[Aneurysmal bone cyst of the clavicle: about a case]. / Kyste anévrismal osseux de la clavicule: à propos d'un cas.

Anevrysmal bone cyst is an aggressive, destructive but benign lesion in the long bones, spine or basin, affecting mainly children and young adults. However, it is a very rare tumor. We here report the case of a 8-year old boy with a very rare localization of anevrysmal cyst in the clavicle, initially presenting with pathologic bone fracture, that is a benign cystic lesion. The child underwent complete radical resection of the cyst located at the level of the right clavicle, followed by anatomopathological examination of surgical specimen which confirmed the diagnosis. Patient's evolution was marked by the absence of recurrences and by good radiologic bone remodeling. Radical cyst resection seems to avoid recidivism. This study aims to update the current understanding of this rare orthopaedic condition by comparing our results with those reported in the world literature.

[Scapular involvement: uncommon presentation of childhood tuberculosis]. / Tuberculose de l'omoplate chez l'enfant: à propos d'une localisation exceptionnelle.

Tuberculosis of bone is an infectious disease which represents a major public health problem in developing countries where it is endemic. Osteoarticular involvement accounts for 1-5% of all cases of tuberculosis, shoulder involvement is very rare and accounts for 1-2% of all cases of osteoarticular tuberculosis. We here report an uncommon case of TB infection involving the scapula, reaching the scapular body. Tuberculosis is still an important differential diagnosis of rare or chronic bone diseases, including tumors. In our study anatomopathological examination led to the diagnosis.

Surgical normalization of the shoulder joint in obstetric brachial plexus injury.

Obstetric brachial plexus injuries (OBPI) result in bony derangements that include posterior humeral head subluxation, glenoid retroversion, and joint incongruity. Often these deformities are accompanied by scapular hypoplasia, elevation, and rotation, which further exacerbate shoulder dysfunction. The purpose of the current study was to investigate the effects of triangle tilt surgery on glenohumeral joint anatomy in 100 OBPI patients. The triangle tilt surgery restores the distal acromioclavicular triangle from an abnormal superiorly angled position to a neutral position, thereby restoring normal glenohumeral anatomic relationships.Axial computed tomography and magnetic resonance images taken before and 12- to 38-months after surgery showed significant improvements in both posterior subluxation and glenoid version. Patients with complete posterior glenohumeral dislocation improved from 19% preoperatively, to 11% postoperatively. Glenoid shape was also improved, with 81% of patients classified as concave or flat after surgery compared with 53% before surgery.Triangle tilt surgery allows for both repositioning and remodeling of the glenohumeral joint. These anatomic improvements after triangle tilt surgery hold promise for improving shoulder function and quality of life for OBPI patients.

Triangle tilt surgery in an older pediatric patient with obstetric brachial plexus injury.

Children with an obstetric brachial plexus injury have an elevated risk of long-term impairment if they do not fully recover by the age of 3 months. Persistent nerve damage leads to muscle abnormalities and progressive muscle and bone deformities. Several procedures have been described to treat this severe deformity. We have demonstrated the benefits of the triangle tilt procedure in young children with a mean age of 6.4 years (2.2 to 10.3), yet the treatment of humeral head subluxation secondary to obstetric brachial plexus injury represents a challenge in older pediatric patients. This case report demonstrates the effectiveness of triangle tilt surgery for the treatment of glenohumeral joint deformity in a 12 year old pediatric patient with left sided residual brachial plexus injury. The patient in this study showed noticeable clinical improvements, an improvement in glenohumeral joint dysplasia, and a reduction in humeral head subluxation 2 years after triangle tilt surgery. There was functional improvement 25 months after surgery. The patient's total Mallet score for shoulder function improved from 14 to 20 (of 25). In this case report, we demonstrate that the triangle tilt procedure can be used for older pediatric patients without modification. This observation has provided valuable information and is, to our knowledge, the first documented improvement of a glenohumeral joint deformity in an older pediatric patient. Future studies will be needed to determine the long-term success of triangle tilt surgery in this age group.

[Congenital elevation of the scapula]. / Surélévation congénitale de l'omoplate.

21 cases of Sprengel deformity in 19 patients were treated in Paediatric orthopaedic unit of Children's hospital of Rabat in 20 years. Only 6 patients (4 girls, 2 boys) were operated on. The ages of the patients at operation ranged from four to fifteen years (mean age: 10 years). The duration of follow-up ranged from 8 months to 10 years (average: 4 years and 2 months) The Woodward procedure was constantly used. Post operatively, the average increase in total abduction was 40 degrees (range 30 to 75 degrees) Functional and cosmetic results were judged good in 3 patients, moderate in 2 and fair in one case. We emphasize that patients who are less than 4 years old are the ideal candidates for scapular displacement procedure.