Intraoperative Use of High-Flow Nasal Cannula in Elderly Patients Undergoing Hip Fracture Repair Under Spinal Anesthesia: A Randomized Controlled Study.

BACKGROUND: The procedure of hip fracture repair poses a risk for postoperative pulmonary complications (PPCs) in elderly patients, accompanied by anesthesia and operations. Various noninvasive methods of respiratory support are used as prophylactic and therapeutic, mainly in the postoperative period.  Objective: This study aims to determine whether intraoperative use of a high-flow nasal cannula (HFNC) impacts elderly patient outcomes after hip fracture surgery. METHOD: Seventy patients aged 65 and older undergoing traumatic hip surgery under spinal anesthesia for isolated hip fractures were randomly assigned to either an interventional group (I) utilizing a high-flow nasal cannula or a control group (C) without respiratory intervention in a six-month single-blind controlled study at Sahloul Teaching Hospital. RESULTS: The two groups had identical socio-demographic traits and baseline data. Respiratory postoperative complications occurred in two patients in group (I) and in nine patients in group (C), with a significant difference (p = 0.023). The main respiratory postoperative complications in group (I) were atelectasis (one case) and pulmonary edema (one case). The main respiratory postoperative complications in group (C) were atelectasis (four cases), pneumonia (two cases), COPD decompensation (two cases), and pulmonary edema (one case). No intensive care unit admissions or intraoperative complications were associated with using HFNC. The mean length of stay (LOS) in the hospital was 8.83 ± 2.91 for group I and 10.46 ± 3.4 for group (C), which differed significantly (p = 0.03) with no in-hospital mortality for the two groups. CONCLUSION: The intraoperative administration of HFNC may lower the incidence of postoperative respiratory complications and the duration of hospital stays.

Divergent Elbow Dislocation Associated with Ipsilateral Fractures of Ulnar Diaphysis and Radial Styloid Process in Adult: A Case Report.

Introduction: The divergent elbow dislocation represents a rare lesion where the proximal radioulnar joint is torn and the distal part of the humerus goes between the radius and the ulna, the forearm dislocates posteriorly. Case Report: We report the case of a 37-year-old male patient who had a traumatic divergent dislocation of the left elbow, associated with ipsilateral fractures of the ulnar diaphysis and the radial styloid process. The elbow joint was reduced under general anesthesia with internal fixation of the ulnar diaphysis fracture and a pinning of the radial styloid fracture. At 3 years of follow-up, the fractures were consolidated and the elbow was stable with a satisfying mobility. Conclusion: The aim of our case report is to underline the diagnostic and therapeutic challenges of this complex lesion.

Osteonecrosis of the Humeral Head Following Arthroscopic Repair of Rotator Cuff Tears: A Case Report.

Introduction: The osteonecrosis and the collapse of the humeral head may have many risk factors such as trauma, alcoholism, metabolic diseases, and corticosteroid therapy. Otherwise, it was described as a rare complication of shoulder arthroscopy in the past few years. Case Report: We report the case of a 65-year-old right-handed woman who had a rotator cuff tear of the right shoulder. She underwent a double-row arthroscopic repair. Six months later she had an intense shoulder pain, with radiological and MRI signs of humeral head osteonecrosis. The patient had a reverse total shoulder arthroplasty. Conclusion: The aim of this case report is to underline the diagnostic particularities of this complication, and to shed light on the pathogenesis of the interruption of blood supply in the humeral head following rotator cuff repair. We also discuss the management of this complication with reverse total shoulder arthroplasty.

Osteoid osteoma of the sesamoid bone: An unusual localization.

Osteoid osteoma is the most common benign bone tumor because it accounts for 10-12% of all these tumors. Localized most often with long bones (75% of cases), especially in the tibia and femur, osteoid osteoma can evoke other etiologies, especially when it is juxta-articular. We report the case of an osteoid osteoma of the sesamoid in a 23-year-old patient with no particular history who presented pain at the root of his hallux evolving for 6 months. The clinical examination was without abnormalities. Standard X-rays found no lesions. The tomodensitometry of the foot showed an image "cockade" with a peripheral sclera ring. The patient underwent surgical excision with simple operative follow-up and disappearance of pain at one year of follow-up. The histopathological study confirmed the diagnosis. The osteoid osteoma of the sesamoid bone is exceptional. The diagnosis may be delayed due to misleading "articular" symptomatology.

Monteggia fracture with unreducable anterior dislocation of the radial head and a lesion of the external collateral ligament of the elbow.

Monteggia described a fracture of the proximal third of the ulna with anterior dislocation of the radial head from both the proximal radioulnar and radiocapitellar joints. The key treatment principle in Monteggia fractures is stable anatomic alignment of the ulna. We present an uncommon case of a Monteggia fracture-dislocation with an unreducable anterior dislocation of the radial head and associated with a lesion of the lateral collateral ligament of the elbow. The patient in our report had a successful clinical outcome and functional range of motion after rigid fixation of the ulnar shaft fracture and exploration of the elbow joint, reduction of the radial head and repair of the lateral collateral ligament. This case is unusual because of the association of a complete tear of the external collateral ligament of the elbow.

An unusual Monteggia equivalent type 1 lesion: Diaphyseal ulna and radius fractures with a posterior elbow dislocation in a child.

In this report, we describe an extremely unusual Monteggia equivalent type 1 lesion in a 10-year-old boy following a fall from a height of 1 m. On the plain radiographs, our patient had a particular Monteggia equivalent type 1 injury associating a posterior elbow dislocation with diaphyseal radius and ulna fractures. The patient was treated by closed reduction technique. At six months of follow-up, the fractures were consolidated and the elbow was stable. To our knowledge, only 8 adult cases and one paediatric observation with similar lesions had been reported through medical literature. Therefore, the aim of our case report is to remind this rare entity and also to provide a comprehensive review of the literature related to this uncommon lesion.

Villonodular Synovitis of the Subtalar Joint: A Case Report.

INTRODUCTION: Villonodular synovitis (SVN) is a rare benign pseudotumoral proliferation of the synovial joint, of unknown etiology. In general, it reaches the big joints, especially the knee. Localization at the subtalar level is extremely rare, with only a few cases published in the literature. CASE REPORT: We report the case of an SVN of the subtalar in a 60-year-old patient without particular histories, who consulted for a swelling of the external border of the right foot evolving for 2 years. Biology, as well as the standard radiographs, was without anomalies. The diagnosis was evoked on magnetic resonance imaging (MRI) and confirmed by surgical biopsy and excision. The operative follow-up was simple with no recurrence after 3 years. CONCLUSION: SVN of the subtalar is rare. Surgical treatment is based mainly on synovectomy, and the prognosis depends mainly on the osteocartilaginous lesion and the quality of excision.

Odontoideum Bone Revealed by c1-c2 Dislocation of the Cervical Spine during a Diving Accident.

INTRODUCTION: Odontoideum bone or the mobile odontoid process is one of the rarest malformations of the cervico-occipital hinge. It exposes to the atlo-axial instability and to the risk of bulbo-medullary compression threatening then the vital and functional prognosis. We report the case of a 16-year-old patient who was the victim of a raod accident resulting in acervical spine injury. Radiological investigation found an odontoideum bone malformation associated with C1C2 dislocation. CASE REPORT: A 16-year-old patient with no medical history had a road accident. Clinical evaluation found an incomplete tetraplegia.The imaging has revealed an atlo-axoidal dislocation with aspinal cord compression. Furthermore, radiological exams relvealed an odentoideum bone. A transcranial traction by a Gardner stirrup was set for 15 days to obtain a progressive reduction of the displacement. A full neurological recovery (FB-FD) was obtained.The patient was then operated to stabilize the reduction. A C1-C2 posterior zygapophyseal arthrodesis was performed. An autograft harvested from the iliac crest was used. Complementary open reduction and fixation of the cervico-occipital hinge was made using lamellar hooks and compression rods. At the 18-month follow-up, the clinical examination found no neurological deficiency and the plain radiography showed a complete fusion of the arthrodesis. CONCLUSION: Odontoideum bone is a rare and potentially life-threatening malformation. It is most often asymptomatic but symptoms could occur any time after a benign trauma. The prognosis mainly depends on the precocity of the management. Preventive surgery is recommended byseveral authorsin case ofinstability.

Intra-articular knee arborescent lipoma: a case treated with arthroscopic synoviectomy.

Arborescent lipoma is an unusual intra-articular lesion that typically develops in the knee and has to be evoked before chronic effusion. It corresponds to hyperplasia of mature fatty tissue and hypertrophy of synovial villi, developing within a joint. The reference treatment is synovectomy by arthrotomy. The rare forms localized to the anterior compartment of the knee can benefit from an arthroscopic synovectomy. The authors report a case of arborescent knee lipoma in a 47-year-old patient who received arthroscopic synoviectomy. To our knowledge, only a few cases of arborescent lipoma treated by arthroscopic synoviectomy have been reported in the literature.

Uncommon Floating Knee in a Teenager: A Case Report of Ipsilateral Physeal Fractures in Distal Femur and Proximal Tibia.

INTRODUCTION: The concomitance of ipsilateral physeal fractures of the distal femur and the proximal tibia is an extremely scarce entity. It is conceptually similar to floating knee in pediatric population. CASE REPORT: One case with this injury is reported in a 16-year-old teenager. He was treated surgically by close reduction and internal fixation. The diagnosis of the tibial fracture was initially missed and the fracture was seen on the post-operative radiographs. Orthopedic treatment was made for this injury. 2 years after, no angular deformity neither shortening of the limb were found. CONCLUSION: These rare injuries could have serious immediate and remote complication with a considerable functional impact. The diagnosis of proximal tibia physeal fracture could be missed in the context of a concomitant more impressive distal femur fracture. The possibility of a combination of these two injuries should then be kept in mind. Anatomic reduction should be made as soon as possible using a gentle technique and attention should be given to the diagnosis of the neurovascular complications.

Uncommon Floating Knee in a Teenager: A Case Report of Ipsilateral Physeal Fractures in Distal Femur and Proximal Tibia.

INTRODUCTION: The concomitance of ipsilateral physeal fractures of the distal femur and the proximal tibia is an extremely scarce entity. It is conceptually similar to floating knee in the pediatric population. CASE REPORT: One case with this injury is reported in a 16-year-old teenager. He was treated surgically by close reduction and internal fixation. The diagnosis of the tibial fracture was initially missed, and the fracture was seen on the post-operative radiographs. Orthopedic treatment was made for this injury. 2 years after, no angular deformity neither shortening of the limb were found. CONCLUSION: These rare injuries could have serious immediate and remote complication with a considerable functional impact. The diagnosis of proximal tibia physeal fracture could be missed in the context of a concomitant more impressive distal femur fracture. The possibility of a combination of these two injuries should then be kept in mind. Anatomic reduction should be made as soon as possible using a gentle technique, and attention should be given to the diagnosis of the neurovascular complications.

Chondroblastic osteosarcoma of the distal tibia: a rare case report.

Chondroblastic osteosarcoma, representing about 25% of osteosarcoma, is a fatal primary malignancy of the skeleton if not diagnosed and treated appropriately. It most commonly occurs in the long bones of the extremities near the metaphyseal growth plates. In this report, we describe the occurrence of chondroblastic osteosarcoma involving the left distal tibia in a 14-year-old male. The diagnosis was confirmed by the histological examination of a surgical biopsy. The patient was treated by both surgery and neoadjuvant chemotherapy. No recurrence was noted at 3 years of follow-up. To our knowledge, only two cases describing chondroblastic osteosarcoma of the distal tibia had been reported through English medical literature. Therefore, the aim of our article is to make the clinician aware of this rare clinical presentation and also to provide a comprehensive review of the literature related to this uncommon malignant tumour.

Ulnar paddlefish carpometacarpal dislocation of the three lesser fingers: a case report.

The long fingers' paddlefish carpometacarpal (CMC) dislocation is exceptional. Most dislocations occur after high energy trauma. Untreated, these lesions can result in chronic instability of the CMC joints and early osteoarthritis. We report the case of a 20-year-old patient presenting with an ulnar paddlefish CMC fracture-dislocation of the three lesser fingers resulting from a hand trauma in the context of an occupational accident. Treatment is usually surgical though no strict consensus can be found upon literature review. If diagnosed early and no associated fractures are found, CMC dislocation could benefit from conservative treatment.