L’entorse grave ouverte de la cheville chez le sportif. À propos d’un cas

Severe ankle sprain is frequent in daily practice but the association with a skin opening is exceptional.We report a rare case of severe open ankle sprain in athlete. The mechanism of the injury is reminded with a review of the literature.     

Tumeur neuroectodermique primitive des parties molles de l’index chez l’adulte. À propos d’un cas

The primitive neuroectodermal tumours (PNET) of soft tissues belong to the Ewing's tumors family and affects particularly the child. The localization of the disease at the extremities is very rare within the adult population and raises the problem of differential diagnosis with others tumors of the soft tissues. We report the case of a 48-year-old patient with a localized tumor, at the level of the second right finger, of six months evolution. The biopsy showed the infiltrating nature of the tumour; and the diagnosis of (PNET) was confirmed after the histological and immunohistochemical study. The extension assessment was negative and the patient had an amputation of the second and third rays of the right hand. Four years afterwards, the patient showed no recurrence or metastases.     

Tumeur glomique de la capsule antérieure du coude. À propos d’un cas

Glomus tumors are rare tumors, benign but painful and responsible for a major functional impairment. Although their preferential localization is digital, 35% of glomus tumors are extradigital. Ignorance of this disease characterized by atypical clinical signs and the absence of specific imaging are responsible for a significant diagnostic delay, 7 to 10 years in extradigital forms. Treatment by surgical excision simply ensures immediate disappearance of pain without recurrence in 90% of cases. It is therefore necessary to emphasize the existence of this sometimes debilitating condition benefiting from effective therapeutic solution. We report the case of a glomus tumor of the anterior capsule of the left elbow in a 24-year-old woman with a diagnostic delayed by 12 years.     

Les fractures de fatigue de l’extrémité distale de la fibula. À propos de trois cas avec revue de la littérature

Introduction

The stress fractures are injuries that occur following repeated periodical constraints on a normal bone. They are more common on the lower members; the distal fibula localization is rare and it is estimated lower than 6% of all localizations.

Material and methods

It is about a retrospective study of three cases of stress fractures of distal fibula collected in the archives of the orthopedic department of our hospital. The average age was of 29 years (25–36 years) with a male predominance; in two cases the right ankle was affected. Pain was present in all cases, extending up to threeweeks in two cases and to ten days in one case. The anamnesis helped in the diagnosis, whereas the physical examination was poor. Imaging helped the diagnosis; ultrasound also contributed formally to it on this superficial localization of a bone like distal fibula. The conventional treatment is mainly based on immobilization of ankle by orthosis, avoiding all physical activities and taking rest. Results: The fractures in all cases healed within six to eight weeks.

Conclusion

The new therapeutic modes (stimulation of the osseous consolidation) are under assessment and would be promising to athletes.     

Métastases osseuses d’un épendymome d’emblée de double localisation. À propos d’un cas

A case of cerebral and sacral ependymoma revealed by cerebellar syndrome and sciatica in a 68-year-old man is reported. Bone metastases were diagnosed seven months after surgical excision of the brain tumor.     

Multiples fractures de contrainte chez une jeune fille atteinte d’arthrite chronique juvénile. À propos d’un cas

The occurrence of stress fractures in patients with long standing rheumatoid arthritis (RA) is widely known. Osteoporosis, corticosteroid therapy, joint stiffness, contracture, angular deformity of the joint and failed joint reconstruction – all together or separately – predispose to bone loss and stress fractures. In the present report we describe the history of a girl with juvenile idiopathic arthritis (JIA) having multiple stress fractures. The relationship between corticosteroid therapy and immobilisation in the treatment of fractures is discussed.     

Rupture de coiffe de la hanche. À propos d’un cas de rupture du moyen fessier révélée par une tendinite rebelle

We report a case of gluteus medius tear in a patient who presented with an 11-month history of severe trochanteric pain. Neither magnetic resonance imaging nor ultrasonography visualized the tear, the only findings being inflammatory thickening of the tendon and bursitis. A glucocorticoid injection into the bursa under fluoroscopic guidance and three glucocorticoid injections at the contact of the tendon failed to relieve the pain. At surgery, a 2- by 4-cm tear was found in the tendon of the right gluteus medius muscle. Partial tendon reconstruction was followed by prompt and lasting pain relief, in accordance with the few similar reports in the literature. This paucity of publications is in sharp contrast with hip fracture surgery findings suggesting that at least 10% of patients older than 60 years of age may have painless hip rotator cuff tears.     

Pseudarthrose congénitale de l’avant-bras. À propos de deux cas et revue de la littérature

Congenital pseudarthrosis of the forearm represents a rare entity which is often associated with neurofibromatosis type I. Isolated pseudarthrosis of the ulna is the most frequent deformity, followed by pseudarthrosis of the radius and both forearm bones. The treatment of these deformities remains difficult: conventional bone grafts rarely lead to complete fusion. The reconstruction by a vascularized fibular graft represents the treatment of choice if the radial head is not dislocated. This procedure allows restoration of a balance between radius and ulna during growth. The presence of a vascularized graft enhances the potential for bony fusion in a fibrous environment. In cases of isolated ulna pseudarthrosis, a luxation of the proximal radial epiphysis may occur when the ulnar deformity increases with time. The single-bone forearm represents a salvage procedure that creates a stable upper limb with a satisfactory wrist and elbow function. The two clinical cases of a pseudarthrosis of both forearm bones and of an ulna pseudarthrosis are presented.     

Premier métatarsien flottant : à propos d’un cas

Bipolar dislocation of the first metatarsal or floating first metatarsal is an exceptional foot injury. The authors report a case of open floating first metatarsal in a 32-year-old woman. The injury was resulting from a road traffic accident. The floating metatarsal was associated with a dorsal dislocation of the second tarsometatarsal joint and ipsilateral metatarsal fractures. The treatment included debridement followed by reduction of dislocations and stabilization by Kirschner wires. Fractures were closed reduced and the foot was immobilized in a below-the-knee posterior splint. Two years after surgery, the patient complained of intermittent pain in the midfoot and had osteoarthritis of the Lisfranc and first metatarsophalangeal joints.     

Implantation auditive du tronc cérébral chez l’enfant. À propos de trois cas

Aim of the studyTo present three pediatric cases of auditory brainstem implantation (ABI) and review literature data concerning this topic.PatientsThe first two children had a neurofibromatosis type II with bilateral sensorineural deafness; in both cases, the implant was inserted during the surgical removal of a vestibular schwannoma; the third patient had profound deafness due to bilateral cochlear nerve insufficiency associated with inner ear malformation.ResultsTwo postoperative complications were observed: patient 1 had a persistent fever which required the replacement of the fat graft used to seal the translabyrinthine approach; patient 3 had a CSF leakage requiring additional surgery and lumbar external drainage. In our three patients, the numbers of active electrodes were 6/22 (Cochlear ABI 24M ABI), 11/12 (Medel Opus II ABI) and 11/12 (implant Medel), respectively. Due to additional major surgical procedures and to disappointing functional results of the ABI, patient 1 stopped wearing her implant 18 months after implantation. Nine months after surgery, patient 2 achieved open-set speech recognition and was very satisfied with the implant. Six months after implantation, patient 3 (cochlear nerve deficiency), who was 3.5 years-old at the time, clearly reacted to some environmental sounds but was not yet able to achieve speech recognition.ConclusionsABI has now entered the list of treatments that can be proposed in pediatric profound sensorineural deafness. Its major risks of complications are CSF leakage and non-auditory side effects. Its outcomes are worse and less predictable than cochlear implants. Thus, its indications must remain restricted to cases meeting the following conditions: absence of alternative option to restore hearing, patients and parents high level of motivation and realistic expectations.     

L’atteinte des tendons fléchisseurs dans la maladie goutteuse. À propos d’un cas et revue de la littérature

We present a case of synovial and flexor tendons gouty involvement associated to the flexion contracture of a single digit. The case was treated surgically by tenosynovectomy and resection of the flexor superficialis tendon followed by arthrolysis of the proximal interphalangeal joint. This rare etiology of flexion contracture must be taken into account in every patient with a history of gout and tendon pathology.     

Luxation trans-scapholunaire antérieure du carpe. À propos d’un cas

Volar perilunar dislocations of the carpus are rare. They occur in young patients following a violent injury. Open reduction is often needed because of instability of the lesion. The authors report a case of volar transscaphoid perilunate fracture-dislocation treated surgically, with a satisfactory functional result after a follow-up of two and a half years.     

Arthrite de l’arrière-pied révélatrice d’un ostéome ostéoïde intra-articulaire. À propos de deux cas

Osteoid osteoma is a tumour, commonly found in the long bones. The intra-articular presentation in the hindfoot is very rare. We are reporting on two cases of intraarticular osteoid osteoma of the subtalar joint located on the calcaneus. Atypical clinical symptomatology was the reason for the delayed diagnosis. In both cases, a CAT scan of the ankle enabled a diagnosis of osteoid osteoma to be made. Open surgical resection enabled a full recovery to be achieved, with all pain being alleviated. Through these two case studies, clinical, paraclinical and therapeutic aspects of the intra-articular presentation of osteoid osteoma in the foot and ankle will be discussed.     

Résultat du traitement chirurgical de l’hallux valgus sévère par la technique « scarf ». À propos de 20 cas

Introduction

The “scarf” technique is a reliable tool in the correction of the moderate static disorders of the forefoot. The purpose of this study is to evaluate the result of this technique in the treatment of extreme deformations and their functional correlation.

Material and methods

This retrospective analysis included 16 patients (20 feet) who underwent hallux valgus surgery between 2005 and 2011. The minimal follow-up was 12 months. We used AOFAS score or Kitaoka score that supports both subjective and objective clinical criteria.

Results

The data included 14 women and 2 men. The average age during surgery was 58.5. By analyzing the subjective results related to footwear, the appearance and the function over 80% were satisfied. The mean AOFAS score improved from 22 to 78 postoperatively. The HV was corrected by 66% while the MV decreased from 18.3° to 8.8°.

Conclusion

The hallux valgus surgery remains primarily a functional surgery rather than a cosmetic surgery. The “scarf” technique has widely kept its position in dealing with the hallux valgus and even in maximal deformations.     

Les récidives tardives de la maladie de Wegener. À propos d’un cas après 20 ans de rémission

Immunosuppressive drugs have transformed the prognosis of systemic Wegener’s granulomatosis. Nowadays, the main residual problem is illness relapses, for which management is largely undefined. We describe the case of a patient, aged 47 in 1977. The diagnosis of Wegener’s granulomatosis was made when faced with polyarthralgias, cutaneous vasculitis, rhinitis, dyspnea, hemoptysis and global decline of her physical condition. The treatment associated high-dose corticotherapy and intramuscular cyclophosphamide for one year. This treatment led to a complete remission. Twenty years later, the patient was hospitalized for reoccurrence of rhinitis, dyspnea and right knee effusion associated with biological inflammatory syndrome, renal insufficiency and antibodies against polymorphonuclear neutrophil cytoplasm, type c-ANCA. Chest CT-scan disclosed parenchymal infiltrates. Wegener relapse was diagnosed and the combination of three methylprednisolone perfusions followed by oral prednisone (1 mg/kg/d) and a monthly bolus of cyclophosphamide led to a new remission. Nevertheless, 4 months after beginning the treatment the patient died from an infectious complication (Pneumocystis carinii and aspergillosis). Relapses of Wegener’s granulomatosis are frequent and difficult to predict. Moreover, some cases occur very lately. The remarkable efficiency of cyclophosphamide to induce remission is however shaded by the high rate of relaps. Other drugs are studied to identify more efficient therapy, able to both induce remission and prevent relapses, but reliable data are still missing to determine the best therapeutic regimen.     

Mycétome osseux métatarsien: à propos d’un cas

Actinomycosis of bone or bone mycetoma is an infectious disease caused by a fungal or actinomycotic organism presenting as apseudo-tumour.The condition develops insidiously. It is very unusual to find this infection in the foot. Bone involvement makes medical management more difficult. We report the case of a man aged 26 years, admitted with mycetomatous osteitis of the third metatarsal. This was treated by surgical extirpation and a 12-month course of antibiotic therapy. Progress was satisfactory. The objective of this report is to draw attention to this very rare condition, which is little known by many doctors and can present therapeutic problems.