Brace treatment results of thoracolumbar vertebral osteomyelitis.

INTRODUCTION: Vertebral osteomyelitis is a destructive affection for disc and vertebral body leading to deformities that disturb coronal and sagittal balance of the spine. Brace immobilization ought to reduce the damage caused by these deformities in long term follow up. Unfortunately, results of this therapy has never be reported Aim: Describe results of brace immobilization in thoraco-lumbar vertebral osteomyelitis. METHODS: We reported a retrospective descriptive study during 10 years in 31 patients treated for vertebral osteomyelitis in which a brace immobilization was performed. MRI were performed before and after immobilization and then different radiologic segmental parameters were measured. RESULTS: The mean age was 54. Koch bacillus was the identified in 19 cases. Vertebral compression rate was significantly higher in thoracic localization at diagnosis (p=0,021). It evolved from 25% to 33%. Neither the vertebral compression rate at diagnosis nor the period between diagnosis and immobilization were related to this progression. Mean progression of segmental angulation was 3,13°. Vertebral kyphosis was 11° before and after brace immobilization. Lombar lordosis evolved from -42° to -43°. Lombar lordosis was at least stabilized in 92% of patients up to 70 Kg in weight (p=0,013). Thoracic kyphosis evolved from 48° to 51° after immobilization. CONCLUSION: At diagnosis, vertebral compression was higher in thoracic localizations. In vertebral osteomyelitis, brace immobilization was more effective in lombar than thoracic localizations and in patients up to 70 Kg in weight.

The effect of Scarf osteotomy on the distal metatarsal articular angle in hallux valgus: a case series.

BACKGROUND: Hallux valgus is a deformity of the forefoot involving a phalangeal valgus and a metatarsal adductus. In most cases its correction requires surgical treatment with different types of osteotomies. The best known is Scarf osteotomy. AIM: To study the effet of Scarf osteotomy on distal metatarsal articular angle (DMAA) as well as the validitiy of this angle and the value of its correction after review of the literature. METHODS: It was a retrospective study including patients operated on for severe hallux valgus by a Scarf osteotomy. The clinical assessment was based on the the American-Orthopedic-Foot-and-Ankle-society (AOFAS) score. Radiologically, we calculated the metatarsophalangeal angle, the inter-metatarsal angle and the DMAA. This assessment was performed preoperatively and one year postoperatively. RESULTS: We collected 37 cases of evolved hallux valgus. The average AOFAS score went from 60.7 to 85.8 / 100 postoperatively with a gain of 25 points. We've noted a significant correction of the 3 angular measurements at one year postoperatively (the metatarsophalangeal angle, the inter-metatarsal angle and the DMAA) which went from 38.8° to 20.5°, from 17° at 10° and 13.5° to 8.5° respectively (p<0.05). CONCLUSION: The literature has shown that there is no consensus regarding the effect of HV surgery on the DMAA. As for the accuracy, reproducibility and interest of correcting this angle we deduce that the DMAA is an interesting measure in the pathology of HV. Its correction seems not to be necessary in order not to hamper the correction of metatarsus varus. But in cases where the preoperative DMAA is high (> 15 °), efforts should be made to correct it to avoid recurrence.

Symptomatic Scapular Osteochondromas: Case report.

Osteochondroma is a developmental lesion rather than a true neoplasm. Osteochondromas are composed of cortical and medullary bone with an overlying hyaline cartilage cap and must demonstrate continuity with the underlying parent bone cortex and medullary canal. Osteochondromas may be solitary or multiple. We report  the case of a patient carrying the here ditary form and who has presented a thoracic deformity and a progressive dyspnea for 5 months. Imaging was related to a bulky osteochondroma of the scapula responsible for thoracic deformity. Benign character was confirmed on the histology data and the resection was performed posteriorly with muscular preservation.

Isolated tuberculous abscess in longissimus muscle.

Muscle's tuberculosis (TB) without coexistent active skeletal involvement is very rare. We presented a case of tuberculous abscess of longissimus muscle in a young immunocompetent female. Magnetic resonance imaging showed a well-circumscribed lesion in the longissimus muscle. No bony abnormality was noticed. An ultrasound-guided biopsy revealed the presence of granulomatous features on cytological pathology. A good response was seen with antitubercular treatment. TB should be considered in the differential diagnosis of any unexplained soft-tissue swelling in people born in tubercular endemic areas. To the best of our knowledge, our observation is the third reported case in immunocompetent patient.

Traumatic Atlantoaxial Dislocation with an Odontoid Fracture: A Rare and Potentially Fatal Injury.

Traumatic dislocation of the atlanto-axial joint in combination with an odontoid fracture remains a rare entity. Beaucause of its instability, it's alsoo a seriuous injury. A fatal outcome is feared especially in elderly. We report a case of 74-year-old man who presented with neck pain Confusion and spastic tetraparesia after a low energy trauma. Radiographs and computed tomography demonstrated a C1C2 dislocation with odontoid fracture. After an unsuccessful attempt at closed reduction with halo traction, a surgical stabilisation was performed using a posterior approach. Death was occured in early postoperative due to respiratory distress.

Effect of sesamoid position on functional outcome of operated hallux valgus.

INTRODUCTION: The loss of correct relationships between the sesamoid and the first metatarsal is one of the architectural consequences of the hallux valgus (HV). The reduction of this dislocation by lateral soft tissue release (LSTR) is one of the objectives of surgery. AIM: To study the relationship between postoperative position of sesamoid and clinical outcome at one-year postoperative follow-up. METHODS: It's a retrospective study including patients operated for evolved HV performed in la Rabta orthopedic department in Tunis. These patients had a Scarf osteotomy associated with at least one Weil osteotomy. The functional evaluation was based on the AOFAS score (American-orthopedic-foot-and-ankle-society). We classified the sesamoid position according to 3 scores: Hardy & Clapham , RCAOFAS and the Agrawal. We compared each score of the sesamoid position to the clinical outcome. RESULTS: We collected 46 cases of HV in 45 patients. The mean AOFAS score increased from 60,9 to 85,5/100 postoperatively. Our patients were divided into 2 groups: group A whose result was excellent and group B whose result was good, fair and poor. The analytical study of this work concluded that there was no relationship between the postoperative sesamoid position and the clinical outcome, regardless of the radiological classification used (p=0,361, p=0,222, p=0,260). CONCLUSION: Sesamoids that remain in postoperative dislocation are not necessarily predictive of a poor clinical outcome at one year of the surgical cure.

An unexpected etiology of lumbosciatica.

Lumbosciatica is a frequent symptom. When it is hyperalgic and/or deficient, it requires urgent exploration and an eventual surgical procedure. In most of the cases, medullary lumbar (instead of medullary) MRI is required looking in the first place at an intervertebral disc herniation. Other etiologies are rare but must be kept in mind. We report a case of a 37-year-old man with left L5 hyperalgic and deficient lumbosciatica. The conclusion of the etiological research led to pseudoaneurysm of the internal iliac artery compressing the ipsilateral sciatic nerve. The patient was operated on with a good clinical course.

A knee stiffness unusual etiology.

Progressive unilateral knee stiffness is an uncommon complaint in older adult. Tumor and specific infection should be considered in addition to osteoarthritis. We report a case of intracapsular and paraarticular chondroma in the infrapatellar Hoffa's fat pad that presented as a painless limited knee in 64-year old man. A physical examination revealed a firm, movable mass in the infrapatellar area. Radiographs and Magnetic resonance images showed an ovoid, well-defined, soft tissue mass with focal calcification in the infrapatellar fat pad. The mass was completely resected surgically through a medial parapatellar approach. The final pathology revealed an intracapsular and paraarticular chondroma. At follow-up, 3 years after the operation, patient was pain-free, with complete recovery of the range of motion of the knee and without any clinical or radiographic evidence of recurrence. Intracapsular and paraarticular chondroma is a rare benign lesion of the large joints (mostly the knee). The Pathogenesis of these tumours is controversial. The diagnosis is made with correlation of clinical, radiological and histological features. The treatment of choice is surgical excision.

Midshaft clavicle fracture synthesis with twisted one-third tubular plate with anterior-inferior approach.

BACKGROUND: Fractures of the clavicle are common and usually treated as minor injuries. The middle-third fractures account for 80% of all clavicle fractures. For many years, these fractures have been treated conservatively. After recent studies, this traditional approach has been reconsidered pointing the need to operate in some cases. AIM: To describe functional and radiological outcome of midclavicular fractures fixation using one-third tubular molded plate through an anterior inferior incision and to compare it to the outcome in the literature. METHODS: It was a retrospective study, using data gathered in 40 months from 38 cases of mid-shaft clavicle fractures treated operatively using one-third tubular molded plate with minimum perspective of 12 months. RESULTS: The mean age of the patients was 27 years with a sex ratio of 4.42. 8% of patients were suffering from diabetes. 58% were manual workers. 89% of fractures occurred on the side of the dominant limb, mostly after a domestic accident. In ⅔ of cases, the fracture occurred on the right side after an indirect injury. No vascular or neurological complications were reported. Fractures were most frequently classified Allman type I, AO type A1 and A2 and Edinburgh type 2A2 and 2B1. The mean operative time was 55 minutes. Immobilization with a sling were recommended for 24 hours. The mean consolidation time was 53 days. There was no postoperative complications and none of our patients underwent plate removal for infection. The mean Constant score at last follow up was 90. CONCLUSION: Operative treatment of mid-shaft clavicle fractures using one-third tubular molded plate allows avoiding neurovascular and skin complications with a low financial cost and helps patients, especially manual workers and young athletics, recover a normal shoulder function and return sooner to their usual activities.

Traumatic cervical spine injuries in a patient with pycnodysostosis.

Pycnodysostosis is a rare hereditary disease, characterized by systemic bone sclerosis. Susceptibility to long bone fractures is characteristic, whereas vertebral fractures are extremely rare. We report a case of a 21-year-old man with a past history of pycnodysostosis and spontaneous leg fractures who was admitted in hospital for a neck pain after a banal fall. Radiological examination revealed C1-C2-C3 posterior arch fractures with a C3-C4 left articular fracture dislocation. A surgical stabilization was decided but refused by the patient. To the best of our knowledge, this is the first publication that reports pycnodysostosis with cervical spine traumatic staged injuries.

sFRP3 and DKK1 Regulate Fibroblast-Like Synoviocytes Markers and Wnt Elements Expression Depending on Cellular Context.

CONTEXT: Fibroblast-like synoviocytes (FLS) from rheumatoid arthritis (RA) display pathogenic behavior. Various members of the Wnt pathway, especially the canonical Wnt/ß-catenin cascade, may contribute to autonomous RA FLS activation. It has been shown that the two Wnt inhibitors: sFRP3 and DKK1 contribute to several critical aspects of joint biology. However, their effects on RA FLS are poorly characterized. The aim of our study was to investigate the effects of sFRP3 and DKK1 on FLS markers, Wnt components, and target oncogenes expression by RA FLS and compare the findings to osteoarthritic (OA) FLS. MATERIALS AND METHODS: RA and OA FLS were treated with sFRP3 and DKK1 for 6 days. Wnt signaling components (Wnt5a, LRP5 and ß-catenin), Wnt target oncogenes (cyclin E1 and WISP1), and FLS markers (fibronectin and MMP3) were analyzed using western blotting and/or qRT-PCR. RESULTS: Our data indicated that sFRP3 down-regulated the key gene ß-catenin in RA FLS. sFRP3 decreased fibronectin, a well-known downstream effectors gene of Wnt/ß-catenin pathway, and LRP5 expression in both RA and OA FLS. In OA FLS, sFRP3 induced increased expression of Wnt5a and MMP3 but did not affect their levels in RA FLS. On the other hand, DKK1 increased fibronectin expression in RA FLS and decreased its expression in OA FLS. CONCLUSION: Our results confirm the involvement of Wnt signaling in FLS transformation and show that two inhibitors of the same cascade can regulate differently the same elements and that a single inhibitor can initiate signaling depending on cellular context. ABBREVIATIONS: FLS: fibroblast-like synoviocytes; RA: rheumatoid arthritis; Wnt: Wingless; Fz: frizzled; LRP: Fz/low-density lipoprotein receptor protein; WISP1: Wnt1 inducible signaling pathway protein 1; sFRP: secreted Fz-related proteins; DKK: Dickkopf; OA: osteoarthritis; DMEM: Dulbecco's modified Eagle's medium; FBS: fetal bovine serum; PBS: phosphate buffered saline; SDS-PAGE: sodium dodecyl sulfate-polyacrylamide gel electrophoresis; ECL: enhanced chemiluminescence detection solution; MMP3: metaloproteinase 3; qRT-PCR: quantitative real-time polymerase chain reaction; S.D: standard deviation; CRD: cysteine-rich domain; MeCP2: methyl-CpG-binding protein; RANKL: nuclear factor-kappa B ligand.

[Gastrointestinal stromal tumor: epidemiology and outcome study in 40 cases]. / Tumeurs stromales du tube digestif: étude épidemiologique et évolutive à propos de 40 cas.

The aim of this study was to analyze epidemiology and outcome of 40 patients with gastrointestinal stromal tumor (GIST) expressed CD 117. All epidemiological data (age, sex, location) and survival data were analyzed retrospectively. The tumors occurred in 17 men and 23 women. Stomach was the most common site of localization (47.5%). Of the 37 patients without Gleevec treatment, 18 benignant cases (66.6%) showed long-term survival (2 to 8 years) and 9 malignant cases (33.3%) were diagnosed. 10 cases were still being in followed (< 2 years). Gastric tumor's survival was better than extragastric tumor's survival without statistically significance (p>0.05). Our experience confirms that GIST is an aggressive tumor. 33.33% of them are malignant with recurrence or metastatic potential. Additionnally, epidemiologic factors (age, sex and location) do not have a predictive value.