Necrotizing fasciitis of the thigh: An unexpected route to discover an infected colonic cancer.

Introduction: Necrotizing fasciitis (NF) is a rare but potentially fatal soft tissue infection characterized by its aggressive nature. This case report highlights a unique and atypical presentation of NF associated with colorectal cancer. Case presentation: A 76-year-old male with no significant medical history presented with left knee pain and rapidly progressing septic shock. Clinical examination revealed skin necrosis, inflammation, and swelling in the left thigh and inguinal region. Laboratory investigations showed leukocytosis and elevated C-reactive protein levels. Computed tomography angiography revealed fluid and gas tracking along fascial planes in the left thigh. Surgical intervention revealed NF in the thigh and abdominal wall, with the underlying cause being a perforated sigmoid colon cancer. Conclusion: Recognizing the polymorphic clinical manifestations of NF and its potential association with underlying abdominal pathology can aid in early diagnosis and improve patient outcomes. This report serves as a reminder of the life-threatening nature of NF and the necessity for rapid and comprehensive management.

Anterior Traumatic Lumbosacral Dislocation: A Case Report.

Traumatic dislocation of the lumbosacral joint is a rare and severe lesion usually caused by high-energy trauma. The literature on traumatic spondylolisthesis is limited, and most published papers are sporadic case reports. By presenting the case of an anterior traumatic L5-S1 spondylolisthesis without neurological deficits caused by a 6-meter fall, we discuss the anatomopathological mechanism of this injury, clinical and radiological evaluation, and current management options. The patient was treated surgically with a combined posterior instrumented reduction and transforaminal interbody fusion. At the final follow-up after seven years, the radiological evaluation showed an unchanged spondylolisthesis reduction with reliable fusion healing. In addition, the patient had good functional results and resumed recreational activities and work. Traumatic lumbosacral spondylolisthesis requires a careful and well-documented initial clinical and radiological assessment. Most authors advocate surgical treatment as the mainstay of management. However, the long-term prognosis remains unclear and unpredictable.

Risk factors for atlantoaxial dislocation in rheumatoid arthritis: A comparative study.

BACKGROUND: The objective of the study was to assess clinical and imaging features of rheumatoid arthritis associated with atlantoaxial dislocation (RA-AAD) in comparison to RA without AAD (RA-C) and to identify the associated factors to AAD. METHODS: This was a retrospective comparative study including RA patients over 18 years old. The control group of RA-C was matched according to age (±2 years), gender, and RA duration (±2 years). General data, RA characteristics, AAD features, and treatment modalities were recorded. Statistical analysis was performed to determine the predictive factors of AAD. RESULTS: A total of 120 patients were included (78 RA-AAD and 42 RA-C); sex-ratio was 0.15. Mean age was 58.55 ± 9.14 years (RA-AAD) versus 60.43 ± 10.78 years (RA-C), (p = 0.31). Regarding RA features, RA-AAD patients have significantly a higher rheumatoid factor (RF) rate (p = 0.002), extra-articular manifestations (p = 0.009) especially osteoporosis (p < 10-3 ), eye involvement (p = 0.02), coxitis (p < 0.0001), Disease Activity Score (DAS28) (p < 10-3 ), and global health status scale (HAQ) (p = 0.003). X-ray analysis showed pathologic PADI (<14 mm) in 51.6% of cases. The AADI was pathological (>3 mm) in 100% of patients with the following distribution: 67.9% between (3-6 mm) and 23.3% between (6-9 mm). Atlantoaxial dislocation (AAD) was presumed anterior (85.4%), lateral (7.3%) and rotatory (7.3%). The abnormalities observed on magnetic resonance imaging (MRI) were: C1-C2 synovitis (61%), confirmed AAD (34.1%) and basilar impression (4.9%). AAD diagnosed by cervical MRI was anterior in 89.8% of cases, lateral (5.3%) and with a double ascending and anterior component in 4.9% of cases. An immobilisation with a type C4 cervical collar was indicated for all the patients and five of them had boluses of corticosteroid (methylprednisolone 1 g/day) for three consecutive days. C1-C2 arthrodesis by trans-articular screwing was performed in four patients with neurological signs or pathological measurements on cervical MRI. The outcome was favourable in 100% of cases after surgical treatment with improvement in neck pain and neurological condition within a mean decline of 4 ± 3 years [1-7]. Multivariate analysis identified coxitis, osteoporosis, high baseline DAS28, and a high rate of RF positivity as predictive factors of AAD. CONCLUSION: Our results confirmed that predictive factors of AAD were related to higher disease activity and structural damage. These modifiable factors may be prevented by tight control, early treatment, and educating RA patients to improve treatment adherence.

Synovial Chondromatosis of the Shoulder in Rheumatoid Arthritis: A Case Report and Brief Review of the Literature.

BACKGROUND: Synovial chondromatosis is an uncommon benign condition characterized by synovial membrane proliferation and metaplasia. Synovial chondromatosis cases in patients with rheumatoid arthritis have been reported. However, involvement of the glenohumeral joint is rare. CASE PRESENTATION: We herein report a case of a rare association of synovial chondromatosis involving the shoulder in a rheumatoid arthritis patient. The symptoms have improved with anti-tumor necrosis factor drugs. Consequently, there was no need for invasive therapy to treat synovial chondromatosis. CONCLUSION: Synovial chondromatosis can be aggressive and destructive. More trials are needed to establish a better clinical diagnostic strategy and pharmacological management.

Relevance of the video capsule as a tool for learning Schöber Index measurement in medical students.

INTRODUCTION: Medical education has progressed considerably. Information and communication technologies have been adopted as a learning tool. AIM: We aimed to evaluate the contribution of an educational video in the acquisition of knowledge on the measurement of the Schöber index in young medical students. METHODS: This is a prospective study, spread over 4 months (February 2022-May 2022) and conducted in the rheumatology and orthopedics departments of the Charles Nicolle Hospital in Tunis. We included medical students during their externship at the mentioned services. We compared the realization of the steps of the Schöber test (testing the flexibility of the lumbar spine) before and after the visualization of an educational video. RESULTS: A total of 32 students (6 men and 26 women) were enrolled. There were 18 students (56%) in DCEM1 and 14 students (44%) in PCEM2. Our study showed that the number of students who correctly performed the different steps of the Schöber test increased after viewing the instructional video compared to the beginning, but this increase was not significant. There were some differences between the PCEM2 and DCEM1 groups before viewing the video, but this difference decreased after viewing the video. CONCLUSION: Our study has demonstrated the value of an educational video in improving the knowledge of medical students. This work needs to be applied on a larger scale in different medical specialties.

Lumbar Spinal Involvement in Calcium Pyrophosphate Dihydrate Disease: A Systematic Literature Review.

Background: Calcium-pyrophosphate-dihydrate-disease (CPPD) is a crystal-induced arthropathy. The lumbar-spinal involvement is rare and often under-diagnosed. This study aimed to report the case of a lumbar spine CPPD involvement and to perform a systematic review of clinical, imaging features of lumbar involvement in CPPD patients, and treatments that have been implemented. Methods: This systematic review was conducted in accordance with the Preferred-Reporting-Items-for-Systematic-Reviews and Meta-Analyses (PRISMA) guidelines. Results: One hundred and sixty-seven articles met the search criteria using electronic databases searches. We retained 28 articles (20 case reports, 2 case series, 1 family survey, 4 retrospective studies, and 1 prospective study) involving a total of 62 patients. The age ranged between 39 and 89 years old. Among patients with lumbar spine CPPD, 32 were women. The duration of symptoms varied between one day and 8 years. The affection has been discovered during back pain in most cases. In 5 studies, the diagnosis was made on histological specimens of patients operated on for another pathology. X-ray showed calcifications in 2 cases. CT-scan detected calcium deposit in 7 cases. MRI showed lesions going from the increased signal of the disk, to calcified or not-cystic lesion of the facet joints, an intramedullary mass mimicking a schwannoma. Histological examination established the diagnosis of CPPD in 21 patients in all studies. Medical treatment included NSAIDs, Colchicine, Interleukin-1-receptor-antagonist, and antibiotics. Surgery was performed on 13 patients and allowed to establish the histological diagnosis. Conclusion: In the case of inflammatory back pain in elderly subjects, without an infectious gateway, diagnosis of CPPD should be considered, especially for patients with a history of spinal surgery or degenerative radiography changes. CT scan is more sensitive than conventional radiographs. The discovertebral biopsy is the Gold-Standard and should be performed whenever the diagnosis was uncertain. Treatment includes the medical and surgical components.

Traumatic Floating Neural Arch of the Subaxial Cervical Spine: Case Report.

Bilateral traumatic pedicle fracture in the lower cervical spine is a very unusual lesion. Its association with bilateral facet dislocation has been reported once in the literature. We report a unique traumatic lesion considered as subaxial cervical floating neural arch with special emphasize on reduction maneuvers and surgical management. It was a case of bilateral C7 pedicle fracture with bilateral C6/C7 facet dislocation in a neurologically intact 70-year-old patient. Open posterior reduction with fixation followed by anterior fusion was performed with good functional and radiological outcomes at last follow up. The floating neural arch lesion is the combination of bilateral pedicle fracture and facet dislocation. The detection of such lesions imposes a two-stage surgery with open posterior reduction and anterior fusion.

Fortuitous discovery of isolated tuberculosis of the tenth and eleventh costotransverse joints: A case report.

Involvement of posterior elements of the spine in spinal tuberculosis is rare. We report a case of a 56-year-old woman who presented with asymptomatic tuberculosis of the tenth and eleventh costotransverse joints. The latter was discovered with a CT scan made to look for a pulmonary embolism. Magnetic Resonance Imaging (MRI) showed liquid in the costotransverse joints with a paravertebral abscess. The patient was managed conservatively. Although rare, posterior tuberculosis of the spine should be known by spine surgeons. MRI is the key to the diagnosis. Conservative treatment is the standard treatment, and surgery is reserved for patients with neurological deficit.

Sciatica and femoral head osteonecrosis complicating a gluteal hydatid cyst: A case report.

INTRODUCTION AND IMPORTANCE: Hydatid disease is an endemic echinococcal infestation in Tunisia. Only 4% of hydatid cysts are located in the muscle. The gluteal localization is a very rare entity. The present case illustrates a gluteal hydatid cyst resulting in sciatica and osteonecrosis of the femoral head, an exceptional entity. CASE PRESENTATION: A 49-year-old man of urban origin, with free medical history, presented to our outpatient clinic with left sciatica and mechanical hip pain, that have been ongoing for 2 years. Pelvic radiograph showed femoral head osteonecrosis and lytic lesions of the ischium. MRI scan identified an extra-articular vesicular cyst in the left gluteal region involving the gluteus maximus. It suggested the diagnosis of musculo-skeletal echinococcosis. The patient underwent surgery and intraoperative findings showed a gluteal vesicular cyst with direct compression of the sciatic nerve, it also revealed femoral head necrosis. The cyst was drained and the pericyst excised. Total hip arthroplasty was postponed and the patient received a course of anthelmintic chemotherapy. CLINICAL DISCUSSION: Muscular involvement of hydatid cysts is rare and seen only in 4% of cases. Neurological complications from sciatic nerve compression can present as sciatica, with a principal differential diagnosis of nerve root compression. Aseptic femoral head osteonecrosis, an exceptional complication of an extra-articular gluteal hydatid cyst, can result from three mechanisms: a direct mechanical compression, an ischemic process due to vessel obstruction or a cellular process mediated by osteoclasts. Treatment is based on surgical excision combined with anthelmintic chemotherapy, the latter reduces the number of live cysts and the risk of recurrence. CONCLUSION: Although gluteal cysts are extremely rare with different clinical symptoms, surgery associated with anthelmintic treatment has a good functional outcome.

Advantages of three-dimensional printing in the management of acetabular fracture fixed by the Kocher-Langenbeck approach: randomised controlled trial.

PURPOSE: To compare the outcomes of the Kocher-Langenbeck reduction and fixation of the posterior structures of the acetabulum between 3D printing technique and conventional technique. METHODS: Forty-three patients who sustained fractures of the posterior part of the acetabulum were randomly assigned to two groups: 3D printing (G1; n = 20) and conventional technique (G2; n = 23). The surgical time, intra-operative blood loss, differences between pre-and post-operative haemoglobin, universal functional and radiographic scores, and complications were compared between the groups. The minimum follow-up was 18 months. RESULTS: The average operating time (120.75 min) and intra-operative blood loss (244 ml) were lower in G1 than in G2 (125.87 min and 268.7 ml, respectively; p = 0.42, p = 0.1, respectively). The difference between the pre- and post-operative haemoglobin was 1.71 g/dl in G1 and 1.93 g/dl in G2 (p = 0.113). Post-operative complications occurred more frequently in patients in G2 (34.7%) than in patients in G1 (15%), though these differences were also not significant (p = 0.6). The radiographic result was satisfactory in 16 patients (80%) in G1 and 18 patients (78.26%) in G2 (p = 0.5). The clinical result was satisfactory in 15 patients (75%) in G1 and in 17 patients (73.9%) in G2 (p = 0.6). CONCLUSIONS: No significant differences were found in terms of surgical time, overall complications, and radiographic or functional outcomes between 3D printing and the conventional technique.

Transstyloid radiocarpal dislocation: A case report.

INTRODUCTION AND IMPORTANCE: Transstyloid radiocarpal dislocation is a rare injury. It is due to high-energy trauma. It usually associates a radiocarpal dislocation, a fracture of the radial and/or cubital styloid process, and a cortical volar/dorsal margin avulsion. CASE PRESENTATION: We present a case of a 31-year-old male who sustained a fell from a 4 m height causing a transstyloid radiocarpal dislocation. He was treated with a radial styloid process pinning and wrist arthrorisis with and splint immobilization. CLINICAL DISCUSSION: Different treatment options can be available for this type of injury with or without ligaments reconstruction. CONCLUSION: Although it is rare, the transstyloid radiocarpal dislocation has a good outcome with different types of treatment.

Acetabular roof stress fracture: a rare cause of hip pain in children.

Stress fracture of acetabular roof is an unusual cause of hip pain. It is considered as an underdiagnosed entity. People who are more susceptible to experience this fracture are athletes, soldiers and dancers. We present the case of an 11 year old girl with a roof acetabular stress fracture for which the diagnosis and follow-ups were possible by the means of MRI. The treatment was keeping the child at a complete rest. Failure to abide with this treatment can cause the stress fracture to evaluate into a complete fracture.

Traumatic atlantoaxial rotatory fixation associated with C2 articular facet fracture in adult patient: Case report.

Traumatic atlantoaxial rotatory fixation is a very rare injury in adults which is often misdiagnosed initially. Its combination with C2 fractures is predominated by dens lesions. Therapeutic management is challenging because of the difficulty to achieve optimal reduction and permanent stability. We report a rare case of traumatic atlantoaxial rotatory fixation in a 56-year-old women associated with C2 articular facet fracture successfully treated by conservative means after patient-awake manual reduction with optimal functional and radiographic outcome.