Surface osteosarcoma: Clinical features and therapeutic implications.

INTRODUCTION: Surface osteosarcoma are rare variant of osteosarcoma that include parosteal osteosarcoma, periosteal osteosarcoma and high grade surface osteosarcoma. These lesions have different clinical presentation and biological behavior compared to conventional osteosarcoma, and hence need to be managed differently. GOAL: The aim of this study is to analyze the clinico-pathological features and outcome of a series of surface osteosarcoma in an attempt to define the adequate treatment of this rare entity. PATIENT AND METHOD: It is a retrospective and bicentric study of 18 surface osteosarcoma that were seen at the KASSAB's Institute and SAHLOUL Hospital from 2006 to 2013. The authors reviewed the clinical and radiologic features, histologic sections, treatments, and outcomes in this group of patients. RESULTS: Seven patients were male (38.9%) and 11 were female (61.1%) with mean age of 25 years (range from 16 to 55 years). Eleven lesions were in the femur and 7 in the tibia. We identified 11 parosteal osteosarcoma (six of them were dedifferentiated), 3 periosteal osteosarcoma and 4 high grade surface osteosarcoma. Six patients had neoadjuvant chemotherapy and all lesions had surgical resection. Margins were wide in 15 cases and intra lesional in 3 cases. Histological response to chemotherapy was poor in all cases. The mean follow up was 34.5 months. Six patients (33.3%) presented local recurrence and 8 patients (44.4%) presented lung metastases. Six patients (33.3%) died from the disease after a mean follow up of 12 months (6-30 months); all of them had high grade lesions. CONCLUSION: Histological grade of malignancy is the main point to assess in surface osteosarcoma since it determines treatment and prognosis. Low grade lesions should be treated by wide resection, while high grade lesions need more aggressive surgical approach associated to post operative chemotherapy.

[Not Available]. / Diagnostic clinique et paraclinique des infections ostéoarticulaires digitales dans les brûlures thermiques de la main.

Infectious complications of finger-joints in association with hand burns are common and dominated by osteoarthritis. However, this issue has hardly ever been addressed in the literature. This ailment can either be identified while patients with extensive burns are undergoing intensive care, or during patient rehabilitation. In the former instance, it is difficult to recognize because patient sedation means the clinical signs are not obvious. In the latter phase, however, the pain, swelling (tumefaction), stiffness and radiological signs are clear. These infections should be diagnosed as soon as possible in order to preserve the function of the hand.

Patients with complicated Pott's disease: management in a rehabilitation department and functional prognosis.

OBJECTIVE: The objective is to study the rehabilitation management and to assess autonomy in daily life activities as well as walking recovery in patients with complicated Pott's disease. PATIENTS AND METHODS: Retrospective study in nine patients over a period of 8 years extending from 2000 to 2008, collated in the Department of Physical Medicine and Functional Rehabilitation, CHU Sahloul, Sousse, Tunisia. RESULTS: The mean age of our patients was 43.8 years; sex ratio was 5/4. The spine involvement of tuberculosis was dorsal in seven cases, dorso-lumbar in one patient, and multiple (cervical, dorsal and lumbar) in one case. All patients were paraplegic with a neurological involvement of the bladder. They had prior antituberculosis chemotherapy for at least 8 months. Decompression surgery was performed in six cases. Two female patients presented disorders of spinal posture during treatment requiring surgical revision with osteosynthesis. All patients received additional rehabilitation care. Following a mean duration of hospitalisation in the Rehabilitation department of 47 days with twice-daily sessions of tailored physiotherapy, three patients remained in complete paraplegia, autonomous in wheel-chair and with vesical and sphincter incontinence. The measure of functional independence (MFI) was at admission/discharge 71/92. CONCLUSION: Rehabilitation takes an important place in the medico-surgical management in Pott's disease, to limite or compensate the disabilities and handicap related to this pathology.

[Screw fixation without bone graft of calcaneal joint fractures: 35 cases]. / Résultats de l'ostéosynthèse par vissage sans greffe osseuse des fractures articulaires du calcaneus: à propos de 35 cas.

PURPOSE OF THE STUDY: The prognosis of calcaneal joint fractures is less favorable than fractures without joint involvement. Surgical treatment is frequently recommended. The type of fixation and the usefulness of a bone graft remain subjects of debate. The purpose of this work was to present the functional and anatomic results obtained with simple screw fixation without bone grafting in a retrospective series of 35 displaced joint fractures of the calcaneus. MATERIAL AND METHODS: The series included 31 patients (four bilateral fractures), 86% men. Mean age was 36 years (17-60 years). Using the Duparc classification, there were 12% type III fractures and 88% type IV fractures. Horizontal joint impaction was observed in 36% of patients, vertical impaction in 8%, and mixted impaction in 56%. The mean Bohler angle was 2 degrees (range -25 degrees to 15 degrees ). According to the Utheza classification, 70% of the fractures had two sagittal fracture lines, 16.5% one sagittal fracture line, and 13.5% comminutive fractures. Incongruency of the subtalar joint was noted in 70%, with a conflict with the lateral malleolus in 50%. Mean time to surgery was 12 days (7-30 days). The sub- and retromalleolar approach was used to achieve simple screw fixation. Bone grafts were not used. Mean follow-up was two years (range 12-38 months). RESULTS: There were no serious complications. Functional outcome was analyzed with the Kitaoka scale, mean score 74.3 +/- 1.1 (range 46-98), with 16% excellent outcome, 56% good outcome, 25.2% fair outcome, and 2.5% poor outcome. There was a correlation between functional outcome and age, etiology, and type of fracture. Anatomic results were assessed with the Babin scale and were very good in 24%, good in 8%, fair in 28%, and poor in 40%. Secondary loss of the initial heightening of the joint surface was noted in 48% of the cases, 3 degrees on average. DISCUSSION: This series confirms the value of surgical treatment compared with conservative treatment. Compared with plate fixation, screw fixation exposes the patient to less risk of skin and infectious problems. Simple screwing generally provides satisfactory results with acceptable stability. In light of the present results, adjunction of a bone graft would not be necessary since the loss of correction of the joint surface height was often minimal. CONCLUSION: Screw fixation of calcaneal joint fractures is a reliable technique. Adjunction of a bone graft does not appear to be necessary.