Unusual locations of osteoarticular tuberculosis in children: a report of 12 cases.

INTRODUCTION: Unusual locations of osteoarticular tuberculosis (OA-TB) raise diagnostic issues due to their untypical and non-suggestive clinical and radiological presentation. OBJECTIVES: The present retrospective study analyzed the various clinical, radiological and therapeutic aspects. PATIENTS AND METHODS: A retrospective series included 12 children (mean age, 7 years 4 months; sex-ratio, 0.7), treated in our department between 1980 and 2010. Knee, hip and spine locations were excluded. RESULTS: Mean time to diagnosis was 32 months. Active TB infection was identified in 42% of cases. Pain was the presenting symptom in 83% of cases, with a preponderance of osteitis. Bone loss was the main radiological sign. Phemister's triad was found in two cases of combined articular and bone infection. Diagnosis was confirmed on histology in 92% of cases. All patients were managed according to the Moroccan national TB protocol. Surgery was indicated in five cases, comprising abscess drainage with or without bone surgery (notably for joint dislocation). Four patients showed orthopedic sequelae, including two with associated spinal locations. DISCUSSION: Rare osteoarticular tuberculosis locations often cause diagnostic problems. Any chronic clinical presentation or suspected atypical bone lesion should suggest a diagnosis of osteoarticular tuberculosis. LEVEL OF EVIDENCE: Level IV. Retrospective study.

[Medial epicondyle fractures in children]. / Les fractures de l'epicondyle médial chez l'enfant.

INTRODUCTION: Medial epicondylar fractures account for 11% of elbow injuries in children. It represents a Salter-Harris type I lesion. Diagnosis is difficult but on the whole, results are satisfactory. The treatment of this fracture is controversial. PATIENTS AND METHODS: Our study looked at fifty-nine patients between 7 and 14 years old. The main mechanism of injury in our study was a fall (98%). The significance of the fracture displacement was judged according to the classification of Marion and Faysse. We noted 10 cases of stage II, 14 cases of stage III and 35 cases of stage IV according to their classification. Forty-one patients were treated by surgical fixation. Fifty patients were reviewed at an average of six years follow up and the results evaluated according to the criteria of Hardacre. RESULTS: The result was good in 95% of those cases with conservative treatment and in 80% of those cases with operative treatment. Prominence of the medial epicondyle and limitation of elbow motion were the main complications. DISCUSSION: According the literature, a sports accident is the most frequent cause of the injury. The results are better with conservative treatment because there is no relation between fracture displacement and final results. The excellent results of conservative treatment permit us to recommend this method except in those cases with a persistent intra-articular fragment or neurovascular complication.

[Aneurismal bone cyst in children: 17 cases]. / Le kyste osseux anévrysmal chez l'enfant: à propos de 17 cas.

INTRODUCTION: The aneurismal bone cyst (KOA) represents 1.5 to 4% of benign osseous tumors. It affects the young patients and its etiopathogeny is still discussed. Numerous difficulties of diagnostic, therapeutic and specially evolution, characterize this pathology. MATERIAL AND METHODS: Our study reports 17 patients who were treated between 1976 and 2000. The average age was 8 years and delay of diagnostic was 11 months. It affected the long bones in 70%, the brief bones in 25% and the flat bones in 5%. In limbs, the pathological fracture was revealing in 47%, the painful lameness in 35% and tumefaction in 18% of cases. For two vertebral locations, pain was associated with a stiff neck for the cervical spine and there was a deformation with a medullar compression for the lumbar vertebral location. The radiological aspect was typical in 82% of cases. First biopsy in 13 cases allowed to confirm the KOA in eight cases; for five cases, a second biopsy was necessary to confirm diagnosis. In four cases, diagnosis was hold on typical radiographic aspect or on the hemorrhagic nature of the cyst. The surgery was realized in 15 cases (88%), with 13 eventrations and graft (three osteosynthesis) and two complete exeresis. The radiotherapy was performed for a hemorrhagic cyst located in cervical spine. Finally, a cast immobilization alone was realized for a location of the patella. RESULTS: A good result was observed in nine cases, the recurrence in three cases, degeneracy in one case and we deplore one death following a toxic shock. Degeneracy seems to be due to an initial misunderstanding of the osteosarcoma. Three patients could not be evaluated for the study. DISCUSSION: The KOA is a solitary bone dystrophy that can be primitive, or secondary to a sometimes-sly underlying hurt. The symptomatology is varied according to the location; modern imaging allows to better defining of the KOA aspects. Biopsy is indispensable for the diagnosis, but histological confirmation is not always certain. The best treatment must permit the "carcinologic" removal of the KOA. The reconstruction will be done by graft and osteosynthesis if necessary. The injection of ethibloc and the embolisation are indicated for the voluminous and very aggressive cysts. Radiotherapy, with its important morbidity, can be used for the inoperable cases. Unpredictable evolution remains threatened by the risk of local recurrence and later, by the risk of degeneracy.

[Vertebral hydatidosis: three case reports]. / Hydatidose vertébrale: à propos de trois cas.

PURPOSE OF THE STUDY: Vertebral hydatidosis, the most frequent localization of skeletal hydatidosis, has an ominous prognosis with the risk of progressive but permanent neurological damage. There is no consensus on appropriate management. Treatment is often unsuccessful with frequent recurrence. The purpose of this study was to assess our experience with this rare disease to identify diagnostic, therapeutic and prognostic features. MATERIAL AND METHODS: We reviewed the charts of three patients with vertebral hydatidosis treated at the department of orthopedics at the Casablanca children's hospital between January 1989 and January 1998. Diagnosis was made early in the first patients, allowing complete excision of the hydatid cyst. Follow-up was uneventful 10 years after surgery. The second patient presented after a long disease course and had definitive neurological complications despite treatment. The lesions were extensive in the third patient and cure could not be achieved although the patient remained asymptomatic. DISCUSSION: Vertebral hydatidosis is a severe disease causing frequent neurological complications. Surgical treatment, though difficult, is the only efficient option. Complete recovery can be achieved after surgical excision of lesions diagnosed early. Prevention is the best therapeutic strategy in endemic areas.

[Surgical complications of intestinal ascariasis]. / Les complications chirurgicales de l'ascaridiose intestinale.

Ascaridiosis is a usually benign disease caused by the parasite Ascaris lumbricoides. Medical treatment is usually sufficient. Prevalence in tropical zones is high, sometimes leading to severe surgical complications requiring treatment and having a high morbidity and mortality. Codified treatments are needed to reduce the incidence of ascaridiosis. Large scale prevention is needed, especially in endemic zones.