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.

Case Report: Tuberculous abscess of the popliteal fossa: A case report.

Introduction Tuberculosis of the soft tissues is a rare form of extra pulmonary tuberculosis, and isolated localization in the popliteal fossa is particularly exceptional. Atypical clinical presentation can lead to delayed diagnosis and serious complications. Case report We report the case of a 17-year-old patient who was diagnosed with tuberculosis of the popliteal fossa. He presented with a painful inflammatory swelling of the right popliteal fossa associated with a homolateral inguinal lymph node, without knee joint effusion. Standard chest and knee X-rays were normal, while MRI showed an 8 cm well vascularized, partly liquefied mass in the popliteal fossa, developed in contact with the semimembranosus and medial gastrocnemius muscles, associated with a popliteal lymph node without synovial effusion or thickening. Microbiological tests did not isolate any germs. The diagnosis was made on histological examination after biopsy, which revealed a caseous granuloma surrounded by epithelioid cells. The patient was treated with anti-tuberculosis therapy for 9 months. The clinical and radiological regression of the swelling was observed without recurrence at 2 years of follow-up. Conclusion Any soft tissue abscess should raise suspicion of tuberculosis, especially in endemic countries. The importance of histopathological examination should be emphasized to establish the diagnosis in the absence of signs in favor of a primary localization.

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.