The Challenging Diagnosis and Management of a Pediatric Bicondylar Hoffa Fracture: A Case Report.

Introduction: Hoffa fractures are uncommon fractures in adults and less common in children. They are defined as fractures of the femoral condyles that occur in the coronal planes. To this day, Hoffa fractures in children comprise only of case reports. Case Report: Our case report is focused on a 12-year-old patient victim of a high-impact trauma causing a bicondylar Hoffa fracture. The diagnosis was based on an X-ray in front and lateral views and confirmed by a computed tomography scan and 3D reconstructions. A screw fixation truth open reduction with a lateral approach. We report the satisfactory results of our case after a 24-month follow-up with a good range of motion. Conclusion: To avoid necrosis of the fragment, pain and stiffness at long-term follow-up make the management of this fracture a serious challenge, and in the pediatric population, the prevention of growth cartilage injuries is crucial to accurate management.

Ewing's Sarcoma Disguised as Aneurysmal Bone Cyst Lesion: About a Case.

Aneurysmal bone cysts are defined as benign lesions. They expose the patients to a higher risk of pathological fractures. The typical clinical and radiological aspects of the tumor usually do not require a pathological confirmation before a definite treatment. However, in some cases, a malignant tumor will have the same clinical and radiological characteristics of a begin lesion. Our case highlights this fact. We present a case of a 13-year-old patient that presented to us with a pathological fracture. The X-ray and CT scan were in favor of ABC; however, the postoperative pathology revealed an Ewing sarcoma. A salvage treatment became mandatory after this finding but was refused by the parents, resulting in the death of the patient 6 months later. A biopsy must be mandatory each time we have a suspicious aneurysmal bone cyst even with typical clinical and radiological characteristics before starting a treatment plan.

An Uncommon Presentation of Osteosarcoma in a Child: A Case Report.

Introduction: Osteosarcoma is the most common primary malignant bone tumor in childhood distinguished by its clinical aspects, epidemiological features, and radiological and histological findings. Around 10% of patients present with distant metastasis at the most frequent sites, which are lungs and bone. Furthermore, death rates for osteosarcoma have been declining by about 1.3% per year. Case Report: We report the case of a 12-year-old child who presented to the emergency department with a large thigh hematoma, and after running all the necessary clinical investigations, it turned out to be secondary to femoral osteosarcoma. Conclusion: In this case, our aim is to highlight the unusual clinical manifestations observed in a child with osteosarcoma, which can lead to a diagnosis delay and the subsequent impact on prognosis.

Posterior Sternoclavicular Dislocation in Children: A Case Report.

Introduction: Sternoclavicular dislocation (SCD) occurs very rarely in children. There is different clinical manifestations that reflect the direction of displacement; diagnosis is difficult, especially if the dislocation was initially unnoticed. We will report this case while conducting a review of the literature to evaluate and adapt our management. Case Report: We report the case of a 12-year-old boy who presented with a right posterior SCD after a trauma occurring 24 h earlier at a sports activity. Clinical examination and radiological investigations by X-ray and computed tomography scan leads to diagnosis. He underwent an orthopedic closed reduction treatment without complications at 24 months of follow-up. Conclusion: Management of posterior sternoclavicular dislocation is different between teams, with a tendency to use orthopedic reduction in case of fresh dislocation and absence of complications. Late diagnosis and management, as well as the presence of complications, may be difficult and life-threatening (due to vascular or tracheal compression).

Chronic recurrent multifocal osteomyelitis mimicking a malignant bone tumor: a case report.

Chronic recurrent multifocal osteomyelitis (CRMO) is an unusual form of non-microbial chronic osteomyelitis. It is an exclusion diagnosis that can only be considered after ruling out infectious osteomyelitis and bone tumors. We report the case of a 13-year-old girl who was admitted for a painful swelling of the left thigh. Biological examinations did not find an inflammatory syndrome. X-rays and Magnetic Resonance Imaging were very suggestive of malignant bone tumor. But the biopsy disclosed a nonspecific osteomyelitis. Considering the strong suspicion of a malignant origin, a second biopsy was performed and confirmed the diagnosis of osteomyelitis. During the hospital stay, the patient developed a second location in the left humerus. Thus, the diagnosis of CRMO was retained. The patient was treated by NSAIDs with good clinical and radiological outcomes. This case report reminds the diagnostic challenge of this pathology that can mimic malignant tumor.

Open reduction in treatment of neglected elbow dislocation in children.

Elbow dislocation in children is uncommon condition in children, it's occurred in 3 to 6% of all elbow injuries. Only case reports and small series reported in the literature. The aim of our study is to evaluate the outcomes of open reduction of neglected elbow dislocation (NED) in children. A retrospective review of 26 neglected elbow dislocation was treated by open reduction at our institution between January 2010 and December 2018 was performed. Age, mechanism of injury, associated fracture, manipulation by bone- setters, infectious complications, were recorded. The SOFCOT criteria was used to assess the stiffness of the elbow in preoperative and in postoperative. Besides, in postoperative we used DI SCHINO Criteria to assess useful ROM and subjective criteria to evaluate pain and performance of daily activity. A total of 26 patients with a mean age of 10 years ranging from 5 to 14 years, were identified and followed for a median of 4 years postoperatively. The median duration before presentation was 5 months ranges from 22 days to 5 years. All patients except one were manipulated by bonesetters with massage and manipulation. The dislocation was postero-lateral in 15 cases (58%). 17 patients (65%) have associated fracture. 17 patients went for internal approach, 5 posterior approach, and 4 with combined internal and external approach. Reduction of the ulnar humeral joint was assisted with a lengthening of the triceps with a Speed V-Y muscle plasty in 13 patients. According to SOFCOT criteria at the last follow-up we obtained 15(58%) of minim and moderate elbow stiffness, and according to DI- SCHINO criteria at the last follow-up, 7(27 %) has a very good result, 7(27%) has a good result. The open reduction and the early rehabilitation remain the key stone of treatment of NED in children regardless the chronicity of the injury. Prevention remains the best way to improve the prognosis of neglected elbow dislocations.

Psoas Hydatid Cyst in Children: A Rare Localization about a Case.

INTRODUCTION: The development of hydatid cysts in the muscle is rare, and it is even rarer in children. We report the case of a 9-year-old child treated in pediatric orthopedics department at the University Hospital of Marrakech for a hydatid cyst psoas muscle revealed by lameness. RESULT: The child was consulted for painless and afebrile lameness of the left hip evolving since 3 months. The clinical examination finds a mass of the left flank. Investigations based on the abdominal ultrasound in first intention showed a hydatid cyst depending on the left psoas muscle. Pelvic CT and abdominal MRI were able to confirm the diagnosis and allowed a better study of the cyst neighboring elements. The drainage of the cyst followed by pericystectomy after evacuation of the vesicles contained in the cyst was done as radical treatment. CONCLUSION: The hydatid cyst of the psoas is a rare entity in the child requiring a good radiological study of the cyst as well as its neighboring elements to propose the most adapted surgery.

Isolated tuberculosis of metacarpal bone in a 3 year-old child.

Primary tuberculosis osteomyelitis of metacarpal bone is rare. The majority of cases occur in children and young adults and there is difficulty in diagnosis mainly in young children. We report a new case in children aged of 3 years, presenting a swelling on the dorsal side of her right hand since 8 months. X-ray showed an expansile, cystic and lytic lesion involving the little finger metacarpal. Tuberculosis was confirmed on histological examination. No lesions in lung parenchyma or lymphadenopathy were associated. Patient was successfully managed by anti-tubercular drugs.

[Bone tuberculosis mimicking malignancy: a case report]. / Forme pseudotumorale de la tuberculose : à propos d'un cas.

Bone tuberculosis may mimic malignant tumor. We here report the case of a 4-year old child with bone tuberculosis mimicking femoral osteosarcoma. The diagnosis was rectified thanks to anatomo-pathologic examination. This case study underlines the importance of knowing the clinical and radiological aspects of bone tuberculosis which can mimic malignant tumor. In order to avoid any delay in diagnosis, surgeons, pediatricians and radiologists should know that tuberculosis can mimic many pathologies, both clinically and radiologically.

Tuberculosis of the wrist in children: A rare manifestation.

Tuberculosis (TB) is still endemic in many developing countries. Involvement of wrist joint is very rare, and the diagnosis is often missed. We present a case of isolated TB of the wrist, which was confirmed with intraosseous tissue histopathological examination in a 10-year-old boy. Antibacterial chemotherapy during 12 months promoted healing and good outcome.

[Gangrene of the hand due to accidental intra-arterial injection of floxacilline: about a case]. / Gangrène de la main après injection accidentelle intra artérielle de floxacilline: à propos d'un cas.

Floxacilline is a beta-lactam antibiotic of the penicillin class. In our context it is used to fight against infections caused by gram-positive bacteria, including staphylococcus aureus. However, floxacilline should be administered with great caution due to its possible side-effects. Our study reports the case of a 6-year old boy who underwent surgery for the treatment of a humeral fracture. The child was treated with injectable floxacilline following a suspected orthopaedic device infection 2 months after surgery. The day after starting antibiotic treatment, the child presented with acute ischemia of the right hand. Then, he was referred to us. Explorations objectified occlusion of the radial artery. The patient underwent relieving fasciotomy and received postoperative heparin. The evolution was marked by gangrene affecting the whole hand. The aim of our study was to educate caregivers about the risk of occurrence of this disastrous complication and about the measures to prevent it.