An extensor tenosynovitis complicated with extensor tendon rupture revealing a hand tuberculosis.

Tuberculous hand tenosynovitis is a rare localization of tuberculosis. It is dominated by flexor tendon involvement; tenosynovitis of the extensor tendons is exceptional. The diagnosis is usually delayed and sometimes overlooked because of the paucity and the chronicity of the symptoms and signs with the patients often seen at the stage of tendon rupture. We, hereby, report the case of a tuberculous tenosynovitis of the extensors of the left hand having evolved into a ruptured extensor tendons to the 4th and 5th digits. The surgical treatment in conjunction with the antituberculous drugs resulted in the healing of this condition.

Comparative study of Iselin's technique for the treatment of Bennett's fracture with large and small fragments.

Objective: The thumb is very exposed to trauma due to its position and function. Fractures of the base of the first metacarpal bone are very frequent in hand traumatology. Most Bennett's fractures are treated surgically. However, the optimal surgical approach is controversial. The aim of this study is to compare the results of closed reduction and percutaneous pinning in the treatment of Bennett's fracture of the base of firsthand metacarpal in fractures with both small and large fragments. Methods: We studied retrospectively the data of 40 patients treated for a Bennett's fracture in the department of orthopaedic and traumatologic surgery between January 2016 and December 2018. The purpose of this study was to compare the functional (pain, grip strength, first web space opening and thumb opposition) and radiological (quality of reduction and arthritic changes) results of the Iselin's technique for the treatment of Bennett's fractures in two groups of patients with large and small bone fragments according to the size of articular surface detached with the antero-medial fragment (superior or inferior to 25%). Results: The average age of the patients was 34 (range = 19-66) years. Males were by far the most affected (90%). We noted 24 cases of large fragment fractures (60%) and 16 cases of small fragment fracture (40%). An excellent overall functional result was found in 68.8% of cases of small fragment fractures versus 50% of cases of large fragment fractures. Radiological results were roughly similar. Conclusion: All surgical techniques aim to restore the articular congruence to the best, maintain the opening of the first web space and obtain a stable and painless trapezo-metacarpal joint. The Iselin's technique is simple, inexpensive and easy to perform even by inexperienced surgeons. It yields satisfactory results in most cases of Bennett's fracture regardless of the size of the fragment.

Humeral artery aneurysm revealing a rare association between tuberculosis and behçet's disease.

The association of pulmonary tuberculosis and Behçet's disease revealed by an aneurysm of the humeral artery is exceptional with a complicated management. We report a case in which the two conditions occurred concomitantly with the vascular complication, apart from any use of immunosuppressive therapy, something that has never been reported in the literature. We report an extremely rare case of a spontaneous rupture of an aneurysm of the humeral artery of a 29-year-old woman with no history. The patient underwent axillo-humeral bypass. Investigations concluded the diagnosis of Behçet's disease associated with pulmonary and lymph node tuberculosis. Antituberculous chemotherapy followed by corticosteroids, immunosuppressants, and colchicine has been administrated. Based on this observation, we insist on the necessity of searching the symptoms of Behçet's disease in the presence of arterial involvement when having a young patient. Therapeutic management must include medical treatment to control inflammation and limit the risk of recurrence. Endovascular or surgical treatment is necessary if the arterial involvement is threatening. The association with tuberculosis complicates management and requires close monitoring.

Bilateral tuberculous dacryoadenitis.

Tuberculosis is a real public health problem in developing countries. The ophthalmic form is a rare clinical entity. Dacryoadenitis presents an exceptional manifestation. We report the case of a 45-year-old female who presented with a 1-month history of painless bilateral dacryoadenitis with a normal initial work-up. Anatomopathological examination of the lacrimal glandular tissue showed a gigantic epithelioid granuloma with caseous necrosis confirming the diagnosis of tuberculosis. The search for a primary focus was negative. Evolution was good under anti-tuberculosis chemotherapy. The objective of this work is to think of the tuberculous etiology when having dacryoadenitis in an endemic country.

The surgical management of a hypogastric dermatofibrosarcoma protuberans.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon skin tumor with intermediate grade of malignancy. Wide surgical resection with disease-free margin offers an excellent probability of cure. These large excisions cause large skin defect that can be difficult to cover. Through this case report we describe a surgically treated DFSP that was covered by a Mc Gregor flap; which despite its seniority is still relevant and continues to serve plastic surgery.

Glomus tumor of the leg: a case report.

Glomus tumors are uncommon benign tumors developing from the neuro-myo-arterial glomus body. They are typically located in the fingers. The extra-digital involvement is unusual and makes diagnosis difficult. Only few cases have been reported in literature. We report an exceptional case of a glomus tumor of the lower leg in a 65-year-old male. The diagnosis was clinically suspected and confirmed by a biopsy. Surgical excision gave immediate pain relief. The aim of this report is to make the surgical community more aware of this entity based on the analysis of our own experience and a review of the literature.

A Rare Case of Glomus Tumor of the Thigh with Literature Review.

INTRODUCTION: GTs are rare, benign tumors, developing from a neuro-myo-arterial structure. Their typical location is in the hand, but they may develop anywhere else. Extra-digital glumus tumors GTs, like the location in the thigh, are rare and much more difficult to diagnose. They are usually misdiagnosed and unproperly treated, due to the absence of the typical symptoms. CASE REPORT: We report a case of a GT of the thigh in a 25-year-old female, presenting with a painful mass on the posterior side of her left thigh, evolving for 15 months. She was suffering from pain and hyperesthesia of the underlying skin exacerbated by movements. The patient was successfully treated by excisional biopsy. CONCLUSION: Gts of the thigh represent an exceptional location of extra-digital Gts, very rare themselves. Pain, hypersensitivity to cold, and severe amyotrophy should raise suspicion for Gts. Through this case we discuss the diagnostic difficulties and the treatment of extra-digital Gts.

The epidemiology of tuberculous dactylitis: A case report and review of literature.

The literature on tuberculous dactylitis is poor, and most literature consists of isolated case reports. The aim of this case series is to study the particularities and the epidemiological aspects of tuberculous dactylitis in Tunisian patients. Google and Medline search was done using key words "tuberculous dactylitis" and "spina ventosa." Only Tunisian reports in adult patients were included. Eleven cases including this mentioned case were included in this review. There was a female predominance, high frequency of trauma before disease installation, rarity of predisposing factors, and less inflammation in blood tests when comparing with other cases in literature.

Place of the reposition flap in the treatment of distal amputations of the fingers.

PURPOSE: Distal finger amputations pose a therapeutic problem with the distal fragment quality. Reimplantation remains the reference treatment for functional and aesthetic recovery of the hand. The interest of this study is to propose the reposition flap as an alternative to different hedging techniques in the proximal stump, in many situations where revascularization is impossible. It consists in osteosynthesis of the bone fragment and its coverage by a pedicled local flap. METHODS: The technique of reposition flap was evaluated retrospectively between 2003 and 2016 through a study of 13 patients compiled in Nabeul orthopedic department. For each patient, the sensitivity, the pulp trophicity, the interphalangeal mobility, the digital length, the appearance of the nail and radiological consolidation were evaluated. RESULTS: The reposition flap keeps more than 80% of the length of p3. This procedure improves nail aesthetics in comparison with the regularizations. There is no significant difference in sensitivity of the pulp or of the mobility of the distal inter-phalangeal (DIP) joint as a function of the technique studied. However there is a significant difference in average test of the Quick Dash (350 against 500 for regularizations). CONCLUSION: The reposition flap seems to be a good alternative to regularization in the context of trans-p3 fingers amputations, in which the distal fragment is not revascularizable. It allows better aesthetic and functional results.

An exceptional location of tuberculous arthritis: The metatarsal phalangeal joint.

Osteoarticular tuberculosis is a rare type of tuberculosis. The spine is the most frequent location, while peripheral locations in the limbs are rare. We report a case of tuberculous osteoarthritis of the metatarsophalangeal joint of the first ray of the foot in a 48-year-old woman. The patient presented with painful swelling of the dorsum of the big toe, insidiously evolving for 6months. Diagnosis was obtained with histological study after surgical biopsy. Antitubercular chemotherapy for 12months promoted healing. Through this clinical case the authors describe the epidemiological, diagnostic features, and treatment of osteoarticular tuberculosis and discuss the causes of delayed diagnosis often encountered in these exceptional locations and differential diagnoses, gout in particular, for this particular case.

Kuhlmann vascularized bone grafting for treatment of Kienböck's disease: a case report.

Treatment of Kienböck's disease has historically been determined by staging, ulnar variance, and presence or absence of arthritic changes. With the advent of newer techniques of vascularized bone grafting, the status of the cartilage shell of the lunate has become another factor that can influence the procedure performed. The purpose of this article is to describe the technique of Kuhlmann vascularized bone graft for Kienböck's disease. In addition, the indications, contraindications, and outcomes are described.

Intraosseous ganglion cyst of the lunate: A case report.

Intraosseous ganglion cyst of the carpal bones represents a rare cause of wrist pain. We report a case of a 42 year-old, right-handed female, who presented with pain of the right wrist following a fall on the palm of the hand. Clinical study revealed a moderate swelling over the mid-section of the palmar face and pain through extreme ranges of motion of the wrist. Plain radiographs and CT-scan of the wrist have revealed an intraosseous ganglion cyst of the lunate bone. Curetting-filling by Kuhlman's vascularized radial bone graft allowed a good functional recovery. The clinical, radiological and therapeutic aspects are discussed.

Transformation of Dermatofibrosarcoma Protuberans into a Fibrosarcoma.

Dermatofibrosarcoma protuberans is a rare cutaneous mesenchymal tumor characterized by a low potential of malignancy with a very low rate of metastasis but an important rate of local recurrence. Its transformation into a fibrosarcoma is exceptional, responsible for a higher metastatic potential. This transformation implies a closer surveillance. Through a case report and literature review, we will try to expose epidemiological, clinical, histological, therapeutic, and outcome particularities of this entity.

Pseudotumoral form of soft-tissue tuberculosis of the wrist.

Tuberculosis is a major public health problem in developing countries. Hand and wrist is a rare localization for extra-pulmonary tuberculosis, a pseudotumoral form of soft tissue tuberculosis of the wrist is exceptional. We report the case of a 45-year-old male presenting with a painful swelling of the dorsal aspect of the right wrist evolving for six months. Clinical study was evoking a ganglion cyst of the wrist. Intraoperatively a pseudotumoral mass with rice bodies was found, suggesting tuberculous tenosynovitis. The histopathological study revealed caseating giant cell granulomas with epithelioid cells. Cultures on Löwenstein-Jensen medium detected Mycobacterium tuberculosis. Synovectomy with removal of all the rice bodies followed by anti-tuberculous chemotherapy provided uneventful recovery.

Pseudotumoral form of soft tissue tuberculosis of the hand: six cases.

Musculoskeletal involvement is not uncommon in extra-pulmonary tuberculosis, but the localization in the soft tissue of the hand is very rare. Diagnosis is much more difficult because of the atypical location and non-specific symptoms. We report 6 cases of pseudotumoral form of soft tissue tuberculosis of the hand treated in our department during the past 12 years. The mean age of the patients was 51 years with extremes of 44 and 63 years. A marked female predominance was observed (sex ratio = 0.2). All patients presented with swelling of the finger, two of which were painful swelling. All long fingers were involved; the thumb was involved in two cases. The histological study after excisional biopsy revealed caseating giant cell granulomas with epitheloid cells confirming the diagnosis. Antibacillary chemotherapy promoted healing and good outcome in our patients.

Carpal tunnel syndrome caused by lipoma: a case report.

Lipoma is a relatively frequent, benign soft-tissue tumor rarely located in the hand. A lipoma of the hand causing a carpal tunnel syndrome by compression of the median nerve is exceptional. We report the case of a 70-year-old female presenting with a carpal tunnel syndrome. A compression of the median nerve by a lipoma was discovered during surgery. Transverse carpal ligament release with lipoma excision and neurolysis of the median nerve were performed. Histopathological study of the resected mass was consistent with a lipoma. Two-month postoperatively, the patient recovered full hand function with entire disappearance of acroparesthesia. Carpal tunnel syndrome caused by space occupying lesions is rare. Diagnosis is difficult, usually based on the clinical study, electrophysiology and magnetic resonance imaging (MRI). Transverse carpal ligament release and excision of lipoma provides excellent functional recovery.

Acute carpal tunnel syndrome of the hand following a cat bite.

Cat bites at the hand are common situation in emergency departments. Neglected or poorly supported, these lesions sometimes lead to serious injuries that may compromise the function of the hand. Pasteurellamultocida is the most offending germ in these lesions, despite their sensitivity to antibiotics; it can sometimes lead to deep infections involving the skin, bones and joints. Acute carpal tunnel syndrome is exceptional after cat bite. We report a case of a 56 Year old female presenting with an acute carpal tunnel syndrome associated with compartment syndrome of the right hand 6 days after a cat bite of her right thumb. The patient was treated by surgery to relieve the median nerve. Microbiology identified PasteurellaMultocida.

Tuberculous flexor tenosynovitis of the hand.

Tuberculosis is a major public health problem in developing countries. Flexor tenosynovitis of the fingers constitutes an exceptional tuberculosis localization (Gabl et al., 1997; Senda et al., 2011) [1,2]. Unusual presentations, such as tuberculous tenosynovitis, often go undetected and are associated with a diagnostic and therapeutic delay, especially when bacteriological research proves to be negative. Here, we report a case of tuberculous flexor tenosynovitis of the hand.

A rare localization of tuberculosis of the wrist: The scapholunate joint.

The tuberculosis of the hand and the wrist is a rare entity. Affecting the scapholunate joint is exceptional. It is usually diagnosed at an advanced stage of carpal destruction, due to slowly development of the symptoms. We report the case of a 58-year-old female, presenting as wrist pain for 3 months. Clinical study showed a local swelling in the left wrist, the mobility of the wrist was normal but painful at the end of motion. The diagnosis of osteoarticular tuberculosis was suspected after radiological and biological study then confirmed after histological study. Antibacillary chemotherapy during 12 months promoted healing and good outcome.

Osteoarticular tuberculosis dactylitis: Four cases.

Tuberculosis dactylitis is exceptional. We report 4 cases of osteoarticular tuberculous dactylitis in 3 women and 1 man. The diagnosis was suspected on chronic and insidious clinical presentation, and confirmed by histology. Patients were treated by anti-tubercular drugs with good functional and radiological outcome in all cases. Clinical and therapeutic issues are discussed by the authors in the context of an endemic country.