A Locked Posterior Shoulder Dislocation: An Injury Not to Miss.

Locked posterior shoulder dislocations are dislocations that remain unreduced for more than three weeks. In most cases, they are associated with other injuries. We report the case of a 38-year-old male who presented with pain and total functional impotence due to a complex injury, including posterior glenohumeral dislocation, a reverse Hill-Sachs lesion, and a clavicle fracture. Because of the unsuccessful attempts at closed reduction, the patient underwent surgery. We performed the McLaughlin technique, which included the transfer of the subscapularis tendon to the reverse Hill-Sachs lesion, stabilized by bone anchors. At the last follow-up, the patient was doing well and had regained full range of motion with no recurrent dislocation. Clinicians should maintain clinical and radiological suspicion about this injury to timely manage this rare and dangerous injury.

Surgical Management and Reconstruction of Dedifferentiated Chondrosarcoma in the Proximal Femur: A Case Report.

A primary malignant bone tumor, or more commonly, metastasis, can occur in the proximal femur. Surgical treatment can have palliative or curative purposes. In the case of the latter, it involves two stages: resection of the tumor, which aims to address the cancer, and reconstruction of the bone and soft tissue, which aims to restore function. It is important for the excision to be wide with adequate resection margins in the soft tissue, particularly when the goal is curative treatment. Typically, surgery involves excision and reconstruction to ensure good mechanical stability. Reconstruction can be done using different methods, such as a composite prosthesis or a massive prosthesis, which may be modular or custom-made. Joint reconstruction options include hemiarthroplasty, intermediate prosthesis, or, in some cases, total hip replacement.

Comparison of Modified Kessler and McLarney Techniques in Zone II Flexor Tendon Repair.

Introduction Hand injuries are common in the routine practice of any upper limb surgeon. The laceration of the flexor tendons can engage the functional prognosis of the hand. Hence, there exist a multitude pf suturing techniques whose goal is to have a solid repair, allowing an early rehabilitation. Our study aims at comparing the functional results after flexor tendon repairs in zone II using two different techniques, modified Kessler technique and McLarney technique. Methods Our study included 42 patients, divided into two groups, one having benefited from the modified Kessler technique and the other from the McLarney technique. The modified Strickland classification was used to compare the functional results at six months after surgery of the two techniques. Results Our study showed a better post-operative functional outcome with a lower risk of post-operative rupture in patients operated with the McLarney four-strand technique compared to patients operated with the modified Kessler two-strand technique. Conclusion Hand wounds in zone II remain a therapeutic challenge for any orthopedic surgeon due to the multiplicity of factors involved in the prognosis, in particular the type of suture. The suture with more than two strands has proven its effectiveness and its reproducibility, making it possible to find the balance sought by the surgeon, namely a suture that is not cumbersome, easy and quick to perform, and strong enough to start early rehabilitation.

Modified Technique of Single-Bone Forearm in the Treatment of Deformities.

The single-bone forearm is a salvage technique for massive loss of bone due to serious trauma, malignant tumors, infections or congenital deformity. It is also described to treat the sequelae of hereditary multiple exostoses disease that affects the distal end of the ulna. We present the case of a 29-year-old patient, operated for sequelae of hereditary multiple exostoses disease of the left forearm by a modified single-bone forearm technique. The patient, right-handed, operated on twice in childhood for a hereditary multiple exostoses disease of the left forearm: incomplete excision of the exostosis of the distal end of the ulna and lengthening of this last on external fixator, without improvement. The patient presented for a deformation of the left forearm with shortening compared to the right side|. Significant limitation of prono-supination (pronation 15°, supination 20°). Elbow flexion at 110° and extension with deficit of 15°. Wrist flexion at 50° and extension at 50°, radial inclination at 25° and ulnar at 30°. The pain score was 3 according to the Visual Analogue Scale (VAS), especially on effort. Dash score was 31,82/100. We chose the forearm technique with a single bone. The immediate postoperative result found a realignment of the forearm, without neurological or vascular damages. Consolidation was obtained in four months. At five months, the patient recovered elbow flexion at 110° and full extension, wrist flexion at 45° and extension at 50°. Radial inclination at 20° and ulnar at 25°. The single-bone forearm technique has been described, not only for the treatment of hereditary multiple exostoses disease, but also for serious trauma or tumors with massive loss of bone. The technique generally consists of an osteotomy of the radius as well as the ulna, fixing the radius to the ulna creating a synostosis, with or without resection of part of one or both bones of the forearm. The most described complications of single-bone forearm procedure are pain, complications related to soft tissue secondary to the previous injury, and infections. The one-bone forearm remain a salvage technique for massive loss of bone of the forearm, or large deformities due to congenital malformations. This technique could allow the excision of massive bone and keep only a part of the ulna and the radius, with function maintenance and aesthetic forearm preservation.

A Painless Restricted Motion of the Thumb: What Etiology? About An Uncommon Tumor in Uncommon Localization.

Lipomas in fingers are rare and account for less than 1% of all cases. As a type of lipoma, the spindle cell lipoma is exceptional and it presents 1.5% of total adipocyte tumors. Moreover, its localization in the thumb is extremely rare. Only three cases have already been reported in adults; our case constitutes the fourth case, which is about a 61-year-old female who presented since 18 months a mass on the ulnar lateral aspect of the thumb. After clinical and radiological assessments, an entire excisional biopsy of the mass was performed. The histopathological analysis confirmed the spindle cell lipoma of the thumb. At the last follow-up of two years, the patient did well with no recurrence and no restricted motion of the thumb. So, although lipomas of the digit are rare, they should be considered a possible etiology of either painful or mechanic restricted motion of the digit.

A report of two challenging cases of bone infection: Mycobacterium tuberculosis. How to manage?

The incidence of bone tuberculosis is less than 5% of all tuberculosis cases. Furthermore, multifocal bone tuberculosis is uncommon, which rarely occurs without primary foci. It is difficult to diagnose, particularly if it is localized in both humeral heads. On the other hand, the isolated iliac bone tuberculosis is exceptional; it constitutes, also, a challenging diagnosis, which requires a high index of clinical suspicion and advanced investigations. Herein, we first report a case of multifocal tuberculosis of both humeral heads with no primary foci, and we secondarily report a case of isolated iliac bone tuberculosis. At last, however, the histological exam and polymerase chain reaction for the Mycobacterium tuberculosis complex are not always positives; they are mandatory as tests to ascertain the diagnosis.

Simultaneous Ipsilateral Floating Hip and Knee: A Complex Combination and Difficult Surgical Challenge.

Simultaneous ipsilateral floating hip and floating knee are extremely rare. To the best of our knowledge, only four cases have been described in the literature. This uncommon injury is mostly caused by high-velocity impact and associated with life-threatening lesions. We report a unique case of concomitant ipsilateral floating hip and floating knee following road traffic accident. The patient presented ipsilateral hip dislocation and acetabular, femoral, and tibial fractures associated with chest trauma. The aim of this report is to highlight the severity and rarity of this combination and to describe the therapeutic recommendations.

[Schwannoma of the sciatic nerve: a case report]. / Schwannome du nerf sciatique: à propos d´un cas.

Schwannomas of the sciatic nerve are rare tumors. They are mainly manifested by sciatic neuralgia rather than by sensory-motor deficits. We report the case of a 30-year-old female patient with right buttock pain for 1 year. Palpation revealed a positive Tinel sign. A magnetic resonance imaging (MRI) was performed which objectified a roughly rounded, regular mass of 2 cm in diameter in intimate contact with the large sciatic nerve. A complete excision of the tumor was carried out. This excision allowed the pain to disappear and the pathology examination concluded with a plexiform schwannoma.

[Squamous cell carcinoma in a patient with chronic osteomyelitic lesion: a case report]. / Carcinome épidermoïde survenant sur une lésion d'ostéomyélite chronique: rapport de cas.

Squamous cell carcinoma associated with chronic osteomyelitis is rare. However, it must be suspected in patients with modification of common local symptoms. Delayed diagnosis can be fatal. Repeated biopsies can greatly help physicians who treat patients. We report the case of a 47-year-old patient diagnosed with carcinomatous degeneration associated with chronic osteomyelitis fistulized to the skin. Amputation was performed.

[Compartment syndrome complicating tennis leg: about a case]. / Syndrome de loges compliquant un tennis leg: rapport de cas.

Tennis-leg is a partial or total disinsertion of the medial head of the gastrocnemius muscle from its musculoskeletal junction. Patients receiving adequate treatment generally have favorable outcome. Tennis leg is rarely associated with major complications such as acute compartment syndrome. We report the case of a judo athlete with disinsertion of the right medial head of the gastrocnemius muscle complicated by acute compartment syndrome. Emergency aponeurotomy was required.

Unusual Etiology of Chronic Posterior Leg Pain in a Running Athlete: Could It Be a Schwannoma? A Case Report and Review of the Literature.

Schwannomas represent only 5% of all soft tissue tumors. As a variant of this tumor, the plexiform schwannoma is rare accounting for less than 5% of all schwannomas. Herein, we report a rare case of a 49-year-old athlete who suffered from a pain in the posterior aspect of the right leg one year before his presentation. Initially, a radiograph of his right leg showed no abnormality, and so, the emergency physician discharged him on analgesics and anti-inflammatory medications, and rest was advised. The persistent pain obliged the patient to consult our orthopedic department. On examination, we found a firm mass in the proximal medial aspect of his right leg. The neurovascular exam was normal. Sonography of the leg was not conclusive. Therefore, magnetic resonance imaging was performed, and a hemangioma or schwannoma was suspected. The patient underwent surgery in which the entire tumor mass was shelled out in one piece with no damage. The histopathological finding was concomitant with a plexiform schwannoma. Follow-up evaluation, sixteen months later, showed no evidence of recurrence, and the patient has regained his previous level of sportive activities. So, given the case described here, despite the rarity of the schwannoma, it should be taken into consideration as a possible diagnosis in such situation to promote early diagnosis and appropriate treatment.

Complex metacarpophalangeal joint dislocation of the litter finger: A sesamoid bone seen within joint. What does it mean?

Dislocation of the metacarpophalangeal joint is a rare injury. The index finger is most frequently involved, followed by the thumb; the little finger is very seldom affected. The Complex dislocation of the little finger metacarpophalangeal joint is extremely rare. A few cases only had been described. Herein, we report a case of 40 years old presented, after a road accident, a dorsal metacarpophalangeal joint dislocation of the litter finger confirmed on radiographs with a clear view of the sesamoid bone within joint prompting the patient to undergo open reduction with no attempts of closed reduction initially. We elected, to treat our case, for the volar approach which allowed successful relocation of the head of the metacarpal in its anatomical position. The view of sesamoid bone within the joint is pathognomonic of volar plate entrapment. Recognition of this fact should alert the treating physician to the inevitability of open reduction for anatomical repositioning of the joint and avoid repeated attempts at closed reduction which may arise the risk of degenerative arthritis and reduced final range of motion.

Domestic Horse Bite: An Unusual Etiology of Crush Injury of the Fourth Finger-How to Manage?

Almost 2% of all emergency admissions involve an animal bite. While horses bite humans very rarely, their bites are mostly associated with fatalities. Herein, we report the case of a 23-year old bitten by a domestic horse causing a crush injury to his fourth finger with fracture dislocation of the proximal interphalangeal joint. The patient benefited upon arrival at the emergency department from copious irrigation with saline serum, tetanus toxoid, postexposure rabies vaccination, and prophylactic antibiotic therapy. In the operating room, surgical exploration found the ulnar digital pedicle sectioned, the flexor and extensor tendons sectioned and shredded, and the skin shredded. An excisional debridement of devitalized tissue with copious irrigation was performed, and the finger regularized at the level of traumatic amputation with tendon striping followed by coverage of the bone by the radial digital flap with careful clinical and biological monitoring after the surgery. At the last follow-up, the patient revealed no sign of infection, and he returned to his usual activities and has been discharged from care. This wound management, based on a careful examination, a meticulous debridement, and an efficient cleaning with early and targeted antibiotic therapy, might promote good results and avoid dangerous complications.

Pure Isolated Dorsal Hamatometacarpal Dislocation in a Rider: A Case Report and Review of Literature.

INTRODUCTION: Pure isolated dislocations of the fifth carpometacarpal joint are extremely rare. To the best of our knowledge, the case, we present here, is among the extremely rare cases report of an unstable hamatometacarpal dislocation(HMD)injury successfully treated by a well-molded cast. CASE REPORT: A 30-year-old rider fell from his horse, causing swelling of the wrist and the fifth finger was rotated with minimal active motion. The radiological assessment (X-rays and tomography) showed a pure HMD. Under sedation, we performed reduction of the dislocation. However, the reduction was lost at the slightest movement requiring a K-wirefixation. The patient refused the surgical treatment and requested non-operative treatment. Thus, while the joint was held in a reduced position, a well-molded plaster cast was applied which immobilized both the hamatometacarpal joint and the metacarpophalangeal joint. Later, the patient was reviewed weekly until 6 weeks, then the cast was removed altogether and the digits were mobilized. At the follow-up of 6 months, he had regained full range of motion of the little finger with no pain, no recurrence of dislocation and returned to his previous level of sporting activity. CONCLUSION: The early detection with careful clinical assessment and radiological analysis for subtle signs, followed by appropriate treatment usually leads to an excellent result.

Pseudoaneurysm of the Posterior Tibial Artery After Posterior Tibial Tendon Transfer.

Pseudoaneurysm of the posterior tibial artery is an uncommon condition that, left untreated, can lead to hemorrhage, thrombosis, or emboli. We present the case of a 54-year-old male who developed pseudoaneurysm of the posterior tibial artery 4 months after undergoing tibialis posterior tendon transfer for management of peroneal nerve palsy, which had developed as a complication of hip arthroplasty.

Irreducible dorsal metatarsophalangeal joint dislocation of the fifth toe: a case report.

The authors report a case of a dorsal dislocation of the fifth metatarsophalangeal joint that could not be reduced by closed manipulation, and instead required open reduction with Kirschner-wire fixation to maintain alignment. Although metatarsophalangeal joint dislocation is not unheard of, it is not common for the deformity to resist efforts at closed reduction and immobilization or percutaneous pin fixation. One year after surgery, the patient described in this article had returned to his baseline activity level, and was ambulating without pain while demonstrating full range of motion in the fifth metatarsophalangeal joint.