RESUMO
Old fractures and dislocations of the base of the fifth metacarpal may result in post-traumatic arthrosis which is troublesome from a functional point of view and characterized by a difficult management. Stabilized arthroplasty is based on arthroplastic resection of the base of the fifth metacarpal associated with lateral diaphysometaphyseal arthrodesis between the fourth and the fifth metacarpal. This study involving two patients aimed to describe the advantages and the peculiarities of stabilized arthroplasty compared to other techniques in the treatment of the sequelae of fractures and dislocations of the base of the fifth metacarpal.
Assuntos
Artroplastia/métodos , Artropatias/cirurgia , Ossos Metacarpais/cirurgia , Adulto , Artrodese/métodos , Humanos , Artropatias/etiologia , Artropatias/patologia , Luxações Articulares/etiologia , Luxações Articulares/patologia , Luxações Articulares/cirurgia , Masculino , Ossos Metacarpais/lesões , Ossos Metacarpais/patologia , Adulto JovemRESUMO
Tuberculosis of the shoulder is rare. It encompasses all articular and periarticular tuberculouses of the shoulder. Its insidious evolution, mimicking inflammatory and degenerative diseases, reflects the frequency of its diagnostic delay. We report a rare case of tuberculous bursitis of the shoulder in a woman living in rural areas, with renal insufficiency and treated for peritoneal TB and psoas. The anamnesis revealed signs of tuberculous impregnation. Clinical examination showed painful swelling of the shoulder associated with stiffness. MRI of the shoulder objectified infectious bursal disease. Its tuberculous origin was confirmed by the histological examination of ultrasound-guided synovial biopsy. The patient underwent TB treatment with good outcome. At 9-year follow-up, the patient had satisfactory articular function with no recurrence of infectious disease.
Assuntos
Bursite/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Articulação do Ombro/microbiologia , Tuberculose Osteoarticular/diagnóstico , Bursite/tratamento farmacológico , Bursite/microbiologia , Feminino , Seguimentos , Humanos , Biópsia Guiada por Imagem , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Tuberculose Osteoarticular/tratamento farmacológico , Ultrassonografia de IntervençãoRESUMO
Tophaceous gout occurs years after recurrent attacks of acute inflammatory arthritis. The urate deposits are incriminated in the inflammatory process; however, their infection is exceptional. We report the observation of an infected gouty tophus of the pinky and the wrist of a 40-year-old man, presented as an excruciating inflammatory pain with buff-yellow swelling of the fifth right finger and wrist in a febrile context. As a matter of fact, the evolution was favourable after surgical excision and antibiotic therapy. The infection of a tophus is an exceptional complication of the gout. In daily practice, this diagnosis is really a difficult challenge for the clinician. The systematic bacteriological examination of the tophi with cutaneous fistulation is necessary to introduce prematurely an adapted treatment.
Assuntos
Artrite Gotosa/complicações , Gota/complicações , Mãos/patologia , Articulação do Punho/patologia , Adulto , Antibacterianos/uso terapêutico , Artrite Gotosa/tratamento farmacológico , Artrite Gotosa/microbiologia , Artrite Gotosa/cirurgia , Dedos/cirurgia , Gota/tratamento farmacológico , Gota/microbiologia , Gota/cirurgia , Humanos , Masculino , Resultado do Tratamento , Ácido Úrico/análiseRESUMO
Anterior transolecranon dislocation of the elbow is rarely observed in children, reported in only a small series. The present case involves an anterior transolecranon dislocation of the left elbow joint in a 7-year-old child, which was surgically treated. Two attempts of closed reduction failed because the radial head had buttonholed via the joint capsule. After its release, open reduction was easily performed; osteosynthesis of the olecranon was not performed. Remarkably, good result was obtained, despite a mild flexion deformity at the last follow-up. This case report aims to highlight this treatment method, which may be considered for such an uncommon injury.
Assuntos
Lesões Encefálicas Traumáticas/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Embolia Pulmonar/mortalidade , Adolescente , Adulto , Idoso , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Tunísia/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Unlike most of animal species, human beings lack the enzymatic process for the conversion of glucose to ascorbic acid (vitaminC), and therefore getting the vitamin from food sources is essential. The association of the various signs caused by a deficiency of vitamin C is called scurvy or Barlow's disease, an easily treatable disease but can be fatal. It is rare in the developed countries and even economically underdeveloped societies in which the basic diet is already rich in ascorbate. METHODS: We describe here the case of a 4-year-old girl with cerebral palsy, in whom diagnosis concerns were oriented for osteomyelitis, based upon clinical presentation, ultrasonic and magnetic resonance imaging, led to a surgery revealing subperiosteal hematomas that argues in favor of scurvy. RESULTS: After vitamin C therapy, the symptoms are gone and the general condition of the patient improved despite persistent radiological signs. CONCLUSION: Recent studies of sporadic cases report a high incidence of scurvy in children with autism or psychomotor retardation and the fact that musculoskeletal manifestations are more common. The mosaics of the symptoms of scurvy are varied and include dermatological, dental, bone and systemic manifestations, making it a forgotten and misdiagnosed illness. A heightened awareness is needed to avoid an unnecessary surgery, unnecessary tests and procedures and to be able to start treatment for a potentially fatal but easily curable disease.