Orthopedics

Synovial chondromatosis of the knee is a benign synovial dystrophy characterized by the formation of cartilaginous nodules (chondromas). Their early diagnosis and treatment are primordial to preserve the joint and prevent its degeneration. Its treatment remains controversial, adopting many attitudes, arthroscopic chondromas extraction or arthrotomy, arthroscopic synovectomy, high tibial osteotomies or even a prosthetic replacement. The literature reports many sporadic cases of synovial chondromatosis of the knee each one with its clinical and therapeutic particularity ; In this sense we report our historical case of giant synovial chondromatosis neglected source of knee stiffness, operated by open surgery anterior and posterior approachs allow to extract 600 grams of chondromas agglomerated into several diffuse masses. 

The acromioclavicular disjunction is a very frequent reason of consultation which concerns the young subject and which is favored by the sport practice.Our study is a retrospective study of a series of 5 patients who underwent endoscopic surgical treatment with coraco-clavicular lacing by ligamentoplasty within the orthopedic trauma department over a 24-month period between 01/2016 and 12/2017. The postoperative Constant score was 92 on average.No infectious or early or late cutaneous complications were found in the patients of our series.On the radiological level, the measurement of the coraco-clavicular distance in pre- and immediate postoperative, which was on average 30 mm against 18 mm postoperatively. The rapid recovery and the possibility of performing other arthroscopic therapeutic gestures represent the main advantages of this type of treatment.

The association of a posterior dislocation of the radial head with a diaphyseal fracture of the ipsilateral radius is uncommon condition. We report a rare case of a fracture-traumatic luxation of the radial head associated with a diaphysary fracture of homolateral radius in 52 old patient.

The authors report the case of a 25-years-old officer, a victim of an anti-tank mine explosion. The initial lesional assessment revealed an open fracture of the left foot associated with a complex closed fracture at the middle third level of the ipsilateral tibia and fibula. The treatment was conservative, combining, at a first stage, a surgical act with connection of the talar, tibiotalar and subtalar joints with exo-fixation of the tibia. Followed, at the second stage, by a latissimus dorsi flap coverage of the loss of cutaneous substance secondary to infection. The evolution was marked by the skin healing and malunited unkle fractures. However, the patient had some residual pain in the ankle accompanied by disorders of walking was settled by the use of retrograde intramedullary nail. The evolution was marked by bone healing and resumption of walking. The functional score was at 72 at the last check. This result was highly satisfactory with 25 points of functional score improvement.

We report the case of spinal cord compression from pathological fractures of the vertebral bodies with Gammapathy monoclonal in conjunction with multiple myeloma in a 52-year-old man who had recently been examined for paraplegia after two weeks of full pain. In our kwnoledge we thing that is a rare condition and must mainly been reported as a case presentation in the literature.

Spontaneous ruptures of the quadriceps tendon are infrequent injuries, it is seen primarily in patients with predisposing diseases such as gout, rheumatoid arthritis and chronic renal failure. A 32-year-old man had a history of end stage renal disease and received regular hemodialysis treatment for more than 5 years. He was admitted in our service for total functional impotence of the right lower limb with knee pain after a common fall two months ago. The radiogram showed a ‘’patella baja” with suprapatellar calcifications. The ultrasound and MRI showed an aspect of rupture of the quadriceps tendon in its proximal end with retraction of 3 cm. Quadriceps tendon repair was performed with a lengthening plasty, and the result was satisfactory after a serial rehabilitation program. The diagnosis of quadriceps tendon ruptures needs more attention in patients with predisposing diseases. They should not be unknown because the treatment of neglected lesions is more difficult. We insist on the early surgical repair associated with early rehabilitation that can guarantee recovery of good active extension.

Dislocation of the knee represents a severe injury as a result of high velocity traumatism, multi-ligamentous injuries are usual. Clinical exam must be attentive in searching any vascular or nervous disruption. Closed reduction must be performed promptly. Primary reconstruction of the ligamentous lesions is controversial in literature. Stabilizing the knee limits neurovascular and cartilaginous damages. We report a case report of a patient who has sustained a posterolateral left knee dislocation after a road-traffic accident. Reduction was realized in care unit, followed by early reconstruction of both posterior cruciate and medial collateral ligaments using gracilis, semitendinosus and quadriceps tendon grafts. After six month, the Lysholm score was at 81 points.

Pure tibiotalar and subtalar dislocations are uncommon, they are classically associated to fractures. Open pure total talus dislocation is exceptional and results from a high velocity traumatism, especially, in younger population. Reduction and stabilization of open dislocations should be performed promptly to avoid septic and vascular complications. We report the case of a young sportive patient who had sustained a pure open right ankle dislocation associated with vertebral injury after a mountain climbing accident. The results were interesting after reduction and stabilization of tibiotalar, subtalar, talonavicular and calcaneocuboid joints with Kirschner wires, associated to repair of medial capsular and ligamentous structures.

Osteoarthritisis one of the most common joint disease encountered, affecting more than 80% of people over the age of 55.It is a major cause of musculoskeletal pain and single most important cause of disability and handicap in old age and, is therefore, an important healthcare burden. Osteoarthritis is not a single entity but rather a heterogeneous group of conditions showing common x-ray and pathological changes and is characterized by joint degeneration, loss of cartilage, alteration of subchondral bones etc.Osteoarthritis principally affects the knee and hip. High tibial osteotomy is a welle stablished procedure for the treatment of unicompartmental osteoarthritis of the knee. In osteoarthritis Varus and valgus deformities are fairly common but Varurs is more as compare to valgus & cause an abnormal distribution of the weight bearing stress within the joint. A total of 26 patients were enrolled for this study and all were treated with tomofix plate. Physical examination and radiographs were performed at regular follow-ups. Functional outcomes were analyzed using knee society scoring system. According to the grading used for functional assessment in knee scores there was definite improvement in the function of cases 22 (96.15%) at 1yrs. But up to 3 months patients required some walking aid in half of the cases. There was very little improvement in the functional knee score in 1 case. The pre-operatively mean functional knee score in 26 cases was 46.8 and post-operatively was 92.5 i.e. the mean improvement in functional knee score is 45.7 (the maximum functional knee score is 100).

The authors reported a rare case of carpal tunnel syndrome occurred in old adult anti-coagulated for over ten years for hypertensive and ischemic heart desease with pace-maker.He presented typical symptoms of carpal tunnel syndrome after alterning previscan with lovenox. The echographic diagnosis confirmed a hematoma on the anterior surface of the wrist who had required in emergency the surgical opening of the anterior carpal ligament and the evacuation of the hematoma. In 48 hours we obtained a best recovery.