Orthopedics

A Primary cutaneous leiomyosarcoma located in the left thigh is reported in a 83-year-old patient. The clinical examination found a voluminous ulcero-budding infected tumor, measuring 15 cm long axis. The result of the histological examination and the immuno-histochemical profile revealed the diagnosis of a leiomyosarcoma. The patient underwent extensive excision with cutaneous margins of three to five cm and carried the Gracilis muscle deep down. After one year of control we did not notice local recurrence. The prognosis remains poor. We recommend long-term follow-up of patients to prevent recurrence. The purpose of this work is to show the difficulties to make the diagnosis and describe our management of this rare case.

Replantation of hands has become common in various institutions. But, many problems remain in our context especially the quality of the preservation and real-time of replantation, making surgical care more difficult and thus undermines functional proof our patients. We report one case of a young patient presented with a total amputation at the wrist joint of the left hand, despite technical problems in our emergency department, replantation was successfully possible with an acceptable functional and aesthetic result.our patient have recovered a useful function in their replanted hand in daily activities and work. A need of early rehabilitation is stressed and these severe injuries require long periods of rehabilitation; for a good functional recovery, social and professional reintegration of these patients.

Aneurysmal bone cyst (ABC) is a benign cystic lesion of bone composed of blood-filled spaces separated by connective tissue septa. it usually affects the metaphyseal in long bone (70-90%) and then vertebrae (15% of cases) Talus is an infrequent site of ABC and may be confused with other benign bone tumors because of its behavior less aggressive and his prognosis more favorable than the classical proximal lesions. The curettage with or without bone graft showed a high success rate to treat ABC of the talus cryosurgery for a recurrent lesion and talectomy as the last resort in some cases.

Leg fractures are very common, accounting for 15 to 20% of all fractures [1, 2]. The aim of this study was to describe the epidemiological and lesion-related aspects of leg fractures at the referral hospital. This was a single-center, retrospective and prospective study. Patients were admitted between March 2018 and May 2020 for open or closed fractures of the tibia or both lower leg bones. The information collected included, for the epidemiological component, sex and age, and for the lesion-related component, the etiological characteristics of the fracture, medical and surgical history, admission time, clinical signs at admission, and radiological characteristics of the injuries, including injuries associated with the leg fracture. We used the Gustilo-Anderson and the Osteosynthesis Association classifications as classifications. During the study period, we recorded 846 admissions to the trauma and orthopedic surgery department of the HGR, 90 of which (10.63%) had a leg fracture as the reason for admission; these were the subject of our study. The average age of the patients was 34.58 years and male sex (85.6%) predominated. Women represented 14.4% of the patients. The etiologies were dominated by road traffic accidents (65.6%), which affected more young adults, women being more prone to domestic accidents. In 83% of cases, two-wheelers (motorcycles) were involved in the occurrence of leg fractures. The patient admission time was less than 12 hours. In our series, two patients had a medical history, including 1 hypertensive patient and another hypertensive and diabetic, (2.2%). Only one patient had a history of surgery (1.1%). He was operated on for a fracture of the right leg. Functional signs (pain and functional impotence) were present in almost all patients. Only 7.8% did not present deformity of the affected limb on admission. The right side was the most affected with 56.7% (n=51), its middle third (34.45%) most often; the left side was affected in 42.2% (n=38) and 1 patient with bilateral involvement (1.1%). Open fractures (24.4%) were less represented than closed fractures (75.6%) and among open fractures, 54.6% were classified as type II according to the Gustilo-Anderson classification. Types I and III represented 18.3% and 27.2% respectively (IIIA=22.7; IIIB=4.5%). The most common type of displacement was overlapping, and according to the Osteosynthesis Association (AO) classification, type 42A3 was the most common, with 32.22% (n=29). Femoral injuries had the highest incidence of associated injuries. Conclusion: In the Orthopedic and Trauma Surgery Department of the HGR, leg fractures were more common in young males with road traffic accidents. Patient admission times varied considerably. Open fractures were less common and were dominated by type 2 fractures according to GA. Type 42A3 of the AO classification was more common, and the most frequently identified displacement was overlapping.

The purpose of the study was to compare triceps sparing approach with olecranon osteotomy regarding the effects on functional outcomes of fracture of distal humerus managed with open reduction internal fixation(orif) , by reviewing 71 cases of fracture distal humerus surgically managed with either of approaches during December 2012 to September 2016. The medical reports and radiographs of 42 males and 29 females patients with a mean age of 38.12±15.06 and 34.87±14.11 for olecranon osteotomy and triceps sparing approach respectively and a mean follow up time of 10.2months (range 3-18 months) were retrospectively and prospectively reviewed . flexion , extension, range of motion , mayo elbow performance score (MEPS) , disability of shoulder arm and hand score (DASH SCORE), duration of surgery and blood loss were used to assess the functional outcome of fracture distal end humerus treated with ORIF through the triceps sparing approach or olecranon osteotomy . according to AO foundation (AO) Classification there were 2 cases of type A , 2 cases of type B , 22 cases of type C1 , 26 cases of type C2 and 19 cases of type C3 fractures . although there was no overall statically significant difference in the average flexion , extension , ROM , MEPS AND DASH SCORE between the triceps sparing group (n=47) and olecranon osteotomy group (n=24). Out o 24 patients off group OO ,9(37.5%) , 9(37.5%) , 6(25%) and out of 47 patients 24(51%), 16(34%) , 7(15%) obtained excellent , good , fair MEP score respectively. No patient fallen under poor category of MEP score . On the basis of MEPS, DASH , flexion , extension and ROM results were better in type A, B , C1 AND C2 by using triceps sparing approach and the results were better in typeC3 fracture by using of olecranon osteotomy approach.

Percutaneous treatment of tibial plateau fractures under arthroscopic control, although minimal, is a cause of a decrease in morbidity compared toopen surgery. The objective of this work is to report the functional results, inshort and medium term, of these percutaneous osteosynthesis under arthroscopiccontrol. Fifteen patients were treatedby percutaneous screwing with arthroscopic control for fractures classified Shatzker I to III. The average age was 32 years; the average follow up was 39, 9 months (24 -119 months). We have not noticed postoperative infection, the results were considered good, the score IKS (International Knee Society) average was 83.2 for the knee score and 89 for the function score. One patient presented a secondary bone depression at 35 days post-surgery. Percutaneous treatment of fractures separation or separation anddepression of the lateral plateau conducted under arthroscopy provides satisfaction in terms of postoperative indolence, early recovery and rehabilitation, and seems to have satisfactory results in the short and medium term. We cannot assess the impact on the evolutionosteoarthritis due to lack of sufficient experience.

The corona mortis, or crown of death, is described as an abnormal vascular connection between the obturator and external iliac or inferior epigastric veins or arteries located at the back of the superior pubic ramus in the space of Retzius. The corona mortis has been said to cause massive uncontrolled or profuse bleeding and even life-threatening hemorrhage. Detailed anatomical knowledge of its prevalence, variable anastomotic connections, and morphological characteristics is therefore crucial to reduce the risks of possible iatrogenic errors in surgical procedures in the pubic region, especially the ilio-inguinal approach to the acetabulum. Every surgeon dealing with superior pubic ramus fractures and acetabulum fractures needs to be aware of these anastomoses and avoid undue hemorrhage.

SLAP lesions remain a rare entity of the painful pathology of the shoulder under the labrobicipital complex, of difficult diagnosis given the atypical clinical symptomatology often vague with tests of different reliability although directing towards a strong positive presumption. The advent of imaging by injection of contrast product (arthro scanner and especially arthro MRI) has allowed a better understanding of this type of lesion but there are still variants of this complex which are radiologically limited between what is normal or pathological. Arthroscopy has allowed an unequalled precision of diagnosis with the possibility of adequate therapeutic management and very satisfactory results. Through this clinical case of a young patient with a chronically painful shoulder, we draw attention to this type of pathology, which is rare but not negligible.

In this paper, fatigue damage accumulation were studied using three methods i.e. Miner, new non-linear model and experimental method. The prediction of fatigue lifetimes based on Miner method are uneconomic and non-conservative respectively. However satisfactory predictions were obtained by applying the non-linear damage rule (present model) for 5052-H34 aluminum alloy. Many shortcomings of the Miner methods are related to their inability to take into account the surface treatment effect.

The arthroscopic BANKART technique is part of the panel of surgical treatment of anterior shoulder instability, allowing reinsertion of the anterior-inferior labrum as well as the capsule at the level of the anterior glenoid rim. Its indication is based on a set of criteria gathered in the ISIS score, which must be less than or equal to 3 for an optimal result and a lower recurrence rate. Our initial experience has shown the success of this technique with a zero recurrence rate after an average follow-up of 26 months. The perspective remains to enlarge the series with a long follow-up for a better management.