Isolated dorsal dislocation of the distal radioulnar joint: A case report.

Isolated distal radioulnar joint (DRUJ) dislocation is a rare injury. Reports of isolated DRUJ luxations, volar or dorsal, are often case reports and rarely a series of cases. We present a case of an isolated acute dorsal dislocation of the distal radioulnar joint in a 25-year-old man. The patient underwent closed reduction and a transcutaneous radioulnar pinning was done followed by cast immobilization in neutral rotation during 6 weeks. After six months follow -up, the functional result was satisfactory, patient experienced no pain and had no restrictions in work or sports-related activities.

Bilateral anterior shoulder dislocation with bilateral fractures of the greater tuberosity: A case report.

Bilateral anterior dislocation of the shoulders with fractures of both greater tuberosities is very rare. A 76-year-old woman sustained a bilateral anterior dislocation of her shoulders with fractures of the greater tuberosity on both sides after a fall on stairs. Her arms were abducted and externally rotated. Radiological examination revealed the bilateral anterior dislocation and also the bilateral fractures of the greater tuberosity. Prompt closed reduction followed by a 3 weeks immobilization and subsequent rehabilitation allows a good outcome. Results at one-year follow-up were satisfactory with normal range of motion and no redislocations occurring. To our knowledge, this is the first reported case of bilateral anterior shoulder dislocation associated with fractures of both greater tuberosities in elderly woman.

Multifocal bone tuberculosis: a case report.

Multifocal long bones tuberculosis without articular involvement is very rare. Pain and swelling are the common presenting symptoms. Difficulties in diagnosis often lead to delayed treatment, sometimes with devastating consequences for patients. Radiographs may mimic other diseases. Histopathological study is necessary to establish the diagnosis. The antibacillary chemotherapy produces excellent results. We report a case of a 60-year-old woman afflicted with multifocal tibial tuberculosis.

Open medial ankle dislocation without associated fracture: a case report.

Tibiotalar dislocation without associated fracture is a rare injury. We report a case of an unusual open medial ankle dislocation without any associated bony injury. After reduction and debridement under general anaesthesia, capsule suture and ligaments repair were performed. An external fixator was applied for ankle immobilization. After 3 years follow-up, functional results were excellent without signs of instability or degenerative arthritis.

[Tuberculosis of the hand and wrist: different aspects of 30 cases]. / La tuberculose de la main et du poignet : différents aspects à propos de 30 cas.

Tuberculosis of the hand and wrist is a rare entity. We report 30 cases of tuberculosis of the hand and wrist, including ten cases of wrist osteoarthritis, ten cases of tenosynovitis, four cases of metacarpophalangeal and interphalangeal osteoarthritis and six cases of metacarpal and phalangeal osteitis. The histological study after surgical biopsy revealed caseating giant cell granulomas with epitheloid cells confirming the diagnosis. Antibacillary chemotherapy promoted healing and good outcome in our patients. The aim of our work is to analyze the epidemiological, diagnostic, therapeutic and evolutionary aspects of this disease through a series of 30 cases.

El papel de la escapulectomía en el tratamiento de los tumores de la escápula: a propósito de 6 casos / The role of scapulectomy in the care of the scapular tumors: a report of 6 cases

Este estudio retrospectivo tiene como objetivo mostrar el papel de la escapulectomía en el tratamiento de tumores escapulares analizando los resultados en 6 pacientes tratados en el Servicio de Cirugía Ortopédica del Hospital IBN SINA en Rabat por distintos tumores en la escápula entre los años 1996 y 2009. La evaluación de estos pacientes mediante el sistema de Enneking mostró en el plano funcional, excelentes resultados para 4 pacientes y buenos en los otros dos casos. En el aspecto oncológico, sólo un caso requirió la ampliación de la escapulectomía por recidiva tumoral, teniendo este paciente una buena evolución posterior. Ya que la escapulectomía ampliada es una intervención que lleva a un déficit funcional importante, actualmente el tratamiento de los tumores malignos de la escápula se realiza con una cirugía conservadora de miembro, realizándose una escapulectomía simple. Ésta debe llevarse a cabo tras una buena estadificación del paciente, para lo que es necesario un estudio de imagen completo y buen conocimiento de la anatomía para una correcta indicación quirúrgica (AU)

This retrospective study aims to demonstrate the role of scapulectomy in the treatment of scapular tumours by assessing the results of 6 patients treated for various scapular tumours in the Orthopaedic Department of IBN SINA hospital in Rabat between 1996 and 2009. The evaluation of these patients by the Enneking system showed, on a functional scale, an excellent score for 4 patients and good one for 2 patients; on the oncology scale, a single case required a total scapulectomy after recurrence with a good evolution. Since an enlarged scapulectomy leads to functional deficit, the majority of malignant tumours of the shoulder are currently treated conservatively, by performing a simple scapulectomy. Patient selection must be made after appropriate staging, a complete imaging study and a good knowledge of anatomy for a correct surgical indication (AU)

[Tuberculosis of the wrist. Symptoms and outcome in eleven cases]. / Tuberculose du poignet. Symptômes et évolution de 11 cas.

PURPOSE OF THE STUDY: We present our experience with a rare localization of tuberculosis, the wrist, focusing on symptoms and outcome after treatment. MATERIAL AND METHODS: Our series included eleven patients, eight men and three women, mean age 42 Years, who presented tuberculosis of the wrist. Tuberculosis was known in four patients who were being treated and a context of tuberculosis was recognized in three others. One patient on long-term corticosteroid therapy was immunodepressed. Mean time from symptom onset to consultation was fifteen months indicating a slow and progressive disease process. An inflammatory syndrome was noted in nine patients. Based on the standard x-rays, the David-Chausse classification was: stage I n=1; stage II n=1; stage III n=3; stage IV n=4. The AP view of the wrist was normal in two patients. Diagnosis of tuberculosis was confirmed on the surgical biopsy specimen which revealed epithelio-gigantocellulary granuloma with caseous necrosis. In only five patients Koch bacilli developed in culture on Lowenstein-Jensen. Patients were given anti-tuberculous antibiotics and the wrist was immobilized in a plaster splint. RESULTS: Mean follow-up was two years. The disease course was blunted by the antituberculosis treatment. Surgical drainage was only required to clear abscesses. Wrist stiffness was frequent and had a significant functional impact. DISCUSSION: These eleven cases of a rare localization of tuberculosis illustrate the slow progressive course of clinical symptoms and radiological signs of tuberculosis, emphasizing the difficulties encountered in establishing early diagnosis of such isolated non-abscessed localizations. Anti-tuberculous treatment is effective but the functional outcome depends on early diagnosis before the development of radiological evidence of joint destruction.

[Posterior radiocarpal fracture-dislocation (eight case reports)]. / Les luxations-fractures radiocarpiennes postérieures (à propos de huit cas).

The Authors report a retrospective series of eight cases of posterior radiocarpal fracture-dislocation. Average age of patients was 32 years (23/54), with a male predominance (7 men and a woman). Injury was often due to a fall on the hand in extension from an elevated place (5/8). The wrist in back of fork is the characteristic deformity. Diagnosis was confirmed by AP and lateral views of the wrist. Radial styloïd fracture, posterior dislocation of the carpus and posterior rim avulsion were constant. Ulnar styloïd fracture was present in half of the cases and distal radio-ulnar dislocation in two cases. Four patients were treated conservatively and four surgically. Whatever the treatment choice, results are satisfactory at a short follow-up. The two patients presenting a distal radio-ulnar dislocation resulted in a bad result.

[Divergent dislocation of the elbow in an adolescent. A case report]. / Luxation divergente du coude chez l'adolescent. A propos d'un cas.

A case of simultaneous proximal radio ulnar joint divergent dislocation combined with a bone avulsion of the coronoid apophysis of the same elbow in a 16 years-old girl is presented. After a closed reduction and two weeks of plaster immobilization, normal function of the elbow was recovered within three months. There are only ten cases reported of such a divergent elbow dislocation in modern literature.

[Necrotizing fasciitis of the upper limb. Apropos of 4 cases]. / La fasciite nécrosante du membre supérieur. A propos de quatre cas.

This article is based on the retrospective study of 4 cases of necrotic fasciitis of the upper extremity, in adult patients with a mean age of 57 years (range: 36 to 78 years) and with a male predominance (3 M/1 F). Presenting signs were variable: pain, febrile and inflammatory oedema, ecchymoses with inflammatory masses containing clear or haemorrhagic fluid. Treatment with antibiotics and anti-inflammatory drugs did not prevent progression to painless, necrotic ulcers. Rapid medical and surgical treatment constitutes an element essential of the prognosis and must include wide large debridement, antibiotics and intensive care.

[Divergent dislocation of the elbow. Apropos of a case]. / La luxation divergente du coude. A propos d'un cas.

One case of divergent dislocation of the elbow is reported. It was associated with other lesions of the upper limb due to the violence of the initial trauma. The authors found 6 other cases reported in the literature. They discuss the mechanism, diagnosis and treatment of such lesions.