Unusual circumstances to diagnose cervical Pott's disease.

Tuberculous spondylodiscitis usually affects the dorso-lumbar spine, and its cervical location is a rare condition that can mimic other diseases and consequently cause treatment delays. We report a case of tuberculous spondylodiscitis of the lower cervical spine discovered under unusual circumstances in a patient with severe polytrauma involving a cranio-cerebral trauma, a non-displaced fracture of the two laminæ and the spinous process of the C6 vertebrae as well as fibular and tibial shaft fractures. The patient underwent static tibial nailing, and a collar with occipital and chin supports was applied. At 2-month follow-up, the patient presented with severe neck pain without neurologic deficits. Plain and dynamic cervical radiographs showed a stable C6-C7 subluxation and C7 superior endplate collapse. The CT scan also outlined prevertebral soft tissue swelling. The MRI showed a C6-C7 spondylodiscitis associated with a prevertebral abscess with am 8-cm major axis. The diagnosis of C6-C7 Pott's disease was confirmed by a CT-guided biopsy. The patient received 12 months of antituberculous chemotherapy, after which the paravertebral abscess completely disappeared, and the patient has had no functional sequelae. The diagnosis of cervical spine tuberculosis is difficult and requires a high level of attention. Delays in establishing the diagnosis and starting the appropriate treatment result in severe complications such as spinal cord compression and spinal deformity, which are difficult to manage.

Metatarsal giant cell tumour in a 7-year-old child: a case report.

Giant cell tumours are uncommon benign osseous neoplasias with an obscure origin. They mostly occur in the epiphyses of long bones after skeletal maturity. Occurrence in a metatarsal bone in a child less than 10 years old is quite exceptional. The authors report a case of a 7-year-old girl with an aggressive giant cell tumour of the first metatarsal bone of her right foot. Intralesional excision by curettage and grafting with morselised iliac cortical and cancellous bone was performed. The girl is now disease free since 7 years. Giant cell tumours in this location and age group are rare; they appear to represent a distinct, more aggressive form of tumour. They should be considered in the differential diagnosis of a destructive bony lesion in skeletally immature patients. Curettage and bone grafting with morcelised iliac cortical and cancellous bone remains a treatment option, despite a high potential for recurrence.

Giant cell tumour of a phalanx in the foot: a case report.

Giant cell tumours are uncommon benign osseous neoplasias with an obscure origin. They mostly occur in the epiphyses of long bones after skeletal maturity. Phalangeal bones are a very rare primary site of involvement. The authors report a case of giant cell tumour involving a phalangeal bone in the foot and review the presentation, distinctive features and treatment of this tumour when occurring in this location. A 28-year-old female patient was seen with an aggressive giant cell tumour of the first phalangeal bone of the third ray of her left foot. En bloc resection of the third ray was performed without bone grafting. The patient has now been free from disease for 12 years. When giant cell tumour occurs in such a location, it appears to represent a distinct, more aggressive form of tumour. Because of the higher risks for local recurrence, treatment should be aggressive.

Acute tibial tubercle avulsion fractures in the sporting adolescent.

INTRODUCTION: The authors report 7 cases of acute tibial tubercle avulsion fractures. The fracture occurred in 6 out of the 7, after an abrupt tension of the patellar tendon in male sporting adolescents (age 13-17 years). Two patients presented symptoms of homolateral Osgood-Schlatter's disease before the lesion. METHOD: According to Ogden's classification, the tibial tubercle avulsion fracture was not displaced in 3 cases (stage IA) and was treated conservatively by immobilization for 6 weeks. In 4 cases, the fracture was displaced and necessitated an internal fixation with plaster for about 6 weeks. A torn patellar tendon was noted in one adolescent having a stage IIIB avulsion fracture. RESULT: The mean follow-up was of 4.5 years (1.5-7.5 years). The results were satisfactory: complete functional recovery, resumption of sport at the previous level and absence of recurvatum.