Osteonecrosis of the trapezium: a case report and review of the literature.

We describe the case of a 58-year-old woman with AVN of the left trapezium which was treated surgically. This paper aims to review the etiologies leading to the pathology and the different therapeutic options. Avascular necrosis (AVN) of the carpal bones most commonly involves the lunate and the scaphoid . AVN of the trapezium is extremely rare. To our knowledge only 3 cases have been published in the literature so far and they were all treated differently.

Metacarpal chondrosarcoma, from negligence to rareness : a case report and review of the literature.

Chondrosarcoma is rarely found in the extremities but it remains the most common primary malignant bone tumor of the hand. We report an unusual case of a 46-year-old man with a huge chondrosarcoma on his left hand that has been evolving for more than 30 years. The mass has always been painless, the symptoms were only the deformation and a slight loss of motion. We did a subtotal resection since the patient refused the amputation. The investigation, which in- cluded thoracoabdominal tomography, scintigraphy and blood analysis, turned out to be negative. In the literature, CS are usually associated with a locally destructive growth but metastasis hasn't been often described. CS seems to be an aggressive tumor locally but, unlike in other sites, it seems to rarely metastasize when in the hands.

Total knee arthroplasty after former knee fusion in a patient with Ehlers Danlos syndrome.

A 46-year-old female patient with Ehlers-Danlos Syndrome had undergone fusion of her right knee 25 years before presentation. This markedly affected her quality of life. She underwent a two-stage conversion to a constrained rotating-hinge total knee arthroplasty. She regained a satisfying range of motion and she has a painfree, mobile and stable knee at 42 months follow-up. Conversion of knee fusion to TKA is a demanding procedure that should only be performed by experienced knee surgeons, in selected cases and on highly motivated patients. Complication and revision rates are reportedly very high but global satisfaction is surprisingly good. Ehlers-Danlos Syndrome was not shown to be a contraindication for such surgeries.

Case reports: subtrochanteric femoral stress fractures after prolonged alendronate therapy.

BACKGROUND: Alendronate is known for its ability to reduce bone loss in osteoporotic and osseous metastatic conditions. Its long-term effects remain unclear although several reports describe cases of proximal femur stress fractures associated with long-term alendronate use. CASE DESCRIPTION: We report the cases of four women who sustained low-energy subtrochanteric or femoral shaft stress fractures while being on alendronate therapy for more than 5 years. All radiographs showed typical patterns consisting of a transverse fracture line with external cortical bone reaction and medial cortical spike. Alendronate discontinuation along with nonoperative treatment was sufficient for one patient, whereas surgical stabilization was required in three patients. LITERATURE REVIEW: The side effects of alendronate therapy include osteonecrosis of the jaw, esophageal irritation, and musculoskeletal pain. Several cases of insufficiency femoral fractures associated with prolonged alendronate use have been reported. Their radiographic pattern and clinical presentation are consistent with our observations. Although various hypotheses have been suggested, the physiopathogenesis of these stress fractures is not completely understood. PURPOSES AND CLINICAL RELEVANCE: Although bisphosphonates play an important role in preventing pathologic fractures in patients with cancer, these subtrochanteric stress fractures associated with prolonged use of alendronate should not be ignored.