Bilateral rupture of the quadricipital tendon in patients with chronic kidney disease: The peculiarities of management (case report).

INTRODUCTION: Bilateral forms of quadricipital tendon rupture are rare. They are usually associated with predisposing factors, such as secondary hyperparathyroidism due to chronic renal failure, which need to be treated to avoid recurrence. PRESENTATION OF CASE: A 38-year-old man with a medical history of chronic kidney failure was presented to the hospital for bilateral quadricipital tendon ruptures after a low-energy trauma. Ruptures were in the midportion of the tendon on the right side and in the level of patellar insertion on the left side. We performed a surgical reparation. One year after surgery, he consulted for a recurrence of the left quadricipital tendon rupture after an impeded extension movement. Biology showed secondary hyperparathyroidism due to chronic renal failure. Surgical reparation and reconstruction by a graft tendon were performed. As for his secondary hyperparathyroidism, he got a sub-parathyroidectomy after medical treatment failure. Recovery was remarkably uneventful. DISCUSSION: Despite the early diagnosis and treatment of a bilateral quadricipital tendons rupture, our patient had an iterative rupture. His secondary hyperparathyroidism due to chronic renal failure may weaken the tendon system through physiological and histological modifications, as it is reported in the literature. As a result, treating a bilateral rupture as a banal post-traumatic lesion without management of the predisposing factors may lead to recurrences. CONCLUSION: A non or low-traumatic tendon rupture in a patient with a history of chronic renal failure needs to identify secondary hyperparathyroidism, which must be treated to avoid recurrences.

Two synchronous desmoids tumours of the thoracic wall: A case report.

INTRODUCTION AND IMPORTANCE: Desmoid tumour is a rare neoplasm that develops from the fascia and musculoaponeurotic tissue. These tumours tend to local invasion. Desmoid tumours are usually solitary. We present the first case of two synchronous desmoid tumours of the chest wall. CASE PRESENTATION: A 56-year-old male with no medical history presented a painless chest wall mass. CT scan showed a deep soft tissue mass infiltrating the pectoralis major and minor muscles with an invasion of the subclavian and axillary pedicles and a second tumour infiltrating the latissimus dorsi muscle. MRI has allowed for a better study of these two masses, and a surgical biopsy confirmed the diagnosis of a desmoid tumour. The surgical resection was intra-tumoural for the anterior mass to preserve the axillary and subclavian pedicles, and the tumour resection was marginal for the posterior tumour. The postoperative course was uneventful, and an adjuvant therapy based on Imatinib was performed. The tumour residue was stabilized for two years follow-up. CLINICAL DISCUSSION: Desmoid tumours are considered a locally aggressive disease. Ultrasound, CT scan, and MRI have different roles in their diagnosis. But pathological diagnosis is the "golden standard" diagnosis of desmoid tumours. The treatment of desmoid tumours is still not standardized. Surgery is the best primary treatment, but sometimes oncological resection may not be possible because of extension to the vital structure. Adjuvant therapy, like Imatinib, had demonstrated encouraging results. CONCLUSION: For desmoid tumours with vital or noble structure invasion, intra-tumoural resection associated with adjuvant therapy demonstrated encouraging results.

Knee tuberculosis: A misleading clinical entity (case report).

INTRODUCTION: Bone and joint infections are rare localizations of tuberculosis, and its diagnosis is challenging. The atypical clinical presentation may lead to delayed diagnosis and severe complications. CASE PRESENTATION: We report the case of a 72-year-old female diagnosed with tuberculosis of the knee. She was complaining of progressive right knee pain and swelling without systemic signs. She was misdiagnosed as having a flare-up of osteoarthritis, which led to a delayed diagnosis and a septic subluxation of the knee. We performed a knee arthrotomy, lavage, and stabilization with an external fixator. The microbiologic tests did not isolate any germs. However, a histological examination confirmed the diagnosis by revealing a caseating granuloma surrounded by epithelioid cells. The patient treated with anti-tuberculosis therapy had a good evolution. Three months post-surgery, the external fixator was replaced with a removable knee brace. DISCUSSION: Osteoarticular tuberculosis is often caused by the hematogenous route. The lack of specificity in clinical and radiological signs makes the diagnosis difficult, especially at the early stage, leading to delays in diagnosis and complications. Nevertheless, the recognition of predisposing factors to tuberculosis, with persisting symptoms despite treatment, should draw the intention of further investigation. The treatment of osteoarticular tuberculosis is primary medical with antituberculosis chemotherapy. However, surgical treatment is reserved for specific indications and mostly to treat complications. CONCLUSION: The lack of specificity in clinical and radiological signs in osteoarticular tuberculosis may mislead the physician. Nevertheless, focusing on predisposing factors, especially in endemic areas, may guide diagnosis and avoid complications.

Hydatid disease of proximal femur treated using a mega prosthesis: A case report.

INTRODUCTION: Bone hydatidosis is a rare disease. It is characterised by discreet and nonspecific symptomatology that makes the diagnosis late and the treatment difficult to manage. PRESENTATION OF CASE: We report the case of a 29-year-old woman hospitalised for right hip pain with a lytic image well limited in the upper extremity of the right femur. We retained the diagnosis of a unicameral bone cyst which weakens the cortical bone. Osteosynthesis with a Gamma nailing was indicated to prevent fractures. At five years of follow up, the patient presented a pain recurrence. Radiographs showed almost a destruction of the upper extremity of the femur and a loosening of osteosynthesis material. Thus, we indicated the removal of the osteosynthesis material and a bone biopsy were performed. Histopathological examination leads to an osseous hydatid cyst diagnosis. We decide to carry out a carcinological resection and reconstruction with a mega prosthesis. The clinical results were excellent and no recurrence for three years follow-up. DISCUSSION: Bone hydatidosis is challenging to diagnose at an early stage, mainly when it simulates a bone cyst. Moreover, the consequence of a late or misdiagnosed bone hydatidosis is devastating. Because of its diffuse and infiltrative character, it gradually invades the whole bone, which makes it more complicated to manage. CONCLUSION: Bone hydatidosis is a rare disease that can simulate other pathologies like a bone cyst in our case. In these situations, the anamnesis has a primordial place to guide the diagnosis and investigations.