Partial sterno-costo-claviculectomy for Ewing's sarcoma of the medial clavicle (case report).

INTRODUCTION: Primary clavicle tumors are uncommon and account for <1 % of primary bone tumors. The majority of primary clavicle tumors are malignant. Approximately 1.4 % of all cases of Ewing's sarcoma occur in the clavicle. CASE PRESENTATION: Here, we report the case of a patient diagnosed with Ewing's sarcoma who received neoadjuvant chemotherapy and had an important reduction in the tumoral volume; second, the patient had undergone partial resection of the medial clavicle, first rib, and the sternum. DISCUSSION: The survival rate of patients with nonmetastatic lesions is 56-79 %. The clavicle is connected to major anatomical structures, which makes surgery challenging. Even if there is little morbidity after resection, these studies did not show the superiority of reconstruction. CONCLUSION: The location of Ewing's sarcoma in our patient indicated that the surgical approach was needed for large resection. The functional outcomes were excellent, with no signs of recurrence at the 2-year follow-up.

Variant of the terrible triad of the elbow, a CASE report with a review of the literature.

INTRODUCTION: The terrible triad described by Hotchkiss in 1996 is a complex lesion of the elbow, following a trauma combining forced valgus and external rotation. It is a lesion that puts the elbow at risk of developing complications such as instability, stiffness, or synostosis of the proximal radio-cubital joint. CASE REPORT: We report the case of a patient who suffered a closed trauma to the right elbow following a fall onto the palm of the hand with a valgus lateral rotation mechanism. The lesion assessment showed a B2 fracture of the distal humerus (AO classification) with a line splitting the capitulum in the frontal plane, a type 3 coronoid process fracture (Morrey/Odriscoll classification), and a posterolateral elbow dislocation. The surgical treatment followed the same principles as for the terrible triad, with a reconstruction of the lateral column by osteosynthesis of the humeral palate, followed by an internal approach for osteosynthesis of the coronoid process, with the restoration of a stable elbow without laxity in the frontal plane. DISCUSSION: On the basis of the lesion mechanism, column theory, and the schematization of the constituent elements of elbow stability in a ring, certain lesions can be placed in the same box as the terrible triad of the elbow, which also complies with the same therapeutic implications. CONCLUSION: Our observation underlines the possibility of the existence of lesions other than those described by Hotchkiss, which would have the same consequences: an unstable elbow with the risk of evolving into chronic instability or stiffness and whose management accepts the same management.

"Growth plate fracture of the proximal tibia in a young adult with an unfused growth plate: A case report".

INTRODUCTION: Tibial plateau fractures are recognized as one of the most challenging orthopedic injuries, especially when encountered in adults with unfused growth plates. The rarity of such cases makes them significant for study and discussion. IMPORTANCE: The presence of an open growth plate in adult patients can significantly influence both treatment decisions and outcomes. Understanding these unique cases is vital, as they offer insights into managing similar future cases and advancing orthopedic care. CASE PRESENTATION: A 23-year-old male, following a car accident, presented with a closed knee injury. Radiographic evaluations, including a hand X-ray to determine skeletal age, were employed. The findings confirmed a Salter and Harris type 4 fracture of the proximal tibia and indicated a skeletal age of approximately 15 years ±6 months. Treatment involved open reduction and internal fixation, specifically tailored to account for the patient's preserved growth plate. CLINICAL DISCUSSION: Managing such fractures necessitates a specialized approach, ensuring the growth plate is not jeopardized during treatment. The patient's age, combined with the presence of an unfused growth plate, added complexity to the treatment plan. The emphasis on accurate classification of the fracture, the selected surgical technique, and post-operative care played a pivotal role in the successful recovery. CONCLUSION: This case underscores the importance of a holistic, multidisciplinary approach in managing rare orthopedic presentations. Ensuring the preservation of growth potential while achieving functional recovery is paramount. Such cases enrich the orthopedic literature, guiding future treatments and interventions.

[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.

[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.

[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.

Neuroanatomical identification of mesencephalic premotor neurons coordinating eyelid with upgaze in the monkey and man.

Except during blinks, movements of the upper eyelid are tightly coupled to vertical eye movements. The premotor source for the coordination of lid and eye movements is unknown. The present paper provides the anatomical identification of a new premotor cell group in the rostral mesencephalon of the monkey and human, which lies in close proximity to the premotor center for vertical saccades and is thought to participate in lid-eye coordination. After injections of a retrograde transsynaptic tracer (tetanus toxin fragment C or BII(b)) into the levator palpebrae (LP), the superior rectus (SR), or the inferior oblique (IO) muscle of macaque monkeys, a small circumscribed group of premotor neurons was labeled in the central gray of the rostral mesencephalon, but not after superior oblique or inferior rectus muscle injections. This group lies immediately rostral to the interstitial nucleus of Cajal and medial to the rostral interstitial nucleus of the medial longitudinal fasciculus, each of which contain premotor neurons for vertical saccades, and was termed the M-group. Injections of tritiated leucine into the M-group led to afferent labeling primarily over LP motoneurons. In addition, label was present over the SR- and IO-motoneuron subgroups in the oculomotor nucleus and frontalis muscle motoneurons in the facial nucleus. This projection pattern of the M-group suggests a role in the coordination of the upper eyelid and eyes during upgaze. Double-labeling experiments in macaque monkeys revealed that the M-group is strongly parvalbumin immunoreactive and contains high levels of cytochrome oxidase activity. With these two histochemical markers, the homologue of the M-group was identified in the human brain as well.