Uncommon type 3 Monteggia equivalent lesion due to an ulnar shaft nonunion in adults: A case report.

It is uncommon to observe a nonunion of an isolated ulnar shaft fracture after surgical treatment; therefore, complications due to this nonunion are very rare. Adults are more likely to develop nonunions compared to children. We report the case of a 34-year-old man, who had a left ulnar shaft fracture, treated with a screwed plate. Four months later, a septic nonunion occurred causing a type 3 Monteggia equivalent lesion with a lateral dislocation of the radial head. We describe the consecutive methods of treatment that resulted in complete bone consolidation. The case report aims to underline the diagnostic particularities and the therapeutic challenges of this rare complication.

Management of Ewing Sarcoma of Distal Fibula in Child: A Case Report.

Introduction: Ewing's sarcoma is the second most common primary malignant bone tumor in children and adolescents, after osteosarcoma. It is a rare tumor, with the axial skeleton being the preferred site of development, followed by the long bones. Diagnosis is evoked by imaging and confirmed by histology. Treatment is based on intensive chemotherapy with local surgical treatment in operable forms, and in some cases, radiotherapy. There are only a few sporadic cases in the literature describing distal fibular localization. Case Report: We report the case of a 7-year-old child who presented with pain on the lateral aspect of the left ankle without local inflammatory signs. Radiological findings revealed a metaphyseal-diaphyseal osteolytic tissue process of the left fibula, and histology concluded that it was Ewing's sarcoma. We proceeded with neoadjuvant polychemotherapy followed by segmental resection of the distal fibula with an anteroexternal tibial rod, plus tibiotalar, and talocalcaneal arthrodesis without recourse to radiotherapy. Conclusion: The management of Ewing's sarcoma is constantly evolving. Its distal fibular location in a growing limb makes it even more difficult. It must be personalized, multidisciplinary, and carried out in specialized centers.

Divergent Elbow Dislocation Associated with Ipsilateral Fractures of Ulnar Diaphysis and Radial Styloid Process in Adult: A Case Report.

Introduction: The divergent elbow dislocation represents a rare lesion where the proximal radioulnar joint is torn and the distal part of the humerus goes between the radius and the ulna, the forearm dislocates posteriorly. Case Report: We report the case of a 37-year-old male patient who had a traumatic divergent dislocation of the left elbow, associated with ipsilateral fractures of the ulnar diaphysis and the radial styloid process. The elbow joint was reduced under general anesthesia with internal fixation of the ulnar diaphysis fracture and a pinning of the radial styloid fracture. At 3 years of follow-up, the fractures were consolidated and the elbow was stable with a satisfying mobility. Conclusion: The aim of our case report is to underline the diagnostic and therapeutic challenges of this complex lesion.

Osteonecrosis of the Humeral Head Following Arthroscopic Repair of Rotator Cuff Tears: A Case Report.

Introduction: The osteonecrosis and the collapse of the humeral head may have many risk factors such as trauma, alcoholism, metabolic diseases, and corticosteroid therapy. Otherwise, it was described as a rare complication of shoulder arthroscopy in the past few years. Case Report: We report the case of a 65-year-old right-handed woman who had a rotator cuff tear of the right shoulder. She underwent a double-row arthroscopic repair. Six months later she had an intense shoulder pain, with radiological and MRI signs of humeral head osteonecrosis. The patient had a reverse total shoulder arthroplasty. Conclusion: The aim of this case report is to underline the diagnostic particularities of this complication, and to shed light on the pathogenesis of the interruption of blood supply in the humeral head following rotator cuff repair. We also discuss the management of this complication with reverse total shoulder arthroplasty.

Impact of the COVID-19 Pandemic on Orthopedic and Trauma Departments in Tunisia.

OBJECTIVE: Measure the effect of the strategy to fight the Covid-19 pandemic, based on containment, on the practice of orthopedic and trauma surgery in Tunisia. METHODS: This is a comparative study, concerning the impact of Covid-19 on the flow of patients, operated in orthopedic surgery and trauma departments, during the containment period from March 12, 2020 to April 30, 2020, comparing it to the same period of the year 2019, in the Central-East region of Tunisia (Kairouan, Sousse, Mahdia, Monastir). RESULTS: A significant decrease of 27% in the flow of patients admitted to orthopedic surgery departments in central-eastern Tunisia, during the 2020 containment period, compared to the same period of the previous year was documented. This decrease was generally widespread, notified in three orthopedic departments: Sousse (39%; p<10-3), Monastir (29%; p<10-3) and Mahdia (27%; p<10-3). It focused on the following three groups: infections (45%; p<10-3), wounds (30%; p<10-2), and fractures (20%; p<10-3). CONCLUSION: The collateral effects of the strategy to fight the Covid-19 pandemic, are "obvious" in orthopedic surgical practice. A health crisis management plan (including disasters and pandemics) should be better prepared in orthopedic surgery departments.

Surgical Revascularization With Cardiopulmonary Bypass on a Patient With Severe COVID-19.

The coronavirus disease 2019 (COVID-19) may lead to an acute respiratory distress syndrome by an inappropriate cytokine response and may predispose to a prothrombotic state through multiple pathways. Both can complicate the management of cardiac surgery with cardiopulmonary bypass, which is known to activate the hemostatic system and to exacerbate systemic inflammatory response. Little is known about the impact of cardiac surgery with cardiopulmonary bypass on viral pneumonia, particularly with the new coronavirus. In this article, we describe the case of a diabetic patient with COVID-19 and a concomitant 3-vessel disease with a formal indication for surgical revascularization, who unexpectedly presented with a high heparin resistance during cardiopulmonary bypass. Emphasis is placed on the importance of multidisciplinary team discussions before surgery, on the thorough preoperative assessment, and on the perioperative management, particularly regarding mechanical ventilation and anticoagulation.

Radial neck fracture in children: anatomic and functional results of Metaizeau technique.

Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the anatomical and functional results of the Metaizeau technique. In this retrospective study, we evaluated 22 patients under the age of 16 who were treated for radial neck fracture at the orthopedic and trauma surgery department of Sahloul University Hospital in Sousse over a period of 16 years from January 2001 to April 2017. Authors used Metaizeau classification. Functional results were evaluated by Mayo elbow performance score (MEPS) and the radiological evaluation was based on standard images with measurement of the residual rocker. The average age was 8.6 years (5-13 years). Seven fracture were grade III injuries and three grade IV. In the immediate postoperative period, radiological measurements showed a residual rocker less than 20° in 86.3% and more than 20° in 13.7% of cases. At an average follow-up of 13 months and a half, the MEPS score was excellent and good for 17 patients. Four types of complications were found: necrosis of the radial head in 1 case, pseudarthrosis in 1 case, periarticular calcification in 2 cases and stiff-ness of the elbow in 3 cases. Despite the small number of patients in our series, we believe that the elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children.

Preload Dependence Is Associated with Reduced Sublingual Microcirculation during Major Abdominal Surgery.

BACKGROUND: Dynamic indices, such as pulse pressure variation, detect preload dependence and are used to predict fluid responsiveness. The behavior of sublingual microcirculation during preload dependence is unknown during major abdominal surgery. The purpose of this study was to test the hypothesis that during abdominal surgery, microvascular perfusion is impaired during preload dependence and recovers after fluid administration. METHODS: This prospective observational study included patients having major abdominal surgery. Pulse pressure variation was used to identify preload dependence. A fluid challenge was performed when pulse pressure variation was greater than 13%. Macrocirculation variables (mean arterial pressure, heart rate, stroke volume index, and pulse pressure variation) and sublingual microcirculation variables (perfused vessel density, microvascular flow index, proportion of perfused vessels, and flow heterogeneity index) were recorded every 10 min. RESULTS: In 17 patients, who contributed 32 preload dependence episodes, the occurrence of preload dependence during major abdominal surgery was associated with a decrease in mean arterial pressure (72 ± 9 vs. 83 ± 15 mmHg [mean ± SD]; P = 0.016) and stroke volume index (36 ± 8 vs. 43 ± 8 ml/m; P < 0.001) with a concomitant decrease in microvascular flow index (median [interquartile range], 2.33 [1.81, 2.75] vs. 2.84 [2.56, 2.88]; P = 0.009) and perfused vessel density (14.9 [12.0, 16.4] vs. 16.1 mm/mm [14.7, 21.4], P = 0.009), while heterogeneity index was increased from 0.2 (0.2, 0.4) to 0.5 (0.4, 0.7; P = 0.001). After fluid challenge, all microvascular parameters and the stroke volume index improved, while mean arterial pressure and heart rate remained unchanged. CONCLUSIONS: Preload dependence was associated with reduced sublingual microcirculation during major abdominal surgery. Fluid administration successfully restored microvascular perfusion.

Outcome of total knee arthroplasty following closing wedge high tibialosteotomy: a review of 40 cases.

INTRODUCTION: Total knee replacement after high tibial osteotomy becomes more and more indicated. This intervention needs to identify some pearls and pitfalls. AIM: To evaluate results of total knee arthroplasty after closing wedge high tibial osteotomy. METHOD: Fourty total knee arthroplasty following closing wedge high tibial osteotomy were identified. Demographic features, tibiofemoral alignment and radiolucent lines were documented on postoperatively. Clinical and functional evaluations were performed preoperatively and postoperatively according IKSS score. RESULTS: The average duration of follow-up was 11,5 years. The mean function score increased from 39 points to 70,4 points postoperatively. The mean knee score increased from 40 points to 84,9 points postoperatively. The mean average tibio-femoral angle was 177,7° in preoperatively and 178° (min 176°, max 185°) at the last follow-up. CONCLUSION: The closing wedge high tibial osteotomy does not compromise subsequent total knee replacement. Knowing pearls and pitfalls lead to better outcome.

Villonodular Synovitis of the Subtalar Joint: A Case Report.

INTRODUCTION: Villonodular synovitis (SVN) is a rare benign pseudotumoral proliferation of the synovial joint, of unknown etiology. In general, it reaches the big joints, especially the knee. Localization at the subtalar level is extremely rare, with only a few cases published in the literature. CASE REPORT: We report the case of an SVN of the subtalar in a 60-year-old patient without particular histories, who consulted for a swelling of the external border of the right foot evolving for 2 years. Biology, as well as the standard radiographs, was without anomalies. The diagnosis was evoked on magnetic resonance imaging (MRI) and confirmed by surgical biopsy and excision. The operative follow-up was simple with no recurrence after 3 years. CONCLUSION: SVN of the subtalar is rare. Surgical treatment is based mainly on synovectomy, and the prognosis depends mainly on the osteocartilaginous lesion and the quality of excision.

[Femoral varising osteotomy by external opening for the treatment of lateral femorotibial gonarthroses associated with idiopathic genu valgum: a retrospective a study of 10 cases]. / L'ostéotomie fémorale de varisation par ouverture externe pour les gonarthroses fémoro-tibiales latérales sur genuvalgum idiopathique: étude rétrospective de 10 cas.

Femoral varus osteotomy is a conservative treatment for external single-compartment gonarthrosis. This surgical procedure is little used and outcomes are little studied.This study aimed to assess the clinical and radiological results of femoral varising osteotomy in subjects with external femorotibial gonarthrosis associated with idiopathic genu valgum whose data were recorded over a period of 21 years (1992- 2013) in the Department of Orthopedics at Sahloul University Hospital, Sousse. The clinical evaluation of patients was performed using the IKS score (International Knee Society). Radiological assessment was based on pre-operative work-up and final follow-up assessment. We here report a case series of 9 patients (and 10 knees) whose average age was 45.2 years, with a sex ratio of 0.5. Mean follow-up was 99-months. Average knee score ranged from 48.4 points preoperatively to 73.5 points at the final follow-up assessment, with a statistically significant improvement (p<10-3). Medium functional score significantly improved, with a preoperative value of 49.5 points and a value of 72 points at the final follow-up assessment. Final correction helped to reduce valgus condition with an average of 3.7° and a preoperative value of 14°. This study, as well as the analysis of literature, indicates that femoral varising osteotomy is the treatment of choice for invalidating genu valgum of femoral origin, without any rheumatoid arthritis, overweight, internal femorotibial nor severe femoropatellar arthritis.

Evaluation at long term follow up of medial unicompartmental knee arthroplasty in young patients.

BACKGROUND: The treatment of isolated internal tibiofemoral knee osteoarthritis on young and active patients is controversial. This treatment can be a high tibial osteotomy or a joint replacement that can be a partial unicompartmental knee arthroplasty (UKA) or total knee replacement (TKR). The aim of our study is the long-term evaluation of functional outcome of partial unicompartmental knee arthroplasty (UKA) in elderly patients under than 60 years. METHODS: This is a retrospective study of 25 unicompartmental knee arthroplasties in 22 patients, collected between1993 and 2003 whose age was less than 60 years. The minimum follow-up was 10 years. At last follow, an analysis of IKS score (International Knee Score) with assessment of both articular and functional components have been established. The Radiological score of Knee Society (KS) was used. RESULTS: At mean 14.2 years (min: 10, max: 20), the mean of knee flexion was 110 °. The IKS function score going 47 points preoperatively to 77 points postoperatively and IKS score 40 points knee preoperatively to 94 points postoperative. The radiological assessment found a postoperative mean tibiofemoral mechanical axis of 174.8 ° (172 ° min, max 182 °). The survival of implants at 12 years postoperatively was 84%. The survival of the prostheses was de84 to 12%, with a revision for polyethylene wear, a second for conflict of the femoral component with tibia thorns responsible of chronic pain, a third revision for infection and two for osteoarthritis evolution. CONCLUSION: The long-term evaluation of patients with a unicompartmental does not objective an obvious deterioration of outcome with a normal rate of revision comparatively to other series without particular difficulties during revision.