Traumatic iliac muscle hematoma: A rare etiology of quadriceps palsy (case report).

INTRODUCTION AND IMPORTANCE: Quadriceps palsy is a sign of femoral nerve injury. Classically it is a compression of the nerve by a haematoma of the iliopsoas muscle in haemophiliacs and patients on anticoagulants. Could this haematoma form after a trauma in a healthy athlete? CASE PRESENTATION: We report a case of 16-year-old kickboxer with no previous history who had been complaining of the left groin for 3 weeks after being struck in the left iliac fossa. The examination revealed a complete palsy of the left quadriceps with anesthesia of the anterior aspect of the thigh. Femoral nerve involvement was suspected. MRI of the pelvis revealed a large hematoma of the left iliac muscle compressing the femoral nerve. Blood tests did not show any abnormalities. Surgical evacuation of the hematoma with neurolysis of the femoral nerve was performed. Six months postoperatively, the patient had fully recovered from their neurological deficit and was able to return to all his normal activities. CLINICAL DISCUSSION: The post-traumatic etiology of iliopsoas muscle hematoma compressing the femoral nerve in the absence of any hematological cause is rare. Few cases have been published (39 in 75 years). According to the literature, treatment is conservative if the paralysis is partial, but it must be surgical in case of complete paralysis. CONCLUSION: This rare pathology of the adolescent must be known to avoid any prejudicial diagnostic error for the often athletic patient. Whatever the diagnostic delay, a surgical procedure is necessary in case of complete paralysis of the femoral nerve.

MRI contribution in minimally displaced lateral humerus condylar fractures in children.

INTRODUCTION: Diagnosis and treatment of displaced humerus lateral condylar fracture is well codified with open reduction and pinning. For non-displaced or minimally displaced lateral condylar (NMDLC) fractures, diagnosis can be challenging because of cartilaginous structures none visualized on radiographs. AIM: To determine the usefulness of MRI in evaluating articular extension of NMDLC fracture. METHODS: We reviewed consecutive NMDLC fractures during 6 years including children younger than 15 years old with displacement lesser than 2 mm (Rigault type I) at initial radiographs divided in two groups: only line fracture was viewed (R1a), displacement gap lesser than 2 mm (R1b). After elbow cast immobilization, children have got MRI. Surgery was performed in complete articular fractures. All children were seen after 1 mouth then at 6 month for elbow evaluation. RESULTS: Thirty-one fracture, including twenty-two (70.97%) boys. Average age was 6.24 years (3 to 11). Fifteen fractures was classified R1a and sixteen R1b .According to MRI, seven fractures (22,6%) were metaphyseal Gp1, eleven (35,5%) were metaphyso-epiphyseal with an intact hinge cartilage Gp2 ,nine (29%) were complete Salter IV Gp3 and MRI reveals a supracondylar fractures in four cases. Fracture was metaphyseal more often in R1a group (40.0%) compared to R1b (6.3%). Gp3 group was significantly higher in R1b (50.0%) compared to R1a group (6.7%). For the sixteen R1b cases, eight presented articular cartilage involvement on MRI (Gp3) with concordant operative findings. CONCLUSION: MRI is effective in assessing epiphyseal extension fracture providing accurate information for appropriate treatment.

Chronic recurrent multifocal osteomyelitis of clavicle: a rare isolated location (a case report).

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare disease. It is a non-microbial inflammatory bone affection that occurs more often in children with insidious onset and non specific presentation making diagnosis challenging. This study reports a case of CRMO with an unusual location. A 9-year-old child had a painful swelling over the medial side of clavicle with fixed mass. Radiographs showed osteolytic lesion on the medial part of clavicle extending to the acromioclavicular joint with soft tissue edema in magnetic resonance imaging (MRI). No inflammatory markers in biological exam. Needle biopsy, initially performed, suspected bone infection but children didn´t recover after 2 weeks of antibiotics. Surgical biopsy, histology sections were compatible with CRMO diagnosis. Children received a non steroid inflammatory drug with positive response, pain relief and decreasing of the clavicle swelling. CRMO should be suspected and biopsy is some time helpful in such unusual location.