[Cartilaginous tumours]. / Tumeurs cartilagineuses.

Cartilaginous tumours are rare and often incidentally discovered on imaging. They can also be responsible for osteoarticular symptoms (pain, joint stiffness, deformity or fracture) and will require a clinical, radiological and a histopathological assessment. Depending on the lesion, the management may consist of observation or a complex surgical procedure that will take place after a multidisciplinary discussion including the radiologist, the pathologist and the orthopaedic surgeon. The discovery of such cartilage tumours often induces a significant dose of anxiety in the affected patients. A better knowledge of these lesions by the family practitioner and the orthopaedic surgeon therefore seems very useful to provide optimal care before referring the patient to a specialized centre.

Les tumeurs cartilagineuses sont des pathologies rares, dont la découverte est souvent fortuite sur une imagerie réalisée pour une autre raison. Parfois symptomatiques (douleur, raideur articulaire, déformation, fracture), elles doivent motiver une exploration clinique, radiologique, et histopathologique. La prise en charge dépend des lésions identifiées et peut comporter un simple suivi clinique ou un geste chirurgical complexe, fruit d'une discussion menée par une équipe multidisciplinaire composée de radiologues, pathologues et chirurgiens. La découverte d'une lésion cartilagineuse induit souvent une dose d'inquiétude non négligeable chez les patients atteints. Leur connaissance, par le médecin traitant et le chirurgien orthopédiste, nous semble indispensable afin de proposer une prise en charge optimale qui devra se faire dans un centre spécialisé.

[Management of malignant bone tumors around the knee]. / Prise en charge des tumeurs osseuses malignes autour du genou.

Primary bone tumors arise mostly around the knee. A treatment strategy issued from a multidisciplinary team is the key factor for an optimal management of such patients. Many durable options for reconstructing a functional limb are available, as an alternative to amputation, without lowering patients' survival. Nevertheless complications are frequent and any decision for one technique or the other should be made with the patient, appreciating the specificity of each single case. We discuss here the different techniques with their advantages and drawbacks, including long term results.

Duration of post-surgical antibiotic therapy for adult chronic osteomyelitis: a single-centre experience.

PURPOSE: The optimal duration of concomitant antibiotic therapy after surgical intervention for implant-free chronic osteomyelitis is unknown. No randomized data exist. Available recommendations are based on expert's opinion. We evaluated the duration of post-surgical antibiotic treatment related to remission of chronic osteomyelitis. METHODS: This was a retrospective single-centre study at Geneva University Hospitals with a minimal follow-up of two years after treatment. We used multivariate logistic regression analysis with exclusion of pediatric cases and of implant-related chronic osteomyelitis. RESULTS: A total of 49 episodes of implant-free chronic osteomyelitis in 49 adult patients were studied. The median number of surgical interventions was two (range, 1-10). The median duration of post-debridement antibiotic treatment was eight weeks (range, 4-14 weeks). Thirty-nine patients (80%) were in remission after a minimal follow-up of two years. In multivariate logistic regression analysis, one week of intravenous therapy had the same remission as two to three weeks (0.2, 0.1-1.9) or ≥ 3 weeks (0.3, 0.1-2.4). More than six weeks of total antibiotic treatment equalled ≤  six weeks (0.8, 0.1-5.2). CONCLUSIONS: In chronic osteomyelitis in adults, a post-debridement antibiotic therapy beyond six weeks, or an IV treatment longer than one week, did not show enhanced remission incidences. Prospective randomized trials are required to confirm this observation.

Resuming motor vehicle driving following orthopaedic surgery or limb trauma.

Following elective orthopaedic surgery or the treatment of a fracture, patients are temporarily unable to drive. This loss of independence may have serious social and economic consequences for the patient. It is therefore essential to know when it is safe to permit such patients to return to driving. This article, based upon a review of the current literature, proposes recommendations of the time period after which patients may safely return to driving. Practical decisions are made based upon the type of surgical intervention or fracture. Swiss legislation is equally approached so as to better define the decision.