[McCune-Albright syndrome: a case report and literature review]. / Syndrome de McCune-Albright : à propos d'un cas et revue de la littérature.

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.

Original animal model of lumbar disc degeneration.

PURPOSE: Disc degeneration (DD) is a common cause of low back pain, which represents one of the most widespread public health problems in the world. Therefore, the establishment of a reproducible animal model is indispensable to understand the pathogenic mechanisms of DD and to test new therapeutic strategies. From this perspective, the fundamental objective of this study was to elucidate the effect of ovariectomy in establishing a new animal model of DD in rats. METHODS: 36 female Sprague-Dawley rats were divided into four groups of 9 rats: Group 1: Negative control (Sham): Only an abdominal skin incision and sutures were performed. Group 2: Ovariectomy (OVX): Removal of two ovaries through a transverse incision in the middle of the abdomen. Group 3: Puncture (Punct): Puncture of lumbar intervertebral discs (L3/4, L4/5, and L5/6) by a 21 G needle. Group 4: Puncture+ovariectomy (Punct+OVX): Removal of two ovaries and puncture of L3/4, L4/5, and L5/6 discs. The rats were euthanized 1, 3, and 6 weeks post-surgery, and the discs were harvested. Validity was assessed by radiography, histology, and biochemistry (water content). RESULTS: Disc height, water content, and histologic score decreased significantly in the last 3 groups and at all three-time points (P < 0.05). DD progressed over time in the Punct and Punct+OVX groups (P < 0.05). The changes were more severe in the Punct+OVX group compared to the Punct group and the OVX group. CONCLUSION: The combination of puncture and ovariectomy induced rapid and progressive DD in the lumbar discs of rats without spontaneous recovery.

Establishment of an Animal Model of Disk Degeneration by Intradiskal Injection of Monosodium Iodoacetate.

BACKGROUND: Disk degeneration (DD) stands for the most common cause of low back pain. The establishment of an animal model plays an intrinsic role in the clarification of the physiopathology of DD. The purpose of this study is to select an optimal dose of monosodium iodoacetate (MIA) that may generate a reliable model of DD. METHODS: Thirty-four rats were used in this study. The disks (Co7/8, Co8/9, and Co 9/10) received 1 shot of intradiskal injection of 0.02 mg, 0.1 mg, and 0.5 mg of MIA solution, respectively. Half of the rats were euthanized 3 weeks after MIA injection, and the other half 6 weeks after injection. RESULTS: Magnetic resonance imaging evaluation showed that the mean T2-weighted signal intensity at 6 weeks decreased significantly in the 0.1 and 0.5 mg groups. The disk height of the control group was significantly higher than those of the 0.1 mg and 0.5 mg groups. Histologic and macroscopic results revealed time-and-dose-depending degeneration in the disks that received MIA. Additionally, MIA produced cell death in the nucleus pulposus cells with an elevated percentage. The injected disk with 0.1 mg MIA demonstrated a progressive degeneration, the disk injected with 0.5 mg MIA induced DD acutely 3 weeks post MIA injection, while the dose of 0.02 mg of MIA did not show much degeneration. CONCLUSIONS: We concluded that 0.1 mg MIA is the most suitable dose to establish a model of DD, which enabled us to replicate the onset, progression, and outcome of diverse histopathologies of DD in the clinic.

[Monteggia fractures-dislocations in children: retrospective study of 40 cases in the Department of Orthopedics, Habib Bourguiba University Hospital in Sfax, Tunisia]. / Fractures-luxations de Monteggia chez l'enfant: étude rétrospective de 40 cas dans le Département d'Orthopédie, Centre Hôpital Universitaire Habib Bourguiba de Sfax, Tunisie.

Monteggia's fracture-dislocation is rare in pediatric traumatology and pose a problem of elapsed time before management and of prognosis. The purpose of this study was to describe the epidemiological features of this fracture and to assess functional and anatomical results. We report a series of 40 cases of Monteggia fracture in children whose data were collected and treated at the Habib Bourguiba University Hospital Center in Sfax over a period of 17 years, from January 1998 to January 2015. We listed the epidemiological data of our population as well as the types of fracture dislocations according to the Bado radiological classifications. For functional assessment, the choice of treatment was based on the type of fracture. P. Rigault's score and Kim's score were used. The average age of our study population was 8 years; 20 cases of fractures were classified as Bado I and 12 cases as Bado III. The time elapsed before treatment was less than 24 hours in 82% of cases. Surgical treatment was performed in 28 cases, and functional results were judged to be good in 30 cases. Our results were satisfactory due to the short time elapsed before patient management compared to literature data.

[Anterior cruciate ligament reconstruction using Mac Intosh technique modified by Jaeger: a retrospective study of 80 cases in the Department of Orthopedics and Traumatology at the Habib Bourguiba University Hospital, Sfax, Tunisia]. / Reconstruction du ligament croisé antérieur selon la technique de Mac Intosh modifiée par Jaeger: étude rétrospective de 80 cas au service d'orthopédie et traumatologie CHU Habib Bourguiba, Sfax, Tunisie.

Recent studies about anterior cruciate ligament (ACL) surgery have focused on a better control of rotational stability, but ACL reconstruction is always a topical issue. The purpose of our study was to evaluate clinical and radiological outcomes after the use of the technique for anatomical reconstruction of the ACL with fascia lata, according to Macintosh technique modified by J.H Jaeger. We conducted a study of a continuous series of 80 patients between 2005 and 2019. All patients were assessed according to the International Knee Documentation Committee (IKDC) score and the Lysholm and Tegner scale. All our patients were rated as excellent with an average score of 92. Occasional lateral residual pain was reported by 8 patients. Residual jerk accounted for 2.5%. Radiological examination did not show ballooning or arthrosis at the last follow-up. Anterior cruciate ligament reconstruction is a common procedure that has become more reliable over time. But pivot shift (Jerk test) requires a lateral tenodesis "external rotation", especially in athletes.

Impact of Needle Size on the Onset and the Progression of Disc Degeneration in Rats.

BACKGROUND: Numerous animal models of intervertebral disc (IVD) degeneration have been proposed in the literature. The rat caudal disc has been used in disc degeneration studies because of its low cost and simplicity. However, no consensus on the size of the needle to be used during this process has been reached, yet. OBJECTIVES: This study aims to select an optimal needle size to establish a reproducible IVD degeneration model. STUDY DESIGN: This is a randomized, experimental trial. SETTING: Cell therapy and experimental surgery of musculoskeletal system LR18SP1 Lab, The Faculty of Medicine of Sfax, Tunisia. METHODS: The validity was verified by magnetic resonance imaging (MRI), histological, and immunohistochemical examinations. RESULTS: The MRI, histological, and immunohistochemical examinations showed that a disc that is perforated with a 21G needle degenerated acutely one week after the surgery, while a 29G needle puncture failed to develop disc degeneration. A 25G needle induced progressive degeneration in the IVD. LIMITATIONS: This study was not very long (6 weeks). CONCLUSIONS: We conclude that the size of the needle affects the onset and the progression of disc degeneration; a larger needle size leads to a more extended histological and radiographic degeneration within the IVD and in a relatively short time. Therefore, a 21G needle is an optimal choice to induce rapid degeneration in rats' caudal discs. However, the use of a 29G needle failed to establish a degenerative IVD model, which makes it ideal for IVD injection of drugs, plasmids, and growth factors. A 25G needle may be used to induce gradual degeneration.

[Subungual exoxtosis: case report and literature review]. / Exostose sous-unguéale: à propos d'un cas et revue de la littérature.

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.

Posterior short segment pedicle screw fixation for the treatment of thoracolumbar fracture.

The choice of the type of stabilization device in the osteosynthesis of dorso-lumbar spine fractures remains a subject of controversy. The present study aims to evaluate the efficiency of short segment in patients suffering post-traumatic thoracolumbar fractures. This study was conducted in the Department of Orthopedic Surgery and Traumatology of the Habib Bourguiba University Hospital, Sfax, Tunisia. All our patients had a spinal osteosynthesis via the posterior approach with a short segment pedicle screw fixation. We established a record of the pre and post-operative data, the functional results in the post-operative stage during the follow-up period and in retrospect according to the Denis Pain Scale, as well as the Oswestry score. The correction was evaluated by determining the relative gain and loss at the last period of retrospect: vertebral kyphosis, regional kyphosis, Gardner Segment Kyphotic Deformity (GSKD), and computed tomography (CT) scan in retrospect to check the quality of the arthrodesis. The average Oswestry score was 14%. Twenty-nine patients had an Oswestry score ≤40%. The relative gain obtained postoperatively was 57.3% for vertebral kyphosis, 67.2% for regional kyphosis and 71.3% for Gardner kyphosis deformity; while the loss of correction at the last follow-up was 0.6° for vertebral kyphosis, 1.5° for regional kyphosis and 0.9° for GSKD. No cases of non-union were reported. The short segment fixation makes it possible to limit operating time, the abundance of bleeding and the aggression of the soft tissues.

[Tuberculous bursitis of the shoulder in a patient with chronic renal insufficiency: about a case]. / Bursite tuberculeuse de l'épaule chez une insuffisante rénale chronique: à propos d'un cas.

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.

In situ contouring technique in the treatment of thoracolumbar fractures.

Burst fractures typically occur at T12 or L1 and create a sagittal deformity by a compression mechanism. This posttraumatic kyphosis is evaluated preoperatively by measuring the sagittal index of Farcy. Posterior instrumentation using in situ contouring is based on a bilateral insertion of rods which take the shape of the spine first. The rods are placed in a perpendicular position to monoaxial pedicular screws and then bent in situ, which makes the spine follow the movements of the rods. This principle makes it possible to correct the posttraumatic kyphosis at the level of the fractured vertebra and the overlying disk, which will open progressively using a ligamentotaxis mechanism. An additional anterior approach is indicated if the sagittal correction through the disk represents less than 50% compared to the total correction (in other words, if the correction of the traumatic deformity is obtained more in the disk than in the bone (>50%), an additional anterior approach is performed: more through the disk than the vertebral body (>50%)). This reliable technique meets the requirements of sagittal posttraumatic kyphosis correction, and provides a solid construct which avoids bracing.

Thoracolumbar fractures surgically treated by "in situ contouring".

This is a retrospective study on a series of 70 patients with thoracolumbar fractures (TL), surgically treated by the in situ bending technique (ISB). Its purpose is to show the performances and limits of the ISB technique for the early correction of post-traumatic spine deformities as well as to estimate the overall outcome in this series and to discuss the indications for anterior grafting. Although the management of limbs fractures is a cleared issue today, spine fractures management is still a matter of debate. Surgical treatment progresses fast, while indications, the fixation techniques, fracture reduction options, and associated grafting are still blurry. Seventy patients with TL fractures, mean age 40.3 years (20-80) were treated by posterior fusion with a standard construct and deformity reduction by means of the ISB technique. Mean follow-up was 30.7 months (12-78). Pre- and post-operative deformity was evaluated and the relative deformity as defined by Farcy's sagittal index (SIF) was analyzed. Thirty-eight patients underwent anterior interbody grafting. The pre-operative SIF decreased from 16.98 to 1.62 degrees (15.36 degrees decrease). Eighty percent of patients were normo- or hyper-corrected. The loss of correction during the follow-up occurred within the disc (SIF: -2.24 degrees , vertebral kyphosis 0.94 degrees , p<0.001), and was lower in patients who underwent secondary anterior grafting (-5.21 degrees vs.-1.18 degrees , p=0.002). Clinical outcome is good (Oswestry=29.75) and seems to be better in cases of double approach (20.71 vs. 37.,4, p=0.001). Sepsis occurred in ten cases, and two patients experienced construct dismounting. One patient had a retroperitoneal hematoma that required embolization. Seventy-one percent of operated patients went back to their previous work after surgery. Spine fractures deserve an efficient treatment. The ISB technique improves post traumatic kyphosis. This results is maintained at long term if the posterior fusion is associated with anterior grafting in cases where the correction within the disc exceeds 50% of the total correction.