Giant cell tumour of the femoral neck: Failure of curettage-cavity filling cementation with screw fixation, a case report.

BACKGROUND: Giant cell tumours are common primary long bone tumours with femoral neck locations infrequent and notorious for pathological fractures. Treatment with simple curettage often results in local recurrence. Aggressive treatment that combines tumour resection with cement filling and internal fixation aims at preserving native joint function. CASE REPORT: The authors intend to illustrate the short falls of such conservative approach through a case report of a femoral neck giant cell tumour in a 37 year old patient. Patient had undergone curettage-cavity filling with screw fixation for a pathological femoral neck fracture. Total hip arthroplasty was undertaken following implant failure and severe hip impairment 3 years after initial surgery. CONCLUSION: Intralesional curettage and cavity cementation with internal fixation of giant cell tumour of the proximal femur allows joint preservation. Mechanical failure, local recurrence and degenerative changes hinder long term outcomes especially in the setting of pathological fractures. Further studies are required to delineate the benefits of joint sparing techniques vis-a-vis total hip replacement for giant cell bone tumours of the femoral neck.

Surgical management of intramuscular hemangioma of the foot: a case report.

BACKGROUND: Hemangiomas are benign tumors usually found in the lower extremity yet their surgical management on the location in the foot is rarely documented. CASE PRESENTATION: We report a case of a plantar intramuscular hemangioma in 25-year-old patient with a history of percutaneous therapy. Patient had undergone intralesional sclerotherapy 3 years prior to his admission with persistent pain on weight bearing activities.MRI demonstrated a multi lobulated lesion of the 1st IMS with a peripheral enhancement on gadolinium injection. The patient underwent elective surgery with complete excision and no functional impairment at the last follow-up 3 years after surgery. CONCLUSION: Intramuscular hemangiomas are rare occurrences. Steroid injection and sclerotherapy are effective non-operative methods. Complete excision of isolated hemangioma lesions allows definite diagnosis with no recurrence.

Surgical treatment by percutaneous anterior screw fixation of scaphoid fractures.

The aim of this study was to evaluate the results of percutaneous screw fixation of scaphoid waist fractures in our surgery unit by comparing them with recent data from the literature. This was a retrospective, descriptive study conducted between January 2010 and September 2016. Patients operated due to a recent scaphoid fracture and treated by percutaneous anterograde screw fixation with a Herbert screw were included in this study. Our cohort was a sub-set from a scaphoid fracture group; other fracture sites, other treatment techniques and fractures associated with scapholunate ligament lesions were excluded. The time to union and union rate were recorded. The Youm and McMurtry indices, scaphoid and scapholunate angles were measured on radiographs. A total of 21 patients were included. The mean age was 30 years (18-44) and the sex ratio (male/female) was 9.5. The union rate was 95% with an average follow-up of 24 months. Four patients had a mobility deficit in the sagittal plane of about 9°. No malunion was found, and no major complications were observed. Based on this study, percutaneous fixation of the scaphoid with Herbert's screw is a reliable technique that leads to union in most cases with limited postoperative immobilization.

Musculoskeletal Echinococcus infection as a rare first presentation of hydatid disease: case report.

BACKGROUND: Hydatid disease (HD) is a cosmopolitan parasitosis caused by Echinococcus granulosus that can potentially affect any part of the human body. Liver and lungs are the most frequent localizations. Primary musculoskeletal hydatidosis are seldom reported in literature and their incidence is unknown. CASE PRESENTATION: We deem interesting to report a case of a primary hydatid cyst in a 25-year-old patient who presented with a painful swelling of the right elbow. Meticulous examination and preoperative imaging did not reveal other localizations. Patient was admitted for surgery where total excision of cyst was done without intraoperative spillage and a cutaneous skin flap was subsequently required to make up for soft tissue loss. CONCLUSION: Primary hydatid cysts are sometimes difficult to diagnose preoperatively. It should be considered in the differential diagnosis of subcutaneous cystic lesions in regions where hydatid cysts are endemic. Currently, surgical excision is deemed first choice treatment for solitary cysts and antihelminthic treatment should be initiated preoperatively in the case of risk of rupture or in the event of complications.

[Transscaphoid perilunate dislocation with proximal displacement of the lunate and proximal scaphoid. A case report]. / Fracture-luxation trans-scapho-rétrolunaire du carpe avec énucléation antérieure du lunatum et du fragment proximal du scaphoïde. À propos d'un cas.

We report the case of a patient who suffered from an unusual anatomic form of trans-scaphoid trans-styloid volar dislocation of the lunate with proximal displacement of both the lunate and the proximal pole of scaphoid, proximal to the radiocarpal joint line. Proximal row carpectomy was performed. A good anatomic and functional result was observed at 3 years of follow-up. Etiopathogeny, therapeutic and outcome modalities are discussed.

[An unusual location of juxtaosseous ossified lipoma. A case report]. / Une localisation inhabituelle d'un lipome ossifié juxtaosseux. À propos d'un cas.

We report a case of juxtaosseous ossified lipoma. Clinical and radiological features make it an exceptional case, because of its location at the hand and presence of cortical erosion of the subjacent bone. However, the histological study of this rare benign tumor showed neither cytonuclear atypia nor increasing number of mitosis. It made easy its surgical treatment, without any functional sequelae. The patient reported no local recurrence in the follow-up; the risk is low, given its histological character.

[Anterior dislocation of the elbow joint without peri-articular fracture in an adult]. / Une luxation antérieure du coude sans fracture péri-articulaire chez un adulte.

In view of the comparative frequency of posterior dislocations of the elbow, it is rather remarkable that anterior dislocations of that joint should be among the rarest of injuries [1]. Our case is one of the first cases of anterior dislocation of the elbow without any periarticular fracture or pre-existing deformities around the elbow [2].

[The intermetacarpal double pinning in the surgical treatment of Bennett fracture (report of 24 cases)]. / Le double embrochage intermétacarpien dans le traitement chirurgical de la fracture de Bennett (à propos de 24 cas).

OBJECTIVES: The interest of this work is to show the benefits of surgical treatment of Bennett fractures by intermetacarpal double pinning. PATIENTS AND METHODS: It is a retrospective study of 24 cases of Bennett fracture treated by intermetacarpal double pinning, between January 2005 and December 2009. The treatment was surgical for all patients. The intermetacarpal double pinning using the technique of Iselin has been reserved for fractures with small fragment found in the series in 18 cases (72% of operated patients), and by Tubiana in six cases (24%). RESULTS: After a mean of 36 months, we could follow only 21 patients, the evaluation of results was based on clinical criteria relevant to pain, mobility and the pinch grip, and on criteria after radiological analysis of radiographs specific trapezo-metacarpal. All fractures were consolidated. Two cases of moderate osteoarthritis were observed. Overall, the results were excellent in 15 patients (71%), good in four patients (19%) and poor in two patients (10%). CONCLUSION: Intermetacarpal double pinning is a technique of choice in surgical treatment of Bennett fracture. It ensures a good closed reduction and a satisfactory functional result.

[Anatomical snuffbox lipoma causing nervous compression. A case report]. / Lipome compressif de la tabatière anatomique. À propos d'un cas.

Lipomas are rarely localized at the hand, and more unfrequently at the anatomical snuffbox. We report a case of a lipoma that compressed the lateral branch of the superficial sensory branch of the radial nerve.

[Rare bone tumour of the hand: capillary haemangioma of the second finger: case report]. / Tumeur osseuse rare de la main : hémangiome capillaire du deuxième doigt, à propos d'un cas.

Primary vascular tumours of bone are rare. Haemangiomas occur as incidental findings in the skull or in the spine. A solitary haemangioma of the hand skeleton is rare and difficult in radiological and histological differential diagnosis. We report a case of a 23 year-old patient presenting with a capillary hemangioma of the left second finger of few months duration for which he underwent amputation. Postoperative evolution was good and showed no recurrence. We discuss this through observation and a review of the literature including the different clinical, radiological and pathological diagnostic problems associated with an unusual site for vascular proliferation.

[A giant tumor of the thumb revealing bronchic adenocarcinoma (a case report)]. / Tumeur géante du pouce révélant un adénocarcinome pulmonaire (à propos d'un cas).

Bone metastases in the hand are rare. The authors report a case of a 46-year-old woman diagnosed with a giant hand tumor, revealing a lung adenocarcinoma. An amputation of the thumb was performed. Histology confirmed a metastasis from the lung adenocarcinoma.

Physicians' Belief about Organ Donation.

BACKGROUND: Several studies have suggested that knowledge, attitudes and determinants concerning organ donation are influenced by many factors including gender, educational level, occupation, sociodemographic status, income level, culture and religion. OBJECTIVE: To highlight the awareness of cardiopulmonary and brain death (CD and BD) among the physicians and their belief about the organ donation. METHODS: In a cross-sectional study, 15% of 1700 physicians working under the auspices of Ministry of Health in Makkah region, were selected randomly from two hospitals of Makkah city, i.e., Alnoor Specialist Hospital and King Abdalaziz Hospital. A self-administered questionnaire with dichotomous answers was distributed to them. RESULTS: Out of 185 respondents, 174 (94.1%) identified the right definition of BD and CD and 155 (83.3%) agreed organ donation. The difference among physicians to differentiate CD from BD was not significant (p=0.2). CONCLUSION: Physicians had enough knowledge to differentiate CD from BD; most of them are highly positive regarding the concept of organ donation.

Humerus pathological fracture revealing biliary carcinoma.

Tumors of the biliary tract are rare, and their survival prognosis is short since diagnosis is often made at advanced stages of the disease. Diagnosis remains difficult because symptoms are often unspecific. Bone metastasis from biliary carcinoma are rare. We report a case of a humeral metastasis revealing a biliary carcinoma.

[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.

[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.

Osteogenesis imperfecta tarda. A case report

Osteogenesis imperfecta is a hereditary pathology characterized by the osseous fragility; which causes increasing severe deformities in patients. It affects children and it regresses by puberty. We report a particular observation of 16 year old adolescent boy who presented with tardy form of osteogenesis imperfecta. He was treated by intra -medullary nailing. A review of the literature was done

[Coverage of tissue loss in the upper limb (ten cases)]. / Couverture des pertes de substance du membre supérieur (à propos de 10 cas).

PURPOSE OF THE STUDY: The purpose of this study was to evaluate early cover of post-traumatic tissue loss in the upper limb. MATERIAL AND METHODS: We report 10 cases of tissue loss in the upper limb treated surgically by fasciocutaneous flaps or muscle flaps. The patients were aged from 14 to 60 years. Six patients underwent surgery as an emergency. Surgery consisted of a thorough debridement, internal fixation if required and soft tissue reconstruction as indicated. This was then followed by immediate flap cover. All had antibiotics during and after surgery. The coverage procedure was selected according to the site and its dimensions. We used 8 fasciocutaneous and 2 muscle flaps in our series. RESULTS: One flap underwent necrosis. The flaps otherwise showed good scaring and trophicity. All the patients were satisfied. DISCUSSION: Early or even immediate coverage of substantial tissue loss following trauma has been made possible because of the development of newer flap techniques. Meyer considers that the improved results can be explained by the fact that early cover prevents bone and tendon desiccation and is achieved before substantial bacterial colonisation can occur. Additionally it is a reliable procedure that brings in vascularised tissue, thereby contributing to reduced scarring of the underlying structures. It also permits immediate osteosynthesis thus avoiding the problems of external fixation. To us the key advantage of emergency skin cover is the fact that the operative field may become colonised but does not become infected. This gives the surgeon the freedom to undertake immediate reconstruction without the prospect of subsequent sepsis.

[Fenton's syndrome or scapho-capitate fracture (a case report)]. / Le syndrome de Fenton ou fracture scaphocapitale (à propos d'un cas).

INTRODUCTION: Scapho-capitate fracture is a rare lesion and its mechanism is controversial. Forced extension seems to be the most frequent cause as this movement of the wrist induces scaphoid fracture by compression. Hyperextension of the wrist as a result of the scaphoid lesion, allows contact between the posterior margin of the radius and the neck of the capitate inducing a capitate fracture. MATERIALS AND METHODS: We report a case of Fenton's Syndrome, the patient was operated as an emergency by pining and immobilization of the carpus and thumb until bone consolidation had occurred. RESULTS: Consolidation was noted at 8 weeks with a good mobility of the wrist. DISCUSSION: Fenton's Syndrome is a rare lesion of the wrist. Analysis of our own case and a review of literature demonstrated extension as a causative mechanism, and the frequency of delayed diagnosis. Because of the presence of instability, scaphoid reduction and osteosynthesis is necessary. Immobilization of the carpus and thumb is essential until bony consolidation is obtained.

Transplantation of the human uterus.

Human uterine transplantation was performed on 6 April 2000 on a 26-year-old female who lost her uterus 6 years earlier due to post-partum hemorrhage. The donor, a 46-year-old patient with multiloculated ovarian cysts, underwent a hysterectomy modified to preserve tissue and vascular integrity. The donor uterus was connected in the orthotopic position to the recipient's vaginal vault and additional fixation was achieved by shortening the uterosacral ligament. The uterine arteries and veins were extended using reversed segments of the great saphenous vein, then connected to the external iliac arteries and veins, respectively. Immunosuppression was maintained by oral cyclosporine A (4 mg/kg/body wt.), azathioprine (1 mg/kg/body wt.) and prednisolone (0.2 mg/kg/body wt.). Allograft rejection was monitored by Echo-Doppler studies, magnetic resonance imaging (MRI), and measurement of the CD4/CD8 ratio in peripheral blood by fluorescence activated cell sorter (FACS scan). An episode of acute rejection was treated and controlled on the ninth day with anti-thymocytic globulin (ATG). The transplanted uterus responded well to combined estrogen--progesterone therapy, with endometrial proliferation up to 18 mm. The patient had two episodes of withdrawal bleeding upon cessation of the hormonal therapy. Unfortunately, she developed acute vascular thrombosis 99 days after transplantation, and hysterectomy was necessary. Macro- and microscopic histopathological examination revealed acute thrombosis in the vessels of the uterine body, with resulting infarction. Both fallopian tubes remained viable, however, with no evidence of rejection. The acute vascular occlusion appeared to be caused by inadequate uterine structure support, which led to probable tension, torsion, or kinking of the connected vascular uterine grafts.