Nonunion of Fractures of the Ulna and Radius Diaphyses: Clinical and Radiological Results of Surgical Treatment.

Aseptic nonunion of the radius and ulna is a major complication of forearm fractures, accounting for 2% to 10% of all forearm fractures. The aim of our study is to evaluate the functional and radiological results of surgical treatment of diaphyseal aseptic nonunion of the radius and ulna, with autologous bone grafting, decortication and internal plate fixation. A series of 21 patients (26 nonunions) was retrospectively reviewed, the average age was 35 years with a mean of 31,58 years (range 12-44 years). The fractures included isolated radius (n=6) and ulna (n=10), and both radius and ulna (n=5). The Grace and Eversmann score was used to evaluate our results. Fifteen had very good results, five good and one average. Consolidation of the two bones was attained in 6.2 months. Therefore, the functional prognosis of the upper limb imposes the need for an adequate treatment. This management strategy has enabled us to have satisfactory results. However, the best treatment of nonunion remains the preventive treatment with an optimal management and care of the forearm fractures.

Cutaneous tuberculosis revealing multifocal tuberculosis in immunocompetent patients.

Multifocal tuberculosis (TB) is rare. It occurs especially in immunocompromised patients. Association with skin involvement is rarer, and few cases are reported in the literature. The present study reports 7 cases of multifocal TB with cutaneous localization in immunocompetent patients. Cutaneous forms of TB included in this series are: gummas, scrofuloderma, vasculitis TB and lupus TB. The patients had at least two extra skin locations, namely: osteoarticular, lung, pleural, scrotal, muscular, digestive, laryngeal, nodal and splenic locations. These patients had no context of immunosuppression which is uncommon, but should be kept in mind, especially in endemic countries.

[Surgical treatment of acral melanoma: a report of eight cases]. / Traitement chirurgical du mélanome acral: à propos de huit cas.

Acral melanoma represents 3 to 15% of all cutaneous melanoma. In Morocco, this location is predominant. Through our study, we intend to analyze the therapeutic aspects of acral melanoma, while focusing on the epidemiological, clinical, pathological and prognostic profile of acral melanoma cases listed in osteoarticular surgery department of the CHU Hassan II of Fez in the period from January 2009 to December 2012. The mean age of the patients was 63 years, with slight predominance of women. The most commonly involved location was plantar region (including the heel) and pigmented color was the most common. The concept of micro trauma was found in almost half of our patients. Plantar localization was the most commun lesion. Inguinal lymph nodes attended three patients and one patient had deep lymph nodes. Only one of them had a lymphadenectomy. Nodular melanoma os the most found histological type in our study with a Breslow thickness of 8.5mm on average, and Clark level IV is found in the majority of cases. Excision of the tumour was performed in all patients. It was estimated wide in all cases. Five patients received reparative surgery consisting of flap coverage. This study has proved a high incidence of poor prognostic factors clinically and histologically.

[Aseptic non-union of humeral shaft fractures treated by plating and bone grafting. Report of 20 cases]. / Pseudarthrose aseptique de la diaphyse humérale traitée par plaque vissée et autogreffe osseuse (à propos de 20 cas).

Although aseptic non-union of humeral shaft fractures is generally considered to be an exceptional complication, rates in the literature have varied from 1 to 10%. The aim of this retrospective study was to study the results of treatment by plating and bone grafting for aseptic non-union of humeral shaft fractures. The retrospective study gathered 20 patients, the mean age was 41 years. The most common fracture site was the middle third. For the follow-up evaluation, we used the Steward and Hundley score. According to this score, we noted: 13 very good results, five good results and two poor results. Management of non-union of the humerus should be optimal at immediate surgery. The best treatment of non-union of the humerus is its prevention by correct management of the initial fracture.

[Radiocarpal dislocation (about nine cases)]. / La luxation radiocarpienne (à propos de neuf cas).

Radiocarpal dislocation is an uncommon entity in traumatolgy. The purpose of this study was to detail the pathogenesis of radiocarpal dislocation and describe its complications and treatment. Nine radiocarpal dislocations were reviewed retrospectively. Dorsal displacement was observed for seven dislocations, anterior displacement for two dislocations. All were associated with fractures of the radial styloid. Treatment was always surgical. At last follow-up (mean 3 years), the overall functional outcome was satisfactory. The Green and O'Brien (modified by Cooney) score was excellent for three patients, fair for four, and mediocre for two. Two cases of radiocarpal degeneration were observed at last follow-up. Intracarpal and/or distal radio-ulnar lesions must be stabilized in order to limit the risk of future degeneration.

[Surgical treatment of proximal humeral fractures anatomical plate versus palm tree pinning (26 cases)]. / Le traitement chirurgical des fractures de l'extrémité supérieure de l'humérus : plaque anatomique versus embrochage en palmier, à propos de 26 cas.

BACKGROUND: The aim of this study is to compare functional and radiological results of two surgical techniques in treatment of proximal humeral fractures. PATIENTS AND METHODS: A prospective study was performed, which included 12 patients operated for a proximal humeral fracture by open reduction and internal fixation using an anatomical humeral plate, and another group of patient (14 patients) treated for the same lesion using a palm tree pinning technique of Kapandji. The comparison of results of the two techniques was based on three parameters: the time of healing, quality of reduction, and the functional result. The global mean age was 48.6 (±13,7), and the sex ratio (M/W) was 1. RESULTS: Statistical analysis of functional and radiological results showed no superiority of one technique over another; so the mean time of healing was 6.1 (± 0.7) weeks in the group treated by plate, and 6 (± 0.7) weeks in the group treated by pinning (P=0.5), the mean absolute Constant score was respectively 86 (±10.4) and 90.92 (±2.5) (P=0.09), and the mean measuring of cephalic angle was respectively 46.91 (±17.68) and 55.71 (±19.48) (P=0.24). CONCLUSION: Univariate analysis showed no statistically significant association between endpoints and the two surgical techniques studied. Therefore the study showed no statistical superiority of one surgical technique over another.

A shoulder-hand syndrome revealing a lung cancer.

Shoulder-hand syndrome is a reflex sympathetic dystrophy which is usually associated with minor trauma, fracture or surgical procedures on bones, or follows peripheral nerve injury. In the present report, we describe a patient who developed sympathetic dystrophy which revealed a lung cancer. Reflex sympathetic dystrophy, therefore, should be considered an occasional manifestation of a paraneoplastic syndrome warranting a thorough search for underlying malignancy.

Functional outcome of midclavicular fracture fixation utilising a reconstruction plate.

BACKGROUND: Clavicular fractures are common injuries. The aim of this study is to present results of surgical treatment of midclavicular fracture managed with open reduction and internal fixation (ORIF) with superior reconstruction plating. This study involved 34 patients, with mean age of 31 years, with completely displaced midclavicular fractures, 28 on the right and 6 on the left, stabilized by contoured plate. One patient developed an early wound infection, which was successfully managed by surgical debridement. The average time of union was 14 weeks, with one case of nonunion. The average constant score was 95.33 with SD 3.4 in one year follow up. Plate fixation of completely displaced midshaft clavicular fracture provides stable fixation and improves the functional outcome. KEY WORDS: Clavicle fracture, Open reduction and internal fixation, conservative treatment, surgical treatment.

[Anterior traumatic axial disruption of the middle carpal joint. Case report with literature review]. / Séparation traumatique axiale de la médiocarpienne à déplacement palmaire. À propos d'un cas avec revue de la littérature.

We report a case of traumatic axial disruption of the radial mid carpal joint. This unusual type of scaphotrapezo-trapezoïdal dislocation occurred after falling from a height. We performed open reduction and wire fixation. At 12months follow-up, functional outcome was satisfactory with good muscle strength (clamping force, grip strength and pinch grip: 90% compared to the opposite side) and good range of motion was preserved. Work was resumed at the tenth week. Radial midcarpal disruption is uncommon. It includes the separation of the trapezium, trapezoïdal, first and second and third metacarpal bones from the remaining wrist. This pattern of carpal derangement has not been previously described in the literature. Mechanism of the injury and treatment are discussed.

[Floating elbow: retrospective study and review of literature]. / Le coude flottant : étude rétrospective et revue de la littérature.

The floating elbow represents an uncommon combination of lesions in traumatology. Few studies have described this lesion especially in adults. Over a period of 6 years, 12 floating elbows were reviewed retrospectively. One osteoporotic elderly patient was treated conservatively. Reduction and internal fixation using different implants was performed in the other patients. Consolidation was obtained at the humerus at 3 months (2.5-3.5 months) on average, and 2.6 months (2-3 months) at forearm bones. According to the classification of Lange and Foster, our functional results were good in 67% of cases, fair in 17% and poor in 16% cases. Good functional prognosis of the upper limb requires rapid and adequate management of floating elbows. Internal fixation followed by early rehabilitation is recommended. The choice of surgical acts depends on the location of fractures. This strategy gave satisfactory results.

[Isolated echinococcosis of the flexor digitorum profondus: a case report]. / Echinococcose isolée du muscle flexor digitorum profondus : à propos d'un cas.

Echinococcosis is a widespread zoonosis which is endemic in most sheep-raising countries. Primary isolated muscular localisation is uncommon even in these endemic areas. The authors report a rare case of primary hydatid cyst localized in the myotendinous junction of the flexor digitorum profundus. According to our review of the medical literature, there are no reports of a similar case, making ours the first such report.

[Vives pinning in L of the fractures of the fifth metacarpal neck--24 cases]. / Embrochage en L de Vives des fractures du col du cinquième métacarpien (A propos de 24 cas).

Fractures of the neck of the fifth metacarpal (boxer's fracture) represent 20% of all fractures of the hand and are frequently observed in male patients, involve the dominant hand, and very often follow a direct blow or punch. We present a retrospective study of 24 fractures of the neck of the fifth metacarpal, treated by "L" pinning as described by Vives, between January 2004 and January 2008. All the patients were men with a mean age of 30 years (range 18 to 50). The mechanism of injury was dominated by fist strike (18 cases). Surgical treatment was performed in cases of fractures with a mean palmar tilt of 37 degrees (range 30 degrees to 60 degrees ). Pinning with a Vives procedure consisted of inserting two pins in an "L" configuration; the first a centromedullary pin measuring 20mm, the second a transverse one through the fourth metacarpal bone controlling rotation and measuring 12mm. Surgery was performed under loco-regional anaesthesia in 75% of cases, and under general anaesthesia in 25% of cases. No immobilization was recommended. Physiotherapy was performed in all cases. Fracture consolidation was obtained in all cases, and the pins were removed in the 6th week following surgery. This technique of osteosynthesis allowed us to obtain good clinical and radiological results according to the criteria of Frere with a mean follow up of 24 months.

[Insulated leg pilomatrixoma: a rare localization]. / Pilomatricome isolé de la jambe. Une rare localisation.

Pilomatrixoma is a benign skin neoplasm of the hair follicle. It's common in the pediatric population. It's usually misdiagnosed and confused with other skin lesions. Head and neck represent the usual locations. The extremity remains an exceptional location. Through an observation of a pilomatrixoma of the leg in an adult patient treated surgically without recurrence, different diagnostic and therapeutic aspects of this pathology will be recalled.

Dislocation of the carpometacarpal joint of the thumb associated with trapezium and Bennett's fractures.

We report a case of a 30-year-old man with a carpometacarpal joint dislocation of the thumb associated with trapezium and Bennett's fractures. This combined injury pattern appears to be very rare. Since, to our knowledge a similar case was not found in the literature. The lesion was managed with closed reduction and percutaneous pinning, resulting in good functional outcome.

[The false equivalent Galeazzi in children]. / Un faux équivalent de Galeazzi chez l'enfant. A propos d'un cas.

We report the case of a false Galeazzi equivalent in children. This injury is characterised by an epiphyseal detachment of the distal extremity of the ulna rather than a distal radio-ulnar dislocation. A 16-year-old patient was injured in a fall from a bike. Radiographs showed a fracture of the radial shaft with anterior angulation, together with a type II Salter-Harris epiphyseal injury at the level of the distal ulna. We were unable to perform a closed reduction under general anesthesia due to interposition of periosteum at the fracture site. Thus surgical management was the only option, which consisted of removing the offending periosteum and performing osteosynthesis of the radial shaft fracture with a plate, and the epiphyseal detachment with pins. After 10 months, we noted no bone growth disturbance, or any reduced mobility of the wrist. We will continue the follow-up to monitor bone growth disturbance of the distal extremity of the ulna.

[Bipolar forearm dislocation or floating forearm (a case report)]. / La luxation bipolaire de l'avant-bras ou avant-bras flottant (à propos d'un cas).

Bipolar dislocation of the forearm or floating forearm is a rare injury. It combines concomitant elbow and wrist dislocation. Only six cases have been reported in the literature. The diagnosis of wrist dislocation may initially be missed and therefore the prognosis will be worse. The authors report a case of a bipolar dislocation with a posterior dislocation of the elbow and a perilunate dislocation of the wrist.

[Subcutaneous plexiform schwannoma of the forearm. A case report]. / Schwannome plexiforme sous-cutané de l'avant-bras. A propos d'un cas.

Plexiform schwannoma is an exceptional schwannoma subtype. It's a benign nerve sheath tumor. Mainly, it's solitary, asymptomatic and slowly growing nodule that occurs in the subcutis or dermis. Histology gives the diagnosis. The authors report a case of solitary superficial plexiform schwannoma of the right forearm of a patient aged 22. A review of literature is done.

[Solitary subcutaneous hydatid cyst of gluteal area: an unusual localisation. A case report]. / Le kyste hydatique sous-cutané solitaire de la région glutéale : une localisation inhabituelle. A propos d'un cas.

Subcutaneous localization of hydatid cyst is uncommon even in endemic zone. Symptoms are often discrete. Diagnosis is confirmed by imaging: ultrasonography and/or magnetic resonance imaging, thus avoiding any untimely gesture. The treatment is surgery. Authors report a case of unusual subcutaneous localization of solitary hydatid cystis in the gluteal area.

[Insulated arm pilomatrixoma: A rare localization. A case report]. / Le pilomatricome isolé du bras: une localisation rare. A propos d'un cas.

Pilomatrixoma also known as calcified epithelioma of Malherbe, is a rare benign cutaneous tumor. It is most commonly seen in the head and neck areas, during the first two decades of life. We report a 30-year-old female patient with a rare localisation of pilomatrixoma in the right arm. The pilomatrixoma was excised and at one year follow-up there has been no evidence of recurrence.