of adapted orthopedic equipment and psychological support. The delay of diagnosis and the advanced lesions of mycetoma in Morocco make the medical treatment ineffective. The recourse to leg amputation with suitable equipment is a simple alternative treatment that improves better social and professional reintegration. Mycetoma is characterized by an obvious delay of diagnosis. The forecast is worsened by the osseous infringement. Sometimes it can be dramatic and may lead to amputation.

[Surgical treatment in De Quervain's tenosynovitis. About 20 cases]. / Traitement chirurgical de la ténosynovite de De Quervain. A propos de 20 cas.

INTRODUCTION: The De Quervain's tenosynovitis is an inadequacy into the first extensor compartment between the osteo-fibrous tunnel and the tendons. This mechanical conflict generates a tenosynovitis of the extensor pollicis brevis and the abductor pollicis longus tendons in first dorsal extensor compartment of the wrist. PATIENTS AND METHODS: The authors report a retrospective study of 20 patients who have been treated by a longitudinal surgical approach. The mean age was 49 years old with a net female predominance. The Finkelstein's test was positive in all cases. All patients were treated operatively by incision of the sheath, which was sufficient to unwind the dorsal compartment tendons. The sheath palmar flap has been sutured with skin (Le Viet plasty) to avoid a further tendons luxation. RESULTS: At three years follow-up, the functional results were good in all the patients. However, non-aesthetic scars were noticed in three patients. We did not notice neither a case of anesthesia of the radial nerve nor a tendinous luxation in our series. DISCUSSION: The stenosing tenosynovitis of the first dorsal extensor compartment of the wrist is a relatively frequent pathology in the young woman. We use a longitudinal surgical approach to avoid the radial nerve lesions. Le Viet procedure using the palmar flap of the pulley fixed to the dermis works as a barrier and maintains the tendons sliding on the radial styloid groove.

[Concomitant fractures of the radius and scaphoid with an elbow dislocation]. / Fractures concomitantes du radius et du scaphoïde associées à une luxation du coude.

A variety of associated injuries of the upper limb have been described in the literature. The authors report a case of bifocal fracture of the radius and a scaphoid fracture together with elbow dislocation. In our knowledge, this association of lesions has never previously been described.

[Axillary nerve schwannoma (case report)]. / Schwannome du nerf axillaire (à propos d'un cas).

The schwannoma is a benign tumour that can be eradicated; it usually occurs in the peripheral nerves of the upper limb. We report an exceptional localization in the axillary nerve. The diagnosis is based on the typical MRI appearance: in addition, confirmation of the diagnosis has to be made by histological examination. The surgical treatment by resection, taking care to preserve adjacent nerve fibres. This allows recovery without any after-effects since the recurrence rate as well as the potential for malignant transformation of this type of tumour is low.

[Luxatio erecta of the shoulder. Report of eight cases]. / Luxation erecta de l'épaule (à propos de huit cas).

The luxatio erecta is a rare form of shoulder dislocation frequently described in young patients. The purpose of our study is to review the mechanism of this affection as well as its clinical, radiographic and therapeutic features. We also report eight cases of luxatio erecta observed between 1995 and 2006. We report six males and two females with an average age of 40 years. The left shoulder was dislocated in seven cases and a direct mechanism was reported by two patients. All of our cases presented with the typical attitude described for this dislocation; an upper limb in fixed abduction with the hand raised and inability to bring the elbow back to the body. No neurovascular injury was reported in this study. Radiographic examination showed inferior dislocation of the humeral head and the axis of the shaft above the horizontal line in all of our cases. The treatment consisted of closed reduction under general anaesthesia followed by a Dujarier's bandage for three weeks. Luxatio erecta is the commonest type of inferior dislocation. Its mechanism is a fall on the upper limb in great abduction or antepulsion. The clinical diagnosis is easy, confirmed by an anteroposterior radiograph. The functional long-term prognosis is excellent.

[The Foucher's "kite-flap" (12 cases)]. / Le lambeau en "cerf-volant" de Foucher (à propos de 12 cas).

The "kite-flap" is a cutaneous island flap containing a triple pedicle. It is harvested from the dorsum of the index and is intended to cover skin-loss on the thumb. The purpose of our study was to evaluate 12 "kite-flaps" performed over the course of 11 years. The skin defects were on the dorsum of the distal phalanx of the thumb in 3 cases, on the dorsum of both the distal and proximal phalanges in 4 cases and on the volar aspect of the thumb in 5 cases. The associated lesions consisted of combined bone and skin in one case treated by bone graft with external fixation, and one case of septic arthritis of the interphalangeal joint treated by arthrodesis. The results of our series are very good after an average of 2 years follow-up. We have however had 4 cases of cold intolerance, 2 cases of superficial sepsis and one case of shrinkage of the first commissure. It appears that the "kite-flap" is the best solution for cover of simple or complex skin loss of the thumb. Its technical performance is easy, and it gives durable, sensate and stable skin cover.

[Irreducible traumatic dislocation of the hip caused by labral and capsular entrapment with a buttonhole effect]. / Luxation traumatique de hanche irréductible par incarcération d'une capsule et du labrum entraînant un effet de boutonnière.

Irreducible hip dislocation following capsular and labral entrapment is a rare condition. We report a case of irreducible posterior traumatic pure hip dislocation where reduction was successfully achieved only with open surgery. An analysis of this case in the light of the published literature recalls the different etiologies of irreducible traumatic dislocation of the hip and the requirement for open surgery.

[A case of neglected shoulder anterior dislocation with preservation of joint function]. / Un cas de luxation antérieure invétérée glénohumérale avec conservation de la fonction de l'epaule.

Shoulder neglected anterior dislocation is a rare event and intolerated in young patients. We report a case of shoulder antero-medial dislocation among 15 years. It was a woman aged 35, who had a left shoulder trauma with an unnoticed antero-medial dislocation. Fifteen years later, the patient presented an inesthetic deformity with presevating function. The Rowe and Zarsins score was good. The radiographs showed the humeral neack in a neo-cavity of the joint associated to Malgaine lesion with an advanced arthrosis of the joint.

[Pigmented villonodular synovitis of the wrist invading bone. Case report]. / Synovite villonodulaire hémopigmentée du poignet envahissant l'os. A propos d'un cas.

Pigmented villonodular synovitis of the wrist is a rare and benign lesion. The bone involovement means an agressive form, but adequate treatment permit to avoid the recurrences. The authors analyse a case with good evolution after synovectomy and bone debridement, with review of literature.

[Medial epicondyle fractures in children]. / Les fractures de l'epicondyle médial chez l'enfant.

INTRODUCTION: Medial epicondylar fractures account for 11% of elbow injuries in children. It represents a Salter-Harris type I lesion. Diagnosis is difficult but on the whole, results are satisfactory. The treatment of this fracture is controversial. PATIENTS AND METHODS: Our study looked at fifty-nine patients between 7 and 14 years old. The main mechanism of injury in our study was a fall (98%). The significance of the fracture displacement was judged according to the classification of Marion and Faysse. We noted 10 cases of stage II, 14 cases of stage III and 35 cases of stage IV according to their classification. Forty-one patients were treated by surgical fixation. Fifty patients were reviewed at an average of six years follow up and the results evaluated according to the criteria of Hardacre. RESULTS: The result was good in 95% of those cases with conservative treatment and in 80% of those cases with operative treatment. Prominence of the medial epicondyle and limitation of elbow motion were the main complications. DISCUSSION: According the literature, a sports accident is the most frequent cause of the injury. The results are better with conservative treatment because there is no relation between fracture displacement and final results. The excellent results of conservative treatment permit us to recommend this method except in those cases with a persistent intra-articular fragment or neurovascular complication.

[Snake bite poisoning and compartment syndrome. A report of two cases]. / Envenimations par morsure de serpents et syndrome de loge. A propos de deux observations.

Snakebite poisonings are frequent In Morocco, because of the delay in treatment, they can be very serious even lethal. Treatment has two components: firstly correction of the systemic hemodynamic, respiratory and haematological disturbances and secondly administration of specific antivenom. Envenomation of a limb can lead to cutaneous necrosis, compartment syndrome and even necrotising fascitis. Early diagnosis and prompt treatment is needed to prevent these complications. We report two cases of compartment syndrome of which one was combined with systemic manifestations and the other caused residual pathology in the limb.