Loosening of a Total Hip Arthroplasty Associated with a Periprosthetic Femoral Fracture Caused by Recurrent Hydatidosis of the Hip: A Case Report.

CASE: A 35-year-old woman, who lived in an endemic area for echinococcosis, developed a periprosthetic fracture with loosening of a total hip arthroplasty that had been performed 9 years earlier for hydatidosis of the right proximal femur with a pathological femoral neck fracture. At that time, the patient did not have any signs of liver or lung involvement. She was successfully managed by a cemented revision hip arthroplasty without any signs of recurrence at the last follow-up of 5 years. CONCLUSIONS: Total hip arthroplasty can offer effective management of proximal femur hydatidosis, despite the high rate of recurrence and mechanic failure.

Septic arthritis of the wrist: about six cases.

The wrist is a rare location of septic arthritis. It often involves patients with preexisting joint disease which symptoms could be confused with infection making the diagnosis more difficult and usually delayed. It is often responsible for residual functional impairment and for a high mortality rate among vulnerable patients. We report 6 cases of septic arthritis of the wrist in 3 males and 3 females. The mean age was 32 years in the male patients and 66 in the female patients. All the women were followed for rheumatoid arthritis. Biological results showed elevated rates of white blood cells and c-reactive protein in all the patients. Joint fluid analyses showed elevated white blood cell count. The treatment was medico-surgical consisting in synovectomy, joint debridement and immobilization of the wrist. At the average follow-up of 1 year and 4 months, 3 patients recovered a perfect mobility of the wrist without any limitation of the range of motion nor the strength. Three patients developed stiffness of the wrist.

Outcome of total knee arthroplasty following closing wedge high tibialosteotomy: a review of 40 cases.

INTRODUCTION: Total knee replacement after high tibial osteotomy becomes more and more indicated. This intervention needs to identify some pearls and pitfalls. AIM: To evaluate results of total knee arthroplasty after closing wedge high tibial osteotomy. METHOD: Fourty total knee arthroplasty following closing wedge high tibial osteotomy were identified. Demographic features, tibiofemoral alignment and radiolucent lines were documented on postoperatively. Clinical and functional evaluations were performed preoperatively and postoperatively according IKSS score. RESULTS: The average duration of follow-up was 11,5 years. The mean function score increased from 39 points to 70,4 points postoperatively. The mean knee score increased from 40 points to 84,9 points postoperatively. The mean average tibio-femoral angle was 177,7° in preoperatively and 178° (min 176°, max 185°) at the last follow-up. CONCLUSION: The closing wedge high tibial osteotomy does not compromise subsequent total knee replacement. Knowing pearls and pitfalls lead to better outcome.

Outcome of intramedullary pinning of isolated radial neck fractures in adulthood.

BACKGROUND: The treatment of radial neck fractures is controversial and typically depends on displacement. Surgical procedures based on open reduction-internal fixation (ORIF) may lead to several complications, such as avascular necrosis of the radial head, nonunion, malunion, and elbow stiffness. Closed reduction with intramedullary pinning of radial neck fractures, which is commonly used in children, is a viable option for these fractures in adults and may allow for a lower complication rate compared with ORIF. The aim of this study was to report the functional outcome of closed reduction and intramedullary stabilization in isolated radial neck fractures. METHODS: Fourteen cases were retrospectively reviewed between January 2007 and December 2016. The inclusion criteria were isolated radial neck fractures of type I to III according to the Mason classification, absence of previous injuries of the elbow, and a minimum of 1 year of follow-up. The Mason classification was used to classify these injuries. At final follow-up, functional assessment was established based on functional scores: Morrey Elbow Score, Elbow Self-Assessment Score, and QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score. Range of motion was evaluated similarly. RESULTS: The mean follow-up period was 86 months. The mean age was 44.2 years. Regarding the functional outcome, 78% of patients claimed satisfaction. Concerning the functional scoring, the mean visual analog scale score was 0.2 (range, 0-4) and the mean Morrey Elbow Score was 95.7 (range, 85-100). The mean QuickDASH score was 6.4 (range, 7-22). The complication rate was 35%. Malunion was observed in 7% of patients. CONCLUSION: Intramedullary pinning of radial neck fractures represents a viable technique in adults because of its safety and simplicity. The complication rates are lower than those in other reports of ORIF.

[Femoral varising osteotomy by external opening for the treatment of lateral femorotibial gonarthroses associated with idiopathic genu valgum: a retrospective a study of 10 cases]. / L'ostéotomie fémorale de varisation par ouverture externe pour les gonarthroses fémoro-tibiales latérales sur genuvalgum idiopathique: étude rétrospective de 10 cas.

Femoral varus osteotomy is a conservative treatment for external single-compartment gonarthrosis. This surgical procedure is little used and outcomes are little studied.This study aimed to assess the clinical and radiological results of femoral varising osteotomy in subjects with external femorotibial gonarthrosis associated with idiopathic genu valgum whose data were recorded over a period of 21 years (1992- 2013) in the Department of Orthopedics at Sahloul University Hospital, Sousse. The clinical evaluation of patients was performed using the IKS score (International Knee Society). Radiological assessment was based on pre-operative work-up and final follow-up assessment. We here report a case series of 9 patients (and 10 knees) whose average age was 45.2 years, with a sex ratio of 0.5. Mean follow-up was 99-months. Average knee score ranged from 48.4 points preoperatively to 73.5 points at the final follow-up assessment, with a statistically significant improvement (p<10-3). Medium functional score significantly improved, with a preoperative value of 49.5 points and a value of 72 points at the final follow-up assessment. Final correction helped to reduce valgus condition with an average of 3.7° and a preoperative value of 14°. This study, as well as the analysis of literature, indicates that femoral varising osteotomy is the treatment of choice for invalidating genu valgum of femoral origin, without any rheumatoid arthritis, overweight, internal femorotibial nor severe femoropatellar arthritis.

Ulnar paddlefish carpometacarpal dislocation of the three lesser fingers: a case report.

The long fingers' paddlefish carpometacarpal (CMC) dislocation is exceptional. Most dislocations occur after high energy trauma. Untreated, these lesions can result in chronic instability of the CMC joints and early osteoarthritis. We report the case of a 20-year-old patient presenting with an ulnar paddlefish CMC fracture-dislocation of the three lesser fingers resulting from a hand trauma in the context of an occupational accident. Treatment is usually surgical though no strict consensus can be found upon literature review. If diagnosed early and no associated fractures are found, CMC dislocation could benefit from conservative treatment.

A Rare Case of Tuberculosis with Sacrococcygeal Involvement Miming a Neoplasm.

Infection of the lumbosacral junction by tuberculosis is quite rare and occurs in only 1 to 2% of all cases of spinal tuberculosis; moreover, isolated sacrococcygeal or coccygeal tuberculosis is much rarer. Failure to identify and treat these areas of involvement at an early stage may lead to serious complications such as vertebral collapse, spinal compression, and spinal deformity. In the present paper, we report an uncommon case of spinal tuberculosis with sacrococcygeal location revealed by a chronic low back pain that was successfully managed. Computed tomography scan and magnetic resonance imaging of the pelvis revealed a lytic lesion affecting both of sacrum and coccyx causing osseous destruction and suggesting a malignant process. A surgical biopsy was performed to establish the tissue diagnosis. Histopathological report confirmed the diagnosis of skeletal tuberculosis. The patient was treated with antibacillary chemotherapy for a period of 9 months. The follow-up period was of 36 months. There was a full recovery and the patient was asymptomatic.

Evaluation at long term follow up of medial unicompartmental knee arthroplasty in young patients.

BACKGROUND: The treatment of isolated internal tibiofemoral knee osteoarthritis on young and active patients is controversial. This treatment can be a high tibial osteotomy or a joint replacement that can be a partial unicompartmental knee arthroplasty (UKA) or total knee replacement (TKR). The aim of our study is the long-term evaluation of functional outcome of partial unicompartmental knee arthroplasty (UKA) in elderly patients under than 60 years. METHODS: This is a retrospective study of 25 unicompartmental knee arthroplasties in 22 patients, collected between1993 and 2003 whose age was less than 60 years. The minimum follow-up was 10 years. At last follow, an analysis of IKS score (International Knee Score) with assessment of both articular and functional components have been established. The Radiological score of Knee Society (KS) was used. RESULTS: At mean 14.2 years (min: 10, max: 20), the mean of knee flexion was 110 °. The IKS function score going 47 points preoperatively to 77 points postoperatively and IKS score 40 points knee preoperatively to 94 points postoperative. The radiological assessment found a postoperative mean tibiofemoral mechanical axis of 174.8 ° (172 ° min, max 182 °). The survival of implants at 12 years postoperatively was 84%. The survival of the prostheses was de84 to 12%, with a revision for polyethylene wear, a second for conflict of the femoral component with tibia thorns responsible of chronic pain, a third revision for infection and two for osteoarthritis evolution. CONCLUSION: The long-term evaluation of patients with a unicompartmental does not objective an obvious deterioration of outcome with a normal rate of revision comparatively to other series without particular difficulties during revision.