Loosening of a Total Hip Arthroplasty Associated with a Periprosthetic Femoral Fracture Caused by Recurrent Hydatidosis of the Hip: A Case Report.

CASE: A 35-year-old woman, who lived in an endemic area for echinococcosis, developed a periprosthetic fracture with loosening of a total hip arthroplasty that had been performed 9 years earlier for hydatidosis of the right proximal femur with a pathological femoral neck fracture. At that time, the patient did not have any signs of liver or lung involvement. She was successfully managed by a cemented revision hip arthroplasty without any signs of recurrence at the last follow-up of 5 years. CONCLUSIONS: Total hip arthroplasty can offer effective management of proximal femur hydatidosis, despite the high rate of recurrence and mechanic failure.

Giant cell tumor of the lower end of tibia. Curettage and cement reconstruction.

Bone giant cell tumor (GCT) is a rare, generally benign and locally aggressive tumor. It accounts for about 5% of all primary bone tumors and is located preferentially on the epiphyseal long bone. Ankle localization is rare. We present two cases of GCT of the lower end of tibia, presenting as gradually increasing pain and swelling in the tibial pilon over the course of 3 months. Standard radiology and MRI showed large eccentric, expansile lesion in the distal tibia with rupture of the cortex suggestive of a malignant tumor of the bone. A biopsy was performed which confirmed a GCT of bone. Curettage of the lesion and packing the cavity with bone cement resulted in disappearance of the tumor with good functional recovery. We conclude that intralesional curettage and cement packing is a good treatment option for Campanacci grade 2 and 3 GCT lesions of lower tibia.

[Chondroblastoma of bone ]. / Chondroblastomes osseux.

BACKGROUND: Chondroblastoma is a rare and benign cartilaginous tumor of bone often localized in the epiphysis of long bones and affecting young persons between 10 and 20 years. AIM: To study the epidemiological, clinical and radiological aspects of bone chondroblastoma, to assess the outcome of chirurgical treatment and factors associated with recurrence. METHODS: It's a retrospective study, concerning 13 patients with chondroblastoma of bone, attending the orthopedic department of Sahloul hospital between 1991 and 2007. The patients' age, sex, clinical features, radiological aspects, treatment and evolution were recorded. After initial clinical examination, all patients have had plane radiographs. Twelve patients were explored by Computed tomography. The treatment was surgical in every case: curettage of the lesion in 11 cases associated with bone grafting in 5 cases and cementation in one case, one in-bloc resection and one simple biopsy. Histology confirmed the diagnostic in all cases. RÉSULTS: The average age of patients was 18, 2 years and sex ratio was 2, 3. the long bones are the most commonly involved. The main presenting symptoms were pain in all cases and local swelling in 8 cases. Radiographs showed a lytic geographic well-defined lesion in 7 cases. Computed tomography showed better calcifications and soft tissue extension. The mean follow-up of our patients was 8 years (6 mois-18 ans). Two recurrences were noted. Functional results were good in 11 cases. CONCLUSION: Chondroblastoma is a rare and benign cartilaginous tumor of bone which usually involves the epiphysis of long bones. Plane radiographs are sufficient for diagnostic in typical cases. MRI is interesting in unusual presentations and localizations. Curettage and grafting constitute the treatment of choice. Prognosis depends basically on a relatively high rate of recurrence. Aggressive feature of the lesion and incomplete curettage are the most important predictive factors of recurrence.

[Results of the deltoid flap for surgery of rotator cuff tears]. / Resultats du lambeau deltoidien dans la chirurgie des ruptures de la coiffe des rotateurs.

AIM: Was to evaluate the results of deltoid flap for the treatment of massive rotator cuff tears. METHODS: This retrospective study included 20 shoulders in 20 patients with a painful massive, irreparable rotator cuff tears. The average patient age was 54 years. They were all treated with acromioplasty and a deltoid flap according to Augereau technique. Follow-up averaged 6 years 3 months (range 18 months - 11 years 4 months). Clinical and radiologic evaluations were done before and after surgery. Function was evaluated according to Constant's score. RESULTS: The Constant's score increased from 24.6/100 to 54.45/100. Eighty five per cent of patients were satisfied. Results on pain were good, with an average of Constant's score of 11/15. However, improvement strength or motion was not significative, with an average of 7.1/25 and 22.8/40 respectively. CONCLUSION: This study concludes that, this technique is a simple surgical procedure and their results on pain were good. Therefore, we conceder it is an excellent indication for the treatment of massive rotator cuff tears in adults after medical treatment failure.

[Fracture of the radial head: the role of excision]. / Fractures de la tête radiale : place de la résection.

AIM: We assessed retrospectively forty cases of radial head fractures treated by excision. METHODS: The series is composed of men in 60% of cases and women in 40% of cases. The age of patients ranged from 15 to 68 years with an average of 37 years. According to Duparc classification, the fracture was type II in 20% of cases, type III in 32%, type IV in 42% and type V in 6%. An associated lesion in the same elbow was seen in 50% of cases; elbow dislocation was present in 38% of cases. The average of operative delay was 14 days (0 - 40 days). RESULTS: The functional result was evaluated according to clinical score of Western Orthopaedic society. The results were satisfactory. We have noted a correlation between functional result and associated lesions, the delay of excision and postoperative immobilisation. Valgus ulna and ascension of the radius was minors and well tolerated exceptly in cases of fractures associated to elbow dislocations. CONCLUSION: According to the results, we think that excision of radial head can be proposed essentially for the treatment of isolated radial head fracture.

[Arthroscopy of the shoulder. Technics and indications. About 64 cases]. / L'arthroscopie de l'épaule. Technique et indications. A propos de 64 cas.

Arthroscopic surgery replaced at present more and more conventional articular surgery because its anatomic character, its less morbidity and its more simple post-poerative care. After knee, the shoulder is considere as the articulation witch benefit of the progress of arthroscopic technics. Autors reported their experience in shoulder arthroscopy witch is introduced in the service since 1999. The gol of this study is to describe the technic of the shoulder arthroscopy and to precise its main indications.

[Use of radial shortening for Kienbock disease]. / Apport de l'ostéotomie de raccourcissement du radius dans le traitement de la maladie de Kienbock: indications et résultats. A propos de 20 cas.

Kienbock disease is caused by aseptic necrosis of the lunate. The aim of this work is to evaluate the results of the radial shortening procedure for the treatment of stages II. Illa IIb of the disease. We retrospectively reviewed 20 cases of Kienbock disease. This series is composed of 9 men and 11 women. The average age was 32 years. According to Litchman's classification; 17 patients were operate on in stage III (14 IIIa; 311Ib) and 3 patients were operate on in stage III. Average of shortening was: 4 mm. the mean Follow -up was 05 years. Functional results were evaluated according to Michon score. The results were good in 18 cases and poor in 02 cases. Radiologic results were good: Ameliorations were obtained in 3 patients with stage II; 16 stabilizations in 17 patients with stage IIIa and 1 deterioration in 4 patients with stage IIIb. Radial shortening is effective in the treatment of Kienbock disease in wrists that do not have degenerative changes in adjacent carpal joints. Pain, range of motion and strength can be expected to improve but the radiographic aspect of the lunate changes is not likelly to undergo much chance, if any. Osteotomy was effective even in patients who had zero or positive ulnar variance; and an inclination angle of the distal part of the radius.