Proximal femur fracture: Direct medical costs of hospital treatment.

INTRODUCTION: Proximal femur fractures are one of the most common injuries in older adults representing a serious health condition in developed as well as developing countries. AIM: This study aimed to assess the hospitalization costs of the proximal femur fracture. METHODS: We conducted a prospective descriptive study spread over six months about patients hospitalized and operated on for proximal femur fractures. In order to estimate the cost we referred to the nomenclature of professional acts and the prices set by the Ministry of Public Health and the Ministry of Finance. RESULTS: The study included 100 patients, 55 females and 45 males with an average age of 76 years. The average hospital length of stay was 5 days. The preoperative stay was at a mean of three days. The average total hospitalization cost for these fractures was 2877 Tunisian Dinars depending on the type of fracture and surgical treatment. The main components of the costs were hospital stay costs and human resources costs 40%, cost of the implant 25.9%, cost of consumables 12%, operating cost 10%, cost of additional examinations 9% and cost of medications 2%. CONCLUSION: Proximal femur fractures represent an important cause of health resource consumption. To reduce the cost of hospital care, we recommend limiting the length of hospital stay as much as possible, investing in total hip and hemi-arthroplasties and adapting economical behavior taking into account the cost of consumables.

Chordoma of the lumbar spine-A potential diagnosis not to be forgotten!

Chordoma is a rare, malignant neoplasm thought to develop from the notochord. It most commonly occurs in the base of the cranium or the sacro-coccygeal region but around 15%-20% affect the vertebral body. Extra-lesional resection with or without adjuvant radiotherapy is generally accepted as the mainstay of treatment for this slow-growing tumor. We present a case whereby a patient with an extensive vertebral body lesion causing caudal compression, treated with spinal decompression and posterior stabilization. This case highlights the importance of pre-operative tissue diagnosis, and that, although rare (0.8 per 100,000), chordoma should always be considered.

Dermatofibrosarcoma protuberans of the hallux: A case report with review of the literature.

INTRODUCTION AND IMPORTANCE: Darier-Ferrand dermatofibrosarcoma (DFS) is a rare mesenchymal tumor with an aggressive local behavior, high local recurrence frequency and low metastatic potential. It commonly presents as a raised slowly growing mass. It usually occurs on trunk and proximal extremities but rarely touches distal extremities such as hands, fingers, or foot below knees. CASE PRESENTATION: A 15-year-old girl presents with a protuberant painful mass of the right hallux of 2 years. After surgical excision, histological examination revealed a spindle shaped cells with a strong CD34 expression and the diagnosis of Darier-Ferrand dermatofibrosarcoma of the toe was confirmed. We proceeded to a review of the literature of Dermatofibrosarcoma on the toes with the aim to reveal, its clinical presentations, histopathology, and treatment options. CLINICAL DISCUSSION: DFS represents 0.1 % of all cancers. It is a low-grade sarcoma with a locally aggressive behavior and a low metastatic potential. Only 11 cases of DFS of the toes have been reported in the literature. It usually occurs in the trunk, and proximal extremities. Histological and immunohistochemical examination are mandatory to confirm the diagnosis with diffuse expression of CD34 by the tumoral cells. Surgery is the standard treatment for localized and resectable lesions. CONCLUSION: Darier-Ferrand Dermatofibrosarcoma is an uncommon and recurrent dreadful tumor, that rarely occurs on toes, but should be considered in front of persistent slowly growing foot lesions.

Primary patella tuberculosis mimicking pre-patellar bursitis: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: The Patella is very rare site for tuberculosis (TB). The knee is the third most common site for skeletal TB. The incidence of patella TB being 0.09 to 0.15%. CASE PRESENTATION: We report a case of primary tuberculous osteitis isolated from the patella. The complaint was a mixed knee pain without notion of trauma. The CT showed a large osteolysis of the upper half of the patella. The diagnosis was established on the histological study after biopsy. The patient was operated by a medial approach without arthrotomy and the pathological tissue was resected and curetted. Complementary anti-bacillary antibiotic treatment was administered for 12 months. At the last clinical control, the knee was free and painless, and we had no recurrence. CLINICAL DISCUSSION: Aitken reported the first case in literature in 1933. The initial signs and symptoms are non-specific and sometimes confounded by a coincidental history of trauma. It is difficult to diagnose TB of patella in early stages because there are no constitutional symptoms. Sometimes serological parameters are inconclusive. CT scan can help if the osteolysis contained a central bone sequestration, bordered by peripheral sclerosis. Confirmation of patellar tuberculosis is made on biopsy. CONCLUSION: The tuberculous localization in the patella is rare and it can pose a problem of differential diagnosis with other affections, in particular infectious and tumors. It should always be kept in mind, especially in the face of a picture of pre-patellar bursitis which progresses slowly and whose biological inflammatory syndrome is not straightforward.

Acute tibial tubercle avulsion fractures in the sporting adolescent.

INTRODUCTION: The authors report 7 cases of acute tibial tubercle avulsion fractures. The fracture occurred in 6 out of the 7, after an abrupt tension of the patellar tendon in male sporting adolescents (age 13-17 years). Two patients presented symptoms of homolateral Osgood-Schlatter's disease before the lesion. METHOD: According to Ogden's classification, the tibial tubercle avulsion fracture was not displaced in 3 cases (stage IA) and was treated conservatively by immobilization for 6 weeks. In 4 cases, the fracture was displaced and necessitated an internal fixation with plaster for about 6 weeks. A torn patellar tendon was noted in one adolescent having a stage IIIB avulsion fracture. RESULT: The mean follow-up was of 4.5 years (1.5-7.5 years). The results were satisfactory: complete functional recovery, resumption of sport at the previous level and absence of recurvatum.

[Unusual localization of spinal hydatid cyst]. / Localisation rare du kyste hydatique intra dural au niveau de la fosse posterieure.

We report one case of uncommon spinal hydatid cysts particular by its localization. It is intradural, localized with predilection in the big cistem cerebello-medullar. There is no involvement of adjacent vertebral discs and ligaments. We specify characteristic imaging features and polymorphism of this affection who can affect all anatomical structures. We emphasize MRI for diagnosis and follow-up in search for residual or recurrent lesions.