[Malignant transformation of chronic osteomyelitis: a case report]. / Ostéomyélite chronique compliquée d'un carcinome épidermoïde: à propos d'une observation.

Malignant transformation of chronic osteomyelitis is a rare and late complication which mainly occurs at the level of the edges of a fistulous tract with extension and infiltration to the surrounding soft tissues and more rarely to bones. We here report the case of Mr N.J. aged 67 years, followed up for chronic osteomyelitis of the right femur fistulized to the skin and evolving since the age of 16 years. He presented with secerning fistulas. Imaging examination showed pathologic fracture due to osteolytic lesion of the lower extremity of the right femur associated with poorly defined intra-medullary collection of fluid measuring 8 cm along its longer axis. The patient underwent surgical resection of the fistulas with complete evacuation and curettage of the bone cavity. Pathological examination showed differentiated keratinising squamous cell carcinoma, infiltrating the fistulous tract and extending to the soft parts and to the lower extremity of the right femur. Staging was negative. Disarticulation of the HIP was performed. At two-years follow-up the patient was doing well without local recurrence or distant metastasis. Initial treatment of chronic osteomyelitis is essential to prevent alarming complications. Amputation is the treatment of choice in patients with malignant transformation of chronic osteomyelitis in particular to squamous cell carcinoma, as in the case of our patient, in order to to prevent secondary involvement.

[Results of unicondylar femoral fractures: a review of 28 patients]. / Resultats des fractures unicondyliennes du femur. Etude rétrospective à propos de 28 observations.

BACKGROUND: Unicondylar femoral fractures are rare. They form a particular entity of the femoral lower extremity fractures. THE PURPOSE of this work was to evaluate the anatomical and functional results of unicondylar femoral fractures on pain, mobility, walking and stability of the knee. METHODS: We reviewed, retrospectively, 28 patients presenting unicondylar femoral fracture. There were 19 men and 9 women, with average age of 54 years (22 - 87 years), victims essentially of domestic accident. The fracture was alone in 65 % of cases. According to Nordin's classification, the fracture was of type I in 3% of cases, type II in 35 % of cases, type III in 20 % of cases and type IV in 42 % of cases. Twenty five patients had a surgical treatment after a median period of 7 days post-accident, 3 patients were treated orthopedically. RESULTS: After 3 years follow up, results were noted according to MEGY's score which takes into account walking, mobility, pain and the stability. Clinically, we noted 26 good and very good results and 2 moderate results. Anatomically, we obtained 75 % of satisfactory reductions. CONCLUSION: Unicondylar femoral fractures remain rare. It is important to recognize them and to make the exact diagnosis of their type. Surgical treatment exposes old subjects to risk of dismantling anatomical osteosynthesis because of osteoporoses.

[Use of Hoffman external fixation for extra-articular upper metaphysealtibial fractures]. / Traitement des fractures Sous-tuberositaires du tibia par le fixateur externe de Hoffman. A propos de 46 cas.

Treatment of extra-articular upper metaphyseal tibial fractures can be difficult. Orthopedic treatment is frequently complicated by second displacement These fractures are inappropriate for locked intra-medullary nailing because of the shorteness of the proximal extremity. Damages of soft tissues. frequently associated with these factures, expose internal osteosynthesis to many risks. For these reasons, we opted for external fixation. Our study was a retrospective analysis of 46 extra-articular metaphyseal tibial fractures treated by external fixation with Hoffman material. The average follow-up was 24 months. Consolidation was obtained within 4 months in average. Septic complications. inherent to the method were uncommon or minor. Functional results were satisfactory in 84% of cases. So, external fixation with Hoffman material. with particular recommandations, is a promising method for the treatment of extra-articular of proximal metaphyseal tibial fractures.