Intervertebral disc degeneration produced by vertebral body fracture associated with microcirculation disruption of the sub-endplate.

BACKGROUND: Among the causes of the progression of intervertebral disc (IVD) degeneration (IDD) is the loss of nutrient intake to the IVD through the microcirculation disruption of the sub-endplate. Also, the vertebral body fracture intervenes in degenerating the adjacent IVD. This research aimed to create an animal model of IDD using these two strategies. METHODS: 30 male Sprague-Dawley rats were split into 3 groups: a control group, a middle vertebral body injury (MI) associated with ethanol injection (MI+EtOH) group, and an MI associated with phosphate-buffered saline injection (MI+PBS) group. A vertebral body fracture with or without endplate injection of ethanol was generated by either drilling a hole in the center of a caudal rat vertebral body to form a fracture with an unabated endplate or drilling a hole in the center of a rat coccygeal vertebral body with endplate injection of ethanol to establish a vertebral body fracture with endplate damage. X-ray, macroscopic, histologic, and biochemical evaluations were utilized to assess IDD at weeks 3 and 6. RESULTS: According to X-ray findings, the MI+EtOH group demonstrated a significant decrease in intervertebral space height over time in comparison to the 2 other groups. The water content also was significantly decreased. Macroscopic and histological analysis demonstrated progressive degenerative changes in the IVD of the MI+EtOH group. CONCLUSION: The caudal vertebra fracture with ethanol injection is more likely to induce degeneration of adjacent IVD. This model effectively repreduced IDD, which may serve as a theoretical basis for future clinical intervention for IDD.

Establishment of intervertebral disc degeneration models; A review of the currently used models.

One of the frequent causes of low back pain is intervertebral disc degeneration (IDD), which is followed by discogenic pain. Some significant risk factors that have been linked to the onset and progression of IDD include age, mechanical imbalance, changes in nutrition and inflammation. According to recent studies, five types of animal models are established for producing IDD: the spontaneous models, the puncture models, the biomechanical models, the chemical models and the hybrid models. These models are crucial in studying and understanding IDD's natural history and identifying potential treatment targets for IDD. In our study, we'll talk about the technical aspects of these models, the time between model establishment and the apparition of observable degradation, and their potential in various research. Each animal model should be compared to the human natural IDD pathogenesis to guide future research efforts in this area. By improving knowledge and appropriate application of various animal models, we seek to raise awareness of this illness and further translational research.

RANKL, OPG, and RUNX2 expression and epigenetic modifications in giant cell tumour of bone in 32 patients.

Aims: The present study investigated receptor activator of nuclear factor kappa-Β ligand (RANKL), osteoprotegerin (OPG), and Runt-related transcription factor 2 (RUNX2) gene expressions in giant cell tumour of bone (GCTB) patients in relationship with tumour recurrence. We also aimed to investigate the influence of CpG methylation on the transcriptional levels of RANKL and OPG. Methods: A total of 32 GCTB tissue samples were analyzed, and the expression of RANKL, OPG, and RUNX2 was evaluated by quantitative polymerase chain reaction (qPCR). The methylation status of RANKL and OPG was also evaluated by quantitative methylation-specific polymerase chain reaction (qMSP). Results: We found that RANKL and RUNX2 gene expression was upregulated more in recurrent than in non-recurrent GCTB tissues, while OPG gene expression was downregulated more in recurrent than in non-recurrent GCTB tissues. Additionally, we proved that changes in DNA methylation contribute to upregulating the expression of RANKL and downregulating the expression of OPG, which are critical for bone homeostasis and GCTB development. Conclusion: Our results suggest that the overexpression of RANKL/RUNX2 and the lower expression of OPG are associated with recurrence in GCTB patients.

Ozone therapy (O2-O3) alleviates the progression of early intervertebral disc degeneration via the inhibition of oxidative stress and the interception of the PI3K/Akt/NF-κB signaling pathway.

Intervertebral disc degeneration (IDD) stands for the most frequent cause of low back pain. Finding a cure for this disease is an important challenge as current conservative treatments and surgical interventions fail to bring a solution to this disease. Ozone therapy (O2-O3) has yielded outstanding outcomes in intervertebral disc pathology. The ozone's efficacy in the treatment of IDD remains unconfirmed. This study aimed to assess the effectiveness of intradiscal ozone injection on IDD induced in a rat. Effects of ozone therapy on the viability of nucleus pulposus cells were evaluated by CCK-8 assays. Macrophage immunoreactivity was detected by immunohistochemical, the expression of collagen type II was evaluated by western blot, and measurement of oxidative stress parameters was realized. Molecular docking studies were carried out in order to predict the interaction formed between O3 and the target enzymes, on the one hand, O3 with PI3K and, on the other hand, O3 with COX-2. IRM, X-ray, hematoxylin-eosin, and bleu alcian staining were realized to assess the therapeutic impacts of ozone in the puncture-induced rat model of IDD. In vivo, O3 ameliorated the IDD in the early stage of this disease. It was also displayed in molecular docking that O3 might bind to PI3K to suppress the PI3K/Akt/NF-κB signaling pathway. This study's results show that the O3 should be administered at the low grade of IDD and at an early stage because it cannot restore the advanced inflammatory alteration of the IVD. Our results corroborated also that O3 inhibits the progression of IDD via the PI3K/Akt/NF-κB signaling pathway, which supports O3 as an effective therapeutic option for treating IDD.

[McCune-Albright syndrome: a case report and literature review]. / Syndrome de McCune-Albright : à propos d'un cas et revue de la littérature.

McCune-Albright syndrome is an inherited disease characterized by the association of fibrous dystrophy of bone, café-au-lait skin spots and precocious puberty revealing endocrine hyperactivity. Genetically, this disease is due to a mutation of the Gs protein responsible for activation of adenylate cyclase with excessive production of cAMP. The particular morphology of café-au-lait spots should suggest early diagnosis. Its treatment depends on the endocrinopathy from which the patient suffers and the extent of the fibrous dysplasia. Bisphosphonates have proven their effectiveness on bone pain and the limitation of fibrous dysplasia. Surgery retains its place in complicated forms. We report a rare case of McCune-Albright syndrome complicated by a femur fracture in a 12-year-old girl and we discuss the clinical and paraclinical characteristics of this pathological entity.

Original animal model of lumbar disc degeneration.

PURPOSE: Disc degeneration (DD) is a common cause of low back pain, which represents one of the most widespread public health problems in the world. Therefore, the establishment of a reproducible animal model is indispensable to understand the pathogenic mechanisms of DD and to test new therapeutic strategies. From this perspective, the fundamental objective of this study was to elucidate the effect of ovariectomy in establishing a new animal model of DD in rats. METHODS: 36 female Sprague-Dawley rats were divided into four groups of 9 rats: Group 1: Negative control (Sham): Only an abdominal skin incision and sutures were performed. Group 2: Ovariectomy (OVX): Removal of two ovaries through a transverse incision in the middle of the abdomen. Group 3: Puncture (Punct): Puncture of lumbar intervertebral discs (L3/4, L4/5, and L5/6) by a 21 G needle. Group 4: Puncture+ovariectomy (Punct+OVX): Removal of two ovaries and puncture of L3/4, L4/5, and L5/6 discs. The rats were euthanized 1, 3, and 6 weeks post-surgery, and the discs were harvested. Validity was assessed by radiography, histology, and biochemistry (water content). RESULTS: Disc height, water content, and histologic score decreased significantly in the last 3 groups and at all three-time points (P < 0.05). DD progressed over time in the Punct and Punct+OVX groups (P < 0.05). The changes were more severe in the Punct+OVX group compared to the Punct group and the OVX group. CONCLUSION: The combination of puncture and ovariectomy induced rapid and progressive DD in the lumbar discs of rats without spontaneous recovery.

Establishment of an Animal Model of Disk Degeneration by Intradiskal Injection of Monosodium Iodoacetate.

BACKGROUND: Disk degeneration (DD) stands for the most common cause of low back pain. The establishment of an animal model plays an intrinsic role in the clarification of the physiopathology of DD. The purpose of this study is to select an optimal dose of monosodium iodoacetate (MIA) that may generate a reliable model of DD. METHODS: Thirty-four rats were used in this study. The disks (Co7/8, Co8/9, and Co 9/10) received 1 shot of intradiskal injection of 0.02 mg, 0.1 mg, and 0.5 mg of MIA solution, respectively. Half of the rats were euthanized 3 weeks after MIA injection, and the other half 6 weeks after injection. RESULTS: Magnetic resonance imaging evaluation showed that the mean T2-weighted signal intensity at 6 weeks decreased significantly in the 0.1 and 0.5 mg groups. The disk height of the control group was significantly higher than those of the 0.1 mg and 0.5 mg groups. Histologic and macroscopic results revealed time-and-dose-depending degeneration in the disks that received MIA. Additionally, MIA produced cell death in the nucleus pulposus cells with an elevated percentage. The injected disk with 0.1 mg MIA demonstrated a progressive degeneration, the disk injected with 0.5 mg MIA induced DD acutely 3 weeks post MIA injection, while the dose of 0.02 mg of MIA did not show much degeneration. CONCLUSIONS: We concluded that 0.1 mg MIA is the most suitable dose to establish a model of DD, which enabled us to replicate the onset, progression, and outcome of diverse histopathologies of DD in the clinic.

[Monteggia fractures-dislocations in children: retrospective study of 40 cases in the Department of Orthopedics, Habib Bourguiba University Hospital in Sfax, Tunisia]. / Fractures-luxations de Monteggia chez l'enfant: étude rétrospective de 40 cas dans le Département d'Orthopédie, Centre Hôpital Universitaire Habib Bourguiba de Sfax, Tunisie.

Monteggia's fracture-dislocation is rare in pediatric traumatology and pose a problem of elapsed time before management and of prognosis. The purpose of this study was to describe the epidemiological features of this fracture and to assess functional and anatomical results. We report a series of 40 cases of Monteggia fracture in children whose data were collected and treated at the Habib Bourguiba University Hospital Center in Sfax over a period of 17 years, from January 1998 to January 2015. We listed the epidemiological data of our population as well as the types of fracture dislocations according to the Bado radiological classifications. For functional assessment, the choice of treatment was based on the type of fracture. P. Rigault's score and Kim's score were used. The average age of our study population was 8 years; 20 cases of fractures were classified as Bado I and 12 cases as Bado III. The time elapsed before treatment was less than 24 hours in 82% of cases. Surgical treatment was performed in 28 cases, and functional results were judged to be good in 30 cases. Our results were satisfactory due to the short time elapsed before patient management compared to literature data.

[Anterior cruciate ligament reconstruction using Mac Intosh technique modified by Jaeger: a retrospective study of 80 cases in the Department of Orthopedics and Traumatology at the Habib Bourguiba University Hospital, Sfax, Tunisia]. / Reconstruction du ligament croisé antérieur selon la technique de Mac Intosh modifiée par Jaeger: étude rétrospective de 80 cas au service d'orthopédie et traumatologie CHU Habib Bourguiba, Sfax, Tunisie.

Recent studies about anterior cruciate ligament (ACL) surgery have focused on a better control of rotational stability, but ACL reconstruction is always a topical issue. The purpose of our study was to evaluate clinical and radiological outcomes after the use of the technique for anatomical reconstruction of the ACL with fascia lata, according to Macintosh technique modified by J.H Jaeger. We conducted a study of a continuous series of 80 patients between 2005 and 2019. All patients were assessed according to the International Knee Documentation Committee (IKDC) score and the Lysholm and Tegner scale. All our patients were rated as excellent with an average score of 92. Occasional lateral residual pain was reported by 8 patients. Residual jerk accounted for 2.5%. Radiological examination did not show ballooning or arthrosis at the last follow-up. Anterior cruciate ligament reconstruction is a common procedure that has become more reliable over time. But pivot shift (Jerk test) requires a lateral tenodesis "external rotation", especially in athletes.

Impact of Needle Size on the Onset and the Progression of Disc Degeneration in Rats.

BACKGROUND: Numerous animal models of intervertebral disc (IVD) degeneration have been proposed in the literature. The rat caudal disc has been used in disc degeneration studies because of its low cost and simplicity. However, no consensus on the size of the needle to be used during this process has been reached, yet. OBJECTIVES: This study aims to select an optimal needle size to establish a reproducible IVD degeneration model. STUDY DESIGN: This is a randomized, experimental trial. SETTING: Cell therapy and experimental surgery of musculoskeletal system LR18SP1 Lab, The Faculty of Medicine of Sfax, Tunisia. METHODS: The validity was verified by magnetic resonance imaging (MRI), histological, and immunohistochemical examinations. RESULTS: The MRI, histological, and immunohistochemical examinations showed that a disc that is perforated with a 21G needle degenerated acutely one week after the surgery, while a 29G needle puncture failed to develop disc degeneration. A 25G needle induced progressive degeneration in the IVD. LIMITATIONS: This study was not very long (6 weeks). CONCLUSIONS: We conclude that the size of the needle affects the onset and the progression of disc degeneration; a larger needle size leads to a more extended histological and radiographic degeneration within the IVD and in a relatively short time. Therefore, a 21G needle is an optimal choice to induce rapid degeneration in rats' caudal discs. However, the use of a 29G needle failed to establish a degenerative IVD model, which makes it ideal for IVD injection of drugs, plasmids, and growth factors. A 25G needle may be used to induce gradual degeneration.

Prognostic factors and treatment of relapsed osteosarcoma: A monocentric Tunisian retrospective study.

BACKGROUND: This study aimed to explore the treatment modalities of relapsed osteosarcoma, treatment results, and prognostic factors. METHODS: We conducted a retrospective study of patients treated for relapsed osteosarcoma between 2005 and 2019. Patient survival was compared according to age, performance status, time to relapse, and surgical treatment at the relapse. Values of p<0.05 were considered to indicate statistical significance. RESULTS: We included 49 patients who were treated for osteosarcoma. During the 13-year study period, 16 patients had relapsed osteosarcoma (32.7%). Prognostic factors of relapse were age over 18 years (p = 0.03), axial tumors (p = 0.01), and positive surgical margins (p = 0.018). Nine patients had palliative chemotherapy at the time of relapse. After a median follow-up of 8 months (range: 4-65 months), the overall survival at 1 year, 2 years, and 5 years after diagnosis of the relapse was 46.7%, 31.1%, and 20.7%, respectively. Relapsed osteosarcoma patients who had good performance status, late relapse (after 12 months), as well as surgery of the relapsed disease had better overall survival (OS). CONCLUSION: Surgical treatment of relapsed osteosarcoma should be performed whenever possible since it improves significantly the survival of patients. Good performance status and late relapse were also associated with better survival.

Congenital syndactyly: a retrospective study of 18 cases at the Department of Orthopaedic Surgery and Traumatology of the Habib Bourguiba University Hospital, Sfax, Tunisia.

Congenital syndactylies are frequent congenital malformations of the hand. They can be an isolated finding or they can be found in association with other polymalformative syndromes. Several surgical techniques used to treat them have been described in the literature. The most used is the dorsal commissural omega-flap technique. We here report a study of 18 patients with congenital syndactyly, with multiple involvement in several cases, whose data were collected at the Department of Orthopedics and Traumatology of Sfax (Tunisia). All patients were operated using the dorsal commissural omega-flap technique. We operated 42 commissures in 18 patients. The average age of patients was 7 years. Only 3 patients had syndromic forms. Six of these patients were operated in two stages. For scar quality, mean OSAS score was 11.47 (11.35 for simple types and 12 for complex types). All patients with complex types had long-term complications (100%). Six patients with simple types out of 14 had complications (42.85%). The management of congenital syndactylies is surgical. It is important to provide parents with accurate information on the essential role of follow-up appointments in order to avoid complications in the short and the long term.

[Subungual exoxtosis: case report and literature review]. / Exostose sous-unguéale: à propos d'un cas et revue de la littérature.

Subungual exostosis is a benign, uncommon osteocartilaginous tumour that tends to recur. We here report the case of a 17-year boy with subungual exostosis, who reported a history of trauma. Treatment was based on direct surgery. The tumor was completely excised. The postoperative course was uneventful, with no recurrence identified.

[Retrospective study of 50 cases of tibial pilon fractures in adults at the Department of Orthopedics of the University Hospital Center Habib Bourguiba, Sfax, Tunisia]. / Etude rétrospective de 50 cas de fractures du pilon tibial chez l'adulte dans le Département d'Orthopédie, Centre Hospitalier Universitaire Habib Bourguiba de Sfax, Tunisie.

Tibial pilon fractures are polymorphic fractures posing therapeutic and prognostic challenges. The purpose of this study is to examine the epidemiological profile of these fractures and to assess our findings from an anatomical and functional point of view. We collected data fom 50 medical records of patients treated for tibial pilon fractures and monitored over the period 2004-2013 at the Orthopedic-Trauma Department of the Habib Bourguiba University Hospital in Sfax. Functional outcomes were assessed using the Ankle-Hindfoot score. Radiological findings were used to determine fracture healing. Treatment was based on internal osteosynthesis in 30 cases, external fixation in 11 cases and on a combination of both techniques in 9 cases. At the end of this study, functional outcomes were good and very good in 36 cases. Thirty cases of fracture healing were reported, with 18 cases of vicious callus and two cases of pseudosteoarthritis. Therapeutic management of tibial pilon fractures is difficult in some cases. Solid osteosynthesis with anatomical reduction is the only therapeutic option to secure a satisfactory functional outcome.

[Acute osteomyelitis caused by community-acquired methicillin-resistant Staphylococcus aureus in children: about 15 cases]. / L´ostéomyélite aiguë à Staphylocoque aureus résistant à la méthicilline d´origine communautaire chez l´enfant: à propos de 15 cas.

The treatment of acute osteomyelitis is becoming more challenging since the emergence of community-acquired methicillin-resistant Staphylococcus aureus. We collected data on all patients with acute osteomyelitis caused by this germ over a period of 21 years (January 1995-December 2016) and we analyzed the peculiarities of this disorder. Our case series includes 15 children, with an average age of 9 years. All patients had affected lower limb. Local trauma was reported in 8 cases and skin carriage in 4 cases. Acute onset was reported in 12 cases associated with pseudo-paralysis of the affected limb. One patient had Staphylococcus aureus pulmonary infection with signs of septicopyemia. Blood culture was positive in 8 cases. In one case PCR assay for detection of Panton-Valentine leukocidin was performed with positive result. All these patients underwent surgical debridement and received secondarily adapted empirical antibiotic therapy. Outcome was good in 8 cases and poor in the other cases, with transition to a chronic state in 6 cases and one case of death. Pathological fracture was reported in 3 cases. Osteomyelitis cause by community-acquired methicillin-resistant Staphylococcus aureus is associated with a pejorative outcome. Recognizing the clinical and paraclinical signs of these infections is essential for a specific and early therapeutic management.

The effectiveness of platelet-rich plasma gel on full-thickness cartilage defect repair in a rabbit model.

AIMS: The present study investigates the effectiveness of platelet-rich plasma (PRP) gel without adjunct to induce cartilage regeneration in large osteochondral defects in a rabbit model. METHODS: A bilateral osteochondral defect was created in the femoral trochlear groove of 14 New Zealand white rabbits. The right knees were filled with PRP gel and the contralateral knees remained untreated and served as control sides. Some animals were killed at week 3 and others at week 12 postoperatively. The joints were harvested and assessed by Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) MRI scoring system, and examined using the International Cartilage Repair Society (ICRS) macroscopic and ICRS histological scoring systems. Additionally, the collagen type II content was evaluated by the immunohistochemical staining. RESULTS: After 12 weeks post-surgery, the defects of the PRP group were repaired by hyaline cartilage-like tissue. However, incomplete cartilage regeneration was observed in the PRP group for three weeks. The control groups showed fibrocartilaginous or fibrous tissue, respectively, at each timepoint. CONCLUSION: Our study proved that the use of PRP gel without any adjuncts could successfully produce a good healing response and resurface the osteochondral defect with a better quality of cartilage in a rabbit model. Cite this article: Bone Joint Res 2021;10(3):192-202.

[Retrospective study of Galeazzi fractures in adults hospitalized in the Department of Orthopaedics at the Habib Bourguiba University Hospital, Sfax, Tunisia: about 45 cases]. / Etude rétrospective des fractures de Galeazzi chez l'adulte dans le Département d'Orthopédie du Centre Hospitalier Universitaire Habib Bourguiba Sfax, Tunisie: à propos de 45 cas.

Galeazzi fracture is defined as the association of radius fracture and inferior radioulnar joint dislocation. Its diagnosis is often unrecognized initially. The purpose of our study is to determine the epidemioclinical features of Galeazzi fracture-dislocations in adults and to assess the functional and radiological outcomes of our case series. We conducted a retrospective descriptive study of 45 patients with Galeazzi fractures treated surgically whose data were collected in the Department of Orthopaedics at the Habib Bourguiba University Hospital, Sfax, Tunisia, over a period ranging from 2009 to 2018. We used Mestdagh score for the clinical evaluation of the results. The mean time between fracture and treatment initiation was 5.35 days. Fixation of the radius was performed using screwed plate in 39 cases and fixation of the radio-ulnar joint using a plug in 13 cases. The average time for union was 10.5 weeks. Outcomes were excellent in 35 patients, good in 3 patients, medium in 6 patients and adverse in a patient. We had 3 cases of sepsis at the level of the plug and two cases of malunions. Galeazzi fracture-dislocation is an under diagnosed disorder in some cases. Dynamic intraoperative examination after solid fixation of the radius can allow for good functional results.

Posterior short segment pedicle screw fixation for the treatment of thoracolumbar fracture.

The choice of the type of stabilization device in the osteosynthesis of dorso-lumbar spine fractures remains a subject of controversy. The present study aims to evaluate the efficiency of short segment in patients suffering post-traumatic thoracolumbar fractures. This study was conducted in the Department of Orthopedic Surgery and Traumatology of the Habib Bourguiba University Hospital, Sfax, Tunisia. All our patients had a spinal osteosynthesis via the posterior approach with a short segment pedicle screw fixation. We established a record of the pre and post-operative data, the functional results in the post-operative stage during the follow-up period and in retrospect according to the Denis Pain Scale, as well as the Oswestry score. The correction was evaluated by determining the relative gain and loss at the last period of retrospect: vertebral kyphosis, regional kyphosis, Gardner Segment Kyphotic Deformity (GSKD), and computed tomography (CT) scan in retrospect to check the quality of the arthrodesis. The average Oswestry score was 14%. Twenty-nine patients had an Oswestry score ≤40%. The relative gain obtained postoperatively was 57.3% for vertebral kyphosis, 67.2% for regional kyphosis and 71.3% for Gardner kyphosis deformity; while the loss of correction at the last follow-up was 0.6° for vertebral kyphosis, 1.5° for regional kyphosis and 0.9° for GSKD. No cases of non-union were reported. The short segment fixation makes it possible to limit operating time, the abundance of bleeding and the aggression of the soft tissues.

Continuous external compression for the treatment of humeral pseudarthrosis: a single center experience.

Humeral pseudarthrosis are common with a non-union rate after fracture between 8% and 13%. Several operative methods have been described for the treatment of humeral pseudarthrosis. The aim of this study was to assess a new approach based on compression using a monoplane external fixator without graft. This study was conducted in the Department of Orthopedic Surgery, and Traumatology of Habib Bourguiba University Hospital in Sfax-Tunisia between April 2009 and September 2018. Fifty-eight patients were operated on using a dynamic monoplane axial fixation device with continuous compression by manipulating the compression system of the fixator. All the cases were evaluated according to the modified Stewart and Hundley classification. The fracture was located in the middle third in 53.4% of the cases. The pseudarthrosis was hypertrophic in 34.5% of the cases. Fifty-four patients were treated with this method as a first cure of non-union and four patients had previously a first cure for their pseudarthrosis. We noted 11 septic pseudarthrosis. The average follow-up was 47.2 months. We obtained consolidation in 98% of the cases. The average consolidation time was 5.1 months. Based on the modified Stewart and Hundley criteria, 75.8% had very good results. This study highlights that a continuous external compression is effective in the treatment of non-unions, as it allows consolidation without opening the pseudarthrosis site and without bone grafting while having satisfactory anatomical and functional results.