Interest of longitudinal patellar tunnels in reconstructing chronic patellar tendon rupture with semitendinosus autograft: A case report.

Treatment of chronic patellar tendon ruptures represents a real challenge for orthopaedic surgeons. The superior patellar migration and the pathological aspect of the tendon are the two conditions that aggravate the situation. Several reconstruction methods have been described in the literature. Hamstring tendon augmentation using horizontal patellar tunnel is widely used in such cases. However, underuse of longitudinal patellar tunnels, although they reproduce the native footprint of the patellar tendon insertion, highlights a missed opportunity in chronic patellar tendon rupture reconstruction. In the current article, we describe a semitendinosus tendon autograft reconstruction technique where the patellar tunnels are drilled longitudinally instead of being drilled transversely from medial to lateral. At 34 months follow-up, our patient claimed full active knee mobility with good quadriceps strength. Reproducing the native footprint of the patellar tendon insertion, through longitudinal patellar tunnels, leads to optimal outcomes after chronic patellar tendon rupture reconstruction with Semitendinosus Autograft.

Clinical and radiographic outcomes after paediatric supracondylar humeral fractures treated with combined intramedullary and lateral wire fixation: our experience in fifty-one cases.

PURPOSE: Displaced supracondylar humerus fractures in children are known for their high rate of complications and require urgent surgical treatment. Basically, there are two methods of fracture fixation: the lateral pin technique and the crossed pin technique. However, the best technique remains debated. The aim of this study was to evaluate the clinical and radiographic outcomes of our method of fixation using combined intramedullary and lateral wires for treatment of displaced supracondylar humeral fractures in paediatric patients. METHOD: Fifty-one paediatric patients were treated for displaced supracondylar humeral fractures. The method of fracture fixation used consists of two Kirschner wires inserted one intramedullary and the other laterally. Clinical and radiographic outcomes were assessed at last follow-up. RESULTS: According to Gartland's classification, 17 fractures (33%) were type 2 and 34 (67%) were type 3. The mean follow-up period was 7.8 months. Functional outcome according to Flynn's criteria was satisfactory in all cases with 92% graded as excellent or good. Cosmetic outcome according to Flynn's criteria was satisfactory in all cases. Radiologically, at last follow-up, the mean Baumann angle was 69° (63-82°) and the mean lateral capitellohumeral angle was 41° (32-50°). CONCLUSION: Patients managed with combined intramedullary and lateral wires experience satisfactory results. Moreover, this technique, without risk for the ulnar nerve, can be interesting in the treatment of infrafossal fractures and fractures with anterior displacement.

High-pressure injection of paint into the hand: A small injury with serious consequences.

High-pressure injection injury to the hand is a rare but very serious clinical entity, considered by plastic and hand surgeons as a surgical emergency. Diagnosis of these injuries is frequently delayed due to the initial benign appearance of the wound and the lack of knowledge of the seriousness of this injury.

Atypical emphysema formation in a never-smoker with scleroderma-related interstitial pneumonia: a case report.

Scleroderma is an autoimmune connective tissue disorder which is characterized by fibrosis of visceral organs, blood vessels and skin. The most common manifestations of lung disease in systemic sclerosis are interstitial lung disease and pulmonary hypertension and, together, are the leading cause of mortality in systemic sclerosis. Recently, we notice a new pattern called Combined-pulmonary emphysema and lung fibrosis. Most patients with this entity are male smokers or ex-smokers. This entity is characterized by the coexistence of both centro-lobular and para-septal emphysema in the upper lobes and interstitial lung disease in the lower lobes. Here, we present a case of a nonsmoker adult woman with systemic sclerosis, in which High Resolution Computed Tomography of lung showed combined fibrosis and emphysema with atypical radiological presentation and unusual distribution. This case outlines the importance of recognizing the presence of combined fibrosis and emphysema in patient with systemic sclerosis even without smoking history.

Unusual case of spontaneous hemopneumothorax in a Tunisian pulmonology department: a case report.

Spontaneous hemopneumothorax is a rare encountered entity in clinical practice. It can be life threatening, so a prompt diagnosis and therapeutic intervention are required. We report a case of a right spontaneous hemopneumothorax in a 31-year-old man, complicated with hemorrhagic shock. Conservative therapy with only thoracic drainage with close monitoring of outflow and hemodynamic parameters was performed. In front of hemodynamic instability, an emergency video-assisted thoracoscopic surgery was performed. An apical bulla adhering to the parietal pleura has been identified as the source of the bleeding. The resection of the bullae and electrocauterization of the bleeding adhesion were effectuated. The hemostasis was easily achieved. The actual experience suggests that video-assisted thoracoscopic surgery should be performed as soon as possible after the diagnosis of spontaneous hemopneumothorax. Indeed, conservative therapy with chest drainage should only be performed as bridge to recovery for the stabilization before the video-assisted thoracoscopic surgery.