Diagnosis and treatment of osteo-articular tuberculosis of the foot and ankle (a five case series).

INTRODUCTION: Osteo-articular tuberculosis is a rare manifestation of this disease, often posing diagnostic challenges that necessitate additional diagnostic imaging modalities such as radiography, CT, and MRI. This article presents a series of five cases involving tuberculosis affecting the bones of the foot and ankle, diagnosed at various stages. The patients received appropriate anti-tuberculosis medical treatment following national protocols, along with surgical interventions when necessary. CASE STUDIES: In this series, we describe the clinical characteristics and management of five cases of foot and ankle bone tuberculosis. These cases were diagnosed at different stages, and all patients received standard anti-tuberculosis medical therapy according to national treatment guidelines. Surgical interventions were performed when deemed necessary to optimize patient outcomes. DISCUSSION: The diagnosis of bone tuberculosis should be considered in any clinical scenario that presents with uncertain features, persistent symptoms, or resistance to conventional treatment approaches. It is crucial to employ a multidisciplinary approach involving medical and surgical management to effectively address this challenging disease. However, it is important to note that surgical intervention cannot replace the necessity of proper medical treatment. CONCLUSION: Tuberculosis involving the bones of the foot and ankle remains an infrequent occurrence. However, considering the endemic context, prompt therapeutic interventions are essential to prevent significant osteoarticular damage. Early diagnosis, adherence to established treatment protocols, and a comprehensive approach encompassing both medical and surgical modalities are crucial for successful management of this rare entity.

[Pseudo-tumor digital tuberculosis: A case report and review of the literature]. / Tuberculose osseuse digitale pseudotumorale : un cas et revue de la littérature.

We report a case of a 66-year-old woman, who was treated for a circumferential tumefaction of the middle phalanx of the third finger, evolving for one year. The excision-biopsy of the phalanx led to the diagnosis of an osseous tuberculosis. Through this exceptional case, the authors made a review of the literature on the clinical, radiological and evolutionary aspects of the digital osseous tuberculosis.

[Compression of the superficial branch of the radial nerve by a synovial ganglion of the elbow (about one case and literature review)]. / Compression du rameau superficiel du nerf radial par un kyste synovial du coude (À propos d'un cas et revue de littérature).

Compression of the radial nerve at the elbow is quite rare; entrapment of its superficial branch is exceptional. Extrinsic compression is the most frequent etiology. Magnetic resonance imaging plays a major role in the diagnosis, and early surgical excision or echoguided drainage - in case of synovial ganglion - allows a total recovery. The authors report the case of a compression of the superficial branch of radial nerve by an elbow synovial cyst treated by surgical resection.

[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.

[Intramuscular hemangioma of the forearm: seven cases]. / Les hémangiomes intramusculaires de l'avant-bras: sept cas.

The authors reexamined the files of seven patients dealt with for intramuscular hemangioma of forearm. It concerns five women and two men, between 16 and 39 years old. The average time of consultation was 13 months. The clinical signs were dominated by the development of a generally painless soft mass over the anterior compartment of the forearm and/or the elbow. Two patients presented nervous lesions signs of the ulnar or median nerves. The feeder pedicle was the ulnar artery in five cases and radial artery in two cases. The excision was incomplete in two cases because of the invasion of the ulnar nerve by the hemangioma. With four years average follow-up, the five patients having undergone a complete excision do not present a recurrence and the hand function is excellent. The authors insist on the interest of a preoperative diagnosis with the IRM, which permits to envisage surgical difficulties due to the proximity of vascular and nervous pedicles.

[Giant cell tumors of the distal radius: resection: reconstruction by long avascular fibular graft (a case report)]. / Tumeur à cellules géantes de l'extrémité inférieure du radius : résection - reconstruction par greffon fibulaire long non vascularisé (à propos d'un cas).

Giant cell tumors (GCT) are locally aggressive tumors with a preference for epiphyses and metaphyses of long bones. They represent 5%-10% of all primary bone tumors. They affect mostly young adults between 20 and 40. Their origin remains uncertain. GCT is a purely lytic tumor, recurrent and can even lead to fracture. The distal radius is the third location after the distal femur and proximal tibia. Tumors are benign on histopathology, but "benign" lung metastases can sometimes be seen. Their treatment remains controversial because of the high rate of recurrence; oncological resection of the diseased bone segment with reconstruction reduces the rate of recurrence. Several techniques of resection and reconstruction of the wrist have been proposed. We report a case of giant cell tumor of the distal radius treated by resection and reconstruction by avascular fibular graft to a length of 12cm, and we evaluate the use of this reconstruction to salvage the wrist with this pathology.

[Hemangioma of the clavicle: report of one case]. / Hémangiome osseux de la clavicule (à propos d'un cas).

We present a case of intraclavicular hemangioma with a description of its clinical, radiological and histological features and its differential diagnosis regarding other bony tumors.

[Hibernoma of the thigh]. / Hibernome de la cuisse.

Hibernoma is a rare benign tumour of brown fat. It presents as a voluminous slow-growing mass in the regions where remnants of brown fat can remain in adults. We report a case of a hibernoma on the thigh and present the diagnostic and therapeutic elements of this type of tumour, whose differential diagnosis of liposarcoma.

[Giant lipoma of the hand: case report and literature review]. / Lipome géant de la main : présentation d'un cas clinique et revue de la littérature.

Giant lipoma of the hand is rare. The diagnosis is based on a clinical tumor and acroparesthesia from compression of the median and ulnar nerves. The MRI is the best exam to study local extension. Fibrolipoma of the median nerve and low-grade liposarcoma are the principal differential diagnoses.

[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.

Patella tuberculosis: a case report.

A rare case of patella tuberculosis is reported. Clinical signs comprised chronic inflammatory pain, knee swelling and joint stiffness, with two years' evolution. Standard X-ray showed focal osteolysis with intact joint line. Diagnosis was based on surgical biopsy during arthrotomy. Treatment comprised nine months' antibiotherapy and bone curettage to prevent intra-articular extension. At 42 months' follow-up, functional results were good, without recurrence of infection.

[Myositis ossificans circumscripta of the forearm]. / Myosite ossifiante circonscrite de l'avant-bras.

Myositis ossificans circumscripta is a benign lesion characterized by focal heterotopic soft tissue ossification and occurring in young people generally after localized trauma. The location of this case in the forearm is rare. The clinical signs, radiological appearance and the histological features can be confused with osseous or soft tissue sarcoma, as was the case in our patient.

[Aneurysmal bone cyst of the ulna]. / Kyste osseux anévrismal de l'ulna.

Aneurysmal bone cyst (ABC) accounts for 1 to 4 percent of primary bone tumours. There is a distinct predominance in the 10- to 20-year age group, and it is rare after age 50. Despite its benign character, it is sometimes locally aggressive, and can attain significant size. This was so in the case we report of a patient with an ABC of the ulna.

[Bilateral dorsal elastofibroma]. / Elastofibrome dorsal bilatéral : à propos d'un cas et une revue de la littérature.

Elastofibroma dorsi is a slowly-growing benign tumor which usually occurs at the inferior angle of the scapula. It may be more of a degenerative process than a neoplasia. We seek, through our observations and a review of the literature, to clarify the characteristics of this tumor and its modes of management. We think that all doctors should be aware of this condition, in order to treat it correctly.

[Giant cell tumor of the thumb proximal phalanx: resection-iliac graft and double arthrodesis]. / Tumeur à cellules géantes de la phalange proximale du pouce: résection-autogreffe iliaque et arthrodèse bipolaire.

Giant cell tumours (GCT) of bone are frequent, with variable behaviour, high risk of recurrence and an often benign histological appearance. Their location in the hand is uncommon, and there are few publications on the subject. Surgical treatment as described in the literature is very variable. We report a case of recurrent grade II GCT, arising in the proximal phalanx of the thumb, aggressive and causing a pathological fracture. After a surgical biopsy, we performed an "en bloc" resection of the first phalanx, with an iliac crest graft reconstruction and a double arthrodesis of the metacarpophalangeal and interphalangeal joint. No recurrence or lung metastasis was seen at 18 months follow-up.

[Two osteoid osteomas in the same lunate]. / Une double localisation d'un ostéome ostéoïde du semi-lunaire.

Osteoid osteoma is a small tumour, always benign, consisting of a small focus of osteoblastic hyperactivity surrounded by a zone of sclerosis. Located preferentially on the long bones, femur and tibia, carpal localisation is rare but if present it usually affects the scaphoid. We present a case of double localization of an osteoid osteoma in the lunate bone, presenting as gradually increasing pain in the wrist over the course of 18 months. Standard radiology and tomodensitometry of the wrist showed two central lucencies of the lunate without rupture of the cortex. Curettage of the lesion and packing of the resultant defect with cancellous bone resulted in disappearance of the lesions with good functional recovery. The clinical, radiological and therapeutic aspects will be discussed by the authors.

[Giant cell tumors of the tendon sheath of the hand: 32 cases]. / Les tumeurs à cellules géantes des gaines synoviales de la main: à propos de 32 cas.

Giant cell tumors of tendon sheath (GCTTS) represent a localised form of pigmented villonodular synovitis. They are usually found in the hand (80% of cases) where it represents the second most common tumor of the soft parts after the ganglion cyst. Its surgical treatment is sometimes difficult because of local extension and the invasion of vital digital structures. We report a retrospective study over 10 years of 32 cases of GCTTS with an average age of 35 years and a sex-ratio of 1. The reason for consultation was the presence of a digital mass, associated with an impairment of finger flexion in 43,7% of patients. A palmar localisation was found in 56,2%, especially in the fifth ray (62,5%) and at the level of the distal phalanx (68,7%). Radiological changes were observed in 4 cases. All patients were treated surgically. Macroscopically the lesion presented as an encapsulated tumor, polylobulated and yellow-brownish which invaded the skin (1 case), extended into the sheath of the flexor tendons (3 cases) and under the extensor tendon (4 cases). In the post operative follow up we noted one case of hypoaesthesia of the pulp and three cases of stiffness of the proximal interphalangeal joint. No skin necrosis was found. With a 4 year average follow up (10 months - 9 years), we noted three reccurrences (9,3%) which were all surgically managed. After analysis of the literature, the authors will describe the clinical aspects and the therapeutic difficulties of this condition.

[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.

[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.

[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.