[Villonodular synovitis of the knee: about 20 cases]. / Les synovites villonodulaires du genou: à propos de 20 cas.

Pigmented villonodular synovitis (PVNS) is a rare benign proliferation of synovial joints, serous bursa, tendinous sheaths of unknown etiopathogeny. We here report 20 cases of PVNS of the knee recorded at the Avicenne Military Hospital, Marrakech over a period of 9 years, from January 2000 to December 2009. This study aimed to identify the specific features of this lesion and to examine its anatomoclinic and prognostic aspects. Annual incidence was 2.2 cases per year: 15 men and 5 women. The average age was 32.5 years. It occurred in the right-hand in 55%, 18 patients had monoarticular presentation of the disease while 1 patient had biarticular presentation of the disease. 80% of cases had pain and swelling, palpable mass was detected in 1 case, meniscal syndrome in 1 case, monoseptic arthritis in 3 cases while popliteal cyst in 2 cases. 14 cases (70%) had diffuse involvement, 6 cases had localized involvement. MRI was evocative in 3 patients out of 5; 2 patients underwent diagnostic arthroscopy. Diagnosis was based on anatomo-pathological examination. Treatment was based on subtotal synovectomy in 15 cases and on tumor excision in patients with localized involvement. 2 cases with osteocartilaginous destruction underwent arthroplasty. Patients' evolution was marked by 2 diffuse recurrences after a mean follow-up of 3-7 years. 3 patients had stiffness associated with quadriceps atrophy, therefore arthrolysis was performed. One case of histologically confirmed PVNS had proved to be a monophasic synovial sarcoma invading the bone 5 months after total synovectomy. Hence, the indication for amputation.

[Role of centro-medullary nailing in fractures of the distal quarter of the leg: about 30 cases]. / Intérêt de l'enclouage centromédullaire dans les fractures du quart distal de la jambe: à propos de 30 cas.

The fractures of the distal quarter of the leg are characterized by fracture line located at the level of the lower quarter of the tibia, according to Gerard and Evrard definition [1]. They are serious and pose problems for consolidation, immobilization and stability. We here describe our experience in the Department of Orthopaedics and Traumatology at the Avicenne Military Hospital, Marrakech. We report 30 cases of closed fractures of the lower quarter of the leg treated with centro-medullary nailing over a period of 10 years (January 2001-December 2010). Locked nailing was performed in 80% of cases and simple nailing was performed in the other cases. The average age of patients was 36 years. There was a clear male predominance (27 men, 3 women). The average time for consolidation was 17 weeks and functional outcomes were satisfactory. A single case of infection occurred 6 months after surgery (3.3%) and no other complication was reported. Malunion was detected in 30% of patients. Our epidemiological data and results were almost identical to those in the literature. Angular results were significantly lower than those obtained with the series of plates. By contrast, data on infections called for caution and some nails produced excellent angular results when nail fixation was stable. In the light of these results, codified indications for locked centro-medullary nailing should be extended to the fractures of the lower quarter of the leg, provided that stable fixation using double screw distal locking and primary osteosynthesis of distal fibula fractures are performed.

[Role of Hackethal bundle nailing in the treatment of humerus fractures: about 80 cases]. / Place de l'embrochage fasciculé selon Hackethal dans le traitement des fractures de l'humérus: à propos de 80 cas.

The main debate regarding humerus fractures focuses on their therapeutic indications because any type of orthopedic or surgical stabilization finds unconditional and sometimes vehement defenders. We conducted a retrospective study of 80 patients treated initially with Hackethal's technique of intramedullary bundle nailing in the Department of Orthopaedics and Traumatology at Avicenne Military Hospital between January 2000 and January 2012. The fractures were classified according to AO classification and Hackethal classification (modified by De La Caffinière). Functional assessment was based on the modified Stewart and Hundley classification. We got 60 very good outcomes, 6 good outcomes, 2 quite good outcomes and 2 poor outcomes. The two cases with poor outcomes had pseudarthrosis. We noted no iatrogenic radial nerve palsy, infection or pin migration. The average time for union was 9 weeks and 6 days. This is a reliable, easy to perform and low cost technique, which provides a good stabilization of the fracture site, allowing early mobilization with excellent functional outcomes.