Multifragment fracture of the patellar apex with extensive loss of skin: A case report.

Introduction: Patella fractures account for 1 % of all skeletal fractures, and can interrupt the knee's extensor apparatus. They can also be serious if associated with a cutaneous opening. We report the case of a fracture of the tip of the patella with a large loss of cutaneous substance. Case report: A 22-year-old man was admitted for the management of a left knee trauma following a motorcycle accident. Clinical examination revealed a large loss of skin substance on the anteromedial aspect of the knee, with exposed bone, pain and lack of extension of the left knee. Standard X-ray of the left knee showed an avulsion fracture of the tip of the patella. The patient underwent patellar tendon reconstruction using transosseous stitches, reinforced by a quadricipital tendon reversal plasty, and protected by steel-wire patellotibial cerclage. A medial gastrocnemius flap was used to cover the loss of skin substance. After a functional rehabilitation protocol, the functional results were satisfactory, with a full return to activity after six months. Conclusion: The stability of osteosynthesis using quadricipital tendon reversal plasty and patellotibial cerclage allows mobilization and immediate weight-bearing. This may lead to better clinical results.

Intra-articular elevating osteotomy for tibial plateau fracture malunion with intra-articular depression: Surgical technique and review.

Open reduction with internal fixation is the gold standard treatment for tibial plateau fractures. However, some complications can be observed despite a well-established procedure. Apart from stiffness, malunion is the most frequent complication of tibial plateau fractures. These malunions may be intra-articular or extra-articular or combined. Intra-articular or extra-articular osteotomy is a good option to treat malunion in young and active patients without significant joint damage. When malunion is associated with extensive joint involvement or the initial cartilage damage has resulted in knee osteoarthritis, the surgical option is a total replacement of the knee joint with arthroplasty. We report the case of a patient with a tibial plateau fracture treated initially at a traditional bonesetter complicated at the end of the treatment with the persistent of the knee pain and limping.

A Partial Frontal Fracture of the Humeral Trochlea: A Case Report.

Fractures of the lower end of the humerus are uncommon but serious, potentially compromising elbow function. This article reports the case of a young patient with a fracture of the inner cheek of the humeral trochlea, resulting from a public road accident. The diagnosis was established by radiography and CT scan, confirming a displaced fracture associated with an avulsion fracture of the coronoid process. Surgical treatment was carried out with fixation of the osteochondral fragment and evacuation of the intra-articular fragments. Two months after the operation, the patient regained good joint function with a resumption of professional activity.

Closed medial subtalar dislocation: A case report and literature review.

Subtalar dislocation is characterized by simultaneous dislocation of the subtalar (talocalcaneal) and talonavicular joints, hence the name talocalcaneonavicular. These lesions can be grouped into four distinct categories: anterior and posterior, which are exceptional, lateral and medial. Medial subtalar dislocations are more frequent, are due to low-energy trauma and generally have good functional results. Anatomical reduction and stabilization of the subtalar joint and optimal management of all associated foot injuries are the key to good results.

Primary Hydatid Cyst of the Trapezius Muscle: An Unusual Location and Review of the Literature.

Hydatidosis is a cosmopolitan anthropozoonosis common to humans and many mammals, caused by the development in the body of a dog tapeworm called Echinococcus granulosus. As accidental intermediate hosts, humans contract the infection either directly through contact with dogs or indirectly by ingesting contaminated food. They represent an epidemiological dead-end. Hydatid cysts are typically associated with the liver and lungs and, more rarely, with bones, the brain, eyes, heart, kidneys, and spleen. We present an unusual case of a hydatid cyst located in the trapezius muscle of a 76-year-old woman. Clinical, biological, and radiological data allow us to evoke the diagnosis and avoid an inopportune puncture. Treatment was exclusively surgical, with the removal of the cyst without cyst breach.

Megaprosthesis Total Knee Replacement Following Resection of Extensive Osteoblastic Osteosarcoma in the Distal Femur: A Case Report.

Osteosarcoma is the most common type of primary bone cancer, which usually appears in the distal femur. The diagnosis of this condition typically involves advanced imaging and tissue biopsy, as well as taking into account characteristic clinical and radiographic indicators. The treatment approach for distal femoral osteosarcoma is multidisciplinary and involves initial chemotherapy, followed by limb-sparing surgery, reconstruction of bone and soft tissue, and subsequent adjuvant chemotherapy. We present a case study of a 25-year-old male admitted with a blastic lesion in the distal femur, confirmed via open biopsy to be osteoblastic osteosarcoma. Further evaluation revealed multiple pulmonary nodular lesions, managed with chemotherapy. After four months, regression of the lesion was observed. Due to malignant clinical and imaging features, excision of the lesion and subsequent reconstruction were performed, utilizing a custom-made total knee arthroplasty. The excision encompassed the removal of the distal 14 cm of the femur, with histological examination confirming central osteoblastic osteosarcoma. Satisfactory outcomes were observed during a one-year follow-up, indicating promising results. Vigilance is crucial, especially in young patients with surface-type bone tumors, as this neoplasm requires consideration.

Hydatid Cyst of the Inguinal Region: An Exceptional Localization.

Cystic echinococcosis (CE), stemming from the larval stage of the cestode Echinococcus granulosus, stands as a widespread parasitic zoonosis primarily afflicting the liver and lungs. However, instances in the inguinal region are exceptionally infrequent. We present a distinctive case involving a 49-year-old female with a progressively enlarging inguinal mass over a five-year period, characterized by the absence of hepatic or pulmonary involvement. This case underscores the unique clinical presentation and diagnostic intricacies associated with extrahepatic and extrapulmonary expressions of CE. The presented case contributes to advancing our comprehension of unconventional hydatid disease presentations, highlighting the imperative for a multidisciplinary approach in both diagnosis and treatment. Ongoing research endeavors and collaborative efforts are pivotal for refining strategies and enhancing outcomes in patients with rare manifestations such as inguinal hydatid cysts.

Aseptic Osteonecrosis of the Femoral Head: The Effect of Corticosteroid Therapy and Long COVID Syndrome.

SARS­CoV­2 infection remains a hot topic; it is characterized by its multi-systemic involvement. Corticosteroid intake has been the subject of worldwide attention as a potentially effective treatment against coronavirus disease 2019 (COVID-19). Corticosteroids are registered on the WHO list of essential medicines, easily accessible for a low price, and particularly useful for different categories of people. The authors highlight the impact of corticosteroid administration for COVID-19 treatment on the occurrence of aseptic osteonecrosis in the femoral head. They also examine the pace of onset in comparison to corticosteroid usage unrelated to COVID-19. This article presents a patient with osteonecrosis of the femoral head after taking corticosteroid therapy in the treatment of COVID-19. The dose taken by the patient is 90 mg of dexamethasone equivalent to 600 mg of prednisone. The patient experienced the onset of OTA, and the duration of development was three months, indicating a relatively brief period. Comparison was made with data from the literature from 6 months to 1 year after taking corticosteroids in a context outside of COVID-19.

Bilateral Inverted V-shaped High Tibial Osteotomy: A Case Report.

The article describes the case of a young patient with bilateral genu varum deformity, limiting her mobility. The therapeutic decision was a staged reverse V-shaped tibial osteotomy on both knees at a six-month interval. The surgery faced infectious complications on the left side, requiring additional treatment. Despite this, the patient achieved successful correction, with wound healing and bone consolidation. Preoperative planning was crucial, determining specific correction angles for each knee. The reverse V-shaped osteotomy demonstrated satisfactory functional outcomes compared to other techniques. The conclusion emphasizes the effectiveness of reverse V-shaped high tibial osteotomy (HTO) in addressing varus tibial deformities, providing an alternative before considering total knee arthroplasty. Multicenter studies and long-term evaluations are recommended to refine this surgical procedure.

Achilles Tendon Tear Following an Unusual Pattern of Open Pure Ankle Dislocation: A Case Report.

We present a rare case of concurrent open Achilles tendon tear and pure subtalar dislocation in a 20-year-old male following a motorcycle accident, highlighting the complexity of managing such unique musculoskeletal injuries. The patient was initially admitted with an open and deformed left ankle, underwent prompt primary debridement, and received immediate medical intervention. Despite unsuccessful attempts to reduce the dislocation through external maneuvers, subsequent radiographic evaluation revealed a subtalar dislocation associated with a 90° rotation of the talus. A direct reduction was achieved in the operating room, uncovering a complete tear of the Achilles tendon and a section of the posterior tibial artery during more intensive debridement. The vascular surgery team repaired the posterior tibial artery, followed by Achilles tendon repair using a Kessler suture technique. Postoperative care involved immobilization and adapted rehabilitation, resulting in the patient regaining full range of motion without complications. To the best of our knowledge, this case represents the first reported open lateral subtalar dislocation associated with an open Achilles tendon tear. The detailed treatment strategies and outcomes offer valuable insights for clinicians facing similar challenges and inspire further research on rare musculoskeletal injuries.

Right adductor compartment intramuscular myxoma: A rare case report.

INTRODUCTION: Extracardiac intramuscular myxomas are exceedingly rare benign tumors, necessitating well-planned management for optimal outcomes. CASE PRESENTATION: We report the case of a 63-year-old male with no prior medical history, presenting with a progressively enlarging mass within the adductor compartment of the right thigh. Physical examination revealed a mobile and painless mass measuring 70 mm by 50 mm at the level of the adductor compartment of the right thigh, devoid of signs of inflammation or skin lesions. The patient showed no cachexia, asthenia, or weight loss. Imaging exams confirmed the characteristic features of intramuscular myxoma, leading to the decision for complete surgical excision. Subsequent histological analysis confirmed the diagnosis, and the patient experienced no postoperative complications, showing positive long-term follow-up results. CLINICAL DISCUSSION: In the presence of an intramuscular mass, thorough questioning and meticulous clinical examination enable us to propose a diagnosis of intramuscular myxoma. MRI is the preferred imaging modality, supporting diagnostic reasoning. However, histopathological analysis remains essential to confirm the mass's nature and rule out potential malignant differential diagnoses. Complete surgical resection is considered the gold standard, ensuring favorable results with a low risk of recurrence. CONCLUSION: Extracardiac intramuscular myxomas are exceptionally rare; MRI and histopathological analysis combined help rule out potential malignant differential diagnoses. Total surgical excision yielded good results with a low risk of recurrence.

Pure Open Ankle Dislocation Leading to Isolated Lateral Ligament Complex Tear: A Rare Case.

Pure open ankle dislocation is a rare orthopedic emergency characterized by the absence of associated bony lesions, necessitating prompt and immediate management to prevent disastrous complications. This article details a distinctive case of open pure ankle dislocation in an 18-year-old female following a motorcycle accident, resulting in a 6-cm wound and a dislocated left ankle with a concurrent tear of the anterior talofibular ligament and calcaneofibular ligament. Immediate reduction under sedation was performed, followed by intensive debridement and ligament repair in the operating room. Postoperatively, the patient received antibiotic coverage for five days and underwent immobilization for six weeks. At the 18-month follow-up, the patient exhibited a complete range of motion with no reported pain or instability. This study contributes to the existing literature by presenting a successful treatment paradigm, providing valuable insights for practitioners encountering similar cases.

Osteochondroma of Distal Femur Managed With Complete Excision: A Case Report.

Osteochondromas are benign bone tumors that usually occur between the ages of 10 and 30, with no marked gender preference. These lesions result from the separation of the epiphyseal growth plate and are categorized as growth plate development abnormalities rather than true neoplasms. It is important to note that long-term solitary osteochondromas can evolve into osteosarcomas, with chondrosarcoma being the most common among them. However, the risk of recurrence is considerably reduced if the tumor is completely resected from its original site, with no residual perichondrium or cartilage cap left in place. In this context, a 29-year-old man with osteochondroma in the distal femur was successfully treated with complete resection, showing a favorable evolution.

Primary Hydatid Cyst of the Gluteal Muscle: A Case Report.

Hydatid disease, also known as cystic echinococcus, is a parasitic infection initiated by Echinococcus granulosus. It primarily affects the lungs and liver, but it can also occur in other organs. Hydatid cysts in the gluteal muscle are an exceedingly rare phenomenon, even in areas with high prevalence. We report the case of a 29-year-old farmer who presented with a painful mass in the gluteal region. The diagnostic findings unveiled the existence of a hydatid cyst within the gluteal muscle managed with complete pericystectomy and chemotherapy with antiparasitic drugs. In regions where hydatid cysts are prevalent, it is essential to include them in the list of potential diagnoses for any cystic mass. Diagnosing such cases can be difficult, and surgery remains the most effective treatment.

A Rare Case of Cavernous Intramuscular Hemangioma of the Forearm.

Cavernous intramuscular hemangiomas are a part of a group of rare benign tumors. This case report outlines a unique instance involving a 72-year-old patient who sought medical advice at our department due to a progressively enlarging mass in the posterior aspect of her right forearm. Physical examination revealed a painless, mobile mass with no apparent skin abnormalities. Radiographs showed normal results, and an MRI raised suspicion of a fibrous tumor. A subsequent biopsy confirmed the diagnosis of cavernous hemangioma. The patient underwent a total excision procedure, resulting in favorable outcomes with no observed functional impairment or tumor recurrence over four years. This case is notable for its singularity, involving both the advanced age of the patient and the uncommon location of the tumor.

Bilateral Total Hip Prosthesis in Coxarthritis of Inflammatory Origin: Technical Features and Intraoperative Complications Encountered in Five Cases.

Total hip arthroplasty remains the treatment of last resort in inflammatory coxarthritis, where joint destruction is bilateral as well as the treatment which must be bilateral. We present in this work the experience of our orthopaedic department with a series of five cases (10 hips) operated for total hip arthroplasty. the first particularity observed in this series is the abnormal bone fragility present in 55% of the cases. For this reason, we had two other intraoperative complications that are related to this bone fragility, during the preparation of the acetabulum, we had a destruction of the medial wall by the burr that went unnoticed intraoperatively and was discovered during the patient's recovery from acute ischemia secondary to the burr, which led to an extensive rupture of the common femoral vein and partial sectioning of the common femoral artery. We also had an exceptional incident in a case with two ankylosed hips; in fact, when the approach was performed, the sciatic nerve was found pressed against the posterior surface of the greater trochanter, which was unusual but was explained by the retraction of the structures of the gluteal region secondary to prolonged immobilization. Thus, there was one case of cement shock manifested by hypotension occurring immediately after cement placement. In front of this inflammatory disease and ankylosis terrain, the surgeon must always be prepared for any complication and must keep in mind that he is operating on a hip that is anatomically not normal due to ankylosis and retraction of the vascular, nerve, and muscle structures.

Fracture-Dislocation Dorsal of the Proximal Interphalangeal Joint: A Case Report and Focus on Volar Plate Injuries.

The proximal interphalangeal (PIP) joint is the articulating joint between the proximal and middle phalanges of the fingers. A dorsal fracture-dislocation of the PIP joint of the fingers with volar plate injuries is an uncommon injury. Few cases have been published in the literature. In this article, we report the case of a subluxation fracture of the PIP joint in a 27-year-old male patient, without pathological history, a manual worker, right-handed, diagnosed 28 days after the injury. The treatment was surgical with open reduction and fixation of the fragment of the base of P2 with osteosutures. The functional results after three months were satisfactory with good sagittal and frontal joint stability and active flexion of the PIP joint at 95° and active extension at 0°. The control radiographs confirm the consolidation of the osteochondral fragment of the base of P2. The patient returned to his usual activities without pain.

Isolated dorsal dislocation of the distal radioulnar joint: A case report.

Isolated acute dislocation of the distal radioulnar joint is a rare lesion, and in 50 % of cases goes unrecognized; it may be palmar or dorsal. Its diagnosis is suspected when the wrist is traumatic, painful, with limited pronosupination and no fracture on radiological examination. Treatment is aimed at preventing the development of chronic instability and/or arthrosis, and consists of reduction followed by immobilization.

Tuberculosis of the Pubic Symphysis: A Case Report.

Tuberculosis of the pubic symphysis is rare; the diagnosis is often difficult but guided by CT and confirmed by histopathological examination. We report the case of a 25-year-old female with no particular past medical history, presenting with pain at the level of the pubic symphysis. Clinical examination showed a small renitent mass and pain on palpation without inflammatory signs. Radiological investigation showed demineralization, lysis, and diastasis of the pubic symphysis with a cystic image in favor of tuberculosis. A biopsy followed by resection was performed, and histopathology confirmed the diagnosis. The patient received medical care for nine months using the 2RHZE/7RH protocol (rifampicin, isoniazid, pyrazinamide, ethambutol), with good results at follow-up. Bone lesions of the pubic symphysis may exceptionally reveal tuberculosis, and the positive diagnosis is based on a histopathological test.

Tuberculosis of navicular bone: An exceptional localization of osteoarticular tuberculosis.

Osteoarticular tuberculosis (OAT) is defined by the set of pathological manifestations secondary to the attacks of osteoarticular structures of the locomotor system by the Bacillus of Koch (BK). We report a case of tuberculosis of the navicular bone, which is a rare location of OAT, on a female patient who consulted for chronic pain (mixed appearance) evolving for more than 7 years and for whom we realized a radiological assessment based on standard radiography and magnetic resonance imaging and a biological assessment. The foot is rarely involved, accounting for about 10% of cases of osteoarticular tuberculosis. The diagnosis is often made at a late stage because osteoarticular tuberculosis is paucibacillary, and it is difficult to isolate or culture Koch's bacillus. Clinical manifestations are aspecific; pain and joint swelling are the 2 usual signs. Pain may be mechanical, inflammatory, or mixed. The standard radiography allows first to orient the diagnosis by the demonstration of a lytic process; a biological inflammatory syndrome and the magnetic resonance imaging allow to give more arguments in favor, then the biopsy comes to confirm the diagnosis. Tuberculosis of the navicular bone is a rare localization of OAT; its diagnosis is the same as well as the treatment.