A rare polydactyly of the forefoot with partial duplication of the 5th metatarsal and supernumerary digit: A case report.

INTRODUCTION: Polydactyly of the foot is a congenital anomaly characterized by the appearance of all or part of one or more additional rays. Adult cases are more rare, and surgical management of the deformity is still debated. PRESENTATION OF CASE: A 49-year-old black patient with this condition might complain of an abnormal cosmetic appearance or difficulty with footwear. DISCUSSION: Only a few cases of postaxial polydactyly with a partial duplication of the fifth metatarsal without a supernumerary digit have been reported. CONCLUSION: The surgical indication is always retained in front of the aesthetic discomfort of the patient associated with footwear. The surgical technique must be individualized according to the deformity encountered, either by open or percutaneous approach; we find it interesting to share this unusual case in order to classify it later as a foot deformity.

Molecular classification of soft tissue sarcomas for adequate diagnosis: A study on the northeast population of Morocco.

Background: Soft tissue sarcomas (STS) are a heterogeneous group of tumors. For adequate therapeutic management, an accurate diagnosis is necessary. In Morocco, the diagnosis is essentially based on the morphological and immunohistochemical study. Compared to other techniques, fluorescence in situ hybridization (FISH) is easier to develop and less expensive. This study aims to assess the feasibility and utility of implementing FISH technique to improve diagnostic accuracy and establish a good classification. Material and methods: This is a retrospective cohort study. 211 cases of mesenchymal tumors were included. Hematoxylin Eosin Safran (HES) staining was performed in all cases followed by immunohistochemistry (IHC). FISH was performed in all cases with suspected STS. The probes used were EWSR1, MDM2 and SS18. The performance of FISH and histopathological test were evaluated by the ROC curve method (receiver operating characteristic). We evaluated the concordance between FISH and real time PCR by Cohen test. Results: The real-time PCR technique showed good agreement with the FISH test by a Kappa coefficient of 60% (p = 0.035). FISH was able to confirm that it is more accurate (Youden's Index = 91%) than histological/immunohistochemical analysis (Youden's Index = 51%), as well as the positive predictive value was higher (100%) with an ROC curve finding a larger area under the curve of 0.953 (95% CI: 0.918-0.988), p = 0.000 which supports that FISH shows high performance to present an accurate final diagnosis. Conclusion: This is the first and the largest Moroccan series for the molecular diagnosis of STS by FISH. Our study shows that paraffin FISH is a sensitive and specific ancillary tool in the diagnosis of STS when used in the appropriate clinicopathological context.

How Can a Multidisciplinary Approach Improve Prognosis of Soft-Tissue Sarcomas of Extremities?

Soft-tissue sarcomas are malignant tumors that require good management within specialized centers. Our study aims to assess the benefit of handling these kinds of tumors using the Multidisciplinary Meeting (MDM) approach. The current paper details this approach through a prospective study that has lasted for 42 months in the HASSAN II University Hospital Center, Fez, Morocco. During this research work, 116 cases were selected with an average age of 53 years. In 95.7% of the cases, it was found that the lower limb was the most frequent tumor type (78.4%). Also, ninety-two (92) patients (79.3%) have had a prior biopsy. Ninety-nine (99) patients (85.3%) have received a magnetic resonance imaging scan (MRI) before surgery. Sixty-three (63) patients were operated on, including R0 resection used for 37 patients, R1 used for 21 patients, and R2 used for five patients. As a result, liposarcomas were the most frequent type (30.1%), followed by synovial sarcomas (14.6%), leiomyosarcomas (9.5%), ewing sarcoma (8.6), and undifferentiated pleomorphic sarcomas (7.7%). In addition, neoadjuvant chemotherapy was used for 36 patients. The other 22 patients received adjuvant chemotherapy and/or radiotherapy. The overall survival rate was 60.56 months, which proves a significant improvement, thanks to the multidisciplinary meeting approach. Conclusion. The conducted investigation has shown that using MDM for managing soft-tissue sarcomas of extremities improves the patients' survival rate. Moreover, results have proven MDM might allow optimal treatment regarding less local recurrence and metastasis.

[Total knee replacement without patellar resurfacing: about 60 cases]. / Prothèse totale du genou sans resurfaçage de la rotule: à propos de 60 cas.

During total knee replacement, one of the main problems of surgeon is to choose between preservation of the patella or resurfacing with prosthetic replacement of patellar cartilage. This issue continues to be a subject of controversy within the orthopaedic community. There is no clear consensus on the optimal approach to the patella during total knee arthroplasty (TKA). We conducted a retrospective study of 60 patients undergoing total knee replacement without resurfacing of the patella. These procedures were performed in the Department of Orthopedics and Trauma-Surgery (B) at the University Hospital Hassan II, Fez, since January 2009 to December 2015. The average age of patients was 58 years, ranging between 20 years and 80 years. Female prevalence was clear (41 women, 72% and 16 men, 28%). Clinically, the majority of patients had mechanical pain and all patients underwent clinical and radiological examination. The IKS score was used to assess knee condition before and after surgery. The surgical procedure was based on total knee arthroplasty without patellar resurfacing. Post-operative complications included 7 cases of anterior knee pain, 2 cases of infection of superficial skin treated with appropriate antibiotic therapy and 3 cases of stiffness. No cases of hematoma, phlebitis or sepsis were reported. Clinical results after a follow-up period of 18 months were satisfactory. Given these results, the preservation of the patella allowed for very satisfactory middle term results regarding pain relief and restoration of function. In addition, potential complications of patella prosthesis were avoided. One limitation of these replacements without resurfacing is the occurrence, or sometimes the persistence, of anterior knee pain; hence the need for secondary resurfacing. Current data from the literature show that there is no consensus on the approach to the patella during total knee replacement. Finally, patella resurfacing is an approach that the surgeon should choose on the basis of current data. This said, the debate can continue focusing on a single issue: which approach should be used to the patella.

[Emergency coverage of post-traumatic losses of cutaneous substances of the anterior face of the knee using proximally based sural fasciocutaneous flap: about 4 cases of articular wounds]. / La couverture en urgence des pertes de substances cutanées d'origine traumatique de la face antérieure du genou par lambeau fascio-cutané sural à pédicule proximal: à propos de 4 cas de plaies articulaires.

Our study reports 4 cases of male patients with wounds on the anterior face of the knee loosing cutaneous substance after motorcycle accident. The patients had undergone surgery involving the debridement and the application of four proximally based sural fasciocutaneous flaps since 2012. The average age of patients ranged from 28 to 42 years. The highest loss of cutaneous substance measured 14 x 10 cm. The average pedicle length was 14 cm. The post-operative suites were uneventful with a satisfactory wound healing. From a functional point of view the knee and the ankle were completely mobile. This study shows the effectiveness and reliability of proximally based sural fasciocutaneous flap in the coverage of post-traumatic losses of cutaneous substances of the anterior face of the knee, and allows for limit the indications for heads of the gastrocnemius muscle flaps.

[Triplane fracture of the proximal end of the tibia: a rare lesion (case study and literature review)]. / Fracture triplane de l'extrémité supérieure du tibia: une lésion rare (étude d'un cas et revue de la littérature).

We here report the case of a 16-year old patient with triplane fracture of the proximal end of the tibia due to a sporting accident occurred during a cycling race. CT scan (CT) was performed to assess the fracture with a high level of accuracy. After identification of all fragments requiring osteosynthesis, closed reduction was performed with fixation of fracture fragments using cannulated screws. At the last follow-up visit, radiological and functional results were excellent.

[Infection and detachment of total hip prosthesis due to listeria monocytogenes]. / Infection et descellement d'une prothèse totale de la hanche par listeria monocytogenes.

Joint prostheses are increasingly used in our current practice. Infection is one of the most dreaded complications; it is most often due to germs of the skin flora. Listeria monocytogenes rarely causes this infection. We here report the case of a patient with hip prosthesis infected by this germ. Favorable outcome was obtained by antibiotic therapy and single-stage prosthesis replacement.

[Hip arthroscopy in patients with femoroacetabular impingement: about 2 cases]. / L'arthroscopie de la hanche dans le conflit fémoro-acétabulaire: à propos de 2 observations.

Femoroacetabular impingement (FAI) can causes hip pain in young subjects and in athletes. His diagnosis is based on clinical and radiological examinations. Surgical treatment is based on conventional surgery or on arthroscopy. Arthroscopy proves to be a reliable technique in the treatment of FAI. It is effective on the pain and improves performances of athletes in order to enable them to resume their activities within a very short space of time. We here report our experience within our Department in treating 2 patients with FAI with arthroscopy. Modified Harris score significantly improved at the last follow-up (24 and 18 months).

[Spontaneous simultaneous bilateral rupture of the quadriceps tendon in patients with parathyroid adenoma: case report and literature review]. / Rupture bilatérale spontanée et simultanée du tendon quadricipital dans l'adénome parathyroïdien: à propos d'un cas et revue de la littérature.

Spontaneous as well as bilateral and simultaneous rupture of the quadriceps tendon is rare. We report the case of a 53-year old patient followed up for parathyroid adenoma complicated by renal failure, admitted for spontaneous bilateral rupture of the two quadriceps tendons. He underwent surgical repair allowing him to maintain his autonomy.

[Direct medical costs of hospital treatment of fractures of the upper extremity of the femur]. / Le coût médical direct de la prise en charge hospitalière des fractures de l'extrémité supérieure du fémur.

Fractures of the upper extremity of the femur are serious because of their morbidity and social and/or economic consequences. They have been the subject of several studies of world literature concerning their hospital treatment, evolution and prevention. The increase in the incidence of this pathology seems unavoidable due to population ageing and to the lengthening life expectancy; it is posing a real long-term public health problem whose importance will be further increased by the need to control health care costs. The results of this study show that the average age of onset of fracture of the proximal extremity of the femur is 68,13 ± 16.9 years, with a male predominance and a sex ratio of 1.14. In our study pertrochanterian fractures represented 69.4% of cases. Direct medical costs of the hospital treatment of fractures of the upper extremity of the femur at the Hassan II University Hospital were £387 714,38 in 222 cases, with an average cost of £1757,4 , including costs for patient's stay in hospital, which represented the majority of expenses ( 77% of total costs). It is desirable to raise staff awareness of the costs of consumables in order to reduce treatment costs and to adopt cost-oriented behaviour. Length of stay should be limited to the maximum extent because it only allows to reduce staff and accommodation costs.

Ulnar nerve entrapment complicating radial head excision.

INTRODUCTION: Several mechanisms are involved in ischemia or mechanical compression of ulnar nerve at the elbow. PRESENTATION OF CASE: We hereby present the case of a road accident victim, who received a radial head excision for an isolated fracture of the radial head and complicated by onset of cubital tunnel syndrome. This outcome could be the consequence of an iatrogenic valgus of the elbow due to excision of the radial head. Hitherto the surgical treatment of choice it is gradually been abandoned due to development of radial head implant arthroplasty. However, this management option is still being performed in some rural centers with low resources. DISCUSSION: The radial head plays an important role in the stability of the elbow and his iatrogenic deformity can be complicated by cubital tunnel syndrome. CONCLUSION: An ulnar nerve release was performed with favorable outcome.

[Total hip arthroplasty for the treatment of congenital hip dislocations in adults: about 15 cases]. / L'arthroplastie totale de la hanche dans le traitement des luxations congénitales de la hanche chez l'adulte: à propos de 15 cas.

Total hip arthroplasty for the treatment of congenital dislocation represents a challenge for the orthopedic surgeon. It is now well established that the treatment of congenital hip dislocation in adults is a real "functional miracle". The evolution of surgical techniques and materials has expanded the indications for prosthetic replacement including the most complex cases and thus going against Charnley and Feagin who wrote in 1973 that there was no place for total hip arthroplasty in inveterate dislocations. We conducted a retrospective study of a series of THP 15 for the treatment of congenital hip dislocation in adults;sociodemographic, clinical, paraclinical and therapeutic data were collected from the medical records of 15 patients and also via a written questionnaire which was completed during their last follow-up visit. The average age of our patients was 28 years; female sex ratio was 2F/1H. Severe dysplasia stage VI according to Crowe's classification was present in 4 cases, type III in 9 cases and type II only in 2 cases. All patients underwent cemented total hip arthroplasty, a reinforcement ring was used in 9 cases and a bone graft in 2 cases. At last follow-up visit PMA functional scores were excellent and very good in 74% of cases. Surgical treatment of congenital hip dislocations in adults must meet strict health standards as congenital hip dislocations often occurs in young female population that is more demanding as to the aesthetic and functional outcomes. Several surgical techniques have tried to solve the problems related to this disease, acetabular and femoral hypoplasia, leg length inequality. Total hip arthroplasty for the treatment of congenital dislocations in adults remains a challenge for the orthopaedic surgeon. This is a difficult surgical procedure which requires technical skills and careful pre-design programming to reduce the occurrence of adverse events especially in the particular case of young female population.

Bone lymphoma revealed by cruralgia during pregnancy: a case report.

Pregnancy complicated by Non Hodgkin lymphoma (NHL) is rare, about 100 cases have been reported. We will describe the case of a multifocal bone lymphoma revealed by a left hyperalgetic and deficient cruralgia in a female in the second trimester of pregnancy.

Open fracture of the acromion associated with a supraspinatus tendon rupture: an exceptional case report.

The combination of the acromion Open fracture to a section of the supraspinatus tendon is an exceptional situation. The author reports the case of a young patient with a wound of the posterolateral side of the right shoulder. Screwing was done for the fracture of the acromion after supraspinatus tendon suture with good clinical and radiological outcome after an appropriate rehabilitation.