An uncommon variant of the Essex-Lopresti injury.

The Essex-Lopresti injury is an extremely rare condition combining radial head or neck fracture, distal radio-ulnar joint dislocation and rupture of the interosseous membrane. However, there are rare or unusual varieties or associated injuries. We report a case of a 46-year-old woman with a posterior dislocation of the radio-humeral joint, a radial shaft fracture, and a distal radio-ulnar joint dislocation. She underwent open reduction and internal fixation of the radial shaft fracture followed by an immobilization by a long elbow splint in supination for 6 weeks. At 18 months of follow-up, she was asymptomatic and she had a full range of elbow and wrist motion and had resumed thoroughly her previous job. The Essex-Lopresti injury results from a complex injury to the forearm axis with resultant longitudinal instability, which can be challenging to treat. There are some variations that can lead to a missed diagnosis resulting in persistent pain and instability of the wrist. The best outcomes are reached with early diagnosis and prompt management.

The head to foot screw fixation. A new technique of percutaneous screw fixation of the scaphoid bone.

OBJECTIVES: Many techniques have been described for screw fixation of the scaphoid bone. The approach is either proximal or dorsal. A new percutaneous technique is presented by the authors called the head to foot screw fixation. Indications and results are evaluated. METHODS: It is a percutaneous technique with fixation of the scaphoid bone by two screws introduced in an opposite direction: a proximal screw and a distal screw. No postoperative immobilization was necessary. A prospective study was conducted in 40 patients over a period of three years. The average age was 25 years with extremes of 14 and 44 years. This technique was practiced in fractures (30 cases) and nonunion (10 cases) in which the localization was proximal, corresponding to Schernberg types I, II and III. Forms associated with perilunate dislocation of the carpus were excluded from the study. RESULTS: The results were analysed with a mean of 8 months (6-30). Union was obtained in all the cases. No tendon injury related to percutaneous approach was noted. The technique required a learning curve with progressive decrease in operative time from 45 to 15 minutes. It was necessary in two cases to change protruding screws which were not diagnosed during the first intervention. Percutaneous screw fixation was achieved again in both cases.   Conclusions: The combination in our experience of two screws allowed us to prevent rotation around the unthreated area of a single screw. Our technique, bringing together the head to the foot of the screw, reduces the crowding at the proximal part of the scaphoid bone. This non-invasive method permitted early mobilization with no pain until biological union.

[Study of bone mineral density in adolescent handball players: a study of 20 cases]. / Etude de la densité minérale osseuse chez les adoloescentes handballeuses: a propos d'une étude de 20 cas.

BACKGROUND: The physical activity during adolescence seems to correlate with bone mass at the end of the growth period. aim : To determine the effect of handball regularly practiced by teenage girls on the anthropometric parameters and bone mineral density. METHODS: Cross-sectional case-control, made in the rheumatology department of the Rabta hospital, has enrolled adolescent handball players of high level, which were compared to a control group matched by age and sex, but sedentary. We evaluated our two groups for anthropometric parameters and BMD. RESULTS: The lean mass (LM), fat mass (FM), the mean values of BMD at the lumbar spine and femur of our sports were significantly higher than that of sedentary controls. On bone mineral content (BMC), a statistically significant difference was observed between groups of sedentary and athletic teenagers. Positive and significant correlations were found between anthropometric parameters and measurements of BMD, BMC and of bone area. CONCLUSION: The regular practice of handball seems to be an osteogenic factor. It may be advisable in adolescents during the growth period to optimize the bone.

[Bacteriological profile of urinary tract infections in women in Aziza Othmana Hospital: 495 cases]. / Profil bactériologique des infections urinaires chez la femme à l'Hôpital Aziza Othmana: étude à propos de 495 cas.

BACKGROUND: Urinary infection is a frequent pathology in the community as well as at the hospital. AIM: To analyze the profile of bacteria isolated from urinary tract infectious in women and their antimicrobial resistance. METHODS: During two year period (1 January 2005 to 31 December 2006), 4536 urinary specimens were analyzed at the Laboratory of Aziza Othmana Hospital. All bacteria isolated from urinary tract infection (UTI) at women were retrospectively reviewed. RESULTS: 495 cases of UTI were collected during this period. They were recovered from out patients (67%) or from hospitalized patients in Gynecology and obstetrics (23%). Enterobacteriacae were the most frequently identified strains (90.4%) including Escherichia coli (71%). The identified strains presented natural resistance and a high frequency of acquired resistance to betalactams(60.3% of E.coli, 72% of P.mirabilis were resistant to amoxicillin)and cotrimoxazole(30.4% of E.coli, 19,1 of K.pneumoniae, 21.4% of P.mirabilis). 5.7% of K.pneumoniae and 1.8% of E.coli were producing extended spectrum betalactamase(ESBL). Aminoglycosides remained active on enterobacteriacae(resistance to amikacin<14%,gentamicin<5%).Ofloxacin was highly active against enterobacteriacae (resistance<14%) CONCLUSION: Enterobacteriacae were the most frequent species in women urinary tract infection. Among these isolates, a high frequency of acquired resistance to betalactams and cotrimoxazole was shown. Aminoglysosides and fluoroquinolones remained the most active drugs. In every case antibiotherapy should have been prescribed after performing an antibiogram for each strain. These data were useful for the first line antibiotherapy, however the antimicrobial susceptibility testing is necessary for the rational use to limit the highly active drugs to multiresistant strains.

Popliteal artery entrapment syndrome secondary to a femoral osteochondroma.

BACKGROUND: Osteochondromas (or exostoses) are the most common benign tumors of the bone. Vascular complications of these tumors are rare but have been increasingly reported in recent literature. AIM: Throughout an unusual case report of popliteal artery entrapment syndrome secondary to a femoral osteochondroma, we highlight the necessity of thorough clinical and radiological examinations as well as meticulous and prompt surgical resection. CASE REPORT: A 27-year-old male patient, who had been diagnosed with multiple osteochondromas and had never been operated on, presented with a one-year history of exercise-induced left calf pain, paresthesias of the left leg and pallor in cold weather. After radiographic and Computed Tomography angiographic evaluation, we diagnosed distal femur osteochondroma associated with an arterial compression of the left popliteal artery. A surgical treatment of all lesions was performed. No operative complications occurred. The pain was relieved. Good postoperative results have been noticed. CONCLUSION: Popliteal aretery entrapment syndrome may be caused by solitary or multiple osteochondromas around the knee. Therefore, prophylactic resection of exostoses in the surrounding area of a vessel should be performed. Moreover, the orthopedic surgeon should consider and prevent vascular complications during surgical resection of knee osteochondromas.

Acute traumatic quadrilateral space syndrome following scapula fracture.

The acute tunnel syndrome of the quadrilateral space of Velpeau is a very rare entity in which the axillary nerve and the posterior humeral circumflex artery experience brutal compression in shoulder injuries. We report the case of a burst fracture of the right scapula with great displacement of the lateral border occasioning a total isolated paralysis of the right axillary nerve by axillary nerve compression. The lateral scapula border fracture was reduced and stabilized with neurolysis of the axillary nerve through a posterior approach. The recovery of the axillary nerve occurred in ten weeks. Our case is original, not only because of the rarity of isolated axillary nerve injury follwing scapula fractures without shoulder dislocation, but also because the compression of the axillary nerve by bone impingement could be undiagnosed and comprise prognosis.

Acute tibial tubercle avulsion fractures in the sporting adolescent.

INTRODUCTION: The authors report 7 cases of acute tibial tubercle avulsion fractures. The fracture occurred in 6 out of the 7, after an abrupt tension of the patellar tendon in male sporting adolescents (age 13-17 years). Two patients presented symptoms of homolateral Osgood-Schlatter's disease before the lesion. METHOD: According to Ogden's classification, the tibial tubercle avulsion fracture was not displaced in 3 cases (stage IA) and was treated conservatively by immobilization for 6 weeks. In 4 cases, the fracture was displaced and necessitated an internal fixation with plaster for about 6 weeks. A torn patellar tendon was noted in one adolescent having a stage IIIB avulsion fracture. RESULT: The mean follow-up was of 4.5 years (1.5-7.5 years). The results were satisfactory: complete functional recovery, resumption of sport at the previous level and absence of recurvatum.

[Surveillance of multidrug resistant bacteria in a Tunisian hospital]. / Surveillance des bactéries multirésistantes dans un hôpital Tunisien.

BACKGROUND: Controlling antibiotic resistance of bacteria is a priority for public healthcare. AIM: This study concerned the frequency of multidrug resistant bacteria (MDRB) in a Tunisian Hospital with the aim of establishing guidelines for MDRB prevention. METHODS: The study was conducted during two years (1 January 2005-31 December 2006). Samples collected for the clinical diagnostic were included. The MDRB concerned were: methicillin resistant Staphylococcus aureus(MRSA), Enterobacteriacae resistant to of third generation cephalosporin (ER3GC), Acinetobacter baumannii resistant to both imipenem and ceftazidime, Pseudomonas aeruginosa resistant to both imipenem and ceftazidime. RESULTS: During the study period, 2475 bacteria were tested by disk diffusion. 597 MDRB were collected, the rate of MBR was 24.1%. These MDRB were mainly recovered in burn unit (82.6%). ER3GC (47%) and MRSA (29,2%) were the most frequent MDRB. A. baumannii and P. aeruginosa multiresistant concerned 14,8% and 9% of MDRB. MDRB were isolated mainly from blood cultures (45%). The rate of MRSA was 46.4% among 375 strains of S. aureus. ER3GC represented 25,6% among 1096 isolates. Concerning A. baumannii and P. aeruginosa, 51.7% and 20.5% were resistant to both imipenem and ceftazidime among 170 and 264 isolates. Antibiotic resistance evolution showed a decrease of resistance in 2006 versus 2005. This decrease should be explained by the improvement of hygiene measure especially hand washing with the introduction of hydro- alcoholic solutions, a better targeted antibiotherapy promoted by a close cooperation between microbiologists and clinicians. CONCLUSION: The MDRB were frequent in our hospital. They were mainly isolated from the burn department. The measures of prevention already implemented are effective and must be strengthened with the continuous surveillance of MDRB.

A Rare Cause of Compression of the Suprascapular Nerve: The Paraglenoid Cyst.

INTRODUCTION: The ductal syndromes of the shoulder combine all the compressive processes of the suprascapular nerve at the level of its passage in the spinoglenoid notch and this for several causes. The most common is a lesion of the labrum resulting in the formation of a cyst. These cysts are rare and often underestimated. Provoking a compression of the suprascapular nerve, they are likely to cause an atrophy of the external rotator muscles of the cuff. CASE REPORT: We present a rare case of a paraglenoid cyst resulting in a ductal syndrome by suprascapular nerve compression. A 56-year-old man consulted our department for chronic pain of the left shoulder with a decrease in muscle strength. On clinical examination, the patient had a deficit of external rotation with a clear amyotrophy of the infraspinatus fossa. We opted for arthroscopic surgical resection. At the last follow-up, the patient did not show any more pain, with a total recovery of muscle strength. CONCLUSION: The clinical signs of compressive processes of the suprascapular nerve are quite misleading, so establishing a correct diagnosis and surgical management is vital before irreversible muscularatrophy takes place.

Femoral Head Stress Fracture in Children: A Case Report.

INTRODUCTION: The stress fracture of the femoral head rarely occurs; but, it is generally encountered in case of bone insufficiency, and it is exceptional in younger individuals. The main differential diagnosis may include several diseases, namely, slipped upper femoral epiphysis, septic arthritis, osteomyelitis, and Perthes' disease. Bone scintigraphy is very sensitive but lacks specificity. Nowadays, the magnetic resonance imaging (MRI) is the gold standard for an accurate diagnosis. CASE REPORT: We present the first description of this pathology in the pediatric population with the particularity of its atypical aspect on MRI through a case of stress fracture of femoral head in 12-year-old female. CONCLUSION: Stress fractures may sometimes mimic malignant or infectious lesions and are easily misdiagnosed. MRI is the gold standard which may be the only modality to identify the fracture.

Irreducible Subtalar Dislocation Caused by Sustentaculum Tali Incarceration.

INTRODUCTION: Subtalar dislocation is an uncommon lesion in traumatology chiefly when it concerns the lateral form. Surgical treatment is required when a fracture is related or the dislocation is irreducible. Even well treated, these dislocations progress unavoidably to subtalar arthrosis, which stays well tolerated. CASE REPORT: A 46-year-old male with irreducible lateral subtalar dislocation caused sustentaculum tali incarceration confirmed on computed tomography (CT). The patient underwent emergent open reduction and internal fixation; the sustentaculum tali was reduced and fixed with a compression screw. At 3 years, "American Orthopaedic Foot and Ankle Society Ankle-hindfoot" score was 86, and the functional result was considered excellent despite a Grade I subtalar osteoarthritis on the ankle X-ray. CONCLUSION: An irreducible subtalar dislocation is exceptionally due to the incarceration of sustentaculum tali. CT is of great interest for good fracture analysis and management planning. Anatomical reduction of the articular surfaces, stable osteosynthesis, sufficient immobilization, and a well-conducted rehabilitation are the only guarantors of a good functional outcome.

[Unusual localization of spinal hydatid cyst]. / Localisation rare du kyste hydatique intra dural au niveau de la fosse posterieure.

We report one case of uncommon spinal hydatid cysts particular by its localization. It is intradural, localized with predilection in the big cistem cerebello-medullar. There is no involvement of adjacent vertebral discs and ligaments. We specify characteristic imaging features and polymorphism of this affection who can affect all anatomical structures. We emphasize MRI for diagnosis and follow-up in search for residual or recurrent lesions.

Myxoid liposarcoma of the hand - A rare entity.

Hand liposarcomas are not well recognized in common practice, which leads to erroneous diagnostics and delayed proper treatment. We reported a case of a myxoid liposarcoma classified as stage IIb, and developed in the palmar side of the left hand in a 38-year-old man. There was an initial tumor reduction by a sclerosing agent injection that proved to be a failure. An open excisional biopsy confirmed the diagnostic after pathology examination. Recurrence occurred after 2 years, followed by a second resection and an adjunctive radiotherapy. At 5 years follow-up, the patient was recurrence free. Although myxoid liposarcoma is rare in the hand, it should be considered in the differential diagnosis of a painless soft tissue mass in this region.

Double level arterial injury with neuropraxia following anterior shoulder dislocation.

Vascular and nervous complications are rare after shoulder dislocation. We report the case of a double level arterial injury with neuropraxia following anterior shoulder dislocation that was diagnosed by MultiDetector-row Computed Tomographic (MDCT) angiography and treated by surgical bypass graft and embolectomy. Our case is original, not only because of the rarity of these complications, but also because of the thromboembolism of brachial artery which could be undiagnosed and could compromise prognosis.