RESUMEN
McCune-Albright syndrome is an inherited disease characterized by the association of fibrous dystrophy of bone, café-au-lait skin spots and precocious puberty revealing endocrine hyperactivity. Genetically, this disease is due to a mutation of the Gs protein responsible for activation of adenylate cyclase with excessive production of cAMP. The particular morphology of café-au-lait spots should suggest early diagnosis. Its treatment depends on the endocrinopathy from which the patient suffers and the extent of the fibrous dysplasia. Bisphosphonates have proven their effectiveness on bone pain and the limitation of fibrous dysplasia. Surgery retains its place in complicated forms. We report a rare case of McCune-Albright syndrome complicated by a femur fracture in a 12-year-old girl and we discuss the clinical and paraclinical characteristics of this pathological entity.
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Displasia Fibrosa Ósea , Displasia Fibrosa Poliostótica , Pubertad Precoz , Femenino , Humanos , Niño , Displasia Fibrosa Poliostótica/diagnóstico , Pubertad Precoz/diagnóstico , Pubertad Precoz/etiología , Manchas Café con Leche/etiología , Manchas Café con Leche/complicaciones , MutaciónRESUMEN
Subungual exostosis is a benign, uncommon osteocartilaginous tumour that tends to recur. We here report the case of a 17-year boy with subungual exostosis, who reported a history of trauma. Treatment was based on direct surgery. The tumor was completely excised. The postoperative course was uneventful, with no recurrence identified.
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Neoplasias Óseas , Exostosis , Enfermedades de la Uña , Masculino , Humanos , Exostosis/diagnóstico , Exostosis/cirugía , Exostosis/patología , Enfermedades de la Uña/diagnóstico , Enfermedades de la Uña/cirugía , Enfermedades de la Uña/patología , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/cirugía , Neoplasias Óseas/patología , Periodo PosoperatorioRESUMEN
The treatment of acute osteomyelitis is becoming more challenging since the emergence of community-acquired methicillin-resistant Staphylococcus aureus. We collected data on all patients with acute osteomyelitis caused by this germ over a period of 21 years (January 1995-December 2016) and we analyzed the peculiarities of this disorder. Our case series includes 15 children, with an average age of 9 years. All patients had affected lower limb. Local trauma was reported in 8 cases and skin carriage in 4 cases. Acute onset was reported in 12 cases associated with pseudo-paralysis of the affected limb. One patient had Staphylococcus aureus pulmonary infection with signs of septicopyemia. Blood culture was positive in 8 cases. In one case PCR assay for detection of Panton-Valentine leukocidin was performed with positive result. All these patients underwent surgical debridement and received secondarily adapted empirical antibiotic therapy. Outcome was good in 8 cases and poor in the other cases, with transition to a chronic state in 6 cases and one case of death. Pathological fracture was reported in 3 cases. Osteomyelitis cause by community-acquired methicillin-resistant Staphylococcus aureus is associated with a pejorative outcome. Recognizing the clinical and paraclinical signs of these infections is essential for a specific and early therapeutic management.
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Infecciones Comunitarias Adquiridas/diagnóstico , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Osteomielitis/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Enfermedad Aguda , Adolescente , Antibacterianos/administración & dosificación , Niño , Preescolar , Terapia Combinada , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/terapia , Desbridamiento/métodos , Femenino , Humanos , Masculino , Osteomielitis/microbiología , Osteomielitis/terapia , Estudios Retrospectivos , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/terapiaRESUMEN
AIMS: The present study investigates the effectiveness of platelet-rich plasma (PRP) gel without adjunct to induce cartilage regeneration in large osteochondral defects in a rabbit model. METHODS: A bilateral osteochondral defect was created in the femoral trochlear groove of 14 New Zealand white rabbits. The right knees were filled with PRP gel and the contralateral knees remained untreated and served as control sides. Some animals were killed at week 3 and others at week 12 postoperatively. The joints were harvested and assessed by Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) MRI scoring system, and examined using the International Cartilage Repair Society (ICRS) macroscopic and ICRS histological scoring systems. Additionally, the collagen type II content was evaluated by the immunohistochemical staining. RESULTS: After 12 weeks post-surgery, the defects of the PRP group were repaired by hyaline cartilage-like tissue. However, incomplete cartilage regeneration was observed in the PRP group for three weeks. The control groups showed fibrocartilaginous or fibrous tissue, respectively, at each timepoint. CONCLUSION: Our study proved that the use of PRP gel without any adjuncts could successfully produce a good healing response and resurface the osteochondral defect with a better quality of cartilage in a rabbit model. Cite this article: Bone Joint Res 2021;10(3):192-202.
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Galeazzi fracture is defined as the association of radius fracture and inferior radioulnar joint dislocation. Its diagnosis is often unrecognized initially. The purpose of our study is to determine the epidemioclinical features of Galeazzi fracture-dislocations in adults and to assess the functional and radiological outcomes of our case series. We conducted a retrospective descriptive study of 45 patients with Galeazzi fractures treated surgically whose data were collected in the Department of Orthopaedics at the Habib Bourguiba University Hospital, Sfax, Tunisia, over a period ranging from 2009 to 2018. We used Mestdagh score for the clinical evaluation of the results. The mean time between fracture and treatment initiation was 5.35 days. Fixation of the radius was performed using screwed plate in 39 cases and fixation of the radio-ulnar joint using a plug in 13 cases. The average time for union was 10.5 weeks. Outcomes were excellent in 35 patients, good in 3 patients, medium in 6 patients and adverse in a patient. We had 3 cases of sepsis at the level of the plug and two cases of malunions. Galeazzi fracture-dislocation is an under diagnosed disorder in some cases. Dynamic intraoperative examination after solid fixation of the radius can allow for good functional results.
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Fijación Interna de Fracturas/métodos , Luxaciones Articulares/cirugía , Fracturas del Radio/cirugía , Traumatismos de la Muñeca/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Luxaciones Articulares/diagnóstico , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Fracturas del Radio/diagnóstico , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Túnez , Traumatismos de la Muñeca/diagnóstico , Adulto JovenRESUMEN
Calcification of the lateral collateral ligament of the metacarpophalangeal thumb is a rare pathology. It's may be due to a deposit of hydroxyapatite crystals. We report the case of a 36-year-old man with chronic pain of MCPP. X-ray and Ultrasound finds a calcium deposit of LCL.
RESUMEN
Old fractures and dislocations of the base of the fifth metacarpal may result in post-traumatic arthrosis which is troublesome from a functional point of view and characterized by a difficult management. Stabilized arthroplasty is based on arthroplastic resection of the base of the fifth metacarpal associated with lateral diaphysometaphyseal arthrodesis between the fourth and the fifth metacarpal. This study involving two patients aimed to describe the advantages and the peculiarities of stabilized arthroplasty compared to other techniques in the treatment of the sequelae of fractures and dislocations of the base of the fifth metacarpal.
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Artroplastia/métodos , Artropatías/cirugía , Huesos del Metacarpo/cirugía , Adulto , Artrodesis/métodos , Humanos , Artropatías/etiología , Artropatías/patología , Luxaciones Articulares/etiología , Luxaciones Articulares/patología , Luxaciones Articulares/cirugía , Masculino , Huesos del Metacarpo/lesiones , Huesos del Metacarpo/patología , Adulto JovenRESUMEN
Tuberculosis of the shoulder is rare. It encompasses all articular and periarticular tuberculouses of the shoulder. Its insidious evolution, mimicking inflammatory and degenerative diseases, reflects the frequency of its diagnostic delay. We report a rare case of tuberculous bursitis of the shoulder in a woman living in rural areas, with renal insufficiency and treated for peritoneal TB and psoas. The anamnesis revealed signs of tuberculous impregnation. Clinical examination showed painful swelling of the shoulder associated with stiffness. MRI of the shoulder objectified infectious bursal disease. Its tuberculous origin was confirmed by the histological examination of ultrasound-guided synovial biopsy. The patient underwent TB treatment with good outcome. At 9-year follow-up, the patient had satisfactory articular function with no recurrence of infectious disease.
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Bursitis/diagnóstico , Insuficiencia Renal Crónica/fisiopatología , Articulación del Hombro/microbiología , Tuberculosis Osteoarticular/diagnóstico , Bursitis/tratamiento farmacológico , Bursitis/microbiología , Femenino , Estudios de Seguimiento , Humanos , Biopsia Guiada por Imagen , Imagen por Resonancia Magnética , Persona de Mediana Edad , Tuberculosis Osteoarticular/tratamiento farmacológico , Ultrasonografía IntervencionalRESUMEN
The spontaneous and simultaneous rupture of both quadriceps tendons is uncommon and has rarely been reported in the literature. The current case involves a 43-year-old man with end-stage renal disease requiring hemodialysis for the past 20 years. The patient experienced bilateral knee pain and swelling and was unable to bear weight. Physical examination revealed bilateral quadriceps tendon defect above the patella and loss of active extension. Although plain radiographs of both knees showed no fracture or widening of the joint space, an inferiorly positioned patella was observed. Ultrasonography of the knees revealed a quadriceps tendon defect at the upper edge of each patella, while MR imaging revealed a tear in each quadriceps tendon from the superior poles of the patella. The patient then underwent surgical correction wherein the tendons were repaired using sutures passed through drill holes in the patella. The knees were immobilized with splints for 4 wk before starting physiotherapy. The patient subsequently regained full functional activity within 1 year.
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BACKGROUND: The follow-up of calcaneal fractures has shown that they are difficult to manage and lead to multiple complications such as malunion and subtalar osteoarthritis. Pseudarthrosis of the calcaneus is an extremely rare complication, which was described in the literature through case reports.In the existing literature, only seven studies, including thirteen patients have reported the nonunion. However, to the best of our knowledge, no study elucidates the role of new techniques of regenerative medicine such as Bone Marrow Concentrates (BMC) or Platelet Rich Plasma (PRP) in the management. METHODS: We report a case of a patient with a pseudarthrosis after a calcaneal fracture treated with BMC injection in the non-union site, without the need for surgical approach. RESULTS: Four months after treatment, the patient was ambulant without support and was completely pain-free. Moreover, after one year the radiological follow up by CT scan showed a satisfactory filling of the non union. CONCLUSION: In one case, we try to highlight the advantage of our therapeutic alternatives, which are having a good union while avoiding the complications of surgical approaches and without sacrificing the subtalar joint when it is possible.
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OBJECTIVE: To assess the predictive factors of ventilator associated pneumonia (VAP) occurrence following open tracheotomy in trauma patients. MATERIALS AND METHODS: We conducted an observational, prospective study over 15 months, between 01/08/2010 and 30/11/2011. All trauma patients (except those with cervical spine trauma), older than 15 years, undergoing open tracheotomy during their ICU stay were included. All episode of VAP following tracheotomy were recorded. Predictive factor of VAP onset were studied. RESULTS: We included 106 patients. Mean age was 37.9 ± 15.5 years. Mean Glasgow coma Scale (GCS) was 8.5 ± 3.7 and mean Injury Severity Score (ISS) was 53.1 ± 23.8. Tracheotomy was performed for 53 patients (50%) because of prolonged ventilation whereas 83 patients (78.3%) had tracheotomy because of projected long mechanical ventilation. Tracheotomy was performed within 8.6 ± 5.3 days. Immediate complications were bleeding events (22.6%) and barotrauma (0.9%). Late complications were stomal infection (28.3%) and VAP (52.8%). In multivariate analysis, independent factors predicting VAP onset were delayed tracheotomy (OR = 0.041; CI95% [1.02-7.87]; P = 0.041) and stomal infection (OR = 3.04; CI95% [1.02-9.93]; P = 0.045). Thirty three patients died in ICU (31.1%) without significant impact of VAP on mortality. CONCLUSION: Late tracheotomy and stomal infection are independent factors predicting VAP onset after open tracheotomy in trauma patients. The occurrence of VAP prolongers mechanical ventilation duration and intensive care unit (ICU) length of stay (LOS) but doesn't increase mortality.
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Enfermedad Granulomatosa Crónica/patología , Huesos del Metacarpo/patología , Osteomielitis/patología , Infecciones por Serratia/patología , Antibacterianos/uso terapéutico , Enfermedad Granulomatosa Crónica/microbiología , Humanos , Lactante , Masculino , Huesos del Metacarpo/microbiología , Huesos del Metacarpo/cirugía , Osteomielitis/microbiología , Serratia marcescensRESUMEN
OBJECTIVE: Von Recklinghausen's neurofibromatosis is a dominant autosomic genetic disease characterized by different clinical manifestations. The goal of this work was to study its orthopaedic manifestations and to show the characteristics of their management. METHOD: A retrospective study was carried out on 15 patients having a Von Recklinghausen's neurofibromatosis. For each patient, different orthopaedic manifestations and their evolution after treatment were analyzed. These manifestations were classified in spinal deformities, pseudarthrosis of long bones and tumours of the peripheral nerves. RESULTS: The spinal deformities were observed in 9 cases. A dystrophic scoliosis was observed in 6 patients with an average angle of 50° and was associated to a kyphosis in 5 patients. The treatment was surgical by posterior arthrodesis in 2 cases and circumferential arthrodesis in 2 cases. The congenital curves and pseudarthroses of leg were observed in 5 cases, localized at the lower third of the leg in all cases. An Ilizarov external fixator with segmental osseous transport was carried out in 2 patients. The duration of the external fixator was 23 months ½ with 5 interventions in each case. Four plexiform neurofibromas and 3 nodular neurofibromas were observed. A transformation into neurofibrosarcoma was found in 2 patients. In one case, a resection without functional sacrifice was carried out and in the other case the patient was dead before the resection. CONCLUSION: The orthopaedic manifestations of Von Recklinghausen's neurofibromatosis are frequent, varied and have a difficult management. The functional and sometimes vital prognoses are challenging.
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Cifosis/diagnóstico , Neurofibromatosis 1/diagnóstico , Neoplasias del Sistema Nervioso Periférico/diagnóstico , Seudoartrosis/diagnóstico , Escoliosis/diagnóstico , Adolescente , Adulto , Edad de Inicio , Transformación Celular Neoplásica/patología , Niño , Preescolar , Femenino , Humanos , Técnica de Ilizarov , Lactante , Cifosis/genética , Cifosis/cirugía , Masculino , Persona de Mediana Edad , Neurofibroma Plexiforme/diagnóstico , Neurofibroma Plexiforme/cirugía , Neurofibromatosis 1/genética , Neurofibromatosis 1/cirugía , Neurofibrosarcoma/diagnóstico , Neurofibrosarcoma/cirugía , Osteotomía , Neoplasias del Sistema Nervioso Periférico/genética , Neoplasias del Sistema Nervioso Periférico/cirugía , Pronóstico , Seudoartrosis/genética , Seudoartrosis/cirugía , Estudios Retrospectivos , Escoliosis/genética , Escoliosis/cirugía , Fusión Vertebral , Tomografía Computarizada por Rayos XRESUMEN
Published cases of non-traumatic avascular necrosis of the femoral head associated with pregnancy are rare. We report a case of a 41-year-old woman who suddenly complained of bilateral hip pain 3 weeks after delivery by Caesarean section. For a problem of sterility, she had been treated with human menopausal gonadotropin and human chorionic gonadotropin (hMG-hCG). Initial radiographs of both hip joints were considered regular. After 4 years' evolution, radiographs of the hip joint showed collapse of both femoral heads. Bilaterally, osteonecrosis of the femoral heads was confirmed by MRI. MRI revealed a band pattern of low signal intensity for both hips on T1- and T2-weighted images. She had no history of steroid therapy or alcohol abuse. Osteonecrosis was related to pretentaine. A bilateral total hip arthroplasty was performed. The literature about avascular necrosis of the femoral head associated with pregnancy in previous cases is reviewed.