Ipsilateral open anterior hip dislocation and avulsion fracture of the greater trochanter: An unusual case report.

Approximately 3% of all joint dislocations involve the hip joint, and only 8-10% of these will be anterior. Traumatic anterior open dislocation of the hip is rare in children and prone to be associated with injuries, extensive soft tissue damage, and avascular necrosis of the femoral head. We present a case of a 13-year-old boy who had an open anterior dislocation of the hip with ipsilateral avulsion of the greater trochanter after a tractor wheel crush in an agricultural accident. Additional lesions included a diaphyseal closed fracture of the contralateral femur. We report this case because of the rarity and seriousness of this injury due to its progressive complications and difficulties related to its management.

Septic elbow arthritis in children: Epidemiology and outcome.

INTRODUCTION: Septic elbow arthritis is a rare disease, especially in children. The aim of this study was to report the functional outcome of our pediatric population with both demographic and microbiological features. METHODS: We retrospectively reviewed all our cases of pediatric septic elbow arthritis between 2007 and 2017. Demographic, microbiological, biological, and radiological features were analyzed. Functional outcome was evaluated according to the Morrey Elbow Performance Score (MEPS). RESULTS: In total, 14 cases were reviewed. The mean age was 9 years. Microbiological findings revealed Staphylococcus aureus in 10 cases. The mean white blood cells count in synovial fluid was 101,306 cells per mm 3. The skin was the most frequently reported entry portal. The mean MEPS score was 86.13 points (excellent in eight cases, good in three cases, fair in two cases, and poor in two cases). Stiffness was observed in three cases. No growth disturbance was reported. DISCUSSION: Septic elbow arthritis in children is rare. Biological inflammatory markers are sensitive but not specific. White blood cell count in the synovial fluid is specific. S. aureus is the most frequently cultured agent. Treatment is based on surgical debridement, antibiotics, and elbow immobilization. Concomitant osteomyelitis is frequent and should be diagnosed and treated simultaneously. Functional outcomes are usually satisfactory in contrast to osteomyelitis. CONCLUSION: Pediatric septic elbow arthritis is rare. It may be primary or secondary to trauma and surgery of the elbow. Demographic, biological, and microbial features are similar to those reported for osteomyelitis; however, functional outcomes are better with a negligible rate of growth disturbance.

Neonatal leg fracture and constriction ring syndrome: A case report and literature review.

Congenital constriction of the limbs is usually due to amniotic band syndrome, which often causes damage to the skin and soft tissues. We report an unusual case in which a neonate had recent fractures of both leg bones with an amniotic band encircling the limb. Non-operative treatment was successful. Challenges to the management of neonatal limb constriction include the absence of a consensus about the best treatment and the high frequency of damage to vessels and nerves.

[Hydatid cysts in muscles: eleven cases]. / Kyste hydatique musculaire: à propos de 11 cas.

PURPOSE OF THE STUDY: Echinococciasis or hydatid disease is a cosmopolite antropozoonosis common to humans and several mammal species. The disease results from the development of the larval or hydatid form of the canine tenia (Echinococcus granulosis) in the organism. Hydatic cysts are uncommonly found in muscles, even in endemic zones. The purpose of this work was to describe the epidemiological, clinical and therapeutic aspects of hydatid cysts observed in muscles based on our clinical experience and data in the literature. MATERIAL AND METHODS: For this study, we collected data on eleven cases of hydatid cysts in muscles treated surgically at the Sousse University Hospital in Tunisia over a 17-year period from 1985 to 2002. We noted epidemiological, clinical, ultrasonographic and laboratory data which were analyzed to better detail the characteristic features of these localizations. RESULTS: Mean patient age was 30 years (range 7-50). All patients lived in rural areas where sheep raising and contact with dogs was common. Patients consulted for a tumefaction of the soft tissue which increased in volume progressively. The muscle focus was generally unique and primary. The proximal muscles of the limbs were involved predominantly. Ultrasonography was performed for nine patients and suggested the diagnosis in all cases. The typical feature was a liquid echostructure in an endemic context. Computed tomography was performed in four patients with deep cysts. Magnetic resonance imaging was not used. Surgical treatment was used in all cases with a pericystectomy in six. Early outcome was favorable excepting one case of suppuration of the resection zone observed in one woman. At 2.5 years, there have been no cases of local or distant recurrence. DISCUSSION: Several factors would explain the exceptional nature of muscle localizations of hydatid cysts: efficacy of the hepatic and pulmonary barriers, muscle environment not favorable for growth of hydatid larvae. The predominant localization in the proximal muscles of the lower limbs could be explained by the volume of the muscle mass and its rich blood supply. It is important to establish the diagnosis preoperatively in order limit the risk of anaphylactic shock or dissemination in the event of puncture or accidental opening of the cyst during resection. Ultrasonography is the diagnostic tool of choice. Surgery is required for treatment, ideally by en bloc total pericystectomy. Medical treatment with imidazoles has little efficacy for the treatment of muscular hydatid disease. CONCLUSION: Hydatid cysts are rarely found in muscles, even in highly endemic zones. The diagnosis must nevertheless be entertained depending on the clinical and endemic context. Ultrasonography, and accessorily magnetic resonance imaging, are the exploration tools of choice to confirm the diagnosis before surgery and avoid puncture. Exclusively surgical treatment is indicated, ideally for total pericystic resection without rupture.

[Results of diaphyseal shortening of the radius in the treatment of Kienböck's disease: a series of 31 cases]. / Résultats du raccourcissement diaphysaire du radius dans le traitement de la maladie de Kienböck.

PURPOSE OF THE STUDY: Several therapeutic options have been proposed for the treatment of Kienbock's disease, including shortening of the radius. We report results in a series of 31 cases treated by diaphyseal radial shortening with a mean 6-year follow-up (range 1 - 18 years). MATERIAL AND METHODS: The series included 19 women and 12 men, mean age, 26 years (range 17 - 47 years). According to the Lichtmann classification there were 7 grade II, 23 grade IIIa and 1 grade IIIb. Mean shortening was 4.5 mm, ranging from 3 to 6 mm. Pain, mobility, muscle force and radiological presentation were assessed. RESULTS: Pain relief was achieved in all patients; 20 patients were entirely pain free and 11 had exceptional minor pain at exertion. Mean gain in mobility was 22 p. 100 both for palmar flexion and for dorsal flexion. Muscle force was improved in 30 cases with normal force in 18 and slightly less than normal force in 12. Muscle force remained insufficient in one case. According to the Michon criteria, there were 80 p. 100 excellent and good results. The radiographic assessment showed 14 improvements, 16 stabilizations, and 1 aggravation. Overall clinical ouctcome was independent of age, and preoperative radiographic aspect and length of the ulna. In addition, there was no correlation betwen radiological changes of the lunatum and the clinical result. CONCLUSION: Osteotomy for diaphyseal shortenig of the radius is a reliable simple procedure which does not require supplementary immobilization and which avoids complications encountered with self-compressive paltes.

[Bone hydatidosis. 12 cases]. / L'hydatidose osseuse. 12 cas.

The hydatic cyst is a parasitic disease caused by the development in man of the larval form of echinococcus granulosus. All parts of the body may be involved, but the liver and lungs are the main locations of the disease. The bone site is rare, accounting for 0.9 to 2% of all hydatic lesions. Between 1982 and 1988, we have compiled 12 cases of hydatic disease of bone. They were located in the skull (4 cases), the iliac bone (4 cases), the omoplate (1 case), the ribs (1 case), the femur (1 case) and the fibula (1 case). These lesions are generally considered as primary, but association with visceral locations was noted in 3 cases in our series.