Botulinum toxin and hyperhidrosis of the amputation stump in war amputees.

INTRODUCTION: Stump hyperhidrosis is a common condition after lower limb amputation. It affects the prosthesis use, and the quality of life of patients. Several case reports tried to prove benefit of using Botulinum toxin in its treatment. AIM: This study was to conduct a larger workforce clinical trial and to demonstrate benefits of botulinum toxin injection in the treatment of stump hyperhidrosis. METHODS: A prospective study was conducted. War amputees who complained of annoying excessive sweating of the stump were included. They received intradermal injection of botulinum toxin A in the residual limb area in contact with prosthetic socket. Abundance of sweating and degree of functional discomfort associated with it were assessed before, after 3 weeks, 6 and 12 months. RESULTS: Seventeen male patients, followed for post-traumatic limb amputation were included in the study. Discomfort and bothersome in relation to Hyperhidrosis did decrease after treatment (p<0,001). Reported satisfaction after 3 weeks was 73,33%. Improvement of prothesis loosening up after 3 weeks was 72,5% [±15,6]. Mean injection-induced pain on the visual analogue scale was 5.17/10 (±1.58). The mean interval after the onset of improvement was 5.13 days [min:3, max:8]. The mean time of improvement was 10.4 months after the injection [min:6, max:12]. No major adverse events were reported following treatment. CONCLUSION: Intradermal injections of botulinum toxin in the symptomatic treatment of stump hyperhidrosis are effective and have few adverse effects. It improves the quality of life of our patients thanks to a better tolerance of the prosthesis.

Heterotopic ossification of the shoulder after arthroscopic rotator cuff repair: A case report.

INTRODUCTION AND IMPORTANCE: Heterotopic ossification (HO) often arises in response to trauma, prior surgical procedures, neurological injuries, or burns. However, its presentation as a complication of shoulder arthroscopy is uncommon and can sometimes lead to functional impairment. In our study, we report a case of HO complicating rotator cuff repair, along with details of the surgical treatment and subsequent progression. CASE PRESENTATION: We report the case of a 45-year-old man with no medical history, who had undergone a rotator cuff arthroscopic repair of his left shoulder. Despite initial improvements, he developed intense pain and stiffness of the operated shoulder. X-rays revealed an extensive HO. Surgical revision and excision of the ossification, followed by high-dose indomethacin in combination with proton pump inhibitors and specialized physiotherapy, resulted in remarkable improvement in shoulder function. CLINICAL DISCUSSION: Studies investigating HO in shoulder arthroplasty have unveiled a diverse range of formation rates, spanning from 15 % to 62 %. Nonetheless, it's noteworthy that the prevalence of HO around the shoulder remains less common in comparison to other anatomical sites, especially in the context of arthroscopic surgical procedures. The exact mechanism and pathophysiology that leads to HO formation remains unknown. It is believed to stem from a combination of multiple factors and is associated with various contributors. Arthroscopic intervention, coupled with high-dose Indomethacin, offers an effective approach for managing HO. CONCLUSION: While HO remains an uncommon complication after shoulder arthroscopy, it is crucial for clinicians to consider it in patients experiencing post-surgery stiffness and pain.

Surgical management of neck of femur fractures in patients younger than sixty-five years: a comparative study of three fixation methods.

PURPOSE: Several surgical implants have been used for the treatment of neck of femur fracture (NOF) in younger patients such as dynamic hip screw (DHS) and cannulated compression screw. However, the superiority of one or another osteosynthesis device remains a matter of debate. The aim of this work is to evaluate and compare three fixation modalities: Cannulated Hip Screws (CHS), DHS and DHS associated to anti-rotating screw for surgical treatment of femoral neck fracture in young adults. METHODS: It is a retrospective comparative study of three series of NOF fractures treated surgically over a period of ten years; including young adult patients (age > 18 years and < 65 years) treated conservatively using closed or open reduction and internal fixation. All types of NOF fractures according to Garden classification were included. Pathological, basi-cervical fractures and fractures on previously operated hips were excluded. The minimum follow-up recommended was two years. Clinical evaluation was based on the Postel Merle d'Aubigné score (PMA), the visual analogue scale (VAS), the Parker score, and the Hip Disability and Osteoarthritis Outcome Score (HOOS score). Reduction quality was assessed on X-rays. RESULTS: Our series included 72 patients that were divided in three groups: Group A: Fixation using cannulated hip screws (33 patients). Group B: Fixation using DHS only (21 patients). Group C: Fixation using DHS associated to anti-rotation screw (18 patients). The patients of group A had better PMA and VAS scores, but there was no statistically significant difference. However, a significant difference (p=0.001) was found for the HOOS score. The fractures treated with DHS associated with anti-rotating screws, had the highest loss of reduction in the vertical axis (Yp) with the highest femoral head collapse (Zp) values. Group A had the lowest loss of reduction in the horizontal axis (Xp). There was no significant difference between the three methods of osteosynthesis in terms of loss of correction though. CONCLUSION: We found comparable results in terms of healing and complication rates and loss of reduction for the three groups with no significant difference. However, the HOOS score was significantly better in the cannulated hip screw group.

[Turrett's exostoses: about 35 casesk]. / Les exostoses de Turrett's: à propos de 35 cas.

We conducted a retrospective study of 35 patients with subungual exostosis of the hallux, also known as Turrett's exostosis, in the Department of Orthopedics and Traumatology at the Senior Military Hospital of Instruction of Tunis over the period between 1995 and 2015. We here summarize the outcomes of patients treated for this disease. The average age of patients was 29 years, with a sex ratio of 1.7. The median consultation time was six months. This delay in consultation was caused by a diagnostic error due to clinical picture resemblance with ingrown nail. Diagnosis was always confirmed by frontal and profile X-ray of the involved hallux. Treatment was based on total resection of the exostosis either through large ungual window or by latero-ungual approach. Anatomo-pathological examination was performed systematically. It allowed to confirm the benignity of the disease in all cases. All patients recovered and returned to their previous activity, on average, in 2 months. No patient had a recurrence.