About a new entity in the coronal shear fracture of the distal humerus: Broberg-Morrey's fracture with Laugier's fracture in the same elbow.

Coronal shear fractures of the distal humerus involving only the capitellum or the trochlea are rare injuries. Their combination has rarely been described. Herein, we report the case of a 39-year-old man who presented with pain and total functional impotence in his right elbow following a fall; the clinical and radiological findings revealed a new entity in the coronal shear fractures of the distal humerus, which included a comminuted fracture of the capitellar and displaced separate trochlea in the same elbow. This fracture was treated surgically with a good outcome at the last follow-up.

An unusual cause of tarsal tunnel syndrome: Schwannoma of the posterior tibial nerve; a rare cause and rare localization.

INTRODUCTION: Schwannoma of the posterior tibial nerve is extremely rare. CASE PRESENTATION: A 25-year-old female with a one-year history of left foot pain is presented. Clinical and radiological findings were in favor of a tarsal tunnel syndrome caused by a schwannoma of the posterior tibial nerve, prompting the patient to undergo surgery. We performed a complete excision of the tumor with the aid of a loupe magnification. At the last follow-up, the patient did well, with no recurrent pain and no neurological squeals. DISCUSSION: The diagnosis of a tibial nerve schwannoma can often be difficult as, in the early stages, a mass may not be palpable and symptoms are often non-specific because of the slow-growing soft tissue mass. CONCLUSION: Although schwannoma is a rare cause of tarsal tunnel syndrome, it should be kept in mind by physicians, especially in cases of chronic unexplained foot pain with a positive Tinel's test.

A Painless Restricted Motion of the Thumb: What Etiology? About An Uncommon Tumor in Uncommon Localization.

Lipomas in fingers are rare and account for less than 1% of all cases. As a type of lipoma, the spindle cell lipoma is exceptional and it presents 1.5% of total adipocyte tumors. Moreover, its localization in the thumb is extremely rare. Only three cases have already been reported in adults; our case constitutes the fourth case, which is about a 61-year-old female who presented since 18 months a mass on the ulnar lateral aspect of the thumb. After clinical and radiological assessments, an entire excisional biopsy of the mass was performed. The histopathological analysis confirmed the spindle cell lipoma of the thumb. At the last follow-up of two years, the patient did well with no recurrence and no restricted motion of the thumb. So, although lipomas of the digit are rare, they should be considered a possible etiology of either painful or mechanic restricted motion of the digit.

A report of two challenging cases of bone infection: Mycobacterium tuberculosis. How to manage?

The incidence of bone tuberculosis is less than 5% of all tuberculosis cases. Furthermore, multifocal bone tuberculosis is uncommon, which rarely occurs without primary foci. It is difficult to diagnose, particularly if it is localized in both humeral heads. On the other hand, the isolated iliac bone tuberculosis is exceptional; it constitutes, also, a challenging diagnosis, which requires a high index of clinical suspicion and advanced investigations. Herein, we first report a case of multifocal tuberculosis of both humeral heads with no primary foci, and we secondarily report a case of isolated iliac bone tuberculosis. At last, however, the histological exam and polymerase chain reaction for the Mycobacterium tuberculosis complex are not always positives; they are mandatory as tests to ascertain the diagnosis.

Unusual Etiology of Chronic Posterior Leg Pain in a Running Athlete: Could It Be a Schwannoma? A Case Report and Review of the Literature.

Schwannomas represent only 5% of all soft tissue tumors. As a variant of this tumor, the plexiform schwannoma is rare accounting for less than 5% of all schwannomas. Herein, we report a rare case of a 49-year-old athlete who suffered from a pain in the posterior aspect of the right leg one year before his presentation. Initially, a radiograph of his right leg showed no abnormality, and so, the emergency physician discharged him on analgesics and anti-inflammatory medications, and rest was advised. The persistent pain obliged the patient to consult our orthopedic department. On examination, we found a firm mass in the proximal medial aspect of his right leg. The neurovascular exam was normal. Sonography of the leg was not conclusive. Therefore, magnetic resonance imaging was performed, and a hemangioma or schwannoma was suspected. The patient underwent surgery in which the entire tumor mass was shelled out in one piece with no damage. The histopathological finding was concomitant with a plexiform schwannoma. Follow-up evaluation, sixteen months later, showed no evidence of recurrence, and the patient has regained his previous level of sportive activities. So, given the case described here, despite the rarity of the schwannoma, it should be taken into consideration as a possible diagnosis in such situation to promote early diagnosis and appropriate treatment.

Complex metacarpophalangeal joint dislocation of the litter finger: A sesamoid bone seen within joint. What does it mean?

Dislocation of the metacarpophalangeal joint is a rare injury. The index finger is most frequently involved, followed by the thumb; the little finger is very seldom affected. The Complex dislocation of the little finger metacarpophalangeal joint is extremely rare. A few cases only had been described. Herein, we report a case of 40 years old presented, after a road accident, a dorsal metacarpophalangeal joint dislocation of the litter finger confirmed on radiographs with a clear view of the sesamoid bone within joint prompting the patient to undergo open reduction with no attempts of closed reduction initially. We elected, to treat our case, for the volar approach which allowed successful relocation of the head of the metacarpal in its anatomical position. The view of sesamoid bone within the joint is pathognomonic of volar plate entrapment. Recognition of this fact should alert the treating physician to the inevitability of open reduction for anatomical repositioning of the joint and avoid repeated attempts at closed reduction which may arise the risk of degenerative arthritis and reduced final range of motion.

Domestic Horse Bite: An Unusual Etiology of Crush Injury of the Fourth Finger-How to Manage?

Almost 2% of all emergency admissions involve an animal bite. While horses bite humans very rarely, their bites are mostly associated with fatalities. Herein, we report the case of a 23-year old bitten by a domestic horse causing a crush injury to his fourth finger with fracture dislocation of the proximal interphalangeal joint. The patient benefited upon arrival at the emergency department from copious irrigation with saline serum, tetanus toxoid, postexposure rabies vaccination, and prophylactic antibiotic therapy. In the operating room, surgical exploration found the ulnar digital pedicle sectioned, the flexor and extensor tendons sectioned and shredded, and the skin shredded. An excisional debridement of devitalized tissue with copious irrigation was performed, and the finger regularized at the level of traumatic amputation with tendon striping followed by coverage of the bone by the radial digital flap with careful clinical and biological monitoring after the surgery. At the last follow-up, the patient revealed no sign of infection, and he returned to his usual activities and has been discharged from care. This wound management, based on a careful examination, a meticulous debridement, and an efficient cleaning with early and targeted antibiotic therapy, might promote good results and avoid dangerous complications.

Pure Isolated Dorsal Hamatometacarpal Dislocation in a Rider: A Case Report and Review of Literature.

INTRODUCTION: Pure isolated dislocations of the fifth carpometacarpal joint are extremely rare. To the best of our knowledge, the case, we present here, is among the extremely rare cases report of an unstable hamatometacarpal dislocation(HMD)injury successfully treated by a well-molded cast. CASE REPORT: A 30-year-old rider fell from his horse, causing swelling of the wrist and the fifth finger was rotated with minimal active motion. The radiological assessment (X-rays and tomography) showed a pure HMD. Under sedation, we performed reduction of the dislocation. However, the reduction was lost at the slightest movement requiring a K-wirefixation. The patient refused the surgical treatment and requested non-operative treatment. Thus, while the joint was held in a reduced position, a well-molded plaster cast was applied which immobilized both the hamatometacarpal joint and the metacarpophalangeal joint. Later, the patient was reviewed weekly until 6 weeks, then the cast was removed altogether and the digits were mobilized. At the follow-up of 6 months, he had regained full range of motion of the little finger with no pain, no recurrence of dislocation and returned to his previous level of sporting activity. CONCLUSION: The early detection with careful clinical assessment and radiological analysis for subtle signs, followed by appropriate treatment usually leads to an excellent result.

[Pertrochanterian fracture revealing multiple myeloma: how is it treated?] / Une fracture pertrochanterienne révélant un myélome multiple: quelle prise en charge?

Skeletal involvement is the major clinical complication of multiple myelomas, resulting in pathological fractures. Proximal femoral fractures are very frequent during multiple myeloma evolution and they seriously compromise survival and quality of life of patients with cancer. Early surgical treatment allows mortality and morbidity improvement. Cervicomedullary Gamma locking nail osteosynthesis allows efficient, sustainable and stable fixation associated with early patient mobilization and survival improvement. However, prolonged survival imposes regular monitoring of the osteosynthesis in order to detect and to treat equipment failure. We should not overlook the fact that the recovery of independence after pertrochanterian fracture also influences myeloma control through the possibility to perform bone marrow autograft or not.